During the past two decades, ARV drugs have been prescribed for patients with post-exposure prophylaxis (PEP) resulting from both occupational exposure and non-occupational exposures. The use of ARV for post-exposure prophylaxis is supported by a single case-control study in health workers that illustrated that ARV drugs could avert the formation of chronic HIV infection if administered within a short time after exposure (Hughes & Henderson, 2016). The effectiveness of ARV drugs in averting HIV infection resulting from exposure is further reinforced by the efficacy of ARV drugs in preventing mother- to- child transmission of HIV. For any prevention intervention, effectiveness is dependent on high degrees of adherence and completion of the prescribed dose.
First, I would conduct a clinical assessment of exposure on both the nurse and the prisoner to establish the HIV status of the nurse since Post-exposure prophylaxis is never prescribed to a person who is already HIV positive. HIV testing on the prisoner will also be conducted to inform on the best clinical action to be taken. Even though it is reasonable enough to presume that all sources of unknown HIV status may pose a risk of infection, if it will be determined that the prisoner is HIV negative, then the post-exposure prophylaxis will be discontinued. Nevertheless, the commencement of post-exposure prophylaxis will not be delayed by the availability of the prisoner.
Notably, the possibility of exposure to HIV could create anxiety for the nurse(Hughes & Henderson, 2016) and therefore, counseling and support will be a necessity. Counselling has some positive benefits which improve victims' life immensely. These benefits would include an understanding of one's self and greater levels of self- awareness. These would go a long way in improving the nurse' self -esteem. The result of which, will contribute to ensuring that the nurse will feel better than herself and the person she is, a condition that will enhance her treatment. It should be understood that any prescription of PEP should only be administered with the consent of the nurse that is based on an understanding of risks and benefits not limited to a discussion on possible side effects and the significance of full adherence to PEP if it is to be prescribed.
The medication of post-exposure prophylaxis will be offered and initiated as early as it will be possible and ideally this I will conduct within seventy-two hours of the nurse exposure. This will commence with the immediate, thorough cleansing of all the wounds with a veridical agent in case the nurse would have a wound. The administration of the post-exposure prophylaxis drugs will take into consideration the age of the nurse and above all will run for a period of twenty- eight days. During this process of drug prescription, it will be incumbent upon me as the physician to elaborate to the nurse every information about the drug. This information about ARV will enable the nurse to understand how to use the drug, the contra-indications of ARVs, precautions and its negative effects and how the drugs should be utilized and monitored. This will allow the nurse to make an informed decision about the drug and finally to make the best use of the drug after making the decision. An assessment of drug-drug interactions will be of great importance to help avoid drug-related adverse effects. However, most of these drug interactions have delayed onset; it will be essential for me as the doctor to conduct a long-term follow up to predict the clinical significance of these interactions.
After the prescription and issuance of ARV drug to the nurse, as her physician, I will conduct a follow up on the progress of the nurse recovery, basically after the window period. This review will not be essential within the twenty-eight days when the nurse will be on medication, though should she experience side effects that will interfere with her taking the ARVs, then I will encourage her to seek aid. At the third month after the exposure, I will conduct another HIV test on the nurse to help ascertain the medical status of the nurse. If the nurse will test negative on the fourth generation rapid test or lab assay which detects HIV antigens as well as antibodies after three to four weeks of exposure. Should the nurse test negative at this stage then she would likely be HIV negative. Nevertheless, she may test HIV positive a condition that will prompt me as her doctor to link her to a treatment and care service as soon as it is possible. Further still, I would not recommend to the nurse to donate blood during the period when she will be under medication since this would lead to a possible HIV exposure while the nurse will still be within the window period.
In conclusion, conducting an assessment to understand the exposure, eligibility for the HIV post-exposure prophylaxis, conducting HIV testing to those exposed and provision of first aid in cases where the skin has been broken are key to risks associated with HIV exposure. Counseling and support will aid the victim in understanding the risks of HIV, the risks, benefits and side effects of post-exposure prophylaxis. In addition to that counseling will offer specific support to the victims of sexual assault. I will recommend for further research to be conducted to inform future ARV choices for children, adolescents, and adults and for patients to be linked to a medical program should they be found to be HIV positive.
Hughes, H. Y., & Henderson, D. K. (2016). Post-exposure prophylaxis after Hepatitis C occupational exposure in the interferon-free era. Current opinion in infectious diseases, 29(4), 373.
Mponela, M. J., Oleribe, O. O., Abade, A., & Kwesigabo, G. (2015). Post exposure prophylaxis following occupational exposure to HIV: a survey of health care workers in Mbeya, Tanzania, 2009-2010. Pan African Medical Journal, 21(1).
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