(P148) Using the Medical Monitoring Project to Assess Uptake of Sexually Transmitted Infection Screening and Prophylaxis among People Living with Diagnosed HIV

Background: There is a higher prevalence of sexually transmitted infections (STIs) among people living with diagnosed HIV (PLWDH). The United States Centers for Disease Control and Prevention (CDC) recommend PLWDH receive at least annual screening for STIs, including extragenital gonorrhea/chlamydia testing for men who have sex with men (MSM). Recently, doxycycline used as either pre-exposure or post-exposure prophylaxis has been shown to reduce bacterial STIs among PLWDH. Our objective was to assess gonorrhea, chlamydia, and syphilis screening practices as well as doxycycline use to prevent these STIs among PLWDH from data collected through CDC’s Medical Monitoring Project (MMP).

Methods: For the 2021 MMP cycle, California Department of Public Health (CDPH) Office of AIDS surveyed a random sample of PLWDH in California, excluding San Francisco and Los Angeles County. PLWDH aged ≥18 years and in the National HIV Surveillance System were eligible for MMP sampling. CDPH asked participants local supplementary questions about gonorrhea, chlamydia, and syphilis testing as well as doxycycline use to prevent these STIs. Non-response weights and post-stratification weights for sex at birth, age, and race/ethnicity were applied to the data.

Results: 214 participants (median age 54, IQR 41-62) completed the survey, of which 85% were cisgender men, 13% cisgender women, and 2% transgender people. Among 112 who were sexually active, 56%, 55%, and 58% of PLWDH surveyed reported being tested for gonorrhea, chlamydia, and syphilis in the past 12 months, respectively. Among sexually-active MSM being tested for gonorrhea or chlamydia, only 65% reported receiving a rectal or pharyngeal test. Among all participants who responded, 5% reported ever taking doxycycline daily as a preventive medication to reduce STIs, while 4% reported ever taking doxycycline shortly after sex to prevent an STI.

Conclusions: Just over half of sexually-active PLWDH surveyed reported receiving recommended STI screening, and few had ever taken doxycycline to prevent bacterial STIs. Educating health care providers and PLWDH regarding annual STI screenings (including extragenital sites for MSM) is a critical opportunity to reduce STI burden and transmission. Promoting use of doxycycline for prophylaxis may be an additional opportunity given emerging evidence on its effectiveness in STI prevention.