scholarly journals Pre-exposure prophylaxis uptake among users of non-occupational post-exposure prophylaxis: a longitudinal analysis of attendees at a large sexual health clinic in Montréal

2020 ◽  
Author(s):  
Yiqing Xia ◽  
R. Zoë Greenwald ◽  
M. Rachael Milwid ◽  
Claire Trottier ◽  
Michel Boissonnault ◽  
...  
Keyword(s):  
Hiv Transmission ◽  
Health Clinic ◽  
Post Exposure Prophylaxis ◽  
Post Exposure ◽  
Cox Proportional Hazard ◽  
Kaplan Meier ◽  
History Of ◽  
Sex With Men ◽  
Exposure Prophylaxis

AbstractBackgroundReducing HIV transmission using pre-exposure prophylaxis (PrEP) requires targeting individuals at high acquisition risk, such as men who have sex with men (MSM) with a history of non-occupational post-exposure prophylaxis (nPEP). This study aims to characterize longitudinal trends in PrEP uptake and its determinants among nPEP users in Montréal.MethodsEligible attendees at Clinique médicale l’Actuel were recruited prospectively starting in October 2000 (nPEP) and January 2013 (PrEP). Linking these cohorts, we characterized the PEP-to-PrEP cascade, examined the determinants of PrEP uptake after nPEP consultation using a Cox proportional-hazard model, and assessed whether PrEP persistence differed by nPEP history using Kaplan-Meier curves.ResultsAs of August 2019, 31% of 2,682 MSM nPEP cohort participants had two or more nPEP consultations. Subsequent PrEP consultations occurred among 36% of nPEP users, of which 17% sought nPEP again afterwards. Among 2,718 PrEP cohort participants, 46% reported previous nPEP use. Among nPEP users, those aged 25-49 years (Hazard Ratio (HR)=1.3, 95% confidence interval (CI): 1.1-1.7), with more nPEP episodes (HR=1.4, 95%CI: 1.3-1.5), reported chemsex (HR=1.3, 95%CI: 1.1-1.7), with a STI history (HR=1.5; 95%CI: 1.3-1.7), and who returned for their first nPEP follow-up visit (HR=3.4, 95%CI: 2.7-4.2) had higher rates of PrEP linkage. There was no difference in PrEP persistence between PEP-to-PrEP and PrEP only participants.ConclusionOver one-third of nPEP users were subsequently prescribed PrEP. However, the large proportion of men who repeatedly use nPEP calls for more efficient PrEP-linkage services and, among those that use PrEP, improved persistence should be encouraged.

scholarly journals 986. Improvement in Administration of HIV Post-Exposure Prophylaxis in the Emergency Department Following Sexual Assault

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S521-S522
Author(s):  
Jennifer R Silva-Nash ◽  
Stacie Bordelon ◽  
Ryan K Dare ◽  
Sherrie Searcy
Keyword(s):  
Emergency Department ◽  
Sexual Assault ◽  
Hiv Transmission ◽  
Post Exposure Prophylaxis ◽  
Intervention Period ◽  
Post Intervention ◽  
Post Exposure ◽  
Assault Victims ◽  
Exposure Prophylaxis

Abstract Background Nonoccupational post exposure prophylaxis (nPEP) following sexual assault can prevent HIV transmission. A standardized Emergency Department (ED) protocol for evaluation, treatment, and follow up for post assault victims was implemented to improve compliance with CDC nPEP guidelines. Methods A single-center observational study of post sexual assault patients before/after implementation of an ED nPEP protocol was conducted by comparing the appropriateness of prescriptions, labs, and necessary follow up. A standardized order-set based on CDC nPEP guidelines, with involvement of an HIV pharmacist and ID clinic, was implemented during the 2018-2019 academic year. Clinical data from pre-intervention period (07/2016-06/2017) was compared to post-intervention period (07/2018-08/2019) following a 1-year washout period. Results During the study, 147 post-sexual assault patients (59 Pre, 88 Post) were included. One hundred thirty-three (90.4%) were female, 68 (46.6%) were African American and 133 (90.4%) were candidates for nPEP. Median time to presentation following assault was 12.6 hours. nPEP was offered to 40 (67.8%) and 84 (95.5%) patients (P< 0.001) and ultimately prescribed to 29 (49.2%) and 71 (80.7%) patients (P< 0.001) in pre and post periods respectively. Renal function (37.3% vs 88.6%; P< 0.001), pregnancy (39.0% vs 79.6%; P< 0.001), syphilis (3.4% vs 89.8%; P< 0.001), hepatitis B (15.3% vs 95.5%; P< 0.001) and hepatitis C (27.1% vs 94.3%) screening occurred more frequently during the post period. Labratory, nPEP Prescription and Follow up Details for Patients Prescribed nPEP Conclusion The standardization of an nPEP ED protocol for sexual assault victims resulted in increased nPEP administration, appropriateness of prescription, screening for other sexually transmitted infectious and scheduling follow up care. While guideline compliance dramatically improved, further interventions are likely warranted in this vulnerable population. Disclosures Ryan K. Dare, MD, MS, Accelerate Diagnostics, Inc (Research Grant or Support)

scholarly journals 860. Immediate Access to Post-Exposure Prophylaxis (PEP) Through a 24/7 New York City PEP Hotline

