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Brief Report: Outcomes of Individuals Using HIV Postexposure Prophylaxis-In-Pocket ("PIP") for Low-Frequency, High-Risk Exposures in Toronto, Canada
  Nov 1 2023
HIV postexposure prophylaxis-in-pocket ("PEP-in-Pocket" or "PIP") involves prospectively identifying individuals with a very low frequency of higher-risk HIV exposures and providing them with a prescription for 28-days of PEP, along with instructions on when to initiate medications and how to follow-up with care. We previously described PIP care in a cohort of individuals who fit these criteria.5-7 Here, we present longer-term follow-up and outcomes of this cohort of patients provided with PIP for HIV prevention.

HIV postexposure prophylaxis-in-pocket ("PIP") is a self-initiated, event-driven HIV prevention modality for individuals with a low frequency of HIV exposures.
A cohort of 111 patients using PIP as their primary HIV prevention modality was longitudinally evaluated for PIP self-initiation, HIV and sexual transmitted infections, and switching to other HIV prevention modalities between February 2016 and December 2022.
A total of 111 patients had 178.7 cumulative patient-years of PIP use. PIP was self-initiated 69 times by 35 (31.5%) individuals, with 0 HIV seroconversions identified. Thirty four individuals (30.6%) transitioned from PIP to pre-exposure prophylaxis and 33 individuals (29.7%) switched from pre-exposure prophylaxis to PIP.
PIP is a useful addition to other pharmacologic HIV prevention tools, and may help prevent infection in those with a lower frequency of unanticipated HIV exposures.
PIP was prescribed to 111 individuals between February 2016 and December 2022, giving a combined total of 178.7 patient-years. The average age was 36.6 years old (range 18-69), with 106 (95.5%) patients assigned male sex at birth. Thirty-five (31.5%) patients self-initiated their prescribed PIP, and a total of 69 courses of PIP were completed during the observed time. Based on self-reported data, all 69 episodes were initiated for condomless sex; none were initiated for injection drug use. The most common regimens used were DTG + TDF/FTC (n = 51), followed by BIC/TAF/FTC (n = 6), and raltegravir + TDF/FTC (n = 2).

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