Postexposure Prophylaxis Program Research Articles

Cost-effectiveness of antiretroviral regimens used in post-exposure prophylaxis program at United States’ PEPFAR-APIN clinics in a developing country: a retrospective pharmaco-economic analysis

Cost-effectiveness of antiretroviral regimens used in post-exposure prophylaxis program at United States’ PEPFAR-APIN clinics in a developing country: a retrospective pharmaco-economic analysis

Adherence, adverse drug reactions, and discontinuation associated with adverse drug reactions of HIV post-exposure prophylaxis: a meta-analysis based on cohort studies

Objective: Evaluate the profiles of post-exposure prophylaxis (PEP) adherence, adverse drug reactions (ADRs), and discontinuation associated with ADRs to provide information for further PEP program improvement and increase adherence to PEP.Methods: The Web of Science, PubMed, Embase, and the Cochrane Library were searched for cohort studies reporting data related to PEP adherence or ADRs (PROSPERO, CRD42022385073). Pooled estimates of adherence, the incidence of ADRs and discontinuation associated with ADRs, and their 95% confidence intervals (CI) were calculated separately for the included literature using random effects models. For substantial heterogeneity, meta-regression and subgroup analyses were conducted to explore sources of heterogeneity.Results: Overall adherence was 58.4% (95% CI: 50.9%–65.8%), with subgroup analysis showing differences in adherence across samples, with the highest adherence among men who had sex with men (MSM) (72.4%, 95% CI: 63.4%–81.3%) and the lowest adherence among survivors of sexual assault (SAs) (41.7%, 95% CI: 28.0%–55.3%). The incidence of ADRs was 60.3% (95% CI: 50.3%-70.3%), and the prevalence of PEP discontinuation associated with ADRs was 32.7% (95% CI: 23.7%-41.7%), with subgroup analyses revealing disparities in the prevalence of discontinuation associated with ADRs among samples with different drug regimens. Time trend analysis showed a slight downward trend in the incidence of ADRs and PEP discontinuation associated with ADRs.Conclusion: Adherence to PEP was less than 60% across samples, however, there was significant heterogeneity depending on the samples. SAs had the lowest adherence and the highest incidence of PEP discontinuation. Ongoing adherence education for participants, timely monitoring, and management of ADRs may improve adherence.

Sexual Violence and Low Rates of HIV Post-exposure Prophylaxis Access Among Female Sex Workers in Brazil.

Female sex workers (FSW) are disproportionately affected by sexual violence (SV) and HIV. Social and structural barriers limit their access to post-exposure prophylaxis (PEP). Respondent-driven sampling survey in 12 Brazilian cities among 4188 FSW aimed to estimate the rates of SV and factors associated with access to PEP use among FSW who experienced SV. The prevalence of SV was 26.3% (1199). Of the 1199, 7.5% sought out healthcare and used PEP, 19% sought out healthcare, but did not use PEP, and 73.5% did not seek out healthcare after SV. Factors associated with PEP use included PEP awareness, participation in HIV/STI prevention workshops, and disclosure of FSW status in healthcare services. Although Brazil has a PEP program free of charge, it is not readily accessible, even for FSW who seek out healthcare. The development of effective strategies to link FSW to HIV preventive services is urgently needed.

Estimated Health Outcomes and Costs of COVID-19 Prophylaxis With Monoclonal Antibodies Among Unvaccinated Household Contacts in the US

