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The Structure and Outcomes of a HIV Post-Exposure Prophylaxis Program in a High HIV Prevalence Setup in Western Kenya

July 29, 2009

"In 2001, HIV post-exposure prophylaxis (PEP) was initiated in western Kenya," explained the authors of the current study, which sought to describe the design, implementation, and evolution of the program. Patient data were analyzed for reasons, time to initiation, and PEP outcome.

Occupational PEP was initiated first, followed by non-occupational PEP (nPEP). Antiretroviral regimens were based on national PEP guidelines, cost and accessibility, and prevailing HIV prevalence. Emerging side effects data and cost improvements affected regimen changes.

From November 2001 to December 2006, 446 patients sought PEP. Ninety-one patients had occupational exposure. Of these 51 were males, and 72 accepted HIV testing. HIV was detected in 48 of 52 source patients; median exposure-PEP time was three hours (range: 0.3-96 hours). Of 72 HIV-negative patients receiving PEP, three discontinued, 69 completed and 23 performed post-PEP HIV RNA polymerase chain reaction (all negative). Eleven follow-up HIV enzyme-linked immunosorbent assay tests have all turned negative.

Of the 355 patients with non-occupational exposure, 285 were female, 90 children, 300 accepted HIV testing. Median exposure-nPEP time was 19 hours (range: 1-672 hours). Of 296 HIV-negative patients on nPEP, one died, 15 discontinued, 104 are on record having completed PEP and 129 returned for six-week HIV RNA polymerase chain reaction (one patient tested positive). Eighty-seven follow-up HIV enzyme-linked immunosorbent assay tests have all turned negative.

The authors concluded that providing PEP and nPEP in resource-constrained settings is feasible.

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Excerpted from:
05.2009; Vol. 51; No. 1: P. 47-53; Abraham M. Siika, M.Med.; Winston M. Nyandiko, M.Med.; Ann Mwangi, M.Sc.; Michael Waxman, M.D.; John E. Sidle; Sylvester N. Kimaiyo, M.D.; Kara Wools-Kaloustian, M.D.

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