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HIV postexposure prophylaxis in sexual assault: current practice and patient adherence to treatment recommendations in a large urban teaching hospital.
Acad Emerg Med 2005; 12(7):640-6AE

Abstract

BACKGROUND

Although rare, HIV transmission is one of the most feared consequences of sexual assault. While availability of medications to prevent HIV transmission (HIV nonoccupational postexposure prophylaxis [HIV nPEP]) is increasing, little is known about emergency department (ED) prescribing practices and patient adherence to treatment recommendations.

OBJECTIVES

To determine factors associated with offering, following up with, and adhering to treatment when HIV nPEP is initiated for sexual assault victims.

METHODS

This was a retrospective chart review of female patients presenting with complaint of sexual assault to an urban ED from October 1, 1999, to September 30, 2002. HIV nPEP medications and/or follow-up were provided without charge. Chi-square analysis identified factors associated with being offered or referred for nPEP and follow-up. Variables significant at the p < 0.10 level were entered into logistic regression analysis.

RESULTS

Two hundred twenty-nine charts were reviewed. The final sample size was 181. Mean age was 29.1 years; median time from assault to presentation was 10.1 hours; 51.5% of the assailants were known to the victims. HIV nPEP was offered to 89 (49%) patients, and 11 patients were referred to an HIV nurse. Eighty-five (85%) patients accepted, 38 of these 85 (45%) followed up, and 18 of the 85 (21%) completed treatment. In multivariate analysis, three variables were statistically significantly associated with increased likelihood of referral or being offered HIV nPEP: unknown assailant, having insurance, and younger age. Treatment was completed by 15 of 82 (18%) of ED-initiated patients, versus three of three (100%) referred for initiation. The authors were unable to identify factors associated with completing treatment.

CONCLUSIONS

HIV nPEP was offered to less than half of sexual assault patients, and few completed treatment. Further studies are needed to evaluate and improve appropriateness of HIV nPEP administration and follow-up.

Authors+Show Affiliations

Boston University School of Medicine, Boston Medical Center, MA 02118, USA. jlinden@bu.edu <jlinden@bu.edu>No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

15995097

Citation

Linden, Judith A., et al. "HIV Postexposure Prophylaxis in Sexual Assault: Current Practice and Patient Adherence to Treatment Recommendations in a Large Urban Teaching Hospital." Academic Emergency Medicine : Official Journal of the Society for Academic Emergency Medicine, vol. 12, no. 7, 2005, pp. 640-6.
Linden JA, Oldeg P, Mehta SD, et al. HIV postexposure prophylaxis in sexual assault: current practice and patient adherence to treatment recommendations in a large urban teaching hospital. Acad Emerg Med. 2005;12(7):640-6.
Linden, J. A., Oldeg, P., Mehta, S. D., McCabe, K. K., & LaBelle, C. (2005). HIV postexposure prophylaxis in sexual assault: current practice and patient adherence to treatment recommendations in a large urban teaching hospital. Academic Emergency Medicine : Official Journal of the Society for Academic Emergency Medicine, 12(7), pp. 640-6.
Linden JA, et al. HIV Postexposure Prophylaxis in Sexual Assault: Current Practice and Patient Adherence to Treatment Recommendations in a Large Urban Teaching Hospital. Acad Emerg Med. 2005;12(7):640-6. PubMed PMID: 15995097.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - HIV postexposure prophylaxis in sexual assault: current practice and patient adherence to treatment recommendations in a large urban teaching hospital. AU - Linden,Judith A, AU - Oldeg,Paula, AU - Mehta,Supriya D, AU - McCabe,Kerry K, AU - LaBelle,Colleen, PY - 2005/7/5/pubmed PY - 2006/3/15/medline PY - 2005/7/5/entrez SP - 640 EP - 6 JF - Academic emergency medicine : official journal of the Society for Academic Emergency Medicine JO - Acad Emerg Med VL - 12 IS - 7 N2 - BACKGROUND: Although rare, HIV transmission is one of the most feared consequences of sexual assault. While availability of medications to prevent HIV transmission (HIV nonoccupational postexposure prophylaxis [HIV nPEP]) is increasing, little is known about emergency department (ED) prescribing practices and patient adherence to treatment recommendations. OBJECTIVES: To determine factors associated with offering, following up with, and adhering to treatment when HIV nPEP is initiated for sexual assault victims. METHODS: This was a retrospective chart review of female patients presenting with complaint of sexual assault to an urban ED from October 1, 1999, to September 30, 2002. HIV nPEP medications and/or follow-up were provided without charge. Chi-square analysis identified factors associated with being offered or referred for nPEP and follow-up. Variables significant at the p < 0.10 level were entered into logistic regression analysis. RESULTS: Two hundred twenty-nine charts were reviewed. The final sample size was 181. Mean age was 29.1 years; median time from assault to presentation was 10.1 hours; 51.5% of the assailants were known to the victims. HIV nPEP was offered to 89 (49%) patients, and 11 patients were referred to an HIV nurse. Eighty-five (85%) patients accepted, 38 of these 85 (45%) followed up, and 18 of the 85 (21%) completed treatment. In multivariate analysis, three variables were statistically significantly associated with increased likelihood of referral or being offered HIV nPEP: unknown assailant, having insurance, and younger age. Treatment was completed by 15 of 82 (18%) of ED-initiated patients, versus three of three (100%) referred for initiation. The authors were unable to identify factors associated with completing treatment. CONCLUSIONS: HIV nPEP was offered to less than half of sexual assault patients, and few completed treatment. Further studies are needed to evaluate and improve appropriateness of HIV nPEP administration and follow-up. SN - 1553-2712 UR - https://www.unboundmedicine.com/medline/citation/15995097/HIV_postexposure_prophylaxis_in_sexual_assault:_current_practice_and_patient_adherence_to_treatment_recommendations_in_a_large_urban_teaching_hospital_ L2 - https://onlinelibrary.wiley.com/resolve/openurl?genre=article&amp;sid=nlm:pubmed&amp;issn=1069-6563&amp;date=2005&amp;volume=12&amp;issue=7&amp;spage=640 DB - PRIME DP - Unbound Medicine ER -