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HIV postexposure prophylaxis practices by US ED practitioners.
Roland C Merchant1, Reza Keshavarz
1Department of Emergency Medicine, Mount Sinai School of Medicine, New York, NY, USA. merchant@lifespan.org
The American Journal of Emergency Medicine
|August 5, 2003
Summary
Most US emergency department (ED) practitioners have prescribed HIV post-exposure prophylaxis (PEP), particularly for healthcare workers. Willingness to prescribe HIV PEP varies by exposure type and practitioner characteristics, indicating a need for further education.
Area of Science:
- Public Health
- Infectious Diseases
- Emergency Medicine
Background:
- HIV post-exposure prophylaxis (PEP) is crucial for preventing HIV transmission after potential exposure.
- Understanding emergency department (ED) practitioners' prescribing patterns and willingness to offer HIV PEP is vital for public health.
- Previous research has not fully elucidated the extent of HIV PEP utilization and influencing factors among ED practitioners.
Purpose of the Study:
- To assess the frequency of HIV post-exposure prophylaxis (PEP) prescription by US emergency department (ED) practitioners.
- To determine ED practitioners' willingness to offer HIV PEP in various clinical scenarios.
- To identify factors associated with prescribing and offering HIV PEP.
Main Methods:
- A survey was administered to 600 ED practitioners attending a national conference.
- The survey collected self-reported data on past HIV PEP prescription, personal HIV PEP use, and willingness to prescribe in different exposure situations.
- Data analysis focused on prescription rates, willingness based on source risk and exposure type, and demographic/professional correlates.
Main Results:
- Sixty-eight percent of surveyed ED practitioners reported having prescribed HIV PEP previously.
- HIV PEP was most commonly prescribed for needlestick-injured healthcare workers (92%), followed by sexual assault survivors (48%) and non-healthcare needlestick injuries (49%).
- Willingness to prescribe HIV PEP was higher for exposures to known HIV-infected or high-risk sources, and after sexual assault compared to consensual sex. Factors like female gender, prior personal HIV PEP use, resident status, and <6 years of practice were associated with increased willingness.
Conclusions:
- A majority of US ED practitioners have experience prescribing HIV PEP, primarily for occupational exposures.
- Prescribing decisions and willingness to offer HIV PEP are influenced by the perceived risk of exposure and patient characteristics.
- Targeted educational initiatives are needed to optimize ED practitioners' judgment regarding appropriate HIV PEP indications.