Sustainability of an HIV PEP Program for Sexual Assault Survivors: “Lessons Learned” from Health Care Providers

This study explored challenges to continuing an HIV post-exposure prophylaxis (PEP) program of care provided to sexual assault survivors in the province of Ontario, Canada. Data were collected as part of an implementation and evaluation of a universal offering of HIV PEP (known as the HIV PEP Program) at 24 of 34 provincial hospital-based sexual assault treatment centres. Experienced health care providers were surveyed (n = 132) and interviewed in four focus groups (n = 26) about their perceptions of what, if any, factors threatened their ability to maintain the HIV PEP Program. All focus groups were audio-recorded and the recordings transcribed. The transcriptions and open-ended survey responses were analyzed using content analysis. Administrator, nurse, physician, social worker, and pharmacist respondents perceived important barriers to sustainability of the HIV PEP Program. Eight constructs were identified within four broad themes: resources (inadequate funds, overworked and unacknowledged staff), expertise (insufficient external supports, insufficiently trained and knowledgeable staff), commitment (lack of institutional support, physician resistance to offering HIV PEP), and accommodation (lack of flexibility in addressing specific client and community needs, inaccessibility and lack of clarity of tools). We discuss the implications of these findings and the actions that were taken to address the challenges

HIV PEP Study Final Report

HIV post-exposure prophylaxis (PEP) has been recommended to prevent transmission of HIV following non-occupational sexual exposure (CDC, 2005), but available research and guidelines to practically implement this recommendation were limited and have often been inconsistent. The HIV PEP Study was initiated to implement a program of universal offering of HIV PEP in Ontario’s Sexual Assault/Domestic Violence Care & Treatment Centres (SATCs) and to collect data prospectively to identify factors crucial to enabling an effective and sustainable province-wide response. The HIV PEP Study was conducted by the Ontario Network of SATCs in partnership with the Women's College Research Institute (then known as the Centre for Research in Women's Health) and with the support of the Ontario Women’s Health Council (OWHC). This paper describes a viable framework for a universal program of HIV Post-Exposure Prophylaxis, which has since been funded at all of Ontario's Sexual Assault/Domestic Violence Care & Treatment Centres.Ontario Women's Health Counci