Improvement in HIV screening follow-up rates with emergency medicine pharmacist counseling and dispensing of postexposure prophylaxis for sexual assault patients

Abstract

Background

Patients presenting to the emergency department (ED) within 72 hours of sexual assault should be offered HIV nonoccupational postexposure prophylaxis (nPEP) and directed to follow-up care. However, low rates of follow-up HIV screening and medication adherence have been consistently found. Strategies to improve these rates have not been universally established.

Objectives

To describe improvement in follow-up HIV screening and nPEP medication adherence following emergency medicine (EM) pharmacist involvement in counseling and nPEP dispensing.

Methods

This single-center, retrospective, pre-/postimplementation analysis compared rates of sexual assault patient follow-up HIV screening prior to and following initiation of EM pharmacist counseling and dispensing of a 28-day supply of nPEP between January 1, 2016 to December 31, 2016 (preintervention) and January 1, 2017 to December 31, 2019 (postintervention). A telephone survey was administered to identify nPEP medication adherence and related adverse drug event (ADE) rates between August 1, 2018 through August 31, 2019 in the postintervention group.

Results

The chart review included 369 unique sexual assault patients prescribed nPEP. The number of patients completing at least one follow-up HIV screening and number of screening occurrences within 6 months of nPEP initiation increased from 3 (3.3%) to 12 (14%) and 4 (1.4%) to 23 (8.9%) from 2016 (preintervention) to 2019 (postintervention), respectively, both P < 0.01. Twenty of 85 patients completed a telephone survey during the postimplementation period. Eight patients (40%) reported completing the 28-day nPEP regimen, and 14 patients (70%) experienced an nPEP-related ADE.

Conclusions

EM pharmacist counseling and providing a free complete 28-day supply of nPEP contributed to improved rates of follow-up HIV screening for sexual assault patients after ED discharge.