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Draughon Moret J, Wilson M, Humphrey-Staub J, Porter T, Wellington J, Anderson JC. Readiness for HIV Postexposure Prophylaxis (PEP) Decision Making Following Sexual Violence. Issues Ment Health Nurs 2024:1-11. [PMID: 39173124 DOI: 10.1080/01612840.2024.2366324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/24/2024]
Abstract
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.
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Affiliation(s)
| | - Machelle Wilson
- Clinical and Translational Science Center Department of Public Health Sciences, Division of Biostatistics, University of California, Davis, Davis, CA, USA
| | - Jacke Humphrey-Staub
- Betty Irene Moore School of Nursing, University of California, Davis, Davis, CA, USA
| | - Tequila Porter
- Betty Irene Moore School of Nursing, University of California, Davis, Davis, CA, USA
| | - Jessica Wellington
- Nese College of Nursing, Penn State University, University Park, PA, USA
| | - Jocelyn C Anderson
- College of Nursing, University of Arkansas for Medical Sciences, Little Rock, AR, USA
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Heck J, Höner zu Siederdissen C, Krause O, Schröder S, Schulze Westhoff M, Strunz PP, Schumacher C, Stichtenoth DO, Bosch JJ, Pape T, Koop F, Krichevsky B. Concordance of emergency department physicians' decisions on HIV post-exposure prophylaxis with national guidelines: results from a retrospective cohort study. Int Health 2024; 16:219-226. [PMID: 37624102 PMCID: PMC10911529 DOI: 10.1093/inthealth/ihad076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 06/06/2023] [Accepted: 08/10/2023] [Indexed: 08/26/2023] Open
Abstract
BACKGROUND Post-exposure prophylaxis (PEP) is an effective tool to prevent infection with HIV. Patients seeking PEP after potential HIV exposure usually present to the emergency department (ED). Our study sought to determine the concordance of ED physicians' decisions on HIV-PEP with national guidelines (primary objective) and to assess the clinical relevance of drug-drug interactions (DDIs) between the HIV-PEP regimen and patients' concomitant medication (secondary objective). METHODS We conducted a retrospective cohort study at the ED of Hannover Medical School, Germany. Between 1 January 2018 and 31 December 2019, 113 of 11 246 screened patients presented to the ED after potential HIV exposure and were enrolled in the study. RESULTS The median age of the patients (82.3% male) was 30 y (IQR 25-35.5), 85.8% of potential HIV exposures were characterised as sexual and 85.0% presented within 72 h. ED physicians' decisions on HIV-PEP were concordant with national guidelines in 93.8%. No clinically relevant DDIs were detected. CONCLUSIONS ED physicians' decisions on HIV-PEP were highly concordant with national guidelines. Approximately 1% of patient presentations to the ED were related to HIV exposure; therefore, training ED physicians on HIV transmission risk assessment and indications/contraindications for HIV-PEP is paramount.
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Affiliation(s)
- Johannes Heck
- Hannover Medical School, Institute for Clinical Pharmacology, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | | | - Olaf Krause
- Hannover Medical School, Institute for General Practice and Palliative Care, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
- DIAKOVERE Henriettenstift, Center for Medicine of the Elderly, Schwemannstr. 19, 30559 Hannover, Germany
| | - Sebastian Schröder
- Hannover Medical School, Department of Psychiatry, Social Psychiatry and Psychotherapy, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Martin Schulze Westhoff
- Hannover Medical School, Department of Psychiatry, Social Psychiatry and Psychotherapy, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Patrick-Pascal Strunz
- University Hospital Würzburg, Department of Internal Medicine II, Rheumatology and Clinical Immunology, Oberdürrbacher Str. 6, 97080 Würzburg, Germany
| | - Carsten Schumacher
- Hannover Medical School, Center for Clinical Trials, Feodor-Lynen-Str. 15, 30625 Hannover, Germany
| | - Dirk O Stichtenoth
- Hannover Medical School, Institute for Clinical Pharmacology, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Jacobus J Bosch
- Centre for Human Drug Research, Zernikedreef 8, 2333 CL Leiden, The Netherlands
- Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
| | - Thorben Pape
- Hannover Medical School, Institute for Clinical Pharmacology, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Felix Koop
- Hannover Medical School, Institute for Clinical Pharmacology, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
- Technical University of Munich, Department of Internal Medicine II, Division of Clinical Toxicology, Ismaninger Str. 22, 81675 Munich, Germany
