Longitudinal Trends in HIV Non-Occupational Post-Exposure Prophylaxis (NPEP) at a Boston Community Health Center Between 1997 and 2013
Methods: A retrospective longitudinal study of electronic medical records of NPEP recipients between July, 1997 and August, 2013 was performed at a large community health center in Boston. Eligible participants were age ≥18 years, HIV-uninfected, and had sexual or non-occupational intravenous needle exposures. Logistic generalized estimating equation models were used to assess trends in NPEP prescriptions and factors associated with regimen completion.
Results: Data from 894 NPEP patients’ charts were analyzed. Almost all patients were male (92.4%), 5.9% female, 1.7% transgender/genderqueer, and 88.1% men who have sex with men. Most patients (71.5%) were Caucasian, 10.9% Latino/Hispanic, and 7.1% African-American. The mean age was 33.9 years. NPEP use increased over time and increasingly entailed Tenofovir instead of Zidovidine-based regimens (P<0.001); 19.3% had ≥2 NPEP visits. Of 1244 NPEP visits, exposures included: 92.7% consensual sex, 5.3% nonconsensual sex, and 1.1% intravenous needle exposure. Regimen completion was documented for 37.2%, non-completion in 6.2%, and unknown in 56.6% of visits. A known HIV-infected partner (AOR 2.00, 95%CI:1.11-3.60) and Tenofovir-based regimen (AOR 2.60, 95% CI:1.49-4.53) were associated with increased odds of completion. Three-drug regimens (AOR 0.44, 95% CI:0.25-0.77) were associated with decreased odds of completion compared to two-drug regimens. HIV incidence was 2.1 per 100 person-years (95%CI:1.5-2.9).
Conclusion: Many patients in this study demonstrated ongoing high-risk behavior, as manifested by recurrent NPEP and a high HIV incidence. Simpler and better-tolerated regimens are needed to optimize regimen completion. NPEP recipients may benefit from early HIV risk-reduction counseling and pre-exposure prophylaxis.
M. Mimiaga, None
K. Mayer, None