title: Prophylaxis and follow-up after possible exposure to HIV, hepatitis B virus, and hepatitis C virus outside hospital: evaluation of policy 2000-3.
abstract: OBJECTIVE
  Prophylactic treatment and follow-up after exposure to HIV, hepatitis B, and hepatitis C outside hospital needs to be improved.
  
  
  METHODS
  Until January 2000, people in Amsterdam could report exposure outside hospital to either a hospital or the municipal health service. If they reported to the municipal health service, they were then referred to hospitals for HIV prophylaxis, whereas the municipal health service handled treatment and follow-up related to hepatitis B and hepatitis C and traced sources. For cases reported to a hospital, hospital staff often did not trace HIV sources or follow up patients for hepatitis B and hepatitis C.
  
  
  METHODS
  Providing adequate treatment for HIV, hepatitis B and hepatitis C after exposure for all reported exposures outside hospital.
  
  
  METHODS
  On 1 January 2000, a new protocol was introduced in which three Amsterdam hospitals and the municipal health service collaborated in the treatment and follow-up of exposures outside hospital. Both municipal health service and hospitals can decide whether HIV prophylaxis is necessary and prescribe accordingly. All people exposed in the community who report to hospitals are subsequently referred to the municipal health service for further treatment and follow-up.
  
  
  RESULTS
  The protocol is effective in that most people comply with treatment and follow-up. When indicated, HIV prophylaxis is started soon after exposure. In nearly two thirds of cases the municipal health service traced and tested the source.
  
  
  CONCLUSIONS
  Provision of treatment and follow-up in one place enables treatment, tracing and testing sources, and follow-up, including counselling and registration of all reported exposures in Amsterdam, which allows for swift identification of emerging epidemiological trends. Since May 2004 all Amsterdam hospitals have participated in the protocol.
authors.affiliation: Department of Infectious Diseases, Nieuwe Achtergracht 100, 1018 WT, Amsterdam, Netherlands. gsonder@gggd.amsterdam.nl
authors.forename: Gerard J B
authors.initials: GJ
authors.lastname: Sonder
authors.forename: Rosa M
authors.initials: RM
authors.lastname: Regez
authors.forename: Kees
authors.initials: K
authors.lastname: Brinkman
authors.forename: Jan M
authors.initials: JM
authors.lastname: Prins
authors.forename: Jan-Willem
authors.initials: JW
authors.lastname: Mulder
authors.forename: Joke
authors.initials: J
authors.lastname: Spaargaren
authors.forename: Roel A
authors.initials: RA
authors.lastname: Coutinho
authors.forename: Anneke
authors.initials: A
authors.lastname: van den Hoek
mesh_terms: D019380:Anti-HIV Agents / Q000627:therapeutic use; D002985:Clinical Protocols; D003153:Community Health Services / Q000592:standards* / Q000706:statistics & numerical data; D016358:Contact Tracing; D004359:Drug Therapy, Combination; D015658:HIV Infections / Q000517:prevention & control* / Q000635:transmission; D006291:Health Policy; D006509:Hepatitis B / Q000517:prevention & control* / Q000635:transmission; D006526:Hepatitis C / Q000517:prevention & control* / Q000635:transmission; D006801:Humans; D017758:Infectious Disease Transmission, Patient-to-Professional / Q000517:prevention & control; D007373:Interinstitutional Relations; D009426:Netherlands; D016273:Occupational Exposure / Q000009:adverse effects; D010349:Patient Compliance; D015397:Program Evaluation; D012017:Referral and Consultation; D012309:Risk-Taking; D013997:Time Factors
chemical_list: D019380:Anti-HIV Agents