| | - Benjamin Krichevsky
- Hannover Medical School, Institute for General Practice and Palliative Care, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
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Liu S, Yuan D, Zhou Y, Fu G, Wang B. Adherence, adverse drug reactions, and discontinuation associated with adverse drug reactions of HIV post-exposure prophylaxis: a meta-analysis based on cohort studies. Ann Med 2023; 55:2288309. [PMID: 38065681 PMCID: PMC10836249 DOI: 10.1080/07853890.2023.2288309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 11/21/2023] [Indexed: 12/18/2023] Open
Abstract
Objective: Evaluate the profiles of post-exposure prophylaxis (PEP) adherence, adverse drug reactions (ADRs), and discontinuation associated with ADRs to provide information for further PEP program improvement and increase adherence to PEP.Methods: The Web of Science, PubMed, Embase, and the Cochrane Library were searched for cohort studies reporting data related to PEP adherence or ADRs (PROSPERO, CRD42022385073). Pooled estimates of adherence, the incidence of ADRs and discontinuation associated with ADRs, and their 95% confidence intervals (CI) were calculated separately for the included literature using random effects models. For substantial heterogeneity, meta-regression and subgroup analyses were conducted to explore sources of heterogeneity.Results: Overall adherence was 58.4% (95% CI: 50.9%-65.8%), with subgroup analysis showing differences in adherence across samples, with the highest adherence among men who had sex with men (MSM) (72.4%, 95% CI: 63.4%-81.3%) and the lowest adherence among survivors of sexual assault (SAs) (41.7%, 95% CI: 28.0%-55.3%). The incidence of ADRs was 60.3% (95% CI: 50.3%-70.3%), and the prevalence of PEP discontinuation associated with ADRs was 32.7% (95% CI: 23.7%-41.7%), with subgroup analyses revealing disparities in the prevalence of discontinuation associated with ADRs among samples with different drug regimens. Time trend analysis showed a slight downward trend in the incidence of ADRs and PEP discontinuation associated with ADRs.Conclusion: Adherence to PEP was less than 60% across samples, however, there was significant heterogeneity depending on the samples. SAs had the lowest adherence and the highest incidence of PEP discontinuation. Ongoing adherence education for participants, timely monitoring, and management of ADRs may improve adherence.
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Affiliation(s)
- Shanshan Liu
- Department of Epidemiology and Health Statistics, Key Laboratory of Environmental Medicine Engineering of Ministry of Education, School of Public Health, Southeast University, Nanjing, China
| | - Defu Yuan
- Department of Epidemiology and Health Statistics, Key Laboratory of Environmental Medicine Engineering of Ministry of Education, School of Public Health, Southeast University, Nanjing, China
| | - Ying Zhou
- Department of STD/AIDS Prevention and Control, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China
| | - Gengfeng Fu
- Department of STD/AIDS Prevention and Control, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China
| | - Bei Wang
- Department of Epidemiology and Health Statistics, Key Laboratory of Environmental Medicine Engineering of Ministry of Education, School of Public Health, Southeast University, Nanjing, China
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Anderson JC, Boakye MDS, Draughon Moret J. Patient and Provider Decision Making About HIV Postexposure Prophylaxis Following Sexual Violence: A Qualitative Analysis. J Assoc Nurses AIDS Care 2023; 34:566-581. [PMID: 37787738 PMCID: PMC10592041 DOI: 10.1097/jnc.0000000000000430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
ABSTRACT To explore patient and health care provider HIV postexposure prophylaxis (PEP) decision making following sexual assault, semistructured interviews regarding HIV PEP provision with 15 patients and 10 health care providers were conducted. A qualitative, descriptive, thematic analysis approach was used. Four themes were derived: (a) medical concerns; (b) emotional, trauma, and support factors; (c) daily medication management; and (d) ensuring access to HIV PEP. How participants described these themes and the importance placed on factors within each theme varied between the two groups. Altering provider communication so that HIV PEP discussions better align with patient decision-making factors (e.g., trauma and ability to take in information, how to manage side effects) could facilitate improvement in HIV PEP decision making following sexual assault for patients. High-level policy changes would improve HIV PEP access for sexual assault patients without necessitating the extraordinary efforts individual providers currently undertake.
