Non-occupational post-exposure prophylaxis (nPEP) is an antiretroviral drug treatment strategy that can prevent HIV infection, if taken shortly after an exposure to HIV and continued for 28 days.
Although nPEP is widely accepted as an appropriate option for preventing HIV, new infections still occur in Canada at unacceptable rates. Two key implementation challenges have limited nPEP’s clinical and public-health impact in Canada: not all patients complete their 28-day course of medication and get the follow-up care they need, and many rely on specialized, infectious-disease physicians for nPEP prescriptions and care.
Developing and testing new and better ways to deliver this underutilized, effective intervention.
We are evaluating two new models of nPEP delivery, each of which could dramatically change how health systems – in Canada and beyond – roll out this intervention.
- Text-message support. This could help prompt more nPEP patients to complete their course of medication and follow-up blood work, and to attend follow-up appointments
- Nurse-led nPEP follow-up. This could make it possible to shift nPEP delivery to sexual-health clinics and nurses – more accessible options for patients.
Study results will provide important information on how to strengthen retention in care, reduce costs to the health-care system for nPEP delivery province-wide, and optimize the scope of practice of nurses and physicians.
About this study
This is a pragmatic, multicenter, randomized controlled trial using a 2×2 factorial design to determine whether the proportion of nPEP patients that successfully complete their 28-day nPEP regimen and follow-up:
- Is higher among those receiving mobile phone-based text messaging support than among those receiving standard care
- Is non-inferior among those receiving care from a sexual health clinic nurse compared to those receiving hospital-based physician care.
The study will also generate important findings about the tolerability and adherence associated with a novel nPEP regimen, bictegravir / tenofovir alafenamide / emtricitabine (Biktarvy®).
