HIV nPEP* Process Algorithm - DRAFT Apple Pharmacy Closed: Dispense 3 day supply and give 28 day prescription; recommend going to their pharmacy (or Apple) as soon as possible Perform H&P collect baseline labs Apple Pharmacy Open: Send to pharmacy and give prescription for 28 days – confirm receipt of meds before D/C Note Insurance Coverage Confirm patient contact information : Has Insurance Determine need for nPEP medications Refer to Clinical Algorithm on reverse Give patient the nPEP brochure -for any questions, call the immunologist on call No Insurance nPEP Prescribed – fax referral form to Immunology at x4385 Dispense 3 day supply, give 28 day supply prescription, and on faxed referral form to Immunology, clearly note that this patient does not have insurance – tell patient that someone from Immunology will contact them on how to fill it No nPEP and no follow-up needed then nothing further No nPEP but needs Immunology follow-up, fax referral form to Immunology at x4385 *non-occupational post-exposure prophylaxis

Exposure < 72 hours, then assess as Lower Risk vs. Higher Risk nPEP* Clinical Decision Making Algorithm for Significant Potential HIV Exposure - DRAFT Send Baseline Labs Rapid HIV CBC with differential, Hep B surface antigen, Hep B surface antibody, RPR, Hep C antibody, metabolic panel Exposure < 72 hours, then assess as Lower Risk vs. Higher Risk Lower Risk– 2 meds Truvada (emtricitabine and tenofovir) once daily for > 35 kg OR Retrovir (zidovudine) 20 mg/kg/day divided BID (max 300 mg/dose) AND Epivir (lamivudine) 8 mg/kg/day (max 150 mg/dose) Exposure > 72 hours then NO nPEP meds- must follow up in Immunology and/or Child Protection (especially for high risk exposures) for further testing LOW HIGH Higher Risk – 2 meds above PLUS Reyataz (atazanavir) BID: 150 mg/dose (15-25 kg), 200 mg (25-32 kg), 250 mg (32 to 35 kg ) AND Norvir 100 mg OR Kaletra (lopinavir/ritonavir) 20 mg/kg/day divided BID (max 400 mg/dose) High Risk Exposures: Known HIV positive contact, visible trauma and/or secretions, anal penetration, and other factors (call Immunology if assistance is needed) Prevention efficacy is increased by use of 3 drugs, but it also decreases compliance *non-occupational post-exposure prophylaxis