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WORLD HOSPITAL DIRECTORY
Infectious Diseases Medical Sexually Transmitted Infections current issue
<p>White P, O'Donnell K, Brennan A, <I>et al</I>. Hepatitis A and B vaccination in gbMSM in Ireland: findings from the European MSM Internet Survey 2017 (EMIS-2017). Sex Transm Infect 2023;99:337-344.</p>
<p>In this article, the authors have made changes to the original manuscript to acknowledge the broad range of stakeholders who should have been included in our original acknowledgements section.</p>
<p>The funding section has been updated to recognise the funding given to the wider EMIS project, as opposed to this particular study.</p>
<p>The methods section has also been updated to better capture the ethical considerations for this study and cite some important EMIS-related publications which were omitted from the original manuscript.</p>
<p>This correction is being made because any study analysing the EMIS-2017 dataset must meet certain contractually agreed requirements when publishing.</p>
<sec><st>Background</st>
<p>Little is known about the aetiology of urethral discharge syndrome (UDS) and genital ulcer disease (GUD) in Brazil due to limited access to laboratory tests and treatment based mainly on the syndromic approach.</p>
</sec>
<sec><st>Objectives</st>
<p>To update Brazilian treatment guidelines according to the current scenario, the first nationwide aetiological study for UDS and GUD was performed.</p>
</sec>
<sec><st>Methods</st>
<p>Male participants with urethral discharge (UD) and/or genital ulcer (GU) reports were enrolled. Sample collection was performed by 12 sentinel sites located in the five Brazilian regions. Between 2018 and 2020, 1141 UD and 208 GU samples were collected in a Universal Transport Medium-RT (Copan). A multiplex quantitative PCR kit (Seegene) was used to detect UD: <I>Chlamydia trachomatis</I> (CT), <I>Mycoplasma genitalium</I> (MG), <I>M. hominis</I> (MH), <I>Neisseria gonorrhoeae</I> (NG), <I>Trichomonas vaginalis</I> (TV), <I>Ureaplasma parvum</I> (UP), <I>U. urealyticum</I> (UU) and another kit to detect GU: cytomegalovirus (CMV), <I>Haemophilus ducreyi</I> (HD), herpes simplex virus type 1 (HSV1), herpes simplex virus type 2 (HSV2), lymphogranuloma venereum (LGV), <I>Treponema pallidum</I> (TP) and varicella-zoster virus (VZV).</p>
</sec>
<sec><st>Results</st>
<p>In UD samples, the frequency of pathogen detection was NG: 78.38%, CT: 25.6%, MG: 8.3%, UU: 10.4%, UP: 3.5%, MH: 3.5% and TV: 0.9%. Coinfection was assessed in 30.9% of samples, with 14.3% of NG/CT coinfection. The most frequent pathogen identified in GU was HSV2, present in 40.8% of the samples, followed by TP at 24.8%, LGV and CMV at 1%, and HSV1 at 0.4%. Coinfection of TP/HSV2 was detected in 4.4% of samples. VZV and HD were not detected. In 27.7% of the GU samples, no pathogen was detected.</p>
</sec>
<sec><st>Conclusion</st>
<p>This study provided the acquisition of unprecedented data on the aetiology of UDS and GUD in Brazil, demonstrated the presence of a variety of pathogens in both sample types and reaffirmed the aetiologies known to be most prevalent globally.</p>
</sec>
<sec><st>Introduction</st>
<p>The chemiluminescence immunoassay (CLIA) is a widely used screening test for syphilis. A CLIA seroconversion in the absence of a positive line immunoassay (LIA) or rapid plasma reagin (RPR) could indicate either an early incubating syphilis or a false positive result. We aimed to evaluate the diagnostic value of such seroconversions.</p>
</sec>
<sec><st>Methods</st>
<p>We retrospectively analysed data of clients visiting the Centre for Sexual Health Amsterdam between July 2013 and August 2021 with a positive CLIA and a negative RPR and negative or indeterminate LIA (at time T<SUB>o</SUB>), and a preceding visit (T<SUB>–1</SUB>) with a negative CLIA <6 months of T<SUB>o</SUB> (‘unconfirmed CLIA seroconversion’). If available, data of follow-up visits (T<SUB>1</SUB>) <2 months of T<SUB>o</SUB> were also included. A syphilis diagnosis was confirmed if darkfield microscopy or PCR for <I>Treponema pallidum</I> was positive at T<SUB>0</SUB> or T<SUB>1</SUB>, or if RPR and/or LIA were positive at T<SUB>1</SUB>.</p>
