Bloodborne Pathogens Exposure: HIV Post Exposure Prophylaxis Regimen

 
DRAFT
Actions to take for exposure to bloodborne pathogens
(HIV, Hep C)
Do you still
suspect
source HIV
positive?
 
No /UNK
Submit additional blood
 
sample from potential
source to a laboratory for verification.
 
Blot a sample of Blood onto filter-paper and
seal in plastic bag (See Blood Collection and
Shipping Instructions)
 
Sample will travel with Soldier during EVAC to
Germany and shipped via FedEx using account
or be shipped DHL to WRAIR
 
No
 
Yes
 
No
 
No
 
Yes
Educate Soldier and unit
on Risk Factors and
Avoidance
EXPOSURES with increased risk:
Needle Stick, Contact with infected or
suspected person's fluids, OR
contact with assailant body fluid via mucous
membrane, non-intact skin or bite; OR
unknown exposure (e.g, drug assisted)
[AFRICA is considered High Risk]
NO RISK EXPOSURES:
Exposures  where skin remains intact
where there is no anal, vaginal, or oral
penetration; no contact with source body
fluids via mucous membrane,
Conduct RDT 
(Rapid Diagnostic Test)
 on Source: 1
each, HIV, Hep
 B, Hep C
[do
 not use saliva, use blood]
Is Source
RDT
Positive?
 
Yes
 
Yes
HIV
IMMEDIATELY:
Begin Soldier Treatment PEP:
Delay of PEP administration 
greater than 48
hours significantly diminishes efficacy of
treatment regime.
Begin Coordinating for EVAC to
Landstuhl:
 
Due to limited PEP supply on hand,
evacuation should be completed within 72
hours.
Use Triple Drug Therapy, currently the
best combination:
Dolutegravir x 1 tab per day, 
plus
Truvada (two drug combo) X1 Tab per
day
Pre-treat w/Zofran or Phenergan to
offset nausea/vomiting from meds
Points of Contact:
-
LTC Lynch,
 
SOCAF Surgeon 
(all MEDEVACs)
DSN: 314-421-3339  COMM:  +49 (0)711-729-3339
SVOIP: (80) 304-436-2035
NIPR:  
SIPR:  
SOCAFRICA JOC:
  - DSN 421-3340/3370; 0711-729-3340/3370
  - RED: 304-436-2100
  - socafrica.joc@usafricom.smil.mil
usasocafricasocafsurgeon@usafricom.smil.mil
AFRICOM
 ID consultant
ID.consult@us.army.miljlynch@usafricom.smil.miljames.h.lynch.mil@mail.mil
Note: Continued Treatment 
and
consultation required,  
Testing will be
required at 1,  3,  6 and 12 months
Is Contact
Source
HIV
Negative?
Is Source
available
for 
RDT
(
Rapid
Diagnostic
Test)
?
 
HIV PEP Kit Contents
 
Sealable rugged container: Otter/Pelican approx 5W"x7W"x3D"
Labeled on Outside,
HIV Exposure Kit
Kit Contents with pertinent expiration date
Last inspection date and initials
Drugs (should medics fill separate in case of expiration date?
Dolutegravir
Truvada
Rapid Test - HIV RDT, (verify no special handling instructions or expiration)
Include extra lancet for blood sample
Ensure each kit has pipette if applicable (some RDTs have pipets separate)
SOP/Flow Chart/shipping instructions - 5x7 laminated printout
Blood Sample Kit
FTA Micro Card (x2)
alcohol wipe
sterile lancet
adhesive bandage
gloves,
Multi-Barrier Pouch (strong ziplock to hold the blood sample)
mailing envelope
tamper-proof tape for the mailing envelope,
Desiccant
clear outer bag (labeled with code number and expiration date
Gloves
Pre-Printed labels
Desicant bag - keep moisture out
 
Blood Sample Kit
 
Blood Sample Collection Instructions 5x7 laminated
FTA Micro Card (x2)
alcohol wipe
sterile lancet
adhesive bandage
gloves,
Multi-Barrier Pouch (strong ziplock to hold the blood sample)
mailing envelope
tamper-proof tape for the mailing envelope,
Desiccant
clear outer bag (labeled with code number and expiration date
Actions to take for exposure to bloodborne pathogens
(HIV, Hep C)
Is Contact
Source HIV
Negative?
Conduct RDT on
Source
Is Source
RDT
Positive?
Do you still
suspect
source HIV
positive?
 