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Affiliation(s)
- Jocelyn C Anderson
- Jocelyn C. Anderson, PhD, RN, SANE-A, is an Assistant Professor, Ross and Carol Nese College of Nursing, Pennsylvania State University, University Park, Pennsylvania, USA. Michelle D. S. Boakye, PhD, MPH, RN, is a Postdoctoral Fellow, Fitzpatrick College of Nursing, Villanova University, Villanova, Pennsylvania, USA. Jessica Draughon Moret, PhD, RN, is an Associate Clinical Professor, Betty Irene Moore School of Nursing at UC Davis, Sacramento, California, USA
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Wu Y, Zhu Q, Zhou Y, Liang S, Li R, Liang N, Li C, Lan G. Implementation of HIV non-occupational post-exposure prophylaxis for men who have sex with men in 2 cities of Southwestern China. Medicine (Baltimore) 2021; 100:e27563. [PMID: 34713829 PMCID: PMC8556056 DOI: 10.1097/md.0000000000027563] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 09/02/2021] [Accepted: 10/04/2021] [Indexed: 01/05/2023] Open
Abstract
ABSTRACT Non-occupational post-exposure prophylaxis (nPEP) has often relied on the joint work of emergency physicians and infectious disease specialists in busy emergency departments and human immunodeficiency virus (HIV)/sexually transmitted infections clinics abroad, where adherence education and follow-up are invariably reactive. In our pilot study, community-based organizations (CBOs) were invited to together implement the nPEP tailored to men who have sex with men (MSM) in 2 cities of Guangxi in Southwestern China, of which experiences and lessons drawn from would be provided to the promotion of nPEP in China.The study population enrolled MSM individuals prescribed nPEP from September 2017 to December 2019. One-to-one follow-ups by CBOs were applied through the treatment. Predictors of treatment completion were assessed by logistic regression.Of 271 individuals presented for nPEP, 266 MSM with documented treatment completion or non-completion, 93.6% completed the 28-day course of medication. Completion was associated with reporting side effects (aOR = .10; 95% CI: 0.02-0.38; P = .001). The follow-up rate of 91.9% was achieved based on the definition of loss to follow-up. No documented nPEP failures were found, although 1 MSM subsequently seroconverted to HIV due to ongoing high-risk behavior.CBOs' engagement in HIV nPEP, especially the "one-to-one" follow-up supports by peer educators partly ensure adherence and retention to nPEP. Tailored interventions are needed to address the subsequent high-risk behaviors among the MSM population.
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Cherabie JN, Gleason E, Munigala S, Fox B, Trolard A, McCammon C, Hilbert S, Casabar E, Reno H, Liang SY. Post-exposure prophylaxis for human immunodeficiency virus after sexual assault in a Midwestern U.S. emergency department. Am J Emerg Med 2021; 49:117-123. [PMID: 34102456 DOI: 10.1016/j.ajem.2021.05.070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 05/01/2021] [Accepted: 05/28/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Emergency departments (EDs) play an essential role in the timely initiation of HIV post-exposure prophylaxis (PEP) for sexual assault victims. METHODS Retrospective analysis of sexual assault victims evaluated and offered HIV PEP in an urban academic ED between January 1, 2005 and January 1, 2018. Data on demographics, comorbidities, nature of sexual assault, initial ED care, subsequent healthcare utilization within 28 days of initial ED visit, and evidence of seroconversion within 6 months of the initial ED visit were obtained. Predictors of subsequent ED visit and follow-up in the infectious diseases clinic were evaluated using logistic regression analysis. RESULTS Four hundred twenty-three ED visits met criteria for inclusion in this study. Median age at ED presentation was 25 years (IQR 21-34 years), with the majority of victims being female (95.5%), Black (63.4%), unemployed (66.3%) and uninsured (53.9%); psychiatric comorbidities (38.8%) and substance abuse (23.6%) were common. About 87% of the patients accepted HIV PEP (368 of 423 ED visits). Age (OR 0.97, 95% CI 0.94-0.99, p = 0.025) and sexual assault involving >1 assailant (OR 0.48, 95% CI 0.26-0.88, p = 0.018) were associated with lower likelihood of HIV PEP acceptance. Ten patients (2.7%) followed up with the infectious disease clinic within 28 days of starting HIV PEP; 70 patients (19%) returned to the ED for care during the same time period. Psychiatric comorbidity (OR 2.48, 95% CI 1.43-4.30, p = 0.001) and anal penetration (OR 2.02, 95% CI 1.10-3.70, p = 0.024) were associated with greater likelihood of repeat ED visit; female gender (OR 0.30, 95% CI 0.11-0.85, p = 0.023) was associated with lower likelihood of repeat visit. Completion of HIV PEP was documented for 14 (3.3%) individuals. CONCLUSIONS While ED patient acceptance of HIV PEP after sexual assault was high, infectious disease clinic follow-up and documented completion of PEP remained low. Innovative care models bridging EDs to outpatient clinics and community support services are needed to optimize transitions of care for sexual assault victims, including those receiving HIV PEP.