</sec>
<sec><st>Results</st>
<p>We included data of 107 clients with unconfirmed CLIA seroconversion. The value of CLIA seroconversion could not be established in 13 (12.1%) clients. In the remaining 94 clients, the unconfirmed CLIA seroconversion was confirmed as early syphilis in 72 (76.6%) clients and probable syphilis in 6 (6.4%) clients. In 16 (17.0%) clients, the unconfirmed CLIA seroconversion was regarded as a false positive reaction of whom 4 (5.3%) clients had a seroreversion of the CLIA at T<SUB>1</SUB>.</p>
</sec>
<sec><st>Conclusion</st>
<p>The majority of unconfirmed CLIA seroconversions represented early syphilis infections. Therefore, additional <I>T. pallidum</I> PCR, a follow-up consultation or early treatment is recommended.</p>
</sec>
<sec><st>Background</st>
<p>Intimate partner violence (IPV) against women can significantly impact their overall health. While numerous studies in developing nations highlight the association between IPV and sexually transmitted infections (STIs), the evidence available within the Indian context remains limited. Therefore, this study aims to fill this knowledge gap by investigating the relationship between exposure to different forms of IPV and the occurrence of STIs, using a quasi-experimental approach.</p>
</sec>
<sec><st>Methods</st>
<p>The study used a sample of 63 851 women aged 15–49 years from the latest National Family Health Survey-5. Propensity score matching (PSM) was employed to assess the ‘treatment effect’ from exposure to IPV (physical, emotional or sexual) in the past 12 months on STIs.</p>
</sec>
<sec><st>Results</st>
<p>About 12.2% of women (95% CI: 11.7% to 12.8%) reported symptoms of STIs at the time of the survey. Approximately 31.9% (95% CI: 31.2% to 32.7%) of women reported experiencing at least one form of IPV—either physical, emotional or sexual IPV. Of all forms of IPV, physical IPV was the most prevalent, reported by 28.6%, followed by emotional IPV (13.2%) and sexual IPV (5.7%). Women who experienced any form of IPV—whether physical, sexual or emotional—reported a higher prevalence of STIs (17.8%) as compared with those who did not experience any IPV (9.5%). The findings from the PSM analysis indicated that among the three forms of IPV, the impact of sexual IPV on STIs was the most pronounced. The average treatment effect on the treated from exposure to sexual IPV on STIs was 0.15 (95% CI 0.13 to 0.17).</p>
</sec>
<sec><st>Conclusion</st>
<p>This study provides evidence of a significant association between IPV and STIs among women in India and underscores the urgent need for intensified efforts and interventions to address both IPV and STIs, to improve the overall health and well-being of women in India.</p>
</sec>
<sec><st>Background</st>
<p>HIV incidence among men who have sex with men (MSM) in sub-Saharan Africa (SSA) remains high compared with the general population. Many countries in the region still criminalise consensual homosexual relationships, and some are yet to adopt WHO-recommended interventions for MSM into national HIV policies. This study examines how HIV testing of adult MSM in SSA varies according to the legal climate and presence of targeted HIV policy using data from the cross-sectional 2019 Global LGBTI Internet Survey study.</p>
</sec>
<sec><st>Methods</st>
<p>Using data from 3191 MSM in 44 SSA countries, we assessed associations of legal climate and HIV policy with ever and recent HIV testing using linear ecological and logistic multilevel analyses. From the single-level analysis, we can compare our findings to previously reported data, then, extending to a two-level multilevel analysis, we account for the hierarchical structure of the population and simultaneously adjust for differences in context and composition in each country. We then test the sensitivity of our analyses to excluding countries from the model.</p>
</sec>
<sec><st>Results</st>
<p>We find evidence that legalised same-sex relationships were associated with increased odds of ever testing (OR=2.00, 95% CI 1.04, 3.82) in multilevel analyses. We also find evidence of an association of targeted HIV policies with increased odds of ever testing (OR=2.49, 95% CI 1.12, 5.52). We did not find evidence of an association of the legal climate (OR=1.01, 95% CI 0.69, 1.46) and targeted HIV policies (OR=1.26, 95% CI 0.78, 2.04) with recent testing.</p>
