Emergency Department–Based Human Immunodeficiency Virus Preexposure Prophylaxis Referral Program—Using Emergency Departments as a Portal for Preexposure Prophylaxis Services

Zhao, Zezhou; Jones, Joyce; Arrington‐Sanders, Renata; Gladfelter, Gaby; McDonald, Steven; Reed, Christopher Robert; Myer, Deanna; Schlenker, Noah W.; Fulton, Glenn; Jones, Tiana; Saheed, Mustapha; Rothman, Richard E.; Hsieh, Yu Hsiang

doi:10.1097/olq.0000000000001351

Cited by 12 publications

(7 citation statements)

References 12 publications

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“…The linkage to care outcomes described in the preceding two studies differ from the studies conducted by Ketels et al (2020), Ridgway et al (2018), and Zhao et al (2021) wherein ED providers generated PrEP referrals and generally relied on subsequent patient contact to schedule an appointment with a PrEP provider in the future [ 32 – 34 , 38 ]. Between March through December 2019, Ketels et al (2020) describes a sample of patients evaluated in an urban Colorado ED diagnosed with gonorrhea, chlamydia, trichomonas, and/or bacterial vaginosis ( N = 289) who were offered a follow-up call after their ED visit from a PrEP coordinator to discuss HIV prevention when contacted with STI test results [ 34 ].…”

Section: Resultsmentioning

confidence: 97%

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A Systematic Review of HIV Pre-exposure Prophylaxis (PrEP) Implementation in U.S. Emergency Departments: Patient Screening, Prescribing, and Linkage to Care

Jackson,

Chitle,

McCoy

et al. 2023

J Community Health

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In the pursuit of ending the HIV epidemic, U.S. emergency departments (EDs) have emerged as a valuable setting to increase HIV testing and linkage to care. There is limited data available, however, describing the incorporation of HIV prevention initiatives in U.S. EDs. Over the last decade, HIV pre-exposure prophylaxis (PrEP) has significantly changed the HIV prevention landscape globally and very little is known about the provision of PrEP in U.S. EDs. To address this gap in the literature, we conducted a systematic review of peer-reviewed quantitative studies and conference abstracts spanning July 2012 - October 2022. Of 433 citations, 11 articles and 13 abstracts meet our inclusion criteria, representing 18 unique studies addressing PrEP screening, prescribing, and/or linkage to PrEP care.Most studies describe screening processes to identify PrEP-eligible patients (n = 17); most studies leveraged a patient’s STI history as initial PrEP eligibility screening criteria. Fewer studies describe PrEP prescribing (n = 2) and/or linkage to PrEP care (n = 8).Findings from this systematic review highlight the potential for U.S. EDs to increase PrEP uptake among individuals at risk for HIV infection. Despite a growing number of studies exploring processes for incorporating PrEP into the ED setting, such studies are small-scale and time limited. Models providing prescribing PrEP in the ED show higher initiation rates than post-discharge engagement models. Electronic health record (EHR)-based HIV screening is valuable, but post-ED linkage rates are low. Our findings emphasize the need to establish best practices for initiating and supporting prevention effective PrEP use in the ED setting.

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Section: Resultsmentioning

confidence: 97%

“…From December 2018 through April 2019, Zhao et al (2021) describe a total of 314 ED patients evaluated in an academic medical center in Baltimore who were deemed potentially PrEP eligible based upon EHR data [ 32 , 33 ]. Ultimately, 119 patients were approached about HIV prevention and possible PrEP use.…”

Section: Resultsmentioning

confidence: 99%

A Systematic Review of HIV Pre-exposure Prophylaxis (PrEP) Implementation in U.S. Emergency Departments: Patient Screening, Prescribing, and Linkage to Care

Jackson,

Chitle,

McCoy

et al. 2023

J Community Health

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show abstract

“…Assessment of an individual's risk for acquiring HIV, beyond simply screening HIV negative, is a critical step in any ED prevention program. 17, [20][21][22][23][24] We chose to determine eligibility for comprehensive prevention services and PrEP referral using a structured risk assessment administered by an ED navigator. With this strategy, 16% of ED patients completing routine HIV screening were identified as being at increased risk of acquiring HIV, a number consistent with prior studies using similar screening strategies.…”

Section: Discussionmentioning

confidence: 99%

“…Follow-up from the ED for outpatient HIV prevention services tends to be low, and there are limited reports on HIV prevention continuum metrics, including the receipt of and adherence to PrEP for ED patients. 22,24,28,29 This study identifies gaps in the early stages of the PrEP care continuum for ED patients at higher risk for acquiring HIV. In our model, approximately 1 out of 5 ED patients whom we identified at increased risk for HIV acquisition and who expressed interest in outpatient prevention services were linked to care (22%).…”

