997. The Purview Paradox: PrEP Utilization at a Major Southern California County Teaching Hospital and Affiliated Clinics

Abstract

Background: The Centers for Disease Control (CDC) report that 18% of people who have indications for HIV Pre-Exposure Prophylaxis (PrEP) in the U.S. are prescribed it, with reporting higher in California (21.9%). We predict that PrEP prescription is lower at Harbor-UCLA Medical Center (HUMC) and affiliated clinics within Los Angeles County Department of Health Services. Method(s): A retrospective chart review of HIV-negative patients with ICD-10 coded diagnoses of sexually transmitted diseases (STDs) or high-risk sexual behavior was performed across various medical specialties at HUMC and affiliated clinics in 2018. Documentation of PrEP discussion and prescription was reviewed from electronic medical records for each encounter. Proportions and multivariable logistic regression models were completed in STATA. Result(s): Of the 254 primary encounters, 47.6% of patients identified as Latinx and 26.8% Black. While 2.76% of patients were already taking PrEP, 6.69% had de novo PrEP discussions and 1.57% were subsequently prescribed PrEP. Of those prescribed or already taking PrEP, 47% were Latinx, 17.6% Asian/Pacific Islander, 5.8% Black, 58.8% identified as homosexual and 17.6% as bisexual. Although 58.7% of patients were female, <1% were prescribed PrEP. Of the 4 patients newly prescribed PrEP in the primary encounter, 75% were by family medicine and 25% by internal medicine with no new prescriptions by OB/GYN or emergency medicine (EM) providers. Conclusion(s): Our findings demonstrate that the percent of individuals prescribed (1.57%) and already taking PrEP (2.76%) at HUMC and affiliated clinics is less than that reported nationally and in California. This suggests that municipal health systems such as HUMC fall short in PrEP usage, notably for structurally vulnerable populations such as racial minorities as well as heterosexual females. Focused efforts on educating specialty providers (OB/GYN, EM) and identifying other structural barriers faced by patients within safety net settings is necessary to increase PrEP prescription and end the HIV epidemic.