Background Expanding use of preexposure prophylaxis (PrEP) in ways that address current racial/ethnic disparities is an important human immunodeficiency virus (HIV) prevention goal. We investigated missed opportunities to provide PrEP during healthcare visits that occur prior to HIV infection. Methods This retrospective cohort study linked South Carolina HIV case surveillance data to 3 statewide healthcare databases. Characteristics of patients, healthcare visits and providers, sexually transmitted diseases (STDs), and other diagnoses were assessed for medical encounters occurring before an initial HIV diagnosis. Adjusted odds ratios were used to identify correlates of missed opportunities for PrEP provision. Results Of 885 persons newly diagnosed during the study period, 586 (66%) had 4029 visits to a healthcare facility prior to their HIV diagnosis (mean of 6.9 visits) with missed opportunities for provision of PrEP. Emergency medicine-trained clinicians conducted (61%) and primary care clinicians (family practice or internal medicine) conducted 10% of visits. Also, 42% of visits were by persons who were uninsured or self-paid, 36% had public insurance, and 18% had commercial insurance. In multivariable analyses, being female, black, or aged <30 years were statistically significant predictors of having prior healthcare visits. Among persons with at least 1 healthcare visit prior to their HIV diagnosis, 28.5% had a diagnosis of gonorrhea, syphilis, or chlamydia at any visit. Conclusions Healthcare visits occurring among persons who would benefit from provision of PrEP, especially persons with diagnosed STDs, should be leveraged to increase use of PrEP and reduce the risk of HIV acquisition.

中文翻译：

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2013-2016年，在南卡罗来纳州错过了处方前预防的机会。

背景技术以解决当前种族/族裔差异的方式扩大暴露前预防（PrEP）的使用是人类免疫缺陷病毒（HIV）预防的重要目标。我们调查了在感染艾滋病毒之前进行的医疗就诊期间错过的提供PrEP的机会。方法这项回顾性队列研究将南卡罗来纳州的HIV病例监测数据与3个州范围的医疗保健数据库相关联。评估患者的特征，医疗保健就诊者和提供者，性传播疾病（STD）以及其他诊断，以评估在初次HIV诊断之前发生的医疗事故。调整后的优势比用于确定错过的PrEP提供机会的相关性。结果在研究期间新诊断的885人中，586名（66％）在接受HIV诊断之前有4029次就诊（平均6.9次就诊），但错过了提供PrEP的机会。进行了急诊医学培训的临床医生（61％），而初级保健临床医生（家庭医生或内科医生）进行了10％的就诊。此外，有42％的探视是由没有保险或自付费用的人提供的，有36％的人拥有了公共保险，有18％的人拥有了商业保险。在多变量分析中，女性，黑人或年龄小于30岁是进行过医疗保健就诊的统计学显着预测因素。在诊断出HIV之前至少进行过一次医疗保健就诊的人中，有28.5％的人在每次就诊时都被诊断出淋病，梅毒或衣原体感染。结论在受益于提供PrEP的人群（尤其是患有性病的人群）中进行医疗保健就诊，