Post‐exposure prophylaxis for HIV infection in sexual assault victims

Inciarte, Alexy; Leal, Lorna; Masfarre, L; González, Eric Ortega; Díaz-Brito, Vicens; Lucero, Claudia; Garcia‐Pindado, J; León, Agathe; García, Felipe

doi:10.1111/hiv.12797

Cited by 17 publications

(19 citation statements)

References 44 publications

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“…Feeling sick-experienced. Our study supports prior research that HIV PEP side effects were reported by all who initiated HIV PEP and acted as a driving force when participants decided to discontinue the medications (Abrahams & Jewkes, 2010;Inciarte et al, 2020;Krause et al, 2014;Vetten & Haffejee, 2005, 2008. Loutfy et al (2008) found 82% of patients stopped HIV PEP because of side effects; followed by interference with daily routine (42%); and not being able to miss work or school (22%).…”

Section: Discussionsupporting

confidence: 89%

“…Fear of HIV has been reported by patients as both positively and negatively impacting HIV PEP continuance (Vetten & Haffejee, 2005, 2008. Reported barriers to HIV PEP completion include medication side effects (Garcia et al, 2005;Inciarte et al, 2020;Krause et al, 2014;Vetten & Haffejee, 2005, 2008 and financial barriers (Diniz et al, 2007;Malinverni et al, 2018).…”

mentioning

confidence: 99%

“…Globally, rates of HIV PEP completion are lower in the sexual assault population than in occupational, or other non-occupational routes of exposure (Ford et al, 2014). Factors associated with increased HIV PEP completion post-sexual assault globally include: high-risk exposures in Brazil, Spain, and the UK (Garcia et al, 2005; Inciarte et al, 2020; Morgan et al, 2015, respectively); anxiety (as perceived by the health care provider) (Loutfy et al, 2008); knowing the assailant less than 24 hours (Inciarte et al, 2020; Loutfy et al, 2008); and absence of a concomitant physical assault (Loutfy et al, 2008). Fear of HIV has been reported by patients as both positively and negatively impacting HIV PEP continuance (Vetten & Haffejee, 2005, 2008).…”

mentioning

confidence: 99%

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“Reclaiming Control” Patient Acceptance and Adherence to HIV Post-Exposure Prophylaxis Following Sexual Assault

Moret

Sheridan

2021

Global Qualitative Nursing Research

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Sexual assault is an irrefutable trauma; an insult to the autonomy of the person forced into sexual acts. Sexual assault sequelae range from physical injury and acute traumatic stress, to pregnancy and sexually transmitted infections, including human immunodeficiency virus (HIV). HIV post-exposure prophylaxis (HIV PEP) following sexual assault may decrease the likelihood of HIV transmission. Many patients seeking healthcare post-sexual assault either do not initiate HIV PEP or do not complete the 28-day medication regimen. In this qualitative interpretive description, we interviewed sexual assault patients ( N=11) about HIV PEP discussions/reactions, attitudes and understanding related to HIV and PEP, and barriers and facilitators of HIV PEP acceptance and adherence. Participants described a process of losing and reclaiming control throughout post-assault care and follow-up; and how this affected HIV PEP-related decision-making. Most HIV PEP decisions were described as a process of reclaiming control over one outcome while simultaneously losing control of another.

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Section: Discussionsupporting

confidence: 89%

mentioning

confidence: 99%

mentioning

confidence: 99%

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“Reclaiming Control” Patient Acceptance and Adherence to HIV Post-Exposure Prophylaxis Following Sexual Assault

Moret

Sheridan

2021

Global Qualitative Nursing Research

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“…If PEP is offered, the following information should be discussed with the survivor: the necessity of early initiation of PEP to optimize potential benefits (i.e., as soon as possible after and <72 hours after the assault), the importance of close follow-up, the benefit of adherence to recommended dosing, and potential adverse effects of antiretroviral medications. Providers should emphasize that severe adverse effects are rare from PEP ( 1431 – 1435 ). Clinical management of the survivor should be implemented according to the HIV PEP guidelines and in collaboration with specialists ( 1436 ).…”

Section: Sexual Assault and Abuse And Stismentioning

confidence: 99%

Sexually Transmitted Infections Treatment Guidelines, 2021

Workowski¹,

Bachmann²,

Chan³

et al. 2021

MMWR Recomm. Rep.

