HIV nonoccupational postexposure prophylaxis for sexual assault cases: a 3-year investigation.

Objective: Nonoccupational postexposure prophylaxis (nPEP) programs offer antiretroviral therapy to prevent HIV following at-risk exposures like sexual assault. We investigated the levels of elective nPEP uptake among sexual assault cases presenting for emergency medical care.

Design: Retrospective analysis.

Methods: The analysis included over 3 years (1 January 2015 to 30 September 2018) of clinic information from the Sexual Assault and Partner Abuse Care Program (SAPACP) at The Ottawa Hospital, the regional emergency department care point following sexual assault. Descriptive analyses assessed the number of cases eligible for nPEP and those who started nPEP. Bivariable/multivariable logistic regression modelling assessed factors most strongly associated with starting nPEP using odds ratios (OR), adjusted OR (AOR), and 95% confidence intervals (CI).

Results: The SAPACP saw 1712 patients; 1032 were sexual assault cases, 494 were eligible for nPEP, and 307/494 (62%) eligible patients started nPEP. The median age was 23 years (IQR: 20-31), with 446 (90%) cases being female. There were 86 (17%) cases who arrived by ambulance, and 279 (56%) assaults involving a known assailant. Reduced odds of starting nPEP were observed among female cases (AOR: 0.44, 95% CI: 0.21-0.93), those who arrived by ambulance (AOR: 0.56, 95% CI: 0.35-0.91), and those with a known assailant (AOR: 0.56, 95% CI: 0.36-0.78).

Conclusion: We found that 62% of eligible sexual assault cases started nPEP. Key groups most likely to decline nPEP included female cases, those who arrived by ambulance, and those with known assailants. Providers can use these findings to provide recommendations to sexual assault survivors most likely to decline nPEP, yet still in need of care.