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Poster Presentations
PS02 – POSTER VIEWING SESSION – TUESDAY
Tuesday, July 16, 2019 5:45 PM – 7:00 PM
P428 HIV incidence, and pre- and post-exposure prophylaxis (PrEP and PEP) among PEP users at new york city sexual health clinics
Free
  1. Preeti Pathela1,
  2. Kelly Jamison2,
  3. Sarah Braunstein3,
  4. Christine Borges1,
  5. Rachael Lazar3,
  6. Demetre Daskalakis3,
  7. Susan Blank1
  1. 1New York City Department of Health and Mental Hygiene, Bureau of Sexually Transmitted Infections, New York City, USA
  2. 2New York City Department of Health and Mental Hygiene, Bureau of STI, New York City, USA
  3. 3New York City Department of Health and Mental Hygiene, New York City, USA

Abstract

Background Sexually transmitted disease clinics are well-suited to deliver PEP; few provide full courses (28 days) due to cost. Since 2016, NYC Sexual Health Clinic (SHC) staff have provided full-course PEP to eligible HIV-negative patients, and thereafter attempt linkage to PrEP. We examined HIV incidence and patterns of PrEP/PEP use among a PEP cohort.

Methods We matched men-who-have-sex-with-men (MSM) who received PEP at SHC (09/2016-05/2017) to the citywide HIV surveillance registry to identify new HIV diagnoses between last PEP event during this interval and 06/30/2018. We calculated HIV incidence with time-at-risk starting 28 days after PEP provision; periods of additional PEP supplied at SHC during follow-up were excluded from time-at-risk. We examined subsequent PrEP and repeat PEP use during follow-up. For MSM without PrEP/repeat PEP, we calculated the number-needed-to-treat (NNT) with PrEP for one year to prevent 1 HIV infection (assumed 73% efficacy with 90% adherence).

Results Eleven HIV diagnoses occurred among 520 MSM with 652 person-years (PY) follow-up; HIV incidence was 1.7/100PY (95%CI: 0.8–3.0), and highest among Hispanic MSM (2.6/100PY) and MSM aged<30 years (2.2/100PY). Median time to HIV diagnosis was 178 days (range 41–410). During follow-up, 18% (94/520) received PEP again (range 1-4 times), with 58% of PEP-repeaters (55/94) also given PrEP at some point. Of 460 MSM with SHC visits during follow-up, 202 were linked to or self-reported PrEP use, 200 were not linked to PrEP, and 58 declined navigation for PrEP. Of the 202 who linked to/self-reported PrEP use, 31 (15%) had subsequent PEP event(s) at SHC. Eight of 279 MSM without evidence of PEP/PrEP during follow-up were diagnosed with HIV (incidence=2.3/100PY); NNT=61.

Conclusion Despite PrEP availability, fewer than half of PEP patients took up PrEP and a substantial proportion took PEP repeatedly; research to elucidate underlying reasons for PrEP and PEP use patterns (insurance/cost, convenience, self-perceived risk) is warranted.

Disclosure No significant relationships.

  • ART
  • PrEP
  • prevention
  • intervention and treatment
  • HIV

https://doi.org/10.1136/sextrans-2019-sti.514

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