The COVID-19 pandemic has led to more than 900 000 deaths in the US and continues to disrupt lives even as effective vaccines are available. To estimate the health outcomes and net cost of implementing postexposure prophylaxis (PEP) with monoclonal antibodies (mAbs) against household exposure to COVID-19. This study is a decision analytical model of results from a randomized clinical trial of casirivimab with imdevimab administered as subcutaneous injections to unvaccinated, SARS-CoV-2-negative household contacts of people with confirmed COVID-19 with complementary data on household demographic structure, vaccine coverage, and confirmed COVID-19 case counts. The study used US data from May 2021 for a simulated population of US individuals of all ages within low-transmission or high-transmission scenarios. Age, sex, race, ethnicity, and COVID-19 vaccination status. Symptomatic infection, hospitalization, death, and net payer cost of monoclonal antibody PEP for COVID-19. In a month of transmission intensity similar to that of May 2021, a mAb PEP program reaching 50% of exposed, unvaccinated household members aged 50 years and older was estimated to avert 1820 symptomatic infections (95% uncertainty interval [UI], 1220-2454 symptomatic infections), 528 hospitalizations (95% UI, 354-724 hospitalizations), and 84 deaths (95% UI, 55-116 deaths) in a low-transmission scenario and 4834 symptomatic infections (95% UI, 3375-6257 symptomatic infections), 1404 hospitalizations (95% UI, 974-1827 hospitalizations), and 223 deaths (95% UI, 152-299 deaths) in a high-transmission scenario. Without mAb PEP, the estimated cost of hospitalizations due to COVID-19 infections from household exposure in the lower transmission scenario was $149 million (95% UI, $115-$196 million), whereas the estimated hospitalization cost in the higher transmission scenario was $400 million (95% UI, $312-$508 million). In the lower transmission scenario, mAb PEP administered to 50% of eligible contacts aged 80 years and older was estimated to have 82% probability of saving costs, but was not associated with cost savings at age thresholds of 50 years and older or 20 years and older. In contrast, in the high-transmission scenario, mAb PEP administered to 50% of eligible household contacts had estimated cost savings in 100% of simulations at the 80-year age threshold, 96% of simulations at the 50-year threshold, and 2% of simulations at the 20-year thresholds. In this modeling study of a simulated US population, a mAb PEP for COVID-19 program was estimated to improve health outcomes and reduce costs. In the setting of a susceptible variant of SARS-CoV-2, health system and public health actors would have an opportunity to improve health and reduce net payer costs through COVID-19 PEP with mAbs.

Spatio-temporal analysis of leprosy risks in a municipality in the state of Mato Grosso-Brazilian Amazon: results from the leprosy post-exposure prophylaxis program in Brazil

BackgroundLeprosy post-exposure prophylaxis (LPEP) with single dose rifampicin (SDR) can be integrated into different leprosy control program set-ups once contact tracing has been established. We analyzed the spatio-temporal changes in the distribution of index cases (IC) and co-prevalent cases among contacts of leprosy patients (CP) over the course of the LPEP program in one of the four study areas in Brazil, namely the municipality of Alta Floresta, state of Mato Grosso, in the Brazilian Amazon basin.MethodsLeprosy cases were mapped, and socioeconomic indicators were evaluated to explain the leprosy distribution of all leprosy cases diagnosed in the period 2016–2018. Data were obtained on new leprosy cases [Notifiable diseases information system (Sinan)], contacts traced by the LPEP program, and socioeconomic variables [Brazilian Institute of Geography and Statistics (IBGE)]. Kernel, SCAN, factor analysis and spatial regression were applied to analyze changes.ResultsOverall, the new case detection rate (NCDR) was 20/10 000 inhabitants or 304 new cases, of which 55 were CP cases among the 2076 examined contacts. Changes over time were observed in the geographic distribution of cases. The highest concentration of cases was observed in the northeast of the study area, including one significant cluster (Relative risk = 2.24; population 27 427, P-value < 0.001) in an area characterized by different indicators associated with poverty as identified through spatial regression (Coefficient 3.34, P-value = 0.01).ConclusionsThe disease distribution was partly explained by poverty indicators. LPEP influences the spatial dynamic of the disease and results highlighted the relevance of systematic contact surveillance for leprosy elimination.Graphical

Preventing leprosy with retrospective active case finding combined with single-dose rifampicin for contacts in a low endemic setting: results of the Leprosy Post-Exposure Prophylaxis program in Cambodia

