POST EXPOSURE PROPHYLAXIS

Post-exposure prophylaxis (PEP) is the short-term use of ARVs to reduce the likelihood of acquiring HIV infection after potential occupational or non-occupational exposure.

Types of Exposure:

  • Occupational exposures: Occur in health care settings and include sharps and needle stick injuries or splashes of body fluids to the skin and mucous membranes
  • Non-occupational exposures: Include unprotected sex, exposure following assault like in rape & defilement, road traffic accidents and injuries at construction sites where exposure to body fluids occur

Steps in providing PEP

Step 1: Rapid assessment and first aid
Conduct a rapid assessment of the client to assess exposure and risk and provide immediate care

Occupation exposure:

After a needle stick or sharp injury:

  • Do not squeeze or rub the injury site
  • Wash the site immediately with soap or mild disinfectant (chlorhexidine gluconate solution) or, use antiseptic hand rub/ gel if no running
    water (do not use strong irritating antiseptics (like bleach or iodine)

After a splash of blood or body fluids in contact with intact skin/broken:

  • Wash the area immediately or use antiseptic hand rub/ gel if no running water (don’t use strong irritating antiseptics)

After a splash of blood or body fluids contact with mucosae:

  • Wash abundantly with water

Step 2: Eligibility assessment

Provide PEP when:

  • Exposure occurred within the past 72 hours; and
  • The exposed individual is not infected with HIV;
    and
  • The ‘source’ is HIV-infected or has unknown HIV status or high risk

Do not provide PEP when:

  • The exposed individual is already HIV positive;
  • When the source is established to be HIV negative;
  • Exposure to bodily fluids that do not pose a significant risk: e.g. to tears, non-blood-stained saliva, urine, and sweat, or small splashes on intact skin
  • Exposed people who decline an HIV test

Step 3: Counseling and support

  • Counsel on:
    • The risk of HIV from the exposure
    • Risks and benefits of PEP
    • Side effects of ARVs
    • Provide enhanced adherence counseling if PEP is prescribed
    • Link for further support for sexual assault cases

Step 4: Prescription

  • PEP should be started as early as possible, and not beyond 72 hours from exposure
  • Recommended regimens:
    • Adults : TDF+3TC+ATV/r
    • Children: ABC+3TC+LPV/r
  • A complete course of PEP should run for 28 days
  • Do not delay the first doses because of lack of baseline HIV Test

Step 5: Follow up

  • To monitor adherence and manage side effects
  • Discontinue PEP after 28 days
  • Perform follow-up HIV testing 6-week, 3 and 6 months after exposure
    • If HIV infected, provide counseling and link to HIV clinic for care and treatment
    • If HIV uninfected, provide HIV prevention education/risk reduction.

Post-rape care

Health facilities should provide the following clinical services as part of post-rape care:

  • Initial assessment of the client
  • Rapid HIV testing and referral to care and treatment if HIV-infected
  • Post-exposure prophylaxis (PEP) for HIV
  • STI screening/testing and treatment
  • Forensic interviews and examinations
  • Emergency contraception – if person reached within the first 72 hours
  • Counselling

The health facility should also identify, refer and link clients to non-clinical services

  • Some of the services include the following:
  • Long term psycho-social support
  • Legal counseling
  • Police investigations, restraining orders
  • Child protection services (e.g. emergency out of family care, reintegration into family care or permanent options when reintegration into family is impossible).
  • Economic empowerment
  • Emergency shelters
  • Long-term case management

Reporting: Health facilities should use HMIS 105 to report Gender Based Violence (GBV)