摘要
Problem Prophylactic treatment and followup after exposure to HIV, hepatitis B, and hepatitis C outside hospital needs to be improved. Background and settin g Until January 2000, people in Amsterdam could report exposure outside hospital to either a hospital or the municipal health service. If they reported to the m unicipal health service, they were then referred to hospitals for HIV prophylaxi s, whereas the municipal health service handled treatment and followup related to hepatitis B and hepatitis C and traced sources. For cases reported to a hosp ital, hospital staff often did not trace HIV sources or follow up patients for h epatitis B and hepatitis C. Key measures for improvement Providing adequate trea tment for HIV, hepatitis B and hepatitis C after exposure for all reported expos ures outside hospital. Strategies for change On 1 January 2000, a new protocol w as introduced in which three Amsterdam hospitals and the municipal health servic e collaborated in the treatment and followup of exposures outside hospital. Bo th municipal health service and hospitals can decide whether HIV prophylaxis is necessary and prescribe accordingly. All people exposed in the community who rep ort to hospitals are subsequently referred to the municipal health service for f urther treatment and followup. Effects of change The protocol is effective in that most people comply with treatment and followup. When indicated, HIV proph ylaxis is started soon after exposure. In nearly two thirds of cases the municip al health service traced and tested the source. Lessons learnt Provision of trea tment and followup in one place enables treatment, tracing and testing sources , and followup, including counselling and registration of all reported exposur es in Amsterdam, which allows for swift identification of emerging epidemiologic al trends. Since May 2004 all Amsterdam hospitals have participated in the proto col.
Problem Prophylactic treatment and followup after exposure to HIV, hepatitis B, and hepatitis C outside hospital needs to be improved. Background and settin g Until January 2000, people in Amsterdam could report exposure outside hospital to either a hospital or the municipal health service. If they reported to the m unicipal health service, they were then referred to hospitals for HIV prophylaxi s, whereas the municipal health service handled treatment and followup related to hepatitis B and hepatitis C and traced sources. For cases reported to a hosp ital, hospital staff often did not trace HIV sources or follow up patients for h epatitis B and hepatitis C. Key measures for improvement Providing adequate trea tment for HIV, hepatitis B and hepatitis C after exposure for all reported expos ures outside hospital. Strategies for change On 1 January 2000, a new protocol w as introduced in which three Amsterdam hospitals and the municipal health servic e collaborated in the treatment and followup of exposures outside hospital. Bo th municipal health service and hospitals can decide whether HIV prophylaxis is necessary and prescribe accordingly. All people exposed in the community who rep ort to hospitals are subsequently referred to the municipal health service for f urther treatment and followup. Effects of change The protocol is effective in that most people comply with treatment and followup. When indicated, HIV proph ylaxis is started soon after exposure. In nearly two thirds of cases the municip al health service traced and tested the source. Lessons learnt Provision of trea tment and followup in one place enables treatment, tracing and testing sources , and followup, including counselling and registration of all reported exposur es in Amsterdam, which allows for swift identification of emerging epidemiologic al trends. Since May 2004 all Amsterdam hospitals have participated in the proto col.
