HIV medications can be used as post-exposure prophylaxis to efficaciously prevent an HIV-negative person who has come into contact with HIV from becoming HIV-positive. Traditionally, these medications have been available in emergency departments, which have constituted a barrier for the members of many minority groups who are greatly affected by HIV transmission (i.e. gay, bisexual and other men who have sex with men, and persons who use injection drugs). From 5 September 2013 through 4 September 2015, we sought to increase the use of HIV post-exposure prophylaxis by having registered nurses provide these medications, when indicated, in community clinics in Ottawa, Canada. We undertook a chart review of patients who accessed services for HIV post-exposure prophylaxis in this period. Over the two years of data collection, 112 persons requested HIV post-exposure prophylaxis and 64% (n = 72) initiated these medications. Most (93%, or n = 67, of the 72 initiations) were among men, with 88% (n = 59) of these men reporting same sex sexual partners. Among these 58 men, 31% (n = 18) had sexual contact with other men known to be HIV-positive. Among women (n = 8), five initiated post-exposure prophylaxis: three after needle-sharing contact or sexual contact with a male partner who reportedly shared needles, and two after unprotected vaginal sex with a male partner known to be HIV-positive. Overall, no one was diagnosed with HIV at the four-month HIV testing follow-up, although six persons were diagnosed with HIV from the baseline HIV testing, and an additional four were diagnosed with HIV during routine HIV testing one year after completing post-exposure prophylaxis. In total, nine persons in our sample were thus diagnosed with HIV during the study period, which accounted for 9.4% (n = 10 of 106) of all reported HIV diagnoses in Ottawa during this time. We conclude that nurse-initiated HIV post-exposure prophylaxis can be an effective way to provide HIV prevention services to persons who are at high-risk for HIV.
BrantJBaxterLHirdS. Non-occupational postexposure prophylaxis for HIV: a systematic review. Health Technol Assess2009; 13: iii–60.
2.
CardoDMCulverDHCiesilskiCA. CDC Needlestick Surveillance Group. A case-control study of HIV seroconversion in health care workers after percutaneous exposure. N Engl J Med1997; 337: 1485–1490.
3.
HladikFMcElrathMJ. Setting the stage: host invasion by HIV. Nat Rev Immunol2008; 8: 447–457.
4.
BourryOBrochardPSouguiereS. Prevention of vaginal simian immunodeficiency virus transmission in macaques by postexposure prophylaxis with zidovudine, lamivudine and indinavir. AIDS2009; 23: 447–454.
5.
OttenRASmithDKAdamDR. Efficacy of postexposure prophylaxis after intravaginal exposure of pig-tailed macaques to a human-derived retrovirus (human immunodeficiency virus type 2). J Virol2000; 74: 9771–9775.
6.
TsaiCCEmauPFollisKR. Effectiveness of postinoculation (r-)-9-(2-phosphonylmethoxypropyl)adenine treatment for prevention of persistent siminam immunodeficiency virus SIVmne infection depends critically on timing of initiation and duration of treatment. J Virol1998; 72: 4265–4273.
7.
WadeNABirkheadGSWarrenBL. Abbreviated regimens of zidovudine prophylaxis and perinatal transmission of the human immunodeficiency virus. N Engl J Med1998; 339: 1409–1414.
8.
Nielsen-SainesKWattsHVelosoVG. Three postpartum antiretroviral regimens to prevent intrapartum HIV infection. N Engl J Med2012; 366: 2368–2379.
9.
WongKHughesCAPlittS. HIV non-occupational postexposure prophylaxis in a Canadian province: treatment completion and follow-up testing. Int J STD AIDS2010; 21: 617–621.
10.
ChanACHGoughKYoongD. Non-occupational post-exposure prophylaxis for HIV at St. Michael’s Hospital, Toronto: a retrospective review of patient eligibility and clinical outcomes. Int J STD AIDS2013; 24: 393–397.
11.
O’ByrnePMacPhersonPARoyM. Overviewing a nurse-led, community-based HIV PEP program: applying the extant literature in frontline practice. Public Health Nurs2014; 32: 256–265.
12.
BoudreauxEDFriedmanJChanskyME. Emergency department patient satisfaction: examining the role of acuity. Acad Emerg Med2004; 11: 162–168.
13.
TomaGTrinerWMcNuttLA. Patient satisfaction as a function of emergency department previsit expectations. Ann Emerg Med2009; 54: 360–367.
14.
DosekunOFoxJ. An overview of the relative risks of different sexual behaviours on HIV transmission. Curr Opin HIV AIDS2010; 5: 291–297.
15.
JinFJanssonJLawM. Per-contact probability of HIV transmission in homosexual men in Sydney in the era of HAART. AIDS2010; 24: 907–913.
16.
DaarES. Clinical presentation & diagnosis of primary HIV-1 infection. Curr Opin HIV AIDS2008; 3: 10–15.
17.