Post-exposure prophylaxis (PEP) with single-dose rifampicin (SDR) reduces the risk of developing leprosy among contacts of leprosy patients. Most evidence for the feasibility of the intervention is from highly endemic settings while low-endemic areas present unique challenges including reduced awareness of the disease among the population and in the health system, and the only sporadic occurrence of cases which together make defining any type of routine process challenging.We complemented the retrospective active case finding (RACF) approach with SDR administration to eligible contacts, and piloted the intervention across 31 operational districts in Cambodia. The aim was to demonstrate the feasibility of improving early case detection and administering SDR in a low endemic setting. The intervention focused on leprosy patients diagnosed since 2011 and was implemented between October 2016 – September 2019. The “drives” approach was employed to trace contacts: a trained team systematically contacted all eligible cases in a district, traced and screened contacts, and administered SDR.A total of 555 index patients were traced by the drive team, and 10,410 contacts in their household and 5 immediate neighbor houses listed. Among these contacts, 72.0% could be screened while most others were absent on the screening day. A total of 33 new leprosy cases were diagnosed and 6189 contacts received SDR (82.6% of the screened contacts). Sixty-one contacts refused SDR administration.We conclude that integrating PEP with SDR in RACF campaigns is feasible, and that this approach is appropriate in low resource and low endemic settings. Over time, evidence on whether or not the approach reduced leprosy transmission in Cambodia, may become clear.

High post-exposure prophylaxis uptake but low completion rates and HIV testing follow-up in health workers, Harare, Zimbabwe.

Introduction:Health care workers (HCWs), especially from sub-Saharan Africa, are at risk of occupational exposure to HIV. Post exposure prophylaxis (PEP) can reduce this risk. There is no published information from Zimbabwe, a high HIV burden country, about how PEP works. We therefore assessed how the PEP programme performed at the Parirenyatwa Hospital, Harare, Zimbabwe, from 2017–2018.Methodology:This was a cohort study using secondary data from the staff clinic paper-based register. The chi square test and relative risks were used to assess associations.Results:There were 154 HCWs who experienced occupational injuries. The commonest group was medical doctors (36%) and needle sticks were the most frequent type of occupational injury (74%). The exposure source was identified in 114(74%) occupational injuries: 91% of source patients were HIV-tested and 77% were HIV-positive. All but two HCWs were HIV-tested, 148 were eligible for PEP and 142 (96%) started triple therapy, all within 48 hours of exposure. Of those starting PEP, 15 (11%) completed 28 days, 13 (9%) completed < 28 days and in the remainder PEP duration was not recorded. There were no HCW characteristics associated with not completing PEP. Of those starting PEP, 9 (6%) were HIV-tested at 6-weeks, 3 (2%) were HIV-tested at 3-months and 1 (< 1%) was HIV-tested at 6-months: all HIV-tests were negative.Conclusions:While uptake of PEP was timely and high, the majority of HCWs failed to complete the 28-day treatment course and even fewer attended for follow-up HIV-tests. Various changes are recommended to promote awareness of PEP and improve adherence to guidelines.

Determinants of Rabies Prophylaxis Involvement based on Children’s Experiences and Perspectives in An Endemic Area of Indonesia

Rabies studies involving children are still rare despite their vulnerability. As the critical preventive measure,understanding factors associated with their involvement in rabies post-exposure prophylaxis (PEP) isneeded. A storytelling interview was conducted for 23 dog-bite and non-bite child-victims, aged 7-15 years,in an endemic area in Indonesia. Content analysis was carried with the help of Atlas ti.7. Unreported woundsand PEP delays were occurred. Children’s capabilities, motivations, and opportunities can be critical toprevent it. Knowing the source of rabies, its visible features and consequences, and the first aid techniqueare needed. Children’s willingness to report and follow PEP seem to be regulated by their attitude towardsvaccine, familiarity of dog ownership, perceptions of wound type, and emotions around rabies consequences,parental punishment, and injection. Mother, peers, neighbours and dog owners need to be empowered in PEPmeasure. In conclusion, rabies PEP program should attentive to factors influencing children’s behaviour tosupport PEP uptake.

