title: Physicians' and patients' adherence to antiretroviral prophylaxis after sexual exposure to HIV: results from South-Eastern France.
abstract: French national guidelines for the management of HIV non-occupational post-exposure (nPEP) were issued in 1998 and updated in 2003. NPEP is available and free of charge in all emergency or AIDS care units of French hospitals. A regional survey was carried out to study physicians' adherence to national guidelines, and determinants of adherence to nPEP follow-up in individuals sexually exposed to HIV. The survey was based on retrospective data collection of all consultations for nPEP made in the three AIDS information centers in South-Eastern France (January 2001-December 2002). Information included personal data, type of exposure, and treatment at the first visit after exposure and during follow-up. Exposures were classified into high risk (treatment highly recommended), moderate risk (treatment possibly recommended) and negligible risk (treatment never recommended) categories, according to the level of HIV risk of sexual transmission as indicated by the French national nPEP guidelines. Among the 910 sexual exposures, 56%, 37%, and 4% were classified as cases with high, moderate, and no risk respectively. NPEP was prescribed to 85% of cases. HIV risk of sexual exposure was significantly associated with nPEP receipt though more than half of the cases with negligible risk received nPEP. Independent characteristics associated with non-adherence to nPEP follow-up were younger age, being referred to hospital by a physician, sexual exposure with a casual partner or sexual assault, and "moderate risk" exposure. Better information should be provided to physicians prescribing nPEP to limit over-prescription while new strategies should be implemented to improve follow-up of individuals receiving nPEP, especially those who are younger or survivors of sexual assault.
authors.affiliation: Research Unit UMR912 Economic & Social Sciences, Health Systems & Societies, INSERM, Marseille, France. rey@marseille.inserm.fr
authors.forename: Dominique
authors.initials: D
authors.lastname: Rey
authors.forename: Marc Karim
authors.initials: MK
authors.lastname: Bendiane
authors.forename: Anne-Deborah
authors.initials: AD
authors.lastname: Bouhnik
authors.forename: Jesus
authors.initials: J
authors.lastname: Almeda
authors.forename: Jean Paul
authors.initials: JP
authors.lastname: Moatti
authors.forename: Maria Patrizia
authors.initials: MP
authors.lastname: Carrieri
mesh_terms: D000293:Adolescent; D000328:Adult; D044966:Anti-Retroviral Agents / Q000008:administration & dosage*; D004333:Drug Administration Routes; D005260:Female; D005602:France / Q000453:epidemiology; D019983:Guideline Adherence; D015658:HIV Infections / Q000188:drug therapy* / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D017410:Practice Guidelines as Topic; D011364:Professional Practice / Q000592:standards*; D012742:Sex Offenses; D012725:Sexual Behavior / Q000523:psychology*; D016896:Treatment Outcome
chemical_list: D044966:Anti-Retroviral Agents