HIV postexposure prophylaxis in sexual assault: Current practice and patient adherence to treatment recommendations in a large urban teaching hospital
HIV postexposure prophylaxis in sexual assault: Current practice and patient adherence to treatment recommendations in a large urban teaching hospital
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DOI：
10.1197/j.aem.2005.01.015
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发表时间：
2005-07-01
影响因子：
4.4
通讯作者：
LaBelle, C
中科院分区：
文献类型：
--
作者：
Linden, JA;Oldeg, P;LaBelle, C
背景：虽然很少见，但艾滋病毒传播是性侵犯最可怕的后果之一。虽然预防 HIV 传播的药物（HIV 非职业性暴露后预防 [HIV nPEP]）的可用性不断增加，但人们对急诊科 (ED) 的处方做法和患者对治疗建议的依从性知之甚少。目标：确定在对性侵犯受害者启动 HIV nPEP 时与提供、随访和坚持治疗相关的因素。方法：这是对 1999 年 10 月 1 日至 2002 年 9 月 30 日期间向城市急诊科提出性侵犯投诉的女性患者进行的回顾性图表审查。免费提供 HIV nPEP 药物和/或随访。卡方分析确定了与提供或转诊 nPEP 和随访相关的因素。将 p < 0.10 水平显着的变量纳入逻辑回归分析。结果：审查了 229 个图表。最终样本量为 181 人。平均年龄为 29.1 岁；从受到攻击到就诊的中位时间为 10.1 小时； 51.5%的袭击者是受害者认识的。向 89 名 (49%) 患者提供了 HIV nPEP，其中 11 名患者被转介给 HIV 护士。 85 名患者 (85%) 接受了治疗，这 85 名患者中的 38 名患者 (45%) 进行了随访，85 名患者中的 18 名患者 (21%) 完成了治疗。在多变量分析中，三个变量在统计学上与转诊或接受 HIV nPEP 的可能性增加显着相关：未知的攻击者、有保险和年龄较小。 82 名 ED 启动患者中有 15 名 (18%) 完成了治疗，而转诊至 3 名患者中则有 3 名 (100%) 完成了治疗。作者无法确定与完成治疗相关的因素。结论：不到一半的性侵犯患者接受了 HIV nPEP，而且很少有人完成治疗。需要进一步的研究来评估和改进 HIV nPEP 管理和随访的适当性。
Background: Although rare, HIV transmission is one of the most feared consequences of sexual assault. While availability of medications to prevent HIV transmission (HIV nonoccupational postexposure prophylaxis [HIV nPEP]) is increasing, little is known about emergency department (ED) prescribing practices and patient adherence to treatment recommendations. Objectives: To determine factors associated with offering, following up with, and adhering to treatment when HIV nPEP is initiated for sexual assault victims. Methods: This was a retrospective chart review of female patients presenting with complaint of sexual assault to an urban ED from October 1, 1999, to September 30, 2002. HIV nPEP medications and/or follow-up were provided without charge. Chi-square analysis identified factors associated with being offered or referred for nPEP and follow-up. Variables significant at the p < 0.10 level were entered into logistic regression analysis. Results: Two hundred twenty-nine charts were reviewed. The final sample size was 181. Mean age was 29.1 years; median time from assault to presentation was 10.1 hours; 51.5% of the assailants were known to the victims. HIV nPEP was offered to 89 (49%) patients, and 11 patients were referred to an HIV nurse. Eighty-five (85%) patients accepted, 38 of these 85 (45%) followed up, and 18 of the 85 (21%) completed treatment. In multivariate analysis, three variables were statistically significantly associated with increased likelihood of referral or being offered HIV nPEP: unknown assailant, having insurance, and younger age. Treatment was completed by 15 of 82 (18%) of ED-initiated patients, versus three of three (100%) referred for initiation. The authors were unable to identify factors associated with completing treatment. Conclusions: HIV nPEP was offered to less than half of sexual assault patients, and few completed treatment. Further studies are needed to evaluate and improve appropriateness of HIV nPEP administration and follow-up.