Readability and health literacy level of post-exposure prophylaxis patient education materials offered after sexual assault

Readiness for HIV Postexposure Prophylaxis (PEP) Decision Making Following Sexual Violence

HIV post-exposure prophylaxis (PEP) can reduce the risk of acquiring HIV infection following sexual assault. However, only about half of people offered HIV PEP will initiate the medication. Factors associated with patient readiness for HIV PEP following sexual assault have been attributed to structural and clinical barriers. This study utilized the Theory of Reasoned Action and Planned Behavior to better understand how personal factors, cognitive factors, mental health, barriers and facilitators that could influence a patient's decision to start HIV PEP post sexual assault. A web-based cross sectional survey was conducted from October 2017 to January 2020 and a total of 228 responses were included from participants that had experienced sexual assault in the previous 3 months. Using linear regression modeling fear of HIV, post-traumatic stress symptoms, validating social responses to disclosure, and having someone else pay for HIV PEP were all associated with feeling better prepared for HIV PEP decision making. Results indicate that structural, social, and individual factors impact patient decision making. These findings highlight opportunities for health systems and providers to improve HIV education and the importance of initiating HIV PEP following sexual assault.

Factors Impacting HIV Postexposure Prophylaxis Among Sexually Assaulted Patients Presenting to Two Urban Emergency Departments

INTRODUCTION

Sexually assaulted patients who seek care in emergency departments are often recommended for nonoccupational HIV postexposure prophylaxis treatment. HIV postexposure prophylaxis is an effective method in preventing HIV transmission if the treatment is administered promptly and if a full 28-day course is completed. However, research has shown that only a fraction of patients who start the treatment will complete a 28-day course. Research is needed to explore factors that may be associated with compliance to postexposure prophylaxis so that interventions can be designed to address the factors that put patients at risk for noncompletion.

METHODS

A retrospective chart review was conducted examining 246 medical records of sexually assaulted female patients who presented to one of two urban hospitals. A number of patient and event-related factors were examined to determine whether they were associated with HIV postexposure prophylaxis adherence among patients presenting at an emergency room after a sexual assault.

RESULTS

Results revealed that five factors showed significant associations with sexually assaulted female patients completing HIV postexposure prophylaxis treatment. These factors include educational level, employment, health insurance, vaginal injuries, and tongue-mouth assaults.

IMPLICATIONS FOR PRACTICE

The results of this study represent a starting point from which to inform the development of targeted interventions such that those most at risk for nonadherence can receive additional support or services to improve HIV postexposure prophylaxis adherence.