Prophylaxis and follow-up after possible exposure to HIV, hepatitis B virus, and hepatitis C virus outside hospital: evaluation of policy 2000-3.
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.
Sonder
Gerard J B
GJ
Department of Infectious Diseases, Nieuwe Achtergracht 100, 1018 WT, Amsterdam, Netherlands. gsonder@gggd.amsterdam.nl
Regez
Rosa M
RM
Brinkman
Kees
K
Prins
Jan M
JM
Mulder
Jan-Willem
JW
Spaargaren
Joke
J
Coutinho
Roel A
RA
van den Hoek
Anneke
A
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
D019380:Anti-HIV Agents