Reorienting STI Partner Services Among Men Who Have Sex with Men to Focus on PrEP using Case Report-Guided Triage, King County, Washington, 2014-2021

ABSTRACT

BACKGROUND: STI partner services (PS) represent an opportunity to connect MSM to PrEP. We evaluated PrEP linkage through Public Health-Seattle & King County's (PHSKC) STI PS program. METHOD(S) Since 2014, PHSKC has collected data on PrEP use from all HIV-negative MSM receiving PS and offered recipients PrEP referrals. In 2020 when COVID-related staffing shortages limited the ability to provide PS to all MSM with STI, we added questions about HIV status and current PrEP use to STI case report forms and triaged PS to focus on HIV-negative MSM off PrEP. We calculated the percentage of MSM with STI receiving PS and, among HIVnegative PS recipients, trends in the percentage off PrEP and accepting PrEP referrals. We estimated the number of men initiating PrEP using follow-up data from a random sample of cases who were re-interviewed in 2017. RESULT(S) From 2014-2021, 9530 (35%) of 27,101 MSM with STIs received PS. This number increased from 679 (66%) of 1035 in 2014 to 1833 (41%) of 4502 in 2017 and declined thereafter to 490 (18%) of 2787 in 2021. Over 8 years, 2025 (64%) of 3163 HIV-negative MSM off PrEP were offered PrEP referrals, of whom 66% accepted. An estimated 744 (56%) men started PrEP. The percentage of MSM offered PrEP increased from 23% to 91% (P<0.0001, chisquare trend) while the percentage accepting referrals remained stable over time (range 52%-82%). The percentage of HIV-negative MSM PS recipients eligible for PrEP referrals (i.e., off PrEP) decreased from 80% in 2014 to 39% in 2019 but rose to 49% concurrent with adoption of case report-guided PS triage. CONCLUSION(S) Integrating PrEP referrals into STI PS activities is feasible, sustainable and increases PrEP use among MSM. Using data from STI case reports allowed PS to triage and focus on MSM who could benefit from PrEP referrals.