nPEP Awareness Research Articles

Navigating Barriers and Opportunities: Perceptions of the Non-Occupational Post-Exposure Prophylaxis Care Continuum Among Young Sexual Minority Men, Aged 17-24, in the United States.

Human immunodeficiency virus (HIV) is a public health concern among young sexual minority men (YSMM), ages 17 to 24, in the United States. Biomedical prevention methods, such as pre-exposure prophylaxis (PrEP) and non-occupational post-exposure prophylaxis (nPEP), can help reduce the risk of HIV transmission among this population. However, there is limited awareness and use of nPEP by YSMM. This study aims to explore the perceptions of YSMM regarding the nPEP care continuum, which consists of three areas of focus: awareness, uptake, and linkage to other HIV prevention services. This study draws on synchronous online focus groups with a sample of 41 YSMM in the United States. Transcripts from the focus groups were analyzed using reflexive thematic analysis. Participants reported limited nPEP awareness and prior use, a process of personal appraisal of nPEP need based on HIV risk and costs, and a preference for PrEP over PEP for long-term HIV prevention. Interventions should be tailored to increase awareness of nPEP among YSMM and reduce addressable barriers to nPEP use for YSMM, including cost and confidentiality concerns, in situations where nPEP is warranted. Finally, more research is needed on how nPEP use can act as a bridge to PrEP initiation for this population.

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.

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.

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.

Characterizing Biomedical HIV Prevention Awareness and Use Among Black Transgender Women in the United States.

Black transgender women (BTW) in the United States experience disproportionate rates of HIV despite biomedical prevention interventions such as pre-exposure prophylaxis (PrEP) and non-occupational post-exposure prophylaxis (nPEP). Using a sample of 490 BTW collected from 2014 to 2017, bivariate, multivariable, and multinomial analyses were conducted to determine factors associated with awareness and use of PrEP and nPEP. BTW living with HIV were more aware of PrEP than HIV-negative BTW. Structural, demographic, and trans-specific factors (e.g., experiences of homelessness, violence, and current hormone use) related to HIV risk were associated with PrEP and nPEP awareness. PrEP use was associated with behavioral HIV risks (e.g., STI diagnosis, having an HIV-positive partner, and needle-sharing) and may demonstrate risk recognition among BTW. Knowing someone using PrEP was significantly positively associated with PrEP use. Development of guidelines for PrEP and nPEP use for BTW should leverage the strengths of guidelines for other populations, while also acknowledging the unique risks for this population.

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.

Awareness of and barriers to using non-occupational post-exposure prophylaxis among male clients of female sex workers in two cities of China: a qualitative study.

We conducted semi-structured in-depth interviews with 20 clients in two Chinese cities in 2018. Participants were recruited through purposive sampling. The content of the interviews was analysed using thematic content analysis in ATLAS.ti. Overall, just a minority of participants were aware of nPEP. A majority expressed willingness to use nPEP. Potential barriers to nPEP uptake and adherence included adverse drug reactions, price, concerns of drug efficacy, privacy issues, and forgetting to take the drugs. Almost all participants expressed the need to promote nPEP among clients. Participants suggested that the promotion of nPEP should be at hospitals, online, and be integrated with HIV/AIDS health education. Our findings suggested that nPEP guidelines should be formulated and implementation strategies should be developed to address barriers to uptake and adherence in order to successfully tap into the potential of nPEP as an effective HIV prevention tool.

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。

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 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.

Awareness and use of nonoccupational post-exposure prophylaxis among men who have sex with men in Vancouver, Canada.

Nonoccupational post-exposure prophylaxis (nPEP) is a strategy to reduce the risk of HIV infection in those with high-risk exposure. This study characterized nPEP awareness among gay, bisexual and other men who have sex with men (MSM) in Metro Vancouver, British Columbia, Canada after a pilot nPEP programme established in 2012. Momentum Health Study participants were MSM aged ≥16 years recruited via respondent-driven sampling (RDS) who completed a computer-assisted self-interview. Stratifying patients by HIV status, we used multivariable logistic regression with backward selection to identify factors associated with nPEP awareness. All analyses were RDS-adjusted. A total of 51.9% (112 of 173) of HIV-positive and 48.5% (272 of 500) of HIV-negative participants had heard of nPEP. Only 3% (five of 106) of HIV-negative participants who reported recent high-risk sex used nPEP. Generally, nPEP awareness was higher for participants who engaged in sexual activities with increased HIV transmission potential. Factors associated with greater awareness among HIV-negative participants included recent alcohol use, higher communal sexual altruism, previous sexually transmitted infection diagnosis, and greater perceived condom use self-efficacy. Other factors associated with greater awareness among HIV-negative participants included white race/ethnicity, gay sexual identity, more formal education, lower personal sexual altruism, and Vancouver residence. Greater nPEP awareness among HIV-positive participants was associated with greater perceived agency to ask sexual partners' HIV status and more frequently reporting doing so, a higher number of lifetime receptive sex partners, and greater access to condoms. Following implementation of an nPEP pilot programme, nPEP awareness among HIV-negative MSM was 51% and use was 3%. These data support the need to expand access to and actively promote nPEP services.

