Department of Infectious and Parasitic Diseases, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom.
AIDS Patient Care STDS. 2019 Sep;33(9):399-405. doi: 10.1089/apc.2019.0080. Epub 2019 Aug 6.
Adherence to nonoccupational post-exposure prophylaxis (nPEP) among sexual violence (SV) victims and their retention in care after SV represent significant challenges. This study aimed at identifying predictors of adherence to nPEP and retention in clinical-laboratory follow-up among SV victims in São Paulo, Brazil. We conducted a retrospective cohort study of SV victims admitted to care and follow-up at the SV unit of the main reference hospital in São Paulo within 72 h following the SV episode. Eligible patients were submitted to a standardized protocol that included nPEP, screening, and management for other sexually transmitted infection as well as emergency contraception. Predictors of adherence to nPEP for 28 days and retention in care until discharge at 180 days after admission were analyzed. A total of 199 SV episodes in 197 victims were recorded from January 2001 to December 2013 (156 months). Of those episodes, 167 were eligible to receive nPEP and 160 (96%) actually received a prescription. Overall 104/160 [65%, 95% confidence interval (CI) 57-72] SV victims, who received nPEP, were fully adherent to nPEP up to 28 days, whereas 89/199 (45%, 95% CI 38-52) were retained in care for 180 days following admission. In multi-variate analysis, patients undergoing at least one psychological consultation ( = 126) were more likely to adhere to nPEP [adjusted odds ratio (adjOR) 8.32; 95% CI 3.0-23.3] and be retained in care for 6 months (adjOR 40.33; 95% CI 8.33-195.30) compared to patients not receiving psychological support. In contrast, study outcomes were not associated with victims' age and sex and with type of perpetrator. In our cohort, provision of psychological care was shown to be associated with enhanced adherence to nPEP and retention in care.
在性暴力（SV）受害者中，坚持使用非职业性接触后预防（nPEP）以及在 SV 后坚持接受临床实验室随访是重大挑战。本研究旨在确定巴西圣保罗 SV 受害者坚持使用 nPEP 并在 SV 后接受临床实验室随访的预测因素。我们对在 SV 发生后 72 小时内入住圣保罗主要参考医院 SV 病房接受治疗和随访的 SV 受害者进行了回顾性队列研究。符合条件的患者接受了标准化方案，包括 nPEP、筛查和其他性传播感染的管理，以及紧急避孕。分析了 28 天内坚持使用 nPEP 和在 180 天（入院后）前坚持接受治疗的预测因素。2001 年 1 月至 2013 年 12 月（156 个月）期间共记录了 197 名受害者的 199 次 SV 事件。在这些事件中，有 167 例符合接受 nPEP 的条件，有 160 例（96%）实际上接受了处方。总的来说，160 例接受 nPEP 的 SV 受害者中有 104 例（65%，95%置信区间 [CI] 57-72）在 28 天内完全坚持使用 nPEP，而 199 例中有 89 例（45%，95% CI 38-52）在入院后 180 天内坚持接受治疗。多变量分析显示，至少接受一次心理咨询的患者（ = 126）更有可能坚持使用 nPEP（调整后的优势比 [adjOR] 8.32；95% CI 3.0-23.3），并在 6 个月内坚持接受治疗（adjOR 40.33；95% CI 8.33-195.30），而未接受心理支持的患者则没有。相比之下，研究结果与受害者的年龄和性别以及施害者的类型无关。在我们的队列中，提供心理护理与提高 nPEP 坚持使用率和治疗保留率相关。
