Momoko Combs, Alice Johnson, Joanne Abbotsford, Asha C Bowen, Charlie McLeod, David A Foley
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A review of contemporary national and international PEP guidelines was undertaken in parallel.</p><p><strong>Results: </strong>There were 511 alleged CSA events over the study period; 62/511 (12%) were appropriately risk-assessed as requiring PEP by the treating clinician. PEP was not prescribed in 8/62 (13%) events, with a reason documented for 6/8 (75%). Overall, less than half of children who were eligible for PEP were adherent to the 28-day regimen (23/54, 43%). Gastrointestinal upset contributed to early cessation in 5/54 (9%). Final 3-month blood-borne virus serology results were available in less than one in 3 children. A review of international clinical practice revealed significant heterogeneity of criteria for the provision of PEP and a paucity of pediatric-specific data.</p><p><strong>Conclusions: </strong>We identified several areas of our PEP management that required strengthening, with limited direction available in current international guidelines. 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引用次数: 0
摘要
背景:在儿童遭受性侵犯(CSA)后,建议在特定情况下采取艾滋病毒暴露后预防措施(PEP)。据报道,PEP 的坚持率很低。我们评估了西澳大利亚州三级儿科医疗机构对儿童性侵害后建议管理的遵守情况,并将我们的方法与国际指南进行了比较:方法:对所有患儿的病历进行审查:在研究期间,共发生了 511 起指称的 CSA 事件;其中 62 起/511 起(12%)经临床医生适当风险评估后认为需要进行预防性治疗。8/62(13%)起事件未开具预防性治疗处方,6/8(75%)起事件记录了原因。总体而言,符合 PEP 条件的儿童中只有不到一半的人坚持了 28 天的治疗方案(23/54,43%)。有 5/54 名儿童(9%)因肠胃不适而提前停止治疗。每 3 名儿童中只有不到 1 人获得了 3 个月的血源性病毒血清学最终结果。对国际临床实践的回顾表明,提供 PEP 的标准存在很大的差异,针对儿科的数据也很少:结论:我们发现 PEP 管理中需要加强的几个方面,而目前的国际指南提供的指导非常有限。我们已更广泛地使用固定药物组合,并实施了多方面的随访计划。对这些变化的影响进行评估至关重要。
Evaluation of Pediatric HIV Postexposure Prophylaxis Guideline Following Child Sexual Assault in Western Australia.
Background: HIV postexposure prophylaxis (PEP) following child sexual assault (CSA) is recommended in select cases. High rates of poor adherence to PEP are reported. We evaluated adherence to the recommended management of children following CSA at the tertiary pediatric facility in Western Australia and compared our approach with international guidelines.
Methods: Medical records were reviewed for all children <16 years old assessed at Perth Children's Hospital between October 1, 2016 and November 30, 2020 following alleged CSA. Data, including exposure type, PEP adherence and follow-up, were collected. A review of contemporary national and international PEP guidelines was undertaken in parallel.
Results: There were 511 alleged CSA events over the study period; 62/511 (12%) were appropriately risk-assessed as requiring PEP by the treating clinician. PEP was not prescribed in 8/62 (13%) events, with a reason documented for 6/8 (75%). Overall, less than half of children who were eligible for PEP were adherent to the 28-day regimen (23/54, 43%). Gastrointestinal upset contributed to early cessation in 5/54 (9%). Final 3-month blood-borne virus serology results were available in less than one in 3 children. A review of international clinical practice revealed significant heterogeneity of criteria for the provision of PEP and a paucity of pediatric-specific data.
Conclusions: We identified several areas of our PEP management that required strengthening, with limited direction available in current international guidelines. We have adopted a broader use of fixed drug combinations and implemented a multifaceted follow-up program. It will be essential to review the impact of these changes.
期刊介绍:
The Pediatric Infectious Disease Journal® (PIDJ) is a complete, up-to-the-minute resource on infectious diseases in children. Through a mix of original studies, informative review articles, and unique case reports, PIDJ delivers the latest insights on combating disease in children — from state-of-the-art diagnostic techniques to the most effective drug therapies and other treatment protocols. It is a resource that can improve patient care and stimulate your personal research.