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A presentation on pep kie

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A Brief of HIV Post Exposure Prophylaxis following Sexual Violence

A Brief of HIV Post Exposure Prophylaxis following Sexual Violence

Published in: Education

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  • 1. A PRESENTATION ON POST EXPOSURE PPROPHYLAXIS PURITY KAJUJU LIVERPOOL VCT, CARE & TREARTMENT 27 TH APRIL 2010
  • 2. POST EXPOSURE PROPHYLAXIS (PEP)
    • Administration of a combination of Anti-Retroviral drugs (ARV’s) for 28 days following exposure to HIV.
    • PEP is recommended for men, women, girls and boys at risk of HIV infection.
    • The 2004 National ARV guidelines suggest offering 2 ARV’s for PEP.
    • The WHO/ILO PEP guidelines also recommend duo therapy (WHO, 2007).
    • Administered by a trained health practitioner
  • 3. SOURCES OF EXPOSURE
    • 1 . Body fluids containing HIV –
    • High Risk: Blood, pus, breast milk
    • Low risk – saliva,
    • 2. Sexual intercourse - semen, vaginal secretions
    • 3. Needle prick injuries
  • 4. RISK OF EXPOSURE
    • dependent upon:
    • health care personnel practices
    • the prevalence of the illness
    • the amount and frequency of exposure
  • 5. WHEN TO PRESCRIBE PEP
    • High risk exposure + known source status, HIV positive
    • High risk exposure + Known source HIV negative + Risk factors
    • High risk exposure + Unknown source status
  • 6. WHEN SHOULD YOU NOT OFFER PEP?
    • After exposure through any route with low
    • risk materials (e.g. urine, vomit, saliva,
    • faeces) unless they are visibly bloodstained
    • Where testing has shown that the source is HIV negative, or if risk assessment has
    • concluded that HIV infection of the source
    • is highly unlikely
  • 7. TIMING OF PEP FOR HIV
    • The efficacy of PEP decreases with the length of time from exposure to the first dose.
    • Administering the first dose is a priority.
    • Effective up to 80% if given within 72hrs , but ASAP after the exposure.
    • 72 hours after assault, PEP is not effective, but offer all other aspects of post rape care.
  • 8. COMMON SIDE EFFECTS ARE
    • nausea
    • headaches
    • tiredness
    • general aches and pains
    • -Reduce SE by taking pills with food.
    • -These SE improve with time.
    • -Short course do not cause any long-term damage.
    • -Lab clinical monitoring important.
  • 9. MONITORING FOR PEP Baseline, within 3 days of starting PEP
    • Blood
    • HIV
    • - HIV negative, continue PEP.
    • HIV positive, discontinue PEP, refer to care.
    • Hemoglobin level.
    • ALT/Creatinine – Liver functions
    • Urine
      • PDT – Pregnancy test
      • Microscopy
    • (DNA Analysis)
      • Hair
      • Nail clippings/scrapings
      • Body Fluid
  • 10. PEP FOR SEXUAL ASSAULT SURVIVORS
  • 11. ASSESSMENT TO DETERMINE WHETHER PEP IS INDICATED
    • Assess and carefully weigh the
    • following factors:
    • whether or not a significant exposure has
    • occurred during the assault
    • knowledge of the HIV status of the alleged
    • assailant
    • whether the survivor is ready and willing to
    • complete the PEP regimen
  • 12. DEGREE OF RISK BASED ON TYPE OF EXPOSURE
    • significant exposure
    • Provide PEP
    • Where direct contact of the vagina, anus, or mouth with
    • the semen or blood of the alleged assailant, with or
    • without physical injury, tissue damage, or presence of
    • blood at the site of the assault.
    • Or where broken skin or when mucous membranes of
    • the survivor have been in contact with blood or semen
    • of the alleged assailant.
    • In cases of bites that result in visible blood.
  • 13. CONSIDERING THE HIV STATUS OF THE ALLEGED ASSAILANT
    • Unless the identity and HIV status of the alleged
    • assailant has been clearly established to assist with the
    • decision-making:
    • PEP should be promptly initiated when a significant risk
    • exposure has occurred.
    • Even when the alleged assailant is known to be HIV
    • infected, the decision to recommend PEP should be based on the nature of the exposure and the survivor’s ability to complete the regimen.
    • If prophylaxis has been initiated and the alleged assailant
    • is found to be HIV antibody negative, then PEP should be
    • discontinued.
  • 14. FOLLOW-UP HIV TESTING
    • HIV Antibody testing for 6 months post-exposure at 6 weeks, 3 months, 6 months
    • Viral Load testing not recommended unless HIV Infection suspected
  • 15. POST-EXPOSURE PROPHYLAXIS: CORE PRINCIPLES
    • Evidence is limited
    • Balancing of risks vs. benefits
    • Timing: the sooner the better, but interval beyond which there is no benefit is unclear
    • Optimal duration unclear, 28 days is recommended
    • Decision making can get very complex when resistance in PEP suspected
  • 16. POST-EXPOSURE PROPHYLAXIS: CORE PRINCIPLES
    • SEX PEP SHOULD BE CONSIDERED FOR RISKY EXPOSURES AND DOES NOT APPEAR TO INCREASE UNSAFE SEXUAL BEHAVIOR FOR MOST RECIPIENTS.
  • 17.
    • Questions????
    • Thank you wonderful people!!