Sexual Assault and HIV Postexposure Prophylaxis at an Urban African Hospital

Adherence, adverse drug reactions, and discontinuation associated with adverse drug reactions of HIV post-exposure prophylaxis: a meta-analysis based on cohort studies

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.

Postexposure prophylaxis (PEP) of HIV among adults

ABSTRACT

In the last several decades, postexposure prophylaxis (PEP) with antiretroviral therapy (ART) has become an effective tool for the prevention of HIV transmission. The continuous evolution of antiretrovirals and the associated update of clinical practice guidelines create a challenge for NPs caring for patients exposed to HIV. Understanding the life cycle of HIV is of paramount importance in streamlining treatment regimens in exposed individuals. ART is a complex combination of drugs targeting different stages of the virus's life cycle within the host. NPs play an essential role in managing treatment for people exposed to HIV and following up on these patients' response and adherence to the treatment protocol. This article provides a comprehensive overview of HIV and step-by-step guidance for NPs treating patients who have been exposed.

A scoping review of how exposure to urban violence impacts youth access to sexual, reproductive and trauma health care in LMICs

Violence in the community can impact access to health care. This scoping review examines the impact of urban violence upon youth (aged 15-24) access to sexual and reproductive health and trauma care in Low and Middle Income Countries (LMICs). We searched key electronic health and other databases for primary peer-reviewed studies from 2010 through June 2020. Thirty five of 6712 studies extracted met criteria for inclusion. They were diverse in terms of study objective and design but clear themes emerged. First, youth experience the environment and interpersonal relationships to be violent which impacts their access to health care. Second, sexual assault care is often inadequate, and stigma and abuse are sometimes reported in treatment settings. Third is the low rate of health seeking among youth living in a violent environment. Fourth is the paucity of literature focusing on interventions to address these issues. The scoping review suggests urban violence is a structural and systemic issue that, particularly in low-income areas in LMICs, contributes to framing the conditions for accessing health care. There is a gap in evidence about interventions that will support youth to access good quality health care in complex scenarios where violence is endemic.

Assistance to Victims of Sexual Violence in a Referral Service: A 10-Year Experience

OBJECTIVE

 To evaluate the assistance provided to women victims of sexual violence and their participation in the follow-up treatment after the traumatic event, presenting a sociodemographic profile, gynecological background, and circumstances of the event, and reporting the results, acceptance, and side effects of prophylaxis for sexually transmitted infections (STIs) and pregnancy.

METHODS

 A retrospective cohort study comprising the period between 2007 and 2016. All women receiving medical care and clinical follow-up after a severe episode of sexual violence were included. Records of domestic violence, male victims, children, and adolescents who reported consensual sexual activity were excluded. The present study included descriptive statistics as frequencies and percentages.

RESULTS

 A total of 867 medical records were reviewed and 444 cases of sexual violence were included. The age of the victims ranged from 10 to 77 years old, most of them self-declared white, with between 4 and 8 years of education, and denying having a sexual partner. Sexual violence occurred predominantly at night, on public thoroughfare, being committed by an unknown offender. Most victims were assisted at the referral service center within 72 hours after the violence, enabling the recommended prophylaxis. There was high acceptance of antiretroviral therapy (ART), although half of the users reported side effects. Seroconversion to human immunodeficiency virus (HIV) or to hepatitis B virus (HBV) was not detected in women undergoing prophylaxis.

CONCLUSION

 In the present cohort, the profile of victims of sexual violence was low-educated, young, white women. The traumatic event occurred predominantly at night, on public thoroughfare, being committed by an unknown offender. Assistance within the first 72 hours after sexual violence enables the healthcare center to provide prophylactic interventions against STIs and unwanted pregnancies.

Sexual violence perpetrated in adolescence and adult phase: analysis of reported cases in the capital of Rondônia

Abstract Objective to analyze the epidemiological profile of reported cases of sexual violence perpetrated against women in Porto Velho, Rondônia. Method a quantitative, descriptive cross-sectional study, including cases of violence against women aged 12 years or older registered in the Notifiable Diseases Information System from 2010 to 2018. Results statistical significance was found among women who suffered sexual violence in relation to education (p=0.000); marital status (p=0.000); if they were pregnant women (p=0.026); if the aggressor had a relationship/degree of kinship as spouse/boyfriend (p=0.000); ex-spouse/boyfriend (p=0.002); friends/acquaintances (p=0.015); unknown (p=0.000); with suspected alcohol use (p=0.001) and for the place of occurrence (p=0.000), if it occurred other times (p=0.000); procedure performed (abortion provided for by law (p=0.001), emergency contraception (p=0.001), material collection (p= 0.012) and prophylaxis (p=0.000)); and means used in aggression (body strength/beating (p=0.000), threat (p=0.031), sharp object (p=0.000), firearm (p=0.000), hanging (p=0.000) and blunt object (p=0.019)). Conclusion and implications for practice sexual violence was evidenced as prevalent in adolescence, regardless of age group, and the type of aggression was rape. The contribution will enable efforts to be directed to prevent this disease in groups of younger ages in different forms of relationships.

