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1 A Gay Men s Health Service Audit of: Post Exposure Prophylaxis Robert Obara, BSc MPH MBBChBAO Candidate, TCD Class of 2014 Poster for BASHIV, Dr Dominic Rowley (GMHS) et al.
2 PEP Talk Antiretroviral drugs (Truvada + Kaletra) Within 72 hours of HIV exposure Must be taken for 4 weeks Free of charge Side effects often experienced GMHS PEP Audits Main audit: July 2011 October 2011 Compiled demographics Evaluated clinical management Re-audit competed spring 2013
3 PEP Recipient Demographics } 52 PEP recipients were identified 31 from the first audit & 21 from the re-audit } All were MSM }
4 Reason for requesting PEP HIV Risk 13% (n=7) documented partner as HIV positive (3 of 7 documented partner taking HAART) Majority unaware of their partners status 27% (n=14) reported condom accidents No cases of non consensual sex were documented Majority were documented as consensual unprotected intercourse with a casual partner
5 1 st Clinical Review Findings 87% (n=27) had baseline HIV bloods documented 90% (n=29) received Truvada and Kaletra 77% (n=24) completed the full course Reasons for non-completion included discovery of partner HIV status, PEP side effect intolerance, anxiety, and limited HIV exposure 77% (n=24) had a 4 week follow-up HIV test 67% (n=21) had a 12 week test All 31 patients tested HIV negative at subsequent blood tests
6 Re-Audit of Clinical Practice 100% (n=21) had baseline HIV test 95% (n=20) had Hep B immunity status documented 90% (n=19) had Hep C result within the past 2 years Decrease in PEP prescriptions for insertive anal only No seroconversions were discovered Noted inconsistencies in the timing of follow up HIV tests (1 12 weeks) and lab tests (FBCs and LFTs) Thus standardized clinical protocol and patient leaflets
7 PatientInformationLeafletonPEPSE HighRiskPack Youarebeingstartedoncombinationanti viraldrugs.thisistohelppreventhiv afterpossiblesexualexposuretothehivvirus. Thedrugsintwoseparateproducts(colouredtablets)willbeprescribedforatotalof 28Days. Youhavereceivedan8daypack.YoumustattendyournextappointmentatGMHS toobtaintherestofthesupply,beforethe8daysupplyrunsout. Pleasetrynottomissanydoses.Ifyouforgettotakeadose,takeitassoonasyou rememberandthenextdoseatthenormaltime.nevertakeadoubledose. PleasecheckwithyourdoctorattheGMHSabouttakinganynewmedications (prescriptionornonprescription)whilstonthiscombinationtherapy. ContactTelephoneNumber:GMHS DateofPrescription: Doctor: Appointments&Procedures. 1 st Appointment:(7or8daysfromtoday): RestofTabletsandBloodTests:LFT/FBC/Renal. 2 nd Appointment:6WeeksfromprescriptionDate ST Is cre ena n dbl oo d Tes t s: (HIV,HEPC,Syphilis). 3 rd Appointment:12WeeksfromprescriptionDate: FinalBloodTests:(HIV,HEPC,Syphilis). DrugsDescription TRUVADA (BlueTablet) TakeisONEtabletperDAY,withfood. TheTRUVADA tabletcontains2differentdrugs Tenofovir(Ten)andEmtricitabine (FTC).Itisusuallywelltolerated. Possiblesideeffectsincludeachesandpains,dizziness,headaches,diarrhoea, nausea,vomitingandinsomnia.(therearetabletstohelpwiththisseebelow) KALETRA (PaleYellowTablet) TakeTWOtabletsTWICEaday(every12Hours),withorwithoutfood. TheactivedruginKaletra islopinavir.asmalldoseofanadditionaldrug,ritonavir, isincludedtoincreasethebloodlevelsoflopinavir. ThemostcommonsideaffectsofKALETRA arediarrhoeaandincreasedcholesterol. Headache,insomnia,gastrointestinaleffectsandchangesinbloodsugarsorliver enzymesmayalsooccur. TherearesomemedicationsthatcannotbetakenwhenonKALETRA Itisimportanttotellthedoctorandpharmacistaboutanyothermedications (prescriptionornonprescription)youarecurrentlytaking. Helpfulhints: (BLUEtablet:onceperday) (Pale/Yellowtablet:2twiceperdaymorningandevening) OthermedicationbelowtohelpyouwhiletakingPEP Thesecanbeboughtatachemistwithoutprescription Imodium2mgCapsules Anti DiarrhoeaTabletstotakeasneededdaily Motilium10mgTablets Anti NauseaTablets Take2tablets,30minutesbeforetheothertabletsprescribed.Morningandevening forthemonthasnecessary. Paracetamol(takeasdirectedonpack) Thisisasuitablepainkillertotakeforheadache,achesorpains
8
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