Linking emergency department patients at risk for human immunodeficiency virus to pre-exposure prophylaxis

Mahal, Jacqueline J.; Deccy, Stephanie; Seu, Rie

doi:10.1016/j.ajem.2022.01.038

Cited by 10 publications

(7 citation statements)

References 7 publications

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“…Examples of successful solutions internationally include house HIV “navigators” within a US emergency department who provided HIV testing and PrEP information that led to an increased uptake of PrEP and improved knowledge of who was eligible. 12 In California, an online chat service called PleasePrEPMe improved PrEP uptake via free HIV-prevention information and health care navigation services. 13 Alternative approaches that may warrant consideration include development of a more detailed virtual PrEP risk assessment tool, offering remote interactive consultations within online STI testing services, provision of PrEP in venues outside of sexual health services, online PrEP prescribing options and targeted campaigns with peer engagement directed towards under-represented groups.…”

Section: Discussionmentioning

confidence: 99%

Improving awareness and uptake of pre-exposure HIV prophylaxis amongst service users accessing Sexual Health London, a regional online postal sexually transmitted infection testing health service

Caoimhe,

Spate,

Day

2024

Int J STD AIDS

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Background The UK pledged commitment to the global strategy of zero new HIV infections and HIV-related deaths by 2030. PrEP was commissioned in England in 2020 and is fundamental to achieving these targets, yet awareness and uptake are suboptimal in certain populations. Method Sexual Health London (SHL) incorporated questions on its e-triage questionnaire estimating need for PrEP amongst online service users. Two types of signposting messaging were shown to users directing them to more detailed online content: PrEP-discussion (potential need) and PrEP-eligible (assumed need). The effectiveness of this signposting was evaluated by reviewing demographics and triage responses in returning users. Results 426,149 SHL users requested STI screening between 1.7.21-31.10.22. 16% (69,867/426,149) and 32.2% (137,489/426,149) of individuals received PrEP-eligible and PrEP-discussion signposting. The PrEP-eligible cohort were: 41.0% gay/bisexual or other men who have sex with men (GBMSM), 16.3% heterosexual males, 33.1% heterosexual females, and 60.6% were of white ethnicity. The PrEP-discussion cohort were: 9.3% GBMSM, 34.3%% heterosexual males, 45.5% heterosexual females and 63.7% of white ethnicity. 50.4% (35,190/69,867) and 41.3% (56,808/137,489) of the PrEP-eligible and PrEP discussion cohorts ordered a subsequent SHL STI testing kit, during which 10.0% (3510/35,190) and 5.9% (3364/56,808) reported taking PrEP. Of those who denied taking PrEP, 59% (18,702/31,680) and 61.0% (32,559/53,444) triggered PrEP signposting again. 95.4% of PrEP starters were GBMSM (6562/6874) and 1.4% (97/6874) heterosexual males/females. Conclusion The e-service demonstrated feasibility in estimating PrEP need and signposting service users. Up to 16% of returning users subsequently commenced PrEP. This highlights significant missed opportunities for the remaining online users, who continue to report HIV acquisition risk(s). Further efforts regionally/nationally to optimise uptake of PrEP, particularly among under-represented groups are warranted.

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Section: Discussionmentioning

confidence: 99%

Improving awareness and uptake of pre-exposure HIV prophylaxis amongst service users accessing Sexual Health London, a regional online postal sexually transmitted infection testing health service

Caoimhe,

Spate,

Day

2024

Int J STD AIDS

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“…Assessment of an individual's risk for acquiring HIV, beyond simply screening HIV negative, is a critical step in any ED prevention program. 17, [20][21][22][23][24] We chose to determine eligibility for comprehensive prevention services and PrEP referral using a structured risk assessment administered by an ED navigator. With this strategy, 16% of ED patients completing routine HIV screening were identified as being at increased risk of acquiring HIV, a number consistent with prior studies using similar screening strategies.…”

