Post exposure prophylaxis

Post-exposure prophylaxis (PEP) is an emergency medical response that can be used to protect individuals exposed to HIV. PEP consists of medication, laboratory tests and counselling. Ideally PEP should be initiated within 2-24 hours (and no later than 48-72 hours) of possible exposure to HIV, and must continue for approximately four weeks.

Although PEP has not been conclusively proven to prevent the transmission of HIV infection, research studies suggest that if medication is initiated quickly after the possible exposure (ideally within 2-24 hours and no later than 48-72 hours) it may be beneficial. The efficacy of PEP is probably higher if treatment is started within the first few hours of exposure and is probably progressively reduced if started later. After 48-72 hours, the benefits are probably minimal (or non-existent) and the risk of intolerance and side-effects associated with antiretroviral treatments will outweigh any potential preventive benefit.

Each PEP starter kit contains:

• the medication required for the first 5 days of PEP
• a pregnancy test kit and emergency oral contraception ("morning-after" pill)
• guidelines for the attending physician and the patient
• a required consent form

PEP starter kits are available to individuals with a United Nations agency contract (including long-term, short-term, SSA and others) and their recognized spouses and dependent children who are exposed to HIV because of:

• sexual assault; or
• occupational accident

The starter kits are not available to individuals who:

• are (or may be) already infected with HIV; or
• are (or may be) exposed to HIV because of voluntary activities outside work involving potential HIV transmission.

The starter kits may only be used if:

• the attending physician, following their evaluation of the patient, recommends starting PEP and the patient consents to this in writing; or
• in the case of an isolated location without access to a physician, the person assesses themselves as suitable for PEP and then consents in writing.

After benefitting from the starter kit, if adequate facilities are not available locally, the patient will normally be sent to a recognized regional medical evacuation centre. For a list of those centres, click here.

Yes. Before the attending physician initiates PEP they must first obtain the written consent of the patient, provided such patient is physically or legally competent to do so.

In the case of the administration of the treatment to:

• a staff member's dependent child who is under 18 years of age, the staff member or other legally recognized parent or guardian should provide consent; or
• a staff member's spouse or dependent child between the ages 18-21 who is otherwise unable to give informed consent (specifically because of mental incapacity) then the staff member or other legally recognized guardian should provide consent.

Moreover, in order for such consent to be valid, it must be informed consent, that is it must be given after the patient has received a fair and reasonable explanation from the attending physician of the proposed medical treatment.

Before you give your consent, you will be asked to read "Guidelines for the Patient." To see a copy of the Guidelines, click here.

While the use of PEP will be reported to the UN medical services, the name of the person will not be included in the report -- data is collected for research purposes only.

All information and documentation regarding sexual assault or occupational accident is confidential and will be treated as such, whether within offices or during transmission to the UN agency medical service concerned, or to other medical facilities.

Three PEP starter kits per location have been sent to all UN Resident Coordinators. The kits are provided at all duty stations so that the representative of the UN agency concerned can make the necessary arrangements for the evacuation of the patient to a location with adequate medical facilities in order to continue PEP. For a list of PEP kit custodians in the UN system click here.

The cost of the PEP starter kits is met jointly by participating UN agencies.

All other medical expenses for PEP are the patient's responsibility but reimbursement of these expenses may be claimed from the relevant medical insurance plan according to established procedures. In the event of incidents attributable to the performance of official duties, the provisions governing compensation under the staff rules of the agency involved would apply.

First, contact the UN medical service at your duty station if they are available. They should be able to answer most of your questions. If you still have questions or concerns, you can contact:

Dr Pascale Gilbert-Miguet
Coordinator
Joint Medical Service (JMS)
World Health Organization (WHO)
20 avenue Appia
CH-1211 Geneva 27
Switzerland

Tel: 41-22-7913040
Fax: 41-22-7914120

e-mail: gilbertmiguetp@who.int

Further information on PEP is available on the WHO Web site.

A document for UN country teams and physicians with details on PEP can be downloaded here:
Post-exposure prophylaxis (PEP) to prevent HIV infection: Guidelines on the Use of Treatment Starter Kits