April 15, 2014
This article was reported by Healio.
Healio reported on a study of patients' HIV clinic attendance after an emergency department (ED) visit for nonoccupational postexposure prophylaxis (PEP). Researchers from the University of Toronto and Harvard University conducted a prospective cohort study of patients referred to HIV clinic programs after nonoccupational HIV exposure at two EDs. They recorded the two hospitals' referrals to HIV clinics. The ED physicians consulted with HIV clinic physicians on treatment issues and, if recommended, provided the patient with beginning antiretroviral therapy (ART) and instructions to attend an initial HIV clinic appointment and complete 28 days of ART.
Findings indicated that during the yearlong study, ED doctors referred 180 individuals for PEP after they had received starter ART at the emergency visit. More than half of the exposures (57.2 percent) were sexual, 72 percent were nonconsensual, and 22.1 percent were among men who have sex with men. Of the 180 referred for treatment, 98 kept the HIV clinic appointment, and 43 (24.3 percent) completed the 28-day ART. Older age and self-payment were significant predictors of not keeping the clinic appointment.
The researchers noted that clinic appointments are important for continuing ART, maintaining treatment adherence, modifying treatment if the patient developed toxicity, screening for other conditions, and counseling. They recommend that future studies should evaluate strategies to encourage high-risk groups to adhere to clinic appointments and ART.
The full report, "Patient Attrition Between the Emergency Department and Clinic Among Individuals Presenting for HIV Nonoccupational Postexposure Prophylaxis," was published online in the journal Clinical Infectious Diseases (2014; doi:10.1093/cid/ciu118).
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