The Role of Centralized Sexual Assault Care Centers in HIV Post-Exposure Prophylaxis Treatment Adherence: A Retrospective Single Center Analysis.

IF 2.4 Q2 INFECTIOUS DISEASES
Stefano Malinverni, Shirine Kargar Samani, Christine Gilles, Agnès Libois, Floriane Bédoret
{"title":"The Role of Centralized Sexual Assault Care Centers in HIV Post-Exposure Prophylaxis Treatment Adherence: A Retrospective Single Center Analysis.","authors":"Stefano Malinverni, Shirine Kargar Samani, Christine Gilles, Agnès Libois, Floriane Bédoret","doi":"10.3390/idr17040077","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Sexual assault victims involving penetration are at risk of contracting human immunodeficiency virus (HIV). Post-exposure prophylaxis (PEP) can effectively prevent HIV infection if initiated promptly within 72 h following exposure and adhered to for 28 days. Nonetheless, therapeutic adherence amongst sexual assault victims is low. Victim-centered care, provided by specially trained forensic nurses and midwives, may increase adherence.</p><p><strong>Methods: </strong>We conducted a retrospective case-control study to evaluate the impact of sexual assault center (SAC)-centered care on adherence to PEP compared to care received in the emergency department (ED). Data from January 2011 to February 2022 were reviewed. Multivariable logistic regression analysis was employed to determine the association between centralized specific care for sexual assault victims and completion of the 28-day PEP regimen. The secondary outcome assessed was provision of psychological support within 5 days following the assault.</p><p><strong>Results: </strong>We analyzed 856 patients of whom 403 (47.1%) received care at a specialized center for sexual assault victims. Attendance at the SAC, relative to the ED, was not associated with greater probability of PEP completion both in the unadjusted (52% vs. 50.6%; odds ratio [OR]: 1.06, 95% CI: 0.81 to 1.39; <i>p</i> = 0.666) and adjusted (OR: 0.81, 95%CI 0.58-1.11; <i>p</i> = 0.193) analysis. The care provided at the SAC was associated with improved early (42.7% vs. 21.5%; <i>p</i> < 0.001) and delayed (67.3% vs. 33.7%; <i>p</i> < 0.001) psychological support.</p><p><strong>Conclusions: </strong>SAC-centered care is not associated with an increase in PEP completion rates in sexual assault victims beyond the increase associated with improved access to early and delayed psychological support. Other measures to improve PEP completion rates should be developed. <b>What is already known on this topic</b>-Completion rates for HIV post-exposure prophylaxis (PEP) among victims of sexual assault are low. Specialized sexual assault centers, which provide comprehensive care and are distinct from emergency departments, have been suggested as a potential means of improving treatment adherence and completion rates. However, their actual impact on treatment completion remains unclear. <b>What this study adds</b>-This study found that HIV PEP completion rates in sexual assault victims were not significantly improved by centralized care in a specialized sexual assault center when compared to care initiated in the emergency department and continued within a sexually transmitted infection clinic. However, linkage to urgent psychological and psychiatric care was better in the specialized sexual assault center. How this study might affect research, practice or policy-Healthcare providers in sexual assault centers should be more aware of their critical role in promoting PEP adherence and improving completion rates. Policymakers should ensure that measures aimed at improving HIV PEP outcomes are implemented at all points of patient contact in these centers. Further research is needed to assess the cost-effectiveness of specialized sexual assault centers.</p>","PeriodicalId":13579,"journal":{"name":"Infectious Disease Reports","volume":"17 4","pages":""},"PeriodicalIF":2.4000,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Infectious Disease Reports","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.3390/idr17040077","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"INFECTIOUS DISEASES","Score":null,"Total":0}
引用次数: 0

Abstract

Background: Sexual assault victims involving penetration are at risk of contracting human immunodeficiency virus (HIV). Post-exposure prophylaxis (PEP) can effectively prevent HIV infection if initiated promptly within 72 h following exposure and adhered to for 28 days. Nonetheless, therapeutic adherence amongst sexual assault victims is low. Victim-centered care, provided by specially trained forensic nurses and midwives, may increase adherence.

Methods: We conducted a retrospective case-control study to evaluate the impact of sexual assault center (SAC)-centered care on adherence to PEP compared to care received in the emergency department (ED). Data from January 2011 to February 2022 were reviewed. Multivariable logistic regression analysis was employed to determine the association between centralized specific care for sexual assault victims and completion of the 28-day PEP regimen. The secondary outcome assessed was provision of psychological support within 5 days following the assault.

