规范急诊科性侵后 HIV 暴露前预防。

Standardizing HIV post-exposure prophylaxis in the emergency department following sexual assault.

机构信息

College of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA.

Hospital Pharmacy, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA.

出版信息

HIV Med. 2022 Mar;23(3):268-273. doi: 10.1111/hiv.13196. Epub 2021 Nov 2.

DOI:10.1111/hiv.13196

PMID:34725910

Abstract

OBJECTIVES

A standardized non-occupational post-exposure prophylaxis (nPEP) programme was implemented to improve guideline compliance for treatment of post-sexual assault patients within an emergency department (ED).

METHODS

A single-centre, retrospective, observational study of adult patients evaluated in the ED for sexual assault was performed following nPEP programme implementation. A comprehensive nPEP programme consisting of a standardized order set, real-time multidisciplinary consultation, on-site pharmacy and close post-discharge follow-up was implemented between July 2017 and June 2018. Laboratory, treatment, vaccination, prescription and follow-up data during the pre- (July 2016 to June 2017) and post-intervention (July 2018 to August 2019) periods were compared.

RESULTS

Of the 147 post-sexual assault patients included in this study (59 pre-intervention, 88 post-intervention), 133 (90.5%) were eligible for nPEP. Patient demographics and rate of those eligible for nPEP were similar in both cohorts. Antiretroviral therapy (ART) was offered (72.2% vs. 100%; p < 0.005) and ultimately prescribed (51.9% vs. 86.1%; p < 0.005) more frequently following nPEP programme implementation. Patients were more likely to have appropriate screening for renal function, liver function, pregnancy, syphilis, hepatitis B, hepatitis C and HIV in the post-intervention period (all p < 0.005). Hepatitis B vaccination was more commonly administered post-intervention (8.5% vs. 22.7%; p < 0.024). In-person 28-day follow-up was rare in both pre- (3.5%) and post-intervention (11.3%) cohorts (p = 0.278).

CONCLUSIONS

Implementation of a comprehensive nPEP programme resulted in improved guideline compliance with more frequent and appropriate ART administration. Recommended screening laboratories and hepatitis B vaccinations were more commonly performed, but in-person follow-up remained low. The nPEP programmes should be implemented to standardize efforts that decrease the risk of HIV transmission.

摘要

目的

实施标准化的非职业性接触后预防（nPEP）方案，以提高急诊科（ED）内治疗性侵犯后患者的指南遵从性。

方法

在实施 nPEP 方案后，对 ED 评估的成年性侵犯患者进行了一项单中心、回顾性、观察性研究。2017 年 7 月至 2018 年 6 月期间实施了一项综合 nPEP 方案，包括标准化医嘱集、实时多学科咨询、现场药房和密切的出院后随访。比较了干预前（2016 年 7 月至 2017 年 6 月）和干预后（2018 年 7 月至 2019 年 8 月）期间的实验室、治疗、疫苗接种、处方和随访数据。

结果

本研究共纳入 147 例性侵犯后患者（干预前 59 例，干预后 88 例），其中 133 例（90.5%）符合 nPEP 条件。两组患者的人口统计学特征和 nPEP 合格率相似。在 nPEP 方案实施后，更频繁地提供（72.2%比 100%；p<0.005）和最终开具（51.9%比 86.1%；p<0.005）抗逆转录病毒治疗（ART）。在干预后期间，更有可能对肾功能、肝功能、妊娠、梅毒、乙型肝炎、丙型肝炎和 HIV 进行适当的筛查（均 p<0.005）。在干预后，乙型肝炎疫苗接种更为常见（8.5%比 22.7%；p<0.024）。在干预前（3.5%）和干预后（11.3%）两组中，面对面 28 天随访均很少见（p=0.278）。