20th International AIDS Conference - Melbourne, Australia


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.
Results: Overall, 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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