TUPE155 - Poster Exhibition
Do starter packs improve outcomes for people taking HIV post-exposure prophylaxis?
C. Irvine1, Z. Shubber2, M. Doherty1, M. Vitoria1, N. Ford1
1World Health Organization, Geneva, Switzerland, 2Imperial College, London, United Kingdom
Background: Post-exposure prophylaxis for HIV involves
the provision of a 28-day course of antiretroviral (ARV) drugs. Starter packs,
involving an initial provision of ARVs, with the remainder provided at a
subsequent visit, are commonly used as a way to provide timely treatment,
reinforce adherence and encourage intermediate visit attendance to confirm
risk. However, a proportion of people fail to return for their subsequent visit
and are therefore unable to complete the full PEP course.
Methods: Using a database constructed from a
systematic assessment of published PEP outcomes, we used random-effects
meta-analysis to compare completion rates for individuals provided with a PEP
starter pack compared to those who were provided with a full course at initial visit.
a similar proportion of people completed PEP comparing those provided with a
starter pack (n=5897) and those who were given a full course at initial visit
(n=5366): 54.3% (95%CI 45-63.6%) vs 57.4 (95%CI 47.5-67.2%). Among those who
were provided with a starter pack but did not complete treatment 50.2% (95%CI
45.4-53.1%) were lost between the initial and interim visit. The number of people who discontinued PEP because the source case
was subsequently found to be HIV negative was not different between those people
given starter packs (8.2%, 95%CI 6.3-10.1%) and those given the full
course (11.2%, 95%CI 5.3-17.0).
Conclusions: Completion rates are similar when comparing
PEP prescribing approaches. While outcomes among defaulters cannot be known, half
of people who default from care following the provision of starter packs do so
prior to receiving their full course of ARVS, and are thus unable to complete
their course of PEP. This, together with the lack of benefit in terms of
avoiding unnecessary PEP prescriptions, suggests that starter packs offer
little apparent advantage over the provision of a full course of PEP.
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