Health economic assessment of a rabies pre-exposure prophylaxis program compared with post-exposure prophylaxis alone in high-risk age groups in the Philippines

ObjectivesOnce symptoms appear, rabies is almost always fatal and accounts for 200–300 deaths annually in the Philippines. Available rabies vaccines can be administered either in pre- exposure prophylaxis (PrEP) or post-exposure prophylaxis (PEP). After exposure, PrEP-immunized individuals require fewer doses of PEP and no rabies immunoglobulin. MethodsA static decision-tree model was developed to assess cost-effectiveness of a PrEP+PEP program vs PEP alone. Philippines-specific data for people seeking medical advice at the Research Institute for Tropical Medicine between July 2015 and June 2016 were used in the model, together with data from published literature. ResultsOver a 20-year period, in a cohort of 1 million 5-year-old children in the Philippines, PrEP+PEP was expected to prevent 297 deaths compared with PEP alone. From both payer and societal perspectives, the resulting incremental cost-effectiveness ratios were 36 035 (US$759; 2016 US$ conversion) and 18 663 (US$393) Philippine Pesos (PHP) — quality-adjusted life-years gained — respectively, which are both below the willingness-to-pay threshold of PHP140 255 (US$2 953). ConclusionThese data suggest that a universal PrEP program targeting 5-year-olds would be cost-effective in the Philippines.

Community pharmacy delivered PrEP to STOP HIV transmission: An opportunity NOT to miss!

In the United States, 1.1 million persons are living with human immunodeficiency virus (HIV), and approximately 37,800 new infections occur annually. Ending the HIV epidemic requires reducing HIV transmissions by 90% within the next 10 years and requires expanded HIV testing, antivirals for persons infected with HIV, and scale-up of pre-exposure prophylaxis (PrEP) and postexposure prophylaxis (PEP) to prevent new infections. Community pharmacies are widely accessible and employ highly trained health care professionals on-site who can initiate PrEP and PEP. Recommendations are offered to implement a community pharmacy PrEP program. Pharmacy, government, and HIV prevention leaders must be prepared to support and promote transformative changes, including (1) modification or expansion of existing state-specific scope of practice to initiate PrEP and PEP, (2) encouraging pharmacist education about PrEP and PEP, (3) identification and screening of candidates for PrEP eligibility, (4) incorporating pharmacy laboratory ordering and monitoring logistics, (5) adjusting workflow and ensuring confidential spaces for sensitive discussions, and (6) addressing reimbursement to maintain pharmacist-delivered PrEP and PEP programs. HIV disproportionately affects minority communities and younger individuals who may not be engaged in the health care system. Community pharmacies are accessible and can help increase PrEP use. Expansion of community pharmacy PrEP programs are needed to help end the HIV epidemic. Implementation of PrEP requires adaptation of the pharmacy profession to support incorporation of PrEP in a community pharmacy. Endorsement and support of community pharmacists are needed to implement PrEP to increase HIV prevention efforts and expand pharmacists’ scope of practice.

The "Side Effects" of HIV PEP Use: Forced Reflections and Introspections on Sexual Decision-Making.

Postexposure prophylaxis (PEP) for HIV prevention involves giving antiretroviral medications to HIV-negative people to prevent seroconversion after HIV exposure. Available literature suggests this intervention is >80% effective. Accordingly, we implemented a nurse-led PEP program in two sexually transmitted and HIV testing clinics. As part of evaluating this project, we undertook semistructured interviews with participants who accessed PEP to understand their experiences. Twelve men participated: all were HIV-negative males who sought PEP for condomless anal sex with men. Unique to this article is the presentation of the participants' descriptions of the "side effects" they experienced. Notably, the main side effect they described related to emotional distress. Simply put, having to take a medication for 28 days forced reflection and introspection on their sexual decision-making. We feel HIV prevention workers should consider this emotional reaction when designing interventions, and ensure they provide adequate preparation and support to patients.

