(635) High rates of HIV PrEP prescriptions after standardized counseling of high-risk pregnant patients

Thursday, February 9, 2023

4:00 PM – 5:30 PM

Objective: HIV pre-exposure prophylaxis (PrEP) counseling and uptake in pregnancy is historically limited, although rising sexually transmitted infection rates suggest a critical need for an HIV prevention strategy in this population. Historically, our practice was to provide PrEP to individuals with known HIV-positive partners in pregnancy. We expanded to implement standardized HIV PrEP counseling targeted to high-risk pregnant patients treated for syphilis in an ambulatory prenatal clinic.

Study Design: We prospectively studied HIV-negative pregnant patients receiving ambulatory prenatal care, including treatment for syphilis, at an urban, public hospital system. At visits for penicillin treatment, standardized PrEP counseling was conducted (Table 1). Repeat counseling was offered for patients not accepting PrEP at the initial opportunity. Acceptance was documented, with a 3-month prescription given to those who accepted. Medication dispensation was verified by linked pharmacy record review. We compared characteristics of those who accepted versus declined PrEP.

Results: From March 3rd through May 31st 2022, 27 patients met inclusion criteria, received PrEP counseling, and were offered PrEP. Of these, 14 (52%) accepted while 13 (48%) declined. Among 16 non-Hispanic Black, 9 Hispanic White, and 2 non-Hispanic White patients offered PrEP, acceptance rates were 10 (63%), 4 (44%), and 0, respectively. Gestational age and number of counseling sessions were similar. Among the 14 pregnant patients who accepted PrEP, 5 (36%) prescriptions were dispensed from our ambulatory pharmacy to 1 Hispanic White patient and 4 non-Hispanic Black patients.

Conclusion: In an urban safety-net hospital, a majority of high-risk pregnant patients who received standardized HIV PrEP counseling during treatment for syphilis accepted PrEP. Literature suggests 2.1% of all women eligible for PrEP have a prescription. Standardized PrEP counseling targeted to the highest-risk patients may increase frequency of PrEP prescriptions.

Primary & Presenting Author(s)

Whitney Kleinmann, MD
University of Texas Southwestern Medical Center
Dallas, Texas, United States

Coauthor(s)
KW
Kristen Warncke, MD
Parkland Health
Columbia, Missouri, United States

Emily H. Adhikari, MD
Assistant Professor
University of Texas Southwestern Medical Center
Dallas, Texas, United States