Nonoccupational postexposure HIV prevention: emergency physicians' current practices, attitudes, and beliefs

We surveyed emergency physicians to determine current practices, knowledge, attitudes, and beliefs regarding nonoccupational postexposure prevention practices.

Two thousand randomly selected practicing emergency physicians from the American College of Emergency Physicians' national database and all graduating emergency medicine residents in 2000 were surveyed. Knowledge, role responsibility, self-efficacy, and attitudes and beliefs were measured and composite scores developed. Differences in responses between supporters and nonsupporters were compared for each category.

Eight hundred eighty-nine responded, representing 60% (67/113) of emergency medicine residencies, 32% (347/1095) of emergency medicine residents, and 27% (542/2000) of emergency physicians. Responders recommend nonoccupational postexposure prevention for sexual assault (35%), unintentional needle stick (25%), and, rarely (<15%), for unsafe sexual practices and injection drug use. Knowledge of Centers for Disease Control and Prevention recommendations or the time when treatment may be most beneficial is poor (15.5% and 13.7%, respectively). Most agree their role includes providing nonoccupational postexposure prevention drugs and referring patients for counseling (76.5% and 75.6%, respectively). Confidence in assessing need for nonoccupational postexposure prevention varied with exposure type (sexual assault [61.6%], unintentional needle stick [54.8%], unsafe sexual practices [40.4%], and injection drug use [49.7%]). Supporters of nonoccupational postexposure prevention (64.1%) are more likely to have nonoccupational postexposure prevention available (69.3% versus 42.9%; 95% confidence interval [CI] 19.7 to 33.1), written protocols (42.5% versus 33.0%; 95% CI 2.8 to 16.2), and higher mean composite scores than nonsupporters in all categories: knowledge, self-efficacy, role responsibility, and attitudes.

Most emergency physicians surveyed agree that offering nonoccupational postexposure prevention is feasible and within their role responsibility. Establishing nonoccupational postexposure prevention protocols and providing educational programs are important first steps in changing practice.