Patients receiving starter packs of PEP may not complete the full course and non-completers may have a disproportionately high risk of acquiring HIV. This analysis examined factors associated with medication-completion and HIV incidence in patients receiving HIV PEP starter packs.
We analyzed data on HIV-negative men who have sex with men (MSM) who received PEP starter packs at NYC sexual health clinics from April 2014-December 2015. PEP criteria were: anal/vaginal sex with an HIV-positive partner, condomless receptive anal sex (RAI) with a person of unknown HIV status, shared injected drugs with an HIV-positive person, or sexual assault <36 hours prior to clinic visit. Patients received 3 days of PEP on-site and were referred out for the remaining medication. We gathered follow-up information from both patients and providers to ascertain completion. All demographic, risk and completion information was recorded in the electronic medical record. We used multivariable regression to identify patient demographic and risk-related correlates of completion. We measured HIV incidence among patients with PEP completion information via a match with NYC HIV surveillance data through December 2016.
421 MSM received PEP starter packs; the majority were Black or Hispanic (56%) and <30 years (58%). Most reported either sex with an HIV-positive partner (47%) or condomless RAI with a partner of unknown status (47%.) Of patients for whom we had completion information (80%); 77% (257/335) reported completing the PEP course. Completion was not significantly associated with age, race, PEP criteria category, or STI diagnosis on day of clinic visit. There were 13 new HIV diagnoses for an overall HIV incidence of 2.1 per 100 person-years (PY), with higher incidence among non-Hispanic black MSM (3.5/100 PY; 95% CI: 1.3-7.8) and MSM under 30 (2.5/100 PY, 95% CI: 1.2-4.6). HIV incidence was lower among completers (1.7/100 PY, 95% CI: 0.8-3.2) than among non-completers (3.4/100 PY, 95% CI: 1.3-7.6), however, this was not a statistically significant difference.
Most patients who received starter packs completed full course PEP. HIV incidence was lower but not significantly different for completers versus non-completers. PEP starter packs are a viable option for those with a high risk of HIV acquisition who may also face barriers to accessing medication elsewhere. Because of continued HIV risk behavior, linkage to PrEP or other prevention is a key intervention following PEP.