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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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Casalino E, Bouzid D, Antoniol S, Choquet C, Colosi L, Pereira L, Agbessi A, Kenway P, Yazdanpanah Y, Ghazali DA. Assessment of HIV-postexposure prophylaxis prescription quality after a training programme and assistance in decisions provided by a computer-based decision program: a cross-over study. Acta Clin Belg 2022; 77:495-509. [PMID: 33783339 DOI: 10.1080/17843286.2021.1892422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Among the tools for preventing HIV transmission, post-exposureprophylaxis (PEP) is an effective means after potential HIV exposure. OBJECTIVES To evaluate aPEP training program and acomputer-baseddecision program (CBDP) using simulated patients in emergency department (ED) on the quality of PEP prescription. METHODS This cross-overstudy, carried out from 7January2019 to 28June2019, included 20 ED physicians from 10 tertiary referral hospitals. Intervention consisted of two parts: Period Aassessed physicians' compliance with PEP prescription guidelines before and after atraining program, using 400 post-exposuremedical records (200 occupational and 200 non-occupational). Period Bconsisted of arandomized crossover study involving 40 simulated patients, with physicians using or not using aCBDP. Sensitivity, specificity, and accuracy of PEP prescription in accordance with the guidelines were assessed. RESULTS In period A, alpha Cronbach was less than 0.7 whereas it increased after the training to be >0.7. Sensitivity increased, especially for occupational patients ranging from 51.8%-66.6% to 70.4%-90.1%, whereas specificity increased for non-occupationalpatients ranging from 15.5%-51.9% to 52.1%-75.3%. In period B, sensitivity, specificity, and rate of complete assessments significantly increased (p < 0.0001) after the initiation of CBDP. Rate of PEP prescription significantly decreased (p < 0.001) for all subcategories. CONCLUSION Significant recommendations-discordantprescriptions, mainly overprescription, occurred for patients visiting ED for PEP. Training improved quality of PEP prescription but the reduction was modest. The availability of CBDP improved quality of PEP prescription and allowed for better data collection and reduction of PEP prescription.
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Affiliation(s)
- Enrique Casalino
- Assistance Publique-Hôpitaux De Paris (AP-HP), Hôpital Bichat, Emergency Department, Paris, France
- Assistance Publique - Hôpitaux de Paris, Paris, France
- UMR 1137, Université De Paris, IAME, INSERM, Paris, France
- Infectiology Department, Academic Hospital of Bichat, Assistance Publique-Hôpitaux De Paris (AP-HP), Infectious Diseases and HIV Clinic, Paris, France
| | - Donia Bouzid
- Assistance Publique-Hôpitaux De Paris (AP-HP), Hôpital Bichat, Emergency Department, Paris, France
- Assistance Publique - Hôpitaux de Paris, Paris, France
- UMR 1137, Université De Paris, IAME, INSERM, Paris, France
| | - Stéphanie Antoniol
- Assistance Publique-Hôpitaux De Paris (AP-HP), Hôpital Bichat, Emergency Department, Paris, France
- Assistance Publique - Hôpitaux de Paris, Paris, France
- UMR 1137, Université De Paris, IAME, INSERM, Paris, France
| | - Christophe Choquet
- Assistance Publique-Hôpitaux De Paris (AP-HP), Hôpital Bichat, Emergency Department, Paris, France
- Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Luisa Colosi
- Assistance Publique-Hôpitaux De Paris (AP-HP), Hôpital Bichat, Emergency Department, Paris, France
- Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Laurent Pereira
- Assistance Publique-Hôpitaux De Paris (AP-HP), Hôpital Bichat, Emergency Department, Paris, France
- Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Alexis Agbessi
- Assistance Publique-Hôpitaux De Paris (AP-HP), Hôpital Bichat, Emergency Department, Paris, France
- Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Philippe Kenway
- Assistance Publique-Hôpitaux De Paris (AP-HP), Hôpital Bichat, Emergency Department, Paris, France
- Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Yazdan Yazdanpanah
- UMR 1137, Université De Paris, IAME, INSERM, Paris, France
- Infectiology Department, Academic Hospital of Bichat, Assistance Publique-Hôpitaux De Paris (AP-HP), Infectious Diseases and HIV Clinic, Paris, France
| | - Daniel Aiham Ghazali
- Assistance Publique-Hôpitaux De Paris (AP-HP), Hôpital Bichat, Emergency Department, Paris, France
- Assistance Publique - Hôpitaux de Paris, Paris, France
- UMR 1137, Université De Paris, IAME, INSERM, Paris, France
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Abstract
