title: The structure and outcomes of a HIV postexposure prophylaxis program in a high HIV prevalence setup in western Kenya.
abstract: BACKGROUND
  In 2001, HIV postexposure prophylaxis (PEP) was initiated in western Kenya.
  
  
  METHODS
  Design, implementation, and evolution of the PEP program are described. Patient data were analyzed for reasons, time to initiation, and PEP outcome.
  
  
  RESULTS
  Occupational PEP was initiated first followed by nonoccupational PEP (nPEP). Antiretroviral regimens were based upon national PEP guidelines, affordability and availability, and prevailing HIV prevalence. Emerging side effects data and cost improvements influenced regimen changes. Between November 2001 and December 2006, 446 patients sought PEP. Occupational exposure: 91 patients: 51 males; 72 accepted HIV testing; 48 of 52 source patients were HIV infected; median exposure-PEP time 3 hours (range: 0.3-96 hours). Of 72 HIV-negative patients receiving PEP, 3 discontinued, 69 completed, and 23 performed post-PEP HIV RNA polymerase chain reaction (all negative). Eleven follow-up HIV enzyme-linked immunosorbent assay tests have all turned negative. Nonoccupational exposure: 355 patients; 285 females; 90 children; 300 accepted HIV testing; median exposure-nPEP time 19 hours (range: 1-672 hours). Of 296 HIV-negative patients on nPEP, 1 died, 15 discontinued, 104 are on record having completed PEP, and 129 returned for 6-week HIV RNA polymerase chain reaction (1 patient tested positive). Eighty-seven follow-up HIV enzyme-linked immunosorbent assay tests have all turned negative.
  
  
  CONCLUSIONS
  It is feasible to provide PEP and nPEP in resource-constrained settings.
authors.affiliation: Department of Medicine, Moi University School of Medicine, Eldoret, Kenya. amsiika@africaonline.co.ke
authors.forename: Abraham M
authors.initials: AM
authors.lastname: Siika
authors.forename: Winston M
authors.initials: WM
authors.lastname: Nyandiko
authors.forename: Ann
authors.initials: A
authors.lastname: Mwangi
authors.forename: Michael
authors.initials: M
authors.lastname: Waxman
authors.forename: John E
authors.initials: JE
authors.lastname: Sidle
authors.forename: Sylvester N
authors.initials: SN
authors.lastname: Kimaiyo
authors.forename: Kara
authors.initials: K
authors.lastname: Wools-Kaloustian