HIV Prophylaxis in Sexual Assault Periprocedural Care

Updated: Feb 02, 2017
  • Author: Derek T Larson, DO; Chief Editor: Michael Stuart Bronze, MD  more...
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Periprocedural Care

Patient Education and Consent

If HIV nPEP is offered, the following information should be discussed with the patient:

  • The unproven benefit and known toxicities of antiretrovirals
  • The importance of close follow-up
  • The importance of adherence to recommended dosing to prevent selection of resistant viruses
  • The necessity of early initiation of PEP to optimize potential benefits (ie, as soon as possible and up to 72 hours after the assault)
  • Cost of the medication regimen

Patients should be informed that various payment methods for nPEP are available for survivors of sexual assault, including Medicaid, Medicare, or Crime Victims Compensation. Third-party reimbursement may cover nPEP, depending on the plan’s prescription drug policy, if the individual has prescription drug coverage. In cases where the medication-dispensing facility does not receive reimbursement for these services, such expenses may be included in their annual Institutional Cost Report as part of indigent care costs.

The Crime Victim’s Board (CVB) has developed special procedures to ensure availability of nPEP for sexual assault victims. Victims of sexual assault may also contact a Rape Crisis Center or Victims Services Agency in their county or region for assistance in filing claims with the CVB, particularly when emergency assistance is needed. Many of these agencies have 24-hour hotlines. For more information about accessing Crime Victims Compensation and for a list of Victims Services Agencies and other resources, consult the CVB website.

For more details on sexual assault in general, see Sexual Assault. For child sexual abuse, see the article Child Sexual Abuse.

Additional resources for HIV/sexual assault include the following:

Centers for Disease Control and Prevention

1600 Clifton Road

Atlanta, Georgia 30333

(404) 639-3311 Public Inquiries (404) 639-3534, (800) 311-3435

www.cdc.gov

National HIV/AIDS Hotline

American Social Health Association

P.O. Box 13827

Research Triangle Park, NC 27709

(800) 342 - AIDS

(800) 344 - SIDA (Spanish)

(800) 243 - 7889 (TDD)

They provide HIV/AIDS information 24 hours a day, 7 days a week and will send free written information. They also make referrals to any organization/agency that provides information, including legal services, counseling, and therapies.

National AIDS Clearinghouse

P.O. Box 6003

Rockville, MD 20849

(800) 458 - 5231

(800) 243 - 7012 (TDD)

Distributes various educational materials to the public and provides expert referrals.

National Center for Victims of Crime

2000 M Street NW, Suite 480

Washington, DC 20036

Phone: (202) 467-8700

Fax: (202) 467-8701

www.ncvc.org

National Sexual Violence Resource Center

123 North Enola Drive

Enola, Pennsylvania 17025

877-739-3895 (toll-free)

717-909-0710 (phone)

717-909-0714 (fax)

717-909-0715 (TTY)

www.nsvrc.org

Rape, Abuse, and Incest National Network (RAINN) National Sexual Assault Hotline

2000 L Street, NW, Suite 40

Washington, DC 20036

(202) 544-1034

(800) 656-HOPE (4613)

info@rainn.org

www.rainn.org

National Native American AIDS Prevention Center

2100 Lakeshore, Suite A

Oakland, CA 94606

(800) 283 - AIDS

(Hours: 8:30am - 1pm; 2pm - 5pm, PST)

National Association of People with AIDS (NAPWA)

1413 K Street, NW

Washington, DC 20005

(202) 898 - 0414

(202) 789 - 2222 (FAX: AIDS information facts on demand)

NAPWA is a nonprofit organization that provides information services, educational resources, national advocacy, and technical assistance for community-based organizations.

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Pre-Procedure Planning

Assistance with PEP-related decisions can be obtained by contacting the following:

In New York State: For referrals to HIV specialists, call the AIDS Institute’s Office of the Medical Director: (212) 417-4536 (M-F, 8am-5pm); all other hours, call the HIV/AIDS Hotline: 1-866-881-2809. For NYSDOH protocol for management of sexual assault victims, call the NYSDOH Rape Crisis Program: (518) 474-3664 and/or visit the NYSDOH HIV Guidelines Website.

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Follow Up

Patients evaluated for PEP should be educated about the symptoms of acute HIV seroconversion (notably fever and rash) and instructed to seek medical care if they develop. Follow-up with a primary care provider or infectious disease physician should occur at 4-6 weeks, 3 months, and 6 months regardless of whether PEP was initiated in order to screen for medication side effects, to evaluate for symptoms of seroconversion, and to test for development of infections. If initiated, PEP adherence should be stressed, as overall adherence rates are around 60%.

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