</sec>
<sec><st>Conclusions</st>
<p>This study suggests elimination of discriminatory laws and policies might be important for increasing HIV status awareness of MSM, an important first step in epidemic control. Additionally, we highlight heterogeneity between South Africa and other SSA countries, which has implications for studying SSA countries as a homogeneous group.</p>
</sec>
<sec><st>Introduction</st>
<p>Increasing rates of sexually transmitted infections (STIs) over the past decade underscore the need for early testing and treatment. Communicating HIV/STI risk effectively can promote individuals’ intention to test, which is critical for the prevention and control of HIV/STIs. We aimed to determine which visual displays of risk would be the most likely to increase testing or use of prevention strategies.</p>
</sec>
<sec><st>Methods</st>
<p>A vignette-based cross-sectional survey was conducted with 662 clients (a median age of 30 years (IQR: 25–36), 418 male, 203 female, 41 other genders) at a sexual health clinic in Melbourne, Australia, between February and June 2023. Participants viewed five distinct hypothetical formats, presented in a randomised order, designed to display the same level of high risk for HIV/STIs: icon array, colour-coded risk metre, colour-coded risk bar, detailed text report and guideline recommendation. They reported their perceived risk, concern and intent to test for each risk display. Associations between the format of the risk display and the intention to test for HIV/STI were analysed using logistic regression.</p>
</sec>
<sec><st>Results</st>
<p>About 378 (57%) of participants expressed that the risk metre was the easiest to understand. The risk metre (adjusted OR (AOR)=2.44, 95% CI=1.49 to 4.01) and risk bar (AOR=2.08, CI=1.33 to 3.27) showed the greatest likelihood of testing compared with the detailed text format. The icon array was less impactful (AOR=0.73, CI=0.57 to 0.94). The risk metre also elicited the most concern but was the most preferred and understood. High-risk perception and concern levels were strongly associated with their intention to have an HIV/STI test.</p>
</sec>
<sec><st>Conclusions</st>
<p>Displaying risk differently affects an individual’s perceived risk of an HIV/STI and influences their intention to test.</p>
</sec>
<sec><st>Objectives</st>
<p>HIV pre-exposure prophylaxis (PrEP) is highly effective in preventing HIV acquisition. In England, NHS availability was limited to participants of the PrEP Impact Trial until late 2020. Some key populations at greater risk of HIV were under-represented in the trial suggesting inequities in trial PrEP access. We used the PrEP-to-need ratio (PnR; number of PrEP users divided by new HIV diagnoses) to investigate whether PrEP access improved following routine commissioning in October 2020 and identify populations most underserved by PrEP.</p>
</sec>
<sec><st>Methods</st>
<p>Aggregated numbers of people receiving ≥1 PrEP prescription and non-late new HIV diagnoses (epidemiological proxy for PrEP need) were taken from national surveillance data sets. We calculated the PnR across socio-demographics during Impact (October 2017 to February 2020; pre-COVID-19 pandemic) and post-commissioning PrEP era (2021) in England.</p>
</sec>
<sec><st>Results</st>
<p>PnR increased >11 fold, from 4.2 precommissioning to 48.9 in 2021, due to a fourfold reduction in non-late new HIV diagnoses and near threefold increase in PrEP users. PnR increased across genders, however, the men’s PnR increased 12-fold (from 5.4 precommissioning to 63.9 postcommissioning) while the women’s increased sevenfold (0.5 to 3.5). This increasing gender-based inequity was observed across age, ethnicity and region of residence: white men had the highest PnR, increasing >13 fold (7.1 to 96.0), while Black African women consistently had the lowest PnR, only increasing slightly (0.1 to 0.3) postcommissioning, suggesting they were the most underserved group. Precommissioning, the PnR was 78-fold higher among white men than Black women, increasing to 278-fold postcommissioning.</p>
