ModuleB2Session4 – FHI - Family Health International.pptVIP

Objectives Discuss issues and concerns that HCWs might have about working with HIV-infected persons Describe how to effectively manage occupational exposure to HIV Describe the various PEP regimens and when to use which ones Discuss how to help HCWs overcome fears and biases about working with HIV-infected persons Discuss national guidelines with regard to PEP Discuss post sexual exposure prophylaxis Occupational Exposures Relative risk of viral transmission with sharps injury from infected source: ? HBV (HbsAG positive + unvaccinated HCW) 37% to 62% ? Source HbsAG positive 23% to 37% ? Source HbsAG negative 1.8% ? HIV 0.3% Management of Occupational Blood Exposure Immediate care: wash wounds with soap and water; flush mucous membranes with water Risk assessment: Type of fluid and type of exposure Evaluate source: Test source for HIV serology (rapid test if available) Exposed person: Initiate PEP as quickly as possible (see below) Management of Occupational Blood Exposure, continued Follow-up: HIV exposure (source positive HIV serology or acute HIV with positive HIV RNA) HIV serology at baseline, 1.5, 3 and 6 months Reevaluate and adjust regimen at 72 hours, if taking PEP Monitor for drug toxicity Non- occupational Blood Exposure It is important to understand the relative risk of HIV infection as depicted below Non- occupational Blood Exposure, continued Policies for PEP after sexual exposure exist in some states in the US and in France, Italy, Spain, Switzerland, Australia and at the UN, including WHO. In the US, the US Public Health Service does not recommend for or against prophylaxis after non-occupational exposure due to the lack of data. It is biologically possible that PEP medications taken soon after exposure to HIV can prevent HIV infection. Non- occupational Blood Exposure, continued There is limited evidence available to suggest that antiretroviral medications are efficacious when taken prophylactically. In particular, one study of