The Danish PEP Registry: Experience With the Use of Postexposure Prophylaxis (PEP) Following Sexual Exposure to HIV From 1998 to 2006

Lunding, Suzanne; Katzenstein, Terese L.; Kronborg, Gitte; Lindberg, Jens; Jensen, Jeanette Dupont; Nielsen, Henrik; Pedersen, Court; Jørgensen, Lars

doi:10.1097/olq.0b013e3181b6f284

Cited by 26 publications

(28 citation statements)

References 24 publications

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“…Study settings included sexual assault services4 7 15 20–22 25 28 29 34 35 and hospital emergency departments 3 8 37–39. In three studies, data were obtained from PEP databases and sexual assault was studied as a subgroup of ‘sexual exposure’ or ‘non-occupational exposure’ 26 27 30. Eight studies were conducted in developing countries 4 24 25 32–36.…”

Section: Resultsmentioning

confidence: 99%

Adherence to HIV post-exposure prophylaxis in victims of sexual assault: a systematic review and meta-analysis

et al. 2012

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ObjectiveTo assess adherence to post-exposure prophylaxis (PEP) for the prevention of HIV infection in victims of sexual assault.MethodsThe authors carried out a systematic review, random effects meta-analysis and meta-regression of studies reporting adherence to PEP among victims of sexual violence. Seven electronic databases were searched. Our primary outcome was adherence; secondary outcomes included defaulting, refusal and side effects.Results2159 titles were screened, and 24 studies matching the inclusion criteria were taken through to analysis. The overall proportion of patients adhering to PEP (23 cohort studies, 2166 patients) was 40.3% (95% CI 32.5% to 48.1%), and the overall proportion of patients defaulting from care (18 cohorts, 1972 patients) was 41.2% (95% CI 31.1% to 51.4%). Adherence appeared to be higher in developing countries compared with developed countries.ConclusionsAdherence to PEP is poor in all settings. Interventions are needed to support adherence.

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Section: Resultsmentioning

confidence: 99%

Adherence to HIV post-exposure prophylaxis in victims of sexual assault: a systematic review and meta-analysis

et al. 2012

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“…This, of course, leaves aside those studies that focus on individuals actively seeking nPEP [8][9][10][11], who obviously know of its existence.…”

Section: Discussionmentioning

confidence: 99%

“…A number of authors have attempted to characterize the types of person requesting nPEP at health care facilities [8][9][10][11]. Other studies have examined the knowledge that potential users have of its existence.…”

Section: Introductionmentioning

confidence: 99%

“…Those who might need nPEP should be made aware of its existence, and request it immediately after high-risk exposure or condom failures (the frequency of which is not negligible) [7]. A number of authors have attempted to characterize the types of person requesting nPEP at health care facilities [8][9][10][11]. Other studies have examined the knowledge that potential users have of its existence.…”

Section: Introductionmentioning

confidence: 99%

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Awareness and use of nonoccupational HIV post‐exposure prophylaxis among people receiving rapid HIV testing in Spain

