Predictors of time to access to HIV post-exposure prophylaxis: a prospective observational study evaluating the characteristics of HIV-exposure and some syndemic clinical conditions

Enrique CASALINO, Donia BOUZID, Stephanie ANTONIOL, Adriana PINTO, Christophe CHOQUET, Laurent PEREIRA, Thomas PAVLOVSKY, Vittiaroat ING, Yazdan Yazdanpanah, Jade GHOSN, Daniel Aiham GHAZALI

Resumen


Objective: A time delay between HIV exposure and post-exposure prophylaxis (PEP) less than 4h is currently considered as a determinant of PEP efficacy. Aim was to evaluate the factors associated with HIV-exposure to ED arrival (HIV-exposure-to-ED) over 4hr were

Methods: A prospective observational study from January 1st, 2016 to December 31st, 2017 in Bichat academic hospital ED (Paris, France). Healthcare workers with HIV-exposure, other occupational or non-occupational exposures, and sexual exposures were included.

Results: 1,475 patients were included, and 598 of them completed a survey. An HIV-exposure-to-ED delay ≥4h was associated with the type of HIV exposure: healthcare workers (HCWs), other occupational, and sexual (p=0.00000002). Some differences were found between sexual and occupational exposures respectively: knowledge of PEP plan: 65.2% vs. 46.9% (p=0.00001), previous PEP program use: 23.9% vs. 13.1% (p=0.001), alcohol use: 36.2% vs. 18.5% (p=0.000001), drug use: 34.6% vs. 8.6% (p=0.000001), and chemsex: 26.1% vs. 0% (p=0.000001). The following were predictors of HIV exposure-to-ED delays ≥4hr: knowledge of the PEP plan (p=0.0007), previous PEP plan use, drugs, and chemsex for sexual exposure, and knowledge of PEP program (p=0.0000001) and drug use (p=0.000001) for occupational exposure.

Conclusion: HIV exposure-to-ED delay is longer among sexual than occupational exposure groups. Moreover, knowledge of the program and its previous access were major determinants of a shorter delay to access the PEP program. Finally, among sexually exposed persons, syndemic clinical conditions such as alcohol, drug, and chemsex usage, notably among men having sex with men (MSMs), are strongly associated with an increased delay.


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UNAIDS. Fact sheet - Latest statistics on the status of the AIDS epidemic. 2018. http://www.unaids.org/sites/default/files/media_asset/UNAIDS_FactSheet_en. Accessed January 10, 2020.

World Health Organization. World Health Organization. Fact sheet. HIV / AIDS. 2018. http://www.who.int/news-room/fact-sheets/detail/hiv-aids. Accessed January 10, 2020.

Center for Diseases Control. HIV transmission. 2018. https://www.cdc.gov/hiv/basics/transmission.html. Accessed January 10, 2020.

World Health Organization. The world health report. Reducing risks, promoting healthy life. Chapter 4 Quantifying Selected Major Risks to Health. 2002. http://www.who.int/whr/2002/en/whr02_en.pdf?ua=1. Accessed January 10, 2020.

Kuhar DT, Henderson DK, Struble KA, et al. US Public Health Service Working Group. Updated. US Public Health Service guidelines for the management of occupational exposures to human immunodeficiency virus and recommendations for postexposure prophylaxis. Infect Control Hosp Epidemiol. 2013;34(9):875–92.

Krakower DS, Jain S, Mayer KH. Antiretrovirals for primary HIV prevention: the current status of pre- and post-exposure prophylaxis. Curr HIV/AIDS Rep. 2015;12(1):127–38.

Marfatia YS, Jose SK, Baxi RR, Shah RJ. Pre- and post-sexual exposure prophylaxis of HIV: An update. Indian J Sex Transm Dis. 2017;38(1):1–9.

Prise en charge médicale des personnes vivant avec le VIH. Prise en charge des accidents d’exposition sexuelle et au sang (AES) chez l’adulte et chez l’enfant. 2017. https://cns.sante.fr/wp-content/uploads/2017/10/experts-vih_aes.pdf. Accessed January 10, 2020.

Documento de consenso sobre Profilaxis postexposición ocupacional y no ocupacional en relación con el VIH, VHB y VHC en adultos y niños. 2015. https://www.mscbs.gob.es/ciudadanos/enfLesiones/enfTransmisibles/sida/publicaciones/profSanitarios/postexposureProphylaxisHIV.pdf. Accessed December 18, 2019.

Organization Mondiale de la Santé. Guidelines on post-exposure prophylaxis for HIV and the use of co-trimoxazole prophylaxis for HIV-related infections among adults, adolescents and children. Recommendations for a public health approach - December 2014 supplement to the 2013 consolidated ARV guidelines. 2014. https://apps.who.int/iris/bitstream/handle/10665/145719/9789241508193_eng.pdf;jsessionid=1434C5807A76FF85A4AB875CE1EA6465?sequence=1. Accessed January 10, 2020.

Center for Diseases Control. Updated Guidelines for Antiretroviral Postexposure Prophylaxis After Sexual, Injection Drug Use, or Other Nonoccupational Exposure to HIV—United States, 2016. https://stacks.cdc.gov/view/cdc/38856. Accessed January 10, 2020.

British HIV Association. UK National Guideline for the Use of HIV Post-Exposure Prophylaxis Following Sexual Exposure (PEPSE) 2015. https://www.bashh.org/documents/PEPSE%202015%20guideline%20final_NICE.pdf. Accessed January 10, 2020.

