Seamless Care from Sexual Assault through First Follow-Up Appointment for Victims at Risk of HIV Exposure through Nurse-Facilitated NPEP Management

Salt Lake Sexual Assault Nurse Examiners (SL SANE) are the primary medical responders to sexual assault victims in Salt Lake County. On a daily basis, SANE are called out to local emergency departments (EDs) where victims present themselves for evidence collection and proper medical care. At the end of each visit, patients are routinely offered prophylaxis for sexually transmitted infections (STIs). However, nurses expressed concern that HIV non-occupational post-exposure prophylaxis (n(PRP) was not being properly administered as recommended by the Centers for Disease Control and Prevention (CDC). According to the literature, HIV nPEP programs are difficult to implement, are poorly supported abd have poor adherence rates. In order to improve local nPEP administration the author used the PRECEED-PROCEED model to identify and address gaps in administration. NPEP implementation is a time sensitive therapy requiring multiple interactions. In Salt Lake many of the required interactions to administer nPEP were failing to occur. In addition, there were various knowledge deficits. Nurses were uncertain of exposure risk factors, providers were unaware of lab work to draw and drugs to initiate, and neither could offer patients an established follow-up pathway. These knowledge deficits led to dismissal of risk factors, failure to initiate medications promptly, and failure to follow-up. The purpose of this scholarly project was to advocate seamless care fro sexual assault through the first follow up appointment for victims at risk for HIV exposure through nurse-facilitated nPEP management. Addressing the gaps in nPEP implementation has increased nurse and provider comfort in assessing risk and initiating nPEP. It has also provided a clear follow-up pathway that links the patient with providers who can monitor drug therapy and HIV infection. As SANEs continue follow pathways and use provided tools they can establish a standard of care the will be familiar to them and easily carry the patient through all the interactions required from presentation to first follow-up.