Violência sexual perpetrada na adolescência e fase adulta: análise dos casos notificados na capital de Rondônia

Resumo Objetivo analisar o perfil epidemiológico dos casos notificados de violência sexual perpetrada contra as mulheres em Porto Velho, Rondônia. Método estudo quantitativo, descritivo, transversal, incluindo os casos de violência contra mulheres com idade igual ou superior a 12 anos registrados no Sistema de Informação de Agravos de Notificação no período de 2010 a 2018. Resultados verificou-se significância estatística entre mulheres que sofreram violência sexual em relação à escolaridade (p=0,000); situação conjugal/civil (p=0,000); se eram gestantes (p=0,026); se o agressor possuía vínculo/grau de parentesco como cônjuge/namorado (p=0,000); ex-cônjuge/namorado (p=0,002); amigos/conhecidos (p=0,015); desconhecido (p=0,000); suspeita do uso de álcool (p=0,001); local da ocorrência (p=0,000), se ocorreu outras vezes (p=0,000); procedimento realizado (aborto previsto em lei (p=0,001), contracepção de emergência (p=0,001), coleta de material (p=0,012) e profilaxia (p=0,000)); e meio usado na agressão (força corporal/espancamento (p=0,000), ameaça (p=0,031), objeto perfurocortante (p=0,000), arma de fogo (p=0,000), enforcamento (p=0,000) e objeto contundente (p=0,019)). Conclusão e implicações na prática evidenciou-se a violência sexual como prevalente na adolescência, independentemente da faixa etária, e o tipo de agressão foi o estupro. A contribuição possibilitará direcionar esforços na prevenção desse agravo em grupos de idades mais jovens nas diferentes formas de relacionamentos.

Post-exposure prophylaxis for human immunodeficiency virus after sexual assault in a Midwestern U.S. emergency department

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.

Predictors of Adherence to HIV Post-Exposure Prophylaxis and Retention in Care After an Episode of Sexual Violence in Brazil

Adherence to nonoccupational post-exposure prophylaxis (nPEP) among sexual violence (SV) victims and their retention in care after SV represent significant challenges. This study aimed at identifying predictors of adherence to nPEP and retention in clinical-laboratory follow-up among SV victims in São Paulo, Brazil. We conducted a retrospective cohort study of SV victims admitted to care and follow-up at the SV unit of the main reference hospital in São Paulo within 72 h following the SV episode. Eligible patients were submitted to a standardized protocol that included nPEP, screening, and management for other sexually transmitted infection as well as emergency contraception. Predictors of adherence to nPEP for 28 days and retention in care until discharge at 180 days after admission were analyzed. A total of 199 SV episodes in 197 victims were recorded from January 2001 to December 2013 (156 months). Of those episodes, 167 were eligible to receive nPEP and 160 (96%) actually received a prescription. Overall 104/160 [65%, 95% confidence interval (CI) 57-72] SV victims, who received nPEP, were fully adherent to nPEP up to 28 days, whereas 89/199 (45%, 95% CI 38-52) were retained in care for 180 days following admission. In multi-variate analysis, patients undergoing at least one psychological consultation (n = 126) were more likely to adhere to nPEP [adjusted odds ratio (adjOR) 8.32; 95% CI 3.0-23.3] and be retained in care for 6 months (adjOR 40.33; 95% CI 8.33-195.30) compared to patients not receiving psychological support. In contrast, study outcomes were not associated with victims' age and sex and with type of perpetrator. In our cohort, provision of psychological care was shown to be associated with enhanced adherence to nPEP and retention in care.

HIV Non-Occupational Post Exposure Prophylaxis in Nigeria: A Systematic Review of Research Evidence and Practice

BACKGROUND

Although non-occupational Human Immunodeficiency Virus (HIV) post-exposure prophylaxis (nPEP) has been proven to be efficacious in preventing HIV, it remains an underutilized prevention strategy in Nigeria. We aimed to conduct an overview of research studies on nPEP and practice in Nigeria from 2002 to 2018 examining: sociodemographic characteristics of study sample, awareness, knowledge and prior use of nPEP, reasons for HIV nPEP, timeliness in presenting for PEP, antiretrovirals (ARVs) used for nPEP, side effects and adherence, monitoring and follow-up visits, adherence to guidelines and recommendations for nPEP by healthcare institutions and the strength of evidence of reviewed studies.

METHODS

An electronic search on PubMed, PubMed Central (PMC), cumulative Index to Nursing and Allied Health Literature (CINAHL), Scopus, Medline, Embase and Google Scholar for published studies on nPEP from January 2002 to December 2018. We conducted our search using different combinations of the keywords "HIV," "non-occupational," "nonoccupational," "post-exposure," "postexposure," "prophylaxis" and "Nigeria."

RESULTS

Five articles met the inclusion criteria for this study. About 25.4% of college students were aware of PEP.PEP awareness was significantly determined by the following factors ever tested for HIV, nude picture exchanges, sex without condom, and knowledge of partner's HIV status. Across studies, exposed victims who presented for PEP were mostly females (64%-78%). Rape was the most frequently occurring reason for seeking nPEP (25.9%-64.1%). Although most patients presented for nPEP within 72 hours, follow up visits were generally low (0%-2%) across studies assessed, except for one study that reported a high follow up visit of 83.3%. Guidelines adherence by healthcare institutions could not be established due to lack of information on key variables.

CONCLUSION

Our study highlights the paucity of research evidence on nPEP use in Nigeria, the societal and cultural contexts in which non-occupational exposures occur, healthcare providers' roles and the public health and practice implications.