Occupational Post-exposure Prophylaxis Research Articles

Experiences of the National Post-Exposure Prophylaxis Hotline (PEPline): Occupational PEP consultation needs and trends, 2014 to 2022

The National Clinician Consultation Center operates the Post-Exposure Prophylaxis Hotline (PEPline), a federally-funded educational resource providing bloodborne pathogen exposure management teleconsultation to US clinicians. Sixty-seven thousand one hundred nine occupational post-exposure prophylaxis (PEP) consultations (January 2014 to December 2022) were retrospectively analyzed to describe PEPline utilization and common inquiries addressed by National Clinician Consultation Center consultants. Most calls involved percutaneous incidents (70%); blood was the most common body fluid discussed (60%). Inpatient units were the most common exposure setting (35%) and licensed nursing professionals were the most common category of exposed workers (28%). Of 2,295 calls where workers had already initiated PEP for human immunodeficiency virus (HIV) prevention and time to first dose was known, 9% had initiated HIV PEP within 2hours of exposure; almost 80% had initiated HIV PEP between 2 and 24hours; 3% after 24 to 36hours; 5% after 36 to 72hours; and 2% after 72hours. Calls from urgent care providers increased by 10% over time. Overall, more than 90% of callers requested support on risk assessment, including source person testing; other common questions involved PEP side effects and follow-up care. PEPline consultations can help raise awareness about PEP availability and timely initiation, and reduce stigma by addressing common misperceptions about bloodborne pathogen transmission mechanisms and likelihood, particularly regarding HIV.

Occupational Post-exposure Prophylaxis after Blood and Body Fluids Exposure among Healthcare Workers in Siriraj Hospital

Objective: The present study aimed to describe the characteristics of occupational exposure to bloodborne pathogens and occupational post-exposure prophylaxis (oPEP) in Siriraj Hospital.
 Materials and Methods: A descriptive, retrospective cohort study was performed of healthcare workers (HCWs) who had experienced occupational injury in Siriraj Hospital in 2015. Data were extracted from the hospital database.
 Results: In total, 389 injury episodes were described; of which 293 (75.3%) involved female staff, and 112 (28.8%) involved nurses. The highest number of accidents (112, 28.8%) occurred in the operation room. Needlestick injury (210, 54%) was the most common injury. Overall, 94 (24.1%) HCWs received oPEP; 67 (71.2%) events carried a risk of HIV acquisition, and in 27 (28.7%) cases, the patients decided to take oPEP. Common oPEP regimens were TDF/XTC/LPV/r (33, 35.1%) and TDF/XTC/RPV (32, 34%). Nearly half of the HCWs who received an LPV/r-based oPEP regimen had gastrointestinal intolerance and switched to second-line regimens. Among those who received oPEP, 52 (77.6%) returned at 1 month and 26 (38.8%) returned at 3 months after exposure for a serology test. There was no seroconversion in this cohort.
 Conclusion: Occupational exposure to bloodborne pathogens is a common and increasing risk of infection among HCWs. oPEP with effective antiretroviral drugs within 72 hours after exposure is the main strategy for HIV prevention. The selection of an oPEP regimen with less toxic pills should be considered for efficacy, safety, and adherence. Interventions such as a tracking system or message reminders should be implemented to improve the follow-up rate among HCWs.

Clinical Outcomes of Post-exposure Prophylaxis following Occupational Exposure to Human Immunodeficiency Virus at Dental Departments of Hiroshima University Hospital.

BackgroundDental professionals have so many opportunities to use injection needles and sharp instruments during dental treatment that they face an increased risk of needlestick injuries. This retrospective study reports the utilization and clinical outcomes of occupational post-exposure prophylaxis (PEP) with anti-retroviral agents after being potentially exposed to HIV at the dental departments of Hiroshima University Hospital.ObjectiveThis study reports the utilization and clinical outcomes of occupational post-exposure prophylaxis (PEP) with antiretroviral agents after being potentially exposed to HIV at dental departments of Hiroshima University Hospital.MethodsData on the clinical status of HIV-infected source patients and information on HIV-exposed dental professionals from 2007 to 2018 were collected.ResultsFive dentists with an average experience of 5.6 years (1-15 years) were exposed. The averaged CD4-positive cell number and HIV-RNA load were 1176 (768-1898) /μl and less than 20 copies/ml, respectively, in all the patients. Two of the five HIV exposed dentists received PEP. Three months after the exposures, all of their results were negative in HIV antibody/antigen tests.ConclusionThese data might support the concept of “undetectable equals untransmittable”, although HIV exposure in this study was not through sexual transmission.

