A mixed methods study of non-occupational post-exposure prophylaxis at an STI clinic in Singapore: Five-year retrospective analysis and providers' perspectives

Abstract

BackgroundThis mixed methods study aims to describe 1) characteristics of the population treated with non-occupational post-exposure prophylaxis (nPEP), 2) predictors of loss to follow-up (LTFU) and nPEP adherence, and 3) to evaluate the nPEP prescribing practices against current management guideline.MethodsThis study was conducted at the Department of Sexually Transmitted Infections Control Clinic in Singapore using clinical data from 2010 to 2016. Explanatory sequential mixed method design was adopted. Predictors of LTFU and nPEP adherence were assessed using modified Poisson regression with robust sandwich variance. Subsequently, nine in-depth interviews with healthcare providers were conducted to gain their insights into barriers and facilitators to nPEP implementation. Transcripts were coded and themes were explored using applied thematic analysis.ResultsOf 502 nPEP cases reviewed, 46% were LTFU, 42% were adherent to nPEP and 431 prescription decisions were made in accordance with the guideline. Tourists (aRR, 2.29 [1.90–2.74]; p<0.001) and men who have sex with men/bisexual men (aRR, 1.32 [1.09–1.59]; p = 0.004) were significant predictors of LTFU. Absence of side effects (aRR, 1.14 [1.02–1.27]; p = 0.024) and nPEP treatment with TDF/FTC/ATV/r (aRR, 1.15 [1.03–1.29]; p = 0.017) were positively associated with nPEP adherence. Stigma, types of antiretroviral regimen, side effects, and patients’ perception of risk and treatment benefits derived qualitatively further reinforced corresponding quantitative findings.ConclusionTailored socio-behavioral interventions are needed to address inherent differences within heterogeneous populations requesting nPEP, stigma, and patients’ perceptions of nPEP in order to improve follow-up and its adherence.

Drug users’ perceptions, demands, and suggestions for non-occupational post-exposure prophylaxis (nPEP) services in China: a qualitative study

“…Some participants complained that 28-day course of treatment was too long to complete and felt inconvenient to take medicine every day. The problem of adherence was also demonstrated in several studies [29,33,34].…”

“…Some participants claimed that they were not likely to accept nPEP if adverse drug reactions were intolerable. In previous studies, adverse effects were always one of the important barriers of nPEP implement [27][28][29][30]. But in general, the side effects of ARV medication for most subjects within a short period were relatively moderate, mainly including headache and gastrointestinal symptoms.…”

“…A study in Singapore found only 42% of 502 nPEP cases were adherent to nPEP [29]. One prospective observational study in Belgium recorded 66.4% had a documented completion of 28-day course of nPEP among 1881 patients receiving nPEP [34].…”

“…The subjects with high risk perceptions, namely those who realized that the exposures of high-risk sexual practices were more likely to result in HIV infection, inclined to turn to nPEP. Teo et al found that self-perceived chances of infecting HIV and severity of the situation could facilitate nPEP treatment[29]. The newtype drugs can act on neurons and create feelings of pleasure as central nervous system stimulants…”

Nonoccupational post-exposure prophylaxis for HIV after sexual intercourse among women in Brazil: Risk profiles and predictors of loss to follow-up

“…[15] Studies of women in general have analyzed small numbers of individuals, making it difficult to identify differences in comparison with men. [16,17] One exception was a study in Boston, which showed that the rates of adherence to nPEP were lower among women than among men. [18] In general, the reasons for discontinuation of prophylactic treatment include adverse effects, changes in the perception of risk after nPEP, belief that a sufficient number of tablets have been taken, and loss of interest in the prophylaxis.…”