Understanding Post-Exposure Prophylaxis (PEP) in Uganda

HIV remains a major health concern in Uganda, but there are effective ways to reduce the risk of infection after unexpected exposure. One of the most important methods is called post-exposure prophylaxis (PEP). This is a short course of HIV medicines (antiretrovirals, or ARVs) taken after a possible exposure to the virus. If started quickly and taken correctly, PEP can significantly lower the chance of becoming HIV positive.

If you are experiencing possible exposure to HIV, such as a needle injury, unprotected sex, or sexual assault, you can get personalised advice from licensed doctors through Hope Plus. This premium service helps you get timely care and avoid complications.

Below, we explain what patients and families in Uganda should know about PEP, including when it is needed, how it works, and what to expect during and after treatment.

What is Post-Exposure Prophylaxis (PEP)?

PEP is a 28-day course of HIV treatment given after a person may have been exposed to the virus. It is not a cure for HIV and it does not replace other preventive methods like condoms, but it provides a critical safety net when unexpected exposure occurs.

For PEP to work, it must be started as soon as possible—ideally within a few hours. The maximum window is 72 hours (3 days) after exposure. Delays beyond this period make it less effective.

When Might Someone Need PEP?

There are two main categories of exposure where PEP may be needed:

• Occupational exposure: This usually happens in health care settings, for example when a nurse, doctor, or cleaner is injured by a used needle, or when blood or body fluids splash onto the skin or eyes.
• Non-occupational exposure: This includes unprotected sex, sexual assault (such as rape or defilement), road traffic accidents, or injuries at workplaces like construction sites where there is contact with body fluids.

It is important to note that not all body fluids carry a risk of HIV. Tears, sweat, urine, and saliva without blood generally do not pose a significant risk.

What Happens at the Health Facility?

When someone goes to a clinic or hospital for PEP, the healthcare team will take several steps:

1. Immediate care and first aid:
   The exposed area is cleaned gently with soap and water or mild antiseptic. For example, if someone has a needle injury, they are advised not to squeeze the wound, but simply wash it well. Splashes to the eyes or mouth are rinsed thoroughly with plenty of clean water.
2. Eligibility check:
   The health worker will ask questions to confirm whether PEP is necessary. PEP is given if:
   • The exposure happened within the past 72 hours.
   • The person is not already HIV positive.
   • The source of exposure is HIV positive, of unknown status, or at high risk.
   PEP is not given if the source is confirmed HIV negative or if the exposed person is already living with HIV.
3. Counselling and support:
   Before starting treatment, the patient is counselled about the risks, the benefits of taking PEP, possible side effects, and the importance of completing the 28-day course. For survivors of sexual assault, additional emotional and psychological support is offered.
4. Prescription of medicines:
   The exact medicines depend on the patient’s age:
   • Adults are usually given a combination that includes tenofovir, lamivudine, and atazanavir/ritonavir.
   • Children receive a different combination suited for their age and weight.
   The first dose should be taken immediately, even before HIV test results are ready, because every hour matters.
5. Follow-up care:
   Follow-up visits are scheduled to check how the patient is coping with the medicines, manage side effects, and encourage adherence. HIV tests are repeated at 6 weeks, 3 months, and 6 months to confirm the person’s status. If HIV is detected, care and treatment are started right away. If not, further advice on prevention is given.

PEP After Sexual Assault

In Uganda, survivors of rape or defilement can access comprehensive care at health facilities. This includes:

• Rapid HIV testing and PEP if needed.
• Screening and treatment for other sexually transmitted infections (STIs).
• Emergency contraception to prevent pregnancy (if within 72 hours).
• Forensic medical examination to support legal cases.
• Psychological counselling and longer-term psychosocial support.

Survivors may also be referred to other services such as legal aid, police investigations, child protection services, safe shelters, or economic empowerment programmes, depending on their needs.

Key Points to Remember

• PEP only works if started within 72 hours after exposure. The earlier, the better.
• The treatment must be taken every day for 28 days without interruption.
• Regular follow-up testing is essential to confirm HIV status.
• PEP is not for regular use—it is an emergency measure. For ongoing protection, consider prevention methods such as condoms, voluntary medical male circumcision, and pre-exposure prophylaxis (PrEP).