Uptake Of Post-exposure Prophylaxis Research Articles

MHealth-Based Gamification Interventions Among Men Who Have Sex With Men in the HIV Prevention and Care Continuum: Systematic Review and Meta-Analysis.

In the past few years, a burgeoning interest has emerged in applying gamification to promote desired health behaviors. However, little is known about the effectiveness of such applications in the HIV prevention and care continuum among men who have sex with men (MSM). This study aims to summarize and evaluate research on the effectiveness of gamification on the HIV prevention and care continuum, including HIV-testing promotion; condomless anal sex (CAS) reduction; and uptake of and adherence to pre-exposure prophylaxis (PrEP), postexposure prophylaxis (PEP), and antiretroviral therapy (ART). We comprehensively searched PubMed, Embase, the Cochrane Library, Web of Science, Scopus, and the Journal of Medical Internet Research and its sister journals for studies published in English and Chinese from inception to January 2024. Eligible studies were included when they used gamified interventions with an active or inactive control group and assessed at least one of the following outcomes: HIV testing; CAS; and uptake of and adherence to PrEP, PEP, and ART. During the meta-analysis, a random-effects model was applied. Two reviewers independently assessed the quality and risk of bias of each included study. The systematic review identified 26 studies, including 10 randomized controlled trials (RCTs). The results indicated that gamified digital interventions had been applied to various HIV outcomes, such as HIV testing, CAS, PrEP uptake and adherence, PEP uptake, and ART adherence. Most of the studies were conducted in the United States (n=19, 73%). The most frequently used game component was gaining points, followed by challenges. The meta-analysis showed gamification interventions could reduce the number of CAS acts at the 3-month follow-up (n=2 RCTs; incidence rate ratio 0.62, 95% CI 0.44-0.88). The meta-analysis also suggested an effective but nonstatistically significant effect of PrEP adherence at the 3-month follow-up (n=3 RCTs; risk ratio 1.16, 95% CI 0.96-1.38) and 6-month follow-up (n=4 RCTs; risk ratio 1.28, 95% CI 0.89-1.84). Only 1 pilot RCT was designed to evaluate the effectiveness of a gamified app in promoting HIV testing and PrEP uptake. No RCT was conducted to evaluate the effect of the gamified digital intervention on PEP uptake and adherence, and ART initiation among MSM. Our findings suggest the short-term effect of gamified digital interventions on lowering the number of CAS acts in MSM. Further well-powered studies are still needed to evaluate the effect of the gamified digital intervention on HIV testing, PrEP uptake, PEP initiation and adherence, and ART initiation in MSM.

Understanding the Uptake and Outcomes of Non-occupational Postexposure Prophylaxis Use Through an Online Medical Platform in China: Web-Based Cross-sectional Study.

To date, non-occupational postexposure prophylaxis (PEP) has been widely accepted as a safe and effective intervention for HIV in many countries, yet it remains an underutilized prevention strategy in China. Evidence indicated a high demand for PEP among Chinese men who have sex with men, but the uptake and access to PEP service remain limited. In an era of rapid development of web-based technology, online medical platforms in China hold great promise in facilitating PEP provision and delivery by addressing problems such as accessibility, convenience, privacy protection, and antidiscrimination by integrating online and offline resources. However, there is a paucity of data concerning the uptake and outcomes of online PEP in China. The aim of this study is to explore online PEP service provision and understand PEP uptake and outcome through a web-based cross-sectional study. From January 2020 to June 2021, we conducted a retrospective web-based survey among those seeking online PEP services via the internet medical platform "HeHealth" using a structured questionnaire. Participants were surveyed on sociodemographic characteristics, sexual and drug-related behaviors, history of preexposure prophylaxis (PrEP) usage, and PEP uptake. Statistical analysis included descriptive analysis, chi-square test, and multivariable logistic regression. P values <.05 were deemed statistically significant. No HIV seroconversions were observed among 539 PEP users. Our sample demonstrated that most participants seeking online PEP services were gay (397/539, 73.7%), single (470/539, 87.2%), having an education of more than 12 years (493/539, 91.5%), and with an average monthly income of 7000 RMB (1 RMB=US $0.14) or more (274/539, 50.8%). Sexual exposures accounted for 86.8% (468/539) of the cases, with anal sex being the most common indication (389/539, 72.2%) for seeking PEP use. Among 539 participants, 60.7% (327/539) sought online PEP for relatively low-risk exposures, whereas 39.3% (212/539) were considered high-risk exposures. Nearly all (537/539, 99.6%) initiated PEP within 72 hours and 68.6% (370/539) within 24 hours of exposure. All users (539/539) were prescribed a 3-drug regimen, with most comprising 3TC/TDF+DTG (lamivudine, tenofovir disoproxil fumarate, and dolutegravir; 293/539, 54.4%), followed by FTC/TDF+DTG (emtricitabine, tenofovir disoproxil fumarate, and dolutegravir; 158/539, 29.3%). The adjusted model showed that greater odds of PrEP usage were associated with an age of 35 years or older versus the age group of 25-34 years (adjusted odds ratio [AOR] 2.04, 95% CI 1.24-3.37), having an education of 17 years or more versus an education of 12 years or less (AOR 3.14, 95% CI 1.29-7.62), average monthly income of 20,000 RMB or more versus less than 3000 RMB (AOR 2.60, 95% CI 1.09-6.23), and having high-risk sexual behavior during PEP treatment (AOR 2.20, 95% CI 1.05, 3.69). The 0% infection rate in this study demonstrated that online PEP could be a valuable risk-reduction option to improve HIV prevention service within China. However, further research is needed to better facilitate PrEP transition among online PEP users.

