Adherence to HIV post-exposure prophylaxis (PEP) in victims of sexual assault : a systematic review and meta-analysis Liza 1Imperial
1 Chacko ,
Nathan
College London,
2 Ford ,
2Médecins
Mariam
1 Sbaiti
and Ruby
2 Siddiqui
Sans Frontières, E-mail: ruby.siddiqui@london.msf.org
Introduction
Results
Sexual assault: Public health concern placing victims at risk of HIV.
2159 articles from initial search, 24 studies analysed (17 retrospective, 6 prospective and 1 randomised-controlled trial). Only 3 studies assessed interventions
Post-exposure prophylaxis (PEP): 28 day treatment administered within 72 hours of exposure to HIV. Combination of 2 or 3 antiretroviral drugs.
•Pooled PEP adherence varied considerably in the cohort studies (n=2166 patients), ranging from 11.8% to 73.9%, with an overall pooled proportion of 40.3%. (Figure 1)
Adherence: PEP acceptance and completion lower in sexual assault compared with consensual sexual exposure.
Defaulting:
Adherence: •Adherence appeared to be higher in developing country settings (53.2%) compared with developed country settings (33.3%) (p=0.01), a difference confirmed through meta-regression. •Proportion of patients defaulting overall from PEP (n=1972 patients) ranged from 2.9% to 75.7% ,with a pooled proportion of 41.2% •In meta-regression, there was no difference in the overall proportion of patients defaulting from PEP by age (p=0.4) or setting (p=0.3).
Systematic literature review and meta-analysis: To assess rates and determinants of PEP adherence after sexual assault.
Discussion •Adherence to PEP is poor in all settings. •Adherence appears better in developing compared with developed country settings.
Methods Databases searched: MEDLINE, EMBASE, HMIC, PsycInfo, The Cochrane Library, POPLINE, Global Health Library. Search Strategy: Compound strategy with search terms ‘sexual assault’, ‘post-exposure prophylaxis’ and ‘adherence’.
Future research
Inclusion Criteria: •Observational and Experimental studies
•
Reasons for poor adherence.
•
Define and evaluate interventions to support adherence.
•Data on adherence to PEP after sexual assault. Outcomes: 1.Adherence (Primary) 2.Defaulting (Secondary)
Limitations
Quality & Validity:
•Meta-analysis subject to heterogeneity.
Studies assessed for: (1) Refusals, (2) Method of adherence assessment, (3) Reporting of side effects, (4) Specification of inclusion and exclusion criteria, (5) Study design, (6) Sample size calculation and (7) Statistical analysis.
•Small sample sizes. •Lack of objective measures of adherence. •Publication bias.
Data Analysis: 1.Point estimates and 95% CIs for proportion of patients adhering to PEP
Reference Chacko L, Ford N, Sbaiti M, Siddiqui R. Adherence to HIV post-exposure prophylaxis in victims of sexual assault: a systematic review and meta-analysis. Sexually transmitted infections 2012.
2.Calculated for various stages in care pathway (initial offer of PEP to final follow-up appointment) 3.Data pooled using a DerSimonian-Laird random effects model 4.Subgroup analysis and meta-regression to investigate heterogeneity.
Figure 1: Meta-analysis of PEP adherence studies