Telehealth Promotes STI-PEP in Cisgender African American Men

African American cisgender men who had sex with men (MSM) were significantly more likely to continue HIV pre-exposure prophylaxis (PrEP) care after a telehealth initiation of prophylactic doxycycline than those who did not receive this intervention, based on data from a new study of 712 individuals. 

African American cisgender MSM are at increased risk for sexually transmitted infections (STIs) said Ralston Lockett, PNPc, MSP, APRN, FNP-C, AAHIVS, in an interview. 

“Introducing a novel method such as sexually transmitted infection postexposure prophylaxis [STI-PEP] in a nationally scoped telehealth setting focused on HIV prevention and treatment is groundbreaking,” he said.

STI-PEP or Doxy-PEP has been shown to prevent bacterial STIs in MSM and transgender women when taken after condomless sex, but data on the impact of this intervention in priority/high-risk populations in terms of HIV PrEP retention are limited, wrote Lockett and colleagues in a poster presented at the Association of Nurses in AIDS Care 2024 Annual Meeting. 

The researchers reviewed data from PrEP encounters involving African American men in 10 states where STI-PEP was offered between October 1, 2023, and December 31, 2023. Of the 712 patients who completed a PrEP encounter, 291 had started STI-PEP via telehealth.

A sample chart review of 126 individuals was used to assess HIV PrEP retention at 3 and 6 months.

In the retention analysis, 80.9% of patients starting STI-PEP remained in PrEP care at 3 months, compared with 65.8% of those who did not start STI-PEP, representing a 15% improvement. Similarly, 76.6% of patients starting STI-PEP remained in PrEP care at 6 months, compared with 57% of those who did not start STI-PEP — an improvement of nearly 20%. 

The study findings were limited by the lack of data on cisgender women and patients born as female individuals because of the lack of research on STI-PEP use in these populations, the researchers noted. 

However, “The results of our findings displayed that not only are we able to have patients sign up for an initial PrEP visit and remain in care for their 3- and 6-month follow-up, but it also showed that we were reaching patients nationally who might not routinely set foot into a brick-and-mortar practice,” Lockett told Medscape Medical News. “It is important to note that our telehealth practice at Q Care Plus is a confidential and stigma-free, with experts trained on meeting individuals where they are, which allows for more conversation and framework to navigate socio-economic barriers,” he said.

A key message from the study is that although sexual health care and the stigma associated with it can be a challenge to navigate, focusing on finding a solution and using evidence-based practices can help break down barriers that might be in the way, he said.

Additional research needs include advocacy to increase patient awareness of underrepresented communities and health literacy programs, Lockett told Medscape Medical News. In the clinical setting, normalizing STI on a primary care level can ensure that patients are aware of their options for preventative services, he said. More training and professional development related to sexual wellness and cultural sensitivities would improve shared decision-making with patients, he added.

Improve Access to Increase Retention

Identifying ways to deliver preventative care to high-risk groups is very important to help decrease the rates of sexually transmitted infections in the United States, said Shirin Mazumder, MD, associate professor and infectious disease specialist at the University of Tennessee Health Science Center, Memphis, Tennessee, in an interview.

“Since the COVID-19 pandemic, we know that utilization of telehealth services can be successful because it offers convenience and access to care,” said Mazumder, who was not involved in the study. “This study helped to reaffirm the benefit of telehealth services, especially as it pertains to access of preventative care to high-risk patient groups,” she said. The results suggest that providing telehealth services in delivering STI-PEP alongside the delivery of HIV PrEP helped to recruit a younger at-risk patient population and also helped to retain patients in HIV PrEP care, she noted. 

As for additional research, Mazumder said she would be interested in long-term patient retention data beyond 6 months for this study population. “Also, looking at the impact of telehealth for HIV PrEP and STI-PEP beyond the 10 states included in this study could be helpful to determine geographic trends, and the locations where additional education and action can be taken,” she said.

The study received no outside funding. The researchers had no financial conflicts to disclose. Mazumder had no financial conflicts to disclose.