LAC 48:I.13613. HIV Post-Exposure Prophylaxis (PEP)

A. Post-Exposure Prophylaxis (PEP) is the use of antiretroviral drugs after a single high-risk event to decrease the risk of HIV seroconversion. PEP must be started as soon as possible to be effective and always within 72 hours of the possible exposure. B. Under this protocol, pharmacists may assess patients 17 years of age and older for high-risk exposure to HIV and dispense an entire 28-day course of antiretroviral drugs if appropriate. PEP should only be provided for infrequent exposures. C. Pharmacists must ask the following screening question: 1. Do you have existing kidney disease, or do you know if your kidney function is decreased for any reason? 2. If the patient has known kidney disease and can provide renal function test results within 12 months, the pharmacist may initiate a PEP regimen per CDC Guidelines. 3. If the patient has known kidney disease and cannot provide renal function test results within 12 months, the pharmacist shall urgently refer the patient to a provider who can see them to proceed with PEP initiation within 72 hours of possible exposure. D. If the pharmacy is not able to provide care to the patient, or if the patient does not qualify for care at the pharmacy, the patient should be urgently referred to another provider. E. Pharmacists shall follow CDC Guidelines. If the following criteria are met, HIV PEP is recommended: 1. the exposure has likely occurred within 72 hours of the patient’s arrival at the pharmacy; 2. an FDA-approved blood rapid test has yielded a non-reactive result for HIV; 3. a blood rapid test is not available and PEP is otherwise indicated; or 4. the patient’s vagina, rectum, eye, mouth or other mucous membrane, non-intact skin, or perforated skin (e.g., needle stick) came into contact with body fluids from a person with HIV within 72 hours before they sought care. If the exposure source’s HIV status is unknown, the pharmacist should make a case-by-case determination as to whether PEP should be initiated. Exposure types with the highest risk of transmission of HIV to be considered are: a. needle sharing during injection drug use; b. percutaneous needle stick; and c. receptive anal intercourse. F. The following patients should not be prescribed PEP under this protocol and should be referred to an appropriate care provider for further action: 1. patients younger than 17 years of age; 2. patients who seek care more than 72 hours after potential exposure; 3. patients taking any contraindicated medications per guidelines and package insert information; 4. patients with reactive or indeterminate baseline HIV tests; 5. patients who are taking PrEP who report consistent adherence to their medication regimen; or 6. patients who indicate a history of chronic kidney disease without providing renal function test results dated within 12 months. G. Other Considerations: 1. If the case involves a sexually assaulted person (including potential victims of human trafficking), pharmacists shall provide the patient with the information necessary to pursue a Sexual Assault Nurse Examiner (SANE) exam locally (each parish’s SANE program is run through the coroner’s office), as well as the contact information for their closest rape crisis center. 2. If a child (under 17 years of age) presents to the pharmacy with a request for PEP and is potentially a victim of child abuse, child protective services must be contacted at 1-855-4LA-KIDS (1-855-452-5437). H. Medication options include all FDA-approved or CDC-recommended medications or regimens for PEP. Formulations, cautions, and dose adjustments for antiretroviral medications shall minimally follow the CDC guidelines and package insert information for all regimens. I. Labs: follow CDC Guidelines for PEP. 1. All efforts should be made to obtain a non-reactive HIV test at baseline. However, the sooner PEP is initiated, the more effective it is. If the patient refuses to undergo HIV testing but is otherwise eligible for PEP under this section, the pharmacist may dispense PEP. 2. For patients who request PEP, pharmacists shall offer testing for other sexually transmitted infections or refer them to another provider for testing. 3. The pharmacist is authorized to order recommended labs for the patient OR to refer the patient to another provider to order lab work and accept results. 4. The pharmacist shall make every reasonable effort to follow up with the patient post-treatment regimen at 4-6 weeks to test for confirmation of negative HIV status and inform the patient that repeat HIV testing is recommended at three and six months as well. J. counseling shall include (at minimum): 1. instruction on proper medication use, adherence, schedule, and potential common and serious side effects (and how to mitigate them); 2. description of signs/symptoms of acute HIV infection and recommended actions; 3. emergency contraception, when appropriate; 4. the importance of engaging in routine primary care; 5. the importance and requirement of follow-up testing for HIV, renal function, hepatic function, Hepatitis B and C, and other sexually transmitted infections, per CDC Guidelines; and 6. education about pre-exposure prophylaxis (PrEP) and the potential for future need.