No /UNK
Always submit additional blood
sample from the potential source to a
laboratory for verification.
 
Blot a sample of Blood onto filter-
paper and seal in plastic bag
 
Sample will travel with Soldier during
EVAC and turned into lab
 
Yes
 
No
 
Yes
 
Yes
 
No
 
No
 
Yes
Educate Soldier and unit
on Risk Factors and
Avoidance
HIGH RISK EXPOSURES:
Needle Stick, Contact with infected or
suspected person's fluids, OR
contact with assailant body fluid via mucous
membrane, non-intact skin or bite; OR
unknown exposure (e.g,, drug assisted)
[AFRICA]
NO RISK EXPOSURES:
No anal, vaginal, or oral penetration; No
contact with assailant body fluid via
mucous membrane, non-intact skin
or bite Contact with fluids of non-infected
person
HIV
IMMEDIATELY:
Begin Soldier Treatment PEP:
Delay of PEP administration 
greater than
48 hours significantly diminished efficacy
of treatment regime.
Begin Coordinating for EVAC to
Landstuhl:
 
Due to limited PEP supply on hand,
evacuation should be completed within
72 hours.
Use Triple Drug Therapy, currently
the best combination:
Daltegravir x 1 tab per day, 
plus
Truvada (two drug combo) X1 Tab
per day
Pre-treat w/Zofran or Phenergan to
offset nausea/vomiting from meds
Points of Contact:
-
LTC Lynch,
 
SOCAF Surgeon (all
MEDEVACs)
 DSN: 314-421-3339
COMM:  +49 (0)711-729-3339
SVOIP: (80) 304-436-2035
NIPR:  
james.h.lynch.mil@mail.mil
SIPR:  
jlynch@usafricom.smil.mil
ID.consult@us.army.mil
AFRICOM
 ID consultant
Note: Continued Treatment 
and
consultation required,  
Testing will
be required at 1,  3,  6 and 12
months
 
 
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Take immediate action for exposure to bloodborne pathogens like HIV and Hepatitis C through a post-exposure prophylaxis (PEP) regimen. Administer PEP within 48 hours for increased-risk exposures like needle sticks or contact with infected fluids. Coordinate evacuation if needed and conduct Rapid Diagnostic Tests. Educate on risk factors and continue monitoring and treatment. Ensure PEP kit contents are properly labeled and include essential items for testing and collection of samples.

  • Bloodborne pathogens
  • HIV
  • Hepatitis C
  • Post-exposure prophylaxis
  • Rapid Diagnostic Test

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  1. Actions to take for exposure to bloodborne pathogens (HIV, Hep C) HIV Post Exposure Prophylaxis Regimen EXPOSURES with increased risk: Needle Stick, Contact with infected or suspected person's fluids, OR contact with assailant body fluid via mucous membrane, non-intact skin or bite; OR unknown exposure (e.g, drug assisted) [AFRICA is considered High Risk] IMMEDIATELY: NO RISK EXPOSURES: Exposures where skin remains intact where there is no anal, vaginal, or oral penetration; no contact with source body fluids via mucous membrane, Begin Soldier Treatment PEP: Delay of PEP administration greater than 48 hours significantly diminishes efficacy of treatment regime. Begin Coordinating for EVAC to Landstuhl: Due to limited PEP supply on hand, evacuation should be completed within 72 hours. Is Source available for RDT (Rapid Diagnostic Test)? No /UNK Is Contact Source HIV Negative? No Use Triple Drug Therapy, currently the best combination: Dolutegravir x 1 tab per day, plus Truvada (two drug combo) X1 Tab per day Pre-treat w/Zofran or Phenergan to offset nausea/vomiting from meds Yes Yes HIV Conduct RDT (Rapid Diagnostic Test) on Source: 1 each, HIV, Hep B, Hep C [do not use saliva, use blood] Is Source RDT Positive? Points of Contact: -LTC Lynch, SOCAF Surgeon (all MEDEVACs) DSN: 314-421-3339 COMM: +49 (0)711-729-3339 SVOIP: (80) 304-436-2035 NIPR: james.h.lynch.mil@mail.mil SIPR: jlynch@usafricom.smil.mil SOCAFRICA JOC: - DSN 421-3340/3370; 0711-729-3340/3370 - RED: 304-436-2100 - socafrica.joc@usafricom.smil.mil usasocafricasocafsurgeon@usafricom.smil.mil ID.consult@us.army.mil AFRICOM ID consultant Submit additional blood sample from potential source to a laboratory for verification. Yes No Blot a sample of Blood onto filter-paper and seal in plastic bag (See Blood Collection and Shipping Instructions) Sample will travel with Soldier during EVAC to Germany and shipped via FedEx using account or be shipped DHL to WRAIR Do you still suspect source HIV positive? Yes No Educate Soldier and unit on Risk Factors and Avoidance Note: Continued Treatment and consultation required, Testing will be required at 1, 3, 6 and 12 months DRAFT

