“Express testing” in STI clinics: extant literature and preliminary implementation data

O’Byrne, Patrick; Phillips, J. Craig; Campbell, Barbara; Reynolds, Aideen; Metz, Gila; Bennet, Jenna; Boulet, Ruth; Friedman, Dara Spatz; Grayson, Marie-Odile; Hooper, Sandy; Rodo, Jessica

doi:10.1016/j.apnr.2015.06.003

Cited by 8 publications

(9 citation statements)

References 68 publications

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“…These clinics have been detailed elsewhere. 24,25 In these clinics, we trained nurses who were experts in STI care, and authorized them, under medical directives, to provide PEP. 11 After ensuring a patient qualified for PEP, had no contraindications to PEP medications, and was ostensibly HIV-negative (based on a lack of seroconversion symptoms and a non-reactive HIV point-of-care test), 26 these nurses provided the patient with a three-day or six-day starter pack for PEP.…”

Section: Participants Setting and Interventionmentioning

confidence: 99%

“…[26][27][28] Current guidelines recommend these medications based on their tolerability, ease of use, and minimal drug interactions (only Rifampin). 8,25,29 (Please note, at the time of guideline publication and our study initiation, once daily Dolutegravir was not approved.) The cost of these medications was (in CAD) $167 for the three-day starter pack and $1557 for the 28-day course.…”

Section: Participants Setting and Interventionmentioning

confidence: 99%

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

et al. 2016

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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.

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Section: Participants Setting and Interventionmentioning

confidence: 99%

Section: Participants Setting and Interventionmentioning

confidence: 99%

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

et al. 2016

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“…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). Nurses are competent to perform STI assessments, to determine patient's need for PrEP, to provide relevant counseling, and to undertake appropriate monitoring (Becker, 2017).…”

Section: Discussionmentioning

confidence: 94%

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

2019

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HIV prevention has evolved to include the provision of HIV medications to HIV-negative persons. Known as pre-exposure prophylaxis (PrEP), this intervention can reduce HIVacquisition by 96% when taken as prescribed. While previous reviews have established that PrEP is cost-effective, few have focused on the healthcare system delivery costs associated with PrEP. We undertake such a comparative analysis focusing on Ontario, Canada estimating the costs for an infectious disease physician, a primary care physician, and a nurse working in our nurse-led PrEP clinic (PrEP-RN). While the delivery of care by the nurse generated the least overall costs, we acknowledge that this would depend on how many patients breach the protocols established for nurse-led PrEP. We also highlight that targeting PrEP at persons who are at highest risk for HIV acquisition could make PrEP even more cost-effective than we estimated herein.

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“…Pre-COVID, this clinic would see approximately 20,000 patients per year and would account for nearly one-third of all local syphilis diagnoses. 15 , 16 As part of this review, we established protocols for physicians and nurse practitioners to complete DFA tests on patients where a diagnosis of syphilis was suspected. Protocols included indications for testing (e.g., symptoms of concern, anatomical site of lesions) and instructions on how to complete a DFA, per Public Health Ontario Laboratory recommendations.…”

Section: Methodsmentioning

confidence: 99%

Direct fluorescence antibody testing augments syphilis diagnosis, compared to serology alone

Orser

O’Byrne

2021

Int J STD AIDS

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In Ottawa, Canada, we initiated protocols to include non-serologic syphilis testing, as direct fluorescence antibody (DFA) for patients with syphilis symptoms. The purpose was to assess the ability of DFA to detect syphilis during acute infection and to determine if non-serologic testing could yield an increased number of syphilis diagnoses. We reviewed charts of patients of our local sexual health clinic for whom syphilis was suspected. A total of 69 clinical encounters were recorded for 67 unique patients, most of whom were male. The most common symptom was a painless genital lesion. Of the 67 patients, 29 were found to have a new syphilis diagnosis, among whom, 52% had positive syphilis serology and positive DFA, 34% had a positive syphilis serology and negative DFA, and 14% had negative syphilis serology and positive DFA. While DFA testing did not yield an abundance of new cases, it was useful to support findings from syphilis serology or confirm diagnosis where serology was negative. Where available, alternate non-serologic tests, such as nucleic acid amplification tests, should be considered above DFA due to its higher sensitivity for detecting syphilis in primary lesions; however, in clinical situations, when new syphilis infection is suspected, empiric treatment should not be delayed.

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“Express testing” in STI clinics: extant literature and preliminary implementation data

Cited by 8 publications

References 68 publications

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

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

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

Direct fluorescence antibody testing augments syphilis diagnosis, compared to serology alone

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