Non-occupational HIV Post-exposure Prophylaxis Research Articles

Willingness of HIV non-occupational post-exposure prophylaxis and related factors among men who have sex with men in Beijing

Objective: To examine the willingness of HIV non-occupational post-exposure prophylaxis (nPEP) among MSM and factors related were also assessed. Methods: The respondent-driven sampling method was used to recruit MSM for a face-to-face interview with a structured questionnaire,the sample size was estimated at 600 subjects. Demographic data, sexual behavior, awareness, and willingness regarding nPEP were collected. The factors related to willingness to nPEP were assessed using complex logistic regression. Results: A total of 14 rounds were recruited and 608 MSM subjects were included in the study. The average age was (41.6±11.0) years. 55.4% (95%CI: 49.4%-59.4%) were aware of nPEP, and 4.5% (95%CI: 2.9%-6.2%) have used its. 35.9% (95%CI: 31.1%-40.7%) expressed interest in taking nPEP if needed. Among the reasons for not being willing to take nPEP, 68.9% (244/354) were never heard of nPEP, and 24.6% (87/354) were a fluke mentality. The multivariate logistic analysis results showed that the willingness of nPEP awareness of MSM was related to the group aged 25-39 years old (aOR=1.80, 95%CI: 1.01-3.20), knowing a group of HIV prevention knowledge (aOR=2.43, 95%CI: 1.52-3.90), group of consistent condom use in anal sex in the past half of year (aOR=1.76, 95%CI: 1.11-2.79). Conclusions: The use rate of nPEP among MSM in Beijing was low, and the willingness to use in the future also needs to be improved. The training of social organizations should be strengthened to improve the role of peer education in promoting nPEP.

Evaluation of HIV Non-occupational Post-exposure Prophylaxis Utilisation in a Tertiary Health Facility in Nigeria

Background 
 The Sub-Saharan Africa accounts for more than 70% of the global burden of HIV infections. Non-occupational post-exposure prophylaxis, when initiated within 72 hours of HIV exposure for 28 days, can prevent seroconversion in 80% of HIV exposures.
 Objectives 
 To evaluate the characteristics, prevalence and outcome of non-occupational HIV post-exposure prophylaxis utilization in a tertiary hospital.
 Method 
 This was a retrospective study that involved the medical records of 143 patients who sought HIV non-occupational post-exposure prophylaxis between 1st June 2011 and 31st May 2021. A questionnaire was used to collect information about the socio-demographic data, profiles of both the source and exposed persons, antiretroviral completion rate and outcome at follow-up.
 Results 
 Females accounted for 125 (87.4%). Sexual assaults were the main reasons for seeking non-occupational post-exposure prophylaxis in 119 (83.2%). High-risk exposures were observed in 134 (93.7%). HIV status of the sources was unknown in 126 (88.1%). 123 (86.0%) initiated antiretroviral within 72 hours of exposure and antiretroviral completion rate was 70.6%. Only 28 (19.6%) reported for follow-up scheduled HIV screening and were all negative.
 Conclusion 
 Early initiation of postexposure prophylaxis, improvement in baseline HIV testing of the source, and follow-up HIV screening, will significantly improve services and outcomes.
 Rwanda J Med Health Sci 2022;5(3):264-275

Impact of a standardized order set and medication-use process on medication error rates in sexual assault patients presenting to the emergency department for HIV nonoccupational postexposure prophylaxis.

To evaluate the impact of a standardized order set and medication-use process on antiretroviral medication errors in sexual assault (SA) patients presenting to the emergency department (ED) for nonoccupational postexposure prophylaxis (nPEP). In November 2019, a multidisciplinary group collaborated on an initiative to improve the nPEP medication-use process for SA patients presenting to the EDs within a large integrated health system. Electronic medical records of patients 13 years of age or older who presented for SA examination and were prescribed nPEP during the pre- (February 2018-August 2019) and poststandardization (February 2020-August 2021) periods were included. The primary objective was to compare the proportion of patients experiencing a medication error before and after SA/nPEP process standardization. Data regarding the following medication errors were evaluated: incomplete regimen; inappropriate/duplicative regimen; dosing, frequency, or quantity prescribed error; and initiation of nPEP without an HIV test. Two hundred six patients met criteria for inclusion. A higher proportion of patients experienced medication errors in the prestandardization group relative to the poststandardization group (46.5% vs 11.9%, P < 0.001). Fifty-five errors were observed in the prestandardization group, compared to 16 errors in the poststandardization group. The majority of errors in the prestandardization group were directly related to antiretroviral regimens, while the majority of errors in the poststandardization group involved initiation of nPEP without an HIV test. The standardization of the SA/nPEP process was associated with significantly lower medication error rates. Optimization of medication-use technology is an effective strategy in reducing medication errors.

