The impact of the 2011 UK post-exposure prophylaxis for HIV following sexual exposure guidelines: a regional retrospective audit

Bennett, A; Wainwright, Emma; Lord, Emily; Oduru, Mamatha; Chen, F; Desmond, Nicola; Sherrard, Jackie; Duncan, Sarah

doi:10.1177/0956462414556329

Cited by 3 publications

(6 citation statements)

References 3 publications

(7 reference statements)

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“…Several national audits report that the attendance for follow‐up HIV testing at 12 weeks is poor (30–67%) [38‐44 so we suggest services use local mechanisms, including text/email reminders, to encourage attendance for post‐exposure HIV testing. The HIV test must be in a fourth‐generation laboratory assay.…”

Section: How To Provide Hiv Pepmentioning

confidence: 98%

UK guideline for the use of HIV post‐exposure prophylaxis 2021

et al. 2022

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We present the updated British Association for Sexual Health and HIV (BASHH) guidelines for post‐exposure prophylaxis (PEP) to HIV following sexual exposures, occupational exposures and other nonoccupational exposures in the community. This serves as an update to the 2015 BASHH guideline on PEP following sexual exposures and the 2008 Expert Advisory Group on AIDS guidelines on HIV PEP. We aim to provide evidence‐based guidance on best clinical practice in the provision, monitoring and support of PEP for the prevention of HIV acquisition following sexual, occupational and other nonoccupational exposures in the community. The guideline covers when to prescribe PEP, what antiretroviral agents to use and how to manage PEP. This includes (i) evidence of PEP efficacy; (ii) evidence relating to individual‐level efficacy of antiretroviral therapy to prevent the sexual transmission of HIV; (iii) data on the detectable (transmissible) prevalence of HIV in specific populations; (iv) risk of HIV transmission following different types of sexual and occupational exposure; (v) baseline risk assessment; (vi) drug regimens and dosing schedules; (vii) monitoring PEP; (viii) baseline and follow‐up blood‐borne virus testing; (ix) the role of PEP within broader HIV prevention strategies, for example, HIV pre‐exposure prophylaxis (PrEP). The guideline also covers special scenarios such as PEP in pregnancy, breastfeeding and chronic hepatitis B virus infection, and when PEP should be considered in people using HIV PrEP. The guidelines are aimed at clinical professionals directly involved in PEP provision and other stakeholders in the field. A proforma to assist PEP consultations is included. A public consultation process was undertaken prior to finalizing the recommendations.

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Section: How To Provide Hiv Pepmentioning

confidence: 98%

UK guideline for the use of HIV post‐exposure prophylaxis 2021

et al. 2022

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“…57 Worryingly, PEP completion rates to 28 days have been historically poor in the UK (range 42–82%). 58–67…”

Section: Factors Influencing the Efficacy Of Pepmentioning

confidence: 99%

“…Several national audits report that the attendance for follow-up HIV testing at 12 weeks is poor (30–67%). 61–67 Earlier testing at 8–12 weeks post-exposure may improve testing rates. The HIV test must be on a 4th generation laboratory assay.…”

Section: Monitoring and Follow-upmentioning

confidence: 99%

“…Observational studies have found 16.5% of PEP-recipients had an STI at baseline and an additional 4.1% had an incubating STI diagnosed at 2 weeks(116). As loss to follow-up is common in PEPrecipients we recommend opportunistic testing at baseline.Several national audits report that the attendance for follow-up HIV testing at 12 weeks is poor (30-67%)(61)(62)(63)(64)(65)(66)(67). Earlier testing at 8-12 weeks post-exposure may improve testing rates.…”

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confidence: 99%

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UK guideline for the use of HIV Post-Exposure Prophylaxis Following Sexual Exposure, 2015

Cresswell¹,

Waters²,

Briggs

et al. 2016

Int J STD AIDS

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We present the updated British Association for Sexual Health and HIV guidelines for HIV post-exposure prophylaxis following sexual exposure (PEPSE). This document includes a review of the current data to support the use of PEPSE, considers how to calculate the risks of infection after a potential exposure, and provides recommendations on when PEPSE should and should not be considered. We also review which medications to use for PEPSE, provide a checklist for initial assessment, and make recommendations for monitoring individuals receiving PEPSE. Special scenarios, cost-effectiveness of PEPSE, and issues relating to service provision are also discussed. Throughout the document, the place of PEPSE within the broader context of other HIV prevention strategies is considered.

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“…Although nPEP is used since the late 1990s [ 5 ], comprehensive data that address current sexual exposures to HIV care practices are limited [ 6 – 9 ], suggesting that it is often underused by men who have sex with men (MSM) [ 6 ]. Besides 8 to 20% of patients stop nPEP due to adverse events [ 10 – 13 ]. Recently, high-risk sexual behavior [ 14 ], not having a partner known to be HIV-infected and prescription of a three-drug regimen [ 15 ] have been associated with decreased adherence.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2015

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ObjectivesThe care of exposed individuals to HIV remains a challenge regarding follow-up completion and HIV-testing of the partner. Identifying patients with risk of not fulfilling HIV-testing follow-up completion (FC), among patients demanding non-occupational post-exposure prophylaxis (nPEP), may improve clinical practice.MethodsA retrospective chart review was conducted in a single French HIV-infection care center. FC predictors were assessed in a multivariate logistic regression model (Likelihood ratios test).ResultsBetween 2009 and 2013, 646 sexual exposures to HIV were evaluated for nPEP, of which 507 effectively received nPEP (78%). FC rate was 30% (194/646). In the multivariate analysis, FC rates rose with age of exposed individuals (OR, 1.04 [0.25–4.28]; p<0.001) and decreased with the year of sexual exposure (OR, 0.74 [0.65–0.85]; p<0.001). FC was associated with sexual encounter with a sex worker (OR, 4.07 [0.98–16.82]; p<0.001) and nPEP use (OR, 2.69 [2.37–3.06]; p<0.001). nPEP early discontinuation was associated with decreased FC rates (OR, 0.18 [0.08–0.39]; p<0.001). No documented nPEP failure was identified. However, five Men who have Sex with Men (MSM) nPEP recipients for unprotected anal receptive intercourse subsequently seroconverted to HIV more than 6 months after nPEP. Seroconversion to HIV was associated with the lack of FC (p = 0.04) and multiple presentations for nPEP over the study period (p = 0.002).ConclusionsWe identified significant predictors of not fulfilling sequential HIV-testing. They appear to be linked with a self-perceived HIV risk, especially in young adults recently exposed. Enhanced counseling in targeted individuals with high risk behaviors and using smartphone and internet-based strategies may be interesting retention in care options.

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The impact of the 2011 UK post-exposure prophylaxis for HIV following sexual exposure guidelines: a regional retrospective audit

Abstract: A re-audit of prescribing of post-exposure prophylaxis for HIV following sexual exposure in the Thames Valley demonstrated that an updated proforma has led to significant improvements in clinician-led outcomes, but had no impact on completion or follow-up rates.

Cited by 3 publications

References 3 publications

UK guideline for the use of HIV post‐exposure prophylaxis 2021

UK guideline for the use of HIV post‐exposure prophylaxis 2021

UK guideline for the use of HIV Post-Exposure Prophylaxis Following Sexual Exposure, 2015

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

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