title: Post exposure prophylaxis of HIV transmission after occupational injuries in Queen Elizabeth Central Hospital, Blantyre, Malawi, 2003 - 2008.
abstract: Health care worker (HCW) in Malawi may acquire HIV infection through occupational injuries, in particular since HIV prevalence among inpatients and incidence of occupational injuries are high. A post exposure prophylaxis (PEP) programme for occupational injuries at Queen Elizabeth Central Hospital (QECH) commenced in 2003. We performed an audit of this programme from 2003 through 2008. 203 Occupational injuries were reported. The majority were needle stick injuries (76.3%). Half of the clients were in a training position. A dual ART regimen was most frequently prescribed. Triple therapy use increased over time and was more frequent in expatriate students. Many nurses and clinical officers were not fully vaccinated for HBV. Based on previous incidence data, occupational injuries were likely to be underreported. Data on side effects were incomplete, however PEP discontinuation due to side effects occurred only twice. Follow up visits were poorly attended, therefore the efficacy of PEP could not be evaluated. Prevention efforts for occupational injuries should be increased and specifically target HCWs in training positions. Measures to improve quality of the PEP programme include effective publicity campaigns, compulsory Hepatitis B vaccination and active tracing of HCWs who default follow up after PEP.
authors: Department of Medicine, University of Malawi College of Medicine, Blantyre, Malawi.
authors: Gerrit C
authors: GC
authors: van der Maaten
authors: Mulinda
authors: M
authors: Nyirenda
authors: Micheal J
authors: MJ
authors: Beadsworth
authors: Alex
authors: A
authors: Chitani
authors: Theresa
authors: T
authors: Allain
authors: Joep J
authors: JJ
authors: van Oosterhout
references: BMJ. 2004 Nov 6;329(7474):1080-6
references: 15528620
references: J Hosp Infect. 2005 Jul;60(3):276-82
references: 16021690
references: Trop Med Int Health. 2005 Aug;10(8):773-81
references: 16045464
references: J Infect. 2008 Jul;57(1):72-7
references: 18555534
references: Int J Gynaecol Obstet. 2000 Jun;69(3):265-70
references: 10854870
references: Trop Doct. 2006 Jul;36(3):185-6
references: 16884637
references: Trans R Soc Trop Med Hyg. 2003 Jan-Feb;97(1):91-6
references: 12886812
references: Am J Ind Med. 2005 Dec;48(6):482-90
references: 16299710
references: J Acquir Immune Defic Syndr. 2009 May 1;51(1):47-53
references: 19339898
references: N Engl J Med. 1998 Nov 12;339(20):1409-14
references: 9811915
references: BMC Infect Dis. 2008 Oct 21;8:142
references: 18939992
references: Am J Infect Control. 2003 Dec;31(8):469-74
references: 14647109
references: Trop Doct. 2007 Jan;37(1):4-6
references: 17326876
references: J Hosp Infect. 2007 Dec;67(4):344-9
references: 18023920
references: Health Technol Assess. 2009 Feb;13(14):iii, ix-x, 1-60
references: 19236820
references: Int J STD AIDS. 1998 Oct;9(10):591-4
references: 9819109
references: Bull World Health Organ. 1997;75(2):133-40
references: 9185365
references: Infect Control Hosp Epidemiol. 2007 Jun;28(6):761-3
references: 17520560
references: J Virol. 2000 Oct;74(20):9771-5
references: 11000253
references: N Engl J Med. 1997 Nov 20;337(21):1485-90
references: 9366579
references: AIDS Care. 2008 Mar;20(3):304-10
references: 18351477
references: Am J Infect Control. 2008 Dec;36(10):753-6
references: 18945522