Grant: Project Grant

HIV post-exposure prophylaxis (PEP) is an effective HIV prevention strategy for people with a suspected or confirmed HIV exposure. Standard-of-care regimens involve 28 days of oral medication, starting within 72 hours of exposure. PEP is also an important 'gateway' for people to access pre-exposure prophylaxis (PrEP), which offers long-term protection. However, some of the major challenges with PEP include low community awareness and underutilization, and difficulty taking the full 28 days of pills due to inconvenience, side effects and privacy concerns. Long-acting antiretrovirals are anti-HIV medications that can be given less frequently than daily pills. Currently available options include 2-monthly injections, and future options might include pills, implants and intravenous infusions. These products have been successfully used in HIV treatment for people in whom adherence to daily pills is difficult, with high patient-reported satisfaction. They have not been studied as PEP, but may be attractive options that increase PEP uptake overall and also increase access to PrEP. Testing this innovative new approach would require clinical trials evaluating clinical, implementation and equity-related outcomes. To plan for such a trial, we will study the acceptability of long-acting PEP (LA-PEP), among PEP users, communities at increased risk of HIV and clinical stakeholders. We will also quantify clinical outcomes associated with standard of care oral PEP to help plan the trial's sample size and design, and assess the need for additional research on this novel prevention strategy in the future.