Bisom-Rapp Ezra, Patel Kishan, Jaradeh Katrin, Hayirli Tuna C, Peabody Christopher R
University of California, San Francisco School of Medicine, San Francisco, California.
University of California San Francisco, Department of Emergency Medicine, San Francisco, California.
West J Emerg Med. 2024 Nov;25(6):985-992. doi: 10.5811/westjem.33611.
Pre-exposure prophylaxis (PrEP) for HIV-using antiretroviral medication in non-infected individuals to prevent HIV-has immense potential to slow the spread of the virus. However, uptake has been insufficient, and stark racial disparities exist in both HIV acquisition and PrEP usage, making PrEP access a health equity issue. A promising venue to engage high-risk populations in PrEP care is the emergency department (ED); however, existing ED PrEP initiatives have been costly or have had limited success. We hypothesize that two strategies could overcome these barriers: prescribing PrEP during an ED visit and providing patients with an initial supply of PrEP medication in the ED. Here, we describe the results of a qualitative study exploring multidisciplinary emergency clinicians and HIV clinicians' needs and views about the feasibility of such an initiative.
We conducted 22 semi-structured interviews with multidisciplinary clinicians from an urban, safety-net medical center in the ED and the on-site HIV clinic that provides PrEP services. We performed thematic analysis to summarize challenges and potential solutions described by participants.
Participants' responses fell into three thematic categories: operational challenges; patient-level considerations; and potential impacts. Operational challenges highlighted the difficulty of PrEP initiation in a busy ED and clinician support needs. Patient-level considerations included the complex psychosocial needs of ED patients who could benefit from PrEP. Finally, participants anticipated that an ED-based PrEP initiation program could positively impact both individual patients and public health.
Interviews with emergency department and HIV clinic staff revealed important considerations and potential solutions for ED-initiated PrEP workflows. Clinicians in both specialties were enthusiastic about such an initiative, which could facilitate its success. This study lays the groundwork for the future design of an efficient and innovative workflow to leverage the ED as an essential entry point into HIV prevention services.
暴露前预防（PrEP）是指在未感染个体中使用抗逆转录病毒药物来预防HIV感染，这对于减缓病毒传播具有巨大潜力。然而，其使用率一直不足，并且在HIV感染和PrEP使用方面都存在明显的种族差异，这使得PrEP的可及性成为一个健康公平问题。急诊科（ED）是促使高危人群接受PrEP治疗的一个有前景的场所；然而，现有的急诊科PrEP项目成本高昂或成效有限。我们假设两种策略可以克服这些障碍：在急诊科就诊期间开具PrEP处方，并在急诊科为患者提供PrEP药物的初始供应量。在此，我们描述了一项定性研究的结果，该研究探讨了多学科急诊临床医生和HIV临床医生对于此类举措可行性的需求和看法。
我们对一家城市安全网医疗中心急诊科和提供PrEP服务的现场HIV诊所的多学科临床医生进行了22次半结构化访谈。我们进行了主题分析，以总结参与者描述的挑战和潜在解决方案。
参与者的回答分为三个主题类别：操作挑战；患者层面的考虑因素；以及潜在影响。操作挑战突出了在繁忙的急诊科启动PrEP的困难以及临床医生的支持需求。患者层面的考虑因素包括可能从PrEP中受益的急诊科患者复杂的心理社会需求。最后，参与者预计基于急诊科的PrEP启动项目可能会对个体患者和公共卫生产生积极影响。
对急诊科和HIV诊所工作人员的访谈揭示了急诊科启动PrEP工作流程的重要考虑因素和潜在解决方案。两个专业领域的临床医生都对这样的举措充满热情，这可能有助于其取得成功。本研究为未来设计高效创新的工作流程奠定了基础，以利用急诊科作为HIV预防服务的重要切入点。
