Post-exposure prophylaxis

So we've covered so many different topics, HIV care, new FDA approvals around treatment and prevention.

We've discussed PrEP and PEP, STI management and prevention, especially with DoxyPep.

That was a new thing that we kind of covered over the last couple of years.

Behavioral health, DHHS guideline changes.

I think we spent dozens of episodes discussing prevention strategies, including oral PrEP, even the on-demand PrEP that we've talked about before, multiple studies on that.

Injectable PrEP I think has made a big difference in even the updated guidelines for HIV prevention for PrEP.

There was also in the last year we had we had PEP changes to the post-exposure prophylaxis changes for both both occupation or non-occupational guidelines change.

And then I think the old the whole concept of PEP and pocket approaches And obviously other ongoing prevention strategies and expanding access to care, I think, has always been an important piece that we've tried to cover.

The good news is you have some time after animal exposure, says Lorraine Washer, MD, who consulted with Loring following his encounter.

Quote, in most cases, rabies post-exposure prophylaxis, known as PEP, is a medical urgency, not an emergency.

You can normally wait 48 to 72 hours to determine whether an animal is available for testing or observation, end quote.

Unfortunately, you can't always rely on an animal's behavior to tell whether it's infected with rabies.

So what do you do if you've been bitten by an animal? If you were bitten, wash the wound with soap and water and seek medical care.

Dr. Washer says that depending on the severity and the type of bite, a visit to urgent care or an emergency department may be required for a tetanus shot, and depending on rabies reports in your area, rabies immunoglobulin, and the first dose of the rabies vaccine.

Rabies PEP includes four total visits for vaccine doses.

Michigan law requires that animal bites are immediately reported to the local health department.

Remember that testing the source patient requires their consent.

Based on the evaluation, you will be counseled on and offered post-exposure prophylaxis or PEP.

For the exam, it is critical to know that PEP is extremely time-sensitive.

To be effective against HIV, it must be started as soon as possible, ideally within hours and no later than seventy-two hours after the exposure.

I just was going to add that I want to talk about reimbursement, and I think it's important to talk about reimbursement.

But before we move on to the reimbursement discussion, that we talk about pharmacist provision of PrEP, but also pharmacist provision of PEP.

And there are many states where pharmacists also can furnish post-exposure prophylaxis for

HIV as well.

And Liz, can you differentiate for our audience who are less familiar with PrEP versus PEP, just in a little nutshell?

PrEP is antiretrovirals taken prior to and during the time of exposure.

Post-exposure prophylaxis are antiretrovirals taken by uninfected people following an exposure.

So for occupational exposures and for non-occupational exposures like sexual exposures or injection drug