</sec>
<sec><st>Conclusions</st>
<p>Despite the overall increase in PrEP use, substantial PrEP Impact trial inequities widened postcommissioning in England, particularly across gender, ethnicity and region of residence. This study emphasises the need to guide HIV combination prevention based on equity metrics relative to the HIV epidemic. The PnR could support the optimisation of combination prevention to achieve zero new HIV infections in England by 2030.</p>
</sec>
<sec><st>Objectives</st>
<p>International travel combined with sex may contribute to dissemination of antimicrobial-resistant (AMR) <I>Neisseria gonorrhoeae</I> (Ng). To assess the role of travel in Ng strain susceptibility, we compared minimum inhibitory concentrations (MICs) for five antibiotics (ie, azithromycin, ceftriaxone, cefotaxime, cefixime and ciprofloxacin) in strains from clients with an exclusively Dutch sexual network and clients with an additional international sexual network.</p>
</sec>
<sec><st>Methods</st>
<p>From 2013 to 2019, we recorded recent residence of sexual partners of clients (and of their partners) with Ng at the Center for Sexual Health of Amsterdam. We categorised clients as having: (1) exclusively sexual partners residing in the Netherlands (‘Dutch only’) or (2) at least one partner residing outside the Netherlands. We categorised the country of residence of sexual partners by World Bank/EuroVoc regions. We analysed the difference of log-transformed MIC of Ng strains between categories using linear or hurdle regression for each antibiotic.</p>
</sec>
<sec><st>Results</st>
<p>We included 3367 gay and bisexual men who had sex with men (GBMSM), 516 women and 525 men who exclusively had sex with women (MSW) with Ng. Compared with GBMSM with a ‘Dutch only’ network, GBMSM with: (1) a Western European network had higher MICs for ceftriaxone (β=0.19, 95% CI=0.08 to 0.29), cefotaxime (β=0.19, 95% CI=0.08 to 0.31) and cefixime (β=0.06, 95% CI=0.001 to 0.11); (2) a Southern European network had a higher MIC for cefixime (β=0.10, 95% CI=0.02 to 0.17); and (3) a sub-Saharan African network had a lower MIC for ciprofloxacin (β=–1.79, 95% CI=–2.84 to –0.74). In women and MSW, higher MICs were found for ceftriaxone in clients with a Latin American and Caribbean network (β=0.26, 95% CI=0.02 to 0.51).</p>
</sec>
<sec><st>Conclusions</st>
<p>For three cephalosporin antibiotics, we found Ng strains with slightly higher MICs in clients with partner(s) from Europe or Latin America and the Caribbean. International travel might contribute to the spread of Ng with lower susceptibility. More understanding of the emergence of AMR Ng is needed.</p>
</sec>
<sec id="s1"><st>Introduction</st> <p>Chemsex, also called as <I>party and play</I> or <I>intensive sex partying</I>, is the intentional use of psychoactive drugs before or during sex, mostly by gay and bisexual men having sex with men (GBMSM) to enable, enhance and prolong sexual interaction.<cross-ref type="bib" refid="R1">1</cross-ref> The practice is now becoming increasingly common among heterosexual individuals too.<cross-ref type="bib" refid="R1">1</cross-ref> Various chemsex drugs have been described (<cross-ref type="tbl" refid="T1">table 1</cross-ref>), the principal three that are commonly used include mephedrone, gamma-hydroxybutyrate/gamma-butyrolactone (GHB/GBL) and crystallised methamphetamine.<cross-ref type="bib" refid="R1">1</cross-ref> The injectable use of these substances for similar purpose is called as <I>slamming</I> or <I>slam sex</I>.<cross-ref type="bib" refid="R2">2</cross-ref></p> <p> <tbl id="T1" loc="float"><no>Table 1</no><caption><p>Psychoactive drugs used in chemsex, their intended desired effects and associated complications</p> </caption><tblbdy top-stubs="1"><r><c ra="b" cspan="1" rspan="1">Drug</c><c ra="b" cspan="1" rspan="1">Common street names</c><c ra="b" cspan="1" rspan="1">Preparation</c><c ra="b" cspan="1" rspan="1">Route of administration</c><c ra="b" cspan="1" rspan="1">Intended desired effects</c><c ra="b" cspan="1" rspan="1">Adverse effects and complications</c></r><r><c ra="t" cspan="1" rspan="1">GHB/GBL</c><c...
