WOMEN ARE LESS LIKELY TO BE TESTED FOR HIV OR OFFERED PREP AT TIME OF STI DIAGNOSIS.

BACKGROUND: Ending the HIV epidemic requires linkage of at-risk individuals from diverse healthcare settings to comprehensive HIV prevention services. Sexually transmitted infections are significant biomarkers of HIV risk and should trigger pre-exposure prophylaxis discussion. We reviewed STI testing practices outside of sexual health clinics to identify opportunities for improvement in the provision of HIV prevention services. METHODS: An electronic sexual health dashboard was used to identify patient encounters with a positive gonorrhea, chlamydia, and/or RPR test between January 1, 2019 and August 23, 2019 at a large urban academic medical center. A retrospective chart review was performed to assess HIV testing, completeness of STI screening, and HIV prevention discussion; inadequate screening was defined as no HIV test in 12 months prior to STI diagnosis. RESULTS: 815 patients with 856 patient encounters were included. Patients were predominantly female (64.4%); median age was 24 (range 18-85). The most common test and most common positive test was the genitourinary (GU) gonorrhea/chlamydia nucleic acid amplification test. Multi-site testing was rare (7.5% of patient encounters) and performed more frequently in men than in women (20.3% vs. 0.36%). Women were also more likely to be inadequately screened for HIV (15.1% vs. 25.8%).Documentation of PrEP discussion was rare (4.7% of patient encounters) compared with safe sex (44.6%) and condoms (49.8%). PrEP was discussed almost exclusively with men compared to women (17% vs. 1.1%). CONCLUSIONS: In patients diagnosed with bacterial STI outside of sexual health clinics, gaps in HIV prevention exist. HIV screening, multi-site STI screening, and discussion of PrEP were particularly infrequent among women.