title: Transitioning to HIV Pre-Exposure Prophylaxis (PrEP) from Non-Occupational Post-Exposure Prophylaxis (nPEP) in a Comprehensive HIV Prevention Clinic: A Prospective Cohort Study.
abstract: The uptake of pre-exposure prophylaxis (PrEP) for HIV prevention remains low. We hypothesized that a high proportion of patients presenting for HIV non-occupational post-exposure prophylaxis (nPEP) would be candidates for PrEP based on current CDC guidelines. Outcomes from a comprehensive HIV Prevention Clinic are described. We evaluated all patients who attended the HIV Prevention Clinic for nPEP between January 1, 2013 and September 30, 2014. Each patient was evaluated for PrEP candidacy based on current CDC-guidelines and subjectively based on physician opinion. Patients were then evaluated for initiation of PrEP if they met guideline suggestions. Demographic, social, and behavioral factors were then analyzed with logistic regression for associations with PrEP candidacy and initiation. 99 individuals who attended the nPEP clinic were evaluated for PrEP. The average age was 32 years (range, 18-62), 83 (84%) were male, of whom 46 (55%) men who had have sex with men (MSM). 31 (31%) met CDC guidelines for PrEP initiation, which had very good agreement with physician recommendation (kappa=0.88, 0.78-0.98). Factors associated with PrEP candidacy included sexual exposure to HIV, prior nPEP use, and lack of drug insurance (p<0.05 for all comparisons). Combining nPEP and PrEP services in a dedicated clinic can lead to identification of PrEP candidates and may facilitate PrEP uptake. Strategies to ensure equitable access of PrEP should be explored such that those without drug coverage may also benefit from this effective HIV prevention modality.
authors.affiliation: 1 Department of Medicine, University of Toronto , Toronto, Ontario, Canada .
authors.forename: Reed A C
authors.initials: RA
authors.lastname: Siemieniuk
authors.affiliation: 1 Department of Medicine, University of Toronto , Toronto, Ontario, Canada .
authors.forename: Nirojini
authors.initials: N
authors.lastname: Sivachandran
authors.affiliation: 2 Immunodeficiency Clinic, Toronto General Hospital , Toronto, Ontario, Canada .
authors.forename: Pauline
authors.initials: P
authors.lastname: Murphy
authors.affiliation: 2 Immunodeficiency Clinic, Toronto General Hospital , Toronto, Ontario, Canada .
authors.forename: Andrea
authors.initials: A
authors.lastname: Sharp
authors.affiliation: 2 Immunodeficiency Clinic, Toronto General Hospital , Toronto, Ontario, Canada .
authors.forename: Christine
authors.initials: C
authors.lastname: Walach
authors.affiliation: 2 Immunodeficiency Clinic, Toronto General Hospital , Toronto, Ontario, Canada .
authors.forename: Tania
authors.initials: T
authors.lastname: Placido
authors.affiliation: 1 Department of Medicine, University of Toronto , Toronto, Ontario, Canada .|2 Immunodeficiency Clinic, Toronto General Hospital , Toronto, Ontario, Canada .|3 Divisions of General Internal Medicine and Infectious Diseases, University Health Network , Toronto, Ontario, Canada .
authors.forename: Isaac I
authors.initials: II
authors.lastname: Bogoch
mesh_terms: D000293:Adolescent; D000328:Adult; D000554:Ambulatory Care Facilities; D005260:Female; D015658:HIV Infections / Q000517:prevention & control*; D007722:Health Knowledge, Attitudes, Practice; D018451:Homosexuality, Male; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D056990:Post-Exposure Prophylaxis; D065129:Pre-Exposure Prophylaxis; D011446:Prospective Studies; D012309:Risk-Taking; D012959:Socioeconomic Factors; D047568:Unsafe Sex