(P149) PREP CARE CONTINUUM OUTCOMES AMONG BLACK WOMEN IN EHE PRIORITY JURISDICTIONS: HIGH STI BURDEN, LOW PREP UPTAKE

Background:
Black women have disproportionately high rates of HIV infection yet low rates of pre-exposure prophylaxis (PrEP) use. Barriers to PrEP initiation exist on the clinic, provider, and individual level. To improve PrEP uptake among Black women, accurate data regarding each step in the PrEP care continuum is needed.

Methods:
We present data from the control year (1/1/2023- 12/31/2023) of the stepped-wedge cluster randomized POWER Up implementation trial, designed to increase PrEP use among Black women at two federally qualified health centers (FQHCs) in Pinellas County, Florida and Chicago, Illinois. We calculated the proportion of Black women out of all persons for total medical visits, sexually transmitted infection (STI) testing, STI diagnosis, and PrEP prescriptions. Potential opportunities for PrEP education were defined by encounters with the following ICD-10 diagnosis codes: Z11.3, Z11.4, Z20.2, Z20.6, and Z71.7. STI diagnoses were either positive tests for chlamydia, gonorrhea, or syphilis (rapid plasma reagin test (RPR>8)) or one the following ICD-10 diagnosis codes: A74.9, A54-A55, and A51-A53.

Results:
Among all medical visits at the two FQHCs in 2023, Black women accounted for 12.4% (7,109) of all medical encounters, 16.9% (2,864) of STI testing, and 32.0% (367) of those diagnosed with an STI. There were 791 potential opportunities for PrEP education among Black women, representing 12.2% of all potential PrEP education encounters. However, only 8 Black women received a PrEP prescription in 2023, representing just 7.8% of the people who initiated PrEP.

Conclusion:
Despite a disproportionate burden of STIs diagnosis, Black women remained underrepresented among PrEP starts at these two FQHCs located in priority jurisdictions for the national Ending the HIV Epidemic initiative. Programs must recognize vulnerable populations such as Black women as priorities for PrEP education and HIV prevention.