Improving HIV post-exposure prophylaxis rates after pediatric acute sexual assault

Area of Science:

• Pediatric Emergency Medicine
• Public Health
• Quality Improvement Science

Background:

• Pediatric victims of sexual assault require timely and appropriate HIV post-exposure prophylaxis (PEP).
• Baseline data revealed only 40% of eligible children received the recommended 28-day HIV-PEP course.
• Prescribing errors were identified as the primary reason (87%) for inappropriate HIV-PEP administration.

Purpose of the Study:

• To enhance the rate of appropriate HIV-PEP regimens for children diagnosed with sexual assault in a pediatric emergency department.
• To reduce prescribing errors and improve adherence to recommended HIV-PEP protocols.

Main Methods:

• A retrospective chart review of 97 patients (2/2012-8/2014) established baseline HIV-PEP rates.
• A multifaceted quality improvement (QI) intervention was implemented, including standardized follow-up calls, targeted education, revised clinical pathways, and updated electronic order sets.
• Post-intervention data (9/2014-4/2015 and 5/2015-3/2016) were collected to assess changes in HIV-PEP appropriateness.

Main Results:

• Following QI implementation, the rate of appropriate HIV-PEP increased from 40% to 64% (median 60%) and further to 84% (median 100%).
• The average interval between incorrect HIV-PEP regimens increased from 24.5 days to 78.4 days, indicating sustained improvement.
• The QI process successfully addressed prescribing errors and improved the delivery of care.

Conclusions:

• A comprehensive quality improvement program effectively improved the rate of appropriate HIV-PEP for pediatric sexual assault victims.
• Standardized protocols and decision support tools are crucial for maintaining optimal care delivery in pediatric emergency settings.
• Continuous evaluation and refinement of QI interventions are necessary for sustained effectiveness.