Programming Connection

The PEP Program 

Clinique médicale l'Actuel
Montreal, Quebec
2010

Evaluation

According to l’Actuel, the response from the community has been overwhelmingly positive. The following data was collected by the clinic between 2001 and 2009:

  • More than 1,139 people contacted the clinic regarding PEP.
  • After consultations with clinic staff, 931 people were prescribed PEP.
  • Of treated clients, 68% complained of side effects.
  • Of treated clients, six (0.6%) seroconverted.

The effectiveness of PEP, in terms of how many HIV infections it prevents, is difficult to determine because multiple factors are at play with PEP (such as whether or not the client was actually exposed to HIV, whether exposure would have led to infection without PEP, whether or not the client was adherent to treatment, whether the client received the treatment within 72 or 24 hours, etc.).

Nevertheless, in 2008, Quebec Health and Social Services reported that approximately 1.3% of MSM contract HIV each year, which is more than double the rate of seroconversion in participants who were prescribed PEP in The PEP Program. Though there is insufficient evidence to draw a direct correlation between this data and the data from The PEP Program, they do show promise for future research.

After consulting the six individuals who seroconverted in The PEP Program, it was determined that though they presented themselves to the clinic within 72 hours of the activity which they believed may have exposed them to HIV, there was a strong probability that they were also exposed to HIV at least once more outside of the 72-hour window period. Therefore, infection may have been caused by an earlier exposure for which PEP was not accessed.

The l’Actuel staff rarely see clients who are interested in taking PEP but who turn out to be either at low risk for having been exposed to HIV or who present themselves to the clinic after the 72-hour window period has elapsed. This response suggests that the promotional campaign is being well received and understood.

In addition to preventing seroconversion among the target clientele, The PEP Program provides an opportunity for people who believe they have recently been exposed to HIV to speak with a health-care professional about their level of risk for exposure to HIV as well as their options for preventing infection, a benefit of the program that extends even to those who do not qualify for PEP. All participants in the program were able to take advantage of this service, regardless of whether or not they were prescribed treatment.