METHODS: Patient demographics, risk information, and eligibility dates were obtained for all individuals enrolled in PrEP-DAP as of September 1, 2015 and who had been enrolled for at least 180 days. Case information for chlamydia (CT), gonorrhea (GC), and primary and secondary (P&S) syphilis cases was extracted from the WA STD reporting system and matched to PrEP-DAP data. PrEP-DAP eligibility start date was used to determine the length of time enrolled and only STDs diagnosed within the same length of time before enrolling in PrEP-DAP were included for analysis. Statistical significance was calculated using chi-square tests and odds ratios.
RESULTS: As of September 1, 2015, 263 individuals enrolled in PrEP-DAP met study criteria. Over 20% (n=54) were diagnosed with at least one STD prior to enrolling in PrEP-DAP. Eleven percent had at least one CT diagnosis, 10% had at least one GC diagnosis, and 2% had at least one P&S syphilis diagnosis. The percent diagnosed with a STD while enrolled in PrEP-DAP did not significantly increase (n=70, 27%, p=.1003). While enrolled, 16% were diagnosed with CT at least once, 15% with GC at least once, and 2% with P&S syphilis at least once. Of those diagnosed with a STD while enrolled, 17% (n=32) did not have a history of STDs prior to enrollment. Nearly 60% of individuals who had an STD prior to enrolling in PrEP-DAP have not been diagnosed with a STD following enrollment. The odds of being diagnosed with a STD while enrolled in PrEP-DAP were 2.3 times higher for individuals who had a history of STDs prior to enrolling in PrEP-DAP compared to individuals with no prior STD history (95% CI: 1.2-4.3).
CONCLUSIONS:
High-risk sexual activity continues to occur in a minority of PrEP-DAP enrollees. Regular matches between the PrEP-DAP database and STD cases is an effective strategy to determine ongoing high-risk sexual activity among enrollees and which PrEP-DAP enrollees are most at risk of contracting a STD.