by In southeastern Arizona, the only way patients could access emergency non-occupational HIV post-exposure prophylaxis (PEP) was to take their chances at one of the local emergency departments. Many emergency departments are unprepared to give patients needing PEP adequate care. Emergency department providers are often unfamiliar with what exposures warrant PEP, what medication regimens should be prescribed, and how to ensure patients can obtain the expensive PEP medication regimens. In order to address this gap in service, Arizona AETC began working with the university infectious disease clinic and emergency department to identify ways to improve access to PEP.
Arizona AETC facilitated communication between the emergency department and the infectious disease clinic and helped develop a linkage to care system to Infectious Disease for patients prescribed PEP in the emergency department. Arizona AETC also directed the development of order sets in the electronic medical record system that indicated the necessary labs to order and medication to prescribe.
Recently, a woman in her mid-20s presented in the emergency department requesting HIV post-exposure prophylaxis. Her partner is HIV-positive and the condom broke. The appropriate labs were ordered, and she was prescribed nPEP. However, when she went to the pharmacy, she could not afford the medication. She purchased just one dose of the medication. Her plan was to purchase the medication one day at a time as she scrambled to find the money to cover the rest of the prescription. Luckily, the emergency department followed the linkage to care protocol for nPEP and the infectious disease clinic followed up with the woman before she purchased her second dose. The clinic directed the woman to one of the local HIV specialty pharmacies that helped her apply for a patient assistance program, so she could fill her prescription.