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Brief Report: Outcomes of Individuals Using HIV Postexposure Prophylaxis-In-Pocket ("PIP") for Low-Frequency, High-Risk Exposures in Toronto, Canada
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PIP is an effective HIV prevention modality for people with a low frequency of higher-risk HIV exposures that are often (but not always) unanticipated, who are interested in biomedical prevention strategies. Our data demonstrate the utility of PIP for HIV prevention in a cohort of 111 patients, with a combined total of 178.7 patient-years of PIP use, and the ability to seamlessly transition between PIP and PrEP based on shared decision-making between patients and their providers.
We envision PIP being a useful prevention strategy for individuals with infrequent HIV exposures who cannot or do not want to take daily PrEP, where on-demand PrEP may not be feasible or advised, or who face barriers accessing PEP, and who want autonomy and agency over their care. Qualitative studies are underway that assess the attitudes, beliefs, and acceptability of PIP. PIP is an innovative and useful HIV prevention modality for individuals with a low frequency of higher-risk HIV exposures.
Abstract
Background:
HIV postexposure prophylaxis-in-pocket ("PIP") is a self-initiated, event-driven HIV prevention modality for individuals with a low frequency of HIV exposures.
Methods:
A cohort of 111 patients using PIP as their primary HIV prevention modality was longitudinally evaluated for PIP self-initiation, HIV and sexual transmitted infections, and switching to other HIV prevention modalities between February 2016 and December 2022.
Results:
A total of 111 patients had 178.7 cumulative patient-years of PIP use. PIP was self-initiated 69 times by 35 (31.5%) individuals, with 0 HIV seroconversions identified. Thirty four individuals (30.6%) transitioned from PIP to pre-exposure prophylaxis and 33 individuals (29.7%) switched from pre-exposure prophylaxis to PIP.
Conclusions:
PIP is a useful addition to other pharmacologic HIV prevention tools, and may help prevent infection in those with a lower frequency of unanticipated HIV exposures.
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