This leaflet/information sheet is intended for use by healthcare providers in their provision of information and support to individuals on a potentially ongoing basis throughout their HIV Post-Exposure Prophylaxis (PEP) Treatment.

Background to HIV PEP

HIV PEP is a 28-day course of specific antiretroviral (ARV) medication that can help to prevent subsequent development of HIV infection if commenced as soon as possible following an individual’s exposure to HIV (within 72 hours of exposure) (WHO, 2018). Further information on the delivery of HIV PEP in humanitarian settings can be found by reviewing the following health kit: HIV Post-Exposure Prophylaxis (HIV PEP) Kit.

Although not 100% effective, HIV PEP remains the best possible means of HIV infection prevention once a HIV exposure has already occurred (Irvine et al, 2015; UN, 2021). The limits of its effectiveness should be carefully and sensitively communicated to exposed individuals prior to the initiation of HIV PEP, to allow them to make informed decisions regarding their treatment (WHO, 2016).

Importantly, the efficacy of HIV PEP is dependent on consistent regimen adherence (WHO, 2016). Individuals receiving this treatment should therefore take the recommended ARV medication daily and exactly as prescribed (WHO, 2016). Different people may encounter diverse and individual barriers to taking their medication effectively. It is therefore vital that local health services endeavour to identify ways in which they can best encourage medication adherence within their specific working contexts (WHO, 2007).

HIV PEP support and information

The provision of accurate treatment information and patient-centred follow-up care can help to support individuals with the physical and emotional difficulties that may be encountered during HIV PEP treatment (Australian Federation of AIDS organisations, (AFAO) 2021; UN, 2021). It is therefore recommended that wherever possible the delivery of HIV PEP is complemented by the provision of additional support services that can offer information, advice, and treatment counselling as needed throughout the duration of an individual's treatment. 

The use of accessible patient information resources tailored to the communication needs of the local population and/or target demographic group are recommended for use by services involved in each stage of HIV PEP delivery (treatment initiation, monitoring and aftercare). Such materials are helpful to the provision of essential information about the importance of medication adherence and the actions that individuals should take to promote their health and wellbeing following a HIV exposure (UN, 2021). 

It is recognised that the information required by different people undergoing HIV PEP is likely to be dependent on a range of individual and situational factors, including the type of HIV exposure that they have experienced e.g., non-occupational and occupational exposures (UN, 2021). This present leaflet is designed to be tailored to individuals who have had a sexual exposure to HIV infection. 

Compared to a more generalised leaflet on HIV PEP, this HIV PEP Regimen and Follow up Information Sheet is likely to include information and advice on the specific HIV PEP regimen an individual is to take and the importance of treatment adherence throughout the 28-day course. It should also include ways in which treatment adherence can be personally encouraged (e.g., setting a daily alarm, or taking medication before the same meal every day) and the specifics of any necessary follow up care.

Please see the information sheets within UN (2021) for some indication of the modifications required within these differently focused patient information resources. 

Local health services should also ensure the availability of patient information resources that are appropriate for HIV PEP patients that are also victims of sexual assault. Additional specialist resources may be required. 

It is recommended that the following details be considered for inclusion in any procured/developed HIV PEP patient information materials:

• the risk of HIV transmission with and without PEP for the specific exposure an individual has experienced
• the benefits of HIV testing (immediately following exposure, at 6 weeks, at 12 weeks and at 6 months)
• the benefits and risks of HIV PEP
• the use of HIV PEP during pregnancy
• that fact that HIV PEP is not guaranteed to prevent HIV transmission
• the importance of receiving post-test counselling
• details of other recommended blood tests such as specific STI testing
• the importance of personal precautions that the individual should take to prevent HIV transmission (e.g., using condoms, not sharing needles and restricted breastfeeding) for the next six months
• the prohibition against donating blood, semen or tissues for the next six months
• the usual duration of PEP treatment and the possibility of stopping at any time (with emphasis that this will reduce its effectiveness)
• the importance of treatment adherence
• the possible side-effects of and drug interactions with HIV PEP medications
• available support services, including contraception and counselling services and
• specifically for healthcare personnel: the safe work practices that are necessary to observe for the next six months (WHO, 2006; WHO, 2007; UN, 2021; AFAO, 2021).

Services delivering HIV PEP may therefore want to consider the need for multiple leaflets to support individuals at different stages in their treatment as well as more specialist materials for those who have specific health needs e.g., pregnant and/or breastfeeding individuals.

Several examples of HIV PEP patient informational sheets/leaflets by various agencies are included as attachments to this solution to provide an indication of potential design considerations and included details. 

It is however vital that any HIV PEP information materials procured or developed for use in a particular humanitarian setting are tailored to the specific needs of the local population and current local healthcare service delivery. For example, in some clinical settings it may be appropriate for individuals to self-administer their HIV PEP at home, whereas in other contexts individuals may be required to attend a health clinic on a daily or weekly basis so that their medication can be dispensed to them with health personnel present.

Please also note that the attached materials may not reflect current HIV PEP regime recommendations. The latest WHO (currently 2018) and local/national medication guidance should always be consulted during leaflet development/procurement to ensure its containing information remains accurate and appropriate. 

Leaflet specifications

To ensure that any promotional material relating to Sexual and Reproductive Health is accessible and acceptable to the target community within which it is to be distributed, there are a number of factors that need to be considered. These include:

1. Ensuring that the informational material is in a suitable size and format for method of distribution. For example, A5 or A6 for example for a small pamphlet.
2. Selection of an appropriate quality of paper or material for print. For example, sometimes waxed paper, plasticized, waterproof or durable material for the pamphlet may be required if meant to be reused by user.
3. The leaflet should be ideally provided in all locally relevant languages with consideration of the reading and health literacy within different demographic groups. For examples, the need for accessible, pictorial information in target populations with low reading literacy levels.
4. Leaflet choice should be sensitive to local cultural needs and preferences. For example, the leaflet's illustrations may need to be adapted to ensure cultural acceptability.
5. The choice of the key messages and information within the leaflet should be guided by local health needs. Multiple leaflets on HIV PEP may be required to meet the specific needs of different demographic groups for example, for individuals who are at risk of chronic, repeated exposure to HIV infection, the details of HIV Pre-Exposure Prophylaxis (PrEP) may also be relevant.

Additional guidance on HIV PEP delivery programming can be found by accessing the following resources:

HIV/AIDS treatment and care. Clinical protocols for the WHO European Region (WHO, 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)

Get PEP Info website (Australian Federation of AIDS organisations, (AFAO) 2021)

Solution creators

This solution was developed by Stevie-Jade Beeby.