Objectives To explore the risk factors for, and clinical outcomes in men who have sex with men (MSM) prescribed HIV postexposure prophylaxis following sexual exposure (PEPSE) at sexual health clinics (SHCs) in England.
Methods National STI surveillance data were extracted from the genitourinary medicine clinic activity dataset (GUMCADv2) for 2011–2014. Quarterly and annual trends in the number of episodes where PEPSE was prescribed were analysed by gender and sexual risk. Risk factors associated with being prescribed PEPSE among MSM attendees were explored using univariable and multivariable logistic regression. Subsequent HIV acquisition from 4 months after initiating PEPSE was assessed using multivariable Cox proportional hazards models, stratified by clinical risk profiles.
Results During 2011–2014, there were 24 004 episodes where PEPSE was prescribed at SHCs, of which 69% were to MSM. The number of episodes where PEPSE was prescribed to MSM increased from 2383 in 2011 to 5944 in 2014, and from 1384 to 2226 for heterosexual men and women. 15% of MSM attendees received two or more courses of PEPSE. Compared with MSM attendees not prescribed PEPSE, MSM prescribed PEPSE were significantly more likely to have been diagnosed with a bacterial STI in the previous 12 months (adjusted OR (95% CI)—gonorrhoea: 11.6 (10.5 to 12.8); chlamydia: 5.02 (4.46 to 5.67); syphilis: 2.25 (1.73 to 2.93)), and were more likely to subsequently acquire HIV (adjusted HR (aHR) (95% CI)—single PEPSE course: 2.54 (2.19 to 2.96); two or more PEPSE courses: aHR (95% CI) 4.80 (3.69 to 6.25)). The probability of HIV diagnosis was highest in MSM prescribed PEPSE who had also been diagnosed with a bacterial STI in the previous 12 months (aHR (95% CI): 6.61 (5.19 to 8.42)).
Conclusions MSM prescribed PEPSE are at high risk of subsequent HIV acquisition and our data show further risk stratification by clinical and PEPSE prescribing history is possible, which might inform clinical practice and HIV prevention initiatives in MSM.
- POSTEXPOSURE PROPHYLAXIS (HIV)
- EPIDEMIOLOGY (CLINICAL)
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Handling editor Jackie A Cassell
Twitter Follow Nigel Field at @fienige
Contributors HM conducted the analyses and drafted the first version of the manuscript; MF contributed towards the analyses; all authors contributed towards the study design, interpretation of the data, iterations of the paper and approved the final version of the paper submitted for publication.
Funding This work was conducted by Public Health England (PHE) as part of routine public health surveillance.
Competing interests None declared.
Ethics approval As genitourinary medicine clinic activity dataset (GUMCADv2) is a routine public health surveillance activity, no specific consent was required from the patients whose data were used in this analysis. PHE has permission to handle data obtained by GUMCADv2 under section 251 of the UK National Health Service Act of 2006 (previously section 60 of the Health and Social Care Act of 2001), which was renewed annually by the ethics and confidentiality committee of the National Information Governance Board until 2013. Since then the power of approval of public health surveillance activity has been granted directly to PHE.
Provenance and peer review Not commissioned; externally peer reviewed.