OBJECTIVE Nonoccupational postexposure prophylaxis (nPEP) programs offer antiretroviral therapy to prevent HIV following at-risk exposures like sexual assault. We investigated the levels of elective nPEP uptake among sexual assault cases presenting for emergency medical care. DESIGN Retrospective analysis. METHODS The analysis included over 3 years (1 January 2015 to 30 September 2018) of clinic information from the Sexual Assault and Partner Abuse Care Program (SAPACP) at The Ottawa Hospital, the regional emergency department care point following sexual assault. Descriptive analyses assessed the number of cases eligible for nPEP and those who started nPEP. Bivariable/multivariable logistic regression modelling assessed factors most strongly associated with starting nPEP using odds ratios (OR), adjusted OR (AOR), and 95% confidence intervals (CI). RESULTS The SAPACP saw 1712 patients; 1032 were sexual assault cases, 494 were eligible for nPEP, and 307/494 (62%) eligible patients started nPEP. The median age was 23 years (IQR: 20-31), with 446 (90%) cases being female. There were 86 (17%) cases who arrived by ambulance, and 279 (56%) assaults involving a known assailant. Reduced odds of starting nPEP were observed among female cases (AOR: 0.44, 95% CI: 0.21-0.93), those who arrived by ambulance (AOR: 0.56, 95% CI: 0.35-0.91), and those with a known assailant (AOR: 0.56, 95% CI: 0.36-0.78). CONCLUSION We found that 62% of eligible sexual assault cases started nPEP. Key groups most likely to decline nPEP included female cases, those who arrived by ambulance, and those with known assailants. Providers can use these findings to provide recommendations to sexual assault survivors most likely to decline nPEP, yet still in need of care.
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Wang Z, Yuan T, Fan S, Qian HZ, Li P, Zhan Y, Li H, Zou H. HIV Nonoccupational Postexposure Prophylaxis Among Men Who Have Sex with Men: A Systematic Review and Meta-Analysis of Global Data. AIDS Patient Care STDS 2020; 34:193-204. [PMID: 32396477 DOI: 10.1089/apc.2019.0313] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
HIV nonoccupational postexposure prophylaxis (nPEP) has been prescribed to men who have sex with men (MSM) for decades, but the global situation of nPEP implementation among this population remains unclear. To understand nPEP awareness, uptake, and factors associated with uptake among MSM, we searched PubMed, Scopus, Embase, the Cochrane Library, and Web of Science for studies reporting nPEP implementation among MSM published before May 19, 2019. We estimated pooled rates and their 95% confidence intervals (CIs) of awareness, uptake using a random-effects model. We identified 74 studies: 3 studies (4.1%) from upper-middle-income regions and 71 (95.9%) from high-income regions. The pooled rate of nPEP awareness and uptake was 51.6% (95% CI 40.6-62.5%) and 6.0% (5.0-7.1%), respectively. Pooled uptake rate was higher in upper-middle-income regions [8.9% (7.8-10.0%)] than in high-income regions [5.8% (4.8-6.9%)]. Unprotected anal sex was the most common exposure (range: 55.0-98.6%, median: 62.9%). Pooled completion of nPEP was 86.9% (79.5-92.8%). Of 19,546 MSM prescribed nPEP, 500 HIV seroconversions (2.6%) were observed. Having risky sexual behaviors and history of sexually transmitted infections were associated with higher nPEP uptake, whereas insufficient knowledge, underestimated risk of exposure to HIV, lack of accessibility, and social stigma might hinder nPEP uptake. Awareness and uptake of nPEP among MSM worldwide are low. Further efforts are needed to combat barriers to access nPEP, including improving accessibility and reducing stigma. Seroconversions post-nPEP uptake suggest that joint prevention precautions aside from nPEP are needed for high-risk MSM. More evidence from low-income and middle-income regions is needed.
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Affiliation(s)
- Zhenyu Wang
- School of Public Health, Sun Yat-Sen University, Guangzhou, China
| | - Tanwei Yuan
- School of Public Health (Shenzhen), Sun Yat-Sen University, Shenzhen, China
| | - Song Fan
- School of Public Health, Sun Yat-Sen University, Guangzhou, China
| | - Han-zhu Qian
- School of Public Health, Yale University, New Haven, Connecticut, USA
| | - Peiyang Li
- School of Public Health, Sun Yat-Sen University, Guangzhou, China
| | - Yuewei Zhan
- School of Public Health (Shenzhen), Sun Yat-Sen University, Shenzhen, China
| | - Hui Li
- Shizhong District Center for Disease Control and Prevention, Jinan, China
| | - Huachun Zou
- School of Public Health (Shenzhen), Sun Yat-Sen University, Shenzhen, China
- Kirby Institute, University of New South Wales, Sydney, Australia
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