HIV-Negative Partnered Men's Willingness to Use Non-Occupational Post-Exposure Prophylaxis and Associated Factors in a U.S. Sample of HIV-Negative and HIV-Discordant Male Couples.

Non-occupational post-exposure prophylaxis (nPEP) is an underutilized biomedical option for HIV prevention. Few studies have assessed male couples' knowledge of and willingness to use nPEP. Cross-sectional dyadic data from 275 HIV-negative and 58 HIV-discordant male couples were used to describe HIV-negative, partnered men's awareness and willingness to use nPEP, and factors associated with their willingness to use nPEP. Data were analyzed with the use of multivariate multilevel modeling. Less than a third of the men were aware of nPEP, yet 73% were very-to-extremely likely to use nPEP. Partnered men's willingness to use nPEP was positively associated with having an individual income less than $30,000 USD and serosorting within the relationship. Willingness to use nPEP was negatively associated with greater age difference between primary partners and with higher scores on measures of couples' investment in their relationship. Efforts should be made to increase male couples' awareness of nPEP and how to access nPEP. Uptake of nPEP has the potential to help avert new HIV infections among male couples.

After the Fact: A Brief Educational Program on HIV Postexposure Prophylaxis for Female Detainees in a Local Jail.

Women who have been in jail are at increased risk of acquiring HIV when they are in the community. Nonoccupational postexposure prophylaxis (nPEP) reduces HIV transmission following high-risk behaviors and is an effective HIV prevention strategy. The authors designed a 15-minute interactive educational program to increase inmates' knowledge of nPEP. Before the program, participants self-reported high HIV risk yet low risk perception and lack of nPEP awareness. After the program, nPEP knowledge scores increased by 40% regardless of demographic or HIV-risk characteristics. This study demonstrates that a brief, easy-to-deliver educational intervention can be carried out in a jail, is effective at raising awareness of both HIV risk and nPEP, and may be useful for others seeking to increase use of this prevention strategy for high-risk women during incarceration.

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.

Awareness and use of nonoccupational HIV post‐exposure prophylaxis among people receiving rapid HIV testing in Spain

This paper examines the awareness and use of nonoccupational HIV post-exposure prophylaxis (nPEP) in Spain, and the factors that influence this awareness. Between June 2009 and July 2010, a mobile unit offered free, rapid HIV tests in a number of Spanish cities. A total of 2545 people were passively recruited and tested, and answered a self-administered questionnaire containing sociodemographic, behavioural and nPEP-related questions. Bivariate and multivariate analyses were performed, stratifying by gender/sexual behaviour. Some 34% of the responders were men who have sex with men (MSM), 30% were men who have sex exclusively with women (MSW), and 35% were women. Approximately 26% were foreigners, 46% had a university degree, and 51% had previously taken an HIV test. Overall, 22% were aware of nPEP. Only 2% had ever used it; 70% of these after high-risk sexual intercourse. Awareness was higher among MSM (34%) than women (16%) and MSW (15%). Multivariate analysis showed a lack of nPEP awareness to be associated with being born in Latin America, while awareness increased with the number of previous HIV tests among women and MSW. In MSM, awareness was also associated with having a university degree, the degree of interaction with gay culture, number of partners, and use of the internet as the main way of meeting partners. nPEP awareness in the studied population was unacceptably low. The promotion of its availability should be made a major objective of prevention programmes, as a complementary measure to condom use.

Use of Non-Occupational Post-Exposure Prophylaxis does not Lead to an Increase in High Risk Sex Behaviors in Men Who have Sex with Men Participating in the EXPLORE Trial

Non-occupational post-exposure prophylaxis (nPEP) use is an HIV prevention strategy that has been recommended by the CDC to prevent HIV infection after a high risk sexual exposure since 1997. In a behavioral intervention trial of 4,295 MSM we assessed perceptions and use of nPEP over 4 years in six cities across the United States. Overall, 1.9% of MSM reported use of nPEP prior to enrollment, and 6.3% at least once during the trial. Awareness of nPEP was reported by 47.5%, with higher awareness in two sites with funded nPEP programs. Three seroconversions occurred in the 384 visits where nPEP courses were reported, with no effect of nPEP on risk of HIV acquisition in this cohort (hazard ratio = 0.91, 95% confidence interval [0.29, 2.86]). NPEP users were a riskier group: increased odds of nPEP use were observed in association with multiple partners and unprotected receptive and insertive anal sex with HIV infected partners and partners with unknown HIV status. NPEP use was also associated with use of illicit drugs (injection drugs, crack cocaine, hallucinogens, and amphetamines). Importantly, willingness to use nPEP after high risk sex was associated with lower odds of high risk sex. After an episode of nPEP use, nPEP users remained more likely to report high risk sex than those in this cohort who had not previously used nPEP. However, within the subset of people who had previously reported high risk sex, previous nPEP use was not associated with higher odds of high risk sex, thus allaying fears that availability of nPEP would lead to an increase in high risk sex.