Sexual wellness clinic collaborative initiative with a large urban emergency department: sexual health outcomes and linkage to HIV pre-exposure prophylaxis

Abstract

Introduction: Despite escalating rates of sexually transmitted infections (STIs) in the United States (US), there has been progressive divestment of sexual health services leading to the reliance on emergency departments (EDs) for sexual healthcare, particularly among vulnerable populations. The Sexual Wellness Clinic (SWC), a novel care delivery model operating in collaboration with the ED, offers comprehensive sexual health services. Objectives: This study aims to analyze the demographics, STI positivity, and HIV Pre-Exposure Prophylaxis (PrEP) uptake among patients accessing the SWC. Design: This was a retrospective cohort study of patients attending the SWC between February 20, 2019, and September 30, 2022. Methods: Sociodemographic characteristics, STI testing results, and PrEP initiation data were collected from the electronic health record (EHR). Two multivariable logistic regression models were employed to assess associations between patient factors and STI positivity or PrEP initiation. Results: Among 651 individuals across 785 SWC visits, the majority were Black or African American (94.6%), 18–29 years of age (53.2%), and on Medicaid (65.8%). Of all visits, 27.3% resulted in a syphilis diagnosis, 16.1% tested positive for chlamydia test, and 15.0% tested positive for gonorrhea. Decreased STI positivity was associated with insertive vaginal sex (adjusted odds ratio (aOR): 0.34, p = 0.0079) while using condoms most of the time use was associated with increased STI positivity (aOR: 2.68, p = 0.0038). Eighty SWC patients started PrEP on the same day as their visit, most of which were non-Hispanic Black (96.26%), assigned female at birth (53.75%), and on Medicaid or Medicare (68.75%). Factors associated with PrEP initiation at the SWC included a previous STI (aOR: 3.78, p < 0.001), oral sex (aOR: 2.33, p = 0.008), receptive anal sex (aOR: 3.55, p = 0.010), having a partner with HIV (aOR: 8.95, p = 0.019), and participation in transactional sex (aOR: 29.46, p = 0.029). Conclusion: Patients seen within the SWC were priority patient populations for sexual health services and PrEP linkage. The SWC was able to promote the initiation of same-day PrEP in Black cisgender women, a key population that continues to experience inequities in PrEP coverage. The SWC functions as a model for sexual healthcare delivery in populations with unmet sexual health needs.