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Affiliation(s)
- Joseph N Cherabie
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Emily Gleason
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Satish Munigala
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Branson Fox
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Anne Trolard
- Institute for Public Health, Washington University in St. Louis, St. Louis, MO, USA
| | - Craig McCammon
- Department of Pharmacy, Barnes-Jewish Hospital, St. Louis, MO, USA
| | - SueLin Hilbert
- Department of Emergency Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Ed Casabar
- Department of Pharmacy, Barnes-Jewish Hospital, St. Louis, MO, USA
| | - Hilary Reno
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Stephen Y Liang
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA; Department of Emergency Medicine, Washington University School of Medicine, St. Louis, MO, USA.
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Matos MCB, Araújo TMED, Queiroz AAFLN, Borges PDTM. Knowledge of health students about prophylaxis pre and post exposure to HIV. ACTA ACUST UNITED AC 2021; 42:e20190445. [PMID: 34037107 DOI: 10.1590/1983-1447.2021.20190445] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 10/05/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To evaluate students' knowledge of nursing and medical courses at a public university on prophylaxis before and after exposure to HIV/AIDS. METHOD cross-sectional study, carried out with nursing and medical students (n = 167). In order to explain the effect of variables on knowledge, the Multinomial Logistic Regression was used. RESULTS Participants had a mean of 23.03 years, female (56.5%), unmarried (64.3%), and heterosexual (86.3%). The level of knowledge demonstrated was mostly medium (49.4%), and only 28.6% showed a high knowledge about the subject. The multivariate analysis showed that the course (p = 0.03) and age (p = 0.01) were associated with a higher level of knowledge. CONCLUSIONS Nursing and medical students possess knowledge considered as average about HIV preventive prophylaxis, thus it is up to the health education institutions to provide subsidies for a better training of students, treating the theme as a transversal subject in their training.
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Affiliation(s)
- Matheus Costa Brandão Matos
- Universidade Federal do Piauí (UFPI), Centro de Ciências da Saúde, Departamento de Enfermagem. Teresina, Piauí, Brasil
| | | | - Artur Acelino Francisco Luz Nunes Queiroz
- Universidade de São Paulo (USP), Escola de Enfermagem de Ribeirão Preto. Ribeirão Preto, São Paulo, Brasil.,Universidade Nova de Lisboa (NOVA), Escola Nacional de Saúde Pública. Lisboa, Portugal
| | - Paulo de Tarso Moura Borges
- Universidade Federal do Piauí (UFPI), Centro de Ciências da Saúde, Departamento de Medicina. Teresina, Piauí, Brasil
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Silva MMS, Nichiata LYI, Simão NS, Silveira RAD. Conditions associated with adherence to HIV post-sexual exposure prophylaxis. Rev Esc Enferm USP 2021; 55:e03699. [PMID: 33978138 DOI: 10.1590/s1980-220x2019028403699] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 10/20/2020] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To analyze conditions which interfere with adherence to HIV post-sexual exposure prophylaxis. METHOD Cross-sectional study conducted in two health care services specializing in HIV/AIDS in São Paulo city. Interviewees included men and women who were eighteen or older, sought care due to consensual sexual relation, and had a recommendation for prophylaxis. The questionnaires which compose the social reproduction index and adherence to prophylaxis were used as parameters. Non-parametric Kruskal-Wallis and Mann-Whitney tests and summation of the employed instrument through programs Excel® and Statistical Package for the Social Sciences® were performed. Ethical principles have been respected. RESULTS Forty-nine users have been identified; their mean age was 34.7 and they were predominantly men (95.9%). Out of these, 83.6% were men who have sex with men. The conditions which correlated with adherence (p<0.05) were taking post-sexual exposure prophylaxis prior to that appointment and continuing to take the medication. CONCLUSION Health professionals are responsible for establishing rapport with service users, especially during the first appointment, to contribute to adherence interventions plans.
