Post-exposure prophylaxis to prevent HIV: new drugs, new approaches, and more questions

Mayer, Kenneth H; Allan-Blitz, Lao-Tzu

doi:10.1016/s2352-3018(23)00238-2

Cited by 6 publications

(1 citation statement)

References 56 publications

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“…Co-formulated regimens using integrase strand transfer inhibitors are well tolerated [ 58 ] and may simplify medication delivery. New regimens are also under investigation including long-acting injectable therapies, topical gels, and vaginal inserts [ 59 ], which might facilitate improved access and adherence to therapy. Formulations that are required to be prescribed in their original packaging might also limit practical mechanisms of medication adherence support (eg, pill boxes); drug manufacturers should consider provision of drug stability data where applicable to permit such adherence aids.…”

Section: Future Directionsmentioning

confidence: 99%

Missed Opportunities: A Narrative Review on Why Nonoccupational Postexposure Prophylaxis for HIV Is Underutilized

Allan-Blitz,

Mayer

2024

Open Forum Infectious Diseases

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Summary Post-exposure prophylaxis (PEP) is an important tool for preventing human immunodeficiency virus (HIV) infection, but remains underutilized. In this narrative review, we aim to summarize the frequency of missed opportunities for prescribing PEP among study from around the world, discuss the complexities of the challenges facing PEP provision, and describe possible solutions. We identified 20 studies published in the last 10 years among 43,832 individuals, of whom an estimated 41,477 were eligible for PEP. Of those eligible for PEP, PEP was prescribed among 27,705 (66.8%). There was a significant difference in PEP prescriptions between acute compared to non-acute care settings (63.5% vs 94.5%; p < 0.001). Emergent themes contributing to PEP underutilization included lack of provider and patient awareness, reduced PEP acceptability, HIV stigma and homophobia, lack of access (either to care or to medication), and stigmatizing policies. Each of these issues should be the focus of future PEP implementation efforts.

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Section: Future Directionsmentioning

confidence: 99%

Missed Opportunities: A Narrative Review on Why Nonoccupational Postexposure Prophylaxis for HIV Is Underutilized

Allan-Blitz,

Mayer

2024

Open Forum Infectious Diseases

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Occupational post‐exposure prophylaxis among healthcare workers: a scoping review of factors affecting optimal utilization

Auerbach,

Malone,

Forsyth

2024

J Int AIDS Soc.

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IntroductionPost‐exposure prophylaxis (PEP) is an efficacious prevention method when initiated promptly after an HIV exposure. Yet, PEP has been underutilized, even among healthcare workers (HCWs) with occupational exposure in sites with PEP policies and procedures and access to PEP medications. It is important to understand the dynamics of uneven PEP use in what appears to be an optimal context to better protect the health and wellbeing of HCWs.MethodsWe conducted a scoping review to elucidate factors influencing HCWs’ use of PEP after occupational exposure. We searched PubMed, PsychInfo and Google Scholar for peer‐reviewed literature published in English from 2014 to 2022 using the terms HIV, postexposure/post‐exposure prophylaxis, acceptability, healthcare workers, and values and preferences. An inductive narrative review of the resulting 53 studies identified core themes.ResultsNearly all studies (96%) with various HCW types and settings occurred in low‐ and middle‐income countries (LMICs) in Africa and Asia. Identified themes arrayed along a trajectory of PEP use experience: awareness/knowledge; acceptability; availability/access; uptake/use; adherence/completion. Across studies, awareness of PEP for HIV prevention was high, knowledge about drug regimens and healthcare facility policies was moderate to low; acceptability of PEP was moderate to high; PEP's perceived accessibility/availability was inconsistent and varied by geographic location and setting; HCWs’ uptake of PEP was low, affected by not knowing how to report an exposure and being unaware of PEP availability; and adherence/completion of PEP regimens was moderate to low, impeded by side effects and a belief that completing regimens was unnecessary to avert seroconversion. HCWs consistently expressed concern about HIV stigma.DiscussionFindings are limited by the inconsistent use of constructs across studies and a lack of clarity about reporting exposure events. Multi‐level approaches are needed to address the interplay of individual, social and structural barriers that diminish HCWs’ PEP use. Improved training, incident reporting, 24‐hour access to non‐stigmatizing PEP services and monitoring of adherence/completion are essential to optimizing HCWs’ PEP use.ConclusionsLessons from HCWs’ experience in LMICs may inform understanding of PEP under‐use among people in these settings with non‐occupational exposures.

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Assessment of Needlestick and Sharps Injuries (NSSIs) Amongst Orthopaedic Surgeons in Clinical Practice: A Pan-India Cross-Sectional Study

Jeyaraman,

Iyengar

et al. 2024

JOIO

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Post-exposure prophylaxis to prevent HIV: new drugs, new approaches, and more questions

Cited by 6 publications

References 56 publications

Missed Opportunities: A Narrative Review on Why Nonoccupational Postexposure Prophylaxis for HIV Is Underutilized

Missed Opportunities: A Narrative Review on Why Nonoccupational Postexposure Prophylaxis for HIV Is Underutilized

Occupational post‐exposure prophylaxis among healthcare workers: a scoping review of factors affecting optimal utilization

Assessment of Needlestick and Sharps Injuries (NSSIs) Amongst Orthopaedic Surgeons in Clinical Practice: A Pan-India Cross-Sectional Study

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