Technical Guidance for Global Fund HIV Proposals

Broad Area PREVENTION

Service Delivery Area Post-exposure prophylaxis (PEP)

Working document - 2008

Rationale for including the SDA in the proposal

Strong ethical arguments support providing PEP for HIV infection. Each day, thousands of people
around the world experience accidental exposure to blood, other body fluids or tissues. Health care
workers are especially vulnerable. Moreover, in many parts of the world, the potential for workplace
accidents that may expose workers to HIV-infected blood and other body fluids is increasing.
The availability of PEP for health workers also serves to increase staff motivation to work with people
infected with HIV, and may help to reassure and retain staff concerned about the risk of exposure to
HIV in the workplace.
An increasing number of HIV infected patients come into the health care system for care and
treatment. Therefore the number of people who may require invasive procedure is increasing rising
the potential risk of injuries and transmission of HIV. (see the guidelines doc)

Elements to be considered in the situation analysis

The following should be considered in the situation analysis:
• prevalence of HIV in the general population
• HIV infections due to accidental exposure
• national policy and implementation policy development and implementation on both occupational
and non-occupational PEP

Target populations
There are two types of populations of interest in PEP services.
• Occupational populations. These include health care workers, emergency rescue workers,
waste-disposal workers, law enforcement personnel and fire-fighters, who might be exposed to
blood and other potentially infectious body fluids while performing their duties.
Post exposure prophylaxis remains a secondary preventive measure and the primary prevention
of HIV transmission in Health Care Settings should always be considered as a priority,(including
blood safety, safe injections, infection control and safe waste and sharps disposal)

• Non occupational population. The WHO guidelines mainly refer to people such as:

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 o victims of sexual assault : children, orphan, and vulnerable population (refugees, internally
displaced persons)
o Other groups should be considered, depending on the national policies: injection drug users
(sex workers, prisoners)

Suggested main activities

• Developing national policy and guidelines on PEP included in the HIV national strategic
planning: procurement plans, staff training; monitoring and evaluation; quality assurance
• Strengthening primary prevention of exposure: most effective measure to reduce the risk of
HIV transmission and more specifically, universal precautions for the prevention of HIV through
occupational exposure; knowledge about risks of acquiring HIV sexually, and access and
effective use of condoms,
• Developing capacity of health facilities to provide PEP: PEP services include: treatment (First
aid measure), post exposure counseling, testing, ARV regimens and drug for PEP, monitoring
and evaluation (exposure report, HIV-PEP information-such as posters, booklets-, follow-up
report and registers, statutory reporting forms)
• Training of care providers: Health care workers and other related workers need to be trained
for managing PEP. The training should include counseling, testing (initial and follow up testing),
prescription and monitoring the short course of ARV drugs.

Suggested key indicators

• Percentage of health facilities with PEP services available
• Other indicators are described in the guidelines.

Approach to costing
Choice of ARV medications.
• The cost of supplying PEP medication (may be linked to the bulk procurement of ARVs if a
national ART programme exists)
• Medication to prevent or relieve side effects
• Cost of testing the exposed (initial and follow up tests) and source person
• Staff education
• Support and follow-up services

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Linkages with other SDAs/programmes
Programmes related to this SDA include the following:
• Testing and counselling
• Antiretroviral therapies programme (ART)
• Drug supply programme
• All other programmes for the prevention of HIV in the Health Settings: Blood Safety, Safe
Injection, Infection Control, Safe Waste management (see technical brief attach
• Occupational Health
• Reproductive Health programmes
• Gender based violence programmes; emergency programmes.

Addressing gender, human rights and equity

• A non-discriminatory approach to service accessibility, information provision and
education is critical and must underpin any HIV-PEP policy or operational guidelines .
• For occupational exposure, all workers potentially exposed at work (workers and
patients in HCS) should benefit from services
• PEP eligibility policy should always be founded on the principle of equity regardless of
age or gender, or on other grounds such as injection drug use, sex work or male-to-male
sex. Non-citizens (e.g. refugees, asylum seekers, stateless persons) should have equal
access to medical care, including PEP, in the country in which they are currently
residing

Key implementing partners to be considered

• ILO (legal issues and advocacy work)
• UNHCR (refugees and emergency situations)
• UNFPA (reproductive health programmes)
• Médecins Sans Frontières
• Red Cross

Type and sources of technical assistance which might be required during

implementation
• Areas in which technical assistance might be required include:
o Developing/updating national PEP policies , including legal issues,
o Developing/updating national PEP strategy or scale up plan,

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 o Development and implementation of training, supervision and mentoring
o Strengthen drug procurement and supply chain management systems
o Developing/reviewing PEP guideline
o Evaluation, monitoring and quality improvement
Sources of technical support include:
o WHO
o ILO

Documents and guidelines

Joint WHO-ILO Guidelines and Policies for the Use of Occupational and Non-Occupational Post
Exposure Prophylaxis (PEP) to Human Immunodeficiency Virus
http://www.who.int/hiv/topics/prophylaxis/en/

Joint WHO/ILO guidelines on post-exposure prophylaxis (PEP) to prevent HIV infection

http://www.who.int/hiv/pub/guidelines/PEP/en/index.html J

Joint ILO/WHO guidelines on health services and HIV/AIDS: Fact Sheet No. 10. Summary outline for
the management of occupational exposure to blood-borne pathogen, pp. 75-76. ILO: 2005 Geneva.
http://www.who.int/hiv/pub/prev_care/who_ilo_guidelines.pdf

Occupational Health

Prevention of HIV Transmission in Health Care Settings

http://www.who.int/hiv/pub/toolkits/Technical%20update%20on%20prevention%20of%20HIV%20transm
ission.pdf

Protecting Healthcare Workers Preventing Needlestick Injuries

http://www.who.int/occupational_health/activities/pnitoolkit/en/index.html and in Spanish
http://ww.who.int/occupational_health/activities/pnitoolkit/es/index.html
WHO Guidelines on Hand Hygiene in Health Care (Advanced Draft)
http://www.who.int/patientsafety/information_centre/ghhad_download/en/index.html

Sharps injuries: Assessing the burden of disease from sharps injuries to health-care workers at national
and local level http://www.who.int/quantifying_ehimpacts/global/globsharpinjuries/en/index.html

WHO Aide-memoir: Healthcare worker safety

http://www.who.int/injection_safety/toolbox/docs/AM_HCW_Safety.pdf

Prevention of the transmission of HIV in health care settings: Blood Safety; Safe Injections, Standard
Precautions.

Guiding principles to ensure availability of injection equipment

http://www.who.int/injection_safety/WHOGuidPrinciplesInjEquipFinal.pdf

Managing a national Programme on Injection safety

http://www.who.int/injection_safety/toolbox/en/ManagingInjectionSafety.pdf

Safety of injections. World Health Organization, Geneva. WHO (10 September), 2003 http:/
www.who.int/injection_safety/sign/en/

Injection safety Toolbox: http://www.who.int/injection_safety/sign/en/

Blood Transfusion Safety http://www.who.int/bloodsafety/transfusion_services/en/Blood_Safety_Eng.pdf