HIV Non-Occupational Post-Exposure Prophylaxis (nPEP) Use in Rural Emergency Departments
Abstract
Since 2005, the CDC has published non-occupational post-exposure prophylaxis (nPEP) guidelines, yet many people eligible for taking nPEP are not being offered or assisted with taking nPEP as recommended. To increase the use of these guidelines in rural emergency departments across the United States and its territories (US), an educational intervention was done and is highlighted in this poster.
Proposal Summary
With an increase in HIV infection incidence and prevalence in identified US rural communities from sexual and substance using behaviors, providers need to be prepared to provide nPEP rapidly when indicated. Studies show that providers are not consistently offering nPEP for various reasons,1-3 that disparities exist in who is being HIV tested and offered nPEP,3,4 and that 28-day completion rates of persons accepting nPEP in emergency departments following a significant exposure are low.5-7 Historically and currently, a current policy and procedure in place increases the likelihood of nPEP being prescribed in emergency departments.1,8 The AIDS Education and Training Center Program Rural Health Committee, in collaboration with Ryan White HIV/AIDS Program Part A, B, and C providers in rural communities, the International Association of Forensic Nurses, the National Center for Medical-Legal Partnership, and the National Network of STD/HIV Prevention Training Centers, developed a non-occupational post-exposure prophylaxis (nPEP) toolkit (https://aidsetc.org/resource/post-sexual-exposure-npep-hiv-prevention-toolkit) for clinicians. A clinician pocket guide, banner pen, provider-patient assistance program postcard, a policy and procedure template for use in establishing written nPEP protocols, and other educational resources for emergency department (ED) clinicians, sexual assault nurse/sexual assault forensic (physician, PA) examiners (SANE and SAFE clinicians), and primary care providers across the US were developed and made available starting in April 2018. Rural Health Committee members across the US, have provided needed support to increase the use of nPEP in rural (and some urban) EDs. This poster will highlight the resources developed, and the qualitative and quantitative descriptive statistics on the use and response of clinicians to the toolkit between April and August 2018. References: 1. Rodriguez A, Castel AD, Parish CL, et al. HIV medical providers’ perceptions of the use of antiretroviral therapy as non-occupational post- exposure prophylaxis (nPEP) in two major metropolitan areas. JAID. 2013. 64(0 1): https://doi.org/10.1097/QAI.0b013e3182a901a2. 2. Ende AR, Hein L, Sottolano DL, Agins BD. Nonoccupational postexposure prophylaxis for exposure to HIV in New York State emergency departments. AIDS Patient Care and STDs. 2008. 22(10). https://doi.org/10.1089/apc.2007.0157. 3. Misra K, Udeagu C. Disparities in awareness of HIV postexposure and preexposure prophylaxis among notified partners of HIV-positive individuals, New York City 2015–2017. JAIDS. 2017. 76(2):132–140. https://doi.org/10.1097/QAI.0000000000001473. 4. McKenney J, Sullivan PS, Bowles KE, et al. HIV risk behaviors and utilization of prevention services, urban and rural men who have sex with men in the United States: results from a national online survey. AIDS and Behavior. 2018. 22(7):2127-2136. 5. Bogoch II, Scully EP, Zachary KC, et al. Patient attrition between the emergency department and clinic among individuals presenting for HIV nonoccupational postexposure prophylaxis. Clinical Infectious Diseases. 2014. 58(11):1618–1624. https://doi.org/10.1093/cid/ciu118. 6. Scannell M, Kim T, Guthrie BJ. A meta-analysis of HIV postexposure prophylaxis among sexually assaulted patients in the United States. JANAC. 2018. 29(1):60-69. https://doi.org/10.1016/j.jana.2017.10.004. 7. Krause KH, Lewis-O'Connor A, Berger A, et al. Current practice of HIV postexposure prophylaxis treatment for sexual assault patients in an emergency department. Women’s Health Issues. 2014. 24(4):e407-12. https://doi.org/10.1016/j.whi.2014.04.003. 8. Mccausland JB, Linden JA, Degutis LC, et al. Nonoccupational postexposure HIV prevention: emergency physicians' current practices, attitudes, and beliefs. Annals of Emergency Medicine. 2003.42(5):651-6. https://doi.org/10.1016/S019606440300338X.
Relevance And Significance
This project is pertinent to clinical research (nPEP) and to innovative strategies and tools for prevention and intervention in rural communities.
Session Format
Poster Session
Keywords
HIV prevention, sexual exposure, sexual assault, nPEP
Publication Type and Release Option
Presentation (Open Access)
Recommended Citation
Nelson, John A., "HIV Non-Occupational Post-Exposure Prophylaxis (nPEP) Use in Rural Emergency Departments" (2018). 9th Annual Rural HIV Research and Training Conference (2014-2019). 30.
https://digitalcommons.georgiasouthern.edu/ruralhiv/2018/2018/30
HIV Non-Occupational Post-Exposure Prophylaxis (nPEP) Use in Rural Emergency Departments
Since 2005, the CDC has published non-occupational post-exposure prophylaxis (nPEP) guidelines, yet many people eligible for taking nPEP are not being offered or assisted with taking nPEP as recommended. To increase the use of these guidelines in rural emergency departments across the United States and its territories (US), an educational intervention was done and is highlighted in this poster.
