The American College of Obstetricians and Gynecologists (ACOG) has issued updated guidance on HIV screening and prevention, calling for more consistent clinician engagement in preexposure prophylaxis (PrEP) counseling and prescribing.
The guidance updates Committee Opinion No. 595 on PrEP and Committee Opinion No. 596 on routine HIV screening, and is intended to guide obstetrician-gynecologists (ob-gyns) and other reproductive health care professionals in counseling patients on HIV risk and prevention.
HIV remains a substantial public health challenge in the United States.
Ob-gyns are positioned to help advance the US Department of Health and Human Services’ Ending the HIV Epidemic in the US initiative, which set a goal of reducing new HIV diagnoses.
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According to ACOG, ob-gyns provide close to half of all women’s preventive health visits annually, often the only contact some patients have with the health care system in a given year, positioning the specialty to normalize conversations around HIV risk.
The guidance calls for nonjudgmental sexual histories at routine wellness visits for all patients regardless of age, marital status, or perceived risk, and emphasizes a shared decision-making approach to selecting prevention strategies that fit each patient’s lifestyle.
“During annual wellness visits with our patients, we are routinely discussing sex and risks for STIs [sexually transmitted infections],” said Catherine Cansino, MD, MPH, FACOG, a named author of the guidance.
Cansino noted that these conversations can be difficult for patients to bring up on their own at other medical appointments.
As ob-gyns, they have a unique opportunity to counsel patients on their risk of HIV and to discuss prevention strategies.
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At least one lifetime HIV test is recommended for all people using an opt-out approach; more frequent testing should be offered to those with ongoing risk factors.
PrEP should be prescribed to adults and adolescents weighing at least 35 kg (77 lb) with relevant risk behaviors, and to anyone who requests it.
According to the US Centers for Disease Control and Prevention, HIV affects individuals from all walks of life, and it is essential to address the social determinants of health that contribute to HIV risk and disparities in PrEP access.
The update is intended to guide and empower obstetrician–gynecologists and other health care professionals to counsel their patients on HIV screening and prevention.