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Affiliation(s)
- Marcos Morais Santos Silva
- Universidade de São Paulo, Escola de Enfermagem, Programa de Pós-Graduação em Enfermagem, São Paulo, SP, Brazil
| | - Lucia Yazuko Izumi Nichiata
- Universidade de São Paulo, Escola de Enfermagem, Departamento de Enfermagem em Saúde Coletiva, São Paulo, SP, Brazil
| | - Nathália Santana Simão
- Universidade de São Paulo, Escola de Enfermagem, Programa de Pós-Graduação em Enfermagem, São Paulo, SP, Brazil
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Gantner P, Hessamfar M, Souala MF, Valin N, Simon A, Ajana F, Bouvet E, Rouveix E, Cotte L, Bani-Sadr F, Hustache-Mathieu L, Lebrette MG, Truchetet F, Galempoix JM, Piroth L, Pellissier G, Muret P, Rey D. Elvitegravir-Cobicistat-Emtricitabine-Tenofovir Alafenamide Single-tablet Regimen for Human Immunodeficiency Virus Postexposure Prophylaxis. Clin Infect Dis 2021; 70:943-946. [PMID: 31804669 DOI: 10.1093/cid/ciz577] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2019] [Accepted: 06/26/2019] [Indexed: 01/08/2023] Open
Abstract
We evaluated an elvitegravir-cobicistat-emtricitabine-tenofovir alafenamide single-tablet regimen for human immunodeficiency virus postexposure prophylaxis. The completion rate and adherence were good, and the tolerance was acceptable; no seroconversion was observed. We confirm that this regimen could be appropriate for postexposure prophylaxis. CLINICAL TRIALS REGISTRATION NCT02998320.
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Affiliation(s)
- Pierre Gantner
- Laboratory of Molecular Virology, Hôpitaux Universitaires de Strasbourg, Rennes, France.,INSERM, Strasbourg University, Hôpital Saint André, Centre Hospitalier Universitaire de Bordeaux, Rennes, France
| | - Mojgan Hessamfar
- Service de Médecine Interne et Maladies Infectieuses, Hôpital Saint André, Centre Hospitalier Universitaire de Bordeaux, Rennes, France
| | - Mohamed Faouzi Souala
- Service des Maladies Infectieuses et Tropicales, Centre Hospitalier Universitaire Pontchaillou, Rennes, France
| | - Nadia Valin
- Service de Maladies Infectieuses et Tropicales, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris (APHP), APHP, France
| | - Anne Simon
- Service de Médecine Interne et Immunologie Clinique, Hôpital Pitié-Salpêtrière, APHP, France
| | - Faiza Ajana
- Service Universitaire des Maladies Infectieuses et du Voyageur, Centre Hospitalier de Tourcoing, APHP, France
| | | | | | - Laurent Cotte
- Maladies Infectieuses et Tropicales, Hôpital de la Croix Rousse, Lyon, France
| | - Firouzé Bani-Sadr
- Unité des Maladies Infectieuses et Tropicales, Hôpital Robert Debré, Reims, France
| | | | | | - François Truchetet
- Service de Dermatologie, Centre Hospitalier Metz-Thionville, Paris, France
| | - Jean-Marie Galempoix
- Service de Médecine Infectieuse, Centre Hospitalier Manchester, Charleville-Mézières, Paris, France
| | - Lionel Piroth
- Département d'Infectiologie, Centre Hospitalier Universitaire de Dijon, Paris, France
| | - Gérard Pellissier
- Groupe d'étude sur le Risque d'exposition des Soignants aux Agents Infectieux, Paris, France
| | - Patrice Muret
- Laboratoire de pharmacologie clinique, INSERM, Hôpital Jean Minjoz, Besançon, France
| | - David Rey
- Le Trait d'Union, HIV-Infection Care Center, Hôpitaux Universitaires de Strasbourg, France
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Wang L, Huai P, Jiao K, Liu Y, Hua Y, Liu X, Wei C, Ma W. Awareness of and barriers to using non-occupational post-exposure prophylaxis among male clients of female sex workers in two cities of China: a qualitative study. Sex Health 2021; 18:239-247. [PMID: 34148566 DOI: 10.1071/sh20203] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 03/16/2021] [Indexed: 12/27/2022]
Abstract
