Post-Exposure Prophylaxis for HIV Following Possible Sexual 
Transmission: An Ethical Evaluation

Post-exposure prophylaxis (PEP) in the form of combination drug therapy is now recommended for healthcare workers following occupational HIV exposure. The expansion of this form of preventive medicine to include other types of HIV transmission, notably through sexual activity, raises a number of ethical concerns.

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Study of sharp injuries and blood splash exposures among healthcare workers in a tertiary hospital in Bangalore

International Journal of Infection Control ◽

10.3396/ijic.v12i3.016.16 ◽

2016 ◽

Vol 12 (3) ◽

Author(s):

Shalini Sivananjiah Pradeep ◽

Suman Gadicherla Raghu ◽

Prathab A G ◽

Banashankari G Rudresh ◽

Radhika Kunnavil

Keyword(s):

Healthcare Workers ◽

Tertiary Hospital ◽

Post Exposure Prophylaxis ◽

Care Hospital ◽

Post Exposure ◽

Increased Risk ◽

Management Procedures ◽

Exposure Prophylaxis ◽

Sharps Injury ◽

Sharps Injuries

The working environment of healthcare workers (HCW) exposes them to sharp injuries. This communication attempts to examine the injury registers, incidence of sharps injuries and blood splash exposures, and the post-exposure prophylaxis status of employees in a tertiary care hospital. Analysis included records form 54 locations of two units of a tertiary hospital attached to a Medical College. Maintenance of the injury register overall was highly satisfactory in both units. Two hundred and nine injuries were recorded from both units of the hospital. The majority of injuries (60.5%) occurred in the age group of 20-30 years with 70% among females. Waste handlers were at increased risk during waste management procedures. Thirty two percent of sharps injury injuries occurred in wards. Of the ward nursing staff, 25.3% received sharps injuries. Post-exposure prophylaxis for Hepatitis B (primary dose) was given to 25 HCWs; 11 received booster doses. The basic regimen for HIV post-exposure prophylaxis was given to 4 HCWs. Awareness about records maintenance, regular documentation, awareness and training, and implementation of appropriate preventive measures can reduce the incidence of injuries. Key words: Sharps, injury register, Health care workers (HCW),Post exposure prophylaxis (PEP)

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986. Improvement in Administration of HIV Post-Exposure Prophylaxis in the Emergency Department Following Sexual Assault

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.1172 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S521-S522

Author(s):

Jennifer R Silva-Nash ◽

Stacie Bordelon ◽

Ryan K Dare ◽

Sherrie Searcy

Keyword(s):

Emergency Department ◽

Sexual Assault ◽

Hiv Transmission ◽

Post Exposure Prophylaxis ◽

Intervention Period ◽

Post Intervention ◽

Post Exposure ◽

Assault Victims ◽

Exposure Prophylaxis

Abstract Background Nonoccupational post exposure prophylaxis (nPEP) following sexual assault can prevent HIV transmission. A standardized Emergency Department (ED) protocol for evaluation, treatment, and follow up for post assault victims was implemented to improve compliance with CDC nPEP guidelines. Methods A single-center observational study of post sexual assault patients before/after implementation of an ED nPEP protocol was conducted by comparing the appropriateness of prescriptions, labs, and necessary follow up. A standardized order-set based on CDC nPEP guidelines, with involvement of an HIV pharmacist and ID clinic, was implemented during the 2018-2019 academic year. Clinical data from pre-intervention period (07/2016-06/2017) was compared to post-intervention period (07/2018-08/2019) following a 1-year washout period. Results During the study, 147 post-sexual assault patients (59 Pre, 88 Post) were included. One hundred thirty-three (90.4%) were female, 68 (46.6%) were African American and 133 (90.4%) were candidates for nPEP. Median time to presentation following assault was 12.6 hours. nPEP was offered to 40 (67.8%) and 84 (95.5%) patients (P< 0.001) and ultimately prescribed to 29 (49.2%) and 71 (80.7%) patients (P< 0.001) in pre and post periods respectively. Renal function (37.3% vs 88.6%; P< 0.001), pregnancy (39.0% vs 79.6%; P< 0.001), syphilis (3.4% vs 89.8%; P< 0.001), hepatitis B (15.3% vs 95.5%; P< 0.001) and hepatitis C (27.1% vs 94.3%) screening occurred more frequently during the post period. Labratory, nPEP Prescription and Follow up Details for Patients Prescribed nPEP Conclusion The standardization of an nPEP ED protocol for sexual assault victims resulted in increased nPEP administration, appropriateness of prescription, screening for other sexually transmitted infectious and scheduling follow up care. While guideline compliance dramatically improved, further interventions are likely warranted in this vulnerable population. Disclosures Ryan K. Dare, MD, MS, Accelerate Diagnostics, Inc (Research Grant or Support)

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Predictors of adherence to HIV Post-Exposure Prophylaxis protocol among frontline healthcare workers at the Ho Teaching Hospital, Ghana

International Journal of Infectious Diseases ◽

10.1016/j.ijid.2021.03.079 ◽

2021 ◽

Author(s):

