PrEP Use May Result in Increased Receipt of Non-HIV-Related Primary Care

It has been well known that the use of a pre-exposure prophylaxis (PrEP) pill taken on a daily basis is effective in the prevention of HIV infections, but a new study suggests that PrEP could also serve as a gateway to primary care services.

The new data published in American Journal of Public Health was gleaned from a cross-sectional study of potential PrEP candidates in a community health clinic in Boston, Massachusetts, from 2012 to 2016. The researcher team, comprised of members from Harvard Pilgrim Health Care Institute, Harvard Medical School, The Fenway Institute, and the Centers for Disease Control and Prevention (CDC), compared the proportion of PrEP users and non-PrEP users who were also receiving primary care.

Overall, the researchers found that PrEP users were more likely to receive certain vaccines, undergo screening for specific diseases, and receive more mental health screening.

“To our knowledge, this is the first study to identify an association between PrEP use and receipt of primary care,” said the study’s lead author Julia L. Marcus, PhD, MPH, assistant professor of population medicine at Harvard Medical School and Harvard Pilgrim Health Care Institute, and adjunct faculty at The Fenway Institute, in a recent statement. “Although this was a cross-sectional study, which limits our ability to draw conclusions about causation, our results suggest that the benefits of PrEP may extend to behavioral health, mental health, and the prevention and treatment of other infectious and chronic diseases.”

For the study, the researchers identified 5,857 HIV-uninfected individuals who had tested for rectal sexually transmitted diseases between 2012 and 2016; of those found to have had 1 or more rectal STI test, 2,047 (35%) were prescribed daily oral PrEP using a combination of the antiretroviral medications emtricitabine and tenofovir.

Researchers observed that more PrEP users received influenza vaccination (prevalence ratio [PR] = 1.28; 95% confidence interval [CI] = 1.20, 1.37), tobacco screening (PR = 1.06; 95% CI = 1.02, 1.09) and depression screening (PR = 1.07; 95% CI = 1.04, 1.11) in comparison with non-PrEP users.

After additional adjustment for diabetes, hypertension, and overweight or obesity, more PrEP users received glucose testing (PR = 1.64; 95% CI = 1.56, 1.72) but fewer received hemoglobin A1c testing PR = 0.81; 95% CI = 0.71, 0.93) compared with non-PrEP users.

From the findings, the study authors suggest that PrEP could provide a gateway to other types of health care for individuals at risk for HIV infection. Most PrEP users in the United States are gay and bisexual men, and these populations have higher risks of mental health conditions and increased likelihood to smoke and use substances.

“Our study suggests that PrEP users may be motivated to care for their health in other ways,” said senior author Kenneth H. Mayer, MD, of The Fenway Institute and Harvard Medical School in a statement, “This increased engagement in health care may be a reason for PrEP initiation or may actually result from the experience of using PrEP.”

This is especially important considering that compared with the general population, those at higher risk of HIV infection are in greater need of non-HIV-related care. Those infected with HIV are at increased risk of diseases associated with aging, have comorbidities driven by a higher prevalence of behavioral risk factors, and are at increased risk of depression. As such, receipt of non-HIV-related primary care is beneficial and necessary.

Study authors suggest that future efforts are needed to integrate PrEP prescribing into primary care and ensure uptake of recommended primary care among those using PrEP.