scholarly journals Canadian guideline on HIV pre-exposure prophylaxis and nonoccupational postexposure prophylaxis

2018 ◽  
Vol 190 (25) ◽  
pp. E782-E782 ◽  
Keyword(s):  
Postexposure Prophylaxis ◽  
Canadian Guideline ◽  
Exposure Prophylaxis

scholarly journals Canadian guideline on HIV pre-exposure prophylaxis and nonoccupational postexposure prophylaxis

2017 ◽  
Vol 189 (47) ◽  
pp. E1448-E1458 ◽  
Author(s):  
Darrell H. S. Tan ◽  
Mark W. Hull ◽  
Deborah Yoong ◽  
Cécile Tremblay ◽  
Patrick O’Byrne ◽  
...  
Keyword(s):  
Postexposure Prophylaxis ◽  
Canadian Guideline ◽  
Exposure Prophylaxis

scholarly journals Is there sufficient scientific evidence to rule out the use of hydroxychloroquine for postexposure prophylaxis of COVID-19?

2020 ◽  
Author(s):  
Llorenç Quintó ◽  
Jose Miguel Morales-Asencio ◽  
Raquel González ◽  
Clara Menéndez
Keyword(s):  
Public Health ◽  
Effect Size ◽  
Statistical Power ◽  
Scientific Evidence ◽  
Post Exposure Prophylaxis ◽  
Postexposure Prophylaxis ◽  
Post Hoc Analysis ◽  
Exposure Prophylaxis ◽  
Post Hoc ◽  
Rule Out

Since the beginning of the COVID-19 pandemic, the use of hydroxychloroquine (HCQ) has been surrounded by a lot of controversy, both scientific and non-scientific. This has continued with the publication of two trials of HCQ for post-exposure prophylaxis of the infection, which concluded that HCQ is not efficacious to prevent SARS-CoV-2 infection, and their results are influencing public health decisions.We have carried out a comprehensive post-hoc analysis of the statistical power of the two trials, which shows that their power to detect an effect of HCQ in preventing COVID-19 is low, not only for their observed effect size, but also for other clinically important levels of efficacy, and therefore both studies are inconclusive.

Assessing the Potential for Nurse-Led HIV Pre- and Postexposure Prophylaxis in Ontario

2020 ◽  
pp. 084456212092426
Author(s):  
Matthew Clifford-Rashotte ◽  
Natalie Fawcett ◽  
Barbara Fowler ◽  
Jeffrey Reinhart ◽  
Darrell H. S. Tan
Keyword(s):  
Online Survey ◽  
Community Health Center ◽  
Models Of Care ◽  
Health Clinic ◽  
Postexposure Prophylaxis ◽  
Experienced Nurses ◽  
Change Framework ◽  
Exposure Prophylaxis ◽  
High Degree ◽  
Levels Of Support

Background and purpose HIV prevention efforts in Ontario require increased implementation of strategies including post- and pre-exposure prophylaxis. Access to these interventions could be improved by their provision through nurse-led models of care. We assessed nurses’ readiness to deliver these interventions using a behavioral change framework. Methods We distributed an online survey to nurses in every Ontario sexual health clinic, HIV clinic, and community health center between March-June 2018, to determine the level of support for nurse-led postexposure prophylaxis/pre-exposure prophylaxis; we also explored nurses’ “capabilities,” “opportunities,” and “motivations” for providing postexposure prophylaxis/pre-exposure prophylaxis. Results Overall, 72.7% of respondents supported implementation of both nurse-led postexposure prophylaxis and pre-exposure prophylaxis. More experienced nurses were less likely to support nurse-led postexposure prophylaxis and pre-exposure prophylaxis (adjusted odds ratio = 0.55 per decade nursing, 95% confidence interval (0.37, 0.82)). Nurses reported a high degree of knowledge of topics related to postexposure prophylaxis/pre-exposure prophylaxis, with the exception of creatinine interpretation. Conclusions Ontario nurses report high levels of support for nurse-led postexposure prophylaxis and pre-exposure prophylaxis and are well positioned to provide these interventions. Targeted education and implementation efforts are needed to engage these nurses in postexposure prophylaxis and pre-exposure prophylaxis delivery.

scholarly journals Differentiating Nonoccupational Postexposure Prophylaxis Seroconverters and Non-Seroconverters in a Community-Based Clinic in Los Angeles, California

2017 ◽  
Vol 4 (2) ◽  
Author(s):  
Matthew R. Beymer ◽  
Robert E. Weiss ◽  
Robert K. Bolan ◽  
Ryan M. Kofron ◽  
Risa P. Flynn ◽  
...  
Keyword(s):  
Los Angeles ◽  
Postexposure Prophylaxis ◽  
Systematic Screening ◽  
Initial Exposure ◽  
Methamphetamine Use ◽  
Antiretroviral Medications ◽  
Immunodeficiency Virus ◽  
Multivariable Analyses ◽  
Hiv Acquisition ◽  
Exposure Prophylaxis

