Post exposure prophylaxis of HIV transmission after occupational injuries in Queen Elizabeth Central Hospital, Blantyre, Malawi, 2003 – 2008

Abstract

Health care worker (HCW) in Malawi may acquire HIV infection through occupational injuries, in particular since HIV prevalence among inpatients and incidence of occupational injuries are high. A post exposure prophylaxis (PEP) programme for occupational injuries at Queen Elizabeth Central Hospital (QECH) commenced in 2003. We performed an audit of this programme from 2003 through 2008. 203 Occupational injuries were reported. The majority were needle stick injuries (76.3%). Half of the clients were in a training position. A dual ART regimen was most frequently prescribed. Triple therapy use increased over time and was more frequent in expatriate students. Many nurses and clinical officers were not fully vaccinated for HBV. Based on previous incidence data, occupational injuries were likely to be underreported. Data on side effects were incomplete, however PEP discontinuation due to side effects occurred only twice. Follow up visits were poorly attended, therefore the efficacy of PEP could not be evaluated. Prevention efforts for occupational injuries should be increased and specifically target HCWs in training positions.Measures to improve quality of the PEP programme include effective publicity campaigns, compulsory Hepatitis B vaccination and active tracing of HCWs who default follow up after PEP.

Prevalence and Post-exposure Prophylaxis use for Needlestick Injuries among Health Care Providers in a Tertiary Care Hospital in Kochi, India

“…The main reasons for underreporting might be due to the fact that a significant proportion of HPs did not know about the existence of a PEP service and were unaware about whom to contact in the event of an occupational exposure. Other reasons include an underestimation of HIV transmission and an unwillingness to take anti-retroviral drugs, as has been noted in previous studies (7)(8)(9)(10)(11)(12).…”

“…van der Maaten et al (7) reported the highest incidence of NSIs in the obstetrics ward. Observations made in the UK and China, where physicians were not available around the clock and non-of anti-retroviral medications, had reported significant underreporting and improper PEP delivery (7,17).…”

<p>Evaluation of Post-Exposure Prophylaxis Utilization Among Human Immunodeficiency Virus Exposed Victims at University of Gondar Comprehensive Specialized Hospital, North West Ethiopia</p>

“…This result is quite different to that of the research done in Malawi, where a dual ART regimen was prescribed in 85.2% and triple therapy in 14.8% of the cases. 34 Also, research done in a US military trauma hospital in Afghanistan shows 96.8% two-drug regimens prescribed, with the remaining cases prescribed a three-drug regimen. 2 Our study finding was consistent both with WHO guidelines and national protocol, which we come up with as best practice.…”

“…For this reason, the number of clients who took PEP within 2 hr was small. 1,4,34,35 To be effective, prophylaxis has to commence as soon as possible (within 1-2 hr post-exposure). Considering PEP beyond 72 hr postexposure has no impactful result.…”

Post‐exposure prophylaxis in resource‐poor settings: review and recommendations for pre‐departure risk assessment and planning for expatriate healthcare workers

“…In a Malawian PEP programme, just 25.2% of HCW who began PEP attended the first follow‐up visit and only 1.9% completed all four visits (van Der Maaten et al . ). Unfortunately, follow‐up in low‐resource settings is often hampered by poor logistics, lack of awareness, unclear procedures and stigma (van Oosterhout et al .…”