State finally releases n-PEP guidance

LANSING — After more than a year, the Michigan Department of Community Health has released a guidance paper to state health officials on the use of antiretroviral medications to prevent HIV infections in non-work related exposures.

The procedure, called non-occupational post-exposure prophylaxis or n-PEP, has been an approved preventative treatment by the Centers for Disease Control and Prevention since 2005. The World Health Organization has had similar guidance in place since 2006.

“It looks like the n-PEP position statement received final approval April 21,” said Kelly Niebel, spokesperson for MDCH. “It was distributed to high-prevalence local health department AIDS coordinators; Michigan HIV/AIDS Coalition; Expanded Testing Initiative grantees; prevention grantees; designated sites; ADAP [AIDS Drug Assistance Program] doctors; case management agencies. It was also sent to MALPH [Michigan Association for Local Public Health], which distributed it to local health department health officers, medical directors and nursing staff.”

One high prevalence location has already started pushing n-PEP as standard prevention activity. Michigan Messenger reported that Ingham County Health Department has begun to push n-PEP publicly. The decision was made in response to the county having the second highest rate of HIV infection in the state. Ingham County officials announced their plans ten days prior to MDCH’s approval of its policy paper.

A Messenger investigation in December 2009 first brought the issue of n-PEP to the forefront when it was revealed that the state had no policy “written in stone,” and that access to the life saving medications was entirely dependent on where in the state a person was located.

The same day the investigation was published Amna Osman, director of Division of Health, Wellness and Disease Control for MDCH, told Messenger an n-PEP policy would be in place “early” in 2010.

However, a year later, the proposed language continued to be stuck in a bureaucratic system and was not yet approved. As a result of the delay, national and local lesbian, gay, bisexual and transgender organizations condemned the MDCH for failing to have the policy in place, and demanded immediate action.

The policy appears to be a re-write of the 2005 Centers for Disease Control guidance, and is substantially different from drafts released to Michigan Messenger earlier this year in response to a Freedom of Information Act request. Those earlier drafts blurred the distinctions between post exposure prophylaxis, which is a specific treatment designed for health care workers and first responders who might have an exposure to HIV, with the non-occupational post exposure prophylaxis. The later, n-PEP, is designed to be administered to persons with an exposure through sex — whether consensual or non-consensual — and needle sharing.

Both procedures require the person exposed to begin a 28 day course of anti-retrovirals within 72 hours. Anything beyond the 72 hours after exposure is considered too late for the intervention. While the procedures are in fact quite effective in preventing HIV from gaining a foothold in the body, it is rife with potential side effects and is expensive. An average n-PEP or PEP prescription costs about $1,000.

The release of the new policy brought praise from Equality Michigan.

“Equality Michigan is pleased with the Michigan Department of Community Health’s release of its own n-PEP policy,” said Emily Dievendorf, policy director for the civil rights group. “The release of the policy can ensure that Michigan health care providers know that an option exists to prevent the spread of HIV and offer them guidance as to n-PEP’s distribution and effective use. In this case knowledge can save lives. It is my hope that the n-PEP policy is distributed widely along with strong encouragement that health care providers offer it every time an individual may have been exposed to HIV. This is a first step, but an invaluable step toward a healthier Michigan.”