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.
HIV Med. 2022 Mar;23(3):268-273. doi: 10.1111/hiv.13196. Epub 2021 Nov 2.
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).
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.
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).
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.
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。
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。
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）。
实施综合 nPEP 方案可提高指南遵从性，更频繁、更合理地使用 ART。建议的筛查实验室和乙型肝炎疫苗接种更为常见，但面对面随访仍然较低。应该实施 nPEP 方案，以规范减少 HIV 传播风险的工作。
