Predictors of the Initiation of HIV Postexposure Prophylaxis in Rhode Island Emergency Departments

Abstract

The objective of this study was to elucidate factors that predicted the initiation of HIV postexposure prophylaxis (PEP) for blood or body fluid exposures evaluated at Rhode Island emergency departments (EDs). The study involved a retrospective review of patient visits to all civilian Rhode Island EDs for these exposures from 1995 to mid-2001. Multivariate logistic regression models were created to evaluate predictors of the offering and the acceptance and receipt of HIV PEP from 1996 to 2001. The search identified 3622 patients who sustained a blood or body fluid exposure. Of these, 43.8% were health care workers (HCWs) and 57.2% were not HCWs. Most (52.0%) of the exposures were nonsexual. HIV PEP was offered to 21.0% and accepted and received by 9.4% of all patients. HIV PEP was offered more often after significant exposures, exposures to known HIV-infected sources, when time elapsed after the exposure was shorter, if the patients were HCWs, adults, presented to a teaching hospital, presented during the latter years of the study, or sustained nonsexual exposures. Once offered HIV PEP, patients who were male, adult, sustained a significant exposure, knew the source was HIV infected, sustained a nonsexual exposure, or were HCWs had a greater odds of accepting and receiving HIV PEP. Even when controlling for exposure significance, HIV status, and time elapsed since the exposure, several factors such as gender and type of hospital that are unrelated to the exposure appeared to influence the initiation of HIV PEP. ED providers should ensure that these factors do not inappropriately restrict its initiation.

HIV prescriptions on the frontlines: Primary care providers' use of antiretrovirals for prevention in the Southeast United States, 2017

“…The differences between what we observed among PCPs sampled compared with HIV specialists were likely attributed to the general clinical context of nPEP initiations. For instance, nPEP is often initiated during emergency care for incidences of sexual assault (Merchant et al, 2003; Krause et al, 2014; Merchant et al, 2008). Most PCPs in our sample did not practice in emergency care settings and were not likely to encounter such types of urgent clinical situation, whereas HIV specialists might be called upon by emergency care providers to provide expert consultation regarding nPEP.…”

Self-reported occupational exposure to HIV and factors influencing its management practice: a study of healthcare workers in Tumbi and Dodoma Hospitals, Tanzania

“…BBVs can also be found in body fluids other than blood, such as, semen, vaginal secretions and breast milk. BBVs constitute a major occupational hazard for healthcare workers (HCW), especially in highly resource constrained countries [2]. …”

Nonoccupational Post-Exposure Prophylaxis for HIV in New York State Emergency Departments

“…12 When evaluating PEP from the perspective of cases as opposed to provider-based data, a retrospective analysis of Rhode Island EDs in 2008 showed that only 21% of eligible cases had PEP offered, and it was more likely in scenarios with health care workers in the occupational setting. 13 Considering the above-mentioned data, our finding that 88% (n ¼ 161 of 184) of NYS EDs reported evaluating any presenting patient with possible nonoccupational exposure for HIV suggests that the use of nPEP is relatively robust in NYS. This practice is likely due to long-standing efforts of the NYS Department of Health AIDS Institute to promote its use through community education and the Clinical Education Initiative.…”

“…12 When evaluating PEP from the perspective of cases as opposed to provider-based data, a retrospective analysis of Rhode Island EDs in 2008 showed that only 21% of eligible cases had PEP offered, and it was more likely in scenarios with health care workers in the occupational setting. 13…”