Factors Impacting HIV Postexposure Prophylaxis Among Sexually Assaulted Patients Presenting to Two Urban Emergency Departments.

Sexually assaulted patients who seek care in emergency departments are often recommended for nonoccupational HIV postexposure prophylaxis treatment. HIV postexposure prophylaxis is an effective method in preventing HIV transmission if the treatment is administered promptly and if a full 28-day course is completed. However, research has shown that only a fraction of patients who start the treatment will complete a 28-day course. Research is needed to explore factors that may be associated with compliance to postexposure prophylaxis so that interventions can be designed to address the factors that put patients at risk for noncompletion. A retrospective chart review was conducted examining 246 medical records of sexually assaulted female patients who presented to one of two urban hospitals. A number of patient and event-related factors were examined to determine whether they were associated with HIV postexposure prophylaxis adherence among patients presenting at an emergency room after a sexual assault. Results revealed that five factors showed significant associations with sexually assaulted female patients completing HIV postexposure prophylaxis treatment. These factors include educational level, employment, health insurance, vaginal injuries, and tongue-mouth assaults. The results of this study represent a starting point from which to inform the development of targeted interventions such that those most at risk for nonadherence can receive additional support or services to improve HIV postexposure prophylaxis adherence.

Expansion of PrEP and PEP services in China

Despite the progress made in HIV control in China, an average of 15 new HIV infections were identified each hour in 2021, reflecting a cumulative number of 1·14 million cases by the end of the year. More than 97% of the newly identified HIV infections occurred through sexual transmission, with male-to-male sexual contacts accounting for over 25%. 1 Xu J Tang W Zhang F Shang H PrEP in China: choices are ahead. Lancet HIV. 2020; 7: e155-e157 Summary Full Text Full Text PDF PubMed Scopus (12) Google Scholar This infection rate is even worse in developed provinces, where men who have sex with men (MSM) account for more than 50% of new HIV infections. Since 2019, China has started to promote pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP) for HIV prevention by implementing several demonstration projects, approving emtricitabine and tenofovir disoproxil (Truvada, Gilead, Foster City, CA) for PrEP, and issuing technical guidelines for PrEP and PEP. However, only 20% of Chinese MSM have a good knowledge of PrEP and PEP, 2 Li H Wei R Piqueiras E et al. HIV non-occupational postexposure prophylaxis (nPEP) usage among five key populations in China. Sex Transm Infect. 2021; 97: 411-413 Crossref PubMed Scopus (3) Google Scholar and less than 1% have started taking PrEP. 3 Zhang L Peng P Wu Y et al. Modelling the epidemiological impact and cost-effectiveness of PrEP for HIV transmission in MSM in China. AIDS Behav. 2019; 23: 523-533 Crossref PubMed Scopus (23) Google Scholar Many challenges from health-care providers, the health-care system, and public promotion have limited the scale-up of PrEP and PEP in China.

Drug users\u2019 awareness of and willingness to use HIV non-occupational post-exposure prophylaxis (nPEP) services in China: a mixed methods study

BackgroundDrug users are regarded as a high-risk population for HIV infection. Non-occupational post-exposure prophylaxis (nPEP) is internationally regarded as an effective biomedical prevention against HIV but still a small-scale pilot project in China at present. The aim of this study was to understand drug users’ awareness of and willingness to use nPEP service in China.MethodsThis mixed methods study consisting of a qualitative study and a cross-sectional survey was conducted in two cities of China from 2018 to 2019. The in-depth interviews were audio-taped, transcribed verbatim and analyzed using thematic framework analysis. Univariate and multivariate logistic regressions were used to examine factors associated with drug users’ awareness of and willingness to use nPEP.ResultsThere were 401 and 19 participants included in quantitative and qualitative study respectively. Among participants in quantitative study, 30.2% had heard of nPEP and 56.7% reported willingness to use nPEP in future HIV exposure. In multivariate analyses, nPEP awareness was associated with age, sex, education level, AIDS knowledge score and HIV risk perception. nPEP willingness was associated with AIDS knowledge score, HIV risk perception, alcohol use, monthly income and awareness of nPEP. The qualitative results showed the barriers to nPEP willingness included the fatigue after taking drugs, high cost and side effects of nPEP medication, long nPEP course, and fear of privacy disclosure.ConclusionDrug users had low nPEP awareness and only about half participants reported willingness to use nPEP. It is essential to promote nPEP education campaigns among drug users, especially for elders, women and those with lower education level. Simultaneously, price regulation, side effect management, psychological support and privacy protection need to be managed well when nPEP is routinized.

