Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA.
Institute for Public Health, Washington University in St. Louis, St. Louis, MO, USA.
Am J Emerg Med. 2021 Nov;49:117-123. doi: 10.1016/j.ajem.2021.05.070. Epub 2021 Jun 1.
Emergency departments (EDs) play an essential role in the timely initiation of HIV post-exposure prophylaxis (PEP) for sexual assault victims.
Retrospective analysis of sexual assault victims evaluated and offered HIV PEP in an urban academic ED between January 1, 2005 and January 1, 2018. Data on demographics, comorbidities, nature of sexual assault, initial ED care, subsequent healthcare utilization within 28 days of initial ED visit, and evidence of seroconversion within 6 months of the initial ED visit were obtained. Predictors of subsequent ED visit and follow-up in the infectious diseases clinic were evaluated using logistic regression analysis.
Four hundred twenty-three ED visits met criteria for inclusion in this study. Median age at ED presentation was 25 years (IQR 21-34 years), with the majority of victims being female (95.5%), Black (63.4%), unemployed (66.3%) and uninsured (53.9%); psychiatric comorbidities (38.8%) and substance abuse (23.6%) were common. About 87% of the patients accepted HIV PEP (368 of 423 ED visits). Age (OR 0.97, 95% CI 0.94-0.99, p = 0.025) and sexual assault involving >1 assailant (OR 0.48, 95% CI 0.26-0.88, p = 0.018) were associated with lower likelihood of HIV PEP acceptance. Ten patients (2.7%) followed up with the infectious disease clinic within 28 days of starting HIV PEP; 70 patients (19%) returned to the ED for care during the same time period. Psychiatric comorbidity (OR 2.48, 95% CI 1.43-4.30, p = 0.001) and anal penetration (OR 2.02, 95% CI 1.10-3.70, p = 0.024) were associated with greater likelihood of repeat ED visit; female gender (OR 0.30, 95% CI 0.11-0.85, p = 0.023) was associated with lower likelihood of repeat visit. Completion of HIV PEP was documented for 14 (3.3%) individuals.
While ED patient acceptance of HIV PEP after sexual assault was high, infectious disease clinic follow-up and documented completion of PEP remained low. Innovative care models bridging EDs to outpatient clinics and community support services are needed to optimize transitions of care for sexual assault victims, including those receiving HIV PEP.
急诊科在及时启动性侵犯后艾滋病毒暴露前预防（PEP）方面发挥着重要作用。
对 2005 年 1 月 1 日至 2018 年 1 月 1 日期间在城市学术急诊科接受评估并提供艾滋病毒 PEP 的性侵犯受害者进行回顾性分析。获取人口统计学数据、合并症、性侵犯性质、初始急诊科护理、初始急诊科就诊后 28 天内后续医疗保健利用情况以及初始急诊科就诊后 6 个月内血清转换证据。使用逻辑回归分析评估随后在传染病诊所就诊和随访的预测因素。
423 次急诊科就诊符合纳入本研究的标准。急诊科就诊时的中位年龄为 25 岁（IQR 21-34 岁），大多数受害者为女性（95.5%）、黑人（63.4%）、失业（66.3%）和无保险（53.9%）；常见的合并症包括精神疾病（38.8%）和药物滥用（23.6%）。约 87%的患者接受了艾滋病毒 PEP（423 次急诊科就诊中的 368 次）。年龄（OR 0.97，95%CI 0.94-0.99，p = 0.025）和涉及>1名袭击者的性侵犯（OR 0.48，95%CI 0.26-0.88，p = 0.018）与较低的艾滋病毒 PEP 接受率相关。10 名患者（2.7%）在开始接受艾滋病毒 PEP 后 28 天内与传染病诊所进行了随访；70 名患者（19%）在同一时期返回急诊科接受治疗。精神疾病合并症（OR 2.48，95%CI 1.43-4.30，p = 0.001）和肛门穿透（OR 2.02，95%CI 1.10-3.70，p = 0.024）与再次就诊的可能性更大相关；女性（OR 0.30，95%CI 0.11-0.85，p = 0.023）与再次就诊的可能性较低相关。记录了 14 名（3.3%）患者完成了艾滋病毒 PEP。
尽管急诊科患者在性侵犯后接受艾滋病毒 PEP 的意愿很高，但传染病诊所的随访和记录的 PEP 完成情况仍然很低。需要创新的护理模式将急诊科与门诊诊所和社区支持服务联系起来，以优化性侵犯受害者的护理过渡，包括接受艾滋病毒 PEP 的患者。
