Improvement in HIV screening follow-up rates with emergency medicine pharmacist counseling and dispensing of postexposure prophylaxis for sexual assault patients

<h2>Abstract</h2><h3>Background</h3> Patients presenting to the emergency department (ED) within 72 hours of sexual assault should be offered HIV nonoccupational postexposure prophylaxis (nPEP) and directed to follow-up care. However, low rates of follow-up HIV screening and medication adherence have been consistently found. Strategies to improve these rates have not been universally established. <h3>Objectives</h3> To describe improvement in follow-up HIV screening and nPEP medication adherence following emergency medicine (EM) pharmacist involvement in counseling and nPEP dispensing. <h3>Methods</h3> This single-center, retrospective, pre-/postimplementation analysis compared rates of sexual assault patient follow-up HIV screening prior to and following initiation of EM pharmacist counseling and dispensing of a 28-day supply of nPEP between January 1, 2016 to December 31, 2016 (preintervention) and January 1, 2017 to December 31, 2019 (postintervention). A telephone survey was administered to identify nPEP medication adherence and related adverse drug event (ADE) rates between August 1, 2018 through August 31, 2019 in the postintervention group. <h3>Results</h3> The chart review included 369 unique sexual assault patients prescribed nPEP. The number of patients completing at least one follow-up HIV screening and number of screening occurrences within 6 months of nPEP initiation increased from 3 (3.3%) to 12 (14%) and 4 (1.4%) to 23 (8.9%) from 2016 (preintervention) to 2019 (postintervention), respectively, both <i>P</i> < 0.01. Twenty of 85 patients completed a telephone survey during the postimplementation period. Eight patients (40%) reported completing the 28-day nPEP regimen, and 14 patients (70%) experienced an nPEP-related ADE. <h3>Conclusions</h3> EM pharmacist counseling and providing a free complete 28-day supply of nPEP contributed to improved rates of follow-up HIV screening for sexual assault patients after ED discharge.