Post-exposure Prophylaxis Following Sexual Exposure Research Articles

Trends in HIV post-exposure prophylaxis following sexual exposure in Brazil (2011-2019).

We examined trends in the prevalence of post-exposure prophylaxis following sexual exposure (PEPSE) per million population (2011-2019) and the proportion of repeated PEPSE within 365 days of the first PEPSE dispensing (2011-2018) in Brazil. We also compared the prevalence of repeated PEPSE according to patient and health services characteristics in 2018. The prevalence of PEPSE increased 55.5% from 2011 to 2019. Repeated PEPSE increased 11.8%, reaching 8.4% among people with their first dispensing in 2018. The prevalence of repeated PEPSE was higher in cis men or trans women (versus cisgender women); homosexuals (versus heterosexuals); and people aged 25-29 years (versus other age groups). We also observed greater prevalence of repeated PEPSE in HIV services in populous cities or services with elevated caseloads. Our findings highlight the need for strategies to reduce repeated PEPSE and promote other HIV-prevention technologies, particularly among young adults, cisgender men, transgender women, and homosexuals.

Post‐exposure prophylaxis in the era of pre‐exposure prophylaxis

56 Dean Street (56DS), a sexual health clinic in London, provides a quarter of England's HIV post-exposure prophylaxis following sexual exposure (PEPSE). Since the limited introduction of pre-exposure prophylaxis (PrEP) in 2015, PEPSE demand has fallen. We performed a case-note review of individuals who received PEPSE at 56DS in August 2018. Two hundred and forty three PEPSE were given; 97% (236) fitted recommended indications according to UK national guidance. Twenty-eight (12%) had documented prior PrEP use; the most common reason for not taking PrEP was lack of supply (15/28; 54%). Up to 1st April 2020, of 215 who had not previously used PrEP, 106 (49%) re-attended 56DS for PrEP initiation. At 56DS, PEPSE is appropriately given for high-risk HIV exposures. For those who use PrEP, It is important to support their adherence and ensure adequate supply. As PrEP uptake increases, the need for PEPSE may decrease.

P072 Do we meet the criteria? consideration for PrEP provision locally

IntroductionWith various studies demonstrating Pre-Exposure Prophylaxis (PrEP) as highly effective in reducing HIV transmission, Health Departments are under pressure to provide the treatment.MethodsQuestionnaire feedback from 60 men who have sex with men (MSM) attending sexual health clinic, questions were based around the eligibility criteria for the PROUD study and some additional information we felt may be useful.Results58 MSM & 2 Trans women: 35 (58%) reported unprotected anal intercourse (UPAI) in the past 3 months, average number of partners 7. 6/35 had treatment for an infection in the past 6 months, all Gonorrhoea. 25 MSM (42%) reported no UPAI in past 3 months, average number of partners 2. 2 treated for infections, 1 GC and 1 had Syphilis and Chlamydia. Overall 16 (27%) reported drug use, no IVDU. 43 (72%) used social media to meet partners, 16 (27%) used male only saunas. 56 (93%) would use PrEP if available. 24/60 was asked if using PrEP may encourage them to have UPAI, 5 (20%) responded yes. 6 (10%) had used Post Exposure Prophylaxis following Sexual Exposure (PEPSE). In the last 2 years we provided 216 MSM with PEPSE, 29 (14%) used it more than once, 5 (2%) are now HIV positive.DiscussionThere appears to be high risk behaviour within our MSM cohort. PrEP has a role to play in prevention of HIV transmission, if funding became available for PrEP the service may need to find ways to target the higher risk individuals. 58% met the recommended criteria by BASHH/BHIVA.

What are the characteristics of, and clinical outcomes in men who have sex with men prescribed HIV postexposure prophylaxis following sexual exposure (PEPSE) at sexual health clinics in England?

ObjectivesTo explore the risk factors for, and clinical outcomes in men who have sex with men (MSM) prescribed HIV postexposure prophylaxis following sexual exposure (PEPSE) at sexual health clinics (SHCs)...