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S20-S21
Author(s):  
Allison Glaser ◽  
Emma Kaplan-Lewis ◽  
Ana Ventuneac ◽  
Wyley Gates ◽  
Michael Cruz ◽  
...  
Keyword(s):  
New York ◽  
New York City ◽  
York City ◽  
Hiv Transmission ◽  
Clinical Care ◽  
Post Exposure Prophylaxis ◽  
Research Support ◽  
Post Exposure ◽  
Exposure Prophylaxis

Abstract Background Oral post-exposure prophylaxis (PEP) is effective in preventing HIV transmission. To minimize barriers to PEP for New York City (NYC) residents, the Institute for Advanced Medicine (IAM), Mount Sinai Health System, and the NYC Department of Health and Mental Health established a 24-hour 7-days PEP hotline to provide eligible callers with immediate access to PEP and follow-up clinical care. Methods Data from hotline callers (January to December 2017) was analyzed utilizing multivariable logistic regression to determine whether a call resulted in PEP access within 72 hours of exposure by sociodemographic variables and exposure characteristics. We describe transitions from PEP to PrEP (pre-exposure prophylaxis). Results The PEP hotline cohort (n = 1278) was 83% male, 11% female, 1% transgender; 66% LGBTQ and 20% heterosexual; 35% White, 15% Black, 9% Asian; 41% other/unknown; 25% Hispanic; mean age of 30 years (range 14–72). The majority of callers learned about the hotline by Internet search (59%). Mean exposure time prior to call was 31 hours with 57% within 24 hours. Exposures were 98% sexual; 73% anal sex (43% receptive; 30% insertive), 21% vaginal, and 6% other. 63% reported condomless sex and 29% condom failure. 15% of callers reported a partner with HIV. 35% of callers reported alcohol or recreational substances at the time of the exposure. Prior PEP and PrEP use was 20% and 9%, respectively. 91% of callers were eligible for PEP; 69% called afterhours and received a telephone PEP prescription, and 27% called during business hours and were directed to a clinic. Access to PEP within 72 hours of exposure occurred in 1,081 (93%) of eligible callers and within 36 hours in 68%. 90% of callers had confirmed follow-up clinic appointments. Of the 472 callers linked to care at the IAM, 89 (19%) transitioned to PrEP. Conclusion This unique program demonstrates a timely initiative to facilitate PEP access to a diverse cohort with the purpose of mitigating risk from potential exposure to HIV. Further investigation is needed to explore adherence to PEP, follow-up testing results, transitions to PrEP for prevention planning, and coordination of health care and substance use services. Disclosures E. Kaplan-Lewis, Viiv: Consultant, Consulting fee. J. Aberg, Gilead: Research Contractor, Research support. GSK: Research Contractor, Research support. ViiV: Research Contractor, Research support. A. Urbina, Theratechnologies: Scientific Advisor, Consulting fee. ViiV: Scientific Advisor, Consulting fee. Merck: Scientific Advisor, Consulting fee. Gilead: Scientific Advisor, Consulting fee.

scholarly journals Pre-Exposure Prophylaxis and Post-Exposure Prophylaxis awareness among men who have sex with men in Brazil

2020 ◽  
Author(s):  
Artur Acelino Francisco Luz Nunes Queiroz ◽  
Alvaro Francisco Lopes Sousa ◽  
Sonia Dias ◽  
Isabel Amélia Costa Mendes
Keyword(s):  
Analytical Study ◽  
Hiv Transmission ◽  
National Sample ◽  
Post Exposure Prophylaxis ◽  
Cross Sectional ◽  
Level Of Education ◽  
Post Exposure ◽  
Sex With Men ◽  
Prep Awareness ◽  
Exposure Prophylaxis

Abstract AIM: We aim to characterize PEP and PrEP awareness in alarge national sample of Brazilian MSM. SUBJECT: Various disparities exist in HIV transmission among men who have sex withmen (MSM). Post-exposure Prophylaxis (PEP) and Pre-exposure prophylaxis (PrEP)has been shown as important strategies to prevent HIV, but there is variation in uptakewithin the MSM population. METHODS: This was a cross-sectional,population survey-based, analytical study, conducted exclusively online in all theregions of Brazil, with a sample of 2250 MSM. The multivariate logistic regressionmodel was adopted to produce adjusted odds ratios (ORa), considering a significancelevel at .05. RESULTS: We found a low knowledge about forms of prevention, with 54.6%claiming to know PEP and 46.4% PrEP. Men who did not recognize themselves ashomosexual, that is bisexual (ORa = 1.89, 95% CI 1.48-2.40) and heterosexual (ORa =3.83, 95% CI 2.80-5.24) were more likely to know the PEP. Having a higher minimumwage (ORa = 0.72, 95% CI 0.56-0.93) decreased the chances of knowing PrEP, aswell as having a higher level of education, factors that usually coexist, with thegraduate level being the highest of them (ORa = 0.13, 95% CI 0.06-0.28). CONCLUSION: Men still seem to know PEP from experience, after the failure of other preventivemeasures and not beforehand. PrEP awareness is permeated by barriers related tostructure and social determinants.

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