Medical Advocates for Social Justice
Conference Abstract
from the
2nd IAS Conference on HIV and Pathogenesis
Paris, France

July 14-17, 2003

Highly Targeted Use of Non-Occupational Use
of Non-Occupational Prophylaxis (NPEP) in Australia

A Grulich¹, W Zheng¹, S Kippax² , DE Smith¹

1 National Centre in HIV Epidemiology and Clinical Research;
2 National Centre in HIV Social Research, UNSW, Australia

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In Australia, national guidelines recommend the use of NPEP after high-risk exposures to HIV. As around 80% of diagnoses of HIV in Australia occur in homosexual men, targeted prescription of NPEP may be a useful addition to HIV prevention. During 1998–2002, data forms were distributed to registered prescribers of anti-retroviral (ARV) drugs throughout the Eastern Australian states. Monitoring forms were completed by the doctor at the time of prescribing, at 4 weeks, and at 6 months follow-up. By December 2002, 819 participants had received

NPEP and financing records suggested that 77% of all NPEP prescriptions were included. Most (84%) PEP prescriptions followed male homosexual contact and 97% of these were receptive (66%) or insertive (31%) anal sex. There were 232 anal sex exposures, and seven needle sharing exposures, to a known HIV-positive source.

Prescriptions for low risk exposures were uncommon (2%) throughout the study. The median time to receipt of PEP was 23 hours and 77% of participants were followed up for at least 4 weeks. Although 66% of prescriptions were for three or more ARVs, there was a significant trend towards prescribing only two (P=0.005). There were four new diagnoses of HIV at baseline and two in individuals with ongoing risk after PEP. Based on the number and type of risk episodes, and published estimates of per episode risk of HIV transmission and local seroprevalence,

we calculated that 2–6 HIV infections were expected if PEP had no effect. This study demonstrates in the setting of a concentrated HIV epidemic, highly targeted prescribing for NPEP is feasible. The lack of identified cases of HIV infection among 819 potential exposures

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Highly Targeted Use of Non-Occupational Use
of Non-Occupational Prophylaxis (NPEP) in Australia
A Medical Advocates for Social Justice Update

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