A single dose of rifampicin to prevent leprosy: qualitative analysis of perceptions of persons affected, contacts, community members and health professionals towards chemoprophylaxis and the impact on their attitudes in India, Nepal and Indonesia

Introduction: The purpose of this study is to investigate the impact of post-exposure prophylaxis (PEP) and the education given along with PEP on knowledge about leprosy and the attitudes and reported behaviour towards people affected by leprosy. This study is a sub-study of the Leprosy Post-Exposure Prophylaxis (LPEP) programme. Methods: Seventy-two semi-structured interviews and five Focus Group Discussions (FGDs) were conducted in India, Nepal and Indonesia. The study population consisted of i) index patients, ii) contacts, iii) community members and iv) health professionals. The participants were selected purposively. A team of four social scientists analysed the data using a thematic analysis. Results: The participants in this study were mostly positive and sometimes very positive about the possibility to prevent leprosy in close contacts through a single dose of rifampicin. Most respondents reported that there were no changes in their views towards leprosy or people affected by leprosy after the intervention. The study revealed that the incorrect health information that was retained and the wish of some people affected to conceal the illness poses challenges for a PEP programme. Conclusion: The LPEP programme was perceived positively and no negative effects were reported. In this analysis, PEP did not appear to have an effect on the way leprosy or people affected by leprosy were perceived. More research is needed on providing health information that is accurate and understandable for contacts, and on approaches in which disclosure of the index patient is not required.

Nurse-Led HIV PEP Program Used by Men at High Risk for HIV Seroconversion

We trialed a nurse-led HIV postexposure prophylaxis (PEP) program in two sexually transmitted infection clinics in Ottawa, Canada. From September 5, 2013 to September 4, 2015, 112 persons sought PEP: 103 were male, of whom 84 were men who have sex with men (MSM). Seventy-two patients (59 MSM) initiated PEP; 11 were diagnosed with HIV: 6 diagnoses occurred during initial assessment (all MSM; 1 also shared injection equipment); 5 MSM were diagnosed with HIV within 1year of seeking PEP. This level of positivity indicated that, when access is facilitated, individuals at high risk of HIV seek PEP. However, the 8.5% of MSM who seroconverted within a year of taking PEP demonstrated that this group remained at risk and needed additional prevention services. Delivery of PEP should include provision of medication, as well as an opportunity to address individual-level HIV risk strategies and population-level syndemic conditions that contribute to ongoing HIV transmission among MSM.

An Exploratory Study of a Nurse-Led HIV Postexposure Prophylaxis Program.

The provision of HIV medications to HIV-negative persons after exposure to HIV is known as postexposure prophylaxis (PEP). Because this prevention strategy is primarily only available in emergency rooms, we piloted a nurse-led community-based PEP program in Ottawa from September 2013 through August 2015. As part of evaluating this program, we conducted qualitative interviews with persons who initiated PEP. Twelve men who had engaged in condomless anal sex with other males participated. Thematic analysis of the interview transcripts highlighted that PEP was considered unmentionable because the participants' saw it as proof of past behavior that was perceived negatively. Our results thus revealed that PEP was stigmatized, which made our participants reluctant to answer health care professionals' "questions" about why they needed PEP. To do so was to be exposed to stigma. The use of PEP for our participants was a balance between wanting to minimize the risks of HIV acquisition against the risks of disclosing the unmentionable. We take these findings to mean that clinicians and health service policy workers should move PEP into community clinics (decentralizing it from hospitals, and increase the involvement of nurses); aim to provide all required PEP services in community settings (consolidate PEP provision in these clinics); and ensure PEP services are streamlined to remove extraneous data collection (meaning history and exam tools should be standardized to minimize needless questions that may impede PEP access). Together, these recommendations may increase patients' access to PEP, and maximize its HIV prevention effects.

