scholarly journals P073: Single and dual vs. standard triple agent regimens for HIV post-exposure prophylaxis in the sexual assault victim population

CJEM ◽  
2017 ◽  
Vol 19 (S1) ◽  
pp. S103
Author(s):  
T. Kumar ◽  
K. Sampsel ◽  
I.G. Stiell
Keyword(s):  
Side Effects ◽  
Sexual Assault ◽  
Triple Therapy ◽  
Single Agent ◽  
Post Exposure Prophylaxis ◽  
Post Exposure ◽  
Number Of Patients ◽  
Significant Difference ◽  
Patient Reported ◽  
Exposure Prophylaxis

Introduction: Although Tenofovir/Emtricitabine was approved in 2012 as a single-agent regimen for pre-exposure prophylaxis, there have been no studies to our knowledge that demonstrate the efficacy of single and dual agent regimens in post-exposure prophylaxis. Our goal was to compare outcomes of post-exposure prophylaxis with single and dual agent regimens versus triple therapy in victims of sexual assault. Methods: This was a before and after cohort study of patients seen by the Sexual Assault and Partner Abuse Care Program (SAPACP) at the Ottawa Hospital. We reviewed charts of patients seen by the SAPACP from Jan. 1-Dec. 31 2013, when triple therapy was usual care, and Jan. 1-Dec. 31 2015, after the introduction of alternative regimens. Patients who were deemed high risk or who did not get initial treatment at the SAPACP were excluded. Our primary outcome was the number of patients who completed the entire 28-day post-exposure prophylaxis regimen. Secondary objectives were to assess HIV seroconversion rates and patient reported side effects. Results: Six hundred-thirty charts were reviewed, and 429 were included in the study. Baseline characteristics were similar between the two years. We found no significant difference in completion rates of HIV post-exposure prophylaxis between the two cohorts (50.5% vs. 51.6%). However, we did note a decrease in reported side effects in the 2015 cohort (72.2% vs. 17.6%, p<0.0001). In our secondary analysis, we compared all patients in all years who received triple therapy (N=128) versus those who received alternative single or dual agent regimens (N=47). We found that the alternative regimen group had a higher completion rate (66.0% vs. 42.2%; p=0.03), and a dramatic decrease in rate of reported side effects (19.1% vs. 53.9%; p<0.0001). Specifically, we saw decreased reported rates of nausea (12.8% vs. 36.7 %), constipation (0% vs. 7.9%), diarrhea (2.1% vs. 21.1%), mood changes (0% vs. 10.9%), headache (2.1% vs. 16.4%), and fatigue (6.4% vs. 26.6%). There were no HIV seroconversions in either group. Conclusion: Our results suggest that single and dual agent HIV post-exposure prophylaxis regimens are better tolerated by patients and associated with higher rates of completion than triple therapy, and should be considered as stand-alone therapy in the sexual assault victim population.

scholarly journals 986. Improvement in Administration of HIV Post-Exposure Prophylaxis in the Emergency Department Following Sexual Assault

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S521-S522
Author(s):  
Jennifer R Silva-Nash ◽  
Stacie Bordelon ◽  
Ryan K Dare ◽  
Sherrie Searcy
Keyword(s):  
Emergency Department ◽  
Sexual Assault ◽  
Hiv Transmission ◽  
Post Exposure Prophylaxis ◽  
Intervention Period ◽  
Post Intervention ◽  
Post Exposure ◽  
Assault Victims ◽  
Exposure Prophylaxis

