More infomation about PEP for HIV prevention
What it is
Post-exposure prophylaxis (PEP) is short-term antiretroviral treatment to reduce the likelihood of HIV infection after potential exposure, either occupationally or through sexual intercourse. Within the health sector, PEP should be provided as part of a comprehensive universal precautions package that reduces staff exposure to infectious hazards at work.
Why it is important
The risk of transmission of HIV from an infected patient through a needlestick where the skin is punctured by a sharp is less than 1%. The risk for transmission from exposure to infected fluids or tissues is believed to be lower than for exposure to infected blood.
The risk of exposure from needlesticks and other means exists in many settings where protective supplies are limited and the rates of HIV infection in the patient population are high. The availability of PEP may reduce the occurrence of occupationally acquired HIV infection in health care workers. It is believed that the availability of PEP for health workers will serve to increase staff motivation to work with people infected with HIV, and may help to retain staff concerned about the risk of exposure to HIV in the workplace.
There is significant debate on the need to use PEP after sexual exposure. The UN offers PEP to its staff in cases of rape when the likelihood of HIV exposure is considered high.
How it is done
The proper use of supplies, staff education and supervision needs should be outlined clearly in institutional policies and guidelines.
Regular supervision in health care settings can help to deter or reduce risk of occupational hazards in the workplace. If injury or contamination result in exposure to HIV infected material, post exposure counselling, treatment, follow-up and care should be provided. Post-exposure prophylaxis (PEP) with antiretroviral treatment may reduce the risk of becoming infected.
Prevention of exposure
Prevention of exposure remains the most effective measure to reduce the risk of HIV transmission to health workers. The priority must be to train health workers in prevention methods (universal precautions) and to provide them with the necessary materials and protective equipment. Staff should as well be knowledgeable about risks of acquiring HIV sexually, and be easily able to access condoms and confidential STI treatment services.
Managing occupational exposure to HIV
- First AID should be given immediately after the injury: wounds and skin sites exposed to blood or body fluids should be washed with soap and water, and mucous membranes flushed with water.
- The exposure should be evaluated for potential to transmit HIV infection (based on body substance and severity of exposure).
- The exposure source should be evaluated for HIV infection. Testing of source persons should only occur after obtaining informed consent, and should include appropriate counselling and care referral. Confidentiality must be maintained.
- Clinical evaluation and baseline testing of the exposed health care worker should proceed only after informed consent.
- Exposure risk reduction education should occur with counsellors reviewing the sequence of events that preceded the exposure in a sensitive and non-judgmental way.