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P21 Post-exposure prophylaxis following sexual assault

Background HIV post-exposure prophylaxis (PEP) is recommended for survivors of sexual assault. Completion rates are often lower than for PEP prescribed in other settings, which may be related to psychological issues faced by survivors immediately after the assault and a lower threshold for prescribing. Aims To study outcomes of survivors of sexual assault prescribed PEP (Truvada and Kaletra) at an inner city sexual assault referral centre (SARC). Methods Forensic and follow-up notes were interrogated for data on clients prescribed PEP between 1 June 2010 and 31 May 2011. Results Data were available on 54 clients; 46 were female. Median age was 25 (range 14–40 years). Ethnicity: White European 35/54, 11/54 Black African/Caribbean and 8/54 Asian. 48/54 initiated PEP at the SARC, 4 in A&E and 2 in sexual health and all within 72 h. Exposure: 37 RVI, 14 RAI, eight unknown. 20/54 had an additional risk: 11 multiple assailants, eight defloration and seven ano-genital trauma. The assailant HIV status was unknown in all cases, but 11 were assessed to be high risk. 16/54 of the clients had never tested for HIV, 14 had tested negative previously and 24 were not documented. All had PEP prescribed within BASHH guidelines (2006). 36/54 continued care at the SARC. 20/36 (56%) completed 28 days of PEP. Nine were lost to follow-up, four discontinued due to side effects (Grade 1–2 nausea and vomiting), One due to abnormal blood results (Grade 1 rise in ALT and creatinine), one chose to stop and one was not documented. None had their PEP modified. 13/36 had an HIV test at 3 months post-PEP and all were negative. Conclusions This study shows that PEP was prescribed within national recommendations. Completion rates were comparable to a local tertiary sexual health/HIV clinic that followed-up patients prescribed PEP after occupational and sexual exposure (66%) but lower than the 2006 BASHH standards (75%). This suggests that survivors of sexual assault may require greater adherence support.