Non-occupational post exposure prophylaxis (nPEP) is an effective HIV prevention strategy, yet implementation has been limited. To address this gap, the DC Department of Health launched a 24/7 clinician staffed nPEP telephone hotline paired with 5-7 day starter nPEP regimens through local contract pharmacies and follow up at a government run sexual health clinic. Callers who met nPEP CDC criteria, were located in DC, and were able to pick up a starter prescription or initiate nPEP at the clinic within 72 hours were eligible.
Four staff and two community trainings were conducted prior to project launch. Four strategically located contract pharmacies dispensed nPEP bridge prescriptions and were tested with secret shoppers prior to launch. A city-wide nPEP social media and advertising campaign was consecutively launched with the hotline. Modifications to planned implementation were tracked and communicated to partners consistently to ensure fidelity. Caller demographic data was collected and clinical data abstracted from the electronic medical record. Reach, Evaluation, Adoption, Implementation, and Maintenance (RE-AIM) framework was used to evaluate the implementation of the nPEP Hotline at 6 months.
Between 4/1/2021 and 9/16/2021 there were 338 callers; 59% (n=201/338) were eligible for nPEP and referred for nPEP initiation; 84% (n=173/201) attended an initial nPEP clinic consultation; 55% (n=95/201) attended a 28-day follow-up. Sixty-eight percent of those that followed-up at 28 days (n=65/95) transitioned to pre-exposure prophylaxis (PrEP). Seventy percent (n=141/201) of eligible callers received a bridge prescription and 30% (n=60) received same day nPEP at their intake visit. Forty-five percent (n=91/201) of referred individuals were located in ZIP codes representing DC’s top ten HIV incidence rates. Compared to individuals diagnosed with HIV in 2019, the nPEP cohort was more likely to be White than Latino/a/x (OR: 0.38 95% CI 0.19-0.75) or Black (OR: 0.12, 95% CI 0.064-0.21) with a larger proportion of White MSM (25.2%) than 2019 new diagnosis (7.3%), p<.001
The nPEP provider hotline was successfully launched and 6-month metrics indicate uptake among some priority populations in DC. However, uptake among the populations most impacted by HIV was not fully recognized. Current and future efforts will focus on increased awareness and uptake in priority populations, retention in care, and transitions to PrEP where indicated.