Brief Report: Outcomes of Individuals Using HIV Postexposure Prophylaxis-In-Pocket (“PIP”) for Low-Frequency, High-Risk Exposures in Toronto, Canada

Abstract

Background: HIV postexposure prophylaxis-in-pocket (“PIP”) is a self-initiated, event-driven HIV prevention modality for individuals with a low frequency of HIV exposures. Methods: A cohort of 111 patients using PIP as their primary HIV prevention modality was longitudinally evaluated for PIP self-initiation, HIV and sexual transmitted infections, and switching to other HIV prevention modalities between February 2016 and December 2022. Results: A total of 111 patients had 178.7 cumulative patient-years of PIP use. PIP was self-initiated 69 times by 35 (31.5%) individuals, with 0 HIV seroconversions identified. Thirty four individuals (30.6%) transitioned from PIP to pre-exposure prophylaxis and 33 individuals (29.7%) switched from pre-exposure prophylaxis to PIP. Conclusions: PIP is a useful addition to other pharmacologic HIV prevention tools, and may help prevent infection in those with a lower frequency of unanticipated HIV exposures.

HIV postexposure prophylaxis-in-pocket

“…People who may have a higher risk of nonconsensual sex (e.g., sex workers, survivors of domestic assault), people with limited access to urgent care, people who mostly use condoms but infrequently do not, people who inject drugs and infrequently share paraphernalia, or people who may have an HIV exposure while travelling can benefit from PIP. 1 , 2 …”

“… 1 , 5 Many of these issues can be alleviated by advance prescription and procurement of PIP, which allows for referral to social work or community services to navigate assistance in acquiring medications. 1 , 2 …”

“…Patients should complete their PIP course before initiating PrEP; alternatively, patients may initiate PIP following the discontinuation of PrEP. 2 …”