A quality improvement initiative to increase HIV post-exposure prophylaxis treatment for emergency department patients after sexual assault: A pre-post study

TL;DR

A hospital improved HIV treatment rates for sexual assault victims by updating electronic records and providing free medication packs.

Contribution

A quality improvement initiative combining EHR template updates and free PEP packs significantly increased PEP prescribing in EDs.

Findings

HIV PEP prescribing increased from 9.4% to 28.0% after the intervention.

The odds of receiving PEP were 3.7 times higher post-intervention.

The effect remained significant after adjusting for demographics and provider experience.

Abstract

Many emergency department (ED) patients after a sexual assault face barriers to receiving HIV post-exposure prophylaxis (PEP). We implemented a quality improvement initiative which updated the sexual assault electronic health record (EHR) template and made available free, full-course PEP treatment packs for use at provider discretion. The aim of this study was to compare the receipt of HIV PEP for ED patients receiving sexual assault care before and after the initiative.

This was a retrospective, quasi-experimental, pre-post study of all ED patients who completed a sexual assault examination between June 1, 2022 – January 31, 2023 (pre-intervention) and March 1, 2023 – October 31, 2023 (post-intervention). An odds ratio (OR) and 95% confidence interval (CI) were calculated to determine the initiative’s effect on PEP prescribing. Multivariable logistic regression models estimated the independent effect of the initiative while controlling for potential confounders.

Of the 235 sexual assault examinations, 117 (49.8%) were during the pre-intervention and 118 (50.2%) were during the post-intervention periods. Pre-intervention, the mean age was 33.0 years (standard deviation [SD] 12.3), 94.0% were female, 30.8% Black, 31.6% Latinx, and 28.2% White. Post-intervention, the mean age was 29.2 years (SD 12.6), 90.7% were female, 42.4% Black, 28.8% Latinx, and 17.8% White. Patients were more likely to receive HIV PEP post-intervention (33/118, 28.0%) than pre-intervention (11/117, 9.4%) (OR 3.7, 95% CI 1.8 to 7.8). The independent effect of the initiative on HIV PEP prescribing remained significant after controlling for demographics (OR 3.6, 95% CI 1.6 to 8.0), assault characteristics (OR 4.2, 95% CI 1.6 to 11.1), and provider experience (OR 3.5, 95% CI 1.7 to 7.5).

The availability of HIV PEP treatment packs plus a modification to the EHR template led to a significant increase in the provision of HIV PEP for ED patients after sexual assault.

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