LAUSR

Background We assessed the impact of point of care (POC) testing for gonorrhea and chlamydia (GC/CT) on time to treatment in a HIV pre-exposure prophylaxis (PrEP) program in a STD clinic. Methods In May 2018, San Francisco City Clinic implemented express GC/CT testing using the GeneXpert™ for PrEP follow-up visits for men who have sex with men (MSM) and transwomen. PrEP patients who were symptomatic or a contact to GC or CT were empirically treated and excluded from express testing. We describe the population screened using GeneXpert™ and test positivity. We compared their time to treatment with asymptomatic PrEP follow-up visits during the same time frame one year prior. Differences in time to treatment were compared using a t-test. Results From May 2018-December 2018, there were 1623 visits by MSM and transwomen on PrEP at which GC/CT testing was conducted. The GeneXpert™ was used at 596 (36.7%) of visits. Of the 366 unique patients screened using the GeneXpert, the median age was 33; 40% were white, 30% Latino, 22% Asian and 6% black. Either GC or CT were positive at 87 (14.6%) of patient-visits. Positivity was higher at the rectum (10.8%) compared with throat (5.6%) and urine (1.5%). In comparison, from May 2017-December 2017, there were 611 visits by asymptomatic patients on PrEP who were tested for GC/CT but not empirically treated. Either GC or CT was positive at 90 (14.7%) visits. Median age and race/ethnicity did not differ between the groups. Mean and median time to treatment for GC/CT decreased from 6 and 4 days prior to implementing GeneXpert™, to 1.7 and 0 days for those tested with the POC test (p<0.001). Conclusion Prevalence of GC and CT was high among asymptomatic patients on PrEP. The introduction of POC testing decreases time to treatment, reducing duration of infectivity and potentially preventing ongoing transmissions. Disclosure No significant relationships.