Unawareness of partner risk factors thwarts implementation of USPSTF recommendations for HIV pre-exposure prophylaxis in primary care

ABSTRACT

The United States Preventive Services Task Force recommends pre-exposure chemoprophylaxis for persons at high risk of HIV exposure. The optimal screening strategy for at-risk individuals in primary care is not known. We evaluated the strategy of universal screening and discussed challenges to the implementation of this recommendation in primary care. Around 430 of 500 (86%) screening surveys were completed. Mutual monogamy was common but monogamous partners with recent negative HIV testing were uncommon. Likewise, among heterosexually active men and women, inconsistent condom use was common. Such individuals would be on guideline for HIV pre-exposure prophylaxis (PrEP) if their partner was at risk for HIV exposure. None of these potentially at-risk individuals met the criteria for PrEP, but 13% lacked knowledge of their partners' sexual and behavioral risk factors, preventing a clear decision on whether PrEP should be used. Our screen identified no individuals who clearly met the guideline criteria for HIV PrEP. We conclude that universal screening for HIV PrEP in primary care is unlikely to be an efficient strategy; targeted screening is likely more appropriate. Moreover, the 2019 guidelines for heterosexually active men and women rely on information that is often unknown to the patient, which makes these guidelines difficult to implement. Future guidelines should address these problems.

KEYWORDS:

• Preventive care
• human immunodeficiency virus
• pre-exposure prophylaxis
• United States Preventive Services Task Force
• primary care

Sustainable Development Goals:

• SDG 3: Good health and well-being

Acknowledgements

We thank the nursing and administrative staff of the Family Medicine clinic at the University of Kansas Hospital for their assistance in distributing and collecting surveys.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This project was not externally supported but utilized REDCap to securely manage patient data. Support for REDCap was provided in connection with CTSA grant from NCATS awarded to the University of Kansas for Frontiers: University of Kansas Clinical and Translational Science Institute (# UL1TR002366). The contents of this paper are solely the responsibility of the authors and do not necessarily represent the official views of the NIH or NCATS.