Libois A, Florence E, Derdelinckx I, et al. Belgian guidelines for non-occupational HIV post-exposure prophylaxis 2017. Acta Clin Belg. 2018;73(4):275–280.

Centre régional d'information et de prévention du sida et pour la santé des jeunes (CRISP). Regional Information and Prevention Center for AIDS and Youth Health (CRISP). http://www.lecrips-idf.net/miscellaneous/decryptage-traitement-post-exposition-vih.htm. Accessed January 10, 2020.

Instruction Inter Ministérielle N° DGS/SP2/PP2/DGOS/PF2/DSS/1C/DGT/CT2/2019/45 du 25 février 2019 relative aux recommandations de prise en charge des accidents d'exposition au sang et aux liquides biologiques (AES) survenant dans un environnement professionnel et des accidents d'exposition sexuelle. 2019. http://circulaire.legifrance.gouv.fr/pdf/2019/05/cir_44696.pdf. Accessed January 10, 2020.

Stanley K, Lora M, Merjavy S, et al. HIV Prevention and Treatment: The Evolving Role of the Emergency Department. Ann Emerg Med. 2017;70 (4):562–572.

Méconnaissance du traitement post-exposition à un risque de contamination par le sida. 2012. https://www.senat.fr/questions/base/2012/qSEQ120701043.html. Accessed January 10, 2020.

Morrison SA, Yoong D, Hart TA, et al. High prevalence of syndemic health problems in patients seeking post-exposure prophylaxis for sexual exposures to HIV. PLoS One. 2018;13(5):e0197998.

Garvey P, Thornton L, Lyons F. Knowledge of HIV PEP Among Healthcare Workers in Ireland, 2016: Room for Improvement. Ir Med J. 2017;110(1):502.

Makhado L, Davhana-Maselesele M. Knowledge and uptake of occupational post-exposure prophylaxis amongst nurses caring for people living with HIV. Curationis 2016;39(1):1593.

Aminde LN, Takah NF, Dzudie A, et al. Occupational post-exposure prophylaxis (PEP) against human immunodeficiency virus (HIV) infection in a health district in Cameroon: assessment of the knowledge and practices of nurses. PLoS One. 2015;10(4):e0124416.

Beltzer N, Saboni L, Sauvage FC, Sommen C, Groupe KABP. Observatoire Régional de Santé Ile de France. Les connaissances, attitudes, croyances et comportements face au VIH / sida en Ile-de-France en 2010. 2011. http://www.ors-idf.org/dmdocuments/Rapport_KABP_IDF_2004.pdf. Accessed January 10, 2020.

Minas B, Laing S, Jordan H, et al. Improved awareness and appropriate use of non-occupational post-exposure prophylaxis (nPEP ) for HIV prevention following a multi-modal communication strategy. BMC Public Health. 2012;12:906.

Rey D, Bouhnik AD, Peretti-Watel P, Obadia Y, Spire B; VESPA Study Group. Awareness of non-occupational HIV postexposure prophylaxis among French people living with HIV: the need for better targeting. AIDS 2007;21 Suppl 1:S71–6.

Koblin BA, Usher D, Nandi V, et al. Post-exposure Prophylaxis Awareness, Knowledge, Access and Use Among Three Populations in New York City, 2016-17. AIDS Behav. 2018;22(8):2718–2732.

Mehta SA, Silvera R, Bernstein K, Holzman RS, Aberg JA, Daskalakis DC. Awareness of post-exposure HIV prophylaxis in high-risk men who have sex with men in New York City. Sex Transm Infect. 2011;87(4):344–8.

Joshi M, Basra A, McCormick C, Webb H, Pakianathan M. Post-exposure prophylaxis after sexual exposure (PEPSE) awareness in an HIV-positive cohort. Int J STD AIDS. 2014;25(1):67–9.

Lin SY, Lachowsky NJ, Hull M, et al, Hogg RS, Moore DM. Awareness and use of nonoccupational post-exposure prophylaxis among men who have sex with men in Vancouver, Canada. HIV Med. 2016;17(9):662–73.

Goedel WC, Hagen D, Halkitis PN, et al. Post-exposure prophylaxis awareness and use among men who have sex with men in London who use geosocial-networking smartphone applications. AIDS Care. 2017;29(5):579–586.

Palich R, Martin-Blondel G, Cuzin L, et al. Experiences of HIV postexposure prophylaxis (PEP) among highly exposed men who have sex with men (MSM). Sex Transm Infect. 2017;93(7):493–498.

Charpentier N, Quatremère G, Mabire X, et al. Barriers and levers to HIV-post-exposure prophylaxis. Sante Publique. 2016;28(6):791–799.

Pakianathan M, Whittaker W, Lee MJ, et al. Chemsex and new HIV diagnosis in gay, bisexual and other men who have sex with men attending sexual health clinics. HIV Med. 2018;19(7):485–490.

Pufall EL, Kall M, Shahmanesh M, et al. Sexualized drug use ('chemsex') and high-risk sexual behaviours in HIV-positive men who have sex with men. HIV Med. 2018;19(4):261–270.

Observatoire français des drogues et des toxicomanies. Drogues, Chiffres clés - 8e edition. 2019. https://www.ofdt.fr/BDD/publications/docs/DCC2019.pdf. Accessed January 10, 2020.