Shawara daga sabis na Kiwon Lafiyar Jama'a ta Amurka
A shekara ta 1996, Hukumar Kula da Lafiya ta Amurka (USPHS) ta ba da jagorancin farko game da yin amfani da kwayoyin cutar kanjamau (ARVs) a matsayin bayyanar cututtuka (PEP) a lokuta na kamuwa da cutar ta HIV ta ma'aikatan kiwon lafiya (HCP).
A watan Agustan 2013, USPHS ta sabunta sharuɗɗa na karo na hudu, ta bada shawarwari game da samuwa da tasiri na ARVs na zamani, da kuma bayanai na yau da kullum game da tsaro mai tsawo na ARV da aka amince don amfani.
Daga cikin sharuddan tsarin kulawa:
- Gudanar da tasiri na 'yan takara na ARV
- Tolerability da toxicities
- Drug aminci a cikin ciki da lokacin lactation
- Jigilar kwaya da mita na dosing
Ƙayyade Hanyoyin Jiki
Bayyanawa ga cutar HIV a cikin HCP an bayyana shi a matsayin mai raunin raunuka (misali, needlestick ko yanke daga abu mai mahimmanci), ko kuma tuntuɓar membran mucous ko fata marar lahani (misali capped, abraded or afflicted with dermatitis) tare da jini dauke da kwayar cutar HIV , nama, ko sauran ruwan jiki dauke da yiwuwar cutar.
Wadannan sun hada da ruwa mai ruwan sanyi, ruwa mai amniotic, ruwa mai lalacewa (ruwa daga membrane kewaye da ji), ruwa mai tsabta (ruwa daga kewaye da gidajen), rufin ruwa (ruwa daga membranes dake kewaye da huhu); da kuma ruwa mai tsabta (ruwa mai ruɗa daga cikin rami na ciki).
Kuskuren, ɓoye na hanci, saliva, sputum, gumi, hawaye, fitsari da zubar ba su da tsammanin yiwuwar kamuwa da cutar sai dai idan jini ya nuna.
Bugu da ƙari, yayin da za a gwada ƙuƙwalwar mutum a kowanne ɗayan, ba a rubuta takardun da ke dauke da kwayar HIV ba ta hanyar ciwon ɗan adam a cikin tsarin kiwon lafiya.
Canje-canjen Maɓalli a Dokokin USPHS
Sharuɗɗa da suka gabata, da aka bayar a 2005, sun bada shawarar ƙaddamar da ƙananan ɗaukar hoto don sanin ko za a yi amfani da ARV guda biyu ko fiye.
Wannan shawarwarin ya fadi gaba ɗaya, kuma AmurkaPHS yanzu ta amince da amfani da ARV guda uku ko fiye don duk ayyukan halayen sana'a.
Sharuɗɗan da aka sabunta sun ƙara nuna cewa amfani da samfurin antigen / antibody na ƙarni na iya rage wajan gwajin bayan gwagwarmaya daga watanni shida zuwa watanni hudu.
Bayani na Jagororin
A yayin halakar da ake yi wa HIV:
- Dole ne a aiwatar da shirin na PEP nan da nan, a cikin lokutan da za a iya bayyanawa. Dole ne a nemi shawarwarin kwararru yau da kullum, amma ba a kan kuɗin da aka jinkirta ba.
- Za a iya gwada gwajin HIV don gano yanayin HIV na HCP. Idan za ta yiwu, dole ne a nemi yanayin HIV na mai kula da shi don taimakawa wajen jagorancin yin amfani da PEP.
- Ayyukan ARV guda uku ko fiye da za a ba su, bisa ga kyakkyawan tasirin da aka samu a gefe da kuma dacewa da jima'i. (Dubi Zaɓuɓɓukan Drug Shawara , a ƙasa.) Sananne ko ake ɗauka daukar ciki (ko nono) zai kara ƙayyade ƙin magunguna a wasu.
- Bugu da ƙari, a gwada gwajin HIV, dole ne a bai wa HCP jarrabawar jarrabawar jarrabawar rigakafi don jiragen maganin miyagun ƙwayoyi. Dole ne jarrabawar ya ƙunshi, ƙananan, cikakken ƙididdiga jini (CBC), da kuma koda da hanta aikin gwajin.
- PEP zai fara da ci gaba har tsawon kwanaki 28. Dole ne a ba da shawara na rigakafi don magance haɗakarwa daidai , yiwuwar sakamako mai lalacewa, da hulɗar miyagun kwayoyi.
- Wajibi ne ya kamata a fara a cikin sa'o'i 72 na yadawa, kuma ya haɗa da gwagwarmayar gwajin HIV da shawara. Dole ne a yi nazari na biyu na kula da maganin miyagun kwayoyi a makonni biyu.
- Bayan haka, gwajin cutar HIV ya kamata a yi a makonni shida, makonni 12, da watanni shida bayan fitarwa. Idan an yi amfani da gwaji na hudu na kwayar cutar HIV HIV / antigen / HIV, za'a iya gwada gwaje-gwaje a makonni shida da watanni hudu bayan watsawa.
Zaɓuka Drug da aka Gwada
USPHS ya bada shawarar yin amfani da Viread (tenofovir) da Emtriva (emtricitabine) -n haɗuwa da kwayoyi guda biyu a cikin kwayoyin kwayoyin guda daya, Truvada -plus Isentress (raltegravir) na PEP a cikin abubuwan da ke cikin tasiri.
Za'a iya amfani da wasu magungunan don amfani da kwayoyin cutar a yayin yaduwar cututtuka na asali ko wasu yanayi waɗanda zasu iya sabawa amfani da magungunan da aka ba da shawara.
Dole ne a ba da izinin Viramune (nevirapine) ga PEP, yayinda ba a yantar da ARV ba da shawarar ga PEP. Wadannan sun hada da Videx (didanosine) da Aptivus (tipranavir), da haɗin Zerit (stavudine) da Videx.
> Source:
> Kuhar, D .; Henderson, D .; Dama, K .; et al. "Sharuɗɗan Sabis na Harkokin Kiwon Lafiyar Jama'a na Amurka da aka buga don Gudanar da Ayyuka na Abubuwan Hulɗa don Ƙarƙashin Ƙarƙashin Ƙarƙashin Ƙarƙashin Ƙarƙashin Ƙarƙashin Ƙaƙwalwar Kasuwanci". Kwayoyin cuta da kuma asibitin Epidemiology. Agusta 6, 2013; 34 (9): 875-892.