High post-exposure prophylaxis (PEP) uptake among household contacts of pertussis patients enrolled in a PEP effectiveness evaluation - United States, 2015-2017.

Post-exposure prophylaxis (PEP) for pertussis is recommended for household contacts of pertussis cases in the United States within 21 days of exposure, but data on PEP effectiveness for prevention of secondary cases in the setting of widespread pertussis vaccination are limited. We implemented a multi-state evaluation of azithromycin PEP use and effectiveness among household contacts. Culture- or PCR-confirmed pertussis cases were identified through surveillance. Household contacts were interviewed within 7 days of case report and again 14-21 days later. Interviewers collected information on exposure, demographics, vaccine history, prior pertussis diagnosis, underlying conditions, PEP receipt, pertussis symptoms, and pertussis testing. A subset of household contacts provided nasopharyngeal and blood specimens during interviews. Of 299 household contacts who completed both interviews, 12 (4%) reported not receiving PEP. There was no evidence of higher prevalence of cough or pertussis symptoms among contacts who did not receive PEP. Of 168 household contacts who provided at least one nasopharyngeal specimen, four (2.4%) were culture or PCR positive for B. pertussis; three of these received PEP prior to their positive test result. Of 156 contacts with serologic results, 14 (9%) had blood specimens that were positive for IgG anti-pertussis toxin (PT) antibodies; all had received PEP. Very high PEP uptake was observed among household contacts of pertussis patients. Although the number of contacts who did not receive PEP was small, there was no difference in prevalence of pertussis symptoms or positive laboratory results among these contacts compared with those who did receive PEP.

Low rate of pre-exposure prophylaxis and post-exposure prophylaxis uptake and high prevalence of transmitted drug resistance among newly diagnosed primary HIV infections in Shenzhen, China: a real-world retrospective study.

Understanding the characteristics of newly diagnosed primary human deficiency virus-1 (HIV-1) infection in the context of the post-antiretroviral therapy era and HIV drug prophylaxis is essential for achieving the new target of 95-95-95-95 by 2025. This study reported the characteristics of newly diagnosed primary HIV-1 infection in Shenzhen. This is a real-world retrospective study. Eighty-seven newly diagnosed primary HIV-1-infected patients were recruited from January 2021 to March 2022 at the Third People's Hospital of Shenzhen. Demographic, epidemiological, diagnostic, drug resistance, and medical data were described and analyzed. Overall, 96.6% (84/87) of the newly identified primary HIV-1-infected patients were male, including 88.5% (77/87) men have sex with men (MSM), with a median age of 29.0 years (Q1-Q3: 24.0-34.0 years); of these, 85.1% (74/87) reported high-risk sexual behaviors with casual partners. The rate of condom usage was only 28.7% (25/87). The overall rate of pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP) was 8.0% (7/87, including 4 PrEP and 3 PEP cases) around the potential exposure, although 41.4% of the patients had prior awareness of such interventions. Moreover, only 19.5% (17/87) had previously used PrEP or PEP. Of those, 58.8% (10/17) of the patients obtained drugs from the internet, and only 35.3% (6/17) reported good compliance. A total of 54.0% (47/87) of subjects were diagnosed by the HIV nucleic acid test. Acute retroviral syndrome appeared in 54.0% (47/87) of patients. The prevalence of transmitted drug resistance (TDR) mutation was 33.9% (19/56), including 6 (10.7%) against nucleoside reverse transcriptase inhibitor (NRTI) plus non-nucleoside reverse transcriptase inhibitor (NNRTI), 8 (14.3%) against NNRTI, and 5 (8.9%) against protease inhibitor (PI) only. Owing to the low utilization rate and incorrect usage of PrEP and PEP, massive efforts are needed to promote HIV-preventive strategies in the MSM population. The extremely high prevalence of TDR mutation in this population implies the need for future pretreatment drug resistance surveillance.

Associations between self-test and pre- or post-exposure prophylaxis of HIV among men who have sex with men in China.

