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Published on: March 30, 2014
EXPRESS-PrEP: Evaluating PrEP rapid engagement and same-day start for HIV prevention in gbMSM
Kevin Woodward1, Tim Guimond2, Hommood Alrowais3
1HQ Health Hub, Sexual and Mental Health, Toronto, Ontario, Canada; Department of Medicine, Division of Infectious Diseases, McMaster University, Hamilton, Ontario, Canada.
Objectives:
Gay, bisexual, and other men who have sex with men (gbMSM) and transgender women (TGW) remain disproportionately affected by HIV in Canada, yet uptake of pre-exposure prophylaxis (PrEP) is suboptimal. Multi-step clinical pathways and laboratory delays contribute to initiation attrition. This study evaluated the impact of a same-day PrEP initiation model using tenofovir alafenamide/emtricitabine (TAF/FTC) in a Canadian clinic.
Methods:
We conducted a prospective, single-site observational cohort at HQ Health Hub in Toronto. Individuals ≥16 years presenting for sexually transmitted and blood-borne infections (STBBI) testing or treatment were screened for PrEP eligibility using a modified HIV Incidence Risk Index (HIRI) score (≥10) or PrEP request. Eligible participants were offered same-day initiation following testing and returned within 24 hours.
Results:
Of 1766 individuals offered PrEP, 1204 accepted (67.7%), 888 were screened, and 814 (91.7%) initiated within 24 hours. Median age of 31 years (26-34), 67% were non-white, and 94% cis-men. Retention from referred individuals was 66.7% at 6 months and 58.0% at 12 months. Compared to historical norms, more participants remained in care of those referred at 6 months (66.7% vs 31.5%, P <0.001). No serious renal adverse events occurred, and sexually transmitted infection (STI) prevalence did not differ significantly.
Conclusions:
Same-day PrEP initiation is safe, feasible, and improves uptake and persistence. Adoption of this model may reduce barriers and accelerate HIV prevention.