Section: Discussionmentioning

confidence: 99%

“…Although several ED HIV prevention programs report outcome data on linkage to care and PrEP initiation, the number of patients referred for follow-up and PrEP treatment is generally very low, making comparisons across models difficult. 21,22,24,29,30 Harmonization of the reporting of indicators in future studies could contribute to a more robust body of evidence on the utility of ED HIV prevention programs.…”

Section: Discussionmentioning

confidence: 99%

“…outpatient follow-up for ED patients to primary care. 31,32 Mahal et al 21 describe a protocol whereby ED navigators can schedule same-day appointments with hospital-affiliated PrEP providers with good results. Another tool to improve linkage to PrEP services may be to co-localize HIV prevention services, including PrEP treatment, with the receipt of care for other diseases associated with HIV acquisition, such as STIs and substance use disorders.…”

Section: Discussionmentioning

confidence: 99%

“…Direct appointment scheduling has been shown to improve outpatient follow-up for ED patients to primary care. 31,32 Mahal et al 21 describe a protocol whereby ED navigators can schedule same-day appointments with hospital-affiliated PrEP providers with good results.…”

Section: Discussionmentioning

confidence: 99%

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Outcomes of an Emergency Department Program to Identify and Link Patients at Increased Risk for Acquiring HIV Infection to Outpatient HIV Prevention Services: The HIV PreventED Program

White,

Godoy,

Jewett

et al. 2024

JAIDS Journal of Acquired Immune Deficiency Syndromes

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Background: Emergency departments (ED) provide care to patients at increased risk for acquiring HIV and for many of them, the ED serves as their sole point of entry into the healthcare system. We implemented the HIV PreventED Program to increase access to HIV prevention services for ED patients. Setting: Emergency department in Oakland, CA with an annual census of 57,000 visits. Methods: This cross-sectional study evaluated the first 9 months of the HIV PreventED Program. In this program, a navigator surveyed adult HIV negative ED patients to determine their risk for acquiring HIV infection, incorporating HIV prevention counseling into their assessments. Patients at higher risk for acquiring HIV were referred to outpatient prevention services, if interested. The primary outcome measure was the number and proportion of ED patients at higher risk for acquiring HIV that followed up for outpatient prevention services. Results: There were 1,233 HIV negative patients assessed by the navigator and who received ED-based HIV prevention counseling. Of these, 193 (15.7%) were identified at higher risk and offered an outpatient referral for prevention services, of which 104 accepted (53.9%), 23 (11.9%) attended the referral, and 13 (6.7%) were prescribed pre-exposure prophylaxis (PrEP). The median time to linkage was 28 days (interquartile range 15 to 41 days). Conclusion: A navigator focused on providing ED-based HIV prevention counseling and linkage to outpatient services is feasible. Strategies to more efficiently identify ED patients at higher risk for HIV acquisition, such as automated identification of risk data from the electronic health record, and policies to improve follow up and the receipt of PrEP, such as same-day PrEP initiation, should be prospectively evaluated.

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Utilization of an Off-Site Patient Navigator to Facilitate HIV Pre-Exposure Prophylaxis Referrals in Patients with Sexually Transmitted Infections in the Emergency Department

Lipps,

Nielsen,

Dannemiller

et al. 2024

AIDS Behav

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Linking emergency department patients at risk for human immunodeficiency virus to pre-exposure prophylaxis

Cited by 10 publications

References 7 publications

Improving awareness and uptake of pre-exposure HIV prophylaxis amongst service users accessing Sexual Health London, a regional online postal sexually transmitted infection testing health service

Improving awareness and uptake of pre-exposure HIV prophylaxis amongst service users accessing Sexual Health London, a regional online postal sexually transmitted infection testing health service

Outcomes of an Emergency Department Program to Identify and Link Patients at Increased Risk for Acquiring HIV Infection to Outpatient HIV Prevention Services: The HIV PreventED Program

Utilization of an Off-Site Patient Navigator to Facilitate HIV Pre-Exposure Prophylaxis Referrals in Patients with Sexually Transmitted Infections in the Emergency Department

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