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Actions to take for exposure to bloodborne pathogens (HIV, Hep C) 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] Is Contact Source HIV Negative? 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: Is Source available for RDT No /UNK HIV Post Exposure Prophylaxis Regimen Due to limited PEP supply on hand, evacuation should be completed within 72 hours. No (Rapid Diagnostic Test)? Yes Conduct RDT (Rapid Diagnostic Test) on Source: 1 each, HIV, Hep B, Hep C [do not use saliva, use blood] Yes Is Source RDT Positive? Submit additional blood sample from potential source to a laboratory for verification. Yes No DSN: 314-421-3339 COMM: +49 (0)711-729-3339 SVOIP: (80) 304-436-2035 NIPR: [email protected] SIPR: [email protected] •SOCAFRICA JOC: 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? No DRAFT HIV Points of Contact: -LTC Lynch, SOCAF Surgeon (all MEDEVACs) Blot a sample of Blood onto filter-paper and seal in plastic bag (See Blood Collection and Shipping Instructions) Educate Soldier and unit on Risk Factors and Avoidance 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 - DSN 421-3340/3370; 0711-729-3340/3370 - RED: 304-436-2100 - [email protected] •[email protected] •[email protected] •AFRICOM ID consultant Note: Continued Treatment and consultation required, Testing will be required at 1, 3, 6 and 12 months HIV PEP Kit Contents • Sealable rugged container: Otter/Pelican approx 5W"x7W"x3D" – Labeled on Outside, • • • • Drugs (should medics fill separate in case of expiration date? – – • 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 – – – – – – – – – – • • • Dolutegravir Truvada Rapid Test - HIV RDT, (verify no special handling instructions or expiration) – – • • HIV Exposure Kit Kit Contents with pertinent expiration date Last inspection date and initials 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 HIV Post Exposure Prophylaxis Regimen Actions to take for exposure to bloodborne pathogens (HIV, Hep C) 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] Is Contact Source HIV Negative? 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 Is Source available for RDT? No /UNK No Always submit additional blood sample from the potential source to a laboratory for verification. Blot a sample of Blood onto filterpaper and seal in plastic bag Sample will travel with Soldier during EVAC and turned into lab Yes Conduct RDT on Source Is Source RDT Positive? Yes Yes No Do you still suspect source HIV positive? 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 HIV 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: [email protected] SIPR: [email protected] No Educate Soldier and unit on Risk Factors and Avoidance IMMEDIATELY: •Begin Soldier Treatment PEP: Yes •[email protected] •AFRICOM ID consultant Note: Continued Treatment and consultation required, Testing will be required at 1, 3, 6 and 12 months