20th International AIDS Conference - Melbourne, Australia


TUPE154 - Poster Exhibition

Variation in adherence to post-exposure prophylaxis by exposure type: a meta-analysis

N. Ford, C. Irvine, M. Doherty, M. Vitoria, R. Baggaley, Z. Shubber

World Health Organization, Geneva, Switzerland

Background: Post-exposure prophylaxis (PEP) is provided to prevent infection among people exposed to HIV. PEP provision is commonly categorized by the exposure enviroment of occupational exposures or non-occupational exposure (including non-coersive sex and sexual assault). The extent to which adherence to PEP differs by these exposure group is poorly characterized.
Methods: We systematically reviewed 4 databases up to December 2013 to assess reported PEP completion rates and pooled results using random-effects meta-analysis, stratified by exposure group.
Results: 93 studies, reporting outcomes on 20912 PEP initiations, were reviewed. Non-occupational exposure to HIV was the main reason for PEP in 33 studies (n=11,734), occupational exposure for 21 studies (n=2962), sexual assault for 25 studies (n=3156) and in the remainder of studies (12 studies, n=3060) PEP was provided for a range of exposures. 15 studies reported that PEP was provided multiple times with the majority among populations of men who have sex with men (MSM) (13 studies). Overall, 59.5% (95%CI 54.6-64.4%; t2 0.25) of people considered eligible for PEP completed the full 28 day course . Completion rates were highest for non-occupational exposures (64.5%, 95%CI 53.1-75.9%) or mixed exposure (68.1%, 95%CI 56.4-79.7%) and lowest for sexual assault (40%, 95%CI 30.3-49.7%). Higher rates of PEP completion were also reported among MSM (67.6%, 95%CI 59.2-76%). Completion rates appeared to be lower for adolescents (35.8%, 95%CI 10.7-60.8%) compared to adults (59.5%, 95%CI 50-60.2%) or children (59.2%, 95%CI 53.8-64.7%). Completion rates by patient and programme characteristics are summirized in Figure 1.

PEP adherence by subgroup
[PEP adherence by subgroup]

Conclusions: Adherence remains a concern for PEP completion rates irrespective of exposure group with poorest adherence found among victims of sexual assault and adolescents, highlighting the urgent need to identify interventions to support adherence and service delivery models that target the most vulnerable.

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