post exposure prophylaxis- health sector wellness services
DESCRIPTION
HIV and HIV transmission Indicators for PEP Pre—requisite for PEP -baseline and follow up tests Pre-requisite for PEP Provision PEP package ARV- Treatment and adherenceTRANSCRIPT
POST EXPOSURE PROPHYLAXIS (PEP)
Sejojo Phaaroe
Objective
• HIV and HIV transmission
• Indicators for PEP
• Pre—requisite for PEP
• -baseline and follow up tests
• Pre-requisite for PEP Provision
• PEP package
• ARV- Treatment and adherence
THE TRANSMISSION OF
HIV How do you become infected with HIV?
UNDERSTANDING HIV / AIDS H :
I :
V :
HUMAN
IMMUNE DEFICIENCY
VIRUS
HIV is therefore a virus that
breaks down the immune
system within human beings
A :
I :
D :
S :
ACQUIRED
IMMUNE
DEFICIENCY
SYNDROME
AIDS is therefore a collection of
many infections in the body as
a result of a weakened immune
system caused by the HIV Virus
Virus does not survive outside the body
Cannot enter through intact skin
Quantity of virus
Enough time
Point of entry
Enough Quantity
THREE CONDITIONS FOR TRANSMISSION:
NO TRANSMISSION BECAUSE:
You will NOT transmit HIV through:
SOCIAL CONTACT
Shaking hands, swimming, kissing,
hugging, sharing toilet, cutlery
BEING WITH AN HIV+ PERSON
TRAVELLING
FOOD AND EATING
WORK ENVIRONMENT
HIV can only be transmitted through:
Unprotected sexual intercourse
Infected blood
Intra-venous drugging
Mother-to-child
X
Unprotected sexual intercourse
HIV Clinical stages at different CD + counts (1993 CDC)
CD 4+ COUNT INFECTIONS NEOPLASIA/
CANCERS
>500 cells/ ml CANDIDIASIS
CERVICITIES
CIN
Invasive Cancer of
cervix
Idiopathic
Thrombocytopenia
purpura
Hodkins Lymphoma
Non Hogkins
Lymphoma
K.S
200-500 TB ,
Bacterial pneumonia
Herpes Zoster
Oral candidiasis
Oesophagial candidiasis
CIN
Invasive Cancer of
cervix
Idiopathic
Thrombocytopenia
purpura
Hodkins Lymphoma
Non Hogkins
Lymphoma
K.S
50- 200 Extra pulmonary TB
PCP
Cryptococoosis
Toxoplasmosis
Blastomycetes
Septicaemia
Herpes
Wasting-
Anaemia
Peripheral Neuropathy
Non Hodgkins
Lymphoma
Cardiomyopathy
<50 CMV
Where are OIs come from in the health work place ?
• Food
– Raw vegetables, fruits
– Raw meat, eggs, poultry
– Stored food, unwashed food
• Water
– Cryptsporidiosis, microsporidiosis
• Air
– TB, Cryptocococcus
WHY PEP?
• There may be a window of opportunity in the first few hours of days after exposure in which the highly active drugs may prevent HIV infection
• Immediately following an exposure to blood or body fluids, wounds should be washed with soap and water and should not be squeezed
Indicators for PEP
• Occupational exposure – cut,
• Non occupational exposure -bite -Sexual assault - crime scene attendants - car accident • Condom breakage
PEP SERVICE PACKAGE
• behavioural change counselling • STI testing and treatment • Pregnancy testing and prevention
PRE-REQUISITE FOR PEP
• Source: HIV TEST- if Available and consent
• Exposed : HIV test • if test results positive, no PEP- the client
is advised to go to the HIV clinic to start baseline procedures
• Baseline tests- HIV • -PREGNANCY
• HBSAG
FOLLOW UP TESTS
-HIV HBSG 6 WEEKS , 3 MONTHS, 6 MONTHS
REGIMEN
- 3TC = Lamivudine -AZT= Zidovudine Add 3rd medicine for high risk exposure - Kaletra
adherence
• PEP should preferably be stated within 2 hours of the injury and definitely within 72 hours and continue for 28 days
• Clinicians should closely monitor people receiving PEP to detect ARV- induced dangerous effects
summary • PEP might stop a person from getting infected with HIV • It must be started as soon as possible after exposure- and
definitely within 72 hrs ( 3 days) • Strict adherence is essential • Anti-HIV medicine are to be taken for 4 weeks • Side effects are common and can be debilitating
• ---- • PEP is not suitable for individuals with repeated high – risk
behaviour • Who are not willing to risk reduction practices
• Primary prevention remain maintain in control of HIV not
PEP
Thank you