Impact of 24-hour emergency service availability and medication management on post-exposure prophylaxis in cases of sexual violence in the state of São Paulo

Abstract

This study analyzes the impact of 24-hour emergency service availability and medication management practices on the administration of post-exposure prophylaxis (PEP) for victims of sexual violence in the state of São Paulo. Data from 645 municipalities and 13,011 cases of sexual violence recorded in 2023 were examined. The methodology included multivariate logistic regression to identify key predictors of PEP administration, adjusting for confounding factors. Findings show that 50.6% of victims arrived at health services within the recommended 72-hour window for PEP. The presence of 24-hour emergency services significantly increases the likelihood of appropriate PEP administration (OR = 2.87, 95% CI 1.95-4.22), highlighting the need for investments in these services. Medication fractionation practices were associated with lower PEP effectiveness, indicating the importance of policies to ensure a continuous supply of antiretrovirals (ARVs). Regional disparities revealed higher PEP coverage in metropolitan areas compared to rural regions, underscoring the need to expand service access. This study recommends that public policies prioritize the expansion of emergency services with PEP availability and improvements in medication management to reduce disparities and prevent HIV.