Survey of 104 MSM before drug uptake of HIV non-occupational post-exposure prophylaxis in Guangxi

Objective This survey aims to understand AIDS knowledge, behavioral characteristics, awareness of non- occupational post-exposure prophylaxis (nPEP), and reasons for using nPEP, the possible impact on behavior change after receiving services among 104 men who have sex with men (MSM) prior to drug uptake of nPEP in 2 cities of Guangxi. Methods Participants were recruited through community advocacy in Nanning and Liuzhou. A face-to-face questionnaire survey was conducted on MSM who agreed to participate in investigation before taking medication of HIV nPEP. P <0.05 was considered statistically significant, and descriptive analysis was conducted. Results AIDS awareness of 104 MSM respondents reached 98.1% (102/104), and 84.6% (88/104) believed that the HIV prevalence was serious among MSM group in the area where they living. In the past six months, no respondents insisted on condom use each time during homosexual activities, and 54.8% (57/104) experienced condoms torn/ slipped or being deliberately pulled out by sexual partners; 64.4% (67/104) had no fixed partners in the last six months. 88.5% (92/104) had heard of nPEP before the survey, univariate analysis indicated that there was statistically significant difference between nPEP awareness and receiving condom promotion/AIDS voluntary counseling & testing as well as peer education in the past year ( P <0.05). 69.2%(72/104) received nPEP since worrying about the probability of HIV infection by the exposure, while 67.3% (72/104) took the service because they did not understand HIV serological status of sexual partners. If received nPEP, only 9.6% (10/104) believed that condom use would decrease, and 15.4% (16/104) thought the number of sexual partners would increase. Conclusion Separation between AIDS knowledge and action among MSM requires a comprehensive prevention and control strategy that emphasizes biomedical approaches and behavioral interventions. The role of networks and Non-Governmental Organization (NGO) in nPEP publicity should be highlighted to increase the awareness of nPEP among target population. 摘要： 目的 分析广西南宁市、柳州市 104 名男男性行为者(men who have sex with men, MSM)在接受艾滋病非职 业暴露后预防(non-occupational post-exposure prophylaxis, nPEP)用药前的相关艾滋病知识掌握情况、行为学特征、 nPEP 知晓度、使用 nPEP 原因及接受服务后对行为改变可能产生的影响等。 方法 在南宁、柳州市通过社区宣传倡导， 现场招募研究对象。对纳入艾滋病非职业暴露后预防并同意在服药前接受调查的 MSM 开展面对面问卷调查。以 P < 0.05 为差异有统计学意义，对资料进行描述性分析。 结果 104 名 MSM 的艾滋病知晓率为 98.1%(102/104)；认为所生 活地区的 MSM 人群中 HIV 流行严重的占 84.6%(88/104)。最近半年同性性行为时能每次使用安全套的 0 人，54.8%(57/ 104)经历过安全套意外破裂、脱落或被性伴故意拔套，64.4%(67/104)最近半年内没有固定性伴。88.5%(92/104)调查 前听说过 nPEP，单因素分析发现，最近一年接受过安全套宣传与发放/艾滋病咨询与检测、最近一年接受过同伴教育对 nPEP 知晓差异有统计学意义( P <0.05)。69.2%(72/104)选择 nPEP 因为担心此次暴露会感染 HIV，67.3%(72/104)表示 性伴感染状况未知。若接受 nPEP，仅有 9.6%(10/104)认为安全套使用会减少，15.4%(16/104)认为性伴数会增加。 结论 MSM 存在艾滋病“知信行分离”，需采取生物医学干预技术和行为干预并重的综合性防治策略。重视网络和社 会组织在 nPEP 宣传中的作用，提高人群知晓率。

Mobile application development structured in self-care for occupational post-exposure prophylaxis to biological material.

