Nonoccupational HIV postexposure prophylaxis (NPEP) protocols and barriers to NPEP utilization in massachusetts emergency departments

Abstract

Study objectives: Nonoccupational HIV exposures are often evaluated in the emergency department (ED) for nonoccupational HIV postexposure prophylaxis (HIV-NPEP). The Massachusetts Department of Public Health conducted a survey of Massachusetts EDs in 1998, which revealed that only 15% of EDs had established NPEP protocols and that NPEP access varied by geography and clinical setting. The Massachusetts Department of Public Health then distributed a clinical advisory recommending development of written NPEP protocols, suggesting protocol components, and advertising a 24-hour advice line, reporting registry, and free medications for uninsured patients. We determine the change in percentage of EDs with an institutional HIV-NPEP protocol since the 1998 study and identify any remaining barriers to HIV-NPEP implementation. Methods: This was a structured survey mailed to directors of all 73 Massachusetts EDs. A subset of ED directors without protocols, or who did not return the survey, was contacted for a semistructured telephone interview. Data were analyzed with descriptive statistics and χ 2 analysis. Results: After 2 mailings, 49 (67.1%) of 73 questionnaires were returned. Compared with that in 1998, a greater proportion of EDs reported protocols (15% versus 44.9%, P P Conclusion: Although the use of HIV-NPEP in certain exposures is recommended by many state guidelines and experts, many EDs still lack protocols. Availability of resources (HIV clinic) is correlated with protocol development. Increased physician training and awareness is crucial.