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PrEP for HIV Serves as Gateway to Primary Care

Jaime Rosenberg
Researchers found that pre-exposure prophylaxis (PrEP) usage is linked to routine care, such as influenza vaccination, tobacco and depression screening, and glucose testing.
While pre-exposure prophylaxis (PrEP) reduces the risk of contracting HIV significantly, it also serves as a gateway to primary care for those taking the pill, according to a study. Researchers found that PrEP usage is linked to routine care, such as influenza vaccination, tobacco and depression screening, and glucose testing.

Those at risk of HIV are not only in need of PrEP, they are typically also in greater need of non–HIV-related care compared with the general population. While HIV infection is associated with aging-associated diseases, such as cancer and cardiovascular disease, patients with HIV are also likely to experience comorbidities partly driven by behavioral risk factors, such as smoking and substance use. They also have an increased risk of depression.

“Most PrEP users in the United States are men who have sex with men, a population in which discrimination contributes to mental health conditions, substance use, and smoking,” wrote the reserchers. “Thus, PrEP users could benefit from the increased opportunities for non–HIV-related screening and treatment that the PrEP care package may provide.”
The researchers assessed 5857 patients at Fenway Health, a community health center in Boston, Massachusetts, between 2012 and 2016. Of the participants, 2047 (35%) were prescribed PrEP. A total of 2357 (40%) received flu vaccination, nearly two-thirds received tobacco screening (74%) and depression screening (72%). Half of participants received glucose testing, while just 894 (15%) received glycated hemoglobin (A1C) testing.

PrEP users were more likely to receive the vaccinations, screenings, and testing compared to nonusers. They were 28% more likely to receive a flu vaccination, 6% more likely to be screened for tobacco, and 7% more likely to be screened for depression. They were also 78% more likely to get glucose testing. However, they were less likely to receive A1C testing.

According to the researchers, there are 3 possible explanations for these higher rates among PrEP users:
  1. PrEP users may be more motivated to care for their health in other ways—increased engagement in healthcare may be a reason for PrEP initiation or may result from the experience of using PrEP.
  2. PrEP associated monitoring may result in ancillary testing and treatment of unrelated conditions. For example, physicians may order glucose testing as part of a panel that also includes creatinine, which is routinely checked during PrEP use.
  3. Providers may be more likely to screen for certain conditions or behaviors among PrEP users, such as smoking or substance use, if they are perceived as a high-risk patient.


Reference:

Marcus J, Levine K, Grasso C, et al. HIV preexposure prophylaxis as a gateway to primary care [published online July 19, 2018]. Am J Public Health. doi: 10.2105/AJPH.2018.304561.

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