A 28-day regimen of Post-Exposure Prophylaxis (PEP) administered within 72 h significantly reduces HIV infection, for both occupational and non-occupational exposures (NOE), however, adherence to PEP for NOE has been reported to have poor rates of completion. To optimize PEP referrals from our ED to our clinics, we implemented an automated referral system to maximize PEP completion and link patients to outpatient care and HIV pre-exposure prophylaxis (PrEP), if appropriate.
In our ED, PEP patients receive a starter kit from an automated medication dispensing system. Starting in March 2017, a daily automated report of patients who received a starter kit in the ED was generated and emailed to patient navigators who would contact patients and offer follow up appointments. Our main objective was to describe the rate of outpatient follow up of patients initiated on PEP for NOE from March 2017 to March 2018, as well as patient demographics and linkage to PrEP.
Out of 128 patients seen in the ED for PEP, 30% (38) were for NOE. Of these, 68% were female, with a median age of 27 years old (range: 14-59). Nearly half had no insurance (45%). The majority (84%) reported sexual intercourse or sexual assault as the exposure. Most patients were contacted for follow up (76%) and half (48%) had a follow up appointment. Patients who presented to the ED >24 hours after exposure were less likely to complete a follow up (35% vs 75%, p=0.035), as were uninsured patients (24% vs 57%, p=0.052). From 38 patients, 13 (34%) qualified for PrEP, eight (62%) followed as outpatients and one (8%) was started on PrEP.
The automated system ensured that half our PEP patients were seen by an outpatient provider, increasing their likelihood of finishing the 28 days of PEP. Patients presenting late to the ED and uninsured patients were less likely to follow up. Further research is needed to identify interventions to improve follow up. Finally, transition to PrEP was low and additional interventions should be explored to improve this process.
E. Reategui Schwarz,
F. Schubert, None
F. Ita-Nagy, None