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Published on: March 30, 2014
Evaluation of Pediatric HIV Postexposure Prophylaxis Guideline Following Child Sexual Assault in Western Australia
Momoko Combs1, Alice Johnson2, Joanne Abbotsford3
1From the Department of Infectious Diseases, Perth Children's Hospital.
Insights
Adherence to HIV postexposure prophylaxis (PEP) after child sexual assault (CSA) is low, with less than half of eligible children completing the regimen. Improvements in PEP management and follow-up are needed.
Area of Science:
- Pediatric infectious diseases
- Public health
- Clinical management of child sexual assault
Background:
- HIV postexposure prophylaxis (PEP) is recommended for children following child sexual assault (CSA) in specific circumstances.
- Poor adherence to PEP regimens is a significant concern in this population.
- Current international guidelines for PEP in pediatric CSA cases lack specificity.
Purpose of the Study:
- To evaluate adherence to PEP management for children following CSA at a tertiary pediatric facility.
- To compare the facility's approach with existing international PEP guidelines.
- To identify areas for improvement in pediatric PEP protocols.
Main Methods:
- Retrospective review of medical records for children under 16 assessed for CSA at Perth Children's Hospital (October 2016 - November 2020).
- Data collection included exposure details, PEP prescription, adherence, and follow-up.
- Parallel review of contemporary national and international PEP guidelines.
Main Results:
- 511 alleged CSA events were identified; 12% were assessed as requiring PEP.
- PEP was not prescribed in 13% of eligible cases.
- Only 43% of eligible children adhered to the 28-day PEP regimen; gastrointestinal upset was a common reason for early cessation.
- 3-month serology results were available for less than one-third of children.
- International guidelines showed significant heterogeneity in PEP criteria and limited pediatric-specific data.
Conclusions:
- Significant improvements are needed in the management of PEP for children following CSA.
- The facility has adopted broader use of fixed-drug combinations and a comprehensive follow-up program.
- Ongoing review is essential to assess the impact of implemented changes on PEP adherence and outcomes.
Background:
HIV postexposure prophylaxis (PEP) following child sexual assault (CSA) is recommended in select cases. High rates of poor adherence to PEP are reported. We evaluated adherence to the recommended management of children following CSA at the tertiary pediatric facility in Western Australia and compared our approach with international guidelines.
Methods:
Medical records were reviewed for all children <16 years old assessed at Perth Children's Hospital between October 1, 2016 and November 30, 2020 following alleged CSA. Data, including exposure type, PEP adherence and follow-up, were collected. A review of contemporary national and international PEP guidelines was undertaken in parallel.
Results:
There were 511 alleged CSA events over the study period; 62/511 (12%) were appropriately risk-assessed as requiring PEP by the treating clinician. PEP was not prescribed in 8/62 (13%) events, with a reason documented for 6/8 (75%). Overall, less than half of children who were eligible for PEP were adherent to the 28-day regimen (23/54, 43%). Gastrointestinal upset contributed to early cessation in 5/54 (9%). Final 3-month blood-borne virus serology results were available in less than one in 3 children. A review of international clinical practice revealed significant heterogeneity of criteria for the provision of PEP and a paucity of pediatric-specific data.
Conclusions:
We identified several areas of our PEP management that required strengthening, with limited direction available in current international guidelines. We have adopted a broader use of fixed drug combinations and implemented a multifaceted follow-up program. It will be essential to review the impact of these changes.
