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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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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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O'Connell KA, Kisteneff AV, Gill SS, Edwards JF, Sherrerd-Smith WW, Moraczewski LA, Derber CJ, Lo BM. HIV post-exposure prophylaxis in the emergency department: An updated assessment and opportunities for HIV prevention identified. Am J Emerg Med 2020; 46:323-328. [PMID: 33069548 DOI: 10.1016/j.ajem.2020.10.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 09/28/2020] [Accepted: 10/02/2020] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES Research suggests nonoccupational post exposure prophylaxis (nPEP) is under prescribed for people seeking treatment within 72 h of human immunodeficiency virus (HIV) exposures in the emergency department (ED). This study is an assessment of ED prescribers' knowledge, attitudes and practices regarding administration of HIV nPEP. METHODS This was an anonymous survey based on literature review and modified Delphi technique. We approached 153 ED participants at work over a 4-month period from 5 hospital-based and 2 freestanding EDs. There were 152 completed surveys: 80 attendings, 27 residents, and 44 physician assistants. RESULTS The majority of those surveyed (133/149, 89.3%) believe it is their responsibility to provide HIV nPEP in the ED. Although 91% (138/151) and 87% (132/151) of participants are willing to prescribe nPEP for IV drug use and unprotected sex, respectively, only 40% (61/152) of participants felt they could confidently prescribe the appropriate regimen. Only 25% (37/151) of participants prescribed nPEP in the last year. Participants considered time (27%), connecting patients to follow-up (26%), and cost to patients (23%), as barriers to prescribing nPEP. CONCLUSIONS This study identified perceived barriers to administration of nPEP and missed opportunities for HIV prevention in the ED. Although most ED prescribers were willing to prescribe nPEP and felt it is their responsibility to do so, the majority of prescribers were not confident in prescribing it. The most commonly cited barriers to prescribing nPEP were time and access to follow-up care.
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Affiliation(s)
- Katie A O'Connell
- Eastern Virginia Medical School, School of Medicine, 825 Fairfax Avenue, Norfolk, VA, 23507, United States.
| | - Alice V Kisteneff
- Eastern Virginia Medical School, School of Medicine, 825 Fairfax Avenue, Norfolk, VA, 23507, United States.
| | - Shanedeep S Gill
- Eastern Virginia Medical School, School of Medicine, 825 Fairfax Avenue, Norfolk, VA, 23507, United States.
| | - Joshua F Edwards
- Eastern Virginia Medical School, Healthcare Analytics and Delivery Science Institute, P.O. Box 1980, Norfolk, VA 23501, United States.
| | - William W Sherrerd-Smith
- Eastern Virginia Medical School, School of Medicine, 825 Fairfax Avenue, Norfolk, VA, 23507, United States.
| | - Laila A Moraczewski
- Eastern Virginia Medical School/Children's Hospital of King's Daughters, Department of Pediatric Emergency Medicine, P.O. Box 1980, Norfolk, VA 23501, United States.
| | - Catherine J Derber
- Eastern Virginia Medical School, Department of Internal Medicine, Division of Infectious Diseases, P.O. Box 1980, Norfolk, VA 23501, United States.
| | - Bruce M Lo
- Eastern Virginia Medical School, Department of Emergency Medicine/Sentara Norfolk General Hospital, Sentara Norfolk General Hospital, 600 Gresham Drive, Room 304, Norfolk, VA 23507, United States.
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Yankellow I, Yingling CT. Nonoccupational Postexposure Prophylaxis: An Essential Tool for HIV Prevention. J Nurse Pract 2019. [DOI: 10.1016/j.nurpra.2019.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Koblin BA, Usher D, Nandi V, Tieu HV, Bravo E, Lucy D, Miles L, Ortiz G, Kindlon MJ, Parisi DM, Frye V. Post-exposure Prophylaxis Awareness, Knowledge, Access and Use Among Three Populations in New York City, 2016-17. AIDS Behav 2018; 22:2718-2732. [PMID: 29858737 DOI: 10.1007/s10461-018-2175-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Post-exposure prophylaxis (PEP) is a cost-effective, but underused HIV prevention strategy. PEP awareness, knowledge, access, and usage was assessed among young men of color who have sex with men (YMSMOC; n = 177), transgender women (TW; n = 182), and cisgender women of color (CWOC; n = 170) in New York City. 59% were aware of PEP: 80% among YMSMOC, 63% among TW and 34% among CWOC (p < 0.001). 13% had ever used PEP. PEP awareness was higher among YMSMOC with a recent HIV test and lower among those with ≥ 4 partners. PEP awareness was lower among TW who anticipated stigma and reported barriers to taking PEP, and higher among TW who exchanged sex for resources. Among CWOC, more barriers to taking PEP reduced the odds of PEP awareness. PEP education and outreach needs to be deliberate about population-specific campaigns, with a need to focus on reducing PEP stigma and other barriers which impede PEP access.
