Nurse-Led HIV PEP Program Used by Men at High Risk for HIV Seroconversion

Abstract

We trialed a nurse-led HIV postexposure prophylaxis (PEP) program in two sexually transmitted infection clinics in Ottawa, Canada. From September 5, 2013 to September 4, 2015, 112 persons sought PEP: 103 were male, of whom 84 were men who have sex with men (MSM). Seventy-two patients (59 MSM) initiated PEP; 11 were diagnosed with HIV: 6 diagnoses occurred during initial assessment (all MSM; 1 also shared injection equipment); 5 MSM were diagnosed with HIV within 1 year of seeking PEP. This level of positivity indicated that, when access is facilitated, individuals at high risk of HIV seek PEP. However, the 8.5% of MSM who seroconverted within a year of taking PEP demonstrated that this group remained at risk and needed additional prevention services. Delivery of PEP should include provision of medication, as well as an opportunity to address individual-level HIV risk strategies and population-level syndemic conditions that contribute to ongoing HIV transmission among MSM.

HIV PEP and Nursing Scholarship: A Review of Critical Theory and Social Justice

“…This last group was precisely the subset of patients we sought to help with the grant: those affected by HIV who not only belonged to a marginalized group (mostly men who have sex with men and persons who inject drugs), but also were disadvantaged socioeconomically and unable to afford PEP. Another noteworthy outcome was that 9.8% of the patients who sought PEP through our program were diagnosed with HIV, accounting for nearly 7% of HIV diagnoses that occurred in Ottawa during the study period (O'Byrne, MacPherson & Orser, 2018;O'Byrne, MacPherson, Roy & Orser, 2017). This finding further supported the importance of providing equitable HIV prevention to this small group of individuals who needed PEP.…”

Immediate PrEP after PEP: Results from an Observational Nurse-Led PEP2PrEP Study

“…This rate of access and uptake, plus the client demographics of these patients, also resembles our published data on this clinical service. For more information on this PEP program and its participants and outcomes, please see O’Byrne et al 3 , 14 …”

“…Our rationale is that, before PrEP, approximately 13.1% of gay men who obtained PEP from our STI clinic were diagnosed with HIV within 12 months of using PEP. 3 We, therefore, feel that a single episode of PEP use justifies PrEP use.…”

“…Persons who use post-exposure prophylaxis (PEP), which is the use of antiretroviral medications after a potential HIV exposure to prevent seroconversion, are vulnerable to HIV acquisition in the past, present, and future: (1) in the past—this is why PEP is used; (2) in the present—PEP can fail, and did so at a rate of 19% in the only case–control study to evaluate its efficacy, 1 yet at rates of less than 5% to 10% in subsequent observation studies 2 ; and (3) in the future—because studies have found diagnosis rates of up to 13% among gay men within 12 months of PEP use among patients who used this intervention. 3 This last point has led some guidelines to suggest that PEP use more than once warrants pre-exposure prophylaxis (PrEP), which is the use antiretroviral medications before a potential HIV exposure to prevent seroconversion. 4 , 5 The possibility of HIV acquisition in the near future (eg, less than 12-month period) after PEP use has also led the United States Centers for Disease Control and Prevention 4 and the International Antiviral Association (USA Panel) 6 to recommend immediate PEP-to-PrEP (PEP2PrEP) transitions, such that persons who use PEP start PrEP without interruption in drug therapy.…”

PrEP-RN

“…Although the U.S. and Canadian guidelines recommend PrEP for persons who use PEP more than once, we feel a single use warrants an offer of PrEP (Centers for Disease Control and Prevention, 2018a; Tan et al, 2017). Of 84 MSM who sought and completed a single course of PEP in our nurse-led PEP program, 9% went on to acquire HIV within 12 months due to ongoing risks and exposures (O'Byrne, MacPherson, & Orser, 2018). Notably, these diagnoses were not PEP failures but the outcome of subsequent HIV exposures (O'Byrne et al, 2018).…”