Rita Esi Suglo ◽

Fortress Yayra Aku ◽

Judith A. Anaman-Torgbor ◽

Elvis Enowbeyang Tarkang

Keyword(s):

Teaching Hospital ◽

Healthcare Workers ◽

Post Exposure Prophylaxis ◽

Post Exposure ◽

Exposure Prophylaxis ◽

Frontline Healthcare Workers ◽

Predictors Of Adherence

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Post-exposure prophylaxis

International Journal of STD & AIDS ◽

10.1258/095646202762226137 ◽

2002 ◽

Vol 13 (1_suppl) ◽

pp. 30-34 ◽

Cited By ~ 6

Author(s):

◽

Marchina E Van Der Ende ◽

Rosa M Regez ◽

Gerrit Schreij ◽

Jan T M Van Der Meer ◽

...

Keyword(s):

The Netherlands ◽

Hiv Transmission ◽

Standard Procedure ◽

High Plasma ◽

Antiretroviral Drugs ◽

Post Exposure Prophylaxis ◽

Serious Adverse Events ◽

Post Exposure ◽

Occupational Setting ◽

Exposure Prophylaxis

The mean risk of acquiring HIV after an occupational exposure, injecting drug use or sexual exposure varies from <0.1 to 3%. A high plasma HIV-RNA of the source increases the risk of each of the exposures. Other factors, such as the volume of the inoculum involved to which the individual was exposed, other sexually transmitted diseases and ruptures of mucous membranes are associated with a higher risk of HIV transmission. Based on the calculated risk, post-exposure prophylaxis (PEP) should be recommended. In the Netherlands, prescription of PEP in the occupational setting is a standard procedure and has proved to be feasible. This was associated with a high percentage (62%) of mild and reversible toxicity and a small percentage (2%) of serious adverse events related to antiretroviral drugs, i.e. nephrolithiasis (due to indinavir) and toxic hepatitis (due to nevirapine). In The Netherlands so far no HIV-seroconversions have been recorded after an occupational accident.

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Understanding the magnitude of occupational exposure to human immunodeficiency virus (HIV) and uptake of HIV post-exposure prophylaxis among healthcare workers in a rural district in Tanzania

Journal of Hospital Infection ◽

10.1016/j.jhin.2015.04.024 ◽

2017 ◽

Vol 96 (3) ◽

pp. 276-280 ◽

Cited By ~ 2

Author(s):

P. Mabwe ◽

A.T. Kessy ◽

I. Semali

Keyword(s):

Human Immunodeficiency Virus ◽

Occupational Exposure ◽

Healthcare Workers ◽

Rural District ◽

Post Exposure Prophylaxis ◽

Post Exposure ◽

Immunodeficiency Virus ◽

Exposure Prophylaxis

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Post-exposure prophylaxis in resource-poor settings: review and recommendations for pre-departure risk assessment and planning for expatriate healthcare workers

Tropical Medicine & International Health ◽

10.1111/tmi.12080 ◽

2013 ◽

Vol 18 (5) ◽

pp. 588-595 ◽

Cited By ~ 3

Author(s):

Nidhi Vaid ◽

Katherine M. Langan ◽

Richard J. Maude

Keyword(s):

Risk Assessment ◽

Healthcare Workers ◽

Post Exposure Prophylaxis ◽

Post Exposure ◽

Resource Poor ◽

Exposure Prophylaxis

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Post-exposure prophylaxis following occupational exposure to HIV and hepatitis B: an analysis of a 12-year record in a Nigerian tertiary hospital

Journal of Infection Prevention ◽

10.1177/1757177417746733 ◽

2017 ◽

Vol 19 (4) ◽

pp. 184-189 ◽

Cited By ~ 4

Author(s):

Salisu Abubakar ◽

Garba Iliyasu ◽

Farouq Muhammad Dayyab ◽

Salisu Inuwa ◽

Rabiu Alhassan Tudun Wada ◽

...

Keyword(s):

Occupational Exposure ◽

Hepatitis B ◽

Healthcare Workers ◽

Tertiary Hospital ◽

Post Exposure Prophylaxis ◽

Post Exposure ◽

Increased Risk ◽

Exposure Prophylaxis ◽

North Western

Background: Healthcare workers (HCWs) have an increased risk of occupational exposure to blood-borne pathogens. Aims/objectives: We aim to examine the utilisation and outcome of post-exposure prophylaxis (PEP) for both HIV and hepatitis B (HBV) among HCWs. Methods: This was a retrospective study conducted in a tertiary hospital in North-Western Nigeria. We reviewed data on HIV or HBV PEP given to HCWs between 2004 and 2016. Results: A total of 115 HCWs presented for PEP during the study period. Intern doctors were the most exposed group (40/115; 34.8%). There were 86/115 (74.8%) needle stick exposures. While 53/115 (46.1%) of the sources of exposure were HIV-positive, 9/115(7.83%) were HBV-positive. Zidovudine-based regimen (40/70) was the most commonly prescribed. No seroconversion occurred among those that completed PEP treatment and follow-up. Discussion: No seroconversion occurred among those that received either or both HIV and HBV PEP and completed PEP treatment.

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