  2. HIV PEP Kit Contents Sealable rugged container: Otter/Pelican approx 5W"x7W"x3D" Labeled on Outside, HIV Exposure Kit Kit Contents with pertinent expiration date Last inspection date and initials Drugs (should medics fill separate in case of expiration date? Dolutegravir Truvada Rapid Test - HIV RDT, (verify no special handling instructions or expiration) Include extra lancet for blood sample Ensure each kit has pipette if applicable (some RDTs have pipets separate) SOP/Flow Chart/shipping instructions - 5x7 laminated printout Blood Sample Kit FTA Micro Card (x2) alcohol wipe sterile lancet adhesive bandage gloves, Multi-Barrier Pouch (strong ziplock to hold the blood sample) mailing envelope tamper-proof tape for the mailing envelope, Desiccant clear outer bag (labeled with code number and expiration date Gloves Pre-Printed labels Desicant bag - keep moisture out

  3. Blood Sample Kit Blood Sample Collection Instructions 5x7 laminated FTA Micro Card (x2) alcohol wipe sterile lancet adhesive bandage gloves, Multi-Barrier Pouch (strong ziplock to hold the blood sample) mailing envelope tamper-proof tape for the mailing envelope, Desiccant clear outer bag (labeled with code number and expiration date

  4. HIV Post Exposure Prophylaxis Regimen Actions to take for exposure to bloodborne pathogens (HIV, Hep C) IMMEDIATELY: HIGH RISK EXPOSURES: Needle Stick, Contact with infected or suspected person's fluids, OR contact with assailant body fluid via mucous membrane, non-intact skin or bite; OR unknown exposure (e.g,, drug assisted) [AFRICA] NO RISK EXPOSURES: No anal, vaginal, or oral penetration; No contact with assailant body fluid via mucous membrane, non-intact skin or bite Contact with fluids of non-infected person Begin Soldier Treatment PEP: Delay of PEP administration greater than 48 hours significantly diminished efficacy of treatment regime. Begin Coordinating for EVAC to Landstuhl: Due to limited PEP supply on hand, evacuation should be completed within 72 hours. Is Contact Source HIV Negative? Is Source available for RDT? No /UNK No Use Triple Drug Therapy, currently the best combination: Daltegravir x 1 tab per day, plus Truvada (two drug combo) X1 Tab per day Pre-treat w/Zofran or Phenergan to offset nausea/vomiting from meds Always submit additional blood sample from the potential source to a laboratory for verification. Blot a sample of Blood onto filter- paper and seal in plastic bag Sample will travel with Soldier during EVAC and turned into lab Yes HIV Conduct RDT on Source Points of Contact: -LTC Lynch, SOCAF Surgeon (all MEDEVACs) DSN: 314-421-3339 COMM: +49 (0)711-729-3339 SVOIP: (80) 304-436-2035 NIPR: james.h.lynch.mil@mail.mil SIPR: jlynch@usafricom.smil.mil Yes Is Source RDT Positive? Yes No ID.consult@us.army.mil AFRICOM ID consultant Educate Soldier and unit on Risk Factors and Avoidance Do you still suspect source HIV positive? No Yes Note: Continued Treatment and consultation required, Testing will be required at 1, 3, 6 and 12 months

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