An overview of post exposure prophylaxis for HIV in health care personals: Gujarat scenario

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Abstract

Average risk of acquiring HIV infection after a percutaneous exposure to HIV infected blood is 0.3%. Post exposure prophylaxis (PEP) for HIV refers to a set of comprehensive services to prevent HIV infection in exposed individuals where the exposure can be occupational/ non occupational and a provision of short term (28 days) antiretroviral drugs are given depending on the risk assessment. It also includes counselling and relevant laboratory investigations after taking informed consent of the exposed person and source. PEP inhibits the replication of the initial inoculum of virus and thereby prevents establishment of chronic HIV infection, and is best effective when initiated within 2 hours but certainly within 72 hours. Present communication deals with the registry of 278 cases of PEP from Gujarat in terms of various determinants, their status and the outcome in terms of HIV sero positivity.

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Health disparities experienced by black or African Americans--United States.

(2005)

In the 2000 census, 36.4 million persons, approximately 12.9% of the U.S. population, identified themselves as Black or African American; 35.4 million of these persons identified themselves as non-Hispanic. For many health conditions, non-Hispanic blacks bear a disproportionate burden of disease, injury, death, and disability. Although the top three causes and seven of the 10 leading causes of death are the same for non-Hispanic blacks and non-Hispanic whites (the largest racial/ethnic population in the United States), the risk factors and incidence, morbidity, and mortality rates for these diseases and injuries often are greater among blacks than whites. In addition, three of the 10 leading causes of death for non-Hispanic blacks are not among the leading causes of death for non-Hispanic whites: homicide (sixth), human immunodeficiency virus (HIV) disease (seventh), and septicemia (ninth). This week's MMWR is the third in a series focusing on racial/ethnic health disparities. Eliminating these disparities will require culturally appropriate public health initiatives, community support, and equitable access to quality health care.

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National AIDS Control Organisation

(2010)

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High risk for occupational exposure to HIV and utilization of post-exposure prophylaxis in a teaching hospital in Pune, India

Amita Gupta, Shuchi Anand, Jayagowri Sastry … (2008)

Background The risk for occupational exposure to HIV has been well characterized in the developed world, but limited information is available about this transmission risk in resource-constrained settings facing the largest burden of HIV infection. In addition, the feasibility and utilization of post-exposure prophylaxis (PEP) programs in these settings are unclear. Therefore, we examined the rate and characteristics of occupational exposure to HIV and the utilization of PEP among health care workers (HCW) in a large, urban government teaching hospital in Pune, India. Methods Demographic and clinical data on occupational exposures and their management were prospectively collected from January 2003–December 2005. US Centers for Diseases Control guidelines were utilized to define risk exposures, for which PEP was recommended. Incidence rates of reported exposures and trends in PEP utilization were examined using logistic regression. Results Of 1955 HCW, 557 exposures were reported by 484 HCW with an incidence of 9.5 exposures per 100 person-years (PY). Housestaff, particularly interns, reported the greatest number of exposures with an annual incidence of 47.0 per 100 PY. Personal protective equipment (PPE) was used in only 55.1% of these exposures. The incidence of high-risk exposures was 6.8/100 PY (n = 339); 49.1% occurred during a procedure or disposing of equipment and 265 (80.0%) received a stat dose of PEP. After excluding cases in which the source tested HIV negative, 48.4% of high-risk cases began an extended PEP regimen, of whom only 49.5% completed it. There were no HIV or Hepatitis B seroconversions identified. Extended PEP was continued unnecessarily in 7 (35%) of 20 cases who were confirmed to be HIV-negative. Over time, there was a significant reduction in proportion of percutaneous exposures and high-risk exposures (p < 0.01) and an increase in PEP utilization for high risk exposures (44% in 2003 to 100% in 2005, p = 0.002). Conclusion Housestaff are a vulnerable population at high risk for bloodborne exposures in teaching hospital settings in India. With implementation of a hospital-wide PEP program, there was an encouraging decrease of high-risk exposures over time and appropriate use of PEP. However, overall use of PPE was low, suggesting further measures are needed to prevent occupational exposures in India.

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Author and article information

Journal

Journal ID (nlm-ta): Indian J Sex Transm Dis

Journal ID (publisher-id): IJSTD

Title: Indian Journal of Sexually Transmitted Diseases

Publisher: Medknow Publications (India )

ISSN (Print): 0253-7184

ISSN (Electronic): 1998-3816

Publication date (Print): Jan-Jun 2011

Volume: 32

Issue: 1

Pages: 9-13

Affiliations

[1]Associate Consultant, Infectious Disease & Tropical Medicine Clinic, and Ex. Regional Co-ordinator - CST (NACO), Ahmedabad

[1 ]Centre of Excellence, ART Centre, BJ Medical College and Civil Hospital, Ahmedabad

[2 ]Additional Project Director, Gujarat State AIDS Control Society (GSACS), Ahmedabad

Author notes

Address for correspondence: Dr. Pradeep Kumar, Gujarat State AIDS Control Society, O-1 Block, New Mental Hospital Complex, Meghaninagar, Ahmedabad - 380016, Gujarat, India. E-mail: drpkumar_55@ 123456yahoo.com

Article

Publisher ID: IJSTD-32-9

DOI: 10.4103/0253-7184.81247

PMC ID: 3139298

PubMed ID: 21799569

SO-VID: 1287eee5-0974-4a2e-95bd-3dfb6da5fdb9

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This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

An overview of post exposure prophylaxis for HIV in health care personals: Gujarat scenario

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Most cited references 15

Health disparities experienced by black or African Americans--United States.

National AIDS Control Organisation

High risk for occupational exposure to HIV and utilization of post-exposure prophylaxis in a teaching hospital in Pune, India

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