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Patient attrition between the emergency department and clinic among individuals presenting for HIV nonoccupational postexposure prophylaxis.
Clin Infect Dis 2014; 58(11):1618-24CI

Abstract

BACKGROUND

Nonoccupational postexposure prophylaxis (nPEP) is recommended after a sexual or parenteral exposure to human immunodeficiency virus (HIV). Patients frequently seek care in an emergency department (ED) after an exposure and are usually referred to an HIV clinic for further management. There have been few data on determinants of attrition after presentation to EDs for nPEP.

METHODS

From July 2010 to June 2011, we prospectively recorded all referrals to nPEP programs from 2 large EDs at 2 academic medical centers in Boston, Massachusetts. Data were recorded on patient demographics, nature of potential HIV exposures, referrals to and attendance at HIV clinics, and reported completion of 28 days of antiretroviral therapy (ART). Multivariable logistic regression was used to evaluate risk factors for (1) patient attrition between the ED and HIV clinic follow-up and (2) documented completion of ART.

RESULTS

Of 180 individuals who were referred to clinic follow-up for nPEP care from the ED, 98 (54.4%) attended a first nPEP clinic visit and 43 (23.9%) had documented completion of a 28-day course of ART. Multivariable analysis revealed older age (adjusted odds ratio [aOR], 0.96; 95% confidence interval [CI], .93-.99) and self-payment (aOR, 0.32; 95% CI, .11-.97) were significant predictors for failing to attend an initial HIV clinic appointment. Women were less likely than men to complete a 28-day ART regimen (aOR, 0.34; 95% CI, .15-.79).

CONCLUSIONS

Commonly used nPEP delivery models may not be effective for all patients who present with nonoccupational exposures to HIV. Interventions are needed to improve rates of follow-up and completion of nPEP to reduce the risk of preventable HIV infections.

Authors+Show Affiliations

Divisions of Internal Medicine and Infectious Diseases, University Health Network.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Observational Study
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

24723288

Citation

Bogoch, Isaac I., et al. "Patient Attrition Between the Emergency Department and Clinic Among Individuals Presenting for HIV Nonoccupational Postexposure Prophylaxis." Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America, vol. 58, no. 11, 2014, pp. 1618-24.
Bogoch II, Scully EP, Zachary KC, et al. Patient attrition between the emergency department and clinic among individuals presenting for HIV nonoccupational postexposure prophylaxis. Clin Infect Dis. 2014;58(11):1618-24.
Bogoch, I. I., Scully, E. P., Zachary, K. C., Yawetz, S., Mayer, K. H., Bell, C. M., & Andrews, J. R. (2014). Patient attrition between the emergency department and clinic among individuals presenting for HIV nonoccupational postexposure prophylaxis. Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America, 58(11), pp. 1618-24. doi:10.1093/cid/ciu118.
Bogoch II, et al. Patient Attrition Between the Emergency Department and Clinic Among Individuals Presenting for HIV Nonoccupational Postexposure Prophylaxis. Clin Infect Dis. 2014;58(11):1618-24. PubMed PMID: 24723288.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Patient attrition between the emergency department and clinic among individuals presenting for HIV nonoccupational postexposure prophylaxis. AU - Bogoch,Isaac I, AU - Scully,Eileen P, AU - Zachary,Kimon C, AU - Yawetz,Sigal, AU - Mayer,Kenneth H, AU - Bell,Chaim M, AU - Andrews,Jason R, Y1 - 2014/04/10/ PY - 2014/4/12/entrez PY - 2014/4/12/pubmed PY - 2015/1/6/medline KW - HIV KW - care linkage KW - postexposure prophylaxis KW - prevention KW - retention SP - 1618 EP - 24 JF - Clinical infectious diseases : an official publication of the Infectious Diseases Society of America JO - Clin. Infect. Dis. VL - 58 IS - 11 N2 - BACKGROUND: Nonoccupational postexposure prophylaxis (nPEP) is recommended after a sexual or parenteral exposure to human immunodeficiency virus (HIV). Patients frequently seek care in an emergency department (ED) after an exposure and are usually referred to an HIV clinic for further management. There have been few data on determinants of attrition after presentation to EDs for nPEP. METHODS: From July 2010 to June 2011, we prospectively recorded all referrals to nPEP programs from 2 large EDs at 2 academic medical centers in Boston, Massachusetts. Data were recorded on patient demographics, nature of potential HIV exposures, referrals to and attendance at HIV clinics, and reported completion of 28 days of antiretroviral therapy (ART). Multivariable logistic regression was used to evaluate risk factors for (1) patient attrition between the ED and HIV clinic follow-up and (2) documented completion of ART. RESULTS: Of 180 individuals who were referred to clinic follow-up for nPEP care from the ED, 98 (54.4%) attended a first nPEP clinic visit and 43 (23.9%) had documented completion of a 28-day course of ART. Multivariable analysis revealed older age (adjusted odds ratio [aOR], 0.96; 95% confidence interval [CI], .93-.99) and self-payment (aOR, 0.32; 95% CI, .11-.97) were significant predictors for failing to attend an initial HIV clinic appointment. Women were less likely than men to complete a 28-day ART regimen (aOR, 0.34; 95% CI, .15-.79). CONCLUSIONS: Commonly used nPEP delivery models may not be effective for all patients who present with nonoccupational exposures to HIV. Interventions are needed to improve rates of follow-up and completion of nPEP to reduce the risk of preventable HIV infections. SN - 1537-6591 UR - https://www.unboundmedicine.com/medline/citation/24723288/Patient_attrition_between_the_emergency_department_and_clinic_among_individuals_presenting_for_HIV_nonoccupational_postexposure_prophylaxis_ L2 - https://academic.oup.com/cid/article-lookup/doi/10.1093/cid/ciu118 DB - PRIME DP - Unbound Medicine ER -