491. Five years implementation of a HIV post-exposure prophylaxis program for occupational and sexual exposure in Brazil
Session: Poster Abstract Session: HIV Testing and Prevention
Friday, October 21, 2011
Room: Poster Hall B1
Background: A network was stablished to offer PEP anti-retroviral drugs and STD prophylaxis to occupational and sexual exposures, offering multidisciplinary health assistance, PEP and follow-up for a target population of 1.5 million from 137 cities in Brazil.

Methods: 

Study describes results of the first 5 years of implementation of a PEP healthcare program for occupational and sexual HIV exposures, surveillance data and strategies to ensure access and adherence. Staff was trained to assist exposed individuals based on a standardized protocol. Every case (HCWs, serodiscordant couples and sexual violence victims) is followed by an infectious diseases specialist and counseling staff at the Center for Testing and Counseling.

Results: 

-          4,490 cases reported (3,471 occupational; 1,019 sexual) in 87 cities.

-          PEP initiated in 32% of cases.

-          Only 2.9% of occupational exposures, 62.0% of sexual exposures had emergency assistance >72 hrs after exposure.

-          11 (0.2%) individuals had new diagnosis of HIV, 3 (0.06%) of HBV and 4 (0.8%) of HCV in baseline.

-          One HCW tested positive to HCV 3 months after percutaneous occupational exposure.

-          Many sexual abuse cases did not receive adequate PEP due to delayed time to medical assistance. One case tested positive for syphilis during follow-up.

-          Most commonly prescribed anti-retroviral regimen: AZT/3TC.

-          84.5% completed 28 days of PEP (as per protocol).

-          Individuals that followed the protocol showed enhanced adherence to condom use after counseling/testing.

Conclusion: 

Significant increase in referral to ER since implementation. Meetings/training of institutions/community counselors enhanced network capability of detecting occupational and sexual exposure cases. Free drug access, testing and specialized assistance were important to reach these results. Merging previous existent testing and counseling structure with education and follow-up was relevant to ensure adherence to testing follow-up. Multidisciplinary approach was important to effective assistance and ensure adherence to PEP/follow-up.

Emergency assistance was effective with satisfactory interval between exposure and PEP initiation for occupational exposures/serodiscordant couples. Sexual violence cases had larger lag time.


Subject Category: H. HIV/AIDS and other retroviruses

Guilherme Cortes Fernandes, MD PhD, Infectious Diseases Unit, Santa Casa de Misericórdia de Juiz de Fora, Juiz de Fora, Brazil, Ana Claudia Bastos, Parbos, Prefeitura Municipal de Juiz de Fora, Juiz de Fora, Brazil, Marly Guercio, Programa Municipal DST/AIDS, Prefeitura Municipal de Juiz de Fora, Juiz de Fora, Brazil and Cristiane Rapparini, MD, PhD, Projeto Riscobiologico.org, Rio de Janeiro, Brazil

Disclosures:

G. Cortes Fernandes, None

A. C. Bastos, None

M. Guercio, None

C. Rapparini, None

Findings in the abstracts are embargoed until 12:01 a.m. EST Thursday, Oct. 20 with the exception of research findings presented at IDSA press conferences.