Original Research
Saturday, November 11, 2023
11:30 AM–01:00 PM
Abstract
Introduction: Two thirds of people with HIV live in SubSaharan Africa (SSA). Post-exposure prophylaxis (PEP) is an underused HIV prevention strategy in SSA. There are well-described barriers to PEP usage at the individual, clinician, and system levels. One aspect of the system-level response is the publication of national HIV clinical guidelines to standardize clinical decision making for PEP and pre-exposure prophylaxis (PrEP).
Research Question or Hypothesis: Do national HIV guidelines for PEP reference PrEP for ongoing risk after non-occupational exposure and identify prior PEP usage as a consideration for PrEP eligibility?
Study Design: Systematic Review
Methods: National HIV guidelines in SSA countries published from 2012 were obtained from PrEPwatch.org database and database search using keywords of “National HIV Guidelines''. We used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 checklist to determine the guidelines included in this study. Two researchers reviewed and recorded guideline elements using RedCAP.
Results: Twelve national guidelines were included. All guidelines recommended PEP treatment for non-occupational HIV exposure and acknowledged sexual violence to be an indication for the 28-day PEP therapy. Beyond the inclusion of sexual violence, eight out of twelve guidelines referenced sexual encounter as an indication, but none specified types of consensual sexual encounters where HIV risk may be higher. No guidelines mentioned considering PrEP following the completion of PEP for individuals with ongoing risk. Two out of twelve guidelines mentioned prior PEP usage as a consideration when determining PrEP eligibility.
Conclusion: Non-occupational PEP guidelines in SSA are oriented towards a solitary, nonrecurrent exposure, with rape as the most frequently cited indication. For PEP to be integrated as an HIV prevention strategy for non-occupational exposures, the clinical guidelines must reflect that eligibility for non-occupational PEP should lead clinicians to assess ongoing risk, and potential eligibility for PrEP, beyond a 28-day course of therapy.
Presenting Author
Nicole Y. Nguyen PharmDUniversity of California, San Francisco
Authors
Jean Armas MPH
Global Stragtegies
Joshua Bress MD
University of California San Francisco
Victoria Nguyen PharmD
UCSF Health
Cathi Dennehy Pharm D
University of California San Francisco