Cognition and related factors on the use of HIV non-occupational post-exposure prevention among men who have sex with men

Objective: To understand the cognition and related factors on the use of HIV non-occupational post-exposure prophylaxis (nPEP) among men who have sex with men (MSM). Methods: The snowballing method was applied to recruit research subjects who were ≥18 years old, had sex with men in the past three months, and were aware of nPEP in MSM groups in Beijing, Shenzhen, and Kunming from March 15 to April 14, 2019. Data on social demographics, behavioral characteristics, basic knowledge of nPEP, consultation, and using nPEP were collected through "i guardian Platform". The logistic regression model was used to analyze the related factors affecting the use of nPEP. Results: Among 1 809 investigated, 39.8% (720 persons) were aware of the basic knowledge of nPEP, 33.4% (605 persons) had consulted nPEP, and 15.0% (271 persons) had used nPEP. In addition, multivariate logistic regression analysis showed that factors as whether to have sex with men infected with HIV in the last three months (OR=2.58, 95%CI: 1.64-4.07), the frequency of HIV testing in the past year (OR=2.47, 95%CI: 1.28-5.11), nPEP knowledge awareness (OR=0.70, 95%CI: 0.49-0.99), whether to consult nPEP (OR=70.98, 95%CI: 40.51-136.83) were related to the use of nPEP. Conclusions: MSM still have poor cognition of nPEP. It is necessary to strengthen the publicity and education of nPEP in MSM and promote the use of nPEP after HIV exposure as soon as possible.

Awareness and use of nonoccupational HIV post-exposure prophylaxis and factors associated with awareness among MSM in Beijing, China.

BackgroundHuman immunodeficiency virus (HIV) sexual transmission among men who have sex with men (MSM) has increased markedly in Beijing, China, during the past decade. Nonoccupational HIV post-exposure prophylaxis (nPEP) is a highly efficacious biomedical prevention strategy that significantly reduces HIV-transmission risk. This study examined nPEP awareness among MSM and the factors influencing it.MethodsConsecutive, cross-sectional MSM surveys were conducted from April to August of 2018 and 2019. Demographic data as well as that on behavior and awareness regarding nPEP was collected. Factors influencing nPEP awareness were assessed using univariate and multivariable logistic regression.ResultsThere were 1,202 eligible responders recruited. Of the responders, 42.5% had nPEP awareness, and 59.9% expressed interest in receiving nPEP in the future, if required. Greater odds of nPEP awareness were associated with younger age, higher education level (adjusted odds ratio [aOR]: 4.011, 95% confidence interval [CI]: 2.834–5.678, P<0.001), higher income, use of the Internet to meet sexual partners (aOR: 2.016, 95% CI: 1.481–2.744, P<0.001), greater HIV-related knowledge (aOR: 3.817, 95% CI: 1.845–7.899, p<0.001), HIV testing (aOR: 2.584, 95% CI: 1.874–3.563, p<0.001), and sexually transmitted infections (aOR: 1.736, 95% CI: 1.174–2.569, P = 0.006). Lower odds of nPEP awareness were associated with greater stigma score (aOR: 0.804, 95% CI: 0.713–0.906, P<0.001).ConclusionsThe findings indicate suboptimal awareness and low utilization of nPEP in Beijing and highlight nPEP inequities among MSM with stigma. Strengthening the training of health service providers and peer educators in reducing stigma and disseminating nPEP knowledge is imperative.

