This repository contains the analysis scripts and tables for the following study:

Chandra C, Weiss K, Kelley C, Marcus J, Jenness SM. Gaps in Sexually Transmitted Infection Screening among Men who have Sex with Men in PrEP Care in the United States. Clin Infect Dis. Published online July 23, 2020. [LINK]

The U.S. Centers for Disease Control and Prevention (CDC) recommends comprehensive sexually transmitted infection (STI) screening every 3–6 months for men who have sex with men (MSM) using HIV preexposure prophylaxis (PrEP). The gaps between these recommendations and clinical practice by region have not been quantified.

We used survey data collected from the internet-based ARTnet study between 2017 and 2019 on STI screening among MSM across the U.S., stratified by current, prior, and never PrEP use. Poisson regression models with robust error variance were used to model factors, including residence in the Southeast, associated with consistent (“always” or “sometimes”) exposure site-specific STI screening during PrEP care.

Of 3259 HIV-negative MSM, 19% were currently using PrEP, 6% had used PrEP in the past, and 75% had never used PrEP (Table 1). Among ever PrEP users, 87%, 78%, 57%, and 64% were consistently (always or sometimes) screened for STIs by blood sample, urine sample/urethral swab, rectal swab, or pharyngeal swab, respectively, during PrEP care (Table 2). PrEP users in the Southeast were significantly less likely to be consistently screened for urogenital (adjusted prevalence ratio [aPR], 0.86; 95% confidence interval [CI], 0.76–0.98) and rectal STIs (aPR, 0.76; 95% CI, 0.62–0.93) during PrEP care (Table 5).

Significant gaps exist between CDC recommendations for STI screening during PrEP care and current clinical practice, particularly for rectal and pharyngeal exposure sites that can harbor asymptomatic infections and for MSM in Southeastern states where the STI burden is substantial.

We used data from ARTnet - an anonymous cross-sectional online survey of HIV-related risk behaviors, testing, and use of prevention services among MSM in the United States. MSM were recruited from the American Mens’ Internet Survey (AMIS) Survey, so the dataset also includes variables from AMIS.

Additional documentation on ARTnet and information to accessing the data can be found here. Code to install the “ARTnetData” package can be found below, but it may require a Github Personal Access Token since it is a private repository.

install.packages("remotes")
remotes::install_github("EpiModel/ARTnetData")

The analysis script analysis.R is the script used for analysis. This includes code used to prepare the ARTnet data for analysis, exploratory analyses, and code for bivariable and multivariable regression models.