Assessment of knowledge, attitudes and practices of HIV post exposure prophylaxis among the doctors and nurses in Princess Marina Hospital, Gaborone: a cross-sectional study.

IntroductionBotswana is one of the HIV/AIDS hardest hit countries in Sub-Saharan Africa with a prevalence of 17.6 percent while incidence is estimated to be 2.9 percent. The average risk of HIV transmission after a percutaneous exposure to HIV-infected blood has been estimated to be approximately 0.3% posing a threat to health care workers. This has resulted in HIV post exposure prophylaxis (PEP) being very important in the healthcare setting. The aim of this study was to assess knowledge, attitudes and practices of health care workers towards HIV PEP.MethodsA cross-sectional study was conducted at Princes Marina Hospital (PMH) in Gaborone from the 26th March-2nd April 2014. Inclusion criteria- registered medical doctors and nurses. Collected sample size was 199. Data was collected using self-administered questionnaires.ResultsThe majority of respondents 70.7% of the respondents had adequate knowledge about PEP, with 191(97.4%) of the study participants being aware of HIV PEP while 82.2% of the respondents had a positive attitude toward PEP. A significant number had been exposed 107(53.7%) to risky exposures. Of the exposed, 80(74.8%) took PEP, while 27(25.2%) did not take PEP. From the respondents that took PEP 21(26.6%) did not complete PEP, with 15(71.4%) quitting because of adverse side effects, 1(4.76%) assuming it was enough treatment and 1(4.76%) doubting drug efficacy.ConclusionThe participants were knowledgeable of the existence of HIV PEP and had a positive attitude toward the HIV PEP program. Although the participants were knowledgeable, they showed inadequate practices with regard to HIV PEP.

Knowledge, Attitudes and Beliefs regarding Post Exposure Prophylaxis among South African Men who have Sex with Men.

The Soweto Men's Study (2008), demonstrated an overall HIV prevalence rate of 13.2%, with 10.1% among straight-identified Men-who-have-sex-with-men (MSM), 6.4% among bisexual-identified MSM and 33.9% among gay-identified MSM. Behavioral interventions are imperative, but insufficient to prevent new HIV infections. Biomedical prevention of HIV offers a variety of combination prevention tools, including Post-exposure prophylaxis (PEP). PEP studies amongst MSM have been conducted in Amsterdam, Brazil and San Francisco, but never before in Africa. A cross-sectional, Internet-based survey was initiated to measure knowledge, attitudes and beliefs regarding PEP among South African MSM. Recruitment commenced in June 2014 and ran until October 2015. Participants were recruited through banner advertisements on Facebook.com and mambaonline.com, advertisements in the local gay media and at Health4Men (H4M) MSM-targeted clinics. Outreach workers distributed flyers advertising the study in their local communities. The survey was also made available on a computer at the H4M clinics in Cape Town and Johannesburg to reach MSM who may not have Internet access. A total of 408 men completed the survey. The majority of these men were under the age of 40, identified as gay/homosexual and were employed; 51% (208/408) self-identified as black or of mixed race. In multivariate analysis participants who identified as gay had greater odds of having previously heard of PEP (AOR 1.91, 95% CI 1.04, 3.51; p=0.036), as did those who reported their HIV status as positive (AOR 2.59, 95% CI 1.47, 4.45; p=0.001). Participants with medical insurance had greater odds of having used PEP previously (AOR 2.67, 95% CI 1.11, 6.43; p=0.029). Bivariate analysis showed that condomless sex in the past 6months was not significantly associated with PEP knowledge (p=0.75) or uptake (p=0.56) of PEP. Our findings suggest a lack of PEP knowledge and uptake among non-gay identified, HIV negative and un-insured MSM. Focusing PEP programs on these men may potentially increase uptake. Increased knowledge needs to be provided to MSM who engage in risky sexual behaviors.