Results: We analyzed 856 patients of whom 403 (47.1%) received care at a specialized center for sexual assault victims. Attendance at the SAC, relative to the ED, was not associated with greater probability of PEP completion both in the unadjusted (52% vs. 50.6%; odds ratio [OR]: 1.06, 95% CI: 0.81 to 1.39; p = 0.666) and adjusted (OR: 0.81, 95%CI 0.58-1.11; p = 0.193) analysis. The care provided at the SAC was associated with improved early (42.7% vs. 21.5%; p < 0.001) and delayed (67.3% vs. 33.7%; p < 0.001) psychological support.

Conclusions: SAC-centered care is not associated with an increase in PEP completion rates in sexual assault victims beyond the increase associated with improved access to early and delayed psychological support. Other measures to improve PEP completion rates should be developed. What is already known on this topic-Completion rates for HIV post-exposure prophylaxis (PEP) among victims of sexual assault are low. Specialized sexual assault centers, which provide comprehensive care and are distinct from emergency departments, have been suggested as a potential means of improving treatment adherence and completion rates. However, their actual impact on treatment completion remains unclear. What this study adds-This study found that HIV PEP completion rates in sexual assault victims were not significantly improved by centralized care in a specialized sexual assault center when compared to care initiated in the emergency department and continued within a sexually transmitted infection clinic. However, linkage to urgent psychological and psychiatric care was better in the specialized sexual assault center. How this study might affect research, practice or policy-Healthcare providers in sexual assault centers should be more aware of their critical role in promoting PEP adherence and improving completion rates. Policymakers should ensure that measures aimed at improving HIV PEP outcomes are implemented at all points of patient contact in these centers. Further research is needed to assess the cost-effectiveness of specialized sexual assault centers.

集中性侵犯护理中心在HIV暴露后预防治疗依从性中的作用:一项回顾性单中心分析。
背景:涉及插入的性侵犯受害者有感染人类免疫缺陷病毒(HIV)的风险。暴露后预防(PEP)如果在暴露后72小时内及时开始并坚持28天,可以有效预防HIV感染。尽管如此,性侵犯受害者的治疗依从性很低。由受过专门训练的法医护士和助产士提供的以受害者为中心的护理可能会增加依从性。方法:我们进行了一项回顾性病例对照研究,以评估性侵犯中心(SAC)为中心的护理与急诊科(ED)的护理对PEP依从性的影响。回顾了2011年1月至2022年2月的数据。采用多变量logistic回归分析来确定性侵犯受害者集中特殊护理与完成28天PEP方案之间的关系。评估的次要结果是在袭击后5天内提供心理支持。结果:我们分析了856例患者,其中403例(47.1%)在专门的性侵犯受害者中心接受治疗。与ED相比,SAC的出席率与未调整的PEP完成的可能性无关(52% vs. 50.6%;优势比[OR]: 1.06, 95% CI: 0.81 ~ 1.39;p = 0.666)和校正(OR: 0.81, 95%CI 0.58-1.11;P = 0.193)分析。SAC提供的护理与早期改善相关(42.7% vs. 21.5%;P < 0.001)和延迟(67.3% vs. 33.7%;P < 0.001)心理支持。结论:以sac为中心的护理与性侵犯受害者PEP完成率的增加无关,而与早期和延迟心理支持的改善相关。应该制定其他措施来提高PEP完成率。关于这个话题我们已经知道的是:性侵犯受害者的艾滋病毒暴露后预防(PEP)完成率很低。专门的性侵犯中心提供全面的护理,与急诊科不同,有人建议将其作为提高治疗依从性和完成率的潜在手段。然而,它们对治疗完成的实际影响尚不清楚。本研究补充的内容:本研究发现,与在急诊科开始并在性传播感染诊所继续治疗相比,在专门的性侵犯中心进行集中治疗并没有显著提高性侵犯受害者的艾滋病毒PEP完成率。然而,在专门的性侵犯中心,与紧急心理和精神护理的联系更好。这项研究可能会对研究、实践或政策产生怎样的影响?性侵犯中心的医疗保健提供者应该更多地意识到他们在促进PEP依从性和提高完成率方面的关键作用。决策者应确保在这些中心的所有患者接触点实施旨在改善艾滋病毒PEP结果的措施。需要进一步的研究来评估专门的性侵犯中心的成本效益。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
求助全文
约1分钟内获得全文 求助全文
来源期刊
Infectious Disease Reports
Infectious Disease Reports INFECTIOUS DISEASES-
CiteScore
5.10
自引率
0.00%
发文量
82
审稿时长
11 weeks
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
确定
请完成安全验证×
copy
已复制链接
快去分享给好友吧!
我知道了
右上角分享
点击右上角分享
0
联系我们:info@booksci.cn Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。 Copyright © 2023 布克学术 All rights reserved.
京ICP备2023020795号-1
ghs 京公网安备 11010802042870号
Book学术文献互助
Book学术文献互助群
群 号:604180095
Book学术官方微信