Understanding Opportunities for Prescribing Pre-exposure Prophylaxis at Two Academic Medical Centers in a High Priority Jurisdiction for Ending the HIV Epidemic

Pre-exposure prophylaxis (PrEP) is an effective yet underutilized tool for HIV prevention. We examined opportunities for prescribing PrEP at two large, urban, academic healthcare institutions. We analyzed electronic medical record data for 1/1/2015-12/31/2021 among patients ≥ 18 years of age, with ≥ 1 negative HIV test with indications for PrEP. Eligible encounters were six months after a sexually transmitted infection, or when injection drug use (IDU) was documented. We categorized encounter setting, including the emergency department (ED) and obstetrics and gynecology/women's health (OBGYN) department. We performed logistic mixed effects regression, reporting odds ratios and confidence intervals (OR, aOR, 95% CI). Overall, 9644 people contributed 53,031 encounters with 4653 PrEP prescriptions. The two institutions had different patient population demographics, with institution A having a higher proportion of women, patients aged 18-24, and non-Hispanic Blacks (NHB), and institution B having a higher proportion of men who have sex with men (MSM), non-Hispanic Whites (NHW), and Hispanic/Latinos. Adjusted models found lower odds of PrEP prescriptions for NHB (aOR 0.21 [0.15, 0.29]), Hispanic/Latino (aOR 0.53 [0.37, 0.76]), heterosexual women (aOR 0.10 [0.06, 0.17]), IDU (aOR 0.01 [0.001, 0.08]), and encounters at the ED or OBGYN (0.14 [0.06, 0.31]). Increased odds of PrEP prescription were seen among NHW (aOR 4.85 [3.45, 6.82]), MSM (aOR 24.87 [15.79, 39.15]), and patients at institution B (aOR 1.78 [1.25, 2.53]). Institution A contained people historically underrepresented in PrEP prescriptions, while institution B accounted for most PrEP prescriptions. Opportunities exist to improve equity in PrEP prescriptions among demographic groups and in hospital settings.