HIV Prophylaxis Following Non-occupational Exposure
HIV Prophylaxis Following Non-occupational Exposure
Recommendations:
• The clinician or a member of the HIV care team should provide risk-reduction counseling and primary prevention counseling whenever someone is assessed for nPEP, regardless of whether PEP is initiated. (AII)
• Clinicians should assess for emotional, psychological, and social factors that can contribute to risk behavior, such as depression, history of sexual abuse, and drug and alcohol use. (AII)
• Clinicians should refer patients to mental health and/or substance use programs when indicated and should consider the need for intensive risk-reduction counseling services. (AII) See Appendix C for a contact list for AIDS Institute-funded HIV prevention programs that provide risk-reduction counseling.
• Persons who present with repeated high-risk behavior or for repeat courses of nPEP should be the focus of intensified education and prevention interventions and, after completion of the 28-day nPEP regimen, initiation of pre-exposure prophylaxis (PrEP) should be considered. (AII) See the CDC interim guidance documents for use of pre-exposure prophylaxis in men who have sex with men, heterosexually active adults, and injection drug users.
Non-occupational PEP should not be routinely dismissed solely on the basis of repeated risk behavior or repeat presentation for nPEP. Rather, presentation of persons with repeated high-risk behavior or for repeat courses of nPEP should be viewed as an opportunity for intensification of education and prevention planning in a high-risk individual. Intent to change behavior should be assessed, and an individualized risk-reduction plan should be developed. After completion of the 28-day nPEP regimen, initiation of pre-exposure prophylaxis (PrEP) should be considered. See the CDC interim guidance documents for use of pre-exposure prophylaxis in men who have sex with men, heterosexually active adults, and injection drug users.
For more information regarding risk-reduction counseling, refer to Prevention with Positives: Integrating HIV Prevention into Primary Care and the PozKit: A Prevention with Positives ToolKit for Clinicians.
Behavioral Intervention and Risk-Reduction Counseling
Recommendations:
• The clinician or a member of the HIV care team should provide risk-reduction counseling and primary prevention counseling whenever someone is assessed for nPEP, regardless of whether PEP is initiated. (AII)
• Clinicians should assess for emotional, psychological, and social factors that can contribute to risk behavior, such as depression, history of sexual abuse, and drug and alcohol use. (AII)
• Clinicians should refer patients to mental health and/or substance use programs when indicated and should consider the need for intensive risk-reduction counseling services. (AII) See Appendix C for a contact list for AIDS Institute-funded HIV prevention programs that provide risk-reduction counseling.
• Persons who present with repeated high-risk behavior or for repeat courses of nPEP should be the focus of intensified education and prevention interventions and, after completion of the 28-day nPEP regimen, initiation of pre-exposure prophylaxis (PrEP) should be considered. (AII) See the CDC interim guidance documents for use of pre-exposure prophylaxis in men who have sex with men, heterosexually active adults, and injection drug users.
Non-occupational PEP should not be routinely dismissed solely on the basis of repeated risk behavior or repeat presentation for nPEP. Rather, presentation of persons with repeated high-risk behavior or for repeat courses of nPEP should be viewed as an opportunity for intensification of education and prevention planning in a high-risk individual. Intent to change behavior should be assessed, and an individualized risk-reduction plan should be developed. After completion of the 28-day nPEP regimen, initiation of pre-exposure prophylaxis (PrEP) should be considered. See the CDC interim guidance documents for use of pre-exposure prophylaxis in men who have sex with men, heterosexually active adults, and injection drug users.
For more information regarding risk-reduction counseling, refer to Prevention with Positives: Integrating HIV Prevention into Primary Care and the PozKit: A Prevention with Positives ToolKit for Clinicians.
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