Children’s works to lower HIV risk for assault victims
The question was not one Barbara Cuene, a longtime nurse at Children’s Hospital of Wisconsin, had expected.
“What is your role in my life?” a 15-year-old patient asked.
No one had ever asked her that before.
“That is a really good question,” she recalled telling him. “I’m a tiny piece of the puzzle for you.”
Cuene is just one member of a team at Children’s Hospital taking a new approach to drastically reduce the risk of child victims of sexual assault contracting HIV.
That innovative work, in partnership with Walgreens, puts an entire 28day supply of the medication, known as post-exposure prophylaxis, into the hands of victims and their families before they leave the emergency room.
In the year since implementing the new process, the rate of patients who took their full regimen of medication soared from 64% to 92%.
That’s critical because the medication reduces the risk of HIV by 98% to 99% if the treatment is started within 72 hours of possible exposure.
“People really came together to do this to make it better for the families,” said Peter Havens, an HIV infectious disease physician at Children’s Hospital.
‘In crisis’
When a child or caregiver report sexual abuse or assault, it starts a cascade of responses.
The child is taken to an emergency room for a sexual assault exam. He or she comes in contact with doctors, police officers, social workers and child advocates who are asking questions and explaining what happens next.
There is a risk for sexually transmitted infections. Syphilis and chlamydia can be prevented with a single-dose pill taken at the hospital. But to prevent HIV, the child must take medication for 28 days, at the same time every day.
The medication is not routinely kept in stock at local pharmacies because it is rarely prescribed and can expire if left on the shelf too long. Different forms of the medication — pills or liquid — must be available for patients of all ages and sizes. Many assaults are reported at night, when most pharmacies are closed.
Previously at Children’s Hospital, the child would receive a three-day starter pack of the medication from the in-hospital pharmacy. Then nurses, such as Cuene, would help them figure out where to find it at other pharmacies.
“It’s complicated with families,” Cuene said.
For youth and families who experience sexual assault or abuse, “they’re in crisis and it can be the worst time of their life,” said Deborah Bretl, a pediatric nurse practitioner with the Child Advocacy Center.
“With this program, it’s just one less thing they have to be thinking about,” Bretl said. “It makes things easier for them and it improves their medical care by making sure they get those needed medications to prevent HIV.”
How it works
Now, emergency room physicians at Children’s Hospital enter the prescription for the medication and send it to the 24hour Walgreens pharmacy at North Ave. and Mayfair Road, about two miles from the hospital.
A courier service picks up the medication and delivers it to families in the emergency department. Families leave with the full 28-day supply.
“We know that if we give them the medication, there’s a better chance they’re going to take it and prevent a child from getting HIV,” said Marlene Melzer-Lange, a pediatric emergency medicine physician at Children’s Hospital of Wisconsin.
Walgreens has partnered with Children’s Hospital in the past on flu shots and was eager to help some of the hospital’s most vulnerable patients who have suffered sexual abuse or sex trafficking, said Rocky LaDien, health care supervisor for Walgreens in its Milwaukee north division.
“If we can protect one person, it’s worth everything,” LaDien said.
To make that happen, the hospital and pharmacy had to collaborate closely, updating computer systems and streamlining the process so it was efficient, he said.
Experts say providing the full 28-day supply after a sexual assault exam is best practice.
Medical professionals also are advised to “consider efficient methods” to facilitate completion of the regimen, including providing the full supply upfront to patients, said Kristina Rose, executive director of End Violence Against Women International.
The recommendations were included in a Justice Department report published in 2016. But not all hospitals are equipped to implement those best practices, which require intense collaboration within the hospital system and outside it.
“I think we’re unique and one of the only ones in the country that has this service,” said Tom Lausten, director of pharmacy for Children’s Hospital.
“We’ve shown two things: We’ve reduced the length of time in the emergency department by two hours and our rate of compliance has improved,” he added. “Patients are getting the medications that they need.”