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Adherence to HIV postexposure prophylaxis: a systematic review and meta-analysis
Nathan Ford1, Cadi Irvine, Zara Shubber
1aDepartment of HIV/AIDS, World Health Organization Geneva, Switzerland bDepartment of Infectious Disease Epidemiology, Imperial College London, London, UK cStanford Prevention Research Center, Stanford University, Stanford, California, USA dHIV/AIDS Unit, Infectious Disease Service, Geneva University Hospital, Geneva, Switzerland.
HIV postexposure prophylaxis (PEP) completion rates are poor overall, with significant variations based on exposure type and patient demographics. Adolescents and sexual assault survivors show particularly low adherence to the 28-day course.
Area of Science:
- Public Health
- Infectious Diseases
- Pharmacology
Background:
- Evaluating completion rates of HIV postexposure prophylaxis (PEP).
- Assessing variations by exposure type (occupational, nonoccupational, sexual assault), patient, and program characteristics.
Purpose of the Study:
- To analyze factors influencing completion rates of HIV postexposure prophylaxis (PEP).
- To identify patient groups with lower adherence to PEP.
Main Methods:
- Systematic literature search of four major databases and conference abstracts up to December 2013, updated in June 2014.
- Inclusion of randomized and nonrandomized studies reporting PEP completion rates.
- Random-effects meta-analysis to pool data across studies regardless of exposure type, age, or location.
Main Results:
- Ninety-seven studies involving 21,462 PEP initiations were reviewed.
- Overall PEP completion rate was 56.6%, with significant variations: highest for nonoccupational exposures (65.6%) and lowest for sexual assault (40.2%).
- Higher completion rates were observed in men who have sex with men (MSM) (67.2%) and children (64.0%), while adolescents showed the lowest rates (36.6%).
Conclusions:
- Adherence to the full 28-day course of antiretroviral drugs for PEP is suboptimal.
- Simplifying prescribing guidelines and enhancing adherence support are crucial.
- Particular attention is needed for adolescents and sexual assault survivors to improve PEP completion.
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