UK guideline for the use of HIV Post-Exposure Prophylaxis Following Sexual Exposure, 2015.

We present the updated British Association for Sexual Health and HIV guidelines for HIV post-exposure prophylaxis following sexual exposure (PEPSE). This document includes a review of the current data to support the use of PEPSE, considers how to calculate the risks of infection after a potential exposure, and provides recommendations on when PEPSE should and should not be considered. We also review which medications to use for PEPSE, provide a checklist for initial assessment, and make recommendations for monitoring individuals receiving PEPSE. Special scenarios, cost-effectiveness of PEPSE, and issues relating to service provision are also discussed. Throughout the document, the place of PEPSE within the broader context of other HIV prevention strategies is considered.

P044 PEP/PEPSE reaudit - Whose notes are they anyway? – the data protection act restricting clinical audit

Background/introduction Post Exposure Prophylaxis (PEP) is prescribed to patients presenting with a history of occupational or sexual exposure to HIV infection. The British Association for Sexual Health and HIV (BASHH) published new clinical guidelines on PEP following Sexual Exposure (PEPSE) in 2015. Aim(s)/objectives To audit occupational PEP/PEPSE related attendances in a sexual health clinic (SHC) in 2015 and compare to a previous audit (2011–2013). Methods A retrospective case note review of patients attending in 2015 for PEP/PEPSE. Clinical records were unavailable for patients attending prior to April 2015 due to the SHC contract transferring to a new provider. Results A total of 8 patients attended for PEPSE, two were initiated in A&E, 1 in a Sexual Assault Referral Centre (SARC) and 4 in the SHC. All patients attended after sexual exposure, with none attending after needle stick injury. All patients were started on PEPSE within 72 hours, had baseline HIV test and STI screen. All had PEPSE prescribed within the recommended indications compared to 88% previously. Fifty percent finished PEP course whilst 25% had a documented HIV test 4–6 weeks post PEP. Discussion/conclusion Issues around clinical record ownership have been interpreted differently across trusts. Locally, when the provider for the SHC changed, minimal patient record information was transferred to the new trust. This limited access contributed to small audit numbers. Compared to previous audit smaller numbers of patients finished the PEP course and attended for follow up HIV test but clinicians have a greater understanding of recommended indications for PEPSE.

P73 The source of the problem – re-audit of pepse provision at an inner city sexual health clinic

Background Post exposure prophylaxis following sexual exposure (PEPSE) reduces transmission of HIV. BASHH updated it’s guidance on the provision of PEPSE in 2011. Aim To review provision of PEPSE at an inner city sexual health clinic. Method Retrospective case note review of patients attending for PEPSE between January and June 2014. Comparison was made with a previous audit from 2012; following which recommendations were made, including efforts to contact the source patients. Results A total of 126 patients attended for PEPSE during the 2014 audit period; median age 28 years (range 17–53); majority male (93.7%); homosexual (81.0%); White British (79.4%). Baseline HIV tests were performed in 99.2%; PEPSE was prescribed in accordance with BASHH recommendations in 98.4% and 97.6% were provided In comparison with our 2012 audit, there were fewer women (6.3% vs 20.6%) who accessed PEPSE and there was an improvement in PEPSE being prescribed in accordance with BASHH recommendations (98.4% vs 92.7%). There was a statistically significant improvement in the number of source patients contacted (15.1% vs 2.9%; p Discussion/conclusion The number of patients accessing PEPSE has remained high and forms an important part of service provision in sexual health clinics. Contacting the source is an important step to reduce the unnecessary prescribing of PEPSE.