<sec><st>Objectives</st>
<p>Infectious syphilis has been proposed as an indication for HIV pre-exposure prophylaxis (PrEP) in women. We explored how many women experienced HIV seroconversion after being diagnosed with syphilis in Ontario between 20 April 2010 and 31 December 2021.</p>
</sec>
<sec><st>Methods</st>
<p>Through deterministic linkage of laboratory data at the Public Health Ontario laboratory, which conducts the vast majority of syphilis and HIV testing in Ontario, we quantified the number of females with positive syphilis diagnoses who subsequently exhibited HIV seroconversion between April 2010 and December 2021. New HIV cases were identified by diagnostic serology or HIV viral load test result of ≥20 copies/mL at least 60 days after the positive syphilis test. We report aggregate numbers of women with new laboratory evidence of HIV infection after their first positive syphilis test.</p>
</sec>
<sec><st>Results</st>
<p>Among 7957 women with positive syphilis tests during the study period, 6554 (82.4%) had linkable HIV serology tests and 133 (1.7%) ever tested HIV positive. With further linkage to viral load data, the number of women who ever had laboratory evidence of HIV infection increased to 184 (2.3%). However, when restricting to women whose first positive HIV test or HIV viral load occurred after their first positive syphilis test, this number decreased to 34 (0.4%). The median (IQR) time between the positive syphilis test and the first laboratory evidence of HIV was 551 (IQR=226–1159) days.</p>
</sec>
<sec><st>Conclusion</st>
<p>Although it is clinically appropriate to recommend HIV PrEP to women with syphilis, Ontario surveillance data suggest that the population-level impact of this strategy on the HIV epidemic in Ontario would have been modest during this 11-year period. Future studies should explore additional ways of prioritising women for PrEP.</p>
</sec>
<p>Drückler <I>et al</I> suggest that chemsex engagement among men who have sex with men (MSM) is significantly associated with reporting non-consensual sex.<cross-ref type="bib" refid="R1">1</cross-ref> Inspired by clinical stories gathered in a sexual healthcare service, we investigated a possible relationship between childhood sexual abuse (CSA), that is, having been a victim of forced genital contact by an adult before age 13, and current chemsex engagement. To our knowledge, only one recent study reports a ‘higher frequency’ of early sexual abuse—but without specification of type and age of sexual abuse—among adult chemsex-users MSM.<cross-ref type="bib" refid="R2">2</cross-ref></p> <p>These data were collected during youth festivals using a computerised, anonymous, self-administered survey of a non-selected population of 225 MSM (median age=23, aged 16–39) living mainly in the Paris area.</p> <p>After adjustment for potential confounding factors, those who had experienced CSA were more likely than the other MSM to report not having a regular partner (adjusted...
<p>Non-gonococcal urethritis (NGU) is a common presentation to sexual health clinics and in a significant proportion of cases, no pathogen is detected following routine investigations.<cross-ref type="bib" refid="R1">1</cross-ref> <I>Haemophilus influenzae</I> has been identified as an occasional cause of male urethritis. We report a case of <I>H. influenzae</I> urethritis and describe a relatively novel treatment approach.</p> <p>A man presented to Melbourne Sexual Health Centre with a 3-day history of penile discharge and dysuria. He engaged in condomless oral and anal sex with casual male partners in preceding months. On examination, purulent urethral discharge was noted. Urethral microscopy showed Gram-positive bacilli and epithelial cells. Screening for chlamydia, gonorrhoea, <I>Mycoplasma genitalium</I>, <I>Trichomonas vaginalis,</I> HIV and syphilis was performed. He was treated for NGU with a 1-week course of doxycycline. Initial investigations were all negative.</p> <p>He re-presented to clinic 14 days after completing doxycycline with ongoing purulent urethral discharge. He reported one new sexual...
<p>In our correspondence, we describe the results from a quality improvement survey in a sexual health clinic in North Carolina regarding attitudes and perceptions among adolescents and providers regarding specimen self-collection. We find that adolescents have high levels of acceptability for self-collection and confidence in their ability to self-collection; however, providers expressed hesitation regarding the ability of adolescents to self-collection. Our study shows that while self-collection may provide a way to expand testing access to difficult-to-reach populations, we must ensure that providers are confident in the corresponding results.</p>
<p>A 30-year-old homosexual man living with HIV and receiving virologically suppressive antiretroviral treatment presented to the emergency department with a 3-day history of pain in his left wrist accompanied by fever and chills. On examination, the left wrist showed redness, swelling, tenderness and decreased range of movement. The patient had no history of trauma, insect bites or scratches. Four weeks earlier, he had engaged in unprotected oral sex with a casual partner. Nucleic acid amplification tests (NAATs) for <I>Chlamydia trachomatis</I> and <I>Neisseria gonorrhoea</I> (Ng) were performed from oropharyngeal, anal and urine samples. Arthrotomy and washout of the left radiocarpal joint were done. Ng was detected in both the oropharyngeal swab and the synovial fluid. Ceftriaxone 1 g daily was administered intravenously and a second washout of the joint was performed,<cross-ref type="bib" refid="R1">1</cross-ref> leading to resolution of symptoms within a few days.</p> <p>Gonococcal arthritis results from blood dissemination of Ng from...