Abstract Background Nonoccupational post exposure prophylaxis (nPEP) following sexual assault can prevent HIV transmission. A standardized Emergency Department (ED) protocol for evaluation, treatment, and follow up for post assault victims was implemented to improve compliance with CDC nPEP guidelines. Methods A single-center observational study of post sexual assault patients before/after implementation of an ED nPEP protocol was conducted by comparing the appropriateness of prescriptions, labs, and necessary follow up. A standardized order-set based on CDC nPEP guidelines, with involvement of an HIV pharmacist and ID clinic, was implemented during the 2018-2019 academic year. Clinical data from pre-intervention period (07/2016-06/2017) was compared to post-intervention period (07/2018-08/2019) following a 1-year washout period. Results During the study, 147 post-sexual assault patients (59 Pre, 88 Post) were included. One hundred thirty-three (90.4%) were female, 68 (46.6%) were African American and 133 (90.4%) were candidates for nPEP. Median time to presentation following assault was 12.6 hours. nPEP was offered to 40 (67.8%) and 84 (95.5%) patients (P< 0.001) and ultimately prescribed to 29 (49.2%) and 71 (80.7%) patients (P< 0.001) in pre and post periods respectively. Renal function (37.3% vs 88.6%; P< 0.001), pregnancy (39.0% vs 79.6%; P< 0.001), syphilis (3.4% vs 89.8%; P< 0.001), hepatitis B (15.3% vs 95.5%; P< 0.001) and hepatitis C (27.1% vs 94.3%) screening occurred more frequently during the post period. Labratory, nPEP Prescription and Follow up Details for Patients Prescribed nPEP Conclusion The standardization of an nPEP ED protocol for sexual assault victims resulted in increased nPEP administration, appropriateness of prescription, screening for other sexually transmitted infectious and scheduling follow up care. While guideline compliance dramatically improved, further interventions are likely warranted in this vulnerable population. Disclosures Ryan K. Dare, MD, MS, Accelerate Diagnostics, Inc (Research Grant or Support)

scholarly journals Knowledge, attitude and practices of medical and health science students on the antiretroviral based HIV post-exposure prophylaxis in an Ethiopian hospital: an institutional based cross-sectional study

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Betelhem Anteneh ◽  
Sewunet Admasu Belachew ◽  
Alem Endeshaw ◽  
Zewdu Birhanu Wubneh ◽  
Barun Ranjan Sarkar
Keyword(s):  
Side Effects ◽  
Cross Sectional Study ◽  
Health Science ◽  
Post Exposure Prophylaxis ◽  
Science Students ◽  
Sectional Study ◽  
Cross Sectional ◽  
Health Science Students ◽  
Post Exposure ◽  
Exposure Prophylaxis

Abstract Background HIV/AIDS in resource-limited settings poses a high risk of occupational exposure to healthcare workers due to higher number of HIV infected patients. Hence, antiretroviral based post-exposure prophylaxis (PEP) for HIV is very crucial. The aim of the study was to determine the knowledge, attitudes, and practices of medical and Health science students on antiretroviral based HIV PEP in University of Gondar comprehensive specialized hospital (UOGCSH), Northwestern Ethiopia. Methods An institutional-based cross-sectional study was conducted among 220 medical and health science graduating students in UOGCSH from May to July 2015. Data were collected using a self-administered pretested questionnaire. The collected data were analyzed using SPSS software version 22. Results were summarized in frequencies, percentages, and means with standard deviations and presented using tables or figures. Results Among the respondents, only sixty-six (30%) of the 220 study participants has had adequate knowledge about HIV PEP. Furthermore, over 90 % of the students had positive attitude towards HIV PEP f. Out of the total respondents, 37/220 (16.8%) were in need of HIV PEP and of these students only 18/37 (48.6%) took PEP. On the other hand, merely 50% of the study subjects completed the full course of HIV PEP, while the rest 50% failed to finish. As to the respondents self-report, the sole reason for starting but failing to complete the full course of HIV PEP was intolerance to the side effects of antiretroviral. Conclusions Although majority of the respondents had poor knowledge and practice, they owned a good attitude towards HIV PEP. Therefore, a pre-service intensive training for all students regarding HIV PEP prior to their clinical attachments is mandatory. In addition, potential side effects of ARTs and its managements should be priory informed to the students so as to prevent the associated non-adherence to ultimately reduce the incidence of drug resistance. Moreover, the habit of needle stick injury reporting was found to be poor that needs due improvement and there has been also a pressing need to supply sufficient protective barriers to the students while planning and rendering services.

Characterization of Emergency Department Rabies Post-Exposure Prophylaxis Procedures with an Infectious Diseases Clinic Referral Process

2020 ◽  
pp. 001857872097388
Author(s):  
Jessica J. Frederickson ◽  
Alexandra K. Monroe ◽  
Gregory A. Hall ◽  
Kyle A. Weant
Keyword(s):  
Emergency Department ◽  
Retrospective Chart Review ◽  
Future Research ◽  
Post Exposure Prophylaxis ◽  
Referral Process ◽  
Post Exposure ◽  
Care Plans ◽  
Number Of Patients ◽  
Exposure Prophylaxis