This study aims to assess HIV self-testing (HIVST), pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP) uptake and associations of three HIV prevention strategies among men who have sex with men (MSM) in China. This study included two stages, baseline and follow-up, and was conducted in Harbin, the capital city of Heilongjiang province in North China. MSM were recruited online and by peer-referral. Data contained an online questionnaire and sampling blood for HIV tests. The research group generated a QR code linking to the survey, and participants were asked to scan this QR code with a cellphone to fill out the questionnaire. MSM at the baseline were imparted knowledge of PrEP, PEP and condom use. Between January 2018 and March 2019, the research team enrolled 773 MSM for baseline analysis, and 699 were HIV negative at baseline. For follow-up, 62% (430/699) participants were retained. At baseline, 11.6% (50/430) of the participants was aware of PrEP and 40.9% (176/430) of PEP; 0.7% (3/430) had ever taken PrEP and 3.3% (14/430) had taken PEP. At follow-up, 77.7% (334/430) reported awareness of PrEP and 54.0% (232/430) for PEP; Only 2.6% (11/430) initiated PrEP uptake and 3.0% (13/430) for PEP. Additionally, at follow-up, only 21 participants newly conducted HIVST. Results showed that being willing to pay for PrEP and PEP uptake was associated with conducting HIVST, and initiations of two HIV prevention methods, PrEP and PEP uptake, were significantly associated with each other. Knowledge dissemination increased participant awareness and acceptance of PrEP and PEP effectively. Uptake of HIVST, PrEP, and PEP were low and associated with each other. It is promising to achieve high uptake by promoting HIVST, PrEP and PEP as one prevention package.

HIV/AIDS post-exposure prophylaxis knowledge and uptake among health professionals in Africa: Systematic review and meta-analysis.

Healthcare workers in developing countries are at particularly increased risk of infections from blood-borne pathogens because of the high prevalence of such pathogens in their communities as well as the lack of basic personal protective equipment, such as gloves, gowns and goggles. For those exposed healthcare workers, the immediate administration of antiretroviral drugs following exposure to potentially infected blood or other bodily fluids is essential in order to minimize the risk of acquiring HIV infection. This review is aimed at estimating the pooled prevalence of knowledge and uptake of post-exposure prophylaxis among healthcare providers in Africa. We accessed PubMed, Science Direct, Google Scholar, SCOPUS, African Journals Online (AJOL), Journal Storage (JSTOR) and EMBASE. The search for unpublished studies included Google and institutional repositories were also used. This meta-analysis follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The quality of studies was assessed using the modified Newcastle-Ottawa Scale (NOS). Meta-analysis was carried out with a random-effects method using STATA v.14software. Out of 654692 studies retrieved, 37studies from four African regions involving 6482healthcare providers were included in this meta-analysis. The overall estimated pooled uptake and knowledge of HIV/AIDS post-exposure prophylaxis among healthcare providers in Africa using a random-effects model were 40.09% (95% CI: 30.14-50.04) and 57.67% (95% CI: 44.32-71.01) respectively, whereas the highest uptake and knowledge were 45.48% (95% CI: 24.79-66.17) and 61.37% (95% CI: 46.39-76.36) in the southern and eastern regions, respectively. The results of this meta-analysis indicated that the knowledge and uptake of post-exposure prophylaxis, one of the best approaches to tackling HIV/AIDS transmission, are significantly low. Therefore, healthcare organizations should work on strategies to increase knowledge and uptake of post-exposure prophylaxis among healthcare providers. Prospero (ID: CRD42021244003).

Awareness and Use of Post-exposure Prophylaxis for HIV Prevention Among Men Who Have Sex With Men: A Systematic Review and Meta-Analysis

Background: The use of post-exposure prophylaxis (PEP) is effective in reducing HIV risk, but it is underused by men who have sex with men (MSM) due to certain psychological and sociostructural factors. This article assessed the awareness and use of PEP among MSM in an effort to increase the visibility and uptake of PEP among at-risk populations.Methods: We conducted a systematic literature search of the PubMed, Web of Science, PsycINFO, and Google Scholar electronic databases. Studies were screened for inclusion, and relevant data were abstracted, assessed for bias, and synthesized. Pooled effect estimates were calculated using random effects meta-analysis, meta-regression and subgroup analysis, and a qualitative review and risk of bias assessment were performed (PROSPERO, CRD42019123815).Results: Twenty eligible studies involving 12,579 MSM were included in the meta-analysis. The pooled estimate of the proportions of MSM who were aware of PEP was modest at 59.9% (95% CI: 50.5~68.7) and that of MSM who previously used PEP was very low at 4.9% (95% CI: 2.4~9.8). PEP awareness showed no clear change over time, while PEP use significantly changed over time. Multiple factors affected awareness, including educational attainment, race/ethnicity, levels of HIV stigma, access to condoms, and so on. Many factors could potentially impede or facilitate the use of PEP, such as income, lack of PEP information, and partnership.Conclusion: We observed that PEP is an underused HIV prevention strategy among MSM and that once MSM become aware of PEP, the majority are willing to use it if they are supported appropriately in terms of a range of individual, social, and structural barriers.Systematic Review Registration: http://www.cdr.york.ac.uk/prospero, PROSPERO [CRD42019123815].

