Non-occupational HIV Post-exposure Prophylaxis Research Articles

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.

Nonoccupational post-exposure prophylaxis for HIV after sexual intercourse among women in Brazil: Risk profiles and predictors of loss to follow-up.

Access to antiretroviral-based HIV prevention has been marked by sex asymmetries, and its effectiveness has been compromised by low clinical follow-up rates. We investigated risk profiles of women who received nonoccupational post-exposure prophylaxis (nPEP), as well as the rates and predictive factors of loss to follow-up after nPEP initiation.Retrospective study evaluating 501 women who received nPEP between 2014 and 2015 at 5 HIV centers (testing centers-VCT, outpatient clinics, and infectious diseases hospital). Risk profiles were drawn based on the characteristics of the women and their sexual partners, and then stratified by sociodemographic indicators and previous use of HIV prevention services. Loss to follow-up (LTFU) was defined as not presenting for follow-up visits or for HIV testing after nPEP initiation. Predictors of LTFU were analyzed by calculating adjusted prevalence ratios (aPRs).Approximately 90% of women had sexual encounters that met the criteria established in the Brazilian guidelines for nPEP. Those who declared to be sex workers (26.5%) or drug users (19.2%) had the highest social vulnerability indicators. In contrast, women who had intercourse with casual partners of unknown HIV risk (42.7%) had higher education and less experience with previous HIV testing (89.3%) or nPEP use (98.6%). Of the women who received nPEP after sexual intercourse with stable partners, 75.8% had HIV-infected partners. LTFU rate was 72.8% and predictors included being Black (aPR = 1.15, 95% confidence interval [CI]: 1.03–1.30), using drugs/alcohol (aPR = 1.15, 95% CI: 1.01–1.32) and having received nPEP at an HIV outpatient clinic (aPR = 1.35, 95% CI: 1.20–1.51) or at an infectious diseases hospital (aPR = 1.37, 95% CI: 1.11–1.69) compared with a VCT. The risk of LTFU declined as age increased (aPR 41–59 years = 0.80, 95% CI: 0.68–0.96).Most women who used nPEP had higher socioeconomic status and were not part of populations most affected by HIV. In contrast, factors that contribute to loss to follow-up were: having increased social vulnerability; increased vulnerability to HIV infection; and seeking nPEP at HIV treatment services as opposed to at a VCT.

Canadian guidelines on HIV pre-exposure prophylaxis (PrEP) and non-occupational post-exposure prophylaxis (nPEP): Discussion beyond the guidelines and commentary on the role of infectious diseases specialists

Pre-exposure prophylaxis (PrEP) and non-occupational post-exposure prophylaxis (nPEP) are part of combination HIV prevention strategies that include behavioural interventions such as condoms and risk-reduction counselling. A 25-member panel was convened to develop Canadian guidelines for PrEP and nPEP, with the full guidelines recently published in the Canadian Medical Association Journal (CMAJ). This article provides a discussion beyond the guideline, highlighting areas of particular interest to infectious disease (ID) specialists and discusses the possible role of ID specialists as access to both PrEP and nPEP become more widely available across the country.

New Canadian guideline provides evidence-based approach to non-occupational HIV prophylaxis.

The incidence of HIV infections in Canada has increased yearly since 2014. New cases of HIV have resulted almost exclusively from non-occupational exposures, including sexual contact and needle sharing. Appropriate HIV post-exposure prophylaxis is under-prescribed to patients who present to the emergency department after a high-risk exposure. In November of 2017, a Canadian guideline on HIV pre-exposure prophylaxis (PrEP) and non-occupational post-exposure prophylaxis (nPEP) was published. The guideline presents a standardized, evidence-based approach to assessing risk for HIV transmission and prescribing HIV prophylaxis. This summary highlights the key points from the guideline that are relevant to the practice of emergency medicine in Canada.

