Abstract Body

Background:

Pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP) are two established methods to prevent HIV acquisition. However, the suitability of these tools for individuals with infrequent, higher-risk HIV exposures might be limited due to cost, high pill burden, or barriers to care. HIV post-exposure prophylaxis-in-pocket (PIP) involves prospectively identifying individuals with a low frequency of high-risk exposures and providing them with 28 days of PEP medication before an exposure occurs, along with instructions on when to initiate medications and how to follow up with care. We present long-term follow-up of a cohort of patients provided with PIP for HIV prevention.

Methods:

We conducted a retrospective evaluation of the clinical characteristics and outcomes of patients who used PIP as their primary HIV prevention method. Patients referred for PrEP or PEP care were offered the option of PIP if they reported an ongoing risk of low frequency (0-4 per year), high-risk HIV exposures of any type. Importantly, HIV prevention method was chosen based on shared decision-making between patients and clinicians and was outside the realm of this study. Typical PIP regimens prescribed include Biktarvy® and tenofovir disoproxil fumarate/emtricitabine plus dolutegravir. Patients were followed at regular 4-6 months intervals. Demographic and clinical information was collected from two large HIV-prevention and care centres in Toronto, Canada between January 2016 and June 2022.

Results:

PIP was prescribed to 109 patients, who were followed for a total of 168 patient-years. The average age was 37 years-old (range 20-69), with 106 (97.2%) patients assigned male at birth. Thirty-three (30.3%) patients self-initiated a total of 59 courses of PIP during the observation period. Patients fluidly transitioned between HIV prevention modalities as circumstances warranted: 34 (31.2%) changed from PIP to PrEP, and 32 individuals (29.4%) changed from PrEP to PIP.. There were 13 episodes of bacterial sexually transmitted infections in 9 individuals (8.3%) using PIP. No HIV seroconversions were detected.

Conclusions:

PIP is an innovative and useful HIV prevention modality for individuals with a low frequency of higher-risk HIV exposures. Patients may transition between PIP and PrEP based on evolving HIV risk. PIP may be included with PEP and PrEP as a biomedical HIV prevention option for HIV-negative individuals at risk for infection.