500. Pre-exposure Prophylaxis for HIV prevention: the use and effectiveness of PrEP in the Veterans Health Administration (VHA)
Session: Poster Abstract Session: HIV Prep and PEP
Thursday, October 27, 2016
Room: Poster Hall
Posters
  • Van Epps_ID week Poster.pdf (741.1 kB)
  • Background:    Once daily Emtricitabine/Tenofovir (FTC/TDF) was FDA approved for pre-exposure prophylaxis (PrEP) in July 2012. VHA is the largest single provider of HIV care nationally yet PrEP remains unstudied within the VHA. We aim to characterize the regional patterns of PrEP uptake and the effectiveness of PrEP in the Veteran population.

    Methods: 

    VHA nationwide databases were queried to identify veterans with FTC/TDF prescriptions initiated between July 2012 and April 2016. Subjects with a diagnosis for HIV or chronic hepatitis B prior to the prescription, non-veterans, and those receiving FTC/TDF for non-occupational post exposure prophylaxis were excluded. We performed a nationwide chart review of 200 randomly selected subjects to obtain provider and behavioral data. 

    Results:  We identified 839 veterans who were initiated on FTC/TDF for PrEP indication nationally during the study period. VHA facilities in California had high numbers of PrEP starts (n = 264, 28% of starts). The number of PrEP starts increased yearly, from 44 in 2012 to 479 in 2015. Mean age among PrEP users was 41 years, ranging from 23-77. In our chart reviewed sample, a majority had 3 or more chronic conditions and was taking 3 or more chronic medications other than FTC/TDF. Men who have sex with men (MSM) at high risk for HIV acquisition was identified as the risk factor in 76% of subjects. An infectious disease specialist prescribed PrEP or was consulted to assess PrEP eligibility in 63% of the starts and greater adherence to prescribing and follow-up guidelines for PrEP was observed with this involvement. Three incident HIV infections occurred during the study period. All 3 subjects had the presence of M184V mutation conferring resistance to FTC. Three additional seroconversions were identified among PrEP users after discontinuation.

    Conclusion:  A marked increase in PrEP initiations from 2012 to 2015 was observed in the VHA. The majority of starts were clustered in a few cities/regions, most notably in California. Further efforts to effectively deliver PrEP to at-risk veterans should focus on moderate-to-high HIV prevalence regions and standardization of prescribing and follow-up procedures. Veterans receiving PrEP are older, with more chronic conditions than those who participated in the PrEP clinical trials.

    Brigid Wilson, PhD, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, OH, Will Garner, MD, Internal Medicine, University Hospitals Case Medical Center, Cleveland, OH, Marion Skalweit, M.D., Ph.D., Medicine, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, OH, Amy Hirsch, Pharm.D., BCPS, Pharmacy, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, OH and Puja Van Epps, MD, Geriatric Research Education & Clinical Center (GRECC), Louis Stokes Cleveland VA Medical Center, Cleveland, OH; Infectious Diseases and HIV Medicine, Case Western Reserve University, Cleveland, OH

    Disclosures:

    B. Wilson, None

    W. Garner, None

    M. Skalweit, None

    A. Hirsch, None

    P. Van Epps, None

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