title: Spare non-occupational HIV post-exposure prophylaxis by active contacting and testing of the source person.
abstract: OBJECTIVE
  HIV-1 post-exposure prophylaxis (PEP) is frequently prescribed after exposure to source persons with an undetermined HIV serostatus. To reduce unnecessary use of PEP, we implemented a policy including active contacting of source persons and the availability of free, anonymous HIV testing ('PEP policy').
  
  
  METHODS
  All consultations for potential non-occupational HIV exposures i.e. outside the medical environment) were prospectively recorded. The impact of the PEP policy on PEP prescription and costs was analysed and modelled.
  
  
  RESULTS
  Among 146 putative exposures, 47 involved a source person already known to be HIV positive and 23 had no indication for PEP. The remaining 76 exposures involved a source person of unknown HIV serostatus. Of 33 (43.4%) exposures for which the source person could be contacted and tested, PEP was avoided in 24 (72.7%), initiated and discontinued in seven (21.2%), and prescribed and completed in two (6.1%). In contrast, of 43 (56.6%) exposures for which the source person could not be tested, PEP was prescribed in 35 (81.4%), P < 0.001. Upon modelling, the PEP policy allowed a 31% reduction of cost for management of exposures to source persons of unknown HIV serostatus. The policy was cost-saving for HIV prevalence of up to 70% in the source population. The availability of all the source persons for testing would have reduced cost by 64%.
  
  
  CONCLUSIONS
  In the management of non-occupational HIV exposures, active contacting and free, anonymous testing of source persons proved feasible. This policy resulted in a decrease in prescription of PEP, proved to be cost-saving, and presumably helped to avoid unnecessary toxicity and psychological stress.
authors: Division of Infectious Diseases, University Hospital, Lausanne, Switzerland.
authors: Gilbert
authors: G
authors: Greub
authors: Serge
authors: S
authors: Gallant
authors: Pascal
authors: P
authors: Zurn
authors: Marco
authors: M
authors: Vannotti
authors: Philippe
authors: P
authors: Bürgisser
authors: Patrick
authors: P
authors: Francioli
authors: Giorgio
authors: G
authors: Zanetti
authors: Amalio
authors: A
authors: Telenti
mesh_terms: D019380:Anti-HIV Agents / Q000191:economics / Q000627:therapeutic use*; D003219:Confidentiality; D016358:Contact Tracing; D003362:Cost-Benefit Analysis; D015658:HIV Infections / Q000175:diagnosis / Q000188:drug therapy / Q000517:prevention & control* / Q000635:transmission; D006291:Health Policy; D006801:Humans
chemical_list: D019380:Anti-HIV Agents