1,732

2,621

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These guidelines for the treatment of persons who have or are at risk for sexually transmitted infections (STIs) were updated by CDC after consultation with professionals knowledgeable in the field of STIs who met in Atlanta, Georgia, June 11-14, 2019. The information in this report updates the 2015 guidelines. These guidelines discuss 1) updated recommendations for treatment of Neisseria gonorrhoeae, Chlamydia trachomatis, and Trichomonas vaginalis; 2) addition of metronidazole to the recommended treatment regimen for pelvic inflammatory disease; 3) alternative treatment options for bacterial vaginosis; 4) management of Mycoplasma genitalium; 5) human papillomavirus vaccine recommendations and counseling messages; 6) expanded risk factors for syphilis testing among pregnant women; 7) one-time testing for hepatitis C infection; 8) evaluation of men who have sex with men after sexual assault; and 9) two-step testing for serologic diagnosis of genital herpes simplex virus. Physicians and other health care providers can use these guidelines to assist in prevention and treatment of STIs. BOX 1. The Five P's approach for health care providers obtaining sexual histories: partners, practices, protection from sexually transmitted infections, past history of sexually transmitted infections, and pregnancy intention Additional information about external condoms is available at https://www.cdc.gov/condomeffectiveness. Internal CondomsCondoms for internal vaginal use, also known as female condoms, are available worldwide (e.g., the FC2 Female Condom, Reddy condom, Cupid female condom, and Woman's condom) (31,32). Use of internal condoms can provide protection from acquisition and transmission of STIs, although data are limited. Internal condoms are more costly compared with external condoms; however, they offer the advantage of being controlled by the receptive partner as an STI and HIV prevention method, and the newer versions might be acceptable to all persons. Although the internal condom also has been used during receptive anal intercourse, efficacy associated with this practice remains unknown (33). Additional information about the internal condom is available at http://www.ashasexualhealth. org/pdfs/Male_and_Female_Condoms.pdf. Cervical DiaphragmsIn observational studies, diaphragm use has been demonstrated to protect against cervical gonorrhea, chlamydia, and trichomoniasis (34). However, a trial examining the effect of a diaphragm plus lubricant on HIV acquisition among women in Africa reported no additional protective effect when compared with the use of male condoms alone. Likewise, no difference by study arm in the rate of acquisition of chlamydia, gonorrhea, or herpes occurred (35,36). Diaphragms should not be relied on as the sole source of protection against HIV and other STIs.

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“…Although PEP management of occupational and non-occupational exposure is similar, appropriate medical treatment for sexual assault patients is complex. Compliance with medication adherence and recommended nPEP follow-up is poor in this patient population [13]. This suggests that there may be a need for a standardized, systematic approach to patient treatment; however, data regarding the efficacy or impact of ED nPEP protocols are scarce, in particular standardized electronic medical record (EMR) order sets.…”

Section: Introductionmentioning

confidence: 99%

Standardizing HIV post‐exposure prophylaxis in the emergency department following sexual assault

et al. 2021

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Objectives: A standardized non-occupational post-exposure prophylaxis (nPEP) programme was implemented to improve guideline compliance for treatment of post-sexual assault patients within an emergency department (ED). Methods: A single-centre, retrospective, observational study of adult patients evaluated in the ED for sexual assault was performed following nPEP programme implementation. A comprehensive nPEP programme consisting of a standardized order set, real-time multidisciplinary consultation, on-site pharmacy and close post-discharge follow-up was implemented between July 2017 and June 2018. Laboratory, treatment, vaccination, prescription and follow-up data during the pre-(July 2016 to June 2017) and post-intervention (July 2018 to August 2019) periods were compared. Results: Of the 147 post-sexual assault patients included in this study (59 preintervention, 88 post-intervention), 133 (90.5%) were eligible for nPEP. Patient demographics and rate of those eligible for nPEP were similar in both cohorts.Antiretroviral therapy (ART) was offered (72.2% vs. 100%; p < 0.005) and ultimately prescribed (51.9% vs. 86.1%; p < 0.005) more frequently following nPEP programme implementation. Patients were more likely to have appropriate screening for renal function, liver function, pregnancy, syphilis, hepatitis B, hepatitis C and HIV in the post-intervention period (all p < 0.005). Hepatitis B vaccination was more commonly administered post-intervention (8.5% vs. 22.7%; p < 0.024). In-person 28-day follow-up was rare in both pre-(3.5%) and postintervention (11.3%) cohorts (p = 0.278).Conclusions: Implementation of a comprehensive nPEP programme resulted in improved guideline compliance with more frequent and appropriate ART administration. Recommended screening laboratories and hepatitis B vaccinations were more commonly performed, but in-person follow-up remained low. The nPEP programmes should be implemented to standardize efforts that decrease the risk of HIV transmission.

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Post‐exposure prophylaxis for HIV infection in sexual assault victims

Cited by 17 publications

References 44 publications

“Reclaiming Control” Patient Acceptance and Adherence to HIV Post-Exposure Prophylaxis Following Sexual Assault

“Reclaiming Control” Patient Acceptance and Adherence to HIV Post-Exposure Prophylaxis Following Sexual Assault

Sexually Transmitted Infections Treatment Guidelines, 2021

Standardizing HIV post‐exposure prophylaxis in the emergency department following sexual assault

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