OCCUPATIONAL EXPOSURE TO HUMAN IMMUNO DEFICIENCY VIRUS (HIV) AND POST EXPOSURE PROPHYLAXIS (PEP) DELIVERED AT THE CHILD HEALTH PHARMACY OF KORLE BU TEACHING HOSPITAL FROM JANUARY 2015 TO DECEMBER 2017

Helena Owusu, B.Pharm,MPH, KBTH Obedia Seaneke, KBTH Priscilla Ekpale, KBTH Daniel Bladu, KBTH Josephine Osarfo, Asamankese Government Hospital Grace Essandoh, HealthNet Airport Medical Center Frempomaa Nelson, KBTH Florence Amah Nkansah, KBTH

OUTLINE Introduction Background Methods Results Discussion Study strengths and limitations Conclusion Recommendations

INTRODUCTION Exposure to HIV is a major concern among health workers worldwide. A lot of under-reporting¹. (esp in developing countries) As of Dec 31 2013, 58 confirmed, 150 possible transmissions in US. (only 1 confirmed since 1999)¹ Health Care Worker’s exposed to a needlestick involving HIV infected blood have 0.23% risk of becoming infected¹`². Most effective 1-2 hours after exposure up to 72 hours.³

BACKGROUND KBTH started ART services started in 2003³. A well resourced Adherence Counselling Unit which provides PEP services to staff. KBTH has over 5000 staff ChildHealth Dept is the only unit with separate PEP services. (for staff of CHD and when counselling unit is not available)

PROTOCOL Exposure Incident (NSSI) Report at Child Health Pharmacy (Clean wound, collect data) Antigen/Antibody Test done Risk assessment Source HIV + Source HIV ? Source HIV- High risk no risk low risk negligible risk Start PEP Reassurance &risk mgt

METHODS Retrospective study All cases are documented in the PEP book at the Pharmacy together with the copies of test results. Data carefully extracted manually onto an excel sheet. Imported into STATA® version 13 for analysis

RESULTS

RESULTS

RESULTS Doctors n=32 Nurses n= 6 Orderlies n=11 Others n=5 Antigen/antibody test done/recorded n=39 25 4 7 2 Patient status checked/known/recorded 10 1 Low risk n=12 5 3 High risk n=17 14

RESULTS 29 Cases qualified for PEP 12 Low risk- Combivir (Lamivudine/Zidovudine)only 17 High risk- Combivir+ Aluvia(ritonavir boosted lopinavir) 26 completed the 28 day course 3 were deemed too low risk to continue All cases tested negative at 3 months testing

DISCUSSION Compliance with medications Availability of test strips/sensitivity Poor data on source hiv status Does reassurance work?

STUDY STRENGHTS AND LIMITATIONS Relatively easy and inexpensive Reporting bias Generalizability

CONCLUSION Current system of tracking and treating occupational exposure to HIV at the Childhealth Department of KBTH appears effective. Drs appear at most risk followed by orderlies.

RECOMMENDATIONS Similar services in other Departments Regular workshops for staff on IPC Periodic monitoring and evaluation Mandatory screening PEP help line(to offer round the clock advise) Pharmacies, hairstylists and barbers??

REFERENCES 1. Centers for Disease Control and Prevention, CDC, Occupational HIV Transmission and Prevention among Health Care Workers https://www.cdc.gov/hiv/pdf/workplace/cdc-hiv-healthcareworkers.pdf 2. World Health Organisation, WHO, Post-exposure Prophylaxis to prevent HIV infection http://www.who.int/hiv/pub/guidelines/arv2013/December2014-ARVsupplement- chap5.pdf?ua=1 3. Tetteh R.A, Nartey E.T, Lartey M, et al, Outcomes of a Postexposure Prophylaxis Program at the Korle-Bu Teaching Hospital in Ghana: A Retrospective Cohort Study, Journal of the International Association of Providers of AIDS Care 2015, Vol. 14(6) 544-552,

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