Predictors of Adherence to HIV Post-Exposure Prophylaxis and Retention in Care After an Episode of Sexual Violence in Brazil

Abstract

Adherence to non-occupational post-exposure prophylaxis (nPEP) among sexual violence (SV) victims and their retention in care after SV represent significant challenges. This study aimed at identifying predictors of adherence to nPEP and retention in clinical-laboratory follow-up among SV victims in São Paulo, Brazil.We conducted a retrospective cohort study of SV victims admitted to care and follow-up at the SV unit of the main reference hospital in São Paulo within 72 hours following the SV episode. Eligible patients were submitted to a standardised protocol that included nPEP, screening and management for other STI as well as emergency contraception. Predictors of adherence to nPEP for 28 days and retention in care until discharge at 180 days after admission were analysed. A total of 199 SV episodes in 197 victims were recorded from January/2001 to December/2013 (156 months). Of those episodes, 167 were eligible to receive nPEP and 160 (96%) actually received a prescription. Overall 104/160 (65%, 95%CI 57-72%) SV victims, who received nPEP, were fully adherent to nPEP up to 28 days, whereas 89/199 (45%, 95%CI 38-52%) were retained in care for 180 days following admission. In multivariate analysis, patients undergoing at least one psychological consultation (n=126) were more likely to adhere to nPEP (adjusted OR 8.32; 95%CI 3.0-23.3) and to be retained in care for 6 months (adjOR 40.33;) compared to patients not receiving psychological support. In contrast, study outcomes were not associated with victims' age and sex and with type of perpetrator. In our cohort provision of psychological care was shown to be associated with enhanced adherence to nPEP and retention in care.

Violência sexual contra homens no Brasil: subnotificação, prevalência e fatores associados

“…A total of 53 studies were included, most of them quantitative in approach (n = 48), 38 cross-sectional studies 14 , one exploratory descriptive 51 , three longitudinal 52 , one observational time-series 4 and one case series 55 . The remaining papers consisted of: four qualitative 56 , two literature reviews 8 , 20 , two intervention studies 61 , 62 and one case study 63 .…”

“…Most of the studies in this review did not include exclusively boys or men (n = 36). Among the studies not focused entirely on boys or men, 14 of them include children and adolescents of both sexes 14 , 20 , 28 , eight include adult women and men 8 , 10 , 19 , 21 , 25 , 35 , 44 , 62 , five include drug users 24 , 32 , 33 , 43 , 66 , two focus on patients in health services 21 , 52 , two focus on health professionals 36 , 56 , two target university students 42 , 47 , and one focuses on adolescents and adults 18 .…”

“…Um total de 53 estudos foram incluídos, a maioria de abordagem quantitativa (n = 48), 38 estudos transversais 14 , um descritivo exploratório 51 , três longitudinais 52 , um observacional de série temporal 4 e uma série de casos 55 . Os outros trabalhos consistiram em: quatro qualitativos 56 , duas revisões de literatura 8 , 20 , dois estudos de intervenção 61 , 62 e um de estudo de caso 63 .…”

Typologies of violence against women in Brazil: A latent class analysis of how violence and HIV intersect

“…As such, policies supporting provision of HIV post-exposure prophylaxis (PEP) present an opportunity to reform and strengthen existing services for post-rape care and highlight HIV prevention among sexual violence survivors (Kim et al, 2003). PEP provision in Brazil is highly acceptable and feasible among survivors of sexual violence (Nisida et al, 2019;Pereira et al, 2019). In a study conducted among women survivors of sexual violence in São Paulo, 65% adherence to PEP was reported, with psychological care and social support enhancing PEP adherence (Nisida et al, 2019).…”

“…PEP provision in Brazil is highly acceptable and feasible among survivors of sexual violence (Nisida et al, 2019;Pereira et al, 2019). In a study conducted among women survivors of sexual violence in São Paulo, 65% adherence to PEP was reported, with psychological care and social support enhancing PEP adherence (Nisida et al, 2019). PEP prescription postsexual assault is estimated to have potentially averted 3,138 HIV infections in Brazil between 2009 and 2017, with PEP more commonly prescribed in the Southeast than any other region of Brazil (Pereira et al, 2019).…”