Appropriate usage of post-exposure prophylaxis-in-pocket for HIV prevention by individuals with low-frequency exposures

Author:

Clifford Rashotte Matthew1,Yoong Deborah2,Naccarato Mark3,Pico Espinosa Oscar J4,Fisher Karla5,Bogoch Isaac I56,Tan Darrell HS467ORCID

Affiliation:

1. Division of Infectious Diseases, Department of Medicine, McMaster University, Hamilton, ON, Canada

2. Department of Pharmacy, St. Michael’s Hospital, Toronto, ON, Canada

3. Department of Pharmacy, Henry Ford Hospital, Detroit, MI, USA

4. MAP Centre for Urban Health Solutions, St. Michael’s Hospital, Toronto, ON, Canada

5. Division of Infectious Diseases, Toronto General Hospital, Toronto, ON, Canada

6. Department of Medicine, University of Toronto, Toronto, ON, Canada

7. Division of Infectious Diseases, St. Michael’s Hospital, Toronto, ON, Canada

Abstract

PEP-In-Pocket (Post-Exposure Prophylaxis-In-Pocket, or “PIP”) is a biobehavioural HIV prevention strategy wherein patients are proactively identified and given a prescription for HIV post-exposure prophylaxis (PEP) medications to self-initiate in case of high-risk exposures. We evaluated this strategy in a prospective observational study at two hospital-based clinics in Toronto, Canada. HIV-negative adults using PIP underwent chart review and completed quarterly electronic questionnaires over 12 months. The primary objective was to quantify appropriate PIP initiation, defined as starting PIP within 72 h of a high-risk exposure. Secondary objectives were to quantify HIV seroconversions, changes in sexual risk behaviour, sexual satisfaction, and satisfaction with the PIP strategy. From 11/2017 to 02/2020, 43 participants enrolled and completed ≥1 questionnaire. PIP was self-initiated on 27 occasions by 15 participants, of which 24 uses (89%) were appropriate, 2 were unnecessary, and 1 was for an unknown exposure. Chart review identified no inappropriate non-use. Over 32 person-years of testing follow-up, we observed zero HIV seroconversions. Sexual risk declined modestly over follow-up, with a HIRI-MSM (HIV Incidence Risk Index for MSM) change of −0.39 (95% CI = −0.58, −0.21 per 3 months, p < .001). Sexual satisfaction was stable over time. At 12 months, 31 (72%) remained on PIP, 8 (19%) had transitioned to pre-exposure prophylaxis and 4 (9%) were lost-to-follow-up. Among participants who remained on PIP and completed questionnaires at 12 months, 24/25 (96%) strongly/somewhat agreed that PIP decreased their anxiety about contracting HIV and 25/25 (100%) strongly/somewhat agreed that they would recommend PIP to a friend. PIP is a feasible HIV prevention strategy in carefully selected individuals at modest HIV risk.

Funder

Canada Research Chairs

Canadian Institutes of Health Research

Tier 2 Canada Research Chair in HIV Prevention and STI Research

Publisher

SAGE Publications

Subject

Infectious Diseases,Pharmacology (medical),Public Health, Environmental and Occupational Health,Dermatology

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