HIV Postexposure Prophylaxis in Sexual Assault: Current Practice and Patient Adherence to Treatment Recommendations in a Large Urban Teaching Hospital

Abstract

Background: Although rare, HIV transmission is one of the most feared consequences of sexual assault. While availability of medications to prevent HIV transmission (HIV nonoccupational postexposure prophylaxis [HIV nPEP]) is increasing, little is known about emergency department (ED) prescribing practices and patient adherence to treatment recommendations. Objectives: To determine factors associated with offering, following up with, and adhering to treatment when HIV nPEP is initiated for sexual assault victims. Methods: This was a retrospective chart review of female patients presenting with complaint of sexual assault to an urban ED from October 1, 1999, to September 30, 2002. HIV nPEP medications and/or follow-up were provided without charge. Chi-square analysis identified factors associated with being offered or referred for nPEP and followup. Variables significant at the p , 0.10 level were entered into logistic regression analysis. Results: Two hundred twenty-nine charts were reviewed. The final sample size was 181. Mean age was 29.1 years; median time from assault

Factors Associated With Forensic Nurses Offering HIV nPEP Status Post Sexual Assault

“…At Site 1, the significant factor associated with offering nPEP was open injury to the anus or genitalia. This contrasts with Linden and colleagues’ (2005) finding of no association between the presence of genital bleeding and offering nPEP. This may be due to our definition of open genital injury (meaning an abrasion, laceration, or bleeding not from menstruation) versus genital bleeding only.…”

“…No studies examined whether there is an association between assailant race and whether the patient is offered nPEP. Only one study incorporated forensic exam findings; however, Linden and colleagues (2005) found no association between offering nPEP and genital bleeding noted on exam. Finally, although HIV documentation is usually collected in studies of nPEP after sexual assault, whether a documented HIV risk assessment is associated with offering nPEP has not been assessed (Draughon & Sheridan, 2012).…”

“…In previous research, there has been conflicting evidence about which factors of an assault (patient demographics, assault characteristics, exam findings, and HIV documentation) are associated with the health care provider (HCP) offering nPEP. In one study, being younger than 33 was a factor in offering nPEP (Linden, Oldeg, Mehta, McCabe, & LaBelle, 2005). Others found no association between patient age (Merchant, Phillips, Delong, Mayer, & Becker, 2008; Moe & Grau, 2001; Templeton, Davies, Garvin, & Garsia, 2005), sex (Moe & Grau, 2001; Templeton et al, 2005), or race (Moe & Grau, 2001) and the HCP offering nPEP.…”

“…Multiple studies have found that assaults categorized as high-risk (often those involving anal penetration) were qualitatively associated with the HCP offering nPEP (e.g., Diniz, Almeida, Ribeiro, & Macêdo, 2007; Linden et al, 2005; Loutfy et al, 2008; Rey et al, 2008). Two studies reported that high-risk assaults were significantly associated with the HCP offering nPEP (Merchant et al, 2008; Templeton et al, 2005).…”

South African Sexual Assault Survivors' Experiences of Post-Exposure Prophylaxis and Individualized Nursing Care: A Qualitative Study

“…Prophylactic antiretroviral therapy has been found to reduce the likelihood of HIV infection after potential occupational exposures (Cardo et al, 1997). Sexual assault survivors are often so traumatized when they seek care immediately after the assault that they are unable to fully understand the risks and benefits of PEP (Wiebe, Comay, McGregor, & Ducceschi, 2000), and PEP adherence in this population is often poor (Carries, Muller, Muller, Morroni, & Wilson, 2007; Kim et al, 2009; Limb, Kawsar, & Forster, 2002; Linden, Oldeg, Mehta, McCabe, & LaBelle, 2005; Sikka et al, 2009; Templeton, Davies, Garvin, & Garsia, 2005). …”