to develop and validate an application for cellphones structured in self-care to encourage adherence to antiretroviral prophylaxis after occupational exposure to biological material. phase 1 - descriptive study to identify characteristics of occupational exposure; phase 2 - methodological study to construct and validate an application content aiming to increase adherence to antiretrovirals. phase 1 - 55 occupational exposures were recorded; 32 (58.2%) antiretroviral indication. Blood was present in 96.9% of exposures; most professionals have insufficient knowledge about exposure risks. A statistical relationship was identified between self-care and adherence (p<0.001). Phase 2 - application was constructed, validated by 11 experts, and considered appropriate to encourage health professionals for self-care and adherence to antiretrovirals. the application "Exposição Ocupacional ao HIV" was considered adequate to expand self-care and adherence of professionals to prophylactic treatment to occupational infections arising from biological risks.

Non-Occupational HIV Post-exposure Prophylaxis: A 10-Year Retrospective Review of Data Following Sexual Exposure From Yaounde Central Hospital, Cameroon.

Background:Human Immunodeficiency Virus (HIV) post exposure prophylaxis (PEP) consists of administering antiretroviral therapy within 72 hours of viral exposure and continued for four weeks. PEP has been shown to be an important means of preventing and decreasing the number of new HIV infections in the general population. The purpose of this study was to describe the profile of patients who consulted at the HIV/AIDS Care and Treatment Center of the Yaounde Central Hospital (YCH) for PEP following non-occupational exposure to HIV. To attain our objective, we carried out a 10-year retrospective review of patient records of all persons who consulted for accidental HIV exposure at the YCH, Cameroon.Methods:This study was an observational, retrospective analysis of hospital records of persons who consulted for PEP following accidental exposure to HIV in the outpatient HIV clinic at YCH between January 2007 and December 2016. Data extracted from patients’ records were: type of HIV exposure, sex, age, profession, level of education, HIV status of source and time to consultation. Descriptive and inferential statistics were analyzed using STATA IC 12.0. Results were presented as median and interquartile range for continuous variables. Categorical variables were expressed as frequencies and proportions.Results:There were 628 consultations for PEP of which 48% (299/628) were as a result of non-occupational post exposure prophylaxis (nPEP). Of those who consulted for HIV PEP following non-occupational exposure, 78% (234/299) were females; adolescents group (15-19 years) and young adults group (20 – 24yrs.) constituted 41% (125/299). Forty percent (1208/299) were secondary or high school students (level of education) and 88% (262/299) were non-healthcare workers. The median time-to-consultation for non-occupational PEP (nPEP) was 19 hours (IQR: 12.4-25.0) and HIV status of the source was unknown in 64% (191/299) of cases and positive for 8% (25/299) of cases. The most frequent indications for consulting were sexual assault, 75% (224/299); condom slippage or breakage, 10% (30/299); and unprotected consensual sexual intercourse, 15% (45/299).Conclusion and Global Health Implications:Consultations for nPEP are as frequent as those occupational PEP (48% vs 52% in this study) in clinical practice at YCH. A good history of the source is important as it prevents unnecessary prescriptions of ART (which themselves have potential side effects) for persons consulting for potential HIV non-occupational exposure. In our study, we found that 27% (82/299) unnecessary ART prescriptions were avoided by determining that the exposure source person had negative HIV status. In addition, adolescent or young females consulting for nPEP in clinics could be potential victims of sexual assault or gender-based violence. Where possible, we recommend that clinicians consider the source of suspected viral exposure in clinical practice prior to administering ART for PEP.

Knowledge on Handling of HIV and HBV Patients and Occupational Post-Exposure Prophylaxis against HIV and HBV: Effectiveness of Training Programme for Nurses

Background: During the course of health care of patients, thousands of health care workers suffer occupational exposures among which nurses have high chances of exposure to blood-borne pathogens as they are the primary health care providers to patients in hospitals. Post-exposure prophylaxis has become routine following the occupational exposure of HCWs to HIV and HBV. So it is important that nurses keep their knowledge updated regarding handling of HIV and HBV patients and how to manage occupational exposure. Method: A training programme for nurses was conducted by a tertiary care hospital and their knowledge regarding occupational exposure management and handling of HIV and HBV patients was assessed through pre-test and post-test questionnaire. Result: Total 36 clinically registered nurses participated. The mean score of pre-test was 8.7 which increased to 10.1 in post-test. The knowledge related to PEP and handling of HIV and HBV patients improved significantly after the training class (p=0.0001 and 0.002 respectively). Conclusion: The nurses are quite prone for occupational exposure to HIV and HBV and the findings of this study highlight the importance of continuous training of nurses so that they have a comprehensive understanding of PEP and standard precautions. Thorough orientation to the PEP procedure will help them access appropriate medical advice in a timely manner.

