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HIV PrEP in the Military: Experience at a Tertiary Care Military Medical Center

Abstract Objectives We evaluated human immunodeficiency virus (HIV) pre-exposure prophylaxis (PrEP) administration at the Walter Reed National Military Medical Center (WRNMMC), which serves a geographic area at high risk of HIV infection. Methods Medical records were reviewed for all patients initia...

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Published in:Military medicine 2018-03, Vol.183 (suppl_1), p.445-449
Main Authors: Blaylock, Jason M, Hakre, Shilpa, Decker, Catherine F, Wilson, Bryan, Bianchi, Elizabeth, Michael, Nelson, Beckett, Charmagne, Okulicz, Jason, Scott, Paul T
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cited_by cdi_FETCH-LOGICAL-c421t-9ae9ac00cfda409d023bce2a372f659608d1bc0baec04a970398fa37e524c50e3
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container_issue suppl_1
container_start_page 445
container_title Military medicine
container_volume 183
creator Blaylock, Jason M
Hakre, Shilpa
Decker, Catherine F
Wilson, Bryan
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Michael, Nelson
Beckett, Charmagne
Okulicz, Jason
Scott, Paul T
description Abstract Objectives We evaluated human immunodeficiency virus (HIV) pre-exposure prophylaxis (PrEP) administration at the Walter Reed National Military Medical Center (WRNMMC), which serves a geographic area at high risk of HIV infection. Methods Medical records were reviewed for all patients initiating PrEP at WRNMMC from November 1, 2013, to March 30, 2016. Demographic, laboratory, clinical, and risk exposure characteristics and outcomes were described. Results One hundred fifty-nine patients received PrEP; 133 (84%) patients were active duty, 95 (60%) patients were over 28 yr old. The majority were non-Hispanic Whites (n = 87, 55%). The median men who have sex with men (MSM) risk index score was 18.0 (IQR 12.0–22.0); 20 patients scored less than 10. One hundred and thirty-one (82%) patients remained on PrEP through the evaluation period. Patients mainly discontinued PrEP for service-related or toxicity reasons. Incident STIs occurred in 31 (19%) patients. No cases of HIV seroconversion were observed. Conclusions In this first description of PrEP utilization in a U.S. military health care system, a significant number of patients were non-Hispanic Whites, well-educated, were older, or were otherwise at low risk for HIV acquisition. Further effort is needed to enhance PrEP use among the higher risk young African-American MSM population, and further studies are needed to determine the cost-effectiveness of PrEP in individuals who are not categorized as high risk.
doi_str_mv 10.1093/milmed/usx143
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Methods Medical records were reviewed for all patients initiating PrEP at WRNMMC from November 1, 2013, to March 30, 2016. Demographic, laboratory, clinical, and risk exposure characteristics and outcomes were described. Results One hundred fifty-nine patients received PrEP; 133 (84%) patients were active duty, 95 (60%) patients were over 28 yr old. The majority were non-Hispanic Whites (n = 87, 55%). The median men who have sex with men (MSM) risk index score was 18.0 (IQR 12.0–22.0); 20 patients scored less than 10. One hundred and thirty-one (82%) patients remained on PrEP through the evaluation period. Patients mainly discontinued PrEP for service-related or toxicity reasons. Incident STIs occurred in 31 (19%) patients. No cases of HIV seroconversion were observed. Conclusions In this first description of PrEP utilization in a U.S. military health care system, a significant number of patients were non-Hispanic Whites, well-educated, were older, or were otherwise at low risk for HIV acquisition. Further effort is needed to enhance PrEP use among the higher risk young African-American MSM population, and further studies are needed to determine the cost-effectiveness of PrEP in individuals who are not categorized as high risk.