NPEP protocol implementation and evaluation at a local US Crisis Center

ABSTRACT Non-occupational Post-Exposure Prophylaxis for HIV (nPEP) is recommended by the CDC for isolated exposures that pose “substantial risk” for HIV transmission. To combat multiple barriers to nPEP utilization, a comprehensive program was developed through the local community sexual assault provider. The purpose of this study was to evaluate nPEP protocol implementation. A retrospective chart review was conducted of all sexual assault victims seen during a six-month period, and all patients who accepted nPEP were selected for follow-up phone interviews. 157 patients presented during the study period. Mean time to care was 32.4hrs, with 126/157 (80%) presenting ≤72hrs. 114/157 (73%) patients were offered nPEP by providers. 67/114 (59%) patients accepted, with the most common reason for declining being needing more time to decide. 10/13 (77%) patients able to be contacted reported completing nPEP, with side-effects cited as the most common noncompletion reason. 9 reported side effects and 4 received recommended follow-up HIV testing. 83/99 (84%) patients clearly eligible by chart review were offered nPEP, suggesting good adherence to CDC guidelines. Most patients contacted completed nPEP despite side-effects, suggesting good adherence. Our findings demonstrated multiple points status post-sexual assault to potentially improve the nPEP process.

Service acceptance of HIV non-occupational post-exposure prophylaxis(nPEP) among college students: a cross-sectional study in China

BackgroundCollege students were the key group we should pay more attention for acquired immune deficiency syndrome (AIDS) prevention and control in recent years in China. Few studies of HIV non-occupational post-exposure prophylaxis (nPEP) knowledge and service acceptance had been conducted among them in China. This study conducted a cross-sectional survey to understand the service acceptance of nPEP and its influencing factors among college students in the three cities of China.MethodsA questionnaire survey was conducted to collect information on socio-demographic, behavioral characteristic, HIV/AIDS knowledge, nPEP knowledge, acceptance of nPEP services among the college students in Beijing, Shenzhen, and Kunming of China from March to April of 2019. Each participant completed an anonymous questionnaire on line by computer-assisted or mobile phone-assisted self-interview with informed consent. Multivariable logistic regression analyses identified predictors for service acceptance of nPEP.ResultsA total of 4698 students were surveyed with the average age of 20 years old. 98.0% (4605/4698) of them were undergraduates, 21.8%(1022/4698) had sexual intercourse; 48.6% (2282/4698) heard of nPEP, among which 4.95%(113/2282) received nPEP services. The awareness rate of HIV/AIDS knowledge was 85.6% (5495/4698) with the differences statistically significant between the three cities. The awareness rate of nPEP knowledge was 16.5% (774/4698). There were significant differences in receiving nPEP services among students of different ages, genders, sexual behaviors, and knowledge of HIV/AIDS by univariate analysis. Multivariable analyses indicated that age group of 18 and under (OR = 2.551, 95% CI = 1.153–5.646), male (OR = 3.131, 95% CI = 1.866–5.253), homosexual behavior (OR = 4.661,95%CI = 2.658–8.172), heterosexual behavior (OR = 1.676, 95% CI = 1.040–2.947), no awareness of AIDS knowledge (OR = 3.882, 95% CI = 2.371–6.356) and nPEP (OR = 4.788, 95% CI = 2.50–9.169) knowledge, were associated with the service acceptance of nPEP among the college students.ConclusionThe low acceptance of nPEP services was mainly affected by low level of nPEP knowledge among the college students. Further publicity and education of nPEP knowledge were necessary, as well as promotion of knowledge of HIV/AIDS prevention and treatment. More attention should be paid to the factors associated with acceptance of nPEP services.

HIV non-occupational post-exposure prophylaxis (nPEP) awareness and promotion among five key populations in China: A cross-sectional study

BackgroundThis study investigated HIV non-occupational post-exposure prophylaxis (nPEP) awareness and promotion, and related sociodemographic and behavioural factors among five key populations in China. MethodsFrom November 2018 to September 2019, we adopted convenience sampling to recruit participants who were age ≥ 18, self-reported HIV status as either negative or unknown and provided informed consent from five key populations cross-sectionally in 10 Chinese cities. Univariable and multivariable logistic regressions were adopted. FindingsOur analysis included data from 2022 participants with a mean age of 35 years (SD = 11·62). Approximately 60% of participants reported non-consistent condom use in the past month, and 37% had not been tested for HIV in the past 12 months. There were 857 (42%) participants hearing about nPEP before the study, and 1728 (86%) endorsing nPEP promotion after learning about nPEP. Sociodemographic and behavioural factors related to both nPEP awareness and endorsement of nPEP promotion included the key population indicator, age, HIV knowledge score, and HIV testing over life course. InterpretationThe key populations in China generally had low nPEP awareness, particularly people who use drugs and female sex workers, while seronegative partners had the lowest endorsement of nPEP promotion. nPEP education and promotion campaigns should be integrated into conventional HIV services, and tailored to sexually active young individuals, people with poor HIV knowledge, and people never tested for HIV. FundingChina National Key Research and Development Program and National Science and Technology Major Project, and the i Guardian Platform of the People's Medical Publishing House.