Background Male clients of female sex workers ('clients' hereafter) are considered high-risk and potentially a bridge population in the HIV epidemic. Non-occupational post-exposure prophylaxis (nPEP) is a safe and effective but under-utilised public health intervention to prevent HIV transmission. This study aims to explore clients' awareness of nPEP, intention of uptake, potential barriers to nPEP uptake and adherence, and suggestions for nPEP promotion in China. METHODS We conducted semi-structured in-depth interviews with 20 clients in two Chinese cities in 2018. Participants were recruited through purposive sampling. The content of the interviews was analysed using thematic content analysis in ATLAS.ti. RESULTS Overall, just a minority of participants were aware of nPEP. A majority expressed willingness to use nPEP. Potential barriers to nPEP uptake and adherence included adverse drug reactions, price, concerns of drug efficacy, privacy issues, and forgetting to take the drugs. Almost all participants expressed the need to promote nPEP among clients. Participants suggested that the promotion of nPEP should be at hospitals, online, and be integrated with HIV/AIDS health education. CONCLUSIONS Our findings suggested that nPEP guidelines should be formulated and implementation strategies should be developed to address barriers to uptake and adherence in order to successfully tap into the potential of nPEP as an effective HIV prevention tool.
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Affiliation(s)
- Lin Wang
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, No. 44 West WenHua Road, Jinan 250012, China
| | - Pengcheng Huai
- Shandong Provincial Hospital for Skin Disease, Shandong First Medical University, Jinan, China
| | - Kedi Jiao
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, No. 44 West WenHua Road, Jinan 250012, China
| | - Yicong Liu
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, No. 44 West WenHua Road, Jinan 250012, China
| | - Yumeng Hua
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, No. 44 West WenHua Road, Jinan 250012, China
| | - Xueyuan Liu
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, No. 44 West WenHua Road, Jinan 250012, China
| | - Chongyi Wei
- Department of Health Behavior, Society and Policy, Rutgers School of Public Health, Piscataway, NJ, USA; and Corresponding authors. Emails: ;
| | - Wei Ma
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, No. 44 West WenHua Road, Jinan 250012, China; and Corresponding authors. Emails: ;
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Draughon Moret JE, Sheridan DJ, Wenzel JA. "Reclaiming Control" Patient Acceptance and Adherence to HIV Post-Exposure Prophylaxis Following Sexual Assault. Glob Qual Nurs Res 2021; 8:23333936211046581. [PMID: 35187201 PMCID: PMC8851138 DOI: 10.1177/23333936211046581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 08/27/2021] [Indexed: 11/17/2022] Open
Abstract
Sexual assault is an irrefutable trauma; an insult to the autonomy of the person forced into sexual acts. Sexual assault sequelae range from physical injury and acute traumatic stress, to pregnancy and sexually transmitted infections, including human immunodeficiency virus (HIV). HIV post-exposure prophylaxis (HIV PEP) following sexual assault may decrease the likelihood of HIV transmission. Many patients seeking healthcare post-sexual assault either do not initiate HIV PEP or do not complete the 28-day medication regimen. In this qualitative interpretive description, we interviewed sexual assault patients (N=11) about HIV PEP discussions/reactions, attitudes and understanding related to HIV and PEP, and barriers and facilitators of HIV PEP acceptance and adherence. Participants described a process of losing and reclaiming control throughout post-assault care and follow-up; and how this affected HIV PEP-related decision-making. Most HIV PEP decisions were described as a process of reclaiming control over one outcome while simultaneously losing control of another.
