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

September 10, 2009

Since the early 1990s, in many countries antiretroviral medicines have been prescribed for post-exposure prophylaxis (PEP) following occupational exposure to the human immunodeficiency virus (HIV). This practice has since been extended to non-occupational situations, primarily for cases of sexual assault.

Increasingly, however, both policy-makers and health care providers have been raising questions about certain aspects of the use of HIV PEP: in particular, about the indications for post-exposure prophylaxis, the most suitable antiretroviral medicines to use and various issues relating to prescribing protocols and clinical management. Awareness of these areas of uncertainty has been further heightened by the expanding availability of antiretroviral therapy in more resource constrained settings and has led to calls for clear operational guidance on providing PEP.

In September 2005, a Joint WHO/ILO expert consultation for the development of policy and guidelines on occupational and non-occupational HIV post-exposure prophylaxis was held in Geneva. The objectives of this Consultation were:

  1. to review scientific evidence and programmatic experience in relation to providing PEP in occupational and non-occupational settings; and
  2. to recommend a consensus approach to formulating policy and operational guidelines for HIV PEP.
Although the needs of workers and people who have been sexually assaulted provided the focus of the consultation, consideration was given to other types of non-occupational exposure for which PEP might be indicated: specifically, those arising from isolated or episodic injecting drug use and consensual sexual exposure. The consultation recommendations, which are based on current understanding of the efficacy of PEP and available data for comparing different PEP strategies, represent the collective opinion of experts working in this field and form the basis of the present policy guidelines and service delivery recommendations.

HIV post-exposure prophylaxis for occupational and non-occupational exposure to HIV infection

September 02, 2009

HIV post-exposure prophylaxis for occupational and non-occupational exposure to HIV infection

The use of ARVs for Post-exposure prophylaxis (HIV-PEP) following occupational exposure to HIV, and the recent expansion of HIV-PEP to non-occupational situations, have raised numerous areas of uncertainty for policy makers and healthcare providers caring for potentially exposed individuals. Key issues among these are the appropriate indications for HIV-PEP, ART choices, and management strategies to accompany use of PEP for HIV. With the expanding availability of ART in resource-poor settings, issues of provision of HIV-PEP require policy decision that can be implemented in programme and services delivery planning.

A joint ILO/WHO technical meeting for the development of policy and guidelines on occupational and non-occupational PEP for HIV infection was held in Geneva on 5-7 September 2005 to develop guidelines that address the needs of healthcare workers, non-healthcare workers who experience blood or body fluid exposure in the course of their work, and sexual assault survivors.

These guidelines present a unified framework for policy development and implementation issues for both occupational and non-occupational HIV-PEP in national contexts. Thus WHO and ILO, while presenting guiding principles for PEP policies, recommend and support national adaptations of these guidelines. The guidelines became available at the end of 2006.

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