Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA.
Department of Medicine, Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia, USA.
Clin Infect Dis. 2021 Oct 5;73(7):e2261-e2269. doi: 10.1093/cid/ciaa1033.
The US Centers for Disease Control and Prevention (CDC) recommends comprehensive sexually transmitted infection (STI) screening every 3-6 months for men who have sex with men (MSM) using human immunodeficiency virus (HIV) pre-exposure prophylaxis (PrEP). The gaps between these recommendations and clinical practice by region have not been quantified.
We used survey data collected from the internet-based ARTnet study between 2017 and 2019 on STI screening among MSM across the United States, stratified by current, prior, and never PrEP use. Poisson regression models with robust error variance were used to model factors, including residence in the Southeast, associated with consistent ("always" or "sometimes") exposure site-specific STI screening during PrEP care.
Of 3259 HIV-negative MSM, 19% were currently using PrEP, 6% had used PrEP in the past, and 75% had never used PrEP. Among ever PrEP users, 87%, 78%, 57%, and 64% reported consistent screening for STIs by blood sample, urine sample or urethral swab, rectal swab, or pharyngeal swab, respectively, during PrEP care. Compared to PrEP users in all other regions, PrEP users in the Southeast were significantly less likely to be consistently screened for urogenital (adjusted prevalence ratio [aPR], 0.86; 95% confidence interval [CI], .76-.98) and rectal STIs (aPR, 0.76; 95% CI, .62-.93) during PrEP care.
Substantial gaps exist between CDC recommendations for STI screening during PrEP care and current clinical practice, particularly for rectal and pharyngeal exposure sites that can harbor asymptomatic infections and for MSM in Southeast states where the STI burden is substantial.
美国疾病控制与预防中心（CDC）建议，对于使用人类免疫缺陷病毒（HIV）暴露前预防（PrEP）的男男性行为者（MSM），每 3-6 个月进行全面的性传播感染（STI）筛查。但这些建议与各地区的临床实践之间的差距尚未量化。
我们使用了 2017 年至 2019 年期间在全美范围内通过互联网进行的 ARTnet 研究中收集的调查数据，这些数据是根据当前、过去和从未使用过 PrEP 的情况对 MSM 的 STI 筛查进行分层的。我们使用具有稳健误差方差的泊松回归模型来分析与始终（“总是”或“有时”）进行暴露部位特异性 STI 筛查相关的因素，这些因素包括居住在东南部。
在 3259 名 HIV 阴性的 MSM 中，19%的人目前正在使用 PrEP，6%的人过去曾使用过 PrEP，75%的人从未使用过 PrEP。在曾使用过 PrEP 的人群中，分别有 87%、78%、57%和 64%的人报告在接受 PrEP 治疗期间，始终通过血液样本、尿液样本或尿道拭子、直肠拭子或咽拭子进行 STI 筛查。与所有其他地区的 PrEP 使用者相比，东南部的 PrEP 使用者在接受 PrEP 治疗期间，始终进行泌尿生殖道（调整后患病率比 [aPR]，0.86；95%置信区间 [CI]，0.76-0.98）和直肠 STI 筛查（aPR，0.76；95% CI，0.62-0.93）的可能性显著降低。
在接受 PrEP 治疗期间进行 STI 筛查的建议与当前临床实践之间存在显著差距，尤其是对于那些可能存在无症状感染的直肠和咽暴露部位，以及性传播感染负担较大的东南部各州的 MSM。