O2 An epidemiological analysis of men who have sex with men (msm) who are prescribed hiv post-exposure prophylaxis: implications for wider pre-exposure prophylaxis policy

Background/introduction Post-exposure prophylaxis following sexual exposure (PEPSE) is a potential method of preventing HIV infection in certain circumstances. Initiation of PEPSE is recommended following receptive anal intercourse with a partner of known positive or unknown HIV status from a high risk group. Aim(s)/objectives To investigate the characteristics and risk profile of patients receiving PEPSE to determine whether this could inform development of pre-exposure prophylaxis (PrEP) policy for men who have sex with men (MSM). Methods Data from the Genitourinary Medicine Clinic Activity Dataset (GUMCADv2) were used to investigate the characteristics of patients receiving PEPSE. Associations with PEPSE use were assessed using multivariate logistic regression. Results Between 2011 and 2013, 14,118 patients received PEPSE, of which 63% (8,896) were MSM. Among MSM receiving PEPSE, 14% (1,213) received more than one course (maximum 13 courses), 45% (3,990) were aged 25–34 years and 75% (6,702) were of white ethnicity. 2.0% were diagnosed with HIV between 4 and 16 months after receiving their last course of PEPSE. Compared to MSM controls not receiving PEPSE, MSM receiving PEPSE were significantly more likely to be of non-white ethnicity (adjusted OR = 1.28, 95% CI 1.21–1.36), and to be diagnosed with HIV following a subsequent exposure (adjusted OR = 1.21, 95% CI 1.03–1.41). Discussion/conclusion MSM prescribed PEPSE are at high risk of acquiring HIV infection following a subsequent exposure and may require intensive interventions to ensure course completion and reduce HIV risk behaviour. PrEP may be beneficial for high-risk MSM receiving PEPSE and also avoid the need for repeat PEPSE prescriptions.

U2 What do men who have sex with men (MSM) taking post-exposure prophylaxis (PEP) for hiv following sexual exposure report about their recent sexual risk-taking behaviour?

Background/introduction High-risk sexual behaviour plays a significant role in the increasing incidence of HIV infection among men who have sex with men (MSM) in the UK, despite the availability of post-exposure prophylaxis following sexual exposure(PEPSE). Aim(s)/objectives Behavioural interventions to encourage safer sexual practices need to be effective and acceptable for their target population. Therefore, this study aims to identify the attitudes and interpretation of risk of MSM taking PEPSE. Methods Data was collected as part of an ongoing randomised controlled trial evaluating a psychological intervention in reducing risk behaviour amongst MSM prescribed PEPSE. The intervention group received two 30-minute telephone interventions implementing augmented motivational interviewing. In this study, 30 participants were selected from the intervention arm and their interventions analysed for thematic content. Results Themes included: circumstances of event that led to PEPSE; participant’s interpretation of risk; emotions associated with risk; disclosure of HIV status; value attributed to consequences of risk; and reason for seeking PEPSE. Discussion/conclusion Risks were mostly reported in the context of unprotected anal intercourse (UAI) with casual partners, without discussion of HIV status. One theme that arose was the use of mobile-phone applications to seek casual sexual partners. Reasons given for engaging in UAI included anxiety over suggesting condom use, engaging in UAI as a form of “self-harm”, and alcohol intoxication. Concern about the morbidity and stigma associated with HIV and the desire for relationships were motivating factors for avoiding HIV. PEPSE was frequently described as an insight into life-long antiretroviral therapy for HIV infection.

P17 Four years of post exposure prophylaxis following sexual exposure (PEPSE) prescribing after sexual assault in a sexual assault referral centre (SARC)

AimWe have reviewed 4 years of PEPSE use in our SARC and its follow-up and compared with BASHH guidance on PEPSE after sexual assault.MethodsRetrospective review of SARC and GUM notes...

P20 Potential impact of updated UK guidelines for use of post exposure prophylaxis following sexual exposure in a London sexual health service

BackgroundUpdated UK guidelines for post exposure prophylaxis following sexual exposure (PEPSE) outline new thresholds for when PEPSE is recommended (R), considered (C) or not recommended (NR).Aim/ObjectiveWe compared practice and outcomes...

