Predictors of time to access to HIV post-exposure prophylaxis: a prospective observational study evaluating the characteristics of HIV-exposure and some syndemic clinical conditions

Objective: A time delay between HIV exposure and post-exposure prophylaxis (PEP) less than 4h is currently considered as a determinant of PEP efficacy. Aim was to evaluate the factors associated with HIV-exposure to ED arrival (HIV-exposure-to-ED) over 4hr were Methods: A prospective observational study from January 1 st , 2016 to December 31 st , 2017 in Bichat academic hospital ED (Paris, France). Healthcare workers with HIV-exposure, other occupational or non-occupational exposures, and sexual exposures were included. Results: 1,475 patients were included, and 598 of them completed a survey. An HIV-exposure-to-ED delay ≥4h was associated with the type of HIV exposure: healthcare workers (HCWs), other occupational, and sexual ( p =0.00000002). Some differences were found between sexual and occupational exposures respectively: knowledge of PEP plan: 65.2% vs. 46.9% ( p =0.00001), previous PEP program use: 23.9% vs. 13.1% ( p =0.001), alcohol use: 36.2% vs. 18.5% ( p =0.000001), drug use: 34.6% vs. 8.6% ( p =0.000001), and chemsex: 26.1% vs. 0% ( p =0.000001). The following were predictors of HIV exposure-to-ED delays ≥4hr: knowledge of the PEP plan ( p =0.0007), previous PEP plan use, drugs, and chemsex for sexual exposure, and knowledge of PEP program ( p =0.0000001) and drug use ( p =0.000001) for occupational exposure. Conclusion: HIV exposure-to-ED delay is longer among sexual than occupational exposure groups. Moreover, knowledge of the program and its previous access were major determinants of a shorter delay to access the PEP program. Finally, among sexually exposed persons, syndemic clinical conditions such as alcohol, drug, and chemsex usage, notably among men having sex with men (MSMs), are strongly associated with an increased delay.