(P152) ASSESSING POPULATION CHARACTERISTICS IN PATIENTS ACCEPTING VERSUS DECLINING PREP AFTER TARGETED COUNSELING

Background:
Pre-exposure prophylaxis (PrEP) for Human Immunodeficiency Virus (HIV) is safe and effective with optimal uptake and adherence. However, PrEP implementation in many areas of the US is suboptimal. The US South has disproportionately high numbers of new HIV infections, but low overall PrEP use.

Methods:
Parkland Health has implemented interventions to improve PrEP uptake, including a best practice advisory with an HIV predictive model, provider education, and outreach team. A retrospective electronic record review was conducted to assess the outcome of targeted PrEP counseling for eligible patients in Dallas, Texas, comparing differences between those who accepted versus declined PrEP. All patients offered PrEP in 2022 aged 16 and above were included. Those who accepted were defined by receiving a PrEP prescription or completing a PrEP clinic visit.

Results:
Of 2,219 patients who received PrEP counseling, 287 were excluded for having HIV (7.3%), already receiving PrEP (12.2%), or community screening without follow up (78.4%). Of the remaining 1,932 patients, 195 (10%) accepted a PrEP offer. Those who accepted were younger (median 31 vs 46 years). Males or transgender females with male partners (32/195(16.4%) vs 26/1737(1.5%) and 7/195(3.6%) vs 5/1737(0.3%), respectively) were more likely to accept. Patients tended to be White (102/195(52.3%) vs 745/1737(42.9%)), Hispanic (76/195(39.0%) vs 428/1737(24.6%)), employed (63/195(32.3%) vs 440/1737(25.3%)), and insured (116/195(59.5%) vs 874/1737(50.3%)), with higher rates of active pregnancy and recent STIs. Those who accepted were seen in many outpatient clinics, including Infectious Diseases (34%), maternal-fetal medicine (24%), homeless outreach (21%), and primary/urgent cares (17%).

Conclusion:
A multipronged approach to increasing PrEP uptake in a large safety-net health system in the South reached a variety of eligible patients.  Along with a dedicated PrEP clinic, other outpatient settings were excellent PrEP distribution alternatives. Future efforts should focus on improving PrEP engagement for Black, uninsured, heterosexual, and older individuals at risk for HIV.