Public Health Detailing to Promote HIV Pre- and Postexposure Prophylaxis Among Women's Healthcare Providers in New York City

Equitable access to HIV pre- and postexposure prophylaxis for women is essential to ending the HIV epidemic. Providers' lack of knowledge and comfort in discussing and prescribing pre-exposure prophylaxis to women persist as barriers. From May to November 2019, the New York City Health Department conducted its first public health detailing campaigns among women's healthcare providers to promote pre- and postexposure prophylaxis and the associated best practices. Over 2 campaigns (10 weeks each), trained Health Department representatives visited providers for 1-on-1 visits at select practices to promote key messages. Representatives distributed an Action Kit that addressed knowledge gaps and practice needs on providing pre-exposure prophylaxis and postexposure prophylaxis to cisgender and transgender women. Providers completed an assessment at the beginning of initial and follow-up visits, used to compare responses across visits. Statistically significant changes were evaluated by generalized linear models of bivariate outcomes, adjusted for nonindependence of providers at the same practice. Representatives visited 1,348 providers specializing in primary care (47%), women's health (30%), adolescent health (7%), infectious disease (4%), and other (12%) at 860 sites; 1,097 providers received initial and follow-up visits. Provider report of ever prescribing pre-exposure prophylaxis increased by 12% (n=119 providers); increases were reported in measures of taking sexual history, asking about partners' HIV status, providing postexposure prophylaxis, recognizing pre-exposure prophylaxis's effectiveness, and discussing and referring for pre-exposure prophylaxis. After public health detailing, women's healthcare providers report increased adoption of recommended practices that promote pre- and postexposure prophylaxis uptake and sexual wellness among women. Detailing may be adaptable to other regions and contexts to reach providers.

High post-exposure prophylaxis uptake but low completion rates and HIV testing follow-up in health workers, Harare, Zimbabwe.

Introduction:Health care workers (HCWs), especially from sub-Saharan Africa, are at risk of occupational exposure to HIV. Post exposure prophylaxis (PEP) can reduce this risk. There is no published information from Zimbabwe, a high HIV burden country, about how PEP works. We therefore assessed how the PEP programme performed at the Parirenyatwa Hospital, Harare, Zimbabwe, from 2017–2018.Methodology:This was a cohort study using secondary data from the staff clinic paper-based register. The chi square test and relative risks were used to assess associations.Results:There were 154 HCWs who experienced occupational injuries. The commonest group was medical doctors (36%) and needle sticks were the most frequent type of occupational injury (74%). The exposure source was identified in 114(74%) occupational injuries: 91% of source patients were HIV-tested and 77% were HIV-positive. All but two HCWs were HIV-tested, 148 were eligible for PEP and 142 (96%) started triple therapy, all within 48 hours of exposure. Of those starting PEP, 15 (11%) completed 28 days, 13 (9%) completed < 28 days and in the remainder PEP duration was not recorded. There were no HCW characteristics associated with not completing PEP. Of those starting PEP, 9 (6%) were HIV-tested at 6-weeks, 3 (2%) were HIV-tested at 3-months and 1 (< 1%) was HIV-tested at 6-months: all HIV-tests were negative.Conclusions:While uptake of PEP was timely and high, the majority of HCWs failed to complete the 28-day treatment course and even fewer attended for follow-up HIV-tests. Various changes are recommended to promote awareness of PEP and improve adherence to guidelines.

A Knowledge, Attitudes and Practices (KAP) survey on canine rabies prevention and control in four rural areas of Sri Lanka.

Rabies is a fatal viral disease that affects all mammals. It causes an estimated 59,000 human deaths worldwide annually. Dogs are the main reservoir and transmitter of rabies to human in Sri Lanka. Prevention and control measures include the mass vaccination of dogs and human post-exposure treatment. While these measures appear to be homogeneous across the country, there is a need to identify community-level gaps due to the decentralization of regional health and veterinary services in conducting such activities. A community-based questionnaire survey was conducted to identify potential risk factors and gaps related to knowledge, attitudes and practices on rabies prevention and control in the rural regions of Sri Lanka. Lower knowledge scores were associated with respondents between 18 and 38years old, had no experience of being bitten, and own semi-independent dogs. Despite associated fear of stray dogs with health issues, some communities provide shelter and/or food for the stray dogs. Uptake of population control and vaccination of dogs across the grama niladhari divisions (GNDs), which are the smallest administrative units, differed. More than 80% of dogs were not desexed and community knowledge on vaccination delivery, booster and vaccination schedules were also variable. Even though 69% of respondents identified stray/community dogs as potential carriers' owners allow their dogs to roam the neighbourhood. Most of the respondents were able to identify the need for post-exposure treatment after a dog bite. However, post-exposure prophylaxis uptake by the local victims ranged between 83.00% and 87.50%. Low participation was reported in health education in the communities. Lack of knowledge on other potential carriers was similar to previous survey studies in the last decade. Collaborations between local communities, veterinary and medical services are necessary to scale up the control programme in order to achieve the global target of zero rabies deaths by 2030. Further community-level studies are recommended.

