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Cited by 38HIV/AIDS Research and InterventionsHIV/AIDS drug development and treatmentHIV, Drug Use, Sexual Risk

Starter packs versus full prescription of antiretroviral drugs for postexposure prophylaxis: a systematic review.

Ford, N., Venter, F., Irvine, C., Beanland, R. L., Shubber, Z.·2015·Clinical Infectious Diseases
DOI 10.1093/cid/civ093
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Abstract

BACKGROUND: The provision of starter packs for human immunodeficiency virus postexposure prophylaxis (PEP) is practiced in many settings to facilitate rapid initiation by nonexperts and encourage adherence. However, the impact of starter packs on PEP completion rates has not been systematically assessed. We systematically reviewed the evidence on outcomes associated with starter packs for PEP compared to full prescriptions. METHODS: Four databases and 2 conference abstract sites were searched up to December 2013; this search was updated in 1 database in June 2014. PEP completion rates, stratified by prescribing practice, were pooled using random-effects meta-analysis. RESULTS: Fifty-four studies provided data on 11 714 PEP initiations. Thirty-seven studies, including 3 randomized controlled trials (RCTs) and 34 observational cohorts, provided information on starter packs (although none of the RCTs specifically assessed starter packs), and 17 studies, including 2 RCTs and 15 observational cohorts, provided information on full prescriptions. Overall, outcomes were better when participants were offered a full 28-day course of PEP at initial presentation to healthcare, with fewer refusals (11.4% [95% confidence interval {CI}, 5.3%-17.5%] vs 22% [95% CI, 16.7%-28.1%]) and higher completion rates (70% [95% CI, 56.7%-77.3%] vs 53.2% [95% CI, 44.4%-62.2%]). More than a quarter (28% [95% CI, 21.4%-34.5%]) of individuals provided with a PEP starter pack failed to return for their subsequent appointment and therefore defaulted prior to receiving a full course of PEP. The quality of the evidence overall was rated as very low. CONCLUSIONS: The findings of this review suggest that starter packs do not improve adherence to PEP and may result in lower adherence and completion rates.

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Crossref · 10.1093/cid/civ093

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  • Provision of the entire 28-day PEP medication supply at the initial visit has been reported to increase likelihood of adherence, especially when patients have difficulty returning for multiple follow-up visits.

    “Provision of the entire 28-day PEP medication supply at the initial visit has been reported to increase likelihood of adherence, especially when patients have difficulty returning for multiple follow-up visits (1437).”

    From Sexually Transmitted Infections Treatment Guidelines, 2021 (2021) · cites this paper as [1437]

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Authors
Ford, N., Venter, F., Irvine, C., Beanland, R. L., & Shubber, Z.
Affiliations
  • World Health Organization (CH)
  • University of the Witwatersrand (ZA)
  • Imperial College London (GB)
Corresponding author
Ford, N.
ORCID
Venue
Clinical Infectious Diseases
Publisher
Oxford University Press (OUP)
Published
2015-05-13
Volume
60
Issue
suppl 3
Pages
S182-S186
ISSN
  • 1058-4838 (ISSN-L)
  • 1537-6591
DOI
10.1093/cid/civ093
OpenAlex
W1916764730
Cited by
38
References
58
Citations by year
2025: 4 · 2024: 2 · 2023: 5 · 2022: 2 · 2021: 3 · 2020: 2 · 2019: 7 · 2018: 3 · 2017: 4 · 2016: 2 · 2015: 4
FWCI
0.65
Type
journal article
Language
en
Open access
closed
Locations
  • Clinical Infectious Diseases (publishedVersion)
  • PubMed (publishedVersion)
Funders
World Health Organization
Topics
  • Health Sciences › Medicine › Infectious Diseases › HIV/AIDS Research and Interventions
  • Health Sciences › Medicine › Infectious Diseases › HIV/AIDS drug development and treatment
  • Health Sciences › Medicine › Epidemiology › HIV, Drug Use, Sexual Risk
Keywords
post-exposure prophylaxis, HIV, antiretroviral drugs, medication adherence, medication refusal, missed appointments, HIV prevention
MeSH terms
Humans, Drug Prescriptions, World Health Organization, HIV Infections, Randomized Controlled Trials as Topic, Anti-HIV Agents, Medication Adherence, Post-Exposure Prophylaxis, Observational Studies as Topic

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