From protocol to pilot: Taking baby steps in policy development for a citywide non-occupational post exposure prophylaxis (nPEP) HIV prevention strategy

Issues: In 2005, the Centers for Disease Control and Prevention issued guidelines for antiretroviral postexposure prophylaxis following sexual, injection-drug use, and other non-occupational exposure to HIV (nPEP). These guidelines, although widely accepted, have not been incorporated in most Philadelphia clinical practices and emergency departments. As a result, patients seeking nPEP often face challenges finding this valuable resource when needed. In 2010, a needs assessment distributed to local HIV service providers indicated limited availability of nPEP. Currently, Philadelphia's incidence rate of HIV infection is five times that of the national HIV incidence rate. Description: An AIDS Education and Training Center (AETC) convened a Post Exposure Response Community Workgroup to assess the availability of nPEP in Philadelphia and develop local guidelines to improve accessibility. The Workgroup comprises representatives from the local health department, the local Family Planning grantee, Ryan White Parts A and D providers, and several area hospitals. The Workgroup identified various HIV providers to assist with patient follow-up care. Lessons Learned: Collaborative efforts with various health care/social service agencies were very instrumental to developing local guidelines, policies and procedures. Prior to policy development, a pilot program should be implemented to determine essential elements and logistics needed for effective policy implementation. Recommendations: Components of a local nPEP strategy that should be considered prior to policy development include: funding sources for pilot program implementation; availability and capacity for nPEP provision and patient follow-up; and a local AETC that can serve as a neutral convener of diverse provider and public health stakeholders.