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



Janice Du Mont*, 1, 2, Sheila Macdonald 3, 4, Terri Myhr 1, Mona R Loutfy 1, 5
1 Women’s College Research Institute, Women’s College Hospital, Toronto, Ontario, Canada
2 Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
3 Ontario Network of Sexual Assault/Domestic Violence Treatment Centres, Toronto, Ontario, Canada
4 Faculty of Nursing Science, University of Toronto, Toronto, Ontario, Canada
5 Department of Medicine, University of Toronto, Toronto, Ontario, Canada


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© Du Mont et al.; Licensee Bentham Open.

open-access license: This is an open access article licensed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted, non-commercial use, distribution and reproduction in any medium, provided the work is properly cited.

* Address correspondence to this author at the Women’s College Research Institute, Women’s College Hospital, 790 Bay Street, Toronto, Ontario M5G 1N8, Canada; Tel: 416-351-3732, Ext. 2705; Fax: 416-351-3746; E-mail: Janice.DuMont@wchospital.ca


Abstract

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.

Keywords: Focus groups, HIV, knowledge translation, post-exposure prophylaxis, sexual assault, surveys..