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Epidemiology poster session 6: Preventive intervention: ARV
P1-S6.52 Is PEP a misused therapy? Cross sectional PEP study in sex worker outreach program clinic
  1. Jane Mungai1,2,
  2. Marion Kiguoya1,2,
  3. Charles Wachihi1,2,
  4. Joshua Kimani1,2,
  5. Festus Kiogora1,2,
  6. James Mwanjewe1,2,
  7. Lawrence Gelmon1,2
  1. 1University of Nairobi
  2. 2University of Manitoba STI Collaboration

Abstract

Background Post-exposure prophylaxis (PEP) is a short-term anti-retroviral (ARV) treatment that reduces the likelihood of HIV infection after exposure to HIV-infected blood or sexual contact with an HIV-positive person. We are able to offer PEP mediations in our SWOP clinics to clients reporting high risk exposure. Normally ARVs for PEP are given within 72 h of exposure for a period of 4 weeks. Our objective was to assess whether the clients had already established STIs prior administration of PEP. The clients were aged between 19 and 49 years with each having an average of 9 men clients per day.

Methods A cross sectional study was conducted on 91 female sex workers who came to the clinic for PEP in the period September 2009 to July 2010. The female sex workers were first given counselling, completed a standard questionnaire before having PEP administered. The samples taken included blood for HIV Elisa, high vaginal swab for Gonorrhoea Culture on Thayer martin media and Gram stain smear for Bacteria vaginosis, presence of spermatozoa and white blood cells.

Results The clients were all HIV seronegative. 76% of the women had come for PEP for the first time, 21% for the second time and 3% for the third time. 80% of the patients reported condom burst, 8.6% were as a result of rape or coerced sex, while 3.2% reported client refused condom use. However 73% smears of the women did not have spermatozoa. Overall 9% of the patients were GC positive but 3.2% had GC and spermatozoa while 6.6% had GC without spermatozoa. Trichomonas prevalence was 4.3% but all these patients did not have spermatozoa. 38% had a WBC count of over 6–30 field on gram stain Conclusion: The presence of high white cell count at the time of seeking PEP may indicate a pre-existing infection, hence presence of underlying high risk behaviour. Moreover presence of GC and TV without spermatozoa may also indicate exposure longer reported. There is need to educate sex workers on proper use of PEP and to maintain low risk behaviour. We also need to understand the decision making process of sex workers in choosing post-exposure prophylaxis and any barriers that may contribute to delays in seeking PEP.

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