Use of HIV PEPSE and Hepatitis B vaccine following the introduction of a SARC

Adherence to local guidelines on the use of HIV post exposure prophylaxis (PEP) and hepatitis B vaccine following sexual assault was evaluated by means of audit. Forensic Medical Examiners (FMEs) were asked to complete an audit form after conducting sexual offence examinations at Gloucester Sexual Assault Referral Centre (SARC). Only one HIV PEP pack was prescribed during the six and a half month audit period. Examination of the SARC records of the allegations made by complainants did not reveal any high-risk cases involving a failure to offer HIV post-exposure prophylaxis following sexual exposure (PEPSE). The majority of the examinations performed at the SARC were carried out by trained sexual offence examiners (SOEs). The audit indicates that these SOEs were considering the appropriate use of HIV PEPSE and hepatitis B vaccine when they performed examinations. Some examinations were performed by general forensic medical examiners who completed the audit forms infrequently. It was not possible to determine whether these examiners were considering the appropriate use of HIV PEPSE and hepatitis treatments.

Post-exposure prophylaxis following sexual exposure to HIV: a seven-year retrospective analysis in a regional centre

An audit of 72 patients presenting for post-exposure prophylaxis following sexual exposure (PEPSE) to HIV (68 genitourinary medicine and 4 accident & emergency) was conducted from 2003 to 2009. The principal indications for PEPSE included 27 (38%) unprotected intercourse (15/27 vaginal and 12/27 anal) with a known HIV-positive partner, 20 (28%) unprotected receptive anal sex with male partner of unknown status, 17 (24%) following sexual assault and three (4%) unprotected sex with a partner from an endemic country. Of those who commenced PEPSE, 92% did so within the recommended 72 hours. Concurrent sexually transmitted infection (STI) was diagnosed in 8.3% patients (6.9% non-gonococcal urethritis and 1.4% rectal chlamydia). Fifty (69%) patients attended for follow-up and only 8% of these did not complete treatment. Twenty-five (35%) patients attended for repeat serology at three months and 18 (25%) at six months. All of the patients followed up remained HIV-negative.

Post-exposure prophylaxis for HIV

Definite or suspected occupational exposure of healthcare workers to human immunodeficiency virus (HIV) infection is a medical emergency.1 Post-exposure prophylaxis (PEP) with antiretroviral drugs is widely available following such exposure,...

Will I? Won’t I? Why do men who have sex with men present for post-exposure prophylaxis for sexual exposures?

Background: Failures of post-exposure prophylaxis following sexual exposure (PEPSE) to prevent seroconversion have been reported and are often associated with ongoing risk exposure. Understanding why men who have sex with...

Changes in the provision of post-exposure prophylaxis for HIV after sexual exposure following introduction of guidelines and publicity campaigns

In July 2004, British Association of Sexual Health and HIV (BASHH) published guidelines for post-exposure prophylaxis following sexual exposure (PEPSE) and the Terence Higgins Trust (THT) launched a campaign promoting PEPSE among men who have sex with men (MSM). We evaluated subsequent changes in PEPSE attendances. Individuals requesting PEPSE in 2004 were identified from clinic databases. Comparisons of clinical data, exposure characteristics and follow-up were made pre and post campaign. Data were available for 197/216 (91%) PEP attendances. The proportion requesting PEP following sexual exposure increased significantly following the campaign. The majority commencing PEPSE were MSM, with the proportion of MSM increasing significantly from 36/46 (78%) pre to 76/80 (95%) following the campaign. Most prescriptions were in high-risk groups and within guidelines. Times to initiation and completion rates were unchanged. Access to PEPSE following the THT campaign and introduction of BASHH guidelines increased. Promotion of earlier initiation of PEPSE and improvement of completion and follow-up is required.

Lack of awareness of HIV post-exposure prophylaxis among HIV-infected and uninfected men attending an inner London clinic

An audit of HIV-infected and -uninfected men attending two clinics at an inner London treatment centre demonstrated an alarming lack of awareness of post-exposure prophylaxis following sexual exposure (PEPSE). This audit suggests that strategies for increasing awareness of PEPSE among 'at risk' men are urgently needed.