title: Community-based, nurse-led post-exposure prophylaxis: results and implications.
abstract: HIV medications can be used as post-exposure prophylaxis to efficaciously prevent an HIV-negative person who has come into contact with HIV from becoming HIV-positive. Traditionally, these medications have been available in emergency departments, which have constituted a barrier for the members of many minority groups who are greatly affected by HIV transmission (i.e. gay, bisexual and other men who have sex with men, and persons who use injection drugs). From 5 September 2013 through 4 September 2015, we sought to increase the use of HIV post-exposure prophylaxis by having registered nurses provide these medications, when indicated, in community clinics in Ottawa, Canada. We undertook a chart review of patients who accessed services for HIV post-exposure prophylaxis in this period. Over the two years of data collection, 112 persons requested HIV post-exposure prophylaxis and 64% (n = 72) initiated these medications. Most (93%, or n = 67, of the 72 initiations) were among men, with 88% (n = 59) of these men reporting same sex sexual partners. Among these 58 men, 31% (n = 18) had sexual contact with other men known to be HIV-positive. Among women (n = 8), five initiated post-exposure prophylaxis: three after needle-sharing contact or sexual contact with a male partner who reportedly shared needles, and two after unprotected vaginal sex with a male partner known to be HIV-positive. Overall, no one was diagnosed with HIV at the four-month HIV testing follow-up, although six persons were diagnosed with HIV from the baseline HIV testing, and an additional four were diagnosed with HIV during routine HIV testing one year after completing post-exposure prophylaxis. In total, nine persons in our sample were thus diagnosed with HIV during the study period, which accounted for 9.4% (n = 10 of 106) of all reported HIV diagnoses in Ottawa during this time. We conclude that nurse-initiated HIV post-exposure prophylaxis can be an effective way to provide HIV prevention services to persons who are at high-risk for HIV.
authors.affiliation: 1 School of Nursing, University of Ottawa, Canada.
authors.forename: Patrick
authors.initials: P
authors.lastname: O'Byrne
authors.affiliation: 2 Faculty of Medicine, University of Ottawa, Canada.
authors.forename: Paul
authors.initials: P
authors.lastname: MacPherson
authors.affiliation: 3 Ottawa Public Health, Healthy Sexuality and Risk Reduction Unit, Canada.
authors.forename: Marie
authors.initials: M
authors.lastname: Roy
authors.affiliation: 3 Ottawa Public Health, Healthy Sexuality and Risk Reduction Unit, Canada.
authors.forename: Lauren
authors.initials: L
authors.lastname: Orser
mesh_terms: D000328:Adult; D002170:Canada; D019058:Community Networks; D005260:Female; D015658:HIV Infections / Q000517:prevention & control*; D018451:Homosexuality, Male; D006801:Humans; D008297:Male; D016485:Needle Sharing; D009726:Nurses; D056990:Post-Exposure Prophylaxis; D012309:Risk-Taking; D012725:Sexual Behavior; D012747:Sexual Partners; D047568:Unsafe Sex; D055815:Young Adult
keywords: HIV; North America; antiviral; post-exposure prophylaxis