857. Discussion and Initiation of HIV Pre-exposure Prophylaxis Were Rare Following Diagnoses of Sexually Transmitted Infections among Veterans

Background Healthcare encounters for the diagnosis and treatment of sexually transmitted infections (STIs) are common and represent a window of opportunity to discuss and initiate HIV pre-exposure prophylaxis (PrEP). Little is known about how frequently PrEP is discussed and initiated in association with encounters for STIs. Methods We conducted a retrospective cohort and nested case control study in the national Veterans Administration (VA) healthcare system to determine the frequency of PrEP discussion and initiation in association with clinical encounters for bacterial STIs (i.e. early syphilis, gonorrhea, and chlamydia). We used administrative data to identify patients with a first STI based on ICD 9 / 10 codes from January 2013–December 2018 , excluding patients with prior HIV diagnosis or PrEP use, or STI diagnosed in context of a visit to initiate PrEP (Figure 1). We used pharmacy data to determine the frequency of PrEP initiation within 90 days of the encounter for STI in this cohort. In the case control study, we matched 90 PrEP starters to 180 non-starters by day of STI diagnosis and reviewed chart notes from the STI diagnosis encounter to determine frequency of documentation of sexual history taking and PrEP discussions among subsequent PrEP initiators and non-initiators. Results We identified 23,312 patients with a first STI, of whom 90 (0.4%) started PrEP within 90 days. Adjusting for age, PrEP initiation was associated with urban residence (OR=5.0, 95Cl 1.8–13.4), White compared to Black race (OR=1.7, 95 Cl 1.1–2.8), and syphilis diagnosis (OR = 7.4, 95 Cl 4.7–11.6, table 1). Chart review revealed that discussion of PrEP was rare among people with STIs who did not subsequently start PrEP (1.1%, 95 CI 0.1–4.0, table 2). PrEP initiation was associated with documentation of any sexual history (80.0% of initiators vs. 51.0% of non-initiators, p < 0.01) and discussion of PrEP (52.2% vs. 1.1%, p < 0.01) during the initial STI diagnosis encounter. Figure 1. Study flow chart Table 1. Characteristics of patients with a first healthcare encounter with an STI diagnosis, by PrEP initiation within 90 days of encounter. N= 23,312 Table 2. Chart review findings from case control study. Ninety people who initiated PrEP (i.e., “cases”) were randomly matched to 180 who did not initiate PrEP (i.e., “controls”) by date of STI. Conclusion Discussion and initiation of PrEP were rare in association with healthcare encounters for STIs. Not all individuals with STIs will benefit from starting PrEP, but interventions are needed to improve low rates of sexual history-taking and discussion of PrEP during healthcare encounters for STIs. Disclosures Bruce Alexander, PharmD, Bruce Alexander Consulting (Independent Contractor)

Sexual history taking in primary care

Sexual history can be neglected in a routine nursing or medical assessment. Sarah Kipps gives tips to assist in making a sexual history taking session as comfortable as possible for both health professional and patient Practitioners in primary care are in a unique position to improve the sexual health of men and women. They can do this by introducing the topic of sexual health into their everyday consultations and thereby normalising the subject as part of routine health for the patient. There is evidence that health professionals find sexual history taking to be one of the more challenging aspects of a consultation. There are a number of different reasons for this: feeling not equipped to ask questions of such a sensitive nature; fear of opening a ‘can of worms’ which cannot be dealt with; and the general social embarrassment and difficulties experienced talking about sex in general. This article will give health professionals some tips and guides to assist in making a sexual history taking session as comfortable as possible for both health professional and patient.

Attitudes and perceptions of final year medical students on sexual history taking from patients in Ogun state, Southwestern Nigeria

Background: An important aspect of sexual health is the ability to take a sexual history. Previous studies have shown that most medical students believed that sexual history taking is an important skill for future practice. Still, a majority reported inadequate, inconsistent or no training in this area.Objectives: To assess the attitudes of final year medical students on sexual history taking and perceptions of the training they received in medical schoolDesign: A cross-sectional study using an online surveyParticipants: Consented and conveniently sampled 100 final year medical students.Results: The overall response rate was 74.6%, and the mean age of the respondents was 24.1±2.9 years. The majority (97%) of the students believed it is important for doctors to know how to take a sexual history. Still, only 31% admitted to finding it easy, with 57% of the students admitted to being comfortable taking a sexual history from adult patients. While 70% had exposure on simulated patients, just 54% have observed doctors taking sexual history during clinical rotations, mostly in Obstetrics and Gynaecology (97%) and Urology (60%) postings.Conclusions: Many final year medical students are interested in and appreciated the importance of sexual history taking, but they are not well grounded in many aspects of the topic. Despite the importance of sexual health, many students did not have enough exposure and training on the topic while still in medical schools. There is thus a need for a review of the curriculum of undergraduate medical education in Nigeria.

Neglected sexual dysfunction symptoms amongst chronic patients during routine consultations in rural clinics in the North West province

Background: Sexual dysfunction contributes to personal feelings of loss and despair and being a cause of exacerbated interpersonal conflict. Erectile dysfunction is also an early biomarker of cardiovascular disease. As doctors hardly ever ask about this problem, it is unknown how many patients presenting for routine consultations in primary care suffer from symptoms of sexual dysfunction.Aim: To develop an understanding of sexual history taking events, this study aimed to assess the proportion of patients living with symptoms of sexual dysfunction that could have been elicited or addressed during routine chronic illness consultations.Setting: The research was carried out in 10 primary care facilities in Dr Kenneth Kaunda Health District, the North West province, South Africa. This rural area is known for farming and mining activities.Methods: This study contributed to a broader research project with a focus on sexual history taking during a routine consultation. A sample of 151 consultations involving patients with chronic illnesses were selected to observe sexual history taking events. In this study, the patients involved in these consultations completed demographic and sexual dysfunction questionnaires (FSFI and IIEF) to establish the proportions of patients with sexual dysfunction symptoms.Results: A total of 81 women (78%) and 46 men (98%) were sexually active. A total of 91% of the women reported sexual dysfunction symptoms, whilst 98% of men had erectile dysfunction symptoms. The youngest patients to experience sexual dysfunction were a 19-year-old woman and a 26-year-old man. Patients expressed trust in their doctors and 91% of patients did not consider discussion of sexual matters with their doctors as too sensitive.Conclusion: Clinical guidelines, especially for chronic illness care, must include screening for sexual dysfunction as an essential element in the consultation. Clinical care of patients living with chronic disease cannot ignore sexual well-being, given the frequency of problems. A referral to a sexual medicine specialist, psychologist or social worker can address consequences of sexual dysfunction and improve relationships.

An HIV Primary Care Rotation Improved HIV and STI Knowledge, Enhanced Sexual History-Taking Skills, and Increased Interest in a Career in Infectious Diseases among Medical Students and Residents

Rotations in HIV primary care clinics have the potential to teach trainees core competencies and influence their career pathway. We found that fund of knowledge, confidence in obtaining a sexual history, and interest in an ID career all increased following an HIV clinic rotation.