Community-based, nurse-led post-exposure prophylaxis: results and implications.

Area of Science:

• Public Health
• Infectious Disease Prevention
• Nursing Practice

Background:

• Traditional emergency department access to HIV post-exposure prophylaxis (PEP) presents barriers for key populations disproportionately affected by HIV.
• Minority groups, including men who have sex with men and people who inject drugs, face significant HIV transmission risks.
• Community-based nursing interventions can improve access to essential public health services.

Purpose of the Study:

• To evaluate the effectiveness of nurse-initiated HIV post-exposure prophylaxis (PEP) in community clinics.
• To increase access to and uptake of PEP among high-risk populations in Ottawa, Canada.
• To assess the impact of community-based PEP on HIV transmission rates.

Main Methods:

• A chart review was conducted for patients accessing HIV post-exposure prophylaxis (PEP) services between September 2013 and September 2015.
• Registered nurses provided PEP medications in community clinics when indicated.
• Data collected included patient demographics, PEP initiation, and HIV testing outcomes at baseline, four months, and one year.

Main Results:

• Out of 112 individuals who requested PEP, 64% (n=72) initiated the medication.
• The majority of initiations (93%) were among men, with 88% reporting sex with men; 31% of these men had sexual contact with HIV-positive partners.
• No new HIV infections were diagnosed at the four-month follow-up among PEP initiators; however, 9.4% of reported HIV diagnoses in Ottawa during the study period were identified within the study sample.

Conclusions:

• Nurse-initiated HIV post-exposure prophylaxis (PEP) in community settings is an effective strategy for reaching high-risk individuals.
• This model of care successfully increased access to vital HIV prevention services.
• Community-based PEP delivery demonstrates potential for reducing HIV transmission within vulnerable populations.