Occupational Exposure to Blood and Body Fluids and Knowledge of HIV Post-Exposure Prophylaxis among Medical and Allied Health Students in Northern Nigeria.

Background:Clinical students are at increased risk of exposure to blood-borne pathogens. However, little has been documented about their exposure to blood and body fluids and their knowledge of post-exposure prophylaxis (PEP) in high-HIV burden settings, such as Nigeria.Objective:To determine the prevalence and predictors of BBF exposure and knowledge about PEP among medical and allied health students in northern Nigeria.Methods:In a cross-sectional study, 273 clinical students were asked to complete structured questionnaires. The prevalence of BBF exposure was determined. Binary logistic regression was used to determine the independent predictors of BBF exposure.Results: The majority of the respondents (98.2%) had heard about PEP; 26.0% (n=71) had adequate knowledge about PEP. 76 (27.8%) of the 273 respondents reported accidental exposure to HIV. 230 (84.2%) respondents had positive attitude toward HIV PEP. Of those who had had accidental exposure to HIV (n=76), only 13% (n=10) received PEP. The level of knowledge about PEP was predicted by previous training (aOR 0.43, 95% CI 0.23 to 0.80 ["no" vs "yes"]), year of training (aOR 4.10, 95% CI 1.60 to 10.47 [6th vs 4th year]), course of study (aOR 4.69, 95% CI 2.06 to 10.68 ["allied health" vs "clinical medicine"]) and religion (aOR 5.39, 95% CI 1.40 to 20.71 ["non-Muslim" vs "Muslim"]). Similarly, accidental exposure was independently predicted by respondents’ sex (aOR 2.55, 95% CI1.36 to 4.75 ["female" vs "male"]), age (aOR 2.54, 95% CI 1.06 to 6.15 ["25–29" vs "20–24" years]), ethnicity (aOR 2.15, 95% CI1.10 to 5.14 ["others" vs "Hausa/Fulani"]), course of study (aOR 0.06, 95% CI 0.01 to 0.38 ["allied health" vs "clinical medicine"]), and previous PEP training (aOR 0.39, 95% CI 0.20 to 0.78 ["no" vs "yes"]). Conclusion:One in four clinical students reported exposure to BBF. Most students expressed a positive attitude toward PEP, but knowledge and uptake of PEP was sub-optimal. We recommend strengthening training curricula for infection control and prevention and enhancing protocols for timely post-exposure evaluation and follow up for all exposure incidents.

Occupational Exposure to Blood and Body Fluids and Knowledge of HIV Post-Exposure Prophylaxis among Medical and Allied Health Students in Northern Nigeria.

Clinical students are at increased risk of exposure to blood-borne pathogens. However, little has been documented about their exposure to blood and body fluids and their knowledge of post-exposure prophylaxis (PEP) in high-HIV burden settings, such as Nigeria. To determine the prevalence and predictors of BBF exposure and knowledge about PEP among medical and allied health students in northern Nigeria. In a cross-sectional study, 273 clinical students were asked to complete structured questionnaires. The prevalence of BBF exposure was determined. Binary logistic regression was used to determine the independent predictors of BBF exposure. The majority of the respondents (98.2%) had heard about PEP; 26.0% (n=71) had adequate knowledge about PEP. 76 (27.8%) of the 273 respondents reported accidental exposure to HIV. 230 (84.2%) respondents had positive attitude toward HIV PEP. Of those who had had accidental exposure to HIV (n=76), only 13% (n=10) received PEP. The level of knowledge about PEP was predicted by previous training (aOR 0.43, 95% CI 0.23 to 0.80 ["no" vs "yes"]), year of training (aOR 4.10, 95% CI 1.60 to 10.47 [6th vs 4th year]), course of study (aOR 4.69, 95% CI 2.06 to 10.68 ["allied health" vs "clinical medicine"]) and religion (aOR 5.39, 95% CI 1.40 to 20.71 ["non-Muslim" vs "Muslim"]). Similarly, accidental exposure was independently predicted by respondents' sex (aOR 2.55, 95% CI1.36 to 4.75 ["female" vs "male"]), age (aOR 2.54, 95% CI 1.06 to 6.15 ["25-29" vs "20-24" years]), ethnicity (aOR 2.15, 95% CI1.10 to 5.14 ["others" vs "Hausa/Fulani"]), course of study (aOR 0.06, 95% CI 0.01 to 0.38 ["allied health" vs "clinical medicine"]), and previous PEP training (aOR 0.39, 95% CI 0.20 to 0.78 ["no" vs "yes"]). One in four clinical students reported exposure to BBF. Most students expressed a positive attitude toward PEP, but knowledge and uptake of PEP was sub-optimal. We recommend strengthening training curricula for infection control and prevention and enhancing protocols for timely post-exposure evaluation and follow up for all exposure incidents.

