In 2014, the CDC published comprehensive clinical practice guidelines for the use of pre-exposure prophylaxis (PrEP) that included recommendations for various types of testing for ensuring health and safety. While awareness and use of PrEP has increased rapidly in recent years, the quality of care received by PrEP users and the degree to which healthcare providers comply with CDC guidelines when prescribing PrEP are unknown, according to Ya-lin A Huang, PhD, MS.
For a study published in The Journal of Infectious Diseases, Dr. Huang and colleagues assessed the rate of recommended laboratory testing before and during PrEP. Using a previously developed algorithm, the researchers identified a cohort of persons who initiated PrEP during 2011-2015 and assessed performance of initial tests on or within 3 months before PrEP initiation, including tests for HIV infection, HBV infection, renal function, and sexual transmitted infections. They also assessed performance of recommended laboratory monitoring after PrEP initiation.
“We found that laboratory monitoring of PrEP users in accordance with CDC guidelines was suboptimal,” says Dr. Huang, “and that opportunities exist to improve testing rates both at PrEP initiation and during PrEP follow-up care. Before PrEP initiation, only 44.9% of PrEP users were tested for HIV infection, 54.7% for syphilis, and 43.3% for chlamydia/gonorrhea. Furthermore, only 38.0% were screened for hepatitis B infection, and only 30.0% had renal function assessed.” However, rates of testing at PrEP initiation increased over the years of the study period, likely due to increased healthcare provider knowledge of CDC recommendations for PrEP care. Dr. Huang and colleagues anticipate that this trend will continue as clinicians’ knowledge of and experience with PrEP increases.
“Health clinic policies and operating procedures can help ensure that recommended tests are performed during follow-up visits at the appropriate intervals, and that PrEP prescriptions are not refilled unless these tests were performed,” explains Dr. Huang. She points to the CDC-sponsored PrEPline—(855) HIV-PrEP—as a free resource available to physicians to help guide PrEP management.
Laboratory Testing of a Cohort of Commercially Insured Users of HIV Preexposure Prophylaxis in the United States, 2011–2015