P030 HIV post-exposure prophylaxis to pre-exposure prophylaxis transitioning in men who have sex with men

Background HIV post-exposure prophylaxis following sexual exposure (PEPSE) and pre-exposure prophylaxis (PrEP) are used by people at sexual risk of HIV acquisition including men who have sex with men (MSM). Owing to the high risk of HIV seroconversion due to on-going risk behaviours, it is becoming commonplace for HIV-negative MSM requiring PEPSE (e.g. HIV sexual-exposure within 72-hours) to transition immediately to PrEP following the 28-days of PEPSE. We aimed to review how frequently PrEP is discussed and used by MSM following PEPSE. Method We reviewed the electronic notes of MSM who had accessed PEPSE between January 2018 – November 2020 and collected information on sexual assault, recreational drug use at the time of PEPSE initiation, whether direct transition to PrEP had been discussed, and if PrEP had been initiated after PEPSE. Results During the study period, 277 MSM accessed PEPSE. The median age was 32 years (IQR 26–43), 17 (6%) started PEPSE following a sexual assault, 36 (13%) were using recreational drugs during sex and 30(11%) had used PrEP previously. Discussion about direct transition to PrEP after PEPSE was documented in 155 (56%) MSM, including 128 (51%) MSM who had never used PrEP before, and 67 (24%) MSM actually transitioned directly from PEPSE to PrEP. Clinicians were more likely to discuss PEPSE to PrEP transition in MSM with prior PrEP use (p<0.0001), and MSM were more likely to transition to PrEP from PEPSE if they had used PrEP previously (p<0.00001). Conclusion Only 56% of MSM who used PEPSE had a documented discussion about transitioning to PrEP and only a 24% actually transitioned from PEPSE to PrEP. Where indicated, MSM who access PEPSE should have a documented discussion and ideally transition immediately onto PrEP following completion of PEPSE.