title: Adherence to HIV postexposure prophylaxis: a systematic review and meta-analysis.
abstract: BACKGROUND
  We evaluated variations in completion rates for HIV postexposure prophylaxis (PEP) according to the exposure type (occupational, nonoccupational, and sexual assault), patient, and programme characteristics.
  
  
  METHODS
  Four major databases were searched together with conference abstract databases from inception to 1 December 2013, updated in PubMed on 1 June 2014. Randomized and nonrandomized studies reporting completion rates for PEP were included regardless of exposure type, age, or geographical location and data pooled using random-effects meta-analysis.
  
  
  RESULTS
  Ninety-seven studies, reporting outcomes on 21 462 PEP initiations, were reviewed. Nonoccupational exposure to HIV was the main reason for PEP in 34 studies (n = 11 840), occupational exposure in 22 studies (n = 3058), sexual assault in 26 studies (n = 3093), and the remainder of studies (15 studies, n = 3471) reported outcomes for mixed exposures. Overall, 56.6% [95% confidence (CI) 50.9-62.2%; τ(2) 0.25] of people considered eligible for PEP completed the full standard 28-day course. Compared with the overall estimate of PEP completion, rates were highest for studies reporting PEP for nonoccupational exposures (65.6%, 95% CI 55.6-75.6%) and lowest for sexual assault (40.2%, 95% CI 31.2-49.2%); higher rates of PEP completion were also reported for MSM (67.2%, 95% CI 59.5-74.9%). Completion rates appeared to be lower for adolescents (36.6%, 95% CI 4.0-69.2%) compared with adults (59.1%, 95% CI 53.9-64.2%) or children (64.0%, 95% CI 41.2-86.8%).
  
  
  CONCLUSIONS
  Adherence to a full 28-day course of antiretroviral drugs prescribed for PEP is poor. Efforts should be made to simplify guidelines for prescribers and support adherence for people taking PEP, with particular attention needed for adolescents and victims of sexual assault.
authors.affiliation: aDepartment of HIV/AIDS, World Health Organization Geneva, Switzerland bDepartment of Infectious Disease Epidemiology, Imperial College London, London, UK cStanford Prevention Research Center, Stanford University, Stanford, California, USA dHIV/AIDS Unit, Infectious Disease Service, Geneva University Hospital, Geneva, Switzerland.
authors.forename: Nathan
authors.initials: N
authors.lastname: Ford
authors.forename: Cadi
authors.initials: C
authors.lastname: Irvine
authors.forename: Zara
authors.initials: Z
authors.lastname: Shubber
authors.forename: Rachel
authors.initials: R
authors.lastname: Baggaley
authors.forename: Rachel
authors.initials: R
authors.lastname: Beanland
authors.forename: Marco
authors.initials: M
authors.lastname: Vitoria
authors.forename: Meg
authors.initials: M
authors.lastname: Doherty
authors.forename: Edward J
authors.initials: EJ
authors.lastname: Mills
authors.forename: Alexandra
authors.initials: A
authors.lastname: Calmy
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D005260:Female; D015658:HIV Infections / Q000517:prevention & control*; D006801:Humans; D007223:Infant; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D056990:Post-Exposure Prophylaxis / Q000379:methods*; D055815:Young Adult