TUPE153 - Poster Exhibition
Adherence to PEP along the cascade of care: a systematic review and meta-analysis
N. Ford1, Z. Shubber2, M. Doherty1, M. Vitoria1, C. Irvine1
1World Health Organization, Geneva, Switzerland, 2Imperial College, London, United Kingdom
Background: Post-exposure prophylaxis (PEP) is a
routine intervention using antiretroviral drugs to prevent the establishment of
chronic infection among HIV-exposed individuals. Variable adherence rates have
been reported in the literature but losses along the cascade of care have not
been systematically assessed.
Methods: We reviewed 3 databases from inception to 1
December 2013 to identify all studies reporting completion rates for PEP, irrespective
of exposure type. Outcomes were pooled using random effects meta-analysis.
Results: We identified 89 studies from 22 countries
reporting outcomes on 20,317 individuals initiating PEP. PEP was prescribed for
the following reasons: 56% for non-occupational exposure, 14% for occupational
exposure, 15% for sexual assault, and the remainder for mixed reasons. Losses occurred at every step along the
cascade of care from eligibility determination to follow up visit (Figure 1).
14.1% (11.9-16.4%) refused PEP. In studies where a starter pack was provided,
25.1% (19.5-31.9%) failed to present to pick up the remained of their
prescription. Excluding 8.6% (7.4-9.9%) of patients who were stopped because
the source case was determined to be low risk overall, 59.4% (95%CI 54.9-64.0%)
of individuals needing PEP completed the full course and 50.4% (39.1-61.7%) attended
a follow up visit. Completion rates were highest for
non-occupational exposure (71.7%, 95%CI 65.1-78.2%) and lowest for sexual
assault (43.4%, 95%CI 34.5-52.2%). Adverse events resulted in PEP termination
in 6.4% (5.3-7.4%) of cases.
[Losses along the PEP cascade]
Conclusions: Losses are high at each step along the PEP
cascade, with almost half of the people who need PEP failing to complete a full
course of treatment, suggesting a need for a simplified approach. Intervention
studies to improve retention are also required.
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