Men at Risk of HIV: Sexual Sensation Seeking, Sexual Compulsivity and Sexual Risk Behavior Among Australian MSM Who Frequently Present for Post-Exposure Prophylaxis

ABSTRACTThe increase in Australian Human Immunodeficiency Virus (HIV) infections since the 1990s is considered to be due to a subgroup of MSM (men who have sex with men) who engage in behaviors that increase the risk of sexual transmission of HIV. A population of MSM at risk are those who present for PEP (Post-Exposure Prophylaxis). In this article, data from a sample of N = 23 MSM who repeatedly attended an Australian PEP program and sought psychological assistance regarding sexual risk taking are examined. Findings revealed the current sample had more sexual risk behaviors than those of the wider MSM population and had higher Sexual Compulsivity (SC) and Sexual Sensation Seeking (SSSS) scores than previous samples of gay men, along with the finding that SC and SSSS were positively associated with sexual risk taking. Unfortunately, sexual behavior syndromes may be resistant to change, leaving affected MSM at ongoing risk of HIV. If these data can be replicated with larger samples, they point to the value of offering psychological care to affected PEP recipients, and to the role PreP (Pre-Exposure Prophylaxis) may play in providing a safety net against transmission until behavior change occurs.

Adverse events and adherence to HIV post-exposure prophylaxis: a cohort study at the Korle-Bu Teaching Hospital in Accra, Ghana.

BackgroundThere is strong evidence that post-exposure prophylaxis (PEP) with antiretroviral drugs in the timely management of occupational exposures sustained by healthcare workers decreases the risk of HIV infection and PEP is now widely used. Antiretroviral drugs have well documented toxicities and produce adverse events in patients living with HIV/AIDS. In the era of “highly active antiretroviral therapy”, non-adherence to treatment has been closely linked to the occurrence of adverse events in HIV patients and this ultimately influences treatment success but the influence of adverse events on adherence during PEP is less well studied.MethodsFollowing the introduction of a HIV post-exposure prophylaxis program in the Korle-Bu Teaching Hospital in January 2005, the incidence of adverse events and adherence were documented in occupationally-exposed healthcare workers (HCWs) and healthcare students (HCSs). Cohort event monitoring was used in following-up on exposed HCWs/HCSs for the two study outcomes; adverse events and adherence. All adverse events reported were grouped by MedDRA system organ classification and then by preferred term according to prophylaxis regimen. Adherence was determined by the completion of prophylaxis schedule. Cox proportional regression analysis was applied to determine the factors associated with the cohort study outcomes. Differences in frequencies were tested using the Chi square test and p < 0.05 was considered statistically significant.ResultsA total of 228 exposed HCWs/HCSs were followed up during the study, made up of 101 exposed HCWs/HCSs administered lamivudine/zidovudine (3TC/AZT) for 3 days; 75 exposed HCWs/HCSs administered lamivudine/zidovudine (3TC/AZT) for 28 days; and 52 exposed HCWs/HCSs administered lamivudine/zidovudine/lopinavir-ritonavir (3TC/AZT/LPV-RTV) for 28 days. The frequency of adverse events was 28 % (n = 28) in exposed HCWs/HCSs administered 3TC/AZT for 3 days, 91 % (n = 68) in exposed HCWs/HCSs administered 3TC/AZT for 28 days and 96 % (n = 50) in exposed HCWs/HCSs administered 3TC/AZT/LPV-RTV for 28 days. Nausea was the most commonly reported adverse events in all three regimens. Adherence was complete in all exposed HCWs/HCSs administered 3TC/AZT for 3days, 56 % (n = 42) in exposed HCWs/HCSs administered 3TC/AZT for 28 days and 62 % (n = 32) in exposed HCWs/HCSs administered 3TC/AZT/LPV-RTV for 28 days. In the Cox regression multi-variate analysis, exposed HCWs/HCSs administered 3TC/AZT for 3 days were 70 % less likely to report adverse events compared with exposed HCWs/HCSs administered 3TC/AZT for 28 days (Adjusted HR = 0.30 [95 % CI, 0.18-0.48], p < 0.001). Exposed HCWs/HCSs administered 3TC/AZT for 3 days were 75 % more likely to adhere to the schedule compared with exposed HCWs/HCSs administered 3TC/AZT for 28 days (Adjusted HR = 1.75 [95 % CI, 1.16-2.66], p = 0.008).ConclusionThe intolerance to adverse events was cited as the sole reason for truncating PEP, thereby indicating the need for adequate, appropriate and effective counselling, education, active follow-up (possibly through mobile /phone contact) and management of adverse events. Education on the need to complete PEP schedule (especially for exposed HCWs/HCSs on 28-day schedule) can lead to increased adherence, which is very critical in minimizing the risk of HIV sero-conversion. The present results also indicate that cohort event monitoring could be an effective pharmacovigilance tool in monitoring adverse events in exposed HCWs/HCSs on HIV post-exposure prophylaxis.

