Grant: Planning and Dissemination Grant - Institute Community Support

Despite decades of traditional HIV prevention efforts focused on condom promotion and behaviour change, 2000-4000 new HIV infections occur in Canada every year. The tremendous financial cost of HIV infection (average lifetime cost of treatment alone is $241,153 USD) and the young age of Canadians newly diagnosed (with the majority of new cases occurring in those aged 30 -39 years of age) underscore the economic and social importance of preventing new infections. These figures are particularly concerning because safe and effective medical strategies for preventing HIV have emerged in recent years, including post-exposure prophylaxis (PEP) and pre-exposure prophylaxis (PrEP). PEP involves using a short 28-day course of anti-HIV medications (ARVs) within 72 hours of a known or suspected high-risk exposure to HIV, is very effective, and is widely accepted as a standard of care intervention. PrEP at present involves daily oral dosing of two specific anti-HIV medications (tenofovir/emtricitabine) by persons at high ongoing risk of infection, and has been shown to be highly effective if adherence is high. However, several challenges have limited the clinical and public health impact of PEP and PrEP in preventing HIV in Canada, related to inadequate knowledge levels among front-line health care providers, inconsistencies in guidance documents from other jurisdictions, and patient factors including lack of awareness of biomedical prevention strategies and lack of access to medications for cost reasons. Our primary objective is thus to develop a Clinical Practice Guideline (CPG) on the use of PEP and PrEP in Canada, to guide decision-making by clinicians, policy-makers and patients. Our secondary objective is to initiate a knowledge translation and exchange agenda in which the recommendations from the CPG are disseminated to both care providers and members of at-risk communities who would benefit from additional HIV prevention strategies.