Bibliometric analysis on research hotspots on HIV post-exposure prophylaxis related articles in the world, 2000-2017

Objective: To analyze and reveal the distribution, research hotspots and study trend of worldwide published articles correlated with HIV/AIDS post-exposure prophylaxis (PEP), and provide information for related studies in China. Methods: CiteSpace software 5.1 was used to visualize all related papers in the web of science database published during 2000-2017. Results: The average growth rate of international PEP-related papers was 10.78%,and number of published papers in 2016 was highest (n=34), relevant research hotspots have shifted from the prevention of occupational HIV exposure to the prevention of non-occupational HIV exposure in group at high risk, such as MSM, in recent years. Clustering analysis classified research hotspots into three categories, including risk reduction through enhanced intervention, current status of global HIV PEP and German-Austrian Recommendation. Conclusions: Non-occupational HIV PEP in groups at high-risk, especially MSM, has received increasing attention in recent years, the research of PEP mainly focus on improving the awareness and use of PEP in MSM and compliance in the course of medication. In the context of severe HIV epidemic in MSM without effective control in China, PEP should be strengthened to assess and explore the risk of HIV infection in MSM to provide reference for medical personnel and related departments to implement HIV non-occupation exposure blockade and formulate PEP medication.

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

IntroductionThe standard clinical approach to non-occupational HIV post-exposure prophylaxis (nPEP) focuses on biomedical aspects of the intervention, but may overlook co-occurring or ‘syndemic’ psychosocial problems that reinforce future vulnerability to HIV. We therefore sought to determine the prevalence of syndemic health problems in a cohort of Ontario nPEP patients, and explored the relationship between syndemic burden and HIV risk.MethodsBetween 07/2013-08/2016, we distributed a self-administered questionnaire to patients presenting to three clinics in Toronto and Ottawa seeking nPEP for sexual HIV exposures. We used validated screening tools to estimate the prevalence of depression (CES-D score ≥16), harmful alcohol use (AUDIT ≥8), problematic drug use (DUDIT ≥6 men/≥2 women), and sexual compulsivity (SCS ≥24) among men who have sex with men (MSM) respondents. In exploratory analyses, we examined the relationships between syndemic conditions using univariable logistic regression models, and the relationship between syndemic count (total number of syndemic conditions per participant) and HIV risk, as estimated by the HIRI-MSM score, using linear regression models.ResultsThe 186 MSM included in the analysis had median age 31 (IQR = 26–36), including 87.6% having a college/undergraduate degree or higher. Overall, 53.8% screened positive for depression, 34.4% for harmful alcohol use, 30.1% for problematic drug use, and 16.1% for sexual compulsivity. Most participants (74.2%) had at least one syndemic condition and 46.8% had more than one. Exploratory analyses suggested positive associations between depression and harmful alcohol use (OR = 2.11, 95%CI = 1.13, 3.94) and between harmful alcohol use and problematic drug use (OR = 1.22, 95%CI = 0.65, 2.29). Syndemic count was associated with increased HIRI-MSM risk scores in univariable (2.2, 95%CI = 1.0, 3.3 per syndemic condition) and multivariable (2.1, 95%CI = 0.6, 3.6) linear regression models.ConclusionsThe prevalence of syndemic conditions in MSM seeking nPEP for sexual exposure is alarmingly high, and is associated with underlying HIV risk. Routine screening for these conditions may identify opportunities for intervention and could alleviate future vulnerability to HIV.

Belgian guidelines for non-occupational HIV post-exposure prophylaxis 2017

ABSTRACTWe present the updated Belgian guidelines for the use of non-occupational HIV post-exposure prophylaxis (NONOPEP). This document is inspired by UK guidelines 2015, adapted to the Belgian situation and approved by all AIDS reference centers in Belgium. When recommended, NONOPEP should be initiated as soon as possible, preferably within 24 h of exposure but can be offered up to 72 h. The duration of NONOPEP should be 28 days. These current guidelines include epidemiologic estimations, which can be used to calculate the risk of infection after a potential exposure and help to decide whether or not to start prophylaxis. We review which medications to use in the context of the last Belgian NONOPEP convention, provide a checklist for initial assessment, and make recommendations for monitoring individuals receiving NONOPEP.

Evaluation of non-sexual, non-needlestick, non-occupational HIV post-exposure prophylaxis cases.

Evaluation of non-sexual, non-needlestick, non-occupational HIV post-exposure prophylaxis cases.

Autoimmune thyroid disease occurring as a possible late complication after a non-occupational HIV Postexposure Prophylaxis

Autoimmune thyroid disease occurring as a possible late complication after a non-occupational HIV Postexposure Prophylaxis

Characteristics, sexual practices and sexually transmissible infections diagnoses of men who have sex with men and use non-occupational HIV post-exposure prophylaxis in Victoria, Australia.

