The impact of rapid HIV testing to limit unnecessary post exposure prophylaxis following 9.442 occupational exposures (1997-2001).
Int Conf AIDS 2002 Jul 7-12; 14:(abstract no. MoOrD1106)
Rapparini C, Saraceni V, Cruz M, Mendes R, Durovni B Rio de Janeiro City Health Secretariat, Rio de Janeiro, Brazil
Post exposure prophylaxis (PEP) is recommended for health care workers (HCWs) following high risk occupational exposure. Since the toxicity and side effects of PEP are significant, timely HIV results on the source patient are essential to limit days on PEP when the source is HIV negative. In 1997, rapid HIV tests were introduced in an effort to limit unnecessary PEP. Our purpose was to compare the cost of PEP between the enzyme immunoassay (EIA) and rapid HIV tests (DetermineR, double-checkR or SAVR). The average time from EIA until results is variable among our different health care units in the city - from 1 to even 30 days. The data on occupational exposures were obtained from a surveillance system of occupational exposures to bloodborne pathogens among HCWs in Rio de Janeiro city's - Brazil. From Jan97-Dec01, 9.442 HCWs reported exposures to blood and other body fluids. Most exposures (~75%) involved known source patients. Rapid HIV testing found 5,4% positive and 92,7% negative results. At the time of exposure, 13.3% sources were HIV-positive (15,5% found by rapid test), 40,5% HIV-unknown and 46,3% HIV negative (86,8% found by rapid test). 50,1% HCWs initiated PEP and the most common prescribed combination was ZDV/3TC (72,9%). PEP was initiated for 788/891 (88,4%) HCWs exposed to an HIV-positive source patient; 1.957/3.111 (62,9%) exposed to a source patient with an unknown HIV status and for 313/2.719 (11,5%) exposed even to a source known to be HIV-negative at the moment of the exposure. Assuming that the cost of this combination is $ 4.8 for 3 days of PEP (or $ 11 if the drugs were not distributed by the Ministry of Health - local production with cheaper antiretroviral drugs) and that the cost of each rapid HIV test is $ 2.8, we estimate that during 1997-2001 institutional savings was of ~ $ 10.000 or even higher if expanded regimens were considered. Another important issue was the possibility of limiting unnecessary toxicity and side effects of PEP.
Keywords: AEGIS, HIV, HIV Infections, Occupational Exposure, Anti-HIV Agents, HIV Seropositivity, Health Personnel, Blood-Borne Pathogens, Zidovudine, Lamivudine, Research Design, HIV Protease Inhibitors, Drug Therapy, Combination, Brazil, Animal, Human, prevention & control, therapy, drug therapy