Determinants of Rabies Prophylaxis Involvement based on Children’s Experiences and Perspectives in An Endemic Area of Indonesia

Rabies studies involving children are still rare despite their vulnerability. As the critical preventive measure,understanding factors associated with their involvement in rabies post-exposure prophylaxis (PEP) isneeded. A storytelling interview was conducted for 23 dog-bite and non-bite child-victims, aged 7-15 years,in an endemic area in Indonesia. Content analysis was carried with the help of Atlas ti.7. Unreported woundsand PEP delays were occurred. Children’s capabilities, motivations, and opportunities can be critical toprevent it. Knowing the source of rabies, its visible features and consequences, and the first aid techniqueare needed. Children’s willingness to report and follow PEP seem to be regulated by their attitude towardsvaccine, familiarity of dog ownership, perceptions of wound type, and emotions around rabies consequences,parental punishment, and injection. Mother, peers, neighbours and dog owners need to be empowered in PEPmeasure. In conclusion, rabies PEP program should attentive to factors influencing children’s behaviour tosupport PEP uptake.

Low awareness and use of post-exposure prophylaxis among adolescents and young adults in South Africa: implications for the prevention of new HIV infections

The vulnerability of adolescents and young adults in South Africa to HIV and sexual violence is well documented. Post-exposure prophylaxis (PEP) is available for victims of sexual abuse in the country but awareness of this measure is required to maximise its HIV-prevention benefits. This study examined levels of PEP awareness and its correlates and the uptake of PEP among 772 students (16–24 years) in a South African university using stratified random sampling. Overall, we included more females (477) than males (295), reflecting the male–female ratio at the university. Adjusted and unadjusted logistic regression models were used to determine correlates of PEP awareness, which was low (24.1%), particularly among those who experienced sexual violence in the past year (19.8%) compared those who had not (24.8%). Only 2.6% of participants had used PEP, while 7.5% had seen it, and 14.6% knew where to get it. In the adjusted model, adequate family support (AOR: 2.22; CI: 1.54–3.20) and prior HIV testing (AOR: 2.65; CI: 1.59–4.42) were associated with a higher likelihood of PEP awareness. The study concluded that awareness of PEP was low in the study setting and especially among those who need it. Social marketing of PEP is needed in the study settings to realise the maximum benefits of PEP in preventing new HIV infections.

Barriers to post exposure prophylaxis use among men who have sex with men in sub-Saharan Africa: An online cross-sectional survey.

BackgroundCurbing new HIV infections among MSM in SSA remains problematic, due to cultural beliefs, norms that oppose same-sex acts, and criminalization of same-sex acts. No study focused on barriers to PEP use in SSA region has been conducted. Our study focused on identifying barriers to Post-Exposure Prophylaxis (PEP) use among MSM in sub-Saharan Africa (SSA).MethodsAn online cross-sectional survey was sent out to members of 14 Lesbian, Gay, Transgender, Bisexual, Queer (LGBTQ) associations in SSA, to identify barriers to PEP utilization in MSM. A total of 207 MSM from 22 countries in SSA completed the survey between 8 January 2019 and 23 February 2019. Descriptive statistics were generated, chi-square and backward stepwise logistic regression analysis were performed to evaluate the association between the outcome “PEP use” and other variables.ResultsMost of the MSM were aged 18 to 30, and the majority (220, 74.6%) described themselves as gay. Rwanda had the highest number of respondents (117, 39.7% of the total), followed by Nigeria, Ghana and South-Africa.The majority of respondents reported having heard about PEP (234, 80.7%), and the average PEP correct knowledge level was 59%.Five characteristics were associated with increased odds of using PEP: Age, having vocational education, having heard of PEP, knowledge of where to get PEP, and having been refused housing.ConclusionThere is a need for a collaborative effort between policy makers, key players in HIV prevention, and MSM associations in SSA to remove barriers to PEP uptake to promote optimal PEP utilization amongst MSM.

A Pilot Program of Pre-Exposure and Post-Exposure Prophylaxis Promotion among Men Who Have Sex with Men - 7 Study Sites, China, 2018-2019.

