IUSTI 2018 World & European Congress 30 June 2018

1. IUSTI 2018 World & European Congress 30 June 2018 STD Partner Services for MSM Can Be Used to Promote PrEP and Identify People Living with HIV Who are Inadequately Engaged in Care David A. Katz, Julia C. Dombrowski, Dawn Spellman, Teal R. Bell, Matthew R. Golden

2. STD Partner Services (PS) • Offered to people diagnosed with bacterial STDs and their partners • Historical objectives: • Ensure appropriate treatment for index case • Elicit, notify, test, and treat partners • Decrease STD transmission and morbidity • Practices vary internationally • In US, provided widely for syphilis, infrequently for GC/CT • Concern that effectiveness may be declining • Opportunity to provide population-based HIV prevention

3. Integrating HIV Prevention into STD PS PrEP = pre-exposure prophylaxis; PLWH = people living with HIV

4. Objectives • Aim 1:Evaluate use of PS for early syphilis and gonorrhea among MSM to: • Ensure HIV testing at time of STD diagnosis • Provide referrals to PrEP care • Identify PLWH who are inadequately engaged in care • Aim 2: Assess differences in efficiency of PS-based HIV prevention by STD diagnosis

5. Methods

6. Outcome Definitions ART = antiretroviral therapy

7. MSM with Early Syphilis & Gonorrhea, 2016-17

8. Overall HIV Prevention Outcomes 4999 early syphilis and GC diagnosed among MSM 3523 (70%) without prior HIV diagnosis 1476 (30%)with prior HIV diagnosis 2205 (63%) interviewed for PS 767 (52%) interviewed for PS 0 (0%) newly HIV-diagnosed as a result of PS 444 (20%) accepted PS PrEP referral 39 (5.1%) reported inadequate engagement in HIV care Case-finding NNTI = ∞ PrEP Referral NNTI = 5.0 Engagement in Care NNTI = 19.7 GC = gonorrhea

9. HIV Case-Finding • No new HIV diagnoses as a result of PS • 32 (1.5%) of PS recipients were newly diagnosed with HIV P&S = primary and secondary. GC = gonorrhea

10. PrEP Promotion 2205 HIV-negative MSM interviewed for PS NNTI: • 1 PrEP referral = 5.0 (3.8 P&S syphilis-5.4 pharyngeal GC) • 1 PrEP initiation* = 9.6 1066 (48%) already on PrEP 1139 (52%) not on PrEP 1066 (94%) offeredPrEP referral 444 (42%) accepted PrEP referral 56% initiated PrEP* *Based on a random sample of cases diagnosed in 2016 (Katz et al, CROI 2018)

11. Promoting Engagement in HIV Care NNTI to identify 1 person inadequately engaged in care • Overall = 19.7 • Range = 10.3 P&S syphilis vs. 22-26 other infections • 767 MSM with prior HIV diagnosis interviewed for PS 696 (91%) assessed for HIV care/ART status 657 (94%) on ART 39 (6%) inadequately engaged in care 30 (77%) not on ART 9 (23%) no provider/visit

12. Limitations • Relied on self-reported ART/care status • Unable to determine effect on (re)linkage to HIV care • Intervention relied on: • Robust local HIV prevention and care infrastructure • Ability to identify MSM prior to case assignment  May limit ability to replicate program • Potential effect of interventions limited by successes in HIV prevention and care • Met 90/90/90 objectives • Declining HIV incidence (50% over last decade) • High PrEP coverage

13. Summary & Conclusions • HIV care and prevention outcomes can be successfully integrated into STD PS • Among MSM in King County: • primarily useful for PrEP promotion • some success identifying PLWH inadequately engaged in HIV care • not effective for HIV case-finding among index cases • In areas with less HIV infrastructure or higher incidence, may have more benefit but be harder to implement • Health departments should consider expanding the scope and objectives of STD PS to include HIV prevention

14. Acknowledgments Public Health – Seattle & King County • Field services staff • PrEP clinic staff • Christina Thibault • Tigran Avoundjian CDC Division of STD Prevention • Brandy Maddox Funding & Support • CDC AAPPS Evaluation Supplement & Minority AIDS Initiative • Washington State DOH Office of Infectious Disease • Public Health – Seattle & King County HIV/STD Program