2894. PEP-in-Pocket (PIP): Long-Term Follow-Up of On Demand HIV Post-Exposure Prophylaxis
Bibliographic record
Abstract
Abstract Background Pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP) are well established methods of HIV prevention through the use of antiretroviral medications. However, the suitability of these tools for individuals with infrequent, higher-risk HIV exposures might be limited due to cost, high pill burden and/or barriers to care. PEP-in-pocket (PIP) involves prospectively identifying such individuals, proactively prescribing them 28 days of PEP medication, and providing instructions on when to self-initiate medications and how to follow up with care. We present long-term follow-up of a cohort of patients provided with PIP for HIV prevention. Methods We evaluated the clinical characteristics and outcomes of patients using PIP for HIV prevention. Patients referred for PrEP or PEP care were offered PIP if they reported a low frequency (0-4 per year) of higher-risk HIV exposures of any type. The HIV prevention method was chosen through shared decision-making between patients and clinicians and was outside the realm of this study. Patients were followed at regular 4-6 months intervals. Results We followed 112 patients prescribed PIP between the ages of 20-69 for a total of 183.8 patient-years. 108 (96%) patients were assigned male at birth. Thirty-five (31%) patients self-initiated a total of 69 courses of PIP during the observation period. Patients fluidly transitioned between HIV prevention modalities as circumstances warranted: 34 (31%) changed from PIP to PrEP, and 33 (30%) changed from PrEP to PIP. There were 18 episodes of bacterial sexually transmitted infections in 13 individuals (12%) using PIP. No HIV seroconversions were detected. Conclusion PIP is an innovative HIV prevention strategy for individuals with a lower frequency of higher-risk HIV exposures, and provides patients with autonomy and agency over their care. Patients may transition between PIP and PrEP based on evolving risk. PIP should be included with PEP and PrEP as a biomedical HIV prevention option for individuals at risk for infection. Disclosures Darrell Tan, MD PhD, Abbvie: Grant/Research Support|Gilead: Grant/Research Support|Glaxo Smith Kline: Grant/Research Support Isaac Bogoch, MD, MSc, BlueDot: Advisor/Consultant|NHL Players' Association: Advisor/Consultant
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.002 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; both teacher heads agree on what is shown here.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".