Missed Opportunities for Pre-Exposure Prophylaxis Initiation in Persons with Newly Diagnosed HIV Infection at Henry Ford Health

Document Type

Conference Proceeding

Publication Date

1-11-2026

Publication Title

Open Forum Infect Dis

Keywords

adult, best practice, CD4 lymphocyte count, conference abstract, controlled study, death toll, diagnosis, electronic health record, emergency ward, female, follow up, high risk population, HIV test, human, Human immunodeficiency virus infection, Human immunodeficiency virus prevalence, incidence, major clinical study, male, Michigan, observational study, opportunistic infection, pre-exposure prophylaxis, primary medical care, retrospective study, screening test, sexually transmitted disease

Abstract

Background: HIV prevalence in Michigan continues to increase as the number of new diagnoses exceeds the number of deaths, with the highest rates occurring in Detroit. In Michigan, PrEP uptake is determined as low to medium, resulting in HIV diagnoses declining by 0.9% as compared to 8% in states with high PrEP uptake. HIV screening initiatives such as HIV testing in emergency departments (EDs) are effective in new case identification; however, opportunities for PrEP initiation are missed. The aim of this study was to identify missed opportunities for the use of PrEP in newly diagnosed persons with HIV (PWH). Methods: This was a retrospective observational study of adults with newly diagnosed HIV at Henry Ford Health in Detroit, Michigan from 1/1/2024 to 8/1/2024. Testing indications in the ED included sexually transmitted infections (STI) or an ED screening initiative where a best practice alert prompted the providers to order a HIV screening test for individuals 18-65 years without a previous HIV test. Electronic health records were reviewed to collect demographic and clinical data. Results: Thirty-three individuals with a new HIV diagnosis were included. Demographics are seen in Table 1. The majority (88%) of diagnoses were made in the ED with the highest rates of incidence in Wayne County. Median baseline CD4 cell count was 281 cells/mm3; 9% of individuals had an opportunistic infection. Median time to first HIV appointment and ART initiation were 9 and 8 days in 66% of individuals. However, 34% individuals were lost to follow up. None of the individuals were actively on PrEP; 14 had a prior STI and only 2/14 were offered PrEP. Conclusion: While we have made progress in screening for HIV and linking newly diagnosed PWH to care, providing PrEP for HIV to prevent infection has not progressed as evidenced by our study. Despite multiple interactions with healthcare systems a significant majority had no discussion about PrEP. These missed opportunities underscore the need for increased efforts to provide high risk populations with tools including PrEP to reduce risk for HIV infection. To achieve this goal, innovative strategies to prevent new HIV infections are needed, including telePrEP and increased primary care outreach.

Volume

13

First Page

S330

Last Page

S331

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