<p>In this updated cross-sectional analysis of the National Hospital Ambulatory Medical Care Survey, we found that among the 2.5 million more weighted emergency department (ED) visits in 2021 compared with 2020, there was an insignificant increase in HIV testing per ED visit in 2021 compared with 2020 (0.81% to 0.86%). This suggests HIV testing during ED visits did not increase in line with rebounding visit volumes after the pandemic nadir.</p>
<p><I>Trichomonas vaginalis</I> is the most common non-viral sexually transmitted infection (STI) worldwide, with an estimated 156 million new cases per year globally.<cross-ref type="bib" refid="R1">1</cross-ref> Incidence and prevalence are highest in low-income settings, especially the African region.<cross-ref type="bib" refid="R2">2</cross-ref> If symptomatic, <I>T. vaginalis</I> causes vaginal discharge and dysuria. Untreated <I>T. vaginalis</I> has been associated with adverse birth outcomes and an increased risk of HIV acquisition and transmission.<cross-ref type="bib" refid="R3">3</cross-ref> Antimicrobial resistance to 5-nitroimidazole agents such as metronidazole is reported to occur in about 5%–10% of isolates in the USA.<cross-ref type="bib" refid="R4">4</cross-ref></p> <p><I>T. vaginalis</I> can be diagnosed by wet mount microscopy, antigen detection test, nucleic acid amplification test (NAAT) and culture.<cross-ref type="bib" refid="R5">5</cross-ref> NAAT is the diagnostic standard in high-resource settings as it achieves the highest sensitivity. Culture is not routinely performed as it has lower sensitivity, requires incubation and takes several days before results are available.<cross-ref type="bib" refid="R4">4 5</cross-ref><cross-ref type="bib" refid="R5"></cross-ref>...
<p>There is a growing relationship between BASHH and IUSTI.<cross-ref type="bib" refid="R1">1</cross-ref> In 2023, several BASHH scholars were invited to give feedback on the IUSTI conference in Malta.</p> <sec id="s1"><st>Asymptomatic STI screening: Chris Kenyon, (Belgium)</st> <p>Despite good evidence for HIV and syphilis screening in asymptomatic patients, evidence is lacking for other STIs, for example, <I>Neisseria gonorrhoeae</I> and <I>Chlamydia trachomatis</I>. Kenyon <I>et al</I><cross-ref type="bib" refid="R2">2</cross-ref> highlighted the potential harms of widespread screening for asymptomatic STIs, particularly in HIV-pre-exposure prophylaxis (HIV-PrEP) cohorts, namely increased antimicrobial consumption and antimicrobial resistance (AMR). In Belgium, clinics have reduced asymptomatic STI screening in men who have sex with men using HIV-PrEP: what we need now are patient perspectives and involvement if we are to reduce screening in an attempt to curtail AMR.</p> <p><b>STIs in teenagers & adolescents: Errol Fields, (USA)</b></p> <p>Fields <I>et al</I><cross-ref type="bib" refid="R3">3</cross-ref> presented interventions developed in Baltimore, USA, to reach vulnerable adolescents and...
<sec id="s1"><st>Published in <I>STI</I>: Self-start HIV postexposure prophylaxis after sexual exposure to reduce time to first dose</st> <p>The efficacy of HIV post-exposure prophylaxis (PEP) increases with a shorter time to treatment initiation. This randomised, prospective, open-label study among men who have sex with men (MSM) in the UK assigned 139 participants to either a 5-day PEP starter pack of emtricitabine/tenofovir disoproxil fumarate/maraviroc, or to the standard of care (SOC) PEP access through sexual health clinics or accident and emergency units. There was a significant reduction in time from sex to first PEP dose in the starter pack arm compared with the SOC (median time 7.3 hours vs 28.5 hours), with full adherence and no serious adverse events in the starter pack arm. The findings suggest the efficacy of home starter packs in HIV prevention strategies.</p> <p>Fox JM, Lee MJ, Fairhead CL, <I>et al</I>. Self-start HIV postexposure prophylaxis (PEPSE), to reduce time...
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