Improving Post-exposure Prophylaxis for HIV in Pediatric Sexual Assault Victims

Purpose/Objectives: The Centers for Disease Control and Prevention guidelines recommend prescribing HIV post-exposure prophylaxis (PEP) on a case-by-case basis for patients who present within 72 hours of sexual contact. However, pediatric victims of sexual assault who are prescribed PEP often have low compliance with therapy and poor follow-up rates. We sought to increase PEP compliance in pediatric sexual assault victims who were prescribed PEP from 10% to 60%. Secondary aims sought to obtain baseline serum transaminase levels in all patients who receive PEP, increase participation in the patient prescription assistance program from 0% to 40%, improve follow-up rates at 3 days and 1 month and increase PEP completion rates from 10% to 60%. Design/Methods: We implemented an intervention bundle based on three key drivers at a pediatric ED: ED-wide education, standardized discharge resources and increase in frequency of follow-up calls to patients. One Plan-Do-Study-Act cycle was performed. Interventions included education of multidisciplinary teams on PEP, enrollment in patient prescription assistance programs, standardized discharge instructions and increased follow-up contact. Unknown follow-up status was deemed no follow-up. Run-charts analyzed the effect of interventions on outcomes. Our balance measure was a change in the median length of stay in the ED. Results: There were 20 patients who were prescribed PEP in the pre-intervention period (Jan’20-Oct’20) and 19 patients during the intervention period (Nov’20-Apr’21). No significant differences existed in patient demographics during the two periods. There was no significant improvement in the frequency of obtaining serum transaminase levels (Baseline:85%, Intervention:74%; p=0.38). The percentage of patients who were followed up at 3-days improved from 15% to 95% (p < 0.00001). About 37% of patients were enrolled in the patient prescription assistance program (baseline: 0%) and PEP prescription filling rates improved from 35% to 84% (p=0.004). Follow-up rates upon completion of PEP improved from 5% to 37% (p=0.013) and more patients completed PEP (baseline:10%, intervention:47%; p=0.009). There was no significant difference in median ED length of stay during the pre-intervention [317 min (IQR: 280,451)] and intervention period [432 min (IQR:293,638)](p=0.19). Conclusion/Discussion: A comprehensive effort involving standardized PEP prescribing and discharge instructions, patient assistance program enrollment, and increasing patient follow-up calls improves patient compliance with PEP for HIV in pediatric sexual assault victims with a negligible effect on median ED length of stay.