Exposure prevention is the primary strategy for reducing both occupational and non-occupational HIV transmission.
However, following accidental contact with blood and other body fluids, exposed individuals may be at risk of HIV, Hepatitis B Virus and Hepatitis C Virus infection.
In addition, depending on the type of exposure, other infections, such as tetanus or STIs, or conditions, such as pregnancy, may also occur. Several clinical studies have demonstrated that the provision of post-exposure prophylaxis can reduce HIV transmission.
Post-exposure prophylaxis (PEP) is the immediate provision of preventive measures and medication following exposure to potentially infected blood or other bodily fluids to minimize the risk of acquiring an infection.
Several clinical studies have demonstrated that HIV transmission can be reduced by 81% following the immediate administration of antiretroviral agents.
The timely administration of PEP reduces the occurrence of both occupationally and non-occupationally acquired HIV infection.
Exposure that may warrant Post-exposure prophylaxis (PEP) include parenteral or mucous membrane exposure (sexual exposure and splashes to the eye, nose, or oral cavity) to the following body fluids:
- Blood-stained saliva
- Breast milk
- Genital secretions
- Rectal, peritoneal or
- Pleural fluid.
Exposures that does not require PEP include:
- When the exposed individual is already HIV positive
- When the source is established as HIV negative
- When exposed to body fluid that does not pose a significant risk: tears, urine, sweat, non-blood-stained saliva.
Timing for PEP
PEP should be initiated as soon as possible, preferably within 2 hours after exposure.
Studies suggest that PEP may be substantially less effective if started more than 24-36 hours post-exposure and not effective after 72 hours.
Exposed persons should be re-evaluated within 72 hours after additional information about source is obtained, including serogonic status, viral load, current treatment, and resistance test results or information about factors that would modify recommendations.
Prophylaxis should be continued for four weeks. If PEP fails and the exposed persons becomes HIV infected, he/she should be referred to a CTC for proper HIV care, treatment, and support.
Follow-up of HIV exposed persons:
Follow-up is based on clinical examination and laboratory testing to determine the seroconversion and adverse effects of ARV drugs.
HIV antibody tests should be performed at 6 weeks and 12 weeks.
- HIV testing should also be performed for any exposed person who has an illness that is compatible with an acute retroviral syndrome, irrespective of the interval since exposure.
- If PEP is administered, the exposed person should be monitored for drug toxicity by testing at baseline and 2 weeks after starting PEP.
- All staff, including cleaners and other non-clinical staff, should receive information about PEP and should know how to contact the responsible for instituting PEP is off duty.
- The ARV medications used for PEP should always be accessible, not locked in a cabinet or room.
- It will be the responsibility of the facility supervisor to put systems in place that guarantee the confidentiality of HIV testing results following an exposure.
- All sexually assaulted women should be offered pregnancy testing at baseline and follow up. Emergency contraception should be offered as appropriate to girls and women, as soon as possible within 5 days following sexual exposure.
- Women of childbearing potential (including those who are using long-term effective contraception) should be given adequate information to enable them to make an informed decision on the use of Dolutegravir (DTG).