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Affiliation(s)
- Jessica E Draughon Moret
- Faculty of the Betty Irene Moore School of Nursing in Sacramento, University of California Davis, Davis, CA, USA
| | - Daniel J Sheridan
- Faculty of the School of Nursing in Baltimore, Johns Hopkins University, Baltimore, MD, USA
| | - Jennifer A Wenzel
- Faculty of the School of Nursing in Baltimore, Johns Hopkins University, Baltimore, MD, USA
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Malinverni S, Bédoret F, Bartiaux M, Gilles C, De Wit S, Libois A. Single-tablet regimen of emtricitabine/tenofovir disoproxil fumarate plus cobicistat-boosted elvitegravir increase adherence for HIV postexposure prophylaxis in sexual assault victims. Sex Transm Infect 2020; 97:329-333. [PMID: 33106437 DOI: 10.1136/sextrans-2020-054714] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 09/17/2020] [Accepted: 09/27/2020] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Postexposure prophylaxis (PEP) is a recommended public health intervention after a sexual assault to prevent HIV infection. METHODS We conducted a retrospective case-control study on how use of a single-tablet regimen (STR) of elvitegravir/cobicistat/emtricitabine/tenofovir disoproxil fumarate (Stribild) affected adherence to PEP and attendance of a follow-up visit to the STI clinic compared with those who received a multitablet regimen (MTR). Data from sexual assault victims consulting for PEP were prospectively recorded between January 2011 and December 2017. Data were systematically collected on patient demographics, time of medical contact, source risk factors, type of exposure, attendance to follow-up visit, reported completion of PEP and adherence based on pharmacy records. RESULTS A total of 422 patients received PEP following a sexual assault, of whom 52% had documented completion of a 28-day PEP regimen and 71% attended a follow-up clinic visit. Patients who received an elvitegravir/cobicistat/emtricitabine/tenofovir disoproxil fumarate (EVG/COBI/FTC/TDF)-based STR had a similar likelihood of attending their first follow-up visit (OR: 0.97; 95% CI: 0.64 to 1.48, p=0.90) but were more likely to complete the PEP regimen (OR: 1.70; 95% CI: 1.16 to 2.50, p=0.007). After adjusting for confounders, those who were prescribed an STR regimen were more likely to complete the PEP regimen (OR: 1.66, 95% CI: 1.09 to 2.53, p=0.019) than those who were prescribed an MTR such as stavudine/lamivudine/lopinavir/ritonavir or zidovudine/lamivudine/indinavir/ritonavir. CONCLUSIONS Sexual assault victims who were prescribed an STR based on EVG/COBI/FTC/TDF were more likely to complete PEP than those who were prescribed an MTR.