Tolerability of Tenofovir-Lamivudine-Rilpivirine as the Human Immunodeficiency Virus (HIV) Occupational Post-exposure Prophylaxis For HIV Infection

Tolerability of Tenofovir-Lamivudine-Rilpivirine as the Human Immunodeficiency Virus (HIV) Occupational Post-exposure Prophylaxis For HIV Infection

Development of an Intervention to Increase Occupational Postexposure Prophylaxis in Sub-Saharan Africa

Development of an Intervention to Increase Occupational Postexposure Prophylaxis in Sub-Saharan Africa

Knowledge and uptake of occupational post-exposure prophylaxis amongst nurses caring for people living with HIV.

BackgroundNurses caring for people living with HIV (PLWH) are at higher risk of exposure to the human immunodeficiency virus (HIV) by needle sticks, cuts, getting body fluids in their eyes or mouth and skin when bruised or affected by dermatitis.ObjectivesTo determine knowledge, insight and uptake of occupational post-exposure prophylaxis (OPEP) amongst nurses caring for PLWH.MethodA cross-sectional descriptive design was used in this study. Stratified random sampling was used to sample 240 nurses. The study was conducted in a regional hospital in Limpopo province. Both parametric and non-parametric statistics were employed to analyse data.ResultsA total of 233 nurses participated in the study. Sixty per cent (n = 138) of all nurses had a situation at work when they thought that they were infected by HIV and 100 (43%) nurses had experienced the situation once or more in the past 12 month. Approximately 40% did not know what PEP (post-exposure prophylaxis) is, and 22% did not know or were not sure if it was available in the hospital. Only few participants (n = 68, 29%) had sought PEP and most (n = 37, 54%) of them did not receive PEP when they needed it. There was a significant association between the knowledge and availability of PEP (r = 0.622).ConclusionThe study recommend an urgent need for policy makers in the health sector to put in place policies, guidelines and programmes that will rapidly scale up PEP services in health care settings, so that preventable occupationally acquired HIV infection can be minimised amongst nurses.

Significant intolerability of efavirenz in HIV occupational postexposure prophylaxis

Completion of human immunodeficiency virus (HIV) occupational postexposure prophylaxis (PEP) is important for successful prophylaxis. To determine factors associated with failure to complete the four-week HIV PEP. A retrospective study was conducted among healthcare workers (HCWs) accidentally exposed to blood or body fluids of patients at the Bamrasnaradura Infectious Diseases Institute, Thailand, between March 1996 and June 2014. Logistic regression analysis was used to determine factors associated with failure to complete the four-week HIV PEP. In total, 225 exposure episodes were reported. The mean age of HCWs was 33.1 (standard deviation 9.9) years, and 189 (84%) were female. Nurses (43%) were exposed most frequently. The HIV status of the source was defined in 149 (66%) episodes, and 101 (68%) of these were positive. Of 225 exposures, PEP was prescribed in 155 (69%) cases, with intentional discontinuation in 26 cases. Ninety-one of 129 (71%) HCWs completed the four-week regimen. Multi-variate analysis showed that a regimen of two nucleotide reverse transcriptase inhibitors (NRTI) + efavirenz (EFV) was the only significant factor associated with non-completion of the four-week course (odds ratio 37.8, 95% confidence interval 4.2-342.3; P < 0.01). Other factors including age, sex, staff position, status of the source and other PEP regimens were not associated with non-completion of the four-week course (P > 0.05). None of the HCWs were documented to have HIV seroconversion. A regimen of two NRTIs + EFV was significantly associated with premature discontinuation of occupational PEP. This regimen should not be used for HIV prophylaxis following occupational exposure.

