Post-exposure prophylaxis in the era of pre-exposure prophylaxis: a study of post-exposure prophylaxis use in South-East Queensland since the Pharmaceutical Benefits Scheme listing of pre-exposure prophylaxis

2020 ◽  
Vol 31 (5) ◽  
pp. 426-431
Author(s):  
Karen Biggs ◽  
Maree O’Sullivan ◽  
Cheryn Palmer ◽  
Jacqualine McLellan ◽  
Fiona Marple-Clark ◽  
...  
Keyword(s):  
Health Services ◽  
Sexual Health ◽  
Condom Use ◽  
Antiretroviral Drugs ◽  
Post Exposure Prophylaxis ◽  
Post Exposure ◽  
Hiv Acquisition ◽  
Exposure Prophylaxis ◽  
The Impact ◽  
Pharmaceutical Benefits Scheme

Both post-exposure prophylaxis (PEP) and pre-exposure prophylaxis (PrEP) involve the use of antiretroviral drugs taken by HIV-uninfected individuals to reduce HIV acquisition risk. While PEP has been available in Australia for many years, PrEP became widely accessible in 2018 after listing on the Pharmaceutical Benefits Scheme (PBS). Studies have reported on the impact of PrEP on condom use. The impact of PrEP on the use of PEP in Australia has not been reported. This project examined PEP use across three public sexual health services in South-East Queensland, Australia, comparing rates in 2016 (prePBS-listed PrEP) and 2019 (postPBS-listed PrEP), to determine if PEP prescribing, and the characteristics of people accessing PEP, have changed. Results showed that PEP prescribing made up 2.85% of all clients seen in 2016, dropping to 2.33% in 2019, reflecting a decrease of 0.5% (p = 0.048). There was a significant increase in Medicare-ineligible clients accessing PEP (9% in 2016; 21% in 2019; p = 0.002) and a significant increase in PrEP-experienced clients accessing PEP between the two study periods (4% in 2016; 14% in 2019; p ≤ 0.001). The marginal decrease in PEP prescribing highlights that PEP remains an important option especially for those with barriers to accessing and adhering to daily PrEP.

Post-exposure prophylaxis

2002 ◽  
Vol 13 (1_suppl) ◽  
pp. 30-34 ◽  
Author(s):  
◽  
Marchina E Van Der Ende ◽  
Rosa M Regez ◽  
Gerrit Schreij ◽  
Jan T M Van Der Meer ◽  
...  
Keyword(s):  
The Netherlands ◽  
Hiv Transmission ◽  
Standard Procedure ◽  
High Plasma ◽  
Antiretroviral Drugs ◽  
Post Exposure Prophylaxis ◽  
Serious Adverse Events ◽  
Post Exposure ◽  
Occupational Setting ◽  
Exposure Prophylaxis

The mean risk of acquiring HIV after an occupational exposure, injecting drug use or sexual exposure varies from <0.1 to 3%. A high plasma HIV-RNA of the source increases the risk of each of the exposures. Other factors, such as the volume of the inoculum involved to which the individual was exposed, other sexually transmitted diseases and ruptures of mucous membranes are associated with a higher risk of HIV transmission. Based on the calculated risk, post-exposure prophylaxis (PEP) should be recommended. In the Netherlands, prescription of PEP in the occupational setting is a standard procedure and has proved to be feasible. This was associated with a high percentage (62%) of mild and reversible toxicity and a small percentage (2%) of serious adverse events related to antiretroviral drugs, i.e. nephrolithiasis (due to indinavir) and toxic hepatitis (due to nevirapine). In The Netherlands so far no HIV-seroconversions have been recorded after an occupational accident.

scholarly journals Guideline on the management of occupational and non-occupational exposure to the human immunodeficiency virus and recommendations for post-exposure prophylaxis: 2015 Update

2015 ◽  
Vol 16 (1) ◽  
Author(s):  
Michelle Moorhouse ◽  
Linda G. Bekker ◽  
Vivian Black ◽  
Francesca Conradie ◽  
Beth Harley ◽  
...  
Keyword(s):  
Occupational Exposure ◽  
Antiretroviral Drugs ◽  
Transmission Risk ◽  
World Health ◽  
Post Exposure Prophylaxis ◽  
Post Exposure ◽  
Adherence Support ◽  
Antiretroviral Medications ◽  
Health Organization ◽  
Exposure Prophylaxis

This guideline is an update of the post-exposure prophylaxis (PEP) guideline published by the Southern African HIV Clinicians Society in 2008. It updates the recommendations on the use of antiretroviral medications to prevent individuals who have been exposed to a potential HIV source, via either occupational or non-occupational exposure, from becoming infected with HIV. No distinction is made between occupational or non-occupational exposure, and the guideline promotes the provision of PEP with three antiretroviral drugs if the exposure confers a significant transmission risk. The present guideline aligns with the principles of the World Health Organization PEP guidelines (2014), promoting simplification and adherence support to individuals receiving PEP.