Just the facts: Non-occupational HIV post-exposure prophylaxis.

Just the facts: Non-occupational HIV post-exposure prophylaxis.

Status and influencing factors of knowledge awareness and service acceptance of HIV non-occupational post-exposure prophylaxis of men who have sex with men among college students among three cities of China, 2019

Objective: To understand the knowledge awareness and service acceptance of HIV non-occupational post-exposure prophylaxis (nPEP) men who have sex with men (MSM) among college students in three cities of China. Methods: Male college students in 10 universities of Beijing, Shenzhen and Kunming aged 18 and above who had sex with men in the last 3 months were recruited as research objects by cluster stratified sampling from March 15, 2019 to April 14, 2019.Basic information, sexual behavior characteristics, knowledge, and service acceptance of nPEP were collected through online questionnaire survey. Multivariate dichotomy and unconditioned logistic regression model was used to explore related factors about knowledge awareness and service acceptance of nPEP. Results: A total of 293 MSM were surveyed. The average age was (21.0±0.2) years old, and 91.1% (267) were undergraduates. In the last 3 months before the survey, 54.3%(159) used condom each time of sex; 4.4%(13) had intercourse with the HIV infected men, and 9.2% (27)suffered STDs in the past 6 months. The 29.4% (86) had not received HIV testing in the past year. The nPEP knowledge awareness rate was 47.8% (140). The 21.2% (62) counseled nPEP services, and 9.9% (29) received nPEP services. After multiple logistic regression analysis, compared with those who not received HIV testing in the past year, OR (95%CI) value of those who received HIV testing for more than twice in the past year to aware the nPEP knowledge was 3.15 (1.01-9.86). Compared with those who not received HIV testing in the past year, OR (95%CI) value of those who received HIV testing for more than twice in the past year to counsel the nPEP services was 5.29 (1.51-18.51). Compared with those who never used rush in the last 3 months, OR(95%CI) value of those who ever used rush in the last 3 months to receive the nPEP services was 3.86 (0.99-14.98). Compared with those who not sexed with HIV infected in the last 3 months, OR (95%CI) value of those who sexed with HIV infected in the last 3 months to receive the nPEP services was 14.30 (3.35-61.03). Conclusion: The proportions of awareness of nPEP knowledge and acceptance of nPEP services are low. MSM among college students need further health education of the nPEP knowledge to improve the accessibility of services.

Survey of 104 MSM before drug uptake of HIV non-occupational post-exposure prophylaxis in Guangxi