Occupational post-exposure prophylaxis (PEP) against human immunodeficiency virus (HIV) infection in a health district in Cameroon: assessment of the knowledge and practices of nurses.

BackgroundHealth care providers are at risk of acquiring human immunodeficiency virus (HIV) infection from occupational exposure, with nurses being the most vulnerable. There is no data on the awareness of post-exposure prophylaxis (PEP) among nurses in Cameroon. This study aimed to assess the knowledge, practices of nurses regarding PEP for HIV and their determinants in Cameroon.MethodsA cross-sectional study was conducted between April and July 2013, and involved 80 nurses in a rural health district in the North West Region of Cameroon. Data was collected using a structured questionnaire and analysed using the SPSS software version 20.ResultsIn all, 73.7% of the participants had poor knowledge about PEP for HIV. Though many (83.8%) had heard about PEP, just 10 (12.5%) had received formal training on PEP for HIV. Only 24 (30%) and 20 (25%) knew the correct drug regimen and duration of treatment respectively. The majority (85%) considered themselves to be at risk of acquiring HIV at work, with 54 (67.5%) having experienced an exposure in the past, mainly while setting up intravenous lines (57.4%), recapping needles (37.0%) and during delivery (24.1%). Of those exposed, ten (18.9%) received PEP, which was started after 24 hours in 50%. In multivariable regression analyses, awareness of hospital policy [OR: 0.043 (0.005–0.404), p-value = 0.006] was associated with Good knowledge on PEP for HIV.ConclusionsThe knowledge and practice of nurses on PEP for HIV in Cameroon is low. There is urgent need for training programmes and workshops to increase awareness, improve practice, and reduce the risk of HIV acquisition from work related activities among health care providers.

Timing, Adherence, Resistance, and ... Persistence? New Insight Into the Mechanisms of Failure of HIV Type 1 Postexposure Prophylaxis

Timing, Adherence, Resistance, and ... Persistence? New Insight Into the Mechanisms of Failure of HIV Type 1 Postexposure Prophylaxis

Assessment of knowledge, attitudes and practices of healthcare workers on occupational HIV post-exposure prophylaxis at a Zimbabwean referral hospital

Objectives : Occupational exposure to blood and body fluids is a serious concern for healthcare workers, and presents a major risk for the transmission of blood-borne infections such as HIV. The prevention of exposures to blood and body fluids is the primary means of preventing occupationally acquired human immunodeficiency virus (HIV) infection; however it has been found that the appropriate use of post-exposure prophylaxis (PEP) is important in the prevention of HIV infection in exposed healthcare workers. The aims of this study were to assess the level of knowledge, attitudes and practices of healthcare workers at Parirenyatwa Hospital on occupational HIV post-exposure prophylaxis. Methods : A cross-sectional survey using a self-administered structured questionnaire was conducted from mid-January 2012 up to the end of February 2012. Systematic random sampling was used to select individuals to participate in the study. Data was entered into and analyzed using Microsoft Excel. Results : A total of 164 questionnaires were distributed and 131 were returned giving a response rate of 80%. The results of the study show that majority of the participants had poor knowledge of occupational HIV PEP. 65% of the respondents scored less than 50% in the section on knowledge, which was regarded as poor knowledge. Only 5% of the respondents scored above 75% which was regarded as good knowledge. Participants were found to have a positive attitude towards HIV PEP. The majority (93%) of respondents expressed willingness to undergo PEP in case of exposure. Out of the 49 respondents who reported a previous exposure to potentially infectious body fluids, only 45% sought PEP. Conclusion : The study found that there are inadequate levels of knowledge on occupational HIV PEP among HCWs at Parirenyatwa Hospital. Attitude was found to be positive; however, the actual rate of PEP uptake among those who were exposed was low.

