NPEP has been in wide-spread use in Australia since 1999 and is recommended by the Australian Government’s Department of Health and Ageing.[11] The Australian National NPEP guidelines recommend 28 days of ART (at prescriber’s discretion) with two or three drugs for an HIV transmission risk event of ≥ 1: 15,000. Australian men who have sex with men and, to a lesser extent, people who inject drugs, are the principal target groups. Nurses have diverse roles in the assessment and provision of PEP (see Table 12). Any nurse working in HIV and sexual health, family planning, an emergency department or in a general practice requires a minimum of PEP literacy (see Table 13).
Table 12: Nursing roles in non-occupational postexposure prophylaxis (NPEP)
|
Table 13: Minimum post-exposure prophylaxis (PEP) literacy
|
Of the 170 (49%) that occurred during a week day, 10% were between the hours of 08:30 and 17:00; the usual operating hours of clinics that provide NPEP. Thus, emergency departments assess the majority of presentation for NPEP and nurses who work in emergency departments are a particular group who need to be PEP literate.
In addition to a minimum PEP skill set, nurses provided with adequate training, support and resources are also capable of independently assessing and managing patients requiring ART as PEP.
The National NPEP Guidelines provide comprehensive information about risk assessment, in brief:
- an HIV risk event needs to have occurred
- the person with whom the event occurred needs to be HIV positive or from a population likely to have HIV
- the patient needs to present for assessment within 72 hours of the event
Table 14 presents a simple flow-chart which can be used as a NPEP risk assessment tool.
Table 14: Non-occupational post-exposure prophylaxis (NPEP) risk assessment#
| Consider NPEP if conditions 1, 2 and 3 are met | |
High-risk exposure
i Condomless means no condom used or condom slippage or breakage Notes: Condomless receptive oral intercourse with ejaculation MAY BE CONSIDERED as a high-risk exposure providing the source is known to be HIV positive with a detectable HIV viral load and there is oral mucosal disease or an open lesion in the mouth or throat. Significant exposure of non-intact skin with blood, sperm or vaginal fluids MAY ALSO BE CONSIDERED as a high-risk exposure providing the source is known to be HIV positive with a detectable HIV viral load. |
|
Source is known to have HIV infectionii OR Source is likely to be at increased risk of HIV
ii NPEP is NOT RECOMMENDED following insertive or receptive anal, vaginal or oral sex, sharing of needles or other injecting equipment, and mucous membrane and non-intact skin exposure when the source’s viral load is KNOWN to be undetectable – this is provided the source is known to be compliant with medication, attends regular follow-up and has no intercurrent sexually transmissible infection (STI). iiiData available at: http://aidsinfo.unaids.org/ |
|
The client presents within 72 hours of exposure |
|
| 1 + 2 + 3 = NPEP |
For a comprehensive guide to risk assessment see the Australian National NPEP guidelines available at: http://www.ashm.org.au/pep-guidelines/
NPEP does not always prevent HIV acquisition. The time to first NPEP dose, incomplete NPEP adherence, continued HIV risk behaviour and primary ART resistance have each been linked to NPEP failure.[12] [13]