1301. Evaluation of the Rates of HIV Post-Exposure Prophylaxis Completion After the Implementation of an Automated Referral System in the Emergency Department

BACKGROUND: A 28-day regimen of Post-Exposure Prophylaxis (PEP) administered within 72 hour significantly reduces HIV infection, for both occupational and nonoccupational exposures (NOE); however, adherence to PEP for NOE has been reported to have poor rates of completion.(1) To optimize PEP referrals from our ED to our clinics, we implemented an automated referral system to maximize PEP completion and link patients to outpatient care and HIV pre-exposure prophylaxis (PrEP), if appropriate. METHODS: In our ED, PEP patients receive a starter kit from an automated medication dispensing system. Starting in March 2017, a daily automated report of patients who received a starter kit in the ED was generated and emailed to patient navigators who would contact patients and offer follow-up appointments. Our main objective was to describe the rate of outpatient follow-up of patients initiated on PEP for NOE from March 2017 to March 2018, as well as patient demographics and linkage to PrEP. RESULTS: Out of 128 patients seen in the ED for PEP, 30% (38) were for NOE. Of these, 68% were female, with a median age of 27 years old (range: 14–59). Nearly half had no insurance (45%). The majority (84%) reported sexual intercourse or sexual assault as the exposure. Most patients were contacted for follow-up (76%) and half (48%) had a follow-up appointment. Patients who presented to the ED >24 hours after exposure were less likely to complete a follow-up (35% vs. 75%, P = 0.035), as were uninsured patients (24% vs. 57%, P = 0.052). From 38 patients, 13 (34%) qualified for PrEP, eight (62%) followed as outpatients and one (8%) was started on PrEP. CONCLUSION: The automated system ensured that half our PEP patients were seen by an outpatient provider, increasing their likelihood of finishing the 28 days of PEP. Patients presenting late to the ED and uninsured patients were less likely to follow-up. Further research is needed to identify interventions to improve follow-up. Finally, transition to PrEP was low and additional interventions should be explored to improve this process. [Image: see text] [Image: see text] Reference 1. Kahn JO, Martin JN, Roland ME, et al. Feasibility of postexposure prophylaxis (PEP) against human immunodeficiency virus infection after sexual or injection drug use exposure: the San Francisco PEP Study. J Infect Dis 183(5):707–714. DISCLOSURES: All authors: No reported disclosures.