HIV post-exposure prophylaxis in the emergency department: An updated assessment and opportunities for HIV prevention identified

O’Connell, Katie; Kisteneff, Alice; Gill, Shanedeep; Edwards, Joshua; Sherrerd-Smith, William; Moraczewski, Laila A.; Derber, Catherine; Lo, Bruce M.

doi:10.1016/j.ajem.2020.10.004

Cited by 7 publications

(6 citation statements)

References 9 publications

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“…The Delphi method is an iterative consensus approach based on information collected from a panel of voters with expertise in the subject under consideration (Boulkedid et al, 2011; Dalkey, 1972; Diamond et al, 2014; Hasson et al, 2000; Hsu & Sandford, 2007; Humphrey‐Murto et al, 2017; Kodjikian et al, 2022; Loblaw et al, 2012; Richard et al, 2022). In recent years, this approach has been used widely in many therapeutic areas and several times both in HIV care and in sleep medicine (Adegbehingbe et al, 2012; Berezin et al, 2021; Cummins et al, 2019; De Silva et al, 2021; Engler et al, 2019; Feyissa et al, 2018; Fredericksen et al, 2015; Geoffroy et al, 2023; Greacen et al, 2016; Johnson et al, 2017; Johnson et al, 2019; Maserati et al, 2014; O'Connell et al, 2020; Tsui et al, 2017; Uyei et al, 2015). Using this structured approach, voting experts give their opinion in an individual and anonymous way, and express their degree of agreement on statements in order to achieve consensus on a specific and well‐defined subject.…”

Section: Methodsmentioning

confidence: 99%

The screening and management of sleep disturbances in people living with HIV: Delphi consensus

Allavena,

Bastides,

Moroy

et al. 2023

Journal of Sleep Research

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SummarySleep disturbances in people living with HIV (PLHIV) are frequent but their management remains insufficient. In the absence of specific recommendations, a DELPHI consensus research project was conducted in France to establish best practice. A multidisciplinary Steering Committee (STC) undertook a literature review and used it with clinical expertise to create statements that were voted on. Two profiles of healthcare professionals with significant experience in monitoring PLHIV were selected for the voting: physicians and nurses/psychologists. Votes were collected electronically, independently, and anonymously. The STC created 27 statements covering six areas: Screening of sleep disturbances, Investigation, First‐line management, Referral to a specialist, Antiretroviral treatment (ARV), and Prevention. Two rounds of votes included 42 physicians and 32 nurses/psychologists. Consensus was reached for 24 out of 27 statements (89%) including: to assess quantity and quality of sleep among PLHIV at least annually, ideally using a common methodology within the medical department; to consider the temporary addition of a hypnotic treatment in cases of acute insomnia not improved by the rules of sleep hygiene, with full awareness of potential drug–drug interactions and risk of dependence; to correct ferritinaemia if <100 ng/mL before referral to a specialist when restless legs syndrome is suspected; to consider changing the time of ARV administration or an ARV switch within the same class when sleep disturbances are caused by an ARV. This DELPHI Consensus provides best practice for screening and managing sleep disturbances in PLHIV and optimising their quality of life.

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Section: Methodsmentioning

confidence: 99%

The screening and management of sleep disturbances in people living with HIV: Delphi consensus

Allavena,

Bastides,

Moroy

et al. 2023

Journal of Sleep Research

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“…Postexposure prophylaxis (PEP) is an underutilized tool for preventing HIV transmission in people who experience both occupational and nonoccupational exposure, and it may represent an opportunity to achieve the UN's 95-95-95 testing, treatment, and viral suppression targets. Although PEP can decrease the risk of HIV transmission by more than 80% when taken as prescribed, one study found that only 40% of providers felt they could confidently prescribe an appropriate regimen and provide care for those exposed to HIV 4,5. Exposure to HIV is a medical emergency, and patients should be treated accordingly 4,6.…”

mentioning

confidence: 99%

“…Although PEP can decrease the risk of HIV transmission by more than 80% when taken as prescribed, one study found that only 40% of providers felt they could confi dently prescribe an appropriate regimen and provide care for those exposed to HIV. 4,5 Exposure to HIV is a medical emergency, and patients should be treated accordingly. 4,6 Given the knowledge gap in practice and the need for reduction in HIV transmission according to the UN's targets, a comprehensive overview of HIV pathophysiology and step-by-step guide for NPs in managing its exposure is critical and timely.…”

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confidence: 99%

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Postexposure prophylaxis (PEP) of HIV among adults

Hussein

Malyshev

2023

The Nurse Practitioner

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In the last several decades, postexposure prophylaxis (PEP) with antiretroviral therapy (ART) has become an effective tool for the prevention of HIV transmission. The continuous evolution of antiretrovirals and the associated update of clinical practice guidelines create a challenge for NPs caring for patients exposed to HIV. Understanding the life cycle of HIV is of paramount importance in streamlining treatment regimens in exposed individuals. ART is a complex combination of drugs targeting different stages of the virus's life cycle within the host. NPs play an essential role in managing treatment for people exposed to HIV and following up on these patients' response and adherence to the treatment protocol. This article provides a comprehensive overview of HIV and step-by-step guidance for NPs treating patients who have been exposed.

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“…Conversely, postexposure prophylaxis involves the initiation of antiretroviral drugs after a potential exposure to HIV, and typically consists of three medications and a 28 day treatment course that must be initiated within 72 hours of an exposure 235. In care models across most high, middle, and low income countries, this requires a person to overcome several barriers—including those related to knowledge gaps, stigma, and finance—to present to an emergency department or urgent care centre for assessment and to obtain a prescription on a semi-urgent basis 256…”

mentioning

confidence: 99%

HIV prevention with postexposure prophylaxis-in-pocket (PIP)

Billick,

Sheps,

Bogoch

2023

BMJ

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HIV post-exposure prophylaxis in the emergency department: An updated assessment and opportunities for HIV prevention identified

Cited by 7 publications

References 9 publications

The screening and management of sleep disturbances in people living with HIV: Delphi consensus

The screening and management of sleep disturbances in people living with HIV: Delphi consensus

Postexposure prophylaxis (PEP) of HIV among adults

HIV prevention with postexposure prophylaxis-in-pocket (PIP)

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