Section: Discussionmentioning

confidence: 99%

“…Although several ED HIV prevention programs report outcome data on linkage to care and PrEP initiation, the number of patients referred for follow-up and PrEP treatment is generally very low, making comparisons across models difficult. 21,22,24,29,30 Harmonization of the reporting of indicators in future studies could contribute to a more robust body of evidence on the utility of ED HIV prevention programs.…”

Section: Discussionmentioning

confidence: 99%

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Outcomes of an Emergency Department Program to Identify and Link Patients at Increased Risk for Acquiring HIV Infection to Outpatient HIV Prevention Services: The HIV PreventED Program

White,

Godoy,

Jewett

et al. 2024

JAIDS Journal of Acquired Immune Deficiency Syndromes

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Background: Emergency departments (ED) provide care to patients at increased risk for acquiring HIV and for many of them, the ED serves as their sole point of entry into the healthcare system. We implemented the HIV PreventED Program to increase access to HIV prevention services for ED patients. Setting: Emergency department in Oakland, CA with an annual census of 57,000 visits. Methods: This cross-sectional study evaluated the first 9 months of the HIV PreventED Program. In this program, a navigator surveyed adult HIV negative ED patients to determine their risk for acquiring HIV infection, incorporating HIV prevention counseling into their assessments. Patients at higher risk for acquiring HIV were referred to outpatient prevention services, if interested. The primary outcome measure was the number and proportion of ED patients at higher risk for acquiring HIV that followed up for outpatient prevention services. Results: There were 1,233 HIV negative patients assessed by the navigator and who received ED-based HIV prevention counseling. Of these, 193 (15.7%) were identified at higher risk and offered an outpatient referral for prevention services, of which 104 accepted (53.9%), 23 (11.9%) attended the referral, and 13 (6.7%) were prescribed pre-exposure prophylaxis (PrEP). The median time to linkage was 28 days (interquartile range 15 to 41 days). Conclusion: A navigator focused on providing ED-based HIV prevention counseling and linkage to outpatient services is feasible. Strategies to more efficiently identify ED patients at higher risk for HIV acquisition, such as automated identification of risk data from the electronic health record, and policies to improve follow up and the receipt of PrEP, such as same-day PrEP initiation, should be prospectively evaluated.

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A Scoping Review of Oral Pre-exposure Prophylaxis for Cisgender and Transgender Adolescent Girls and Young Women: What Works and Where Do We Go from Here?

et al. 2023

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Adolescent girls and young women (AGYW) are disproportionately affected by HIV, and oral pre-exposure prophylaxis (PrEP) can reduce HIV acquisition. The purpose of this scoping review was to synthesize results from interventions along the PrEP continuum for AGYW to inform research and programs. We searched electronic databases for studies published between January 2012–July 2021 and conducted secondary reference searching. Studies were included if they assessed interventions to increase PrEP interest, uptake, or continuation among AGYW. Results were synthesized narratively. Of 2168 citations identified, 50 studies were eligible for inclusion, and 20 contained AGYW-specific data. Among cisgender and transgender AGYW, studies overall demonstrated a positive impact on PrEP interest and uptake but generally attained suboptimal continuation rates. Results demonstrate feasibility of deploying PrEP across diverse settings—particularly when interventions are layered, tailored to AGYW, and include differentiated delivery—but also highlight knowledge gaps and the need for more holistic metrics of success.

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Emergency Department–Based Human Immunodeficiency Virus Preexposure Prophylaxis Referral Program—Using Emergency Departments as a Portal for Preexposure Prophylaxis Services

Cited by 12 publications

References 12 publications

A Systematic Review of HIV Pre-exposure Prophylaxis (PrEP) Implementation in U.S. Emergency Departments: Patient Screening, Prescribing, and Linkage to Care

A Systematic Review of HIV Pre-exposure Prophylaxis (PrEP) Implementation in U.S. Emergency Departments: Patient Screening, Prescribing, and Linkage to Care

Outcomes of an Emergency Department Program to Identify and Link Patients at Increased Risk for Acquiring HIV Infection to Outpatient HIV Prevention Services: The HIV PreventED Program

A Scoping Review of Oral Pre-exposure Prophylaxis for Cisgender and Transgender Adolescent Girls and Young Women: What Works and Where Do We Go from Here?

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