Objective This survey aims to understand AIDS knowledge, behavioral characteristics, awareness of non- occupational post-exposure prophylaxis (nPEP), and reasons for using nPEP, the possible impact on behavior change after receiving services among 104 men who have sex with men (MSM) prior to drug uptake of nPEP in 2 cities of Guangxi. Methods Participants were recruited through community advocacy in Nanning and Liuzhou. A face-to-face questionnaire survey was conducted on MSM who agreed to participate in investigation before taking medication of HIV nPEP. P <0.05 was considered statistically significant, and descriptive analysis was conducted. Results AIDS awareness of 104 MSM respondents reached 98.1% (102/104), and 84.6% (88/104) believed that the HIV prevalence was serious among MSM group in the area where they living. In the past six months, no respondents insisted on condom use each time during homosexual activities, and 54.8% (57/104) experienced condoms torn/ slipped or being deliberately pulled out by sexual partners; 64.4% (67/104) had no fixed partners in the last six months. 88.5% (92/104) had heard of nPEP before the survey, univariate analysis indicated that there was statistically significant difference between nPEP awareness and receiving condom promotion/AIDS voluntary counseling & testing as well as peer education in the past year ( P <0.05). 69.2%(72/104) received nPEP since worrying about the probability of HIV infection by the exposure, while 67.3% (72/104) took the service because they did not understand HIV serological status of sexual partners. If received nPEP, only 9.6% (10/104) believed that condom use would decrease, and 15.4% (16/104) thought the number of sexual partners would increase. Conclusion Separation between AIDS knowledge and action among MSM requires a comprehensive prevention and control strategy that emphasizes biomedical approaches and behavioral interventions. The role of networks and Non-Governmental Organization (NGO) in nPEP publicity should be highlighted to increase the awareness of nPEP among target population. 摘要： 目的 分析广西南宁市、柳州市 104 名男男性行为者(men who have sex with men, MSM)在接受艾滋病非职 业暴露后预防(non-occupational post-exposure prophylaxis, nPEP)用药前的相关艾滋病知识掌握情况、行为学特征、 nPEP 知晓度、使用 nPEP 原因及接受服务后对行为改变可能产生的影响等。 方法 在南宁、柳州市通过社区宣传倡导， 现场招募研究对象。对纳入艾滋病非职业暴露后预防并同意在服药前接受调查的 MSM 开展面对面问卷调查。以 P < 0.05 为差异有统计学意义，对资料进行描述性分析。 结果 104 名 MSM 的艾滋病知晓率为 98.1%(102/104)；认为所生 活地区的 MSM 人群中 HIV 流行严重的占 84.6%(88/104)。最近半年同性性行为时能每次使用安全套的 0 人，54.8%(57/ 104)经历过安全套意外破裂、脱落或被性伴故意拔套，64.4%(67/104)最近半年内没有固定性伴。88.5%(92/104)调查 前听说过 nPEP，单因素分析发现，最近一年接受过安全套宣传与发放/艾滋病咨询与检测、最近一年接受过同伴教育对 nPEP 知晓差异有统计学意义( P <0.05)。69.2%(72/104)选择 nPEP 因为担心此次暴露会感染 HIV，67.3%(72/104)表示 性伴感染状况未知。若接受 nPEP，仅有 9.6%(10/104)认为安全套使用会减少，15.4%(16/104)认为性伴数会增加。 结论 MSM 存在艾滋病“知信行分离”，需采取生物医学干预技术和行为干预并重的综合性防治策略。重视网络和社 会组织在 nPEP 宣传中的作用，提高人群知晓率。

Awareness and Willingness to Use Biomedical Prevention Strategies for HIV Among Sexual and Gender Minority Youth: Results From a National Survey

PurposeSexual and gender minority youth (SGM), an umbrella term encompassing gay, bisexual, and transgender youth, experience disproportionately high rates of new HIV infections, and recent advances in biomedical HIV prevention modalities hold promise in reducing new infections. However, the extent to which SGM youth are aware of and willing to use these modalities is unknown. MethodsUsing data from the Survey of Today's Adolescents Relationships and Transitions, we analyze awareness of and willingness to take HIV pre-exposure prophylaxis (PrEP), nonoccupational HIV post-exposure prophylaxis, and rectal microbicides among adolescent sexual minority males aged 13–18 years and transgender youth aged 13–24 years. ResultsOverall, we found a majority of our respondents were not aware of any of these prevention modalities. Across both subsamples, age and outness to a health care provider were associated with increased PrEP awareness, and any anal sex was associated with PrEP willingness. ConclusionsThese findings highlight the importance of provider education on how to discuss SGM issues with patients and educate them about HIV prevention options.

Non-occupational post-exposure prophylaxis in men who have sex with men in Guangxi Zhuang Autonomous Region

Objective: To analyze the effects of HIV non-occupational post-exposure prophylaxis (nPEP) in men who have sex with men (MSM) in Nanning and Liuzhou, Guangxi Zhuang Autonomous Region. Methods: Participants were recruited through community publicity and advocacy under a "Trinity" approach among non-governmental organizations (NGO), CDCs/hospitals and pharmacies. Basic information, drug taking and follow-up tests of participants who had enrolled for 28 days of the research were collected. Descriptive statistics were used for data analysis. Results: From September 2017 to March 2019, a total of 213 MSM cases consulted for nPEP service, 159 of them were eligible for nPEP, and 154 were enrolled in the study for drug taking. For 132 cases enrolled in the study for 28 days and above, 118 completed the 28-day course of antiretroviral therapy (ART), while 10 failed to complete the 28-day course of ART, and 4 could not be confirmed whether completed the full course of ART due to loss of contact. For those who completed 28-day course of ART, 94.1% (111/118) and 75.4% (89/118) respectively received HIV tests at 4-6 weeks and 3 months after exposure, the results were all HIV negative. Conclusion: Under the "Trinity" approach, taking antiviral drugs earlier after HIV non-occupational exposure can effectively reduce the risk of HIV infection and to some extent, reduce the new infection cases.

