986 - Improvement in Administration of HIV Post-Exposure Prophylaxis in the Emergency Department Following Sexual Assault

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Presenting Author(s)

Jennifer R. Silva-Nash

Medical student
University of Arkansas for Medical Sciences
Little Rock, Arkansas
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.

Co-Author(s)

SB

Stacie Bordelon

HIV Pharmacist
University of Arkansas for Medical Sciences
Little Rock, Arkansas
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
Ryan K. Dare

Associate Professor of Medicine
University of Arkansas for Medical Sciences, College of Medicine
Little Rock, Arkansas
Disclosure: Accelerate Diagnostics, Inc (Research Grant or Support)
SS

Sherrie Searcy

Assistant Director for Digital Health Sexual Assault Assessment Program
University of Arkansas for Medical Sciences
Little Rock, Arkansas
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.

Background: Nonoccupational post exposure prophylaxis (nPEP) following sexual assault can prevent HIV transmission. A standardized Emergency Department (ED) protocol for evaluation, treatment, and follow up for post assault victims was implemented to improve compliance with CDC nPEP guidelines.

Methods: A single-center observational study of post sexual assault patients before/after implementation of an ED nPEP protocol was conducted by comparing the appropriateness of prescriptions, labs, and necessary follow up. A standardized order-set based on CDC nPEP guidelines, with involvement of an HIV pharmacist and ID clinic, was implemented during the 2018-2019 academic year. Clinical data from pre-intervention period (07/2016-06/2017) was compared to post-intervention period (07/2018-08/2019) following a 1-year washout period.

Results: During the study, 147 post-sexual assault patients (59 Pre, 88 Post) were included. One hundred thirty-three (90.4%) were female, 68 (46.6%) were African American and 133 (90.4%) were candidates for nPEP. Median time to presentation following assault was 12.6 hours. nPEP was offered to 40 (67.8%) and 84 (95.5%) patients (P< 0.001) and ultimately prescribed to 29 (49.2%) and 71 (80.7%) patients (P< 0.001) in pre and post periods respectively.
Renal function (37.3% vs 88.6%; P< 0.001), pregnancy (39.0% vs 79.6%; P< 0.001), syphilis (3.4% vs 89.8%; P< 0.001), hepatitis B (15.3% vs 95.5%; P< 0.001) and hepatitis C (27.1% vs 94.3%) screening occurred more frequently during the post period.Labratory, nPEP Prescription and Follow up Details for Patients Prescribed nPEP

Conclusion: The standardization of an nPEP ED protocol for sexual assault victims resulted in increased nPEP administration, appropriateness of prescription, screening for other sexually transmitted infectious and scheduling follow up care. While guideline compliance dramatically improved, further interventions are likely warranted in this vulnerable population.