Survey of nonoccupational HIV postexposure prophylaxis in hospital emergency departments

Background: Nonoccupational HIV postexposure prophylaxis (nPEP) is being used in community settings, but little is known about practice patterns. This study examined the status of nPEP in Massachusetts emergency departments (EDs), community sites where nPEP is most likely to be practiced. Methods: In June 1998, a mailed survey was sent to identified medical directors of the 78 hospital EDs statewide; 66 (85%) responded. Results: Overall, 52% reported having patient requests for nPEP within the prior year. 15% (10 of 66) had established written nPEP protocols: 33% (22 of 66) indicated their protocols were informal and not written. Twenty-five EDs could estimate the number of nPEP patients assessed; their mean estimate was 31 for the prior year (standard deviation [SD], 19.9) and 34% of the patients overall had nPEP recommended. Most (81%) of the hospitals with written or unwritten protocols recommended the use of three-drug antiretroviral regimens, which included two nucleoside analogues and a protease inhibitor; 41% approved more than one nPEP regimen. Conclusions: A demand for nPEP is occurring in hospital EDs. The diversity of practice patterns suggests the need for evidence-based practice guidelines.