Non-occupational post-exposure prophylaxis does not expand or differentiate candidates for pre-exposure prophylaxis

Area of Science:

• Public Health
• HIV Prevention
• Epidemiology

Background:

• Non-occupational post-exposure prophylaxis (nPEP) is a potential strategy for identifying individuals eligible for HIV pre-exposure prophylaxis (PrEP).
• Limited evidence exists on nPEP's effectiveness in engaging at-risk populations beyond men who have sex with men (MSM).

Purpose of the Study:

• To evaluate the role of nPEP in facilitating PrEP initiation among diverse populations.
• To identify factors associated with PrEP uptake following nPEP exposure.

Main Methods:

• Retrospective, real-world analysis of individuals accessing nPEP at an Italian tertiary care center (2018-2025).
• Evaluation of demographic and behavioral characteristics to determine PrEP initiation predictors.

Main Results:

• Of 585 individuals, 149 (25.5%) initiated PrEP.
• PrEP uptake was significantly associated with MSM identity and repeated nPEP courses.
• Women, individuals under 25, sex workers, transgender women, ethnic minorities, and people using recreational drugs did not show increased PrEP initiation. Free PrEP provision did not enhance engagement in these groups.

Conclusions:

• nPEP failed to increase PrEP uptake among non-MSM populations at risk for HIV infection in this real-world setting.
• Alternative implementation strategies are necessary to improve PrEP access for diverse key populations.
• Targeted interventions are crucial for enhancing PrEP engagement among underrepresented groups at high risk of HIV.