1. Managing accidental exposure • The first step: - implement universal precautions • Also: - educate staff about all transmission routes - provide condoms in workplace

2. What is post-exposure prophylaxis?(PEP) Short-term treatment with antiretroviral drugs to reduce the likelihood of HIV infection after potential exposure through occupational accident or through sex

3. Managing occupational exposure 1. First aid 2. Assess risk associated with exposure 3. Evaluate source for HIV infection 4. Counseling on implications of exposure 5. Clinical evaluation & baseline testing (after consent) 6. Provide PEP (when appropriate) 7. Advise on secondary prevention 8. Counseling on reducing future risk • Exposure report • Follow-up HIV testing (6w, 3m, 6m) • Follow-up counseling and care

4. Before starting PEP: Explain: • Risk of infection vs toxicity of drugs • ? Effectiveness (treatment failure) • Side effects of drugs • Need to complete full course

5. ARV treatment for PEP • Start drugs as soon as possible (2 to 4 hours) • Combination treatment (2 or 3 drugs) Zidovudine & Lamivudine Third drug: Indinavir or Effavirenz • Treatment duration: 2 to 4 weeks • Monitor for toxicity

6. What needs to be in place to implement PEP? • Prevention - universal precautions • Organizational policy / guidelines • Staff awareness - training / supervision • Counseling capacity • Supplies • Medical care / referral possibility