Survey of nonoccupational HIV postexposure prophylaxis in hospital emergency departments.
BACKGROUND
Nonoccupational HIV postexposure prophylaxis (nPEP) is being used in community settings, but little is known about practice patterns. This study examined the status of nPEP in Massachusetts emergency departments (EDs), community sites where nPEP is most likely to be practiced.


METHODS
In June 1998, a mailed survey was sent to identified medical directors of the 78 hospital EDs statewide; 66 (85%) responded.


RESULTS
Overall, 52% reported having patient requests for nPEP within the prior year. 15% (10 of 66) had established written nPEP protocols; 33% (22 of 66) indicated their protocols were informal and not written. Twenty-five EDs could estimate the number of nPEP patients assessed; their mean estimate was 31 for the prior year (standard deviation [SD], 19.9) and 34% of the patients overall had nPEP recommended. Most (81%) of the hospitals with written or unwritten protocols recommended the use of three-drug antiretroviral regimens, which included two nucleoside analogues and a protease inhibitor; 41% approved more than one nPEP regimen.


CONCLUSIONS
A demand for nPEP is occurring in hospital EDs. The diversity of practice patterns suggests the need for evidence-based practice guidelines.
JSI Research and Training Institute, Inc., Boston, Massachusetts 02210, USA. lkunches@jsi.com
L M
LM
Kunches
T M
TM
Meehan
R C
RC
Boutwell
J F
JF
McGuire
D019380:Anti-HIV Agents / Q000627:therapeutic use*; D018890:Chemoprevention / Q000379:methods*; D003625:Data Collection; D004636:Emergency Service, Hospital; D015658:HIV Infections / Q000517:prevention & control* / Q000635:transmission; D006801:Humans; D016273:Occupational Exposure; D010818:Practice Patterns, Physicians'; D018894:Reverse Transcriptase Inhibitors / Q000627:therapeutic use*
D019380:Anti-HIV Agents; D018894:Reverse Transcriptase Inhibitors