HIV Pre Exposure Prophylaxis

Our office is participating in a research study through Doctors Nova Scotia evaluating the  perceptions and prescription practices of HIV prevention treatments.  This is a new concept and if you were wondering if you were at risk or eligible for treatment, please book an appointment.

 

Doctors Nova Scotia's Policy and Health Issues Committee is supporting a research project titled, Are we PrEPing for the future? Examining physician perception and prescription of HIV Pre-Exposure Prophylaxis to prevent HIV infection.

This project focuses on providing health care to high-risk populations that have been underserved in the past and will try to determine the ways to increase and implement certain medical practices. Through completing this project, the research will better understand the current medical practices and identify areas for improvement, thus helping our overall delivery of health care in Nova Scotia to all citizens, especially those in high-risk populations.

Part of the research includes a cross-sectional study, which includes surveying local physicians to investigate their perceptions about their familiarity with pre-exposure prophylaxis (PrEP), their history of prescription, their fears concerning PrEP usage, and their view of the role PrEP plays in human immunodeficiency virus (HIV) prevention in Nova Scotia.

This information will explain the reasons physicians may not prescribe PrEP and provide avenues for educational outreach in the future to increase PrEP implementation.


Background
Human immunodeficiency virus poses a great risk within Canada and globally due to its ability to hinder a host’s immune system, and its inability to be cured. In Canada approximately 7.2 people per 100,000 are diagnosed with HIV every year, and as of 2014 approximately 75,500 people are living with HIV in Canada. Pre-exposure prophylaxis is a new HIV transmission prevention method that has demonstrated the ability to inhibit HIV infection within high risk groups. Pre-exposure prophylaxis prescription rates have remained low due to a variety of reasons among physicians, including inaccessibility, a perceived lack of evidence of efficacy, and a lack of established thorough guidelines.


The research project is being led by Dr. Matthew Numer and Mr. Nicholas Cochkanoff, MD Candidate, 2020.

 

Pre-exposure prophylaxis (PrEP)

 

Indications

Men who have sex with men (MSM)

• PrEP is recommended for MSM (strong recommendation; high quality of evidence) and transgender women (strong recommendation; moderate quality of evidence), who report condom less anal sex within the last six months and who have any of the following:

  • Infectious syphilis or rectal bacterial sexually transmitted infection (STI), particularly if diagnosed in the preceding 12 months;

• Recurrent use of nonoccupational post exposure prophylaxis (nPEP) (more than once);

• Ongoing sexual relationship with HIV-positive partner with substantial risk of

transmissible HIV; or

• High-incidence risk index

• PrEP is not recommended in the context of a stable closed relationship with a single partner with no or negligible risk of having transmissible HIV 

• PrEP is recommended for the HIV-negative partner in heterosexual sero discordant relationships reporting condom less vaginal or anal sex where the HIV-positive partner has a substantial risk of having transmissible HIV 

  • PrEP may be considered fort he HIV-negative partner in heterosexual sero discordant relationships reporting condom less vaginal or anal sex, where the HIV-positive partner has a low but non-negligible risk of having transmissible HIV 
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  • PrEP may be considered for PWID if they share injection drug use paraphernalia with a person with a non-negligible risk of HIV infection
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  • Nonoccupational postexposure prophylaxis
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Indications

It is recommended to prescribe nPEP for HIV-negative individuals who present no later than 72 hours after an exposure that is moderate or high risk for HIV transmission with a person who has a substantial risk of having transmissible HIV 

• nPEP can be considered for HIV-negative individuals who present no later than 72hours after an exposure that is moderate or high risk for HIV transmission with a person who has a low but non-negligible risk of having transmissible HIV (weak recommendation; low quality of evid

  •  nPEP is recommended as soon as possible after an exposure, up to a maximum of 72 hours afterward

 

 

 

Charlotte Gallant