What is already known on this topic?Pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP) had been proved to be effective in HIV prevention among men who have sex with men (MSM) internationally. Use of either PrEP or PEP was found to be limited among Chinese MSM. Relatively little data was reported in China.What is added by this report?Our program indicated that PEP was more acceptable than PrEP among MSM in China. Drugs of lower cost and related knowledge dissemination could increase PrEP and PEP uptake among MSM in China.What are the implications for public health practice?PrEP and PEP are likely to contribute significantly to human immunodeficiency virus (HIV) prevention in China.

A cross-sectional study of awareness and practices regarding animal bites in rural community, North India.

Introduction:Repeated epidemiological studies to monitor trends of knowledge and practices are needed to guide strategies to control rabies. We conducted a study to assess the current knowledge, attitudes, and practices in relation to animal bites in the rural area of north India.Methods:House to house survey to collect data on animal bites was conducted among 300 households (assuming awareness regarding animal bites to be 25%, precision 95%, and power of 80%) from the rural area of Punjab, north India. A pretested semi-structured questionnaire comprising of items that explored sociodemographic details (age, educational qualification, occupation, socioeconomic status (assessed through Udai Pareek scale), and awareness regarding rabies, knowledge about first aid, attitude, and practices regarding anti-rabies vaccination (ARV) was used. Detailed questions were asked to those who owned pets.Results:A total of 300 households were included in the analysis. Among all respondents, 30.4% (117) had an episode of animal bite in their family giving a bite incidence rate of 78/1000 population. Bites were more frequent in males (65.8%, n = 77). The commonest site of the bite was lower limb (65%) followed by upper limb (21.4%), and head and neck (5.1%). The participants said that bites by pet animals (47%) are more common than those by stray animals (35.9%), followed by wild animals (12.8%). Almost 91% of respondents told that they would prefer govt. hospital for the treatment. Class I bite was most common (88.9%) followed by class II (8.5%) and class III (1.7%). A lot of respondents (41.4%) did not know about the symptoms of rabies in humans. Only 17.5% knew the appropriate wound care. Inappropriate practices like applying chilly (48.8%), lime (13.1%), tying the limb above the wound (5.1%), and others were common. Only 15.5% washed their wound with soap and water. Most of those who were bitten received post-exposure prophylaxis (PEP) (80%). Most of the respondents (98.3%) had heard about ARV but didn’t know about the site of injection. Almost everyone (99.35) said that no awareness camps/programs had been conducted in their villages/school/health center to date.Conclusion:There is a high incidence of animal bites in rural areas. Awareness regarding the need for rabies vaccine of animals and PEP after an animal bite is quite high and is practiced. However, there is a lack of awareness regarding the course of action to be followed when an animal does develop rabies. Traditional and inappropriate practices of wound management persist and need to be countered. Improving the availability of ARV and rabies immunoglobulin through the public health system may further augment the uptake of PEP and completion of treatment while at the same time reducing out of pocket expenditure and the overall economic cost of rabies. Solid waste management in rural areas along with oral ARV is likely to reduce the incidence of rabies in rural areas.

Utilization of an Animated Electronic Health Video to Increase Knowledge of Post- and Pre-Exposure Prophylaxis for HIV Among African American Women: Nationwide Cross-Sectional Survey.

BackgroundDespite renewed focus on biomedical prevention strategies since the publication of several clinical trials highlighting the efficacy of pre-exposure prophylaxis (PrEP), knowledge of postexposure prophylaxis (PEP) and PrEP continues to remain scarce among women, especially among African American women who are disproportionally affected by HIV. In an effort to address this barrier and encourage uptake of PEP and PrEP, an electronic health (eHealth) video was created using an entertainment-education format.ObjectiveThe study aimed to explore the feasibility, acceptability, and preference of an avatar-led, eHealth video, PEP and PrEP for Women, to increase awareness and knowledge of PEP and PrEP for HIV in a sample of African American women.MethodsA cross-sectional, Web-based study was conducted with 116 African American women aged 18 to 61 years to measure participants’ perceived acceptability of the video on a 5-point scale: poor, fair, good, very good, and excellent. Backward stepwise regression was used to the find the outcome variable of a higher rating of the PEP and PrEP for Women video. Thematic analysis was conducted to explore the reasons for recommending the video to others after watching the eHealth video.ResultsOverall, 89% of the participants rated the video as good or higher. A higher rating of the educational video was significantly predicted by: no current use of drugs/alcohol (beta=−.814; P=.004), not having unprotected sex in the last 3 months (beta=−.488; P=.03), higher income (beta=.149; P=.03), lower level of education (beta=−.267; P=.005), and lower exposure to sexual assault since the age of 18 years (beta=−.313; P=.004). After watching the eHealth video, reasons for recommending the video included the video being educational, entertaining, and suitable for women.ConclusionsUtilization of an avatar-led eHealth video fostered education about PEP and PrEP among African American women who have experienced insufficient outreach for biomedical HIV strategies. This approach can be leveraged to increase awareness and usage among African American women.

