Nonoccupational postexposure prophylaxis for exposure to HIV in New York State emergency departments

We investigate emergency department (ED) directors' knowledge of protocols and practices for nonoccupational postexposure prophylaxis (nPEP) after potential exposure to HIV after sexual assault and consensual sexual exposures in New York State (NYS) EDs. Every ED director in NYS was queried through an electronic survey about protocols, antiretroviral drugs supplied, resources and barriers to implementation. They were also asked for retrospective data, including the number and type of cases seen and percentage in which nPEP was initiated. One hundred eighty-eight of 207 ED directors (91%) responded. One hundred seventy-eight (95%) have a protocol for sexual assault and 111 (59%) have a protocol for voluntary sexual exposure. After sexual assault, 163 ED directors (87%) reported that they typically initiate nPEP in the ED; 25 (13%) either write a prescription only or refer to another facility. After voluntary sexual exposure 132 (70%) typically initiate nPEP in the ED; 55 (29%) either write a prescription only or refer to another facility (p < 0.001). Self-reported ED data indicate that 3439 sexual assault exposures and 6858 voluntary sexual exposures and were seen in NYS EDs in 2005. The nPEP initiation rate was 65% (2244/3439) for sexual assault exposures and 43% (2931/6858) for consensual sexual exposures (p < 0.001). These results suggest that NYS nPEP guidelines are not widely implemented, and raise several important public health policy issues, including access to medication and follow-up care. Our results indicated resources, primarily number of dedicated staff, and physician education as two major factors contributing to this problem.