April 14, 2014
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Few patients attend HIV clinic after ED visit for postexposure care

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Only half of people who were referred to HIV clinics for follow-up after presenting to the ED for nonoccupational postexposure prophylaxis actually attended the clinic for care, researchers from the University of Toronto and Harvard University have found.

In addition, fewer than half of those who visited the HIV clinic had documented completion of the 28-day course of antiretroviral therapy, according to the report in Clinical Infectious Diseases.

“Our prospective cohort study demonstrates significant attrition rates between the ED and HIV clinic in patients suffering HIV exposures,” the researchers wrote. “Future work should evaluate strategies targeted to high-risk groups, including women and uninsured patients, to enable adherence to clinic appointments and ART.”

The researchers recorded all referrals to nonoccupational postexposure prophylaxis (PEP) programs from two EDs from July 2010 to June 2011. ED physicians consulted with the on-call HIV clinic physician to determine whether PEP was warranted. The primary outcome was attendance to an initial HIV clinic appointment after the ED visit, and the secondary outcome was the completion of ART.

Within the 1-year study, 180 individuals were referred for PEP after receiving an ART starter pack in the ED. The median age of the individuals was 28 years; 65.6% were women and 70.6% were white. More than half of the exposures (57.2%) were sexual, and among those, 72% were nonconsensual and 22.1% were men who have sex with men. The nonsexual exposures included injection drug use, accidental needlestick injuries or accidental mucous membrane or percutaneous exposures.

Ninety-eight of the 180 individuals (54.4%) attended the HIV clinic. Forty-three patients (24.3%) had documentation of completing the 28-day treatment course. In a multivariable analysis, the researchers found that older age (adjusted OR=0.96; 95% CI, 0.93-0.99) and self-payment (adjusted OR=0.32; 95% CI, 0.11-0.97) were significant predictors of not attending initial clinic appointment.

“The follow-up clinic appointments are vital for enabling continuation of ART, encouraging drug adherence, modifying ART regimens in cases of significant toxicity, screening for other communicable and non-communicable conditions and counseling,” the researchers wrote. “The high attrition rates from the ED to clinic demonstrated in our current study are very concerning, given the high value that the clinic setting offers.”

Disclosure: The researchers report no relevant financial disclosures.