Session 114Poster Presentations HIV Transmission Session Day and Time: Tuesday 1:30 - 3:30 pm Room: Hall B
905 Demand for a Non-occupational Post-exposure Prophylaxis Telephone Study Referral Line Exceeds Resources M. Roland*, T. Coates, H. Robillard, J. Tapia, T. Neilands, M. Krone, J. Kahn, J. Martin Univ of California at San Francisco
Background: Non-occupational post-exposure prophylaxis (PEP) has been offered in San Francisco since 1996. The demand for PEP has not been described.
Methods: A randomized PEP counseling study was initiated in 4/01. Telephone inquiries were returned 8 am-10 pm daily.
Results: We recorded 968 calls to 7/31/02 (60/month), 28% during non-business hrs. Of these, 719 (74%) calls were from callers seeking study services and 249 (26%) were from callers from out of the area or requesting other information. Among those calling about the study, 22% called within 12 hrs, 59% between 12-48 hrs, and 15% between 48-72 hrs of the exposure. Ninety-four percent (94%) were male; median age was 33 (16-74) yrs; 90% of the callers had an exposure that qualified them for the study (38% receptive anal; 26% insertive anal; 7% receptive oral with ejaculation; and 4% each receptive or insertive vaginal); 38% reported exposures with a source who was known to be HIV+; 60% of sources were at high risk of HIV infection (80% men having sex with men; 4% IDU; 9% sex worker); and 87% had an eligible exposure type with a source who was known to be HIV+ or at high risk of HIV infection. Of these eligible callers, 73% elected to participate in the study, 16% were referred off-study, and 11% declined PEP. Callers who were < 21 yrs (OR = 6.0, p < 0.001), female (OR = 2.9, p = 0.046), and were exposed to partners of unknown HIV status (OR = 1.9, p = 0.035) were less likely to accept PEP. Thirteen percent (13%) of referred callers did not come to the study site; gender was the only association (OR = 4.1, p = 0.007); and 75% received a telephone prescription prior to enrollment in the study (90% Combivir). Source information was used in 18% of telephone evaluations to determine the PEP regimen (current and past antiretroviral use, recent HIV RNA, and/or resistance test results). Among the 249 calling for advice, 38% involved exposures in individuals from out of the area and 13% were from healthcare providers seeking advise. Calls were received from 21 states, Canada, the UK, and Hong Kong.
Conclusions: The majority of exposures merited PEP prescriptions, often provided by telephone due to inability to access same day services. Non-study calls were received from exposed individuals and healthcare providers. Because this intervention may prevent HIV infection and accesses high risk individuals for counseling, the U.S. Public Health Service PEP guidelines should consider including telephone referral and assistance services.