HIV Nonoccupational Postexposure Prophylaxis Among Men Who Have Sex with Men: A Systematic Review and Meta-Analysis of Global Data

HIV nonoccupational postexposure prophylaxis (nPEP) has been prescribed to men who have sex with men (MSM) for decades, but the global situation of nPEP implementation among this population remains unclear. To understand nPEP awareness, uptake, and factors associated with uptake among MSM, we searched PubMed, Scopus, Embase, the Cochrane Library, and Web of Science for studies reporting nPEP implementation among MSM published before May 19, 2019. We estimated pooled rates and their 95% confidence intervals (CIs) of awareness, uptake using a random-effects model. We identified 74 studies: 3 studies (4.1%) from upper-middle-income regions and 71 (95.9%) from high-income regions. The pooled rate of nPEP awareness and uptake was 51.6% (95% CI 40.6-62.5%) and 6.0% (5.0-7.1%), respectively. Pooled uptake rate was higher in upper-middle-income regions [8.9% (7.8-10.0%)] than in high-income regions [5.8% (4.8-6.9%)]. Unprotected anal sex was the most common exposure (range: 55.0-98.6%, median: 62.9%). Pooled completion of nPEP was 86.9% (79.5-92.8%). Of 19,546 MSM prescribed nPEP, 500 HIV seroconversions (2.6%) were observed. Having risky sexual behaviors and history of sexually transmitted infections were associated with higher nPEP uptake, whereas insufficient knowledge, underestimated risk of exposure to HIV, lack of accessibility, and social stigma might hinder nPEP uptake. Awareness and uptake of nPEP among MSM worldwide are low. Further efforts are needed to combat barriers to access nPEP, including improving accessibility and reducing stigma. Seroconversions post-nPEP uptake suggest that joint prevention precautions aside from nPEP are needed for high-risk MSM. More evidence from low-income and middle-income regions is needed.

HIV Non-Occupational Postexposure Prophylaxis (nPEP) Awareness, Usage, Willingness, and Promotion in China: A Cross-Sectional Study Among Five Key Populations

Background: In China, the 13th Five Year Action Plan for HIV/AIDS Containment and Prevention is examining the feasibility of non-occupational post-exposure prophylaxis (nPEP) as a national strategy for HIV prevention. We investigated nPEP usage and willingness and related socio-demographic and behavioural factors. Methods: We conducted a cross-sectional study in 10 cities in China from November 2018 to September 2019, using convenience sampling to recruit participants aged 18 years and over, self-reporting HIV status as either negative or unknown, providing written informed consent and participating voluntarily from five key populations. Findings: Our analysis included data from 2022 participants with a mean age of 35 years (SD = 11.62). There were 57 (2.82%) having used nPEP, 857 (42.38%) participants hearing of nPEP, 1348 (66.67%) willing to use nPEP in future exposure, and 1728 (85.46%) endorsing nPEP promotion. Socio-demographic and behavioural factors related to both nPEP usage and willingness included populations (p < 0.0001, p < 0.001 respectively), age (p < 0.05, p < 0.01 respectively), education (p < 0.05, p < 0.001 respectively), nPEP knowledge (p < 0.01, p < 0.0001 respectively), and receiving conventional HIV prevention services (p < 0.05, p < 0.05 respectively). 26% nPEP users used nPEP medication for more than once and more than 90% of them reported willingness to use nPEP again in future exposure. Medical reliability and trust was an emerging challenge. Interpretation: The key populations in China need nPEP services, particularly older and illiterate individuals with poor knowledge of nPEP, and those from FSWs and drug users. The implementation of nPEP services is an important step to access high-risk individuals for intensive and tailored HIV prevention and intervention. Funding: China National Key Research and Development Program and National Science and Technology Major Project, and the i Guardian Platform of the People's Medical Publishing House. Declaration of Interests: The authors declare no competing interests. Ethics Approval Statement: All study procedures were approved by the Ethics Review Committee of Public Health at Shandong University (IRB No:20180904).