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Liang SY, Adalja AA. Commentary. Ann Emerg Med 2018; 68:338-9. [PMID: 27568418 DOI: 10.1016/j.annemergmed.2016.06.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Stephen Y Liang
- Division of Emergency Medicine and Division of Infectious Diseases, Washington University School of Medicine, St. Louis, MO
| | - Amesh A Adalja
- Department of Emergency Medicine, Department of Critical Care Medicine, and Division of Infectious Diseases, University of Pittsburgh Medical Center, Pittsburgh, PA
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Sivachandran N, Siemieniuk RAC, Murphy P, Sharp A, Walach C, Placido T, Bogoch II. Sexually transmitted infections and viral hepatitides in patients presenting for non-occupational HIV post-exposure prophylaxis: results of a prospective cohort study. Int J Infect Dis 2016; 40:142-4. [PMID: 26616402 DOI: 10.1016/j.ijid.2015.10.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Revised: 09/30/2015] [Accepted: 10/01/2015] [Indexed: 11/20/2022] Open
Abstract
Data evaluating the screening practices for viral hepatitides and sexually transmitted infections (STIs) in patients presenting for non-occupational HIV post-exposure prophylaxis (nPEP) care are limited. Screening practices and prevalences of viral hepatitides and STIs were evaluated in 126 patients presenting to a dedicated HIV prevention clinic for HIV nPEP. Three patients (2.4%) were diagnosed with chronic hepatitis C infection, 28 (22.2%) did not have surface antibodies in sufficient quantity to confer immunity to hepatitis B, and six (4.8%) were diagnosed with an STI. A multivariate regression model did not predict any demographic or clinical features predictive of HBV non-immunity. Beyond screening for HIV infection, evaluation for viral hepatitides and STIs is an important feature in the care of patients presenting for HIV nPEP.
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Affiliation(s)
| | | | - Pauline Murphy
- Immunodeficiency Clinic, Toronto General Hospital, Toronto, Ontario, Canada
| | - Andrea Sharp
- Immunodeficiency Clinic, Toronto General Hospital, Toronto, Ontario, Canada
| | - Christine Walach
- Immunodeficiency Clinic, Toronto General Hospital, Toronto, Ontario, Canada
| | - Tania Placido
- Immunodeficiency Clinic, Toronto General Hospital, Toronto, Ontario, Canada
| | - Isaac I Bogoch
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Immunodeficiency Clinic, Toronto General Hospital, Toronto, Ontario, Canada; Divisions of Internal Medicine and Infectious Diseases, University Health Network, Toronto General Hospital, 14EN-209, 200 Elizabeth Street, Toronto, ON, Canada M5G 2C4.
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Clinical challenges in HIV/AIDS: Hints for advancing prevention and patient management strategies. Adv Drug Deliv Rev 2016; 103:5-19. [PMID: 27117711 DOI: 10.1016/j.addr.2016.04.016] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Revised: 04/08/2016] [Accepted: 04/16/2016] [Indexed: 01/01/2023]
Abstract
Acquired immune deficiency syndrome has been one of the most devastating epidemics of the last century. The current estimate for people living with the HIV is 36.9 million. Today, despite availability of potent and safe drugs for effective treatment, lifelong therapy is required for preventing HIV re-emergence from a pool of latently infected cells. However, recent evidence show the importance to expand HIV testing, to offer antiretroviral treatment to all infected individuals, and to ensure retention through all the cascade of care. In addition, circumcision, pre-exposure prophylaxis, and other biomedical tools are now available for included in a comprehensive preventive package. Use of all the available tools might allow cutting the HIV transmission in 2030. In this article, we review the status of the epidemic, the latest advances in prevention and treatment, the concept of treatment as prevention and the challenges and opportunities for the HIV cure agenda.
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