Awareness and attitude of Nigerian dentists to occupational HIV post-exposure prophylaxis

Background: The incidence of human immunodeficiency virus infection in Nigeria remains worrisome. Dentists are increasingly becoming at risk of occupational exposure to the virus. Post-exposure prophylaxis is known to reduce the risk of sero-conversion when appropriately administered. This study assessed the awareness and attitude of Nigerian Dentists towards post-exposure prophylaxis.Methods: A total of 177 Nigerian Dentists from the geopolitical regions of Nigeria were surveyed in 2003 by use of a self-administered questionnaire in a cross sectional, purposive, pilot study and assessed for awareness and attitude to HIV post-exposure prophylaxis.Results: The mean age of respondents was 33.2 years (S.D = 7.66). Sixty-one percent were males while 39% were females. Seventy five percent are General Dental Practitioners and 25% Specialists. Similarly,80.8% are government employed and 19.2% in private practice. About 58.8% of the total respondents reported being aware of occupational post exposure prophylaxis, 33.3% were not aware while 7.9% were unsure. About 84.7% indicated a willingness to accept, 5.1% were not willing to accept and 10.2% were unsure of whether to accept or reject the post-exposure prophylaxis regime. By geopolitical zone, Dental Surgeons from the South West (63.5%) were more aware of PEP than other zones while Dentists from the North Central and North West (88%) were most willing to accept post-exposure prophylaxis. Only 38.9% had attended continuing medical education on human immunodeficiency virus/acquired immune deficiency disease in the preceeding two years.Conclusion: This study indicates that slightly over half the population of Nigeria Dentists is aware of and have good attitude to occupational human immunodeficiency virus post-exposure prophylaxis treatment. Continuing medical education programmes on human immunodeficiency virus/acquired immune deficiency disease is recommended.

Nonoccupational postexposure prophylaxis for human immunodeficiency virus in Sub-Saharan Africa: A systematic review

Both HIV and sexual assault remain major public health problems in Sub-Saharan Africa. This review examines the state of the science regarding provision of non- occupational post-exposure prophylaxis following sexual assault in Sub-Saharan African countries over the last 10 years. Specifically, rates of provision of HIV nPEP, the number of patients accepting nPEP, patients' rates of completing the HIV nPEP regimen as defined by the individual studies, and patients' perceptions of HIV nPEP from qualitative data.

HIV prevention – where now? Background and introduction

HIV prevention – where now? Background and introduction

Awareness and attitude of nigerian dentists to occupational HIV post-exposure prophylaxis

Awareness and attitude of nigerian dentists to occupational HIV post-exposure prophylaxis

Tolerability of Two Different Combinations of Antiretroviral Drugs Including Tenofovir Used in Occupational and Nonoccupational Postexposure Prophylaxis for HIV

Tolerability of Two Different Combinations of Antiretroviral Drugs Including Tenofovir Used in Occupational and Nonoccupational Postexposure Prophylaxis for HIV

Training health care workers to promote HIV services for patients with tuberculosis in the Democratic Republic of Congo.

BackgroundHIV counseling and testing, HIV prevention and provision of HIV care and support are essential activities to reduce the burden of HIV among patients with TB, and should be integrated into routine TB care.MethodsThe development of training materials to promote HIV services for TB patients involved the definition of target health care workers (HCWs); identification of required tasks, skills and knowledge; review of international guidelines; and adaptation of existing training materials for voluntary counseling and testing, prevention of mother-to-child transmission of HIV, and management of opportunistic infections (OIs). Training effectiveness was assessed by means of questionnaires administered pre- and post-training, by correlating post-training results of HCWs with the centre's HIV testing acceptance rates, and through participatory observations at the time of on-site supervisory visits and monthly meetings.ResultsPre-training assessment identified gaps in basic knowledge of HIV epidemiology, the link between TB and HIV, interpretation of CD4 counts, prevention and management of OIs, and occupational post-exposure prophylaxis (PEP). Opinions on patients' rights and confidentiality varied. Mean test results increased from 72% pre-training to 87% post-training (p < 0.001). Important issues regarding HIV epidemiology and PEP remained poorly understood post-training. Mean post-training scores of clinic's HCWs were significantly correlated with the centre's HIV testing acceptance rates (p = 0.01). On-site supervisory visits and monthly meetings promoted staff motivation, participatory problem solving and continuing education. Training was also used as an opportunity to improve patient-centred care and HCWs' communication skills.ConclusionMany HCWs did not possess the knowledge or skills necessary to integrate HIV activities into routine care for patients with TB. A participatory approach resulted in training materials that fulfilled local needs.