hiv-pep helpline for health proffessionals

FOGSI HIV PEP FOGSI HIV PEP HELPLINEHELPLINEDr.Narendra MalhotraDr.Narendra Malhotra

FOGSI coordinator for PEP FOGSI coordinator for PEP HelplineHelpline

Dr. Alok VashishthaDr. Alok Vashishtha

Consultant in Infectious Consultant in Infectious DiseasesDiseases

HaridwarHaridwar

What is Post What is Post exposure exposure

prophylaxis for prophylaxis for HIV ?HIV ?

OCCUPATIONAL EXPOSUREOCCUPATIONAL EXPOSURE that may that may place a worker at risk of HIV infection is place a worker at risk of HIV infection is a percutaneous injury ,contact of a percutaneous injury ,contact of mucous membrane or contact of skin mucous membrane or contact of skin (especially when the skin is chapped, (especially when the skin is chapped, abraded or affected with dermatitis or abraded or affected with dermatitis or the contact is prolonged or involves an the contact is prolonged or involves an extensive area ) with blood tissue or extensive area ) with blood tissue or other body fluids to which universal other body fluids to which universal precautions apply.precautions apply.

ExposureExposure

Institute of Infectious Diseases

Why this helpline Why this helpline ??

The needle stick injury can not only lead The needle stick injury can not only lead to some life threatening blood borne to some life threatening blood borne infections as well as have severe infections as well as have severe emotional impact on health care emotional impact on health care personnel.personnel.

It is an medical emergency and can It is an medical emergency and can happen anywhere anytimehappen anywhere anytime

FOGSI initiative is first of its kind in FOGSI initiative is first of its kind in worldworld

Why this helpline ?Why this helpline ?


What is the extent of the What is the extent of the problem ?problem ?

Survey of 428 HCW in IndiaSurvey of 428 HCW in India - 343 (80%) had 1 PI in past - 343 (80%) had 1 PI in past

1 year 1 year (IJMR, April,2010)(IJMR, April,2010)

In USA there are 57 In USA there are 57 documented cases of health documented cases of health care workers contracting care workers contracting HIV from exposures; 137 HIV from exposures; 137 other possible casesother possible cases

(NEJM 2003;348:826)(NEJM 2003;348:826)


Rationale of PEPRationale of PEP

Information about primary HIV Information about primary HIV infection indicate that systemic infection indicate that systemic infection does not occur immediately infection does not occur immediately leaving a brief period within ‘window leaving a brief period within ‘window of opportunity’ during which post of opportunity’ during which post exposure anti-retroviral intervention exposure anti-retroviral intervention may modify viral replicaitonmay modify viral replicaiton


Principle behind Principle behind administering PEPadministering PEP

CD4 CELL

Surface ligands of dendritic cells of skin or mucous membrane


It is a medical emergencyIt is a medical emergency

Do not panic Do not panic

WHAT TO DO ON WHAT TO DO ON EXPOSURE EXPOSURE


WHAT NEXTWHAT NEXT

REPORT PROMPTLY REPORT PROMPTLY

PEP MUST START AT THE PEP MUST START AT THE EARLIEST EARLIEST PREFERABLY WITHIN TWO HOURSPREFERABLY WITHIN TWO HOURS MAY BE UPTO 72 HOURSMAY BE UPTO 72 HOURS


How to assess risk ?How to assess risk ?The exposure reportThe exposure report

(Each exposure is unique)(Each exposure is unique)

• Date and time of exposureDate and time of exposure Accurate report: Minute to minute details Accurate report: Minute to minute details

are idealare ideal Procedure details…what, where, how, Procedure details…what, where, how,

with what devicewith what device Exposure details...route, body substance Exposure details...route, body substance

involved, volume/duration of contactinvolved, volume/duration of contact Information about source person and Information about source person and

exposed personexposed person Exposure management detailsExposure management details


Launch of Launch of HELPLINEHELPLINE

International Conference of HIV and International Conference of HIV and WomenWomen

16 November, 2008, Nagpur16 November, 2008, Nagpur

How does HELPLINE work How does HELPLINE work ??

How helpline worksHow helpline works A call is received from an exposed health A call is received from an exposed health

care worker by Dr Alok Vashishtha, care worker by Dr Alok Vashishtha, Specialist in HIV/AIDS on his cell. He then Specialist in HIV/AIDS on his cell. He then follows following procedure:follows following procedure:

Details of exposure are takenDetails of exposure are taken A protocol is decidedA protocol is decided ARV drugs are made available (if required)ARV drugs are made available (if required) Follow up is done as decided Follow up is done as decided Have a team of resource persons for Have a team of resource persons for

complex scenarioscomplex scenarios

How drugs are made How drugs are made availableavailable

Have a memorandum of understanding with Have a memorandum of understanding with all companies making and marketing HIV all companies making and marketing HIV drugs.drugs.

Dr Alok Vashishtha have the mobile numbers Dr Alok Vashishtha have the mobile numbers of National Sales manager of all companies in of National Sales manager of all companies in field of HIV therapy.field of HIV therapy.

Their pan India sales network of about 2500 Their pan India sales network of about 2500 executives is used to locate the pharmacy executives is used to locate the pharmacy catering these drugs.catering these drugs.

Address is given to the exposed health care Address is given to the exposed health care providerprovider

Type of callsType of calls

Call from around all states of IndiaCall from around all states of India Call from Asia, Africa, Europe and Call from Asia, Africa, Europe and

USA.USA. Problem phone calls (General query Problem phone calls (General query

about HIV/AIDS)about HIV/AIDS) Special kind of exposuresSpecial kind of exposures Missed callsMissed calls Stigma callsStigma calls For locating a OBGYNFor locating a OBGYN

ConclusionsConclusions Health care workers put themselves at risk in their Health care workers put themselves at risk in their

workwork Prevention of exposures is criticalPrevention of exposures is critical PEP can be useful interventionPEP can be useful intervention Management of occupational exposure is complexManagement of occupational exposure is complex Expert consultation should be soughtExpert consultation should be sought FinallyFinally Awareness of Universal precautions and PEP options:Awareness of Universal precautions and PEP options: - allay fears of caring for HIV infected persons- allay fears of caring for HIV infected persons - reduced stigma and discrimination- reduced stigma and discrimination - better care of PLHIV- better care of PLHIV


HELP LINE TEAMHELP LINE TEAM

Dr. Narendra MalhotraDr. Narendra Malhotra Dr. C.N. PurandareDr. C.N. Purandare Dr. Laxmi ShrikhandeDr. Laxmi Shrikhande Dr .Alok VashisthaDr .Alok Vashistha

ACKNOWLEDGEMENTSACKNOWLEDGEMENTS All FOGSI MembersAll FOGSI Members

www.fogsi.orgwww.fogsi.org

Prevention is better Prevention is better than curethan cure


Thank You for your kind Thank You for your kind attentionattention

Institute of Infectious DiseasesNirmal Medical Foundation, Hardwar


hiv-pep helpline for health proffessionals

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