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  ID Week
Oct 8-12 2014
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Three Quarters of NPEP Users Show Interest in Trying PrEP
  IDWeek 2014, October 8-12, 2014, Philadelphia
Mark Mascolini
Three quarters of men taking nonoccupational postexposure prophylaxis (NPEP) against HIV in a Boston study expressed interest in preexposure prophylaxis (PrEP), and the proportion interested in PrEP rose after they completed their NPEP course [1]. A separate retrospective study of NPEP at the same Boston center found that NPEP use climbed from about 50 courses per year in the early 2000s to 150 or more per year starting in 2010 [2].
Researchers at Boston's Beth Israel Deaconess Medical Center and collaborating institutions noted that people who use NPEP to prevent HIV acquisition often continue high-risk behavior and could be candidates for PrEP. Because little is known about factors that influence attitudes about PrEP in NPEP users, these investigators surveyed NPEP takers 14 and 90 days after they started taking NPEP as part of an ongoing study from March 1, 2013 to March 30, 2014.
The NPEP study recruited people 18 and older and gave them a 28-day course of tenofovir/emtricitabine plus elvitegravir/cobicistat. Follow-up continued for 90 days. The survey completed on day 14 addressed PrEP knowledge, where PrEP could be accessed, interest in PrEP, and barriers to using PrEP. The survey completed on day 90 addressed interest in using PrEP, where PrEP could be accessed, and barriers to using PrEP.
Forty-five people averaging 35.3 years in age completed the day 14 survey. Forty (89%) were men who have sex with men, 64% Caucasian, 13% Latino, 11% African American, and 4% Asian. Only 24% of survey respondents had never heard of PrEP, while 60% had heard about it at least 6 months ago and 16% within 6 months.
Among the 80% of participants with a primary care physician, 33% did not feel comfortable talking to that physician about PrEP, mostly because they felt uncomfortable about discussing sexual practices.
Thirty people completed both the day 14 survey and the day 90 survey. The proportion interested in starting PrEP rose from 59% at day 14 to 76% at day 90--after they had completed NPEP. While 95% of survey respondents believed they could access PrEP at a clinic serving MSM, 80% thought they could get PrEP at a sexually transmitted disease clinic or from their HIV provider, and 60% thought they could start PrEP with their primary care provider.
The Boston team concluded that most of these NPEP users have high interest in using PrEP, especially after completing NPEP. They recommended strengthening links between NPEP and PrEP programs and proactive discussions of PrEP with NPEP-experienced people by primary care providers. The investigators called for further qualitative studies "to assess facilitators and barriers to transitioning from NPEP to PrEP."
The retrospective NPEP analysis involved 894 people who took an NPEP regimen sometime from July 1997 through August 2013 [2]. Reflecting the demographics of the clinic, most NPEP users (92%) were men and most (88%) were MSM. Almost three quarters (71.5%) were white, 11% Latino, 7% African American, and 5% Asian.
NPEP use rose from a handful of courses in 1997 and 1998 to about 50 per year from 1999 through 2003. Starting in 2007, NPEP course rates rose from 100 yearly to about 150 or more yearly starting in 2010. Over the study period, use of zidovudine-based regimens dropped and use of tenofovir/emtricitabine regimens rose. Most people (61%) used NPEP after unprotected consensual sex, while 31% wanted NPEP after condom failure.
A multivariable logistic regression generalized estimating equation model identified two independent predictors of completing an NPEP regimen: Having a partner known to be HIV-positive almost doubled odds of completion (adjusted odds ratio 1.90, P = 0.03), while using three versus two antiretrovirals for NPEP lowered completion odds 55% (P = 0.005). Factors that did not affect NPEP completion included age, race, MSM status, tenofovir versus zidovudine, or calendar year.
The investigators concluded that "NPEP has been increasingly and repeatedly utilized, reflecting a subpopulation that may benefit from PrEP."
1. Jain S, Gregor C, Krakower D, et al. Attitudes and interest toward HIV pre-exposure prophylaxis among participants using HIV non-occupational post-exposure prophylaxis. IDWeek 2014. October 8-12, 2014, Philadelphia. Abstract 1523.
2. Jain S, Oldenburg C, Mimiaga M, et al. Longitudinal trends in HIV non-occupational post-exposure prophylaxis (NPEP) at a Boston community health center between 1997 and 2013. IDWeek 2014. October 8-12, 2014, Philadelphia. Abstract 1527.