Transitioning to HIV Pre-Exposure Prophylaxis (PrEP) from Non-Occupational Post-Exposure Prophylaxis (nPEP) in a Comprehensive HIV Prevention Clinic: A Prospective Cohort Study

Abstract

The uptake of pre-exposure prophylaxis (PrEP) for HIV prevention remains low. We hypothesized that a high proportion of patients presenting for HIV non-occupational post-exposure prophylaxis (nPEP) would be candidates for PrEP based on current CDC guidelines. Outcomes from a comprehensive HIV Prevention Clinic are described. We evaluated all patients who attended the HIV Prevention Clinic for nPEP between January 1, 2013 and September 30, 2014. Each patient was evaluated for PrEP candidacy based on current CDC-guidelines and subjectively based on physician opinion. Patients were then evaluated for initiation of PrEP if they met guideline suggestions. Demographic, social, and behavioral factors were then analyzed with logistic regression for associations with PrEP candidacy and initiation. 99 individuals who attended the nPEP clinic were evaluated for PrEP. The average age was 32 years (range, 18-62), 83 (84%) were male, of whom 46 (55%) men who had have sex with men (MSM). 31 (31%) met CDC guidelines for PrEP initiation, which had very good agreement with physician recommendation (kappa=0.88, 0.78-0.98). Factors associated with PrEP candidacy included sexual exposure to HIV, prior nPEP use, and lack of drug insurance (p<0.05 for all comparisons). Combining nPEP and PrEP services in a dedicated clinic can lead to identification of PrEP candidates and may facilitate PrEP uptake. Strategies to ensure equitable access of PrEP should be explored such that those without drug coverage may also benefit from this effective HIV prevention modality.

Use of an HIV‐risk screening tool to identify optimal candidates for PrEP scale‐up among men who have sex with men in Toronto, Canada: disconnect between objective and subjective HIV risk

“…Other studies among MSM have also found higher risk sexual behaviours (such as condomless sex) to be associated with hypothetical interest in using PrEP [28,29,35], as well as actual uptake in open-label studies [20,21]. Other characteristics independently associated with willingness to use PrEP in our study included higher perceived HIV risk and prior use of PEP, the latter finding highlighting the potential to transition individuals from PEP to PrEP [39,40]. Further work is needed to better understand the relative preferences regarding the use of new HIV prevention technologies among MSM, for instance, by using discrete choice experiments [41,42].…”

Sexually transmitted infections and viral hepatitides in patients presenting for non-occupational HIV post-exposure prophylaxis: results of a prospective cohort study

“…[5][6][7] Additionally, those individuals diagnosed with bacterial STIs in nPEP settings may be good candidates for HIV pre-exposure prophylaxis (PrEP). 8,9 This study provides evidence that such screening is valuable and that practitioners should be vigilant about investigating for these potentially transmissible infections.…”

High prevalence of syndemic health problems in patients seeking post-exposure prophylaxis for sexual exposures to HIV

“…Second, the cohort was highly educated, and we restricted analyses to MSM, limiting our ability to draw conclusions about other groups. However, this sample does reflect the population typically seen for nPEP in our setting,[ 56 , 57 ] and likely reflects the success of awareness-raising efforts in MSM communities. Of note, people who used nPEP in the context of sexual assault were unlikely included in this sample, since these patients are usually seen at sexual assault centres separate from our hospitals.…”