Antiretroviral Prophylaxis of Health Care Workers at Two Urban Medical Centers

Abstract

We examined the influence of job category, source patient HIV status, and exposure type as predictors of whether health care workers initiated antiretroviral prophylaxis after potential blood-borne pathogen exposures. Of 639 exposures over an 18-month period, 82 individuals (13%) elected to receive prophylaxis, of whom 66% took medications for fewer than 96 hours and 12% completed a 4-week course. Reasons for early drug discontinuation included confirmation of source patient HIV-negative serological status (65%), gastrointestinal side effects (13%), headache (4%), and personal decision after counseling/other input (18%). Individuals exposed to HIV-positive source patients were more likely to initiate prophylaxis (odds ratio [OR], 5.1; 95% confidence interval [CI] 2.6 to 9.9). Licensed nurses were less likely than others to accept prophylaxis (OR, 0.5; 95% CI, 0.3 to 0.8), whereas physicians and medical students were more likely to accept prophylaxis (OR, 1.9; 95% CI, 1.1 to 3.3).

Occupational exposure to bloodborne viruses amongst medical practitioners in Bloemfontein, South Africa

“…In many instances, a 28-day course of prophylaxis is not completed. This is most often due to the source patient being HIV negative -this was found to be true in 65% of cases in a study done by Russi et al 4 Another common reason for discontinuing prophylaxis is the occurrence of side effects, such as gastrointestinal complications (13%) and headaches (4%), or a personal choice after counselling (in 18% of cases) 4,10 The risk of contracting acute hepatitis C infection due to a needlestick injury is estimated to range from 1% 4 to less than 5%. 11 Vardas found that 1.8% of healthcare workers in Johannesburg tested positive for HCV antibodies.…”

“…Needlestick injuries are responsible for 61.5% to 70% of accidental exposure cases. 2,3,4 Exposure may also occur from other sharp objects such as scalpels and broken glass, 4 as well as from mucosal exposure after splashing of blood or other bodily fluids. 5 Seroconversion is more likely in cases of deep injury from a hollow-bore needle, visible blood on the needle, injury during a procedure involving placement of the needle in an artery or vein, or the death of the source patient with AIDS within two months after the exposure occurred.…”

Knowledge, Attitude and Practices of HIV Post Exposure Prophylaxis Amongst Health Workers in Lagos University Teaching Hospital

“…Of great significance is the low level of use of PEP, although the respondents displayed good acceptance of PEP but only 6.3% of respondents who had needle stick injury accepted to use PEP This is not unexpected bearing in mind that majority of the needle stick injury was never reported. Similarly, in a study done by Russi et al, only 13% of the health care workers who reported needle stick injury elected to receive prophylaxis [9].…”

Incidence of Visits for Health Care Worker Blood or Body Fluid Exposures and HIV Postexposure Prophylaxis Provision at Rhode Island Emergency Departments

“…This predictable observation has been reported in other studies. [15][16][17][18] Also, as anticipated, HIV PEP offering was greater as the years progressed from the introduction of the CDC occupational HIV PEP guidelines in 1996. HIV PEP was offered more frequently at academic EDs than at community hospital EDs.…”

“…This trend has been observed elsewhere. Russi et al 16 examined predictors of HIV PEP utilization at 2 Yale University-affiliated hospitals in New Haven. Using a multivariate model, they found that physicians were more likely to be prescribed HIV PEP than other HCWs even when controlling for HIV status of the source and the type of exposure.…”