Putting Prevention into Practice
An Evidence-Based Approach
Screening for HIV Infection and Preexposure Prophylaxis for the Prevention of HIV Infection
Am Fam Physician. 2019 Nov 15;100(10):637-638.
Author disclosure: No relevant financial affiliations.
J.S., a 29-year-old transgender woman, presents for her first maintenance visit with a new family physician. It has been three years since her previous visit with a primary care physician. She has no chronic illnesses, stopped using tobacco products four years ago, and reports that she has never used illicit substances. She drinks alcohol occasionally, about two to three drinks per month. She has been single for the past two years and is actively dating, occasionally meeting others through dating apps. She is sexually active with men, engages in oral and anal intercourse, and uses condoms about two-thirds of the time. She shares that she does not always discuss her partners' sexual history prior to having sex; however, she knows that at least one of her recent sex partners was a man who has sex with both men and women. She requests to be screened for HIV infection.
Case Study Questions
1. Which of the following statements regarding the U.S. Preventive Services Task Force (USPSTF) recommendation statement on screening for HIV infection are correct?
A. The USPSTF recommends that physicians screen for HIV infection in all people 15 to 65 years.
B. The USPSTF recommends that physicians screen for HIV infection in all pregnant women.
C. The USPSTF recommends that physicians screen for HIV infection in pregnant women in labor whose HIV status is unknown.
D. The USPSTF recommends not screening people for HIV infection who have J.S.'s history because they have no risk factors.
2. J.S. returns for a follow-up visit and to review her laboratory results. The HIV test was negative, and the other tests for sexually transmitted infections (STIs) were negative. According to the USPSTF, which one of the following behaviors or factors makes J.S. a candidate for preexposure prophylaxis (PrEP)?
A. J.S. regularly receives STI screenings by visiting urgent care centers.
B. J.S. is a transgender woman.
C. J.S. has never tested positive for STIs.
D. J.S. occasionally does not use condoms
1. Owens DK, Davidson KW, Krist AH, et al. Screening for HIV infection: US Preventive Services Task Force recommendation statement. JAMA. 2019;321(23):2326–2336.
2. Owens DK, Davidson KW, Krist AH, et al. Preexposure prophylaxis for the prevention of HIV infection: US Preventive Services Task Force recommendation statement. JAMA. 2019;321(22):2203–2213.
3. Becasen JS, Denard CL, Mullins MM, et al. Estimating the prevalence of HIV and sexual behaviors among the US transgender population: a systemic review and meta-analysis, 2006–2017. Am J Public Health. 2019;109:e1–e8.
This PPIP quiz is based on the recommendations of the USPSTF. More information is available in the USPSTF Recommendation Statement and supporting documents on the USPSTF website (https://www.uspreventiveservicestaskforce.org). The practice recommendations in this activity are available at https://www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/prevention-of-human-immunodeficiency-virus-hiv-infection-pre-exposure-prophylaxis and https://www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/human-immunodeficiency-virus-hiv-infection-screening1.
This series is coordinated by Kenny Lin, MD, MPH, deputy editor.
A collection of Putting Prevention into Practice published in AFP is available at https://www.aafp.org/afp/ppip.
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