Missed Opportunity for HIV Prevention Among a High-Risk Population of Women Experiencing Intimate Partner Violence
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Center for Health Equity Research and Promotion, Crescenz VA Medical Center, Philadelphia, PA, USA; 2School of Social Work, College of Public Health, Temple University, Philadelphia, PA, USA; 3Department of Health, Law, Policy and Management, Boston University School of Public Health, Boston, MA, USA; 4Lankenau Medical Center, Main Line Health, Wynnewood, PA, USA.
J Gen Intern Med DOI: 10.1007/s11606-019-05372-1 © Society of General Internal Medicine 2019
INTRODUCTION
HIV pre-exposure prophylaxis (PrEP), a daily pill combining two antiretroviral agents, tenofovir disoproxil fumarate/ emtricitabine (TDF/FTC), has been shown to be effective in preventing HIV transmission in men and women and is recommended for those at increased risk of HIV.1 Experience of intimate partner violence (IPV) increases HIV risk for women,2 and women receiving care in the Veterans Health Administration (VHA) experience substantial rates of IPV.3 Given this risk and the availability of PrEP as a prevention tool in VHA, we sought to examine the association between recent IPV exposure disclosed to VHA providers through routine screening and HIV diagnosis, testing, and PrEP prescriptions among this population.
METHODS
Data were extracted from patient medical records through the VHA corporate data warehouse for all female patients routinely screened for past-year IPV across 13 VHA facilities between April 2014 and 2016 (for more information on study methods, see prior paper3). Additional abstracted medical record data included patient demographics (sex, age, race, ethnicity, marital status, and veteran status), VHA facility location, and HIV diagnoses, labs, and prescriptions. HIV infection (HIV+ status) was defined by ICD-9/ICD-10 diagnostic codes. HIV diagnosis data were extracted from the initiation of the VHA electronic medical record system in January 2000 to October 2018. HIV testing was assessed using lab test records for the 30-month period including the year The views expressed in this article do not necessarily reflect the views of the U.S. Department of Veterans Affairs or the United States Government. Received May 9, 2019 Accepted September 12, 2019
prior to and 18 months following IPV screening. PrEP prescriptions were identified through prescription orders (i.e., that a prescription was filled) during the same 30-month period. Bivariate analyses compared patients screening positive for past-year IPV (IPV+) to those screening negative for past-year IPV (IPV−) on the three outcomes: HIV diagnosis, HIV testing, and PrEP prescriptions. TDF/FTC prescriptions for those with an HIV+ diagnosis were excluded from analysis to avoid accounting for these drugs used for HIV treatment rather than prevention.
RESULTS
The study cohort included 8888 female patients with a recorded IPV screening during the observation period; 774 (8.7%) screened positive for past-year IPV (IPV+). Women in the sample ranged in age from 18 to 98 years, with a mean age of 45 years; nearly three quarters (73.2%) were under age 55. More than half (52.6%) of the
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