Non-occupational post exposure prophylaxis as a biobehavioral HIV-prevention intervention

This project evaluated the feasibility and safety of a community-planned and financed program of non-occupational post exposure prophylaxis (nPEP) for 100 individuals. Individuals seeking nPEP within 72 hours of a potential HIV exposure were provided 28-day treatment using twice-daily lamivudine and zidovudine. Participants received a physical examination, HIV test and medications and were scheduled for follow-up counseling and data visits to 26-weeks. Results showed participants were highly educated (mean = 14.7 years), gay identified (63%), males (95%) who experienced an atypical, high-risk sexual event. Two participants tested HIV-positive at intake, who were previously unaware of their HIV status. The strongest demand (31% of cases) was on Mondays. The index event for the majority of cases (58%) involved unprotected anal sex, with 18% reporting condom failures. Only 15% tested positive for illicit drugs at initial visit. Of those dispensed the full 28 days of medication (n=84), 63 successfully completed the treatment course (75%). Retention dropped rapidly after the initial study visit, with only 49% completing a 26-week follow-up visit. No incident seroconversions were observed. That 75% of participants completed a full course of nPEP adds to the emerging evidence regarding nPEP feasibility. This project demonstrates the need for further research in the implementation of nPEP as a biobehavioral strategy for high-risk groups within a comprehensive HIV-prevention plan.