(911) High acceptance of PrEP prescriptions among pregnant patients regardless of syphilis stage

HIV preexposure prophylaxis (PrEP) is an underutilized tool in the fight to end the HIV epidemic – especially in pregnant populations. We implemented an intervention to counsel and offer PrEP to all pregnant patients treated for syphilis in our high-risk ambulatory clinic. The purpose of this study was to determine if patients with early-stage syphilis are more likely to accept PrEP than those with late-stage syphilis or syphilis reinfection.

Study Design:

This was an observational cohort study of HIV-negative pregnant patients who were treated for syphilis at an antepartum clinic. Standardized PrEP counseling was provided at the time of each bicillin injection. Prescriptions were sent to our institutional ambulatory pharmacy for those who accepted. Demographics were collected including stage of syphilis at treatment. Medication dispensation was verified by chart review. Acceptance and dispensation rates of patients with primary, secondary, or early latent syphilis (early-stage) were compared to those with late latent or syphilis of unknown duration (late-stage) or syphilis reinfection. Statistical methods included use of chi-square with p < 0.05 considered significant.

Results:

From March 1, 2022 through February 28, 2023, 107 patients were treated for syphilis and received PrEP counseling with 8 (8%) with early-stage syphilis, 86 (80%) with late-stage syphilis, and 13 (12%) with syphilis reinfection. Fifty-five (51%) patients accepted PrEP, and acceptance rates by stage were 75%, 51%, and 38% respectively, although this was not statistically significant (p = 0.26). Thirty (55%) patients picked up PrEP and dispensation rates by stage were 50%, 57%, and 40% respectively (p = 0.75).

Conclusion:

Pregnant patients treated for early-stage syphilis were more likely to accept a PrEP prescription than those with late-stage syphilis or syphilis reinfection, although these results were not statistically significant. Over half of all patients who received standardized PrEP counseling accepted a prescription. Further opportunities to increase acceptance and dispensation should be pursued.