LAUSR

Background We have previously identified PrEP adherence as a risk factor for STIs in an academically affiliated Deep South PrEP clinic. In this analysis of a community-based Deep South PrEP clinic, we hypothesized that PrEP adherence and high risk sexual behaviors would be associated with STI. Methods This was a retrospective analysis of men who have sex with men (MSM) aged ≥18 years receiving PrEP at a community-based clinic in Birmingham, AL from 2016 to 2018. HIV negative patients were included if they completed ≥1 sexual behavior and PrEP adherence survey and were prescribed PrEP. Screening for gonorrhea, chlamydia, and syphilis and patient-reported outcomes (PROs) were performed at quarterly clinic visits. The outcome of interest was incident bacterial STI. We evaluated the association of sexual behavior and PrEP adherence PROs with STI using logistic regression. Results Of 119 eligible participants, 48% were ≥35 years, 21% reported no condom use, and 75% reported ≥2 sexual partners. Over the study period, 29 cases of STI were detected including 18 chlamydia, 10 gonorrhea and 1 syphilis case. However, 14 participants declined STI testing. Of 85 patients who completed ≥1 PRO (initial visit plus follow-up), 74% reported excellent PrEP adherence. By univariate and multivariable analysis neither condom use, number of sexual partners, or PrEP adherence were significantly associated with STIs, though consistent condom use approached significance. Conclusion In a community-based PrEP clinic in the Deep South, adherence was high and high-risk sexual behaviors were common. Neither adherence nor sexual behaviors were associated with STIs. Although it did not meet statistical significance, there was a trend toward STI for those reporting condomless anal sex. Surprisingly, many patients declined recommended STI testing, leaving missing data and suggesting an overall lack of awareness of STI risk in this community. These results highlight the need for vigorous STI screening and education Disclosure No significant relationships.