Background
Nonoccupational post-exposure prophylaxis (nPEP) is a powerful biomedical intervention used to lower the risk of HIV transmission following potential exposure. It is underutilized due to barriers patients face accessing the medication within 72 hours after exposure and without prohibitive cost.
Methods
In April 2021, the District of Columbia Department of Health (DC Health), in partnership with MedStar Georgetown University Hospital, launched a hotline where callers possibly exposed to HIV can consult with a clinician 24 hours a day. If nPEP is indicated, the caller can receive a 5-day supply of nPEP from a partnering pharmacy and then seen at a clinic operated by DC Health within the next 5 days to receive lab testing, the remainder of the medications, and follow-up care after completing nPEP, including transition to pre-exposure prophylaxis (PrEP) if desired. All services are free of charge.
Results
In the first 30 months, the DC PEP Hotline received 838 calls and 632 (75.4%) callers initiated nPEP and attended an initial nPEP appointment at the clinic. 391 (61.8%) of callers who attended their initial nPEP appointment came for a post-nPEP appointment within 45 days. 14.1% of callers used PEP Hotline services more than once. Participants’ self-identified race was 35.3% Black, 39.7% White, 8.7% Asian, 12.7% other, 0.3% unknown; ethnically, 17.1% identified as Latino. 78.6% of the nPEP users identified as cisgender men, 18.7% as cisgender women, 1.4% as transgender women, 0.3% as transgender men and 1.0% as genderqueer. 272 (43.0%) of those who initiated nPEP (69.6% of those who completed nPEP) transitioned to PrEP. Cisgender men and transgender patients transitioned to PrEP at higher rates (76.2% and 100%) compared to cisgender women (34.3%) (p<0.01). Heterosexual patients were less likely to transition to PrEP (38.7%) compared to those who identified as lesbian, gay or homosexual (84.1%) or bisexual (78.8%) (p<0.01). 9% of the participants in the first 18 months of the program were diagnosed with a bacterial STI (gonorrhea, chlamydia, or syphilis) at their intake or follow-up visit. No HIV seroconversions were identified apart from one participant who acquired HIV four months after completion of nPEP.
Conclusions
Expanding access to nPEP beyond emergency departments and traditional medical settings can improve timely and equitable HIV prevention. A 24-hour PEP hotline can also serve as an effective tool for transitioning people at risk of HIV to PrEP and identifying STIs.