Experiences of the National Post-Exposure Prophylaxis Hotline (PEPline): Occupational PEP consultation needs and trends, 2014 to 2022.

BACKGROUND: The National Clinician Consultation Center operates the Post-Exposure Prophylaxis Hotline (PEPline), a federally-funded educational resource providing bloodborne pathogen exposure management teleconsultation to US clinicians. METHODS: Sixty-seven thousand one hundred nine occupational post-exposure prophylaxis (PEP) consultations (January 2014 to December 2022) were retrospectively analyzed to describe PEPline utilization and common inquiries addressed by National Clinician Consultation Center consultants. RESULTS: Most calls involved percutaneous incidents (70%); blood was the most common body fluid discussed (60%). Inpatient units were the most common exposure setting (35%) and licensed nursing professionals were the most common category of exposed workers (28%). Of 2,295 calls where workers had already initiated PEP for human immunodeficiency virus (HIV) prevention and time to first dose was known, 9% had initiated HIV PEP within 2 hours of exposure; almost 80% had initiated HIV PEP between 2 and 24 hours; 3% after 24 to 36 hours; 5% after 36 to 72 hours; and 2% after 72 hours. Calls from urgent care providers increased by 10% over time. Overall, more than 90% of callers requested support on risk assessment, including source person testing; other common questions involved PEP side effects and follow-up care. CONCLUSIONS: PEPline consultations can help raise awareness about PEP availability and timely initiation, and reduce stigma by addressing common misperceptions about bloodborne pathogen transmission mechanisms and likelihood, particularly regarding HIV.

Parental perspectives on factors influencing eyeglass wear compliance in preschoolers from low-income families in San Francisco.

PURPOSE: To investigate factors associated with spectacle wear among low-income preschoolers who receive glasses through the See Well to Learn (SWTL) program. METHODS: Qualitative study of parental perceptions of factors contributing to compliance during a longitudinal study of eyeglass wear utilizing thematic analysis of a series of three scripted phone calls during the 2017-2018 school year. Participants were parents of 164 children ages 3-5, from 51 Head Start preschools in the greater San Francisco region. RESULTS: A total of 470 scripted parental telephone calls were successfully completed during the study period. Six major themes affecting glasses compliance in this group were identified including: (1) awareness of need and noted visual improvement; (2) continuous efforts to improve compliance by working with parent; (3) collaborative efforts between home and school such as parent-teacher encouragement; (4) child comfort and eyewear preferences; (5) the importance of two functional pairs of eyewear to achieve full-time wear; and (6) coordination of care offered by the SWTL program. CONCLUSIONS: This study offers insight into factors contributing to child eyewear compliance during critical years of vision development. These findings offer lessons to improve compliance and identify a need to adjust California's current policies on vision coverage for children.

Prevalence and Factors Associated With Eyeglass Wear Compliance Among Preschoolers From Low-Income Families in San Francisco, California.

IMPORTANCE: Despite growing support for early school-based vision screening and eyeglass provision, few studies have rigorously monitored the compliance of eyeglass wear among preschool-aged children who receive eyeglasses through such programs. OBJECTIVE: To assess the prevalence and factors associated with eyeglass wear compliance among preschoolers from low-income families who receive eyeglasses through the See Well to Learn program. DESIGN, SETTING, AND PARTICIPANTS: Longitudinal cross-sectional study of eyeglass wear compliance patterns among 188 children 3 to 5 years of age from 51 Bay Area Head Start preschools in San Francisco, California. The study conducted during the 2017 to 2018 school year included students with a failed vision screening who met predetermined refractive criteria following cycloplegic refraction and received eyeglasses through the See Well to Learn program. EXPOSURES: Eyeglass distribution. MAIN OUTCOMES AND MEASURES: Eyeglass wear compliance, measured by a school-year's worth of weekly teacher reports, was a longitudinal measure of consistent eyeglass wear, defined by eyeglass wear for more than 50% of every school day (compliance score of 4). RESULTS: Of 188 students (91 boys [49%]; 94 girls [51%]; mean [SD] age, 3.89 [0.5] years), 133 (71%; 95% CI, 64%-77%) maintained a mean compliance score throughout the school year of 4 or higher. Compliance prevalence was relatively stable throughout the school year, ranging from 139 students (74%) to 164 students (87%). Baseline uncorrected visual acuity in both the better-seeing and worse-seeing eyes was the only assessed factor that was associated with compliance. In the better-seeing eye, the mean uncorrected visual acuity of students with eyeglass wear compliance was 0.473 logMAR (95% CI, 0.433-0.514) (Snellen equivalent, 20/60) compared with 0.394 logMAR (95% CI, 0.334-0.454) (Snellen equivalent, 20/50) for students with noncompliance (P = .03). In the worse-seeing eye, the mean uncorrected visual acuity of students with compliance was 0.576 logMAR (95% CI, 0.530-0.623) (Snellen equivalent, 20/75) compared with 0.492 logMAR (95% CI, 0.433-0.551) (Snellen equivalent, 20/62) for students with noncompliance (P = .03). In the better-seeing eye, the difference between students with compliance vs noncompliance was 0.079 logMAR (95% CI, 0.009-0.150) (5 Snellen letter difference) compared with 0.084 logMAR (95% CI, 0.007-0.160) (5 Snellen letter difference) in the worse-seeing eye. CONCLUSIONS AND RELEVANCE: This study found that nearly 3 of 4 preschool students consistently wore their glasses at school during their first year of use, supporting the continued implementation of preschool-based vision screening programs. These findings suggest that programs involving school-based screening and eyeglass delivery may lessen disparities in accessing pediatric vision care. Consistent with previous studies, students with poorer uncorrected baseline visual acuity were found to be more likely to wear eyeglasses compliantly.