Public Health Agency of Canada. M-Track: enhanced surveillance of HIV, sexually transmitted and blood-borne infections, and associated risk behaviours among men who have sex with men in Canada, http://librarypdf.catie.ca/pdf/ATI-20000s/26403.pdf (2011, accessed 23 June 2016).
TaylorDDurigonMDavisH. Probability of a false-negative HIV antibody test result during the window period: a tool for pre- and post-test counselling. Int J STD AIDS2015; 26: 215–224.
20.
CohenMSGayCLBuschMP. The detection of acute HIV infection. J Infect Dis2010; 202: s270–s277.
21.
AttiaSEggerMMullerM. Sexual transmission of HIV according to viral load and antiretroviral therapy: systematic review and meta-analysis. AIDS2009; 23: 1397–1404.
22.
BrennerBGRogerMRoutyJ-P. High rates of forward transmission events after acute/early HIV-1 infection. J Infect Dis2007; 195: 951–959.
23.
TaylorMMRotblattHBrooksJT. Epidemiological investigation of a cluster of workplace HIV infections in the adult film industry: Los Angeles, California, 2004. Clin Infect Dis2007; 44: 301–305.
24.
O’ByrnePMacPhersonPAEmberA. Overview of a gay men’s STI/HIV testing clinic in Ottawa: clinical operations and outcomes. Can J Pulbic Health2014; 105: e389–e394.
25.
O’ByrnePPhillipsJCCampbellB. “Express testing” in STI clinics: extant literature and preliminary implementation data. Appl Nurs Res2016; 29: 177–187.
26.
BennPFisherMKulasegaramR. UK guideline for the use of post-exposure prophylaxis for HIV following sexual exposure. Int J STD AIDS2011; 22: 695–708.
27.
United States Centers for Disease Control and Prevention (CDC). Updated guidelines for antiretroviral postexposure prophylaxis after sexual, injection drug use, or other nonoccupational exposure to HIV – United States, 2016, http://stacks.cdc.gov/view/cdc/38856 (accessed 20 June 2016).
MayerKHMimiagaMJGelmanM. Raltegravir, tenofovir DF, and emtricitabine for postexposure prophylaxis to prevent sexual transmission of HIV: safety, tolerability, and adherence. J AIDS2012; 59: 354–359.
30.
DaySMearsABondK. Post-exposure HIV prophylaxis following sexual exposure: a retrospective audit against recent draft BASHH guidance. Sex Transm Infect2006; 82: 236–237.
31.
KahnJOMartinJNRolandME. Feasibility of postexposure prophylaxis (PEP) against HIV infection after sexual or injection drug use exposure: the San Francisco PEP Study. J Infect Dis2001; 183: 707–714.
32.
McCartyEJQuahSMawR. Post-exposure prophylaxis following sexual exposure to HIV: a seven-year retrospective analysis in a regional centre. Int J STD AIDS2011; 22: 407–408.
33.
MinasBLaingSJordanH. Improved awareness and appropriate use of non-occupational post-exposure prophylaxis (nPEP) for HIV prevention following a multi-modal communication strategy. BMC Public Health2012; 12: 906–906.
34.
TissotFErardVDangT. Nonoccupational HIV post-exposure prophylaxis: a 10-year retrospective analysis. HIV Med2010; 11: 584–592.
Spatz Friedman D, O’Byrne P and Roy M. Comparing those diagnosed early versus late in their HIV infection: implications for public health. Int J STD/AIDS (accepted).
37.
HamlynEMcAllisterJWinstonA. Is screening for sexually transmitted infections in men who have sex with men who receive non-occupational HIV post-exposure prophylaxis worthwhile?Sex Transm Infect2006; 82: 21–23.
38.
de VriezeNHNvan RooijenMSSchim van de LoeffM. Additional gonorrhea and chlamydia infections found with rapid follow-up screening in men who have sex with men with an indication for HIV postexposure prophylaxis. Sex Transm Dis2014; 41: 515–517.
39.
O’ByrnePMacPhersonPA. HIV treatment as prevention in men who have sex with men: examining the evidence. Can Med Assoc2016; 188: 198–203.
40.
United States Preventive Health Service. PrEP for the Prevention of HIV infection in the US – 2014: a clinical practice guideline, www.cdc.gov/hiv/pdf/prepguidelines2014.pdf (accessed 20 June 2016).
41.
ZablotskaIBPrestageGHoltM. Australian gay men who have taken nonoccupational postexposure prophylaxis for HIV are in need of effective HIV prevention methods. J Acquir Immune Defic Syndr2011; 58: 424–428.
42.
JainSOldenburgCEMimiagaMJ. Subsequent HIV infection among men who have sex with men who used non-occupational post-exposure prophylaxis at a Boston community health centre: 1997–2013. AIDS Patient Care STDs2015; 29: 20–25.
43.
McCormackSDunnDTDesaiM. Pre-exposure prophylaxis to prevent the acquisition of HIV-1 infection (PROUD): effectiveness results from the pilot phase of a pragmatic open-label randomised trial. Lancet2016; 387: 53–60.
