Loutfy Mona Rafik, Macdonald Sheila, Myhr Terri, Husson Heather, Du Mont Janice, Balla Shannon, Antoniou Tony, Rachlis Anita
Department of Medicine, University of Toronto, Ontario, Canada.
Antivir Ther. 2008;13(1):87-95. doi: 10.1177/135965350801300109.
There is a lack of standardized programs for HIV counselling and post-exposure prophylaxis (PEP) in the setting of sexual assault.
We conducted an 18-month prospective cohort study assessing universal HIV counselling for all sexual assault survivors presenting to 18 Ontario Sexual Assault Treatment Centres. HIV PEP was universally offered to those at risk of HIV infection (high risk or unknown risk) presenting < or =72 h after the assault, using Combivir one pill and Kaletra three capsules twice a day for 28 days. Those who accepted HIV PEP were monitored via a schedule of frequent follow ups. The primary outcomes were acceptance and completion rates, and their predictors were determined using multivariable logistic regression. Adverse events (AE) were categorized using a standardized toxicity grading system.
Of the 900 evaluable participants eligible for PEP, 798 (69 at high risk and 729 at unknown risk) were offered treatment. Acceptance rates were 66.7% (n=46) and 41.3% (n=301) for participants at high risk and unknown risk, respectively. Participants at high risk were 2.2 times more likely to accept PEP than those at unknown risk (adjusted odds ratio 2.2; 95% confidence interval 1.2-4.0; P=0.01). Overall, 23.9% high-risk (n=11) and 33.2% unknown-risk participants (n=100) completed PEP (P=0.20). Predictors of acceptance and completion included assault by a stranger and participant anxiety. AEs were common, with 77.1% of participants reporting grade 2-4 symptoms.
A province-wide standardized program of universal HIV counselling and offering of PEP to sexual assault survivors with frequent follow up was successfully implemented and feasible.
在性侵犯情况下，缺乏针对艾滋病毒咨询和暴露后预防（PEP）的标准化方案。
我们进行了一项为期18个月的前瞻性队列研究，评估为前往安大略省18个性侵犯治疗中心的所有性侵犯幸存者提供的普遍艾滋病毒咨询。对于在性侵犯后≤72小时出现艾滋病毒感染风险（高风险或风险不明）的人，普遍提供艾滋病毒PEP，使用双汰芝1片和克力芝3粒胶囊，每天两次，共28天。接受艾滋病毒PEP的人通过定期随访进行监测。主要结局是接受率和完成率，并使用多变量逻辑回归确定其预测因素。不良事件（AE）使用标准化毒性分级系统进行分类。
在900名符合PEP条件的可评估参与者中，798人（69人高风险，729人风险不明）接受了治疗。高风险参与者和风险不明参与者的接受率分别为66.7%（n = 46）和41.3%（n = 301）。高风险参与者接受PEP的可能性是风险不明参与者的2.2倍（调整后的优势比为2.2；95%置信区间为1.2 - 4.0；P = 0.01）。总体而言，23.9%的高风险参与者（n = 11）和33.2%的风险不明参与者（n = 100）完成了PEP（P = 0.20）。接受和完成的预测因素包括陌生人实施的性侵犯和参与者焦虑。不良事件很常见，77.1%的参与者报告有2 - 4级症状。
成功实施了一项全省范围的标准化方案，为性侵犯幸存者提供普遍的艾滋病毒咨询并提供PEP，并进行频繁随访，该方案是可行的。