We conducted a retrospective analysis to compare the demographic characteristics, sexual practices and clinical diagnoses of MSM who were NPEP users and those who were non-NPEP users attending Melbourne Sexual Health Centre from January 2008 to December 2014. Univariate and multivariate logistic regression models were used to examine the association between NPEP use and risk practices. Generalised estimating equations were used to adjust for within-individual correlations related to multiple visits of the same individual. Of the 40395 MSM consultations included in the study, 1776 consultations (4%) were related to NPEP prescription. NPEP prescribing was associated with ever having injected drugs (adjusted odds ratio (AOR) 1.8, 95% confidence interval (CI): 1.4-2.3), sex with males only (AOR 1.9, 95% CI: 1.6-2.3), more than three male partners in the past 3 months (AOR 1.5, 95% CI: 1.4-1.7) and inconsistent condom use with these partners within the past 3 months (AOR 2.1, 95% CI: 1.9-2.4). Sex workers (AOR 0.6, 95% CI: 0.3-0.9), and men reporting sex overseas within the past 12 months (AOR 0.7, 95% CI: 0.6-0.8) were less likely to receive NPEP. MSM who used NPEP were more likely to test positive for any sexually transmissible infection (AOR 1.2, 95% CI: 1.0-1.4). MSM receiving NPEP generally had a higher risk profile than MSM not requesting NPEP, indicating that NPEP was used by MSM at higher risk for HIV. Therefore, consultations for NPEP may be an opportune time for also discussing pre-exposure prophylaxis for HIV.

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

Data evaluating the screening practices for viral hepatitides and sexually transmitted infections (STIs) in patients presenting for non-occupational HIV post-exposure prophylaxis (nPEP) care are limited. Screening practices and prevalences of viral hepatitides and STIs were evaluated in 126 patients presenting to a dedicated HIV prevention clinic for HIV nPEP. Three patients (2.4%) were diagnosed with chronic hepatitis C infection, 28 (22.2%) did not have surface antibodies in sufficient quantity to confer immunity to hepatitis B, and six (4.8%) were diagnosed with an STI. A multivariate regression model did not predict any demographic or clinical features predictive of HBV non-immunity. Beyond screening for HIV infection, evaluation for viral hepatitides and STIs is an important feature in the care of patients presenting for HIV nPEP.

P18.12 People seeking sexually transmitted diseases screening, medical professionals, and members of the general public surveyed regarding knowledge about non-occupational post-exposure prophylaxis for hiv

Introduction Non-occupational post-exposure prophylaxis (NPEP), a medical intervention to prevent HIV infection from risk behaviours conducted by general public, has been advocated by the Centre for Disease Control since 2013. However, general awareness has not yet risen. The aim of this study was to evaluate the knowledge of NPEP among subjects seeking for anonymous screening for sexually transmitted diseases (STD), healthcare professionals and general population in Taiwan. Methods A cross sectional study was conducted with a structured questionnaire for 200 subjects who sought for anonymous STD screening, 125 healthcare professionals who worked in the departments of emergency and infectious diseases and 200 subjects who were recruited from the community to participate in the study. The questionnaire contains 10 items, which embedded NPEP-related knowledge. Statistical analysis was performed on the responses so as to ascertain the knowledge level of NPEP across the different groups. Results Only 56% of those receiving anonymous STD screening and 34% of the general population group have ever heard of NPEP, while 83.2% of healthcare professionals have heard of NPEP. A significantly higher proportion of healthcare professionals was found to know about NPEP (p Conclusion Our study results indicate that over 80% of healthcare professionals know about NPEP, however without correct knowledge. Those who seek for anonymous STD screening have a better understanding of NPEP. Efforts should be reinforced to raise the NPEP awareness. Disclosure of interest statement The Australasian Society for HIV Medicine recognises the considerable contribution that industry partners make to professional and research activities. We also recognise the need for transparency of disclosure of potential conflicts of interest by acknowledging these relationships in publications and presentations. Nothing to declare.

