HIV Post-exposure prophylaxis for patients attending NIMR out-patient clinic - Patients experiences and outcome

1. HIV Post-exposure prophylaxis for patients attending NIMR out-patient clinic - Patients experiences and outcome  Kalejaiye OO, Gab –okafor CV, Oke BO, Oladele DA,Somefun EO, David AN, Onwujekwe DI, Ezechi OC, Odunukwe NN Clinical Sciences Division NIMR.

2. Background HIV infection: The greatest health crisis the world faces today About half of all adults living with HIV are women and 2.5 million children are living with the virus. One of the leading causes of morbidity and mortality in Africa.

3. Worldwide (December 2006) 4.3 million people newly affected with HIV 40 million people living with HIV 24.7 million people living with HIV in ssA Nigeria Prevalence rates of HIV in adults (15-45yrs) - 4.4%

4. Worldwide ( December 2008) 2.7 million people newly affected with HIV 33.4 million people worldwide living with HIV Nigeria Prevalence rates of HIV in adults (15-45yrs) - 3.8%

5. Post Exposure Prophylaxis(PEP) PEP- a medical response given to prevent transmission of pathogens after potential exposure HIV PEP- The immediate use of antiretroviral drugs to prevent HIV sero-conversion after exposure to HIV infected blood or body fluids .

6. Initiation of HIV PEP Preferably between 1-2 hrs of exposure Little evidence to support the use of PEP if greater than 72hrs have elapsed between the exposure and patient presentation for evaluation.

7. HIV PEP (contd) First aid care Counseling, including the assessment of the of risk exposure to the infection HIV testing 28 day course of antiretrovirals Appropriate follow-up (4-6 wks), 3 months, 6 months)

8. Low risk Exposure to small volume (few drops) or fluid contaminated with blood from asymptomatic HIV infected patients with a low viral load <1500 copies/ml Superficial injury or mucocutaneous exposure Percutaneous injury with a solid needle

9. High risk Exposure to a large volume of blood or potentially infectious fluids Exposure to blood or blood-contaminated fluids from an HIV-infected patient with a high viral load.>1500 copies/ml Injury with a hollow needle Deep and extensive injuries Confirmed ARV drug resistance in the source patient.

10. Objective To assess the outcome, challenges and barriers of HIV Post –exposure prophylaxis NIMR out patient clinic

11. Method A five year retrospective case review of individuals who received HIV PEP at the NIMR out –patients clinic (October 2005-2009) following exposure were evaluated

12. Results 116 cases of HIV exposed cases were seen and managed.

14. Age Distribution of Patients

15. Exposure Type Needle stick - 49 pts (42.2%) Sexual assault - 38pts(32.7%) ( all female - 15-42yrs) Consensual unprotected sexual 29pts (25%) (all males - 27-36yrs)

16. Time of Presentation

17. Treatment All received standard treatment according to the national guidelines for post-exposure prophylaxis as well as the Harvard PEPFAR protocol Therapy given for 28 days

18. Follow up and outcome Only 7 patients (6%) receiving treatment returned for follow up visit after 4 weeks. Of these, three reported adverse reactions which were gastro-intestinal. All screened negative for HIV at 4 weeks. All others were lost to follow up.

19. CONCLUSION It has not been possible thus far to assess the efficacy and outcome of HIV PEP in our clinic. This is because most of our patients did not return for follow up visits. There is therefore an urgent need by the various counseling units to institute an efficient and strict contact tracing and follow-up schedules in order that outcomes of treatment be properly assessed