Purpose: Rabies post-exposure prophylaxis (rPEP) in the emergency department (ED) is associated with high costs, complicated administration protocols, and a time-sensitive vaccination series that often requires ED follow-up visits for subsequent vaccine administration. This study sought to characterize the number of redirected vaccine administrations in those patients referred to ID Clinic, guideline compliance, and opportunities for improvement. Methods: Retrospective chart review of adult and pediatric patients presenting to the ED from 2016 to 2019 and prescribed rabies immunoglobulin. Results: Of the 89 patients included, 66.3% were referred to ID Clinic. Those referred to clinic had significantly fewer average visits to the ED for repeat vaccination ( P < .001). Of the 177 vaccinations prescribed for patients referred, 105 were administered in clinic. Overall, having insurance significantly increased the odds of completing the prescribed vaccination series (Odds Ratio (OR) = 4.34, 95% Confidence Interval (CI) = 1.34 to 15.52). Among those patients referred to clinic, having insurance significantly increased the odds of receiving any follow-up doses in clinic (OR = 6.00, 95% CI = 1.48 to 25.98), receiving all of their prescribed follow-up doses in clinic (OR = 10.00, 95% CI = 1.72 to 190.80), and completing the entirety of their vaccination series (OR = 5.89, 95% CI = 1.50 to 26.21). Conclusions: The use of an ID Clinic referral process for rPEP resulted in a significant reduction in the average number of visits to the ED for repeat vaccination, hence avoiding 105 ED visits. Insurance status was a significant factor in both the utilization of the ID Clinic referral system and overall completion of the vaccination series. Future research should explore workflows inclusive of both ED care and outpatient follow-up, care plans for the uninsured, and mechanisms to limit the number of patients that fail to complete the recommended vaccination series.

scholarly journals 1283. Attitudes and Practices Regarding HIV Post-Exposure Prophylaxis

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S462-S462
Author(s):  
William Sherrerd-Smith ◽  
Katie O’Connell ◽  
Shanedeep Gill ◽  
Alice Kisteneff ◽  
Catherine Derber ◽  
...  
Keyword(s):  
Emergency Department ◽  
Unprotected Sex ◽  
Post Exposure Prophylaxis ◽  
Provider Education ◽  
Post Exposure ◽  
Attitudes And Practices ◽  
Significant Difference ◽  
Follow Up Care ◽  
Exposure Prophylaxis

Abstract Background Research suggests nonoccupational Post Exposure Prophylaxis (nPEP) is underprescribed when indicated in the Emergency Department (ED). This study is an assessment of ED providers’ 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 providers at work over a 4-month period from 5 hospital-based and 2 freestanding EDs with an annual census between 35,000 and 75,000 patients. The EDs are a combination of urban, suburban, and rural EDs. There were 152 completed surveys: 80 attendings, 27 residents, and 44 physician assistants. Results The majority of surveyed providers (133/149, 89.3%) believe it is their responsibility as an emergency provider to provide HIV nPEP in the emergency department (Figure 1). Although 91% (138/151) and 87% (132/151) of respondents are willing to prescribe nPEP to a patient in the ED for IV drug use and unprotected sex, respectively, only 40% (61/152) of participants felt they could confidently prescribe the appropriate regimen. Ultimately, only 25% (37/151) of participants prescribed nPEP in the last year. Number of years in practice, age, and gender did not result in a significant difference in nPEP administration. Respondents noted time (27%), access to follow-up care (26%), cost to patients (23%), patients’ perceived interest in HIV counseling (15%), and concern for ongoing risky behaviors (9%) as barriers to prescribing nPEP (Figure 2). 64% (95/149) of respondents feel that it is their responsibility as an ED provider to refer patients at risk of nonoccupational exposures for risk-reduction counseling. Conclusion This study identified an opportunity for HIV prevention in the emergency department. The majority of participants had not prescribed nPEP in the past 12 months. Although most were willing to prescribe nPEP and felt it was their responsibility, the majority of participants were not confident in prescribing it. Future interventions to increase the use of nPEP in the ED should target provider education, cost, access to follow-up care and counseling. Disclosures All authors: No reported disclosures.

Improving HIV post-exposure prophylaxis rates after pediatric acute sexual assault

2017 ◽  
Vol 69 ◽  
pp. 106-115 ◽  
Author(s):  
Samantha Schilling ◽  
Stephanie A. Deutsch ◽  
Rebecca Gieseker ◽  
Jennifer Molnar ◽  
Jane M. Lavelle ◽  
...  
Keyword(s):  
Sexual Assault ◽  
Post Exposure Prophylaxis ◽  
Post Exposure ◽  
Exposure Prophylaxis
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