Abstract Background Nonoccupational postexposure prophylaxis (nPEP) is a 28-day regimen of antiretroviral medications taken within 72 hours of human immunodeficiency virus (HIV) exposure to prevent HIV acquisition. Although nPEP has been recommended since 1998, few studies have analyzed the characteristics that distinguish nPEP failures (seroconverters) and successes (non-seroconverters). Methods This retrospective study analyzed all nPEP courses prompted by sexual exposure that were prescribed at the Los Angeles LGBT Center between March 2010 and July 2014. Fisher exact tests and logistic regressions were used to determine characteristics that distinguished nPEP seroconverters from non-seroconverters. Results Of the nPEP courses administered, 1744 had a follow-up visit for HIV testing within 24 weeks of exposure and 17 individuals seroconverted. Seven reported a known re-exposure, 8 self-reported only condom-protected sex subsequent to the initial exposure, and 2 reported abstinence since the exposure. In multivariable analyses, seroconverters were more likely than non-seroconverters to report methamphetamine use, incomplete medication adherence, and nPEP initiation later in the 72-hour window. Conclusions Nonoccupational postexposure prophylaxis is an important emergency tool for HIV prevention. Our findings corroborate that timing of the initial nPEP dose is an important predictor of seroconversion. Although the current study did not offer the initial nPEP dose at the beginning of the visit, use of this fast-track dosing schedule will ensure that the first dose is taken as early as possible postexposure and may lower the likelihood for seroconversion. Furthermore, we recommend systematic screening for substance use because these individuals may be well suited for pre-exposure prophylaxis given their sustained risk.

scholarly journals Canadian guideline on HIV preexposure prophylaxis and nonoccupational postexposure prophylaxis for pharmacists

2019 ◽  
Vol 152 (2) ◽  
pp. 81-91
Author(s):  
Christine Hughes ◽  
Deborah Yoong ◽  
Pierre Giguère ◽  
Mark Hull ◽  
Darrell H. S. Tan
Keyword(s):  
Postexposure Prophylaxis ◽  
Canadian Guideline ◽  
Preexposure Prophylaxis

scholarly journals Opportunities to Offer Harm Reduction to People who Inject Drugs During Infectious Disease Encounters: Narrative Review

2020 ◽  
Vol 7 (11) ◽  
Author(s):  
Alyssa M Peckham ◽  
Erika H Young
Keyword(s):  
Harm Reduction ◽  
People Who Inject Drugs ◽  
Opioid Use Disorder ◽  
Opioid Use ◽  
Postexposure Prophylaxis ◽  
Treatment Access ◽  
Clinical Encounters ◽  
Exposure Prophylaxis ◽  
Improve Patient ◽  
Major Target

Abstract Increased rates of overdose (OD) and blood-borne infections have been associated with injection drug use (IDU). This increasing overlap between IDU-related infectious diseases (ID) is a byproduct of the opioid OD crisis, especially with the transition to synthetic opioids with faster onset and shorter duration leading to potentially more frequent injections. ID specialists are uniquely positioned to positively impact the opioid OD crisis by capitalizing on opportunistic moments of engagement during clinical encounters with people who inject drugs (PWID). Harm reduction services should therefore be expanded and offered to PWID in ID settings to reduce rates of OD, infection, and hospitalization. Major target areas include (1) teaching and distribution of materials related to safer injection practice such as sterile injection supplies, fentanyl test strips, and naloxone; (2) increased screening and access to pre-exposure prophylaxis and postexposure prophylaxis; and (3) initiation of medications for opioid use disorder. Incorporating these strategies in various treatment settings can expand treatment access, improve patient outcomes, and reduce stigma associated with IDU.

scholarly journals New Canadian guideline provides evidence-based approach to non-occupational HIV prophylaxis

CJEM ◽  
2018 ◽  
Vol 21 (1) ◽  
pp. 21-25
Author(s):  
Shannon O’Donnell ◽  
Darrell H. S. Tan ◽  
Mark W. Hull
Keyword(s):  
Hiv Transmission ◽  
Occupational Exposures ◽  
Hiv Infections ◽  
Risk Exposure ◽  
Post Exposure Prophylaxis ◽  
Evidence Based ◽  
Post Exposure ◽  
Canadian Guideline ◽  
Key Points ◽  
Exposure Prophylaxis

AbstractThe incidence of HIV infections in Canada has increased yearly since 2014. New cases of HIV have resulted almost exclusively from non-occupational exposures, including sexual contact and needle sharing. Appropriate HIV post-exposure prophylaxis is under-prescribed to patients who present to the emergency department after a high-risk exposure. In November of 2017, a Canadian guideline on HIV pre-exposure prophylaxis (PrEP) and non-occupational post-exposure prophylaxis (nPEP) was published. The guideline presents a standardized, evidence-based approach to assessing risk for HIV transmission and prescribing HIV prophylaxis. This summary highlights the key points from the guideline that are relevant to the practice of emergency medicine in Canada.

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