Fernández-Balbuena¹,

Belza²,

Castilla³

et al. 2012

HIV Medicine

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ObjectivesThis paper examines the awareness and use of nonoccupational HIV post-exposure prophylaxis (nPEP) in Spain, and the factors that influence this awareness. MethodsBetween June 2009 and July 2010, a mobile unit offered free, rapid HIV tests in a number of Spanish cities. A total of 2545 people were passively recruited and tested, and answered a self-administered questionnaire containing sociodemographic, behavioural and nPEP-related questions. Bivariate and multivariate analyses were performed, stratifying by gender/sexual behaviour. ResultsSome 34% of the responders were men who have sex with men (MSM), 30% were men who have sex exclusively with women (MSW), and 35% were women. Approximately 26% were foreigners, 46% had a university degree, and 51% had previously taken an HIV test. Overall, 22% were aware of nPEP. Only 2% had ever used it; 70% of these after high-risk sexual intercourse. Awareness was higher among MSM (34%) than women (16%) and MSW (15%). Multivariate analysis showed a lack of nPEP awareness to be associated with being born in Latin America, while awareness increased with the number of previous HIV tests among women and MSW. In MSM, awareness was also associated with having a university degree, the degree of interaction with gay culture, number of partners, and use of the internet as the main way of meeting partners. ConclusionsnPEP awareness in the studied population was unacceptably low. The promotion of its availability should be made a major objective of prevention programmes, as a complementary measure to condom use.Keywords: education, HIV, preventive measures, prophylaxis, public health policy. Accepted 11 September 2012 IntroductionNonoccupational HIV post-exposure prophylaxis (nPEP) has been recommended since 1998 [1]. Guidelines for its use exist in almost every country [2][3][4], and in some, including Spain, nPEP is available at no charge in emergency rooms. The cost-effectiveness of nPEP has been demonstrated, especially for high-risk groups [5] there was some initial concern that being aware of nPEP might encourage high-risk behaviour, the evidence shows this fear to have been unfounded [6]. Those who might need nPEP should be made aware of its existence, and request it immediately after high-risk exposure or condom failures (the frequency of which is not negligible) [7]. A number of authors have attempted to characterize the types of person requesting nPEP at health care facilities [8][9][10][11]. Other studies have examined the knowledge that potential users have of its existence. However, most of these studies have focused entirely on men who have sex with men (MSM) [9,[12][13][14][15], while others have concentrated on HIV-positive persons [16]; almost none have dealt with other groups [17], even though nPEP is being indicated mostly in heterosexual exposure to HIV [9,10].The present study assessed the knowledge and use of nPEP among a more heterogeneous population, including HIV-negative men and women of different sexual orientation and with different sexual behaviour...

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“…A survey of New York State Emergency Department physicians in 2006 further indicated that a lack of resources and physician education were associated with low rates of provision of NPEP [8]. There are no recent longitudinal reports of trends in NPEP use in the United States, though other settings have been observing a rise in NPEP utilization over time [9–12]. …”

Section: Introductionmentioning

confidence: 99%

Practical guidance for nonoccupational postexposure prophylaxis to prevent HIV infection

Jain

Mayer

2014

Aids

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Postexposure prophylaxis (PEP) with antiretroviral medication has been used as an HIV-prevention strategy for nearly 20 years. The fact that approximately 50 000 new HIV infections occur in the United States each year reflects marked underutilization of nonoccupational PEP (NPEP). There have been several advances in NPEP in the past 10 years. Clinical trials from different countries have demonstrated better tolerability, completion rates, and fewer drug–drug interactions with newer antiretroviral agents. Notably, there has been a shift from zidovudine-based to tenofovir-based regimens. Three-drug therapy is now favored for all potential HIV exposures. More recently, the US Public Health Service and the New York State Department of Health recommended tenofovir/emtricitabine and raltegravir as the first-line regimen universally for PEP. Advances in HIV testing technology may also allow shorter duration of follow-up HIV testing after a high-risk exposure. This review will discuss challenges with previously recommended regimens, newer potential candidate agents and the rationale for using them, intervals for laboratory monitoring, and cost considerations for NPEP. NPEP can be viewed as an educable moment and a potential bridge to preexposure prophylaxis, as part of a combination prevention package, for those who are likely to have recurrent higher-risk exposures. Thus, risk-reduction counseling should be an integral aspect of NPEP.

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The Danish PEP Registry: Experience With the Use of Postexposure Prophylaxis (PEP) Following Sexual Exposure to HIV From 1998 to 2006

Abstract: This nationwide study showed a steady but moderate increase in the use of PEP after sexual HIV-exposure from 1998 to 2006. Time to initiation of PEP was low and the PEP prescription practice was targeted toward high risk exposures.

Cited by 26 publications

References 24 publications

Adherence to HIV post-exposure prophylaxis in victims of sexual assault: a systematic review and meta-analysis

Adherence to HIV post-exposure prophylaxis in victims of sexual assault: a systematic review and meta-analysis

Awareness and use of nonoccupational HIV post‐exposure prophylaxis among people receiving rapid HIV testing in Spain

Practical guidance for nonoccupational postexposure prophylaxis to prevent HIV infection

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