Health Care Workers Have Difficulty Complying With Post-Exposure Prophylaxis: Improved Prevention of Occupational Exposures is Needed
Over 30 percent of health care workers who took post-exposure prophylaxis (PEP) to reduce their chances of HIV infection did not complete their course of drugs. For about 75 percent of these, the reason for stopping was the side effects they experienced. These findings, presented by Centers for Disease Control and Prevention (CDC) researchers at the 12th World AIDS Conference this week, point to prevention of initial exposures to HIV as the best line of defense against occupationally-acquired HIV infection in health care workers.
As a society, we tend to focus more on treating, rather than preventing disease, yet this study demonstrates that medical solutions aren't always the easy answer we're looking for," commented Helene Gayle, M.D., M.P.H., Director of CDC's National Center for HIV, STD, and TB Prevention. "While PEP can reduce the chances of infection for exposed health care workers, these drugs can cause adverse side effects and are not 100 percent effective. The most effective way to protect health care workers is to prevent exposure in the first place."
CDC researcher Adelisa Panlilio, M.D., and colleagues assessed the tolerability of medications used as PEP by analyzing information collected by the National Surveillance System for Hospital Health Care Workers (NaSH) from June 1995 through December 1997 in six participating hospitals.
PEP refers to using certain drugs called antiretrovirals, or a combination of these drugs, in an attempt to reduce the risk of HIV infection for health care workers following an exposure to the blood or body fluids of a patient with HIV. One study of health care workers who used PEP after a needle stick injury found an 81 percent reduction in HIV infection. Not all health care workers exposed to HIV decide to take PEP. Decisions are based on numerous factors, including the nature of their exposure and the risk of developing HIV without PEP.
Data were available on 114 health care workers occupationally exposed to HIV, 58 of whom chose to take PEP. Researchers found that 71 percent of health care workers taking PEP reported some side effects. Of the workers who did not complete therapy (36%), 76 percent stopped treatment because of the adverse side effects, including fatigue and nausea.
Panlilio believes that improved counseling prior to treatment may help improve PEP compliance, but that the primary focus of prevention efforts should be preventing exposure. "By providing health care workers more information up front regarding what side effects to anticipate and how to treat the symptoms, we may be able to improve compliance," noted Panlilio, "But the difficulties with compliance highlight the need for improved efforts to prevent HIV exposure." A related poster presentation examines the circumstances leading to continued occupational exposures and concludes that most could be prevented with existing safety measures and precautions.
CDC researcher Denise Cardo, M.D., examines over 100 occupational exposures and finds that at least 50 percent could have been prevented using appropriate work practices, including barriers and safety devices. Over 90 percent of exposures were related to percutaneous injuries, such as needle sticks, cuts, or other injuries that break the skin. These injuries could be prevented through the proper handling and disposal of sharp items. CDC also recommends that needles not be recapped, as a large number of injuries occur when workers attempt to recap needles. Instead, they should be disposed of in puncture-resistant containers.
Improved workplace education on recommended precautions for sharp disposal, as well as expanded use of existing safety devices, could significantly reduce the occupational transmission of HIV.