Sexual Assault: Acute Care and Beyond

Sexual assault, which encompasses any nonconsensual sexual contact, is, unfortunately, common. It results in considerable costs to society, including intangible costs such as loss of quality of life among victims. This review covers the approach to the patient and definitive treatment, disposition, and outcomes for adult and adolescent victims of sexual assault. Figures show female anatomy and common areas for genital injury after rape, a Centers for Disease Control and Prevention algorithm for evaluation of possible nonoccupational HIV exposures and nonoccupational post-exposure prophylaxis, a questionnaire for determining additional key aspects of the history of the assault to be completed and explored in detail by the sexual assault examiner, and the components and steps of the Massachusetts Sexual Assault Evidence Collection Kit. Tables list characteristics that define rape, key aspects of the history, recommended treatment to prevent sexually transmitted infections and pregnancy, calculated risks of acquiring HIV from an isolated sexual contact with a known HIV-positive person, and trauma-informed care. This review contains 5 highly rendered figures, 5 tables, 95 references, and a list of helpful Web sites.

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

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.

High Levels of Concomitant Behavioral Health Disorders Among Patients Presenting for HIV Non-occupational Post-exposure Prophylaxis at a Boston Community Health Center Between 1997 and 2013

A paucity of information regarding mental health exists for patients presenting for HIV non-occupational post-exposure prophylaxis (nPEP). We reviewed electronic medical records of 894 adult nPEP patients seen at a large Boston community health center between 1997 and 2013. Of 821 patients with consensual sexual exposures, 88.3% were men who have sex with men, and 40.0% had a mental health diagnosis. Diagnoses included: depression (24.4%), anxiety (21.9%), attention deficit disorder (7.8%), post-traumatic stress disorder (3.3%), and psychotic disorders (3.3%). Of 129 patients with substance use disorders, alcohol dependence (65.9%) and crystal methamphetamine (43.4%) predominated. Unprotected receptive anal intercourse was associated with psychotic disorders (aOR=4.86; 95%CI:1.76-13.5) and substance use disorders (aOR=1.89; 95%CI:1.28-2.80). Substance use at the time of exposure was associated with: depression (aOR=1.95; 95%CI:1.36-2.80), anxiety (aOR=2.22; 95%CI:1.51-3.25), attention deficit disorder (aOR=1.96; 95%CI:1.18-3.27), and substance use disorder (aOR=4.78; 95%CI:3.30-6.93). Mental illness should be screened for and addressed at nPEP visits to optimize HIV risk-reduction.

Longitudinal trends in HIV nonoccupational postexposure prophylaxis use at a Boston community health center between 1997 and 2013.

Secular trends in nonoccupational postexposure prophylaxis (NPEP) use have not been well characterized. We performed a retrospective longitudinal study of 894 electronic medical records of NPEP users, mostly men who have sex with men, at a Boston community health center who presented between July 1997 and August 2013. NPEP use and condomless sexual exposures increased over time; 19.4% had multiple NPEP courses. Having an HIV-infected partner was associated with increased odds of regimen completion, and 3-drug regimens were associated with decreased odds of completion. Targeted adherence and risk-reduction counseling are warranted for select NPEP users at this center.

1527Longitudinal Trends in HIV Non-Occupational Post-Exposure Prophylaxis (NPEP) at a Boston Community Health Center Between 1997 and 2013

1527Longitudinal Trends in HIV Non-Occupational Post-Exposure Prophylaxis (NPEP) at a Boston Community Health Center Between 1997 and 2013

Nonoccupational post-exposure prophylaxis for HIV in New York State Emergency Departments.

New York State (NYS) established guidelines for nonoccupational post-exposure prophylaxis (nPEP) to HIV in 1997. To assess current nPEP practices in NYS Emergency Departments (EDs), we electronically surveyed all ED directors in NYS, excluding Veterans' Affairs hospitals, about nPEP and linkage-to-care protocols in the EDs. Basic descriptive statistics were used for analysis. The response rate was 96% (184/191). Of respondents, 88% reported evaluating any patient with a possible nonoccupational exposure to HIV, in accordance with NYS guidelines. Of these, 83% provided the patient with a starter pack of medications, while 4% neither supplied nor prescribed antiretroviral drugs in the ED. Sexually transmitted infection screening, risk reduction counseling, and education about symptoms of acute HIV seroconversion were performed inconsistently, despite NYS guidelines recommendations. Only 22% of EDs confirmed whether linkage to follow-up care was successful. Most NYS EDs prescribe nPEP to appropriate patients but full implementation of guidelines remains incomplete.

