Post exposure prophylaxis- HEALTH SECTOR WELLNESS SERVICES
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Transcript of Post exposure prophylaxis- HEALTH SECTOR WELLNESS SERVICES
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POST EXPOSURE PROPHYLAXIS (PEP)
Sejojo Phaaroe
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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
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THE TRANSMISSION OF
HIV How do you become infected with HIV?
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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
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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:
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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
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HIV can only be transmitted through:
Unprotected sexual intercourse
Infected blood
Intra-venous drugging
Mother-to-child
X
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Unprotected sexual intercourse
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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
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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
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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
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Indicators for PEP
• Occupational exposure – cut,
• Non occupational exposure -bite -Sexual assault - crime scene attendants - car accident • Condom breakage
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PEP SERVICE PACKAGE
• behavioural change counselling • STI testing and treatment • Pregnancy testing and prevention
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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
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FOLLOW UP TESTS
-HIV HBSG 6 WEEKS , 3 MONTHS, 6 MONTHS
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REGIMEN
- 3TC = Lamivudine -AZT= Zidovudine Add 3rd medicine for high risk exposure - Kaletra
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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
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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
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Thank you