Retention of care for people on PEP needs to be addressed
Retention of care for people taking post-exposure prophylaxis (PEP) for HIV needs to be improved, with only 56 percent of people eligible for PEP completing the 28-day treatment regime. In a study published in AIDS Journal, the authors analyse data on completion rates for PEP, highlighting the need to understand poor adherence rates and integrate this understanding into the broader HIV agenda.
PEP has been found to significantly reduce the likelihood of HIV seroconversion for people who have been exposed to HIV. In this systematic review and meta-analysis, evidence was collated from 97 studies and 21,462 PEP initiations. Non-occupational exposure reported a higher than average completion rate for PEP (65.6 percent), whilst those who had been sexually assaulted reported the lowest completion rate (40.2 percent). Men who have sex with men (MSM) had high rates of completion for PEP, at 67.2 percent. By age, it was found that completion rates for adolescents were particularly low, at 36.6 percent.
The authors also analysed where people were lost along the cascade of care for PEP. Of the people eligible for PEP, 14 percent refused treatment. After treatment initiation, 43 percent were lost and did not complete the 28-day regimen for a variety of reasons. A further 31 percent of people did not return for a follow-up after completing PEP. The authors report that only three seroconversions can be attributed to failure of the drug regimen.
It is clear from the analysis that retaining patients on PEP is a significant challenge. Despite PEP being a vital tool for the elimination of HIV, little research has been completed to try and understand how and why people are lost in the cascade of care – an issue pertinent across demographics, geographies and exposure categories. It has been suggested that providing counselling and eliminating the number of health centre visits, coupled with tried and testing adherence interventions such as text message services, will improve PEP uptake and retention. It is also particularly important to work with identified vulnerable groups, such as adolescents and victims of sexual assault, to ensure that they are not left behind. The authors conclude that high-quality studies are needed to fully understand retention of care for PEP so to improve its efficacy as an HIV prevention strategy.