Community-based, nurse-led post-exposure prophylaxis: results and implications

Abstract

HIV medications can be used as post-exposure prophylaxis to efficaciously prevent an HIV-negative person who has come into contact with HIV from becoming HIV-positive. Traditionally, these medications have been available in emergency departments, which have constituted a barrier for the members of many minority groups who are greatly affected by HIV transmission (i.e. gay, bisexual and other men who have sex with men, and persons who use injection drugs). From 5 September 2013 through 4 September 2015, we sought to increase the use of HIV post-exposure prophylaxis by having registered nurses provide these medications, when indicated, in community clinics in Ottawa, Canada. We undertook a chart review of patients who accessed services for HIV post-exposure prophylaxis in this period. Over the two years of data collection, 112 persons requested HIV post-exposure prophylaxis and 64% (n = 72) initiated these medications. Most (93%, or n = 67, of the 72 initiations) were among men, with 88% (n = 59) of these men reporting same sex sexual partners. Among these 58 men, 31% (n = 18) had sexual contact with other men known to be HIV-positive. Among women (n = 8), five initiated post-exposure prophylaxis: three after needle-sharing contact or sexual contact with a male partner who reportedly shared needles, and two after unprotected vaginal sex with a male partner known to be HIV-positive. Overall, no one was diagnosed with HIV at the four-month HIV testing follow-up, although six persons were diagnosed with HIV from the baseline HIV testing, and an additional four were diagnosed with HIV during routine HIV testing one year after completing post-exposure prophylaxis. In total, nine persons in our sample were thus diagnosed with HIV during the study period, which accounted for 9.4% (n = 10 of 106) of all reported HIV diagnoses in Ottawa during this time. We conclude that nurse-initiated HIV post-exposure prophylaxis can be an effective way to provide HIV prevention services to persons who are at high-risk for HIV.

HIV PEP and Nursing Scholarship: A Review of Critical Theory and Social Justice

“…This last group was precisely the subset of patients we sought to help with the grant: those affected by HIV who not only belonged to a marginalized group (mostly men who have sex with men and persons who inject drugs), but also were disadvantaged socioeconomically and unable to afford PEP. Another noteworthy outcome was that 9.8% of the patients who sought PEP through our program were diagnosed with HIV, accounting for nearly 7% of HIV diagnoses that occurred in Ottawa during the study period (O'Byrne, MacPherson & Orser, 2018;O'Byrne, MacPherson, Roy & Orser, 2017). This finding further supported the importance of providing equitable HIV prevention to this small group of individuals who needed PEP.…”

Immediate PrEP after PEP: Results from an Observational Nurse-Led PEP2PrEP Study

“…This rate of access and uptake, plus the client demographics of these patients, also resembles our published data on this clinical service. For more information on this PEP program and its participants and outcomes, please see O’Byrne et al 3 , 14 …”

The Costs of HIV Pre-exposure Prophylaxis (PrEP) Care Delivery: Comparing Specialists, Primary Care, and PrEP-RN

“…In most cases, no such cost coverage occurs for medication. As previously established, task shifting to nurses from specialists and primary care physicians is often less costly and associated with safe care provision and high patient satisfaction (Fairall et al, 2012;Mdege, Chindove, & Ali, 2013;O'Byrne, MacPherson, Roy, & Orser, 2017). This Btask shifting^is not an Boff-loading^of care from a provider with more expertise to one with less, but a more appropriate use of various providers (O'Byrne, Phillips, Campbell, Reynolds, & Metz, 2016).…”