688. Impact of Expanded Influenza Post-exposure Prophylaxis on Healthcare Worker Absenteeism at a Tertiary Care Center During the 2017–2018 Season

BackgroundA severe 2017–2018 influenza season was expected for the United States. We hypothesized that a surge in influenza cases paired with decreased vaccine effectiveness could increase healthcare worker (HCW) absenteeism. Because of a potential public health emergency during the 2017–2018 season, we offered oseltamivir post-exposure prophylaxis (PEP) to exposed HCWs regardless of vaccination status. We describe PEP uptake, cost, and impact on absenteeism at the University of Iowa Hospital and Clinics (UIHC).MethodsUIHC serves as a referral and safety net health system for Eastern Iowa. Influenza seasons were defined as the period between Week 40 from 1 year to Week 13 of the following year. During the 2016–2017 season, PEP (75 mg/day for 7 days) was offered free of charge to unvaccinated exposed HCWs. Exposure was defined as proximity within 3 ft of a confirmed influenza-infected person for ≥10 minutes without mask protection, or direct contact with respiratory secretions. During the 2017–2018 season, PEP was expanded to all exposed HCWs regardless of vaccination status. We reviewed surveillance, employee health, pharmacy, and human resources records for the 2016–2017 and 2017–2018 seasons. We defined PEP uptake as prescriptions picked up/all referrals and absenteeism rate as sick-leave requests/scheduled hours.ResultsDuring the 2016–2017 and 2017–2018 seasons, we detected 373 and 427 confirmed influenza cases among patients at UIHC. HCW vaccination rates were similar: 89.7% and 90.9%. PEP was recommended in 49 exposures during 2016–2017 and 280 exposures during 2017–2018. A total of 22 (44.9%) and 133 (47.5%) HCWs picked up oseltamivir from the pharmacy during the 2016–2017 and 2017–2018 seasons. The estimated cost of oseltamivir was $1,791 and $10,828, respectively. Overall, 6,187 sick-leave requests (median = 12 hours, absenteeism rate = 3.2%), and 6,174 sick-leave requests (median = 12 hours, absenteeism rate = 3.4%) were reported during the 2016–2017 and 2017–2018 seasons.ConclusionInfluenza case counts mildly increased from the 2016–2017 to the 2017–2018 season. Expanding PEP to all exposed HCWs, regardless of vaccination status, had moderate uptake and was costly. Absenteeism rates remained similar during both seasons.Disclosures All authors: No reported disclosures.

Epidemiology and surveillance of human animal-bite injuries and rabies post-exposure prophylaxis, in selected counties in Kenya, 2011\u20132016

BackgroundHuman animal-bite injuries are a serious public health problem due to associated risk for rabies virus exposure. Animal-bite injuries especially dog bites are useful indicators for assessing the risk of rabies virus transmission and need for rabies post exposure prophylaxis (PEP). Understanding the epidemiology and surveillance of animal bites and rabies post-exposure prophylaxis is critical in implementing Kenya’s national rabies elimination strategy. We aimed to describe the incidence of human animal-bite injuries, patient/biting animal characteristics, uptake of rabies PEP and factors associated with animal bite incidents.MethodsWe reviewed animal bite records from outpatient and anti-rabies vaccine (ARV) registers of 17 health facilities from five counties. An animal bite was defined as an entry of an animal bite of the class mammal including humans in registers in a person of any age from January 2011 to December 2016. We collected demographic and information on PEP uptake. We calculated descriptive statistics, odds ratios (OR) and 95% confidence interval (CI) to examine factors associated with being an animal bite case-patient. We also calculated incidence of animal bites using health facility catchment population for year 2016 as the denominator.ResultsWe analyzed 7307 records. The median age was 22 years (IQR = 31 years); there were 4019 (55%) male and age < 15 years were 2607 (37%). Dogs accounted for 6720 (93%) of bites of which 78% were owned free-roaming dogs. Of the 5674 (88%) cases that received rabies PEP, 2247 (40%) got at least three-doses. The median time from bite to seeking medical care was 2 days (IQR = 4 days). Being bitten on the head/face (OR = 5.8; CI: 3.3–10.2); being bitten by owned free-roaming dog (OR = 1.7; CI: 1.5–1.9) and being male (OR = 1.4; CI: 1.3–1.5) were significantly associated with being an animal-bite case-patient. Being male, being bitten on head/face and being bitten by owned free-roaming dog remained independently associated with being an animal bite case-patient at multivariable logistic regression. Bite-incidence was 289 bites /100,000 persons among all counties.ConclusionPreventing dog bites would most effectively reduce bite injuries by improving public health education among children below 15 years, encouraging early PEP initiation and completion, development and implementation of responsible dog ownership and animal behaviour educational programmes as well as improving human and veterinary health linkages.