HIV Transmission Prevention

2017 ◽  
Author(s):  
Carolyn Chu ◽  
Christopher M. Bositis
Keyword(s):  
Hiv Transmission ◽  
Hiv Infections ◽  
Risk Groups ◽  
Antiviral Drugs ◽  
Antiretroviral Drugs ◽  
Post Exposure Prophylaxis ◽  
Needle Exchange Programs ◽  
Hiv Acquisition ◽  
Exposure Prophylaxis ◽  
Prevention Of Hiv

The prevention of HIV transmission involves a number of behavioral, structural, and biomedical interventions. Behavioral methods include education about sexual health, drug use, and risk reduction, as well as specific messages for at-risk populations who are HIV positive. Needle exchange programs and consistent use of condoms have proven effective for prevention of HIV infection. Post-exposure prophylaxis against HIV with antiviral drugs is often recommended in occupational health care and non-occupational settings. Voluntary male circumcision also reduces the risk of HIV acquisition. The treatment of pregnant women who are HIV infected can effectively eliminate mother-to-child transmission of the virus. Recently, the use of antiretroviral drugs for pre-exposure prophylaxis has proven highly effective in preventing HIV infections in high-risk groups including men who have sex with men. Promising therapies that likely will be available in the future include injectable antiviral drugs, vaginal microbicides, and HIV vaccines.

HIV seroconversions among male non-occupational post-exposure prophylaxis service users: a data linkage study

Sexual Health ◽  
2011 ◽  
Vol 8 (2) ◽  
pp. 179 ◽  
Author(s):  
Anna B. Pierce ◽  
Keflemariam Yohannes ◽  
Rebecca Guy ◽  
Kerrie M. Watson ◽  
Jude Armishaw ◽  
...  
Keyword(s):  
Risk Behaviour ◽  
Linkage Study ◽  
Incidence Rates ◽  
Post Exposure Prophylaxis ◽  
Hiv Incidence ◽  
Hiv Surveillance ◽  
Post Exposure ◽  
Hiv Seroconversion ◽  
Exposure Prophylaxis ◽  
The Impact

Background: Despite widespread prescription of non-occupational post-exposure prophylaxis (NPEP) in Victoria, little is known about subsequent HIV acquisition among NPEP users. We linked the Victorian NPEP Service (VNPEPS) database and the Victorian HIV Surveillance Registry to determine the number, incidence rate and predictive factors of HIV seroconversions among users of the VNPEPS. Methods: Records from male patients that received NPEP in the VNPEPS database (n = 1420) between January 2001 and February 2008 were linked with all entries in the Victorian HIV Surveillance Registry up to May 2008. Results: Sixty-one men who presented to the VNPEPS were identified as HIV seropositive; 16 of these were diagnosed at initial presentation for NPEP. The incidence of HIV seroconversion in males who were HIV seronegative at first presentation for NPEP was 1.27 (95% confidence interval 0.95–1.70) per 100 person-years. There was no association between HIV seroconversion and number of NPEP presentations or age. The median age of seroconversion was 34.6 years. Conclusion: The incidence of HIV infection among men presenting to the VNPEPS is slightly lower than the HIV incidence in NPEP users in a recent Australian cohort study of men who have sex with men, but higher than HIV incidence in general gay male populations. Frequency of NPEP use was not associated with risk of HIV seroconversion. Examination of risk behaviour before and after NPEP use in this population is required to further assess the impact of NPEP availability and use on HIV incidence rates and risk behaviour in Australia.

Non-occupational HIV post-exposure prophylaxis at a Sydney metropolitan sexual health clinic

Sexual Health ◽  
2013 ◽  
Vol 10 (5) ◽  
pp. 438 ◽  
Author(s):  
Trine Gulholm ◽  
Salina Jamani ◽  
I. Mary Poynten ◽  
David J. Templeton
Keyword(s):  
Sexual Health ◽  
Risk Behaviour ◽  
Anal Intercourse ◽  
Unprotected Anal Intercourse ◽  
Health Clinic ◽  
Post Exposure Prophylaxis ◽  
Prescribing Practices ◽  
Post Exposure ◽  
Hiv Seroconversion ◽  
Exposure Prophylaxis

Background Non-occupational HIV post-exposure prophylaxis (NPEP) is prescribed following a risk exposure in an effort to reduce the risk of HIV seroconversion. We aimed to describe the prescribing practices of NPEP at RPA Sexual Health in Sydney, the prevalence and correlates of adverse events (AEs), and factors associated with completing the 28-day course. Methods: The study population included individuals prescribed NPEP during January 2008–December 2011. Correlates of AEs and course completion were assessed by logistic regression. Results: On 319 occasions during the study period, 282 individuals presented for NPEP. Over 90% of presentations followed unprotected anal intercourse between men, mostly receptive (63.6%). Tenofovir–emtricitabine–stavudine (n = 149; 46.7%) and tenofovir–emtricitabine (n = 136; 42.6%) were most commonly prescribed. AEs were reported at 101 presentations (31.7%, 95% confidence interval (CI): 26.6–37.1%), with nausea and lethargy/malaise being the most common. Younger age (P for trend = 0.032), earlier year of NPEP prescription (P for trend = 0.011), being prescribed a regimen other than tenofovir–emtricitabine (P = 0.026), changing the NPEP regimen (P < 0.001) and known completion of the course (P = 0.005) were independently associated with AEs. The course was completed in 228 presentations (71.5%, 95% CI: 66.2–76.4%). Completion was associated with reporting AEs (P = 0.007) and changing regimen (P = 0.001). No documented NPEP failures were identified, although two recipients subsequently seroconverted to HIV due to ongoing high-risk behaviour. Conclusions: NPEP is appropriately targeted to the highest risk HIV exposures at our clinic. Active recall may improve follow-up rates in NPEP recipients.

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