This kit has been developed to support the provision of a priority health service for a population affected by a humanitarian emergency.

HIV Post-Exposure Prophylaxis (HIV PEP) comprises of antiretroviral (ARV) medications that can help to prevent an individual developing HIV infection following an occupational or non-occupational HIV exposure (WHO, 2018). 

Whilst the use of HIV PEP cannot guarantee the prevention of HIV infection, it remains at present the only available treatment that has been shown to significantly reduce the risk of HIV infection post-exposure (Irvine et al, 2015; Young et al, 2007). Healthcare services offering HIV PEP are therefore widely considered fundamental to the efficacy of national HIV prevention strategies (WHO, 2016).

Potential exposures to HIV that may indicate the need for PEP treatment include (but are not limited to):

• occupational needle-stick injuries
• unprotected consensual sex with an individual living with HIV (and who is not virally supressed through ARV therapy)
• sexual assault and
• the sharing of injection equipment amongst intravenous drug users.

Each type of exposure corresponds to a different level of risk in terms of HIV transmission, with this corresponding risk dependent on a range of individual and situational-specific factors (UN, 2021). Whilst the average risk of infection from one exposure is very small, it is recommended that health personnel working in humanitarian settings are prepared and trained to assess the need for PEP whenever an exposure is reported or suspected (UN, 2021). Should the need for PEP be confirmed, this kit has been designed to facilitate the initiation of prophylactic ARV treatment to an exposed individual as soon as possible. 

Kit components

As per current WHO (2018) guidance, the HIV PEP included in this kit consists of 28-day courses of three-drug ARV therapy (for adults) and other drug combinations for use in children. This kit also includes

• Additional supplementary medications that may be required depending on the nature of the HIV exposure e.g., antibiotics for the treatment of other sexually transmitted infections.
• Pregnancy tests to determine if an exposed individual is pregnant prior to confirming consent for HIV PEP treatment. This is to allow for appropriately tailored advice to be given on the risk and benefits of treatment during pregnancy.
• Emergency oral contraception to prevent unintended pregnancy after unprotected sex or sexual assault.
• Information sheets / leaflets for individuals receiving PEP treatment
• Guidance for health personnel on appropriate kit use (see solution attachments).

Context of use 

This kit is based on the HIV PEP kit that is included as a supplementary module within the Interagency Emergency Health Kit (IEHK 2017). The IEHK 2017 was developed by a partnership of international health agencies including WHO, Médecins Sans Frontières and the UN Population Fund (see WHO et al. 2019; 2021).

The IEHK 2017 is designed to meet the immediate priority health needs of a population in the early stages of a humanitarian emergency. Importantly, it is intended to fill temporary healthcare gaps and facilitate the provision of urgent medical care; it is not intended to support the ongoing provision of care for chronic health conditions or to replace existing medical chain mechanisms (WHO et al. 2019).

The IEHK 2017 comprises of a principal “basic supplies” module and optional supplementary units. Together these act as a temporary, self-sufficient health kit for use within settings where access to routine healthcare services may be limited (WHO et al. 2019). 

The PEP module within the IEHK 2017 was further updated in 2018 to incorporate changes made to WHO guidance on first-line and second-line ARV and PEP regimens (WHO, 2018; WHO et al. 2021). The components in this present kit reflect these changes.

Whereas the basic supplies module was specifically designed to be accessible to health care workers with limited training, the supplementary modules (including the HIV PEP module) are intended for the use of trained doctors or senior health care personnel. 

This adapted HIV PEP kit is therefore intended for use within a health center or hospital-level clinical setting by healthcare staff who have previous experience or training in the use of HIV PEP. 

See prerequisites for additional details on training and facility requirements for kit use. 

Scaling

This kit has been designed to assist in the meeting of primary health care needs and basic hospital care for a population of 10,000 people over an approximately 3-month period. 

It contains sufficient medication to provide PEP treatment to 50 adults and 10 children (9 children weighing between 20-35kg and 1 child <20kg) following a confirmed or suspected exposure to HIV infection (WHO et al. 2021).

A rapid assessment of the local situation is advised to confirm the need for and suitability of sexual and reproductive health kits prior to kit procurement. This will include a review of existing healthcare resources and health facility capacity as well as an assessment of the expected health needs specific to the target population. If possible, this assessment should utilize available pre-crisis demographic and services data. This kit can be modified as required to align with local needs and treatment preferences.

Information materials and guidelines intended to accompany kit: 

• Clinical guidelines (MSF, 2021)
• Essential drugs (MSF, 2021)
• IEHK 2017 Handbook (WHO et al. 2019)
• Consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection. Recommendations for a public health approach – 2nd ed. (WHO, 2016) (Recommendations updated in WHO, 2018)
• WHO Model Lists of Essential Medicines
• WHO Model Formulary
• The logistics handbook: A practical guide for the supply chain management of health commodities.(United States Agency for International Development, 2011)
• MDS-3: Managing access to medicines and other health technologies (Management Sciences for Health, 2012)
• Safe management of wastes from healthcare activities. 2nd edition (WHO, 2014).

The original WHO et al. (2019) guidance stipulates that these documents should be included on a flash drive within the packaged IEHK 2017 kit. Additional guidelines are also recommended for inclusion (e.g., Malaria and non-communicable disease guidance) however are excluded here as may not be relevant to all contexts. 

The complete list of recommended IHEK 2017 guidelines can be found as Annex 1 within the WHO et al. (2019) handbook.  The handbook also provides information on which languages each document is available in and a sample stock card that can be used as part of kit inventory management.

Please refer to this kit's attachments for the documents that are currently available for convenient download. 

Sources: 

Antiretroviral post‐exposure prophylaxis (PEP) for occupational HIV exposure (Young et al, 2007)

Efficacy of HIV Postexposure Prophylaxis: Systematic Review and Meta-analysis of Nonhuman Primate Studies (Irvine et al, 2015)

Consolidated guidelines on HIV prevention, diagnosis, treatment and care for key populations (WHO, 2016)

Updated Recommendations on First-line and Second-line antiretroviral regimes and post-exposure prophylaxis and Recommendations on Early Infant Diagnosis of HIV. Supplement to the 2016 Consolidated Guidelines on the use of Antiretroviral drugs for Treating and Preventing HIV Infection (WHO, 2018).

The Interagency Emergency Health Kit 2017 (WHO et al., 2019)

UN Medical Directors Guidelines for Use of UN-Issued HIV Post-Exposure Prophylaxis (PEP) Kits for Occupational/Non-Occupational HIV Exposure Occurring in UN Personnel and Dependents (UN, 2021)

Intersessional Changes. The Intergency Emergency Health Kit 2017 (WHO et al., 2021)

Solution creators

This solution was developed by Stevie-Jade Beeby with contributions from Paula Przybylowicz Vidal and Anuradha Dissanayake.