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PrEP use for HIV prevention may be gateway to primary care
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Taking pre-exposure prophylaxis, or PrEP, for HIV prevention is independently associated with receiving more thorough primary care, such as getting an influenza vaccine and receiving screening for tobacco use, suggesting additional health benefits, according to researchers.
According to the CDC, when taken consistently, PrEP can reduce the risk for HIV by up to 92%.
Julia L. Marcus, PHD, MPH, assistant professor in the department of population medicine at Harvard Medical School and Harvard Pilgrim Health Care Institute, and a team of researchers studied more than 5,800 potential PrEP candidates at Fenway Health, a community health clinic in Boston, between 2012 and 2016.
The researchers included HIV-uninfected patients tested for rectal STDs, which indicates HIV risk and eligibility for PrEP, they said. They assessed PrEP prescriptions and receipt of primary care during each calendar year.
Of the 5,857 individuals identified, 2,047 were prescribed PrEP. Researchers found that PrEP users were more likely to get influenza vaccinations (prevalence ratio [PR] = 1.28; 95% CI, 1.20-1.37), to be screened for tobacco use (PR = 1.06; 95% CI, 1.02-1.09) and depression (PR = 1.07; 95% CI, 1.04-1.11) and to receive glucose testing (PR = 1.64; 95% CI, 1.56-1.72) used for diabetes screening and monitoring.
“Our results suggest that PrEP might increase the use of routinely recommended primary care, potentially extending its benefits beyond HIV prevention to behavioral health and the prevention and treatment of other infectious and chronic diseases,” Marcus told Infectious Disease News.
The researchers examined differences between PrEP users and nonusers that could account for the associations between PrEP use and primary care.
“The associations remained,” Marcus said. “Even after accounting for differences in key demographic and clinical characteristics, and in the number of medical visits, between PrEP users and nonusers.”
Researchers named three possible explanations for the association. First, PrEP users may be more motivated to care for their health, increasing their health care engagement. Second, PrEP-associated monitoring may result in more testing and treatment of unrelated conditions. Finally, health care providers may be more likely to screen for certain conditions or behaviors among PrEP users, such as smoking or substance use.
“Although the cross-sectional study design limited our ability to draw conclusions about causation, our robust findings suggest that PrEP is indeed helping to engage patients in primary care,” Marcus said. – Caitlyn Stulpin
Disclosures: Marcus reports receiving research grant support outside the submitted work from Merck. Please see the study for the other authors’ relevant financial disclosures.
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