</description><identifier>ISSN: 0026-4075</identifier><identifier>EISSN: 1930-613X</identifier><identifier>DOI: 10.1093/milmed/usx143</identifier><identifier>PMID: 29635556</identifier><language>eng</language><publisher>England: Oxford University Press</publisher><subject>Acquired immune deficiency syndrome ; Adolescent ; Adult ; AIDS ; Armed forces ; Demographics ; Disease control ; Disease prevention ; Epidemiology ; Female ; HIV ; HIV Infections - drug therapy ; HIV Infections - prevention &amp; control ; HIV-1 - drug effects ; Homosexuality, Male - statistics &amp; numerical data ; Human immunodeficiency virus ; Humans ; Male ; Medical laboratories ; Medical records ; Middle Aged ; Military medicine ; Military Medicine - methods ; Military Medicine - trends ; Military personnel ; Military Personnel - statistics &amp; numerical data ; Pre-Exposure Prophylaxis - methods ; Pre-Exposure Prophylaxis - standards ; Risk exposure ; Risk Factors ; Tertiary Care Centers - organization &amp; administration ; Tertiary Care Centers - statistics &amp; numerical data</subject><ispartof>Military medicine, 2018-03, Vol.183 (suppl_1), p.445-449</ispartof><rights>Published by Oxford University Press on behalf of the Association of Military Surgeons of the United States 2018. This work is written by (a) US Government employee(s) and is in the public domain in the US. 2018</rights><rights>Copyright Association of Military Surgeons of the United States Mar/Apr 2018</rights><rights>Published by Oxford University Press on behalf of the Association of Military Surgeons of the United States 2018. This work is written by (a) US Government employee(s) and is in the public domain in the US.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c421t-9ae9ac00cfda409d023bce2a372f659608d1bc0baec04a970398fa37e524c50e3</citedby><cites>FETCH-LOGICAL-c421t-9ae9ac00cfda409d023bce2a372f659608d1bc0baec04a970398fa37e524c50e3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/29635556$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Blaylock, Jason M</creatorcontrib><creatorcontrib>Hakre, Shilpa</creatorcontrib><creatorcontrib>Decker, Catherine F</creatorcontrib><creatorcontrib>Wilson, Bryan</creatorcontrib><creatorcontrib>Bianchi, Elizabeth</creatorcontrib><creatorcontrib>Michael, Nelson</creatorcontrib><creatorcontrib>Beckett, Charmagne</creatorcontrib><creatorcontrib>Okulicz, Jason</creatorcontrib><creatorcontrib>Scott, Paul T</creatorcontrib><title>HIV PrEP in the Military: Experience at a Tertiary Care Military Medical Center</title><title>Military medicine</title><addtitle>Mil Med</addtitle><description>Abstract Objectives We evaluated human immunodeficiency virus (HIV) pre-exposure prophylaxis (PrEP) administration at the Walter Reed National Military Medical Center (WRNMMC), which serves a geographic area at high risk of HIV infection. Methods Medical records were reviewed for all patients initiating PrEP at WRNMMC from November 1, 2013, to March 30, 2016. Demographic, laboratory, clinical, and risk exposure characteristics and outcomes were described. Results One hundred fifty-nine patients received PrEP; 133 (84%) patients were active duty, 95 (60%) patients were over 28 yr old. The majority were non-Hispanic Whites (n = 87, 55%). The median men who have sex with men (MSM) risk index score was 18.0 (IQR 12.0–22.0); 20 patients scored less than 10. One hundred and thirty-one (82%) patients remained on PrEP through the evaluation period. Patients mainly discontinued PrEP for service-related or toxicity reasons. Incident STIs occurred in 31 (19%) patients. No cases of HIV seroconversion were observed. 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Conclusions In this first description of PrEP utilization in a U.S. military health care system, a significant number of patients were non-Hispanic Whites, well-educated, were older, or were otherwise at low risk for HIV acquisition. Further effort is needed to enhance PrEP use among the higher risk young African-American MSM population, and further studies are needed to determine the cost-effectiveness of PrEP in individuals who are not categorized as high risk.</abstract><cop>England</cop><pub>Oxford University Press</pub><pmid>29635556</pmid><doi>10.1093/milmed/usx143</doi><tpages>5</tpages><oa>free_for_read</oa></addata></record>
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source Oxford Journals Online
subjects Acquired immune deficiency syndrome
Adolescent
Adult
AIDS
Armed forces
Demographics
Disease control
Disease prevention
Epidemiology
Female
HIV
HIV Infections - drug therapy
HIV Infections - prevention & control
HIV-1 - drug effects
Homosexuality, Male - statistics & numerical data
Human immunodeficiency virus
Humans
Male
Medical laboratories
Medical records
Middle Aged
Military medicine
Military Medicine - methods
Military Medicine - trends
Military personnel
Military Personnel - statistics & numerical data
Pre-Exposure Prophylaxis - methods
Pre-Exposure Prophylaxis - standards
Risk exposure
Risk Factors
Tertiary Care Centers - organization & administration
Tertiary Care Centers - statistics & numerical data
title HIV PrEP in the Military: Experience at a Tertiary Care Military Medical Center
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