Implementation and impact of a post-exposure prophylaxis helpline.

Despite a 2007 national and regional training programme, there was poor implementation of a post-exposure prophylaxis (PEP) programme to prevent occupational transmission of HIV in health care workers (HCWs) in Delhi. A new initiative was therefore launched by the Delhi State AIDS Control Society in 2010 to improve uptake of PEP in HCWs. To assess the implementation and efficacy of the PEP programme in Delhi. The initiative included a PEP poster and a telephone helpline together with a workshop for senior doctors of 46 public hospitals nominated as PEP supervisors. Data concerning use of the PEP help line and number of HCWs enrolling for PEP between January 2011 and May 2014 were analysed. Until September 2010, only 61% (28) of Delhi hospitals had PEP drugs and medical supervisors to manage the programme and reports concerning the programme were not sent. After roll-out of the PEP helpline, 4057 HCWs accessed the helpline, all public hospitals started implementing the programme and sent monthly reports. During the same period, 1450 HCWs suffered from occupational exposures, 15% were started on PEP drugs of who 98% completed the full course of prophylaxis. The PEP helpline is probably the first in a developing country and has been helpful for the effective implementation of the national PEP programme in Delhi.

Cost-effectiveness of rabies post exposure prophylaxis in Iran.

The rabies is one of the most important officially-known viral zoonotic diseases for its global distribution, outbreak, high human and veterinary costs, and high death rate and causes high economic costs in different countries of the world every year. The rabies is the deadliest disease and if the symptoms break out in a person, one will certainly die. However, the deaths resulting from rabies can be prevented by post-exposure prophylaxis. To do so, in Iran and most of the countries in the world, all the people who are exposed to animal bite receive Post-Exposure Prophylaxis (PEP) treatment. The present survey aimed to investigate the cost-effectiveness of PEP in southern Iran. The present study estimated the PEP costs from the government`s Perspective with step-down method for the people exposed to animal bite, estimated the number of DALYs prevented by PEP in the individuals using decision Tree model, and computed the Incremental cost-effectiveness Ratio. The information collected of all reported animal bite cases (n=7111) in Fars Province, who referred rabies registries in urban and rural health centers to receive active care. Performing the PEP program cost estimated 1,052,756.1 USD for one year and the estimated cost for the treatment of each animal bite case and each prevented death was 148.04 and 5945.42 USD, respectively. Likewise 4,509.82 DALYs were prevented in southern Iran in 2011 by PEP program. The incremental cost-effectiveness ratio for each DALY was estimated to be 233.43 USD. In addition to its full effectiveness in prophylaxis from rabies, PEP program saves the financial resources of the society, as well. This study showed performing PEP to be more cost-effective.