Non-occupational post exposure prophylaxis as a biobehavioral HIV-prevention intervention

Abstract

This project evaluated the feasibility and safety of a community-planned and financed program of non-occupational post exposure prophylaxis (nPEP) for 100 individuals. Individuals seeking nPEP within 72 hours of a potential HIV exposure were provided 28-day treatment using twice-daily lamivudine and zidovudine. Participants received a physical examination, HIV test and medications and were scheduled for follow-up counseling and data visits to 26-weeks. Results showed participants were highly educated (mean = 14.7 years), gay identified (63%), males (95%) who experienced an atypical, high-risk sexual event. Two participants tested HIV-positive at intake, who were previously unaware of their HIV status. The strongest demand (31% of cases) was on Mondays. The index event for the majority of cases (58%) involved unprotected anal sex, with 18% reporting condom failures. Only 15% tested positive for illicit drugs at initial visit. Of those dispensed the full 28 days of medication (n=84), 63 successfully completed the treatment course (75%). Retention dropped rapidly after the initial study visit, with only 49% completing a 26-week follow-up visit. No incident seroconversions were observed. That 75% of participants completed a full course of nPEP adds to the emerging evidence regarding nPEP feasibility. This project demonstrates the need for further research in the implementation of nPEP as a biobehavioral strategy for high-risk groups within a comprehensive HIV-prevention plan.

Acknowledgements

The authors are grateful to GlaxoSmithKline for providing medications, Mary Lucey and the City of Los Angeles AIDS Coordinator's Office for supporting recruitment, National Institute on Drug Abuse grant DA12819 (Kanouse) and Friends Research Institute (Shoptaw).