Prophylaxis and follow-up after possible exposure to HIV, hepatitis B virus, and hepatitis C virus outside hospital: evaluation of policy 2000-3BMJ 2005; 330 doi: http://dx.doi.org/10.1136/bmj.330.7495.825 (Published 07 April 2005) Cite this as: BMJ 2005;330:825
- Gerard J B Sonder, physician ()1,
- Rosa M Regez, head of clinical research department2,
- Kees Brinkman, consultant in infectious diseases2,
- Jan M Prins, consultant in infectious diseases3,
- Jan-Willem Mulder, consultant in infectious diseases4,
- Joke Spaargaren, head of laboratory5,
- Roel A Coutinho, professor6,
- Anneke van den Hoek, head of department1
- 1 Department of Infectious Diseases, Nieuwe Achtergracht 100, 1018 WT, Amsterdam, Netherlands,
- 2 Onze Lieve Vrouwe Gasthuis, Department of Internal Medicine, 1091 HA Amsterdam, Netherlands,
- 3 Academic Medical Center, University of Amsterdam, Department of Internal Medicine, 1105 AZ Amsterdam, Netherlands,
- 4 Slotervaart Ziekenhuis, Department of Internal Medicine, 1066 EC Amsterdam, Netherlands,
- 5 Municipal Health Laboratory, Nieuwe Achtergracht 100, Amsterdam, Netherlands,
- 6 Municipal Health Service Amsterdam, Nieuwe Achtergracht 100, Amsterdam, Netherlands
- Correspondence to: G J B Sonder
Problem Prophylactic treatment and follow-up after exposure to HIV, hepatitis B, and hepatitis C outside hospital needs to be improved.
Background and setting Until January 2000, people in Amsterdam could report exposure outside hospital to either a hospital or the municipal health service. If they reported to the municipal health service, they were then referred to hospitals for HIV prophylaxis, whereas the municipal health service handled treatment and follow-up related to hepatitis B and hepatitis C and traced sources. For cases reported to a hospital, hospital staff often did not trace HIV sources or follow up patients for hepatitis B and hepatitis C.
Key measures for improvement Providing adequate treatment for HIV, hepatitis B and hepatitis C after exposure for all reported exposures outside hospital.
Strategies for change On 1 January 2000, a new protocol was introduced in which three Amsterdam hospitals and the municipal health service collaborated in the treatment and follow-up of exposures outside hospital. Both municipal health service and hospitals can decide whether HIV prophylaxis is necessary and prescribe accordingly. All people exposed in the community who report to hospitals are subsequently referred to the municipal health service for further treatment and follow-up.
Effects of change The protocol is effective in that most people comply with treatment and follow-up. When indicated, HIV prophylaxis is started soon after exposure. In nearly two thirds of cases the municipal health service traced and tested the source.
Lessons learnt Provision of treatment and follow-up in one place enables treatment, tracing and testing sources, and follow-up, including counselling and registration of all reported exposures in Amsterdam, which allows for swift identification of emerging epidemiological trends. Since May 2004 all Amsterdam hospitals have participated in the protocol.
Contributors GJBS collected and analysed data and wrote the article. RMR, KB, JMP, and JWM developed the protocol, collected data, and reviewed the article. JS was responsible for most of the laboratory tests and reviewed the article. RAC developed the protocol, advised on the manuscript, and reviewed the article. AvdH provided advice on the manuscript design, developed the protocol, was responsible for all data collection, contributed to the article, and is guarantor.
Competing interests None declared.
Ethical approval Not applicable.