A teen arrives at Children’s Wisconsin’s Emergency Department after being sexually assaulted. Those automatic doors spring open and a team of doctors and nurses take over their care — they’re safe.
Already scared, hurt, traumatized, they now must cope with the potential risk of sexually transmitted infections. Treatment for gonorrhea and chlamydia is easy enough — they can be prevented with a single dose of post-exposure prophylaxis (PEP), a medication that prevents infections from taking root in a patient’s body after exposure to a pathogen.
Preventing HIV, on the other hand, is still possible but challenging. They have just 72 hours from exposure to get the vital medication they need to prevent the virus from taking root in their body. And the sooner they takes the medicine, the better. Further complicating matters is that the medication — not readily available at every pharmacy — needs to be taken at the same time, every day, for 28 days.
Prior to 2016, this teen would have been given just a three-day supply and it was up to them to fill the remaining prescription.
Leaders at Children’s Wisconsin were convinced there had to be a better way.
“This process often had challenges because not every pharmacy keeps these drugs on hand. And for families who’ve gone through sexual assault, it was one more thing to deal with at a difficult time,” said Barbara Cuene, RN, MSN, program coordinator for the Children’s Wisconsin’s HIV Program. “Kids who come in the ED for sexual assault are often here for 8 to 12 hours, and it is difficult to think we would have to send them out to get their meds after that.”
In 2016, the Children’s Wisconsin Pharmacy, Information Management Services and Emergency Department launched an innovative protocol that quickly gets the teen a full 28-day supply of medication — before they even leave the Emergency Department.
This initiative required collaboration with Walgreens on a new process that submits the order for a full 28-day supply of PEP soon after a patient arrives in the Emergency Department. Walgreens, which has a 24-hour pharmacy nearby, agreed to simplify and speed up the usual insurance approval process, saving the paperwork for the next day. Children’s Wisconsin pays for a courier who picks up the prescription from Walgreens and delivers it to the patient at the hospital as soon as possible — even in the middle of the night.
“This was a team effort,” said Peter Havens, MD, an infectious disease specialist who serves as medical director of Children’s Wisconsin’s HIV Program. “This took partnership between hospital administration and Walgreens at the highest level. Walgreens made a huge commitment to doing the right thing. Everyone made it work because it’s better for children and their families.”
Since the partnership with Walgreens started, 62 youth have received PEP and were served by Children’s Wisconsin’s HIV Program staff. And the percentage of patients who completed the full 28-day treatment increased from 57 to 65 percent. Because of a more efficient protocol, patients also leave the Emergency Department an average of two hours sooner than they did before when they had to wait for the three-day supply.
“These patients and families have been through so much,” Cuene said. “If we can help a patient and family reduce the amount of time they spend in the ED and leave the ED with the resources they need, that’s what matters the most.”
There are no guarantees that patients will complete the medication regimen after leaving the hospital — some stop after a couple of weeks — but Children’s Wisconsin follows up with reminders.
“It is really hard to take medications every day,” Cuene said. “We provide the kids with the best opportunity to be successful by giving them their meds and calling them to help them take their meds.”
The Walgreens initiative is just the latest example of Children’s Wisconsin’s longstanding commitment to HIV prevention. Over the last three decades, Children’s Wisconsin has worked to protect those who already have HIV, those are have been exposed and those who are at risk of exposure.
That work has included providing education about HIV care and treatment to patients and their primary care providers, helping HIV-positive pregnant mothers stick to their treatment plan and manage their virus load to protect their unborn baby and encouraging the use of pre-exposure prophylaxis, better known as PrEP, for sexually active teens and adults.
“Children’s Wisconsin has been on the leading edge of HIV care and prevention since 1991,” Havens said.
If you have questions about how to get HIV medications, call 414-266-2000 and ask to have the HIV Program staff paged. Staff are available 24 hours a day, every day.