The American journal of emergency medicine · 2026
Missed opportunities for HIV prevention: Low linkage to follow-up care after emergency department initiation of nonoccupational postexposure prophylaxis.
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Nguyen Kathleen, Bares Sara H, Davis Jennifer M, Bernhard Sydney, Cox Samantha, Gomez Leigh, Stonewall Hannah, Zeger Wesley, Havens Joshua P, Sunagawa Shawnalyn W
Аннотация
BACKGROUND: HIV non-occupational post-exposure prophylaxis (nPEP) utilizes antiretroviral medications to reduce HIV acquisition risk and is commonly initiated in emergency departments (EDs). Little is known about the linkage to follow-up care and related outcomes for patients initiated on nPEP from an ED. We evaluated the linkage to care for patients initiated on nPEP in the ED at University of Nebraska Medical Center (UNMC) and were referred to the Specialty Care Center (SCC) for follow-up screenings.
METHODS: We conducted a retrospective cohort study of adults prescribed nPEP at the UNMC ED between 1/1/2023-6/30/2024. Patients with prior HIV infection or those seeking occupational post-exposure prophylaxis were excluded. The primary outcome was the completion of a follow-up visit at the SCC within 90 days. Secondary outcomes included documented completion of a 28-day nPEP course, adherence to screening guidelines, and factors associated with successful linkage to care. Outcomes were compared using descriptive statistics, Chi-square, and independent t-tests.
RESULTS: Of 92 patients, 65 were scheduled for nPEP follow-up visits at SCC, but only 23 attended their visit. Guideline-recommended nPEP regimens were prescribed for 98.7% of patients, but only 2.2% had all guideline-recommended baseline screenings. Overall, only 21 patients had documented completion of nPEP at their SCC follow-up visit. Follow-up attendance was more likely among those with commercial insurance (p = 0.012) and a lower social deprivation index (p = 0.043).
CONCLUSION: There was low (25%) nPEP follow-up attendance at SCC visits. Attendance disparities linked to insurance and social deprivation underscore the need for improved processes to improve overall continuity of transitions of care.
METHODS: We conducted a retrospective cohort study of adults prescribed nPEP at the UNMC ED between 1/1/2023-6/30/2024. Patients with prior HIV infection or those seeking occupational post-exposure prophylaxis were excluded. The primary outcome was the completion of a follow-up visit at the SCC within 90 days. Secondary outcomes included documented completion of a 28-day nPEP course, adherence to screening guidelines, and factors associated with successful linkage to care. Outcomes were compared using descriptive statistics, Chi-square, and independent t-tests.
RESULTS: Of 92 patients, 65 were scheduled for nPEP follow-up visits at SCC, but only 23 attended their visit. Guideline-recommended nPEP regimens were prescribed for 98.7% of patients, but only 2.2% had all guideline-recommended baseline screenings. Overall, only 21 patients had documented completion of nPEP at their SCC follow-up visit. Follow-up attendance was more likely among those with commercial insurance (p = 0.012) and a lower social deprivation index (p = 0.043).
CONCLUSION: There was low (25%) nPEP follow-up attendance at SCC visits. Attendance disparities linked to insurance and social deprivation underscore the need for improved processes to improve overall continuity of transitions of care.