Sex Transm Infect doi:10.1136/sextrans-2011-050371
  • Clinical
  • Original article

Adherence to HIV post-exposure prophylaxis in victims of sexual assault: a systematic review and meta-analysis

  1. Ruby Siddiqui2
  1. 1Imperial College London, St Mary's Hospital, London, UK
  2. 2Médecins Sans Frontières, Doctors without Borders (MSF-UK), London, UK
  3. 3Centre for Infectious Disease Epidemiology and Research, University of Cape Town, Cape Town, South Africa
  1. Correspondence to Dr Nathan Ford, Medical co-ordinator, Médecins Sans Frontières, Doctors without Borders (MSF-UK) 67-74 Saffron Hill, London EC1N 8QX, UK;{at}
  1. Contributors RS and LC conceived the review, carried out the search, study selection and data extraction. NF and MS provided critical input on the study design. NF undertook all statistical analyses and NF, RS and LC analysed the results. LC and RS drafted the manuscript. All authors provided critical input on subsequent drafts and approved the final version of the manuscript. RS is the guarantor.

  • Accepted 16 January 2012
  • Published Online First 13 February 2012


Objective To assess adherence to post-exposure prophylaxis (PEP) for the prevention of HIV infection in victims of sexual assault.

Methods The authors carried out a systematic review, random effects meta-analysis and meta-regression of studies reporting adherence to PEP among victims of sexual violence. Seven electronic databases were searched. Our primary outcome was adherence; secondary outcomes included defaulting, refusal and side effects.

Results 2159 titles were screened, and 24 studies matching the inclusion criteria were taken through to analysis. The overall proportion of patients adhering to PEP (23 cohort studies, 2166 patients) was 40.3% (95% CI 32.5% to 48.1%), and the overall proportion of patients defaulting from care (18 cohorts, 1972 patients) was 41.2% (95% CI 31.1% to 51.4%). Adherence appeared to be higher in developing countries compared with developed countries.

Conclusions Adherence to PEP is poor in all settings. Interventions are needed to support adherence.


  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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