HIV NON-OCCUPATIONAL POST-EXPOSURE PROPHYLAXIS IN UKRAINE

Aim. To assess the state of non-occupational HIV post exposure prophylaxis (nPEP) use in Ukraine through exploring the service delivery algorithm, consumption of service, awareness of beneficiaries.Methods. The research has explorative and qualitative design. In-depth semi-structural interviews with experts were conducted. For recruitment snowball sampling technique is used. Geography of the study is Kyiv, Ukraine.Results. Legislative framework of nPEP is established in Ukraine. NPEP is provided in specialized medical facilities with continuous access to the prevention. In order to increase effectiveness in nPEP delivery particular stages of nPEP complex have potential for improvement. Risky sexual behavior and contacts with used syringe or needle are the most common reasons to apply for nPEP. Applications for nPEP include emergency single contacts and cases of multiple appeals from the same persons. Prevention strategy nPEP may be underutilized and require further examination. Awareness of nPEP is considered to be low or insufficient in beneficiaries.Conclusions. 1) It is recommended to analyze the best practices of nPEP delivery and design/adapt supplementary tools in order to increase effectiveness in service delivery. 2) Prevention strategy nPEP may be underutilized. Utilization and potential beneficiaries of nPEP are the directions for further study. For the nPEP adequate targeting purpose, the linkage between nPEP and PreP prevention strategies ought to be established. 3) Low awareness of nPEP and its factors is the topic for further examination.

Non-Occupational HIV Post-Exposure Prophylaxis Among Men Who Have Sex with Men: A Systematic Review and Meta-Analysis of Global Data

Background: Non-occupational HIV post-exposure prophylaxis (nPEP) has been prescribed to men who have sex with men (MSM) for decades, but the global situation of nPEP implementation among this population remains unclear. We reviewed all available evidence on nPEP awareness, uptake, and factors associated with uptake among MSM. Methods: In this systematic review and meta-analysis, we searched PubMed, Scopus, Embase, the Cochrane Library, and Web of Science for studies reporting nPEP uptake among MSM published before May 19, 2019. Interventional or observational studies reporting original data on nPEP awareness, uptake, and associated factors were included. We estimated pooled rates and their 95% confidence intervals of awareness, uptake and completion using a random-effects model. Findings: We identified 74 studies, three studies (4·1%) from upper-middle-income regions and 71 (95·9%) from high-income regions. The pooled rate of nPEP awareness and uptake was 51·6% (95% CI: 40·6%-62·5%, k=30) and 6·0% (5·0%-7·1%, k=38), respectively. Pooled uptake rate was higher in upper-middle-income regions (8·9% [7·8%-10·0%], k=3) than in high-income regions (5·8% [4·8%-6·9%], k=35). Among MSM initiating nPEP, unprotected anal sex was the most common type of exposure (range:55·0% to 98·6%, median: 62·9%). Pooled completion of nPEP was 86·9% (79·5%-92·8%, k=11). Of 19,546 MSM prescribed nPEP, 500 HIV seroconversions (2·6%) were observed. Having risky sexual behaviors and history of sexually transmitted infections were associated with higher nPEP uptake, while insufficient knowledge, underestimated risk of exposure to HIV, the lack of accessibility, and social stigma might hinder nPEP uptake. Interpretation: Awareness and uptake of nPEP among MSM worldwide are low. Further efforts are needed to combat barriers to access nPEP, including improving accessibility and reducing stigma. Seroconversions post nPEP uptake suggests jointed prevention precautions aside from nPEP are needed for high-risk MSM. More evidence from low-income and middle-income regions on nPEP among MSM are needed. Funding Statement: This work is funded by the National Natural Science Foundation of China (grant ID 81703278), the Australian National Health and Medical Research Council Early Career Fellowship (grant ID APP1092621), the Sanming Project of Medicine in Shenzhen, China (grant ID SZSM201811071), and High Level Project of Medicine in Longhua, Shenzhen, China (HLPM201907020105). Declaration of Interests: The authors declare no competing interests. Ethics Approval Statement: This systematic review and meta-analysis was undertaken according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and Metaanalysis Of Observational Studies in Epidemiology (MOOSE) guidelines.