Department of Emergency Medicine, University of Cincinnati College of Medicine, 231 Albert Sabin Way, PO Box 670769, Cincinnati, OH 45267, USA.
Department of Emergency Medicine, University of Cincinnati College of Medicine, 231 Albert Sabin Way, PO Box 670769, Cincinnati, OH 45267, USA.
Am J Emerg Med. 2022 Oct;60:152-155. doi: 10.1016/j.ajem.2022.07.055. Epub 2022 Aug 1.
Pre-exposure prophylaxis (PreP) reduces the rate of HIV transmission in high-risk groups. Emergency departments (EDs) frequently encounter patients at risk for HIV acquisition who are eligible for PrEP. ED HIV screening programs have prioritized testing and linkage to care for patients who test positive, but fail to refer HIV-negative patients to PrEP clinicians. Our objective was to estimate referral acceptance to a PrEP clinician among a sample of at-risk ED patients.
This single-center cross-sectional study electronically queried a prospectively acquired dataset of survey responses from a sample of patients presenting to an urban academic ED from March 2019 to February 2020. Patients completed a risk assessment as part of the HIV screening program. PrEP eligibility was based off survey responses in accordance with 2017 CDC PrEP eligibility criteria. Identified PrEP-eligible patients completed a PrEP questionnaire. The primary outcome was the proportion of PrEP-eligible patients who accepted referral to a PrEP clinician during their ED encounter. We secondarily report patient participant characteristics including the proportion of PrEP-eligible patients who were aware of and were knowledgeable about PrEP as a method to prevent transmission of HIV.
In total, 360 patients completed a PrEP questionnaire, of which 287 (80%) were not currently taking PrEP and eligible for PrEP referral. 57% were males, with 41% Black/African American. Of the 287 eligible for PrEP, 61 (21.3%, 95% CI: 16.8-26.5) indicated awareness of PrEP, of which, 49 (80.3%, 95% CI: 67.8-89.0) demonstrated accurate knowledge of PrEP. PrEP referral was offered to 238 (82.9%, 95% CI: 78.0-87.0) patients, of which, 76 (31.9%, 95% CI: 26.1-38.3) accepted.
Approximately one third of PrEP-eligible ED patients accepted PrEP referral during their ED encounter, demonstrating an opportunity for increased PrEP education and intentional referral for eligible patients. Variability in PrEP acceptability by demographic and risk subgroup may be an important consideration in efforts to expand PrEP utilization.
暴露前预防（PrEP）可降低高危人群中 HIV 的传播率。急诊科（ED）经常遇到有 HIV 感染风险且符合 PrEP 条件的患者。ED 的 HIV 筛查项目优先对检测结果阳性的患者进行检测和转介治疗，但未能将 HIV 阴性患者转介给 PrEP 临床医生。我们的目的是评估高危 ED 患者样本中 PrEP 临床医生的转介接受率。
这是一项单中心横断面研究，通过电子方式查询了 2019 年 3 月至 2020 年 2 月期间从城市学术 ED 就诊的患者样本前瞻性采集的调查应答数据集。患者在 HIV 筛查项目中完成了风险评估。PrEP 资格是根据 2017 年 CDC PrEP 资格标准，根据调查应答确定的。确定符合 PrEP 条件的患者完成了 PrEP 问卷。主要结局是 ED 就诊期间接受 PrEP 临床医生转介的符合 PrEP 条件患者的比例。我们次要报告了患者参与者的特征，包括了解 PrEP 并了解 PrEP 作为预防 HIV 传播方法的符合 PrEP 条件患者的比例。
共有 360 名患者完成了 PrEP 问卷，其中 287 名（80%）未服用 PrEP，符合 PrEP 转介条件。57%为男性，41%为黑人/非裔美国人。在 287 名符合 PrEP 条件的患者中，有 61 名（21.3%，95%CI：16.8-26.5）知晓 PrEP，其中 49 名（80.3%，95%CI：67.8-89.0）对 PrEP 有准确的认识。向 238 名（82.9%，95%CI：78.0-87.0）患者提供了 PrEP 转介，其中 76 名（31.9%，95%CI：26.1-38.3）接受了转介。
约三分之一的 ED 患者在 ED 就诊期间接受了 PrEP 转介，这表明有机会增加 PrEP 教育并为符合条件的患者进行有针对性的转介。在扩大 PrEP 使用的努力中，按人口统计学和风险亚组划分的 PrEP 可接受性的差异可能是一个重要的考虑因素。