Current Practice of HIV Postexposure Prophylaxis Treatment for Sexual Assault Patients in an Emergency Department

BackgroundComprehensive data that address current HIV nonoccupational postexposure prophylaxis (nPEP) practices in the emergency care of sexual assault patients are limited. The U.S. Centers for Disease Control and Prevention released HIV nPEP guidelines in 2005 and updated guidelines for Sexually Transmitted Disease Treatment in 2006 and 2010, each of which support providing nPEP to sexual assault patients. This study examined the offer, acceptance, and adherence rates of nPEP among sexual assault patients treated at an emergency department (ED). MethodsWe conducted a retrospective review between January 1, 2008, and December 31, 2011, of women, aged 16 years and older, treated for sexual assault in an academic ED that participates in the sexual assault nurse examiner program. FindingsOne hundred seventy-one female patients were treated in the ED for 179 sexual assault events. nPEP was not indicated in 19 cases and was offered to all 138 of patients for whom nPEP was appropriate. Five patient cases that exceeded the 72-hour exposure window were offered nPEP. Of the 143 patient cases offered nPEP, 124 (86.7%) initiated nPEP. Of the 124 who accepted PEP, 34 (27.4%) had documented completion of the 28-day course. ConclusionsnPEP was offered in all 138 cases where patients were eligible for treatment. Of patients who accepted nPEP, a minority are documented to have completed a course of treatment. Systems to improve postassault follow-up care should be considered.

A demographic study of patients presenting for HIV non-occupational postexposure prophylaxis and those newly diagnosed with HIV at a large urban hospital

BackgroundThe Spencer Cox Center for Health operates non-occupational postexposure prophylaxis (nPEP) and rapid HIV screening programmes at St Luke's and Roosevelt Hospitals in New York City, USA, funded in part by the New York City Department of Health and Mental Hygiene. The aim of this study was to explore the possibility of disparities in nPEP awareness and/or accessibility by comparing the demographics of individuals presenting for nPEP and those newly diagnosed HIV-positive individuals within the same large urban hospital centre. Both programmes are collaborative efforts between the hospital's HIV centre (Spencer Cox Center for Health) and the emergency department, with patients identified primarily in the emergency department and linked to care at the HIV centre. MethodsDemographic data were extracted from electronic medical records of patients who underwent HIV rapid antibody testing and had newly diagnosed HIV infections, and of patients who received nPEP, between January, 2011, and June, 2013. All data were entered into an SPSS database for descriptive analysis. Characteristics of patients who received nPEP and those who were newly HIV diagnosed were compared with the χ2 test and Wilcoxon test. FindingsThe study population comprised 929 participants, 769 from the nPEP programme and 160 newly diagnosed through the rapid HIV screening programme. Most participants were men (774 [83%]), white (323 [35%]), and reported as a risk factor that they were men who had sex with men (540 [58%]). Mean age was 32 years (range 14–74). For those newly diagnosed with HIV with a documented CD4 cell count, 52 (42%) patients had a CD4 count of fewer than 200 cells per μL, 24 (19%) patients had CD4 count in the range 200–349 cells per μL, and 49 (39%) patients had a CD4 count of more than 350 cells per μL. Most participants resided in boroughs in New York City (799 [86%]), with 519 (56%) from Manhattan. Univariate analysis showed that nPEP patients differed significantly from those newly diagnosed with HIV by race (p<0·0001), insurance status (p<0·0001), and age (p<0·0001). nPEP patients were more likely than were those newly HIV diagnosed to be white (294 [45%] of 652 vs 29 [20%] of 144), commercially insured (392 [51%] of 769 vs 39 [24%] of 160), and young (mean age 32 years vs 37 years, t927=−6·4; p<0·0001). Newly diagnosed HIV patients were more likely to be black (68 [47%] of 144 vs 119 [18%] of 652), publicly insured (53 [33%] of 160 vs 82 [11%] of 769), and reside in the Bronx (18 [11%] of 159 vs 51 [7%] of 766). InterpretationDifferences in race, insurance status, age, and geographical area of residence suggest disparities in nPEP awareness and/or accessibility, and demonstrate a need for public health efforts to educate people about and facilitate access to nPEP in communities at high risk of HIV infection. Possible limitations of this study include varied stage of disease progression among the newly diagnosed sample, the limited number of sites providing nPEP relative to those providing HIV screening, and a lack of ability to survey the newly diagnosed population as to their awareness of nPEP. We aim to do further analysis with zip code geomapping to refine our understanding of differences in geographical distribution of patients accessing nPEP and those accessing HIV testing services. FundingThese programmes are supported in part by the New York City Department of Health and Mental Hygiene.