Ottawa Hospital Research Institute.
Faculty of Medicine, The Ottawa Hospital and University of Ottawa.
AIDS. 2020 May 1;34(6):869-876. doi: 10.1097/QAD.0000000000002507.
Nonoccupational postexposure prophylaxis (nPEP) programs offer antiretroviral therapy to prevent HIV following at-risk exposures like sexual assault. We investigated the levels of elective nPEP uptake among sexual assault cases presenting for emergency medical care.
Retrospective analysis.
The analysis included over 3 years (1 January 2015 to 30 September 2018) of clinic information from the Sexual Assault and Partner Abuse Care Program (SAPACP) at The Ottawa Hospital, the regional emergency department care point following sexual assault. Descriptive analyses assessed the number of cases eligible for nPEP and those who started nPEP. Bivariable/multivariable logistic regression modelling assessed factors most strongly associated with starting nPEP using odds ratios (OR), adjusted OR (AOR), and 95% confidence intervals (CI).
The SAPACP saw 1712 patients; 1032 were sexual assault cases, 494 were eligible for nPEP, and 307/494 (62%) eligible patients started nPEP. The median age was 23 years (IQR: 20-31), with 446 (90%) cases being female. There were 86 (17%) cases who arrived by ambulance, and 279 (56%) assaults involving a known assailant. Reduced odds of starting nPEP were observed among female cases (AOR: 0.44, 95% CI: 0.21-0.93), those who arrived by ambulance (AOR: 0.56, 95% CI: 0.35-0.91), and those with a known assailant (AOR: 0.56, 95% CI: 0.36-0.78).
We found that 62% of eligible sexual assault cases started nPEP. Key groups most likely to decline nPEP included female cases, those who arrived by ambulance, and those with known assailants. Providers can use these findings to provide recommendations to sexual assault survivors most likely to decline nPEP, yet still in need of care.
职业暴露后预防（nPEP）计划为有感染艾滋病毒风险的人群（如性侵犯）提供抗逆转录病毒治疗。我们调查了在性侵犯后接受紧急医疗护理的性侵犯病例中，选择性 nPEP 使用率的水平。
回顾性分析。
分析包括 3 年多（2015 年 1 月 1 日至 2018 年 9 月 30 日）来自渥太华医院性侵犯和伴侣虐待护理计划（SAPACP）的临床信息，SAPACP 是性侵犯后的区域急诊护理点。描述性分析评估了有资格接受 nPEP 和开始 nPEP 的病例数量。使用比值比（OR）、调整后的 OR（AOR）和 95%置信区间（CI）进行二变量/多变量逻辑回归模型分析，以评估与开始 nPEP 最密切相关的因素。
SAPACP 共接待了 1712 名患者；其中 1032 例为性侵犯病例，494 例有资格接受 nPEP，307/494（62%）例符合条件的患者开始接受 nPEP。中位年龄为 23 岁（IQR：20-31），其中 446 例（90%）为女性。有 86 例（17%）通过救护车到达，279 例（56%）侵犯事件涉及熟人。开始接受 nPEP 的可能性降低的因素包括女性病例（AOR：0.44，95%CI：0.21-0.93）、通过救护车到达的病例（AOR：0.56，95%CI：0.35-0.91）和有熟人攻击者的病例（AOR：0.56，95%CI：0.36-0.78）。
我们发现，62%符合条件的性侵犯病例开始接受 nPEP。最有可能拒绝 nPEP 的关键群体包括女性病例、通过救护车到达的病例和有熟人攻击者的病例。提供者可以利用这些发现，向最有可能拒绝 nPEP 但仍需要护理的性侵犯幸存者提供建议。
