AIDS Patient Care and STDs

Doxycycline postexposure prophylaxis (DoxyPEP) is an emerging strategy to prevent bacterial sexually transmitted infections (STIs) among men who have sex with men (MSM) and transgender women (TGW). We evaluated early DoxyPEP implementation in a university-affiliated infectious diseases clinic providing HIV and pre-exposure prophylaxis (PrEP) care in Durham, North Carolina. This retrospective study included two overlapping cohorts: (1) patients prescribed DoxyPEP through December 31, 2024, to characterize early prescribing and follow-up with contextual clinic comparison; and (2) MSM and TGW diagnosed with a bacterial STI between July 1, 2023, and December 31, 2024, in whom factors associated with DoxyPEP receipt were evaluated using mixed-effects logistic regression. Among 219 patients prescribed DoxyPEP, 41% had a bacterial STI in the preceding year, more frequently among people with HIV (PWH) than PrEP users (51% vs. 30%, p = 0.002). Although PWH comprised 90% of the clinic population, they accounted for 53% of DoxyPEP recipients, signaling disproportionate adoption by HIV status. Among 276 MSM/TGW patients with a bacterial STI during the study period, 26% were prescribed DoxyPEP during a median follow-up of 11 months (interquartile range: 6–14). PrEP use (adjusted odds ratio [aOR]: 11.1, 95% confidence interval [CI]: 2.97–41.2) and encounters after Centers for Disease Control and Prevention guideline release (aOR: 2.46, 95% CI: 1.03–5.83) were associated with DoxyPEP receipt. Recurrent bacterial STI incidence prior to DoxyPEP initiation was 51 per 100 person years. Despite increasing uptake over time, missed opportunities for DoxyPEP prescribing were observed following STI diagnoses, particularly among PWH. Targeted strategies are needed to support integration of DoxyPEP into routine HIV care.

While once-daily single-tablet regimens (STRs) are recommended for most people with human immunodeficiency virus (HIV; PWH), some require complex antiretroviral (ARV) regimens due to resistance, contraindications, or drug–drug interactions. We characterized PWH who were virologically suppressed on complex regimens (VS on CR) in a U.S. cohort to inform treatment optimization as new switch options emerge. This retrospective study analyzed electronic medical records from the Trio Health HIV Network and genotypic resistance data from Labcorp. We included PWH ≥ 18 years who were virologically suppressed (viral load [VL] < 200 copies/mL) at complex regimen initiation between January 2016 and November 2023, with ≥6 months from last prescription and ≥1 year of follow-up. Complex regimens included ≥2 of 3 core ARV classes concomitantly, more than once-daily dosing, multi-tablet regimens (MTRs) not replaceable by STRs, or resistance to two ARV classes. Virologic failure (VF) was defined as VL ≥ 500 copies/mL or two consecutive VLs ≥ 200 copies/mL. PWH on ibalizumab, fostemsavir, or lenacapavir were excluded to reflect standard clinical practice. Of 43,236 PWH with ARV prescriptions, 3,320 (8%) were VS on CR. Among these, 69% were on MTRs, 43% used ≥2 core ARV classes, and 11% had resistance to two classes. The median age was 52 years, and 77% were male. Common comorbidities included obesity (69%), neuropsychiatric disorders (35%), and cardiovascular disease (33%). Regimens predominantly included protease inhibitors (77%), nucleoside reverse transcriptase inhibitors (75%), and integrase strand transfer inhibitors (57%). Over a median 2.2-year follow-up, 4% experienced VF. Approximately 8% of PWH on ART remain VS on CR, underscoring the need for education on regimen optimization and novel treatment options for those unable to simplify their therapy.

Barriers to initiating and maintaining HIV care continue to impede efforts to “End the HIV Epidemic” in the United States, particularly among members of Black sexual and gender minoritized (BSGM) groups in the US South. Evidence-informed social network-based interventions may improve engagement in HIV care services among BSGM; however, understanding and addressing context-specific barriers and facilitators to HIV service use are critical for intervention effectiveness. We explored barriers to HIV care engagement to inform the adaptation of a social network strategy to increase participation in HIV prevention and care services in Charlotte, NC. We interviewed BSGM with HIV who were in treatment, local health department officials, clinicians, and community-based organization leaders and held four focus groups (FGs) with HIV public health services staff. Transcripts were iteratively coded and analyzed thematically. We identified two themes across all FGs and in-depth interviews (IDIs). Two additional themes were identified specifically from IDIs with BSGM. Across data sources, participants described multi-level stigma, competing priorities, and logistical hurdles that impede BSGM engagement in HIV care. BSGM with HIV indicated that supportive social networks enhanced HIV treatment adherence and described how their personal agency and self-efficacy evolved after receiving an HIV diagnosis. Interventions to improve HIV care engagement among BSGM with HIV must address inequities, leverage social support networks, and enhance self-efficacy.

Despite its known effectiveness, pre-exposure prophylaxis (PrEP) remains underutilized, particularly among Black women who experience disproportionately high rates of human immunodeficiency virus (HIV). This quality improvement (QI) project evaluated the impact of a provider education intervention, combined with a culturally tailored patient educational video, on PrEP prescribing, uptake, and documentation at an urban sexually transmitted infections (STI) clinic in Detroit, Michigan. Using a pre–post design, data were collected for 3 months before and after implementation of the intervention. Among 549 eligible Black women, PrEP prescribing increased from 3.6% pre-intervention to 11.4% post-intervention (p = 0.001). Among a small sample, nearly one-third of post-intervention patients who were prescribed PrEP received the medication within 30 days, compared with zero pre-intervention. This difference did not reach statistical significance (p = 0.08), likely due to limited sample size, but may be clinically meaningful. Documentation using the recommended International Classification of Diseases, 10th Revision (ICD-10) code Z29.81 for PrEP-related encounters improved from 21.5% to 88.3% (p < 0.001). Multivariable logistic regression analyses showed that post-intervention encounters were independently associated with higher odds of PrEP prescribing within 7 days of the clinical encounter and higher odds of the recommended ICD-10 code Z29.81 being utilized for PrEP-related services. Findings suggest that combining culturally responsive strategies with patient and provider education may improve PrEP prescribing, uptake, and documentation practices. The intervention was successful in addressing persistent disparities while offering a scalable model for similar clinical settings.