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Affiliation(s)
| | | | | | | | | | - Agnes Libois
- Infectious Diseases, CHU Saint-Pierre, Bruxelles, Belgium
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Inciarte A, Leal L, Masfarre L, Gonzalez E, Diaz-Brito V, Lucero C, Garcia-Pindado J, León A, García F. Post-exposure prophylaxis for HIV infection in sexual assault victims. HIV Med 2019; 21:43-52. [PMID: 31603619 PMCID: PMC6916272 DOI: 10.1111/hiv.12797] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/01/2019] [Indexed: 11/01/2022]
Abstract
OBJECTIVES Sexual assault (SA) is recognized as a public health problem of epidemic proportions. Guidelines recommend the administration of post-exposure prophylaxis (PEP) after an SA. However, few data are available about the feasibility of this strategy, and this study was conducted to assess this. METHODS We conducted a retrospective, longitudinal, observational study in SA victims attending the Hospital Clinic in Barcelona from 2006 to 2015. A total of 1695 SA victims attended the emergency room (ER), of whom 883 met the PEP criteria. Five follow-up visits were scheduled at days 1, 10, 28, 90 and 180 in the out-patient clinic. The primary endpoint was PEP completion rate at day 28. Secondary endpoints were loss to follow-up, treatment discontinuation, occurrence of adverse events (AEs) and rate of seroconversion. RESULTS The median age of participants was 25 years [interquartile range (IQR) 21-33 years] and 93% were female. The median interval between exposure and presentation at the ER was 13 h (IQR 6-24 h). The level of risk was appreciable in 47% (n = 466) of individuals. Of 883 patients receiving PEP, 631 lived in Catalonia. In this group, the PEP completion rate at day 28 was 29% (n = 183). The follow-up rate was 63% (n = 400) and 38% (n = 241) at days 1 and 28, respectively. Treatment discontinuation was present in 58 (15%) of 400 patients who attended at least the day 1 visit, the main reason being AEs (n = 35; 60%). AEs were reported in 226 (56%) patients, and were mainly gastrointestinal (n = 196; 49%). Only 211 (33%) patients returned for HIV testing at day 90. A single seroconversion was observed in a men who have sex with men (MSM) patient at day 120. CONCLUSIONS Follow-up and compliance rates in SA victims were poor. In addition, > 50% of the patients experienced AEs, which were the main reason for PEP interruption. Strategies to increase follow-up testing and new better tolerated drug regimens must be investigated to address these issues.
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Affiliation(s)
- A Inciarte
- Infectious Diseases Unit, Hospital Clinic of Barcelona, Barcelona, Spain.,University of Barcelona, Barcelona, Spain.,Institute of Biomedical Investigation August Pi and Sunyer, Barcelona, Spain
| | - L Leal
- Infectious Diseases Unit, Hospital Clinic of Barcelona, Barcelona, Spain.,University of Barcelona, Barcelona, Spain.,Institute of Biomedical Investigation August Pi and Sunyer, Barcelona, Spain
| | - L Masfarre
- University of Barcelona, Barcelona, Spain
| | - E Gonzalez
- Infectious Diseases Unit, Hospital Clinic of Barcelona, Barcelona, Spain
| | - V Diaz-Brito
- Infectious Diseases Unit, Hospital Clinic of Barcelona, Barcelona, Spain.,Hospital Sant Joan De DEU, Santa Boi, Spain
| | - C Lucero
- Infectious Diseases Unit, Hospital Clinic of Barcelona, Barcelona, Spain
| | | | - A León
- Infectious Diseases Unit, Hospital Clinic of Barcelona, Barcelona, Spain.,Institute of Biomedical Investigation August Pi and Sunyer, Barcelona, Spain
| | - F García
- Infectious Diseases Unit, Hospital Clinic of Barcelona, Barcelona, Spain.,University of Barcelona, Barcelona, Spain.,Institute of Biomedical Investigation August Pi and Sunyer, Barcelona, Spain
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Abstract
PURPOSE OF REVIEW Adolescents and young adults continue to contribute to new HIV infections despite improved antiretroviral regimens and HIV preexposure and postexposure prophylaxis (PrEP and PEP). Knowledge about nonoccupational HIV PEP (nPEP) is relevant and important for all pediatricians as adolescents present under a variety of circumstances disclosing past sexual activity. RECENT FINDINGS nPEP is effective in preventing HIV infection, and newer regimens have been shown to increase compliance amongst users, have less side effects, and lead to less HIV resistance. Yet, research on physician prescription practices shows a lack of knowledge regarding appropriate HIV nPEP medication regimens, dosing, and follow-up recommendations. Updated national guidelines are available to providers who may be unfamiliar with indications and drug regimens for nPEP. Studies also provide different strategies to increase nPEP use and compliance among patients as well as ways to increase provider awareness of appropriate nPEP prescription. SUMMARY Research of HIV nPEP shows that it is effective when used correctly, but there needs to be increased education and awareness to increase provider prescription and patient use as well as institutional changes to help patients complete the full course of medication.
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Toward Development of a Stochastic Wake Model: Validation Using LES and Turbine Loads. ENERGIES 2017. [DOI: 10.3390/en11010053] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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