Background:
From January 2021, individuals attending a sexual health service in London, UK who receive HIV post-exposure prophylaxis following sexual exposure (PEPSE) are offered quick-start opt-out PrEP with a 1-month supply to take immediately following completion of PEP, PEP2PrEP, a risk reduction strategy for individuals with ongoing risk of HIV acquisition. We present the uptake of PrEP in GBMSM and transwomen attending our service for PEP and their subsequent PrEP follow-up.
Methods:
We performed a case note review of PEPSE recipients at our service from 1st March to 30th April 2022, collecting demographics, characteristics of the PEPSE risk, previous PrEP use and follow-up consultations up to 31st August 2023. Statistical analysis was done using chi-square and Mann-Whitney U tests.
Results:
282 GBMSM and 6 transwomen received PEPSE during March- April 2022. Median age was 29 y (IQR: 25-37 y). Primary PEPSE indication was condomless anal intercourse: receptive (244, 84.7%) and insertive (43; 14.9%) and receptive vaginal intercourse (1; 0.3%). During the encounter, 31 (10.8%) used chems, 63 (21.9%) had sex with more than one individual. 126 (43.8%) PEPSE recipients stated previous PrEP use. Common reasons for not using PrEP were: having no supply (38, 30.2%), on break (30, 23.8%), spontaneous sex (19, 15.1%), incorrect PrEP dosing requiring PEPSE (16, 12.7%), reason not given (23, 18.3%). 212 (73.6%) subsequently started PrEP. Of these, 114 (54.2%) reattended for a subsequent PrEP consultation in the follow-up period. PEPSE users who subsequently started PrEP compared with those who did not were more likely to have used PrEP previously (50.0% vs. 26.3%, p=0.00036) and to have had sex with multiple individuals during their PEPSE exposure (25.0% vs. 13.2%; p=0.036).
Conclusions:
Almost half of PEPSE recipients have previously used PrEP. The most common reason for not using PrEP was having no supply. In PEPSE recipients, the subsequent uptake of PrEP is high with a majority reattending for PrEP in the subsequent year. Efforts to increase retention in PrEP care are required for those with ongoing risk of HIV acquisition.