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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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Venter WDF. Pre-exposure Prophylaxis: The Delivery Challenge. Front Public Health 2018; 6:188. [PMID: 30035106 PMCID: PMC6043793 DOI: 10.3389/fpubh.2018.00188] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Accepted: 06/13/2018] [Indexed: 01/14/2023] Open
Abstract
HIV pre-exposure prophylaxis (PrEP), despite its efficacy, has been slow in uptake throughout the world. This article discusses the operational and service delivery complexity, based on early real-world experience, with some recommendations on how this promising intervention could be made more available. Currently, access to PrEP is made complex by restricting delivery to dedicated health facilities, as well as requirements around HIV testing and toxicity monitoring. Expanding to verticalized services that focus on well-defined populations where HIV testing and treatment programmes already exist, has proven relatively simple. Providing PrEP outside of this environment has yet to be demonstrated at any scale, and will likely require innovative thinking addressing the regulatory and clinical environment, so as to ensure easier access to this promising HIV prevention tool.
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Affiliation(s)
- Willem D F Venter
- Wits Reproductive Health and HIV Institute, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
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