Predictors of Standard Follow-Up Completion after Sexual Exposure to HIV: Five-Year Retrospective Analysis in a French HIV-Infection Care Center

Gantner, Pierre; Treger, Michèle; Miscault, Constance De; Batard, Marie-Laure; Bernard-Henry, Claudine; Cheneau, Christine; Mautort, E de; Partisani, Marialuisa; Priester, M; Rey, David

doi:10.1371/journal.pone.0145440

Cited by 11 publications

(11 citation statements)

References 28 publications

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“…These low percentages are consistent with previous findings in PEP studies [17, 18]. Besides PEP prescription, good follow-up was previously found associated with older age and sexual encounter with a sex worker [19]. The completeness of HIV-testing follow-up could be increased by reducing the number of HIV testings with one HIV-serology testing 6 weeks after PEP completion, as proposed by the Swedish reference group for antiretroviral therapy [20], and targeting counseling to people receiving PEP.…”

Section: Discussionsupporting

confidence: 92%

Evaluation of tolerability with the co-formulation elvitegravir, cobicistat, emtricitabine, and tenofovir disoproxil fumarate for post-HIV exposure prophylaxis

et al. 2016

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BackgroundThe preferred regimen for HIV post-exposure prophylaxis (PEP) is based mainly on safety and tolerability because it is given to immunocompetent people without HIV infection for a limited time (28 days). The frequency of adverse events (AEs) may be > 60%. Although AEs are generally not severe, they can lead to lack of adherence and failure to complete the regimen. We evaluated the co-formulation elvitegravir, cobicistat, emtricitabine, and tenofovir disoproxil fumarate (Stribild®) prescribed as one pill taken once daily for HIV PEP in terms of tolerability and adherence.MethodsThis was a prospective cohort study conducted in one hospital in Paris (April to December 2015. Each participant receiving the PEP treatment (FTC-150 mg/TDF-245 mg/elvitegravir-200 mg/cobicistat 150 mg once daily) at the pharmacy of the hospital were recruited consecutively. A clinical visit was planned at 8 weeks after sexual exposure. Reminders were sent to participants who missed the appointment. A standardized questionnaire was administered to evaluate completeness and tolerability at week 8.ResultsOverall, 284 participants (86% men; 80% MSM; median age 30 years) were prescribed Stribild®; 50 stopped after reassessment of risk. Among 234 participants who effectively received PEP, 215 (92%) completed 28 days of PEP with only three who switched from Stribild® to another PEP because of side effects. More than 60% of participants reported at least one AE, which were mild to moderate. Fatigue, central neurological and abdominal side effects were the most frequently reported.ConclusionsStribild® seems to be a good option for HIV PEP due to the easiness of use, the side effects profile and the high completion rate.

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Section: Discussionsupporting

confidence: 92%

Evaluation of tolerability with the co-formulation elvitegravir, cobicistat, emtricitabine, and tenofovir disoproxil fumarate for post-HIV exposure prophylaxis

et al. 2016

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“…HIV-testing follow-up remained low (54%), as observed in other similar studies. [ 4 , 12 , 20 ] This could be ascribed to the availability of other avenues (anonymous test sites, private clinics, and hospitals) to get a follow-up HIV test. In this study, MSM was significantly associated with loss to follow-up.…”

Section: Discussionmentioning

confidence: 99%

“…[ 7 – 10 ] Follow-up rates of nPEP patients were documented to be between 30–54% and the suboptimal follow-up rate has been associated with being a female, self-pay, non-consensual sexual exposure, and non-adherence to nPEP. [ 11 , 12 ] Therefore, understanding the demographics of patients accessing nPEP, the accuracy of its prescriptions, as well as predictors of adherence and loss to follow-up (LTFU) may improve clinical practice and outcome.…”

Section: Introductionmentioning

confidence: 99%

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

Teo¹,

Tai²,

Chio³

et al. 2018

PLoS ONE

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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.

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“…This may contribute to the poor outcome in evaluation of PEP utilization in terms of follow-up and adherence, which is contrary to WHO and national guidelines. 1,4,12,17,36 Moreover, the national guideline recommends the ART clinic should have one trained physician/HO/nurse as the PEP focal person for the facility. The contact address of the facility PEP focal person and the facility ART nurse or any other second person assigned to coordinated PEP activity in the facility should be posted in all outpatient and inpatient departments within the health facility.…”

Section: Discussionmentioning

confidence: 99%

“…It shows that 36.9% were found to have inadequate knowledge about PEP for HIV. 36 Having 39.2% source persons being HIV-positive, plus unknown adherence and no follow-up may lead the exposed person to seroconvert.…”

Section: Discussionmentioning

confidence: 99%

<p>Evaluation of Post-Exposure Prophylaxis Utilization Among Human Immunodeficiency Virus Exposed Victims at University of Gondar Comprehensive Specialized Hospital, North West Ethiopia</p>

Temesgen

Weldu²,

Getahun³

et al. 2020

HIV

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Background: Human immunodeficiency virus (HIV) infection is a serious public health problem costing the lives of many people including healthcare workers worldwide. Ethiopia is one of the most seriously affected countries in sub-Saharan Africa, with a large number of people who are living with HIV/AIDS and AIDS-related deaths. Prevention of the virus transmission through the appropriate utilization of post exposure prophylaxis is one of the major strategies. Therefore, the aim of this study was to evaluate the utilization of postexposure prophylaxis (PEP) among victims of HIV at the University of Gondar Comprehensive Specialized Hospital, northwest Ethiopia. A retrospective cross-sectional study was conducted from May 17, 2018, to May 24, 2018 and descriptive statistics were carried out to analyze the Data using SPSS version 20. Results: From a total of 309 patients PEP was prescribed during the study period, of whom 239 (77.34%) were occupational victims and 55 (17.8%) were rape victims, with one missing data. Occupational victims were exposed by blood and blood product splashes and nurses and physicians were exposed almost equally, 14.24% and 13.92%, respectively. The majority of the victims were exposed at a health facility. Two hundred and eighty-five (92.23%) victims received prescriptions containing three-drug regimens, tenofovir + lamivudine + efavirenz, followed by 9 victims (2.91%) with two-drug regimens; zidovudine + lamivudine. There are no follow-up mechanisms as a result the completion rate and the outcome of PEP was not determined. Conclusion: PEP was initiated within 72 hr, most within 24 hr. The adherence was unknown with poor follow-up despite the strong recommendations of the national and WHO guidelines.

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Predictors of Standard Follow-Up Completion after Sexual Exposure to HIV: Five-Year Retrospective Analysis in a French HIV-Infection Care Center

Cited by 11 publications

References 28 publications

Evaluation of tolerability with the co-formulation elvitegravir, cobicistat, emtricitabine, and tenofovir disoproxil fumarate for post-HIV exposure prophylaxis

Evaluation of tolerability with the co-formulation elvitegravir, cobicistat, emtricitabine, and tenofovir disoproxil fumarate for post-HIV exposure prophylaxis

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

<p>Evaluation of Post-Exposure Prophylaxis Utilization Among Human Immunodeficiency Virus Exposed Victims at University of Gondar Comprehensive Specialized Hospital, North West Ethiopia</p>

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