Hello Melanie
We are going to switch to the 4th generation test this month and I was looking at changing our algorithm which I have used for years. I agree with Abijay that there are some outliers. The questions about when to do LFT’s arise as well as testing of those on prophylaxis(includes CBC, LFT’s amylase, etc). Do you have a protocol you are willing to share?

Thanks,
Philip Adamo, M.D., MPH
Baystate Health
On Jun 7, 2016, at 1:05 PM, Abhijay Karandikar via MCOH-EH <mcoh-eh@mylist.net> wrote:

Hi Melanie,

I agree with the reduced frequency of testing for the 4th gen HIV tests and understand why. However, the fun starts when the exposure is unknown and different health systems and providers use different modes of testing (eg. LFTs at 4-6 weeks, 4 months and 12 months, some not doing them at all, etc.). Also, if you have an overly anxious employee, providers seem to order more testing for a prolonged period of time. One of my goals with the chart/table/algorithm is to standardize this evaluation in our system.

Abhijay

From: "Swift, Melanie" <melanie.swift@Vanderbilt.Edu>
To: Abhijay Karandikar <dr_abhik@yahoo.com>; MCOH/EH <mcoh-eh@mylist.net> 
Sent: Tuesday, June 7, 2016 12:50 PM
Subject: RE: [MCOH-EH] BBP follow-up chart

Abjay, if you use a 4th generation HIV test that includes antigen testing, you can just do the followup employee test at 6 weeks and 4 months post exposure.
Moving to this led us to consolidate the schedule so we do HCV Ab testing at 4 months also. In high risk exposures to HCV we add HCV PCR testing at 6 weeks. So it’s pretty simple, just 2 dates for followup testing.
If you use a 3rd generation HIV test you have more followup dates.
 
Melanie Swift, MD
Director, Vanderbilt Occupational Health Clinic
 
From: MCOH-EH [mailto:mcoh-eh-bounces@mylist.net] On Behalf Of Abhijay Karandikar via MCOH-EH
Sent: Tuesday, June 07, 2016 11:45 AM
To: MCOH/EH
Cc: Abhijay Karandikar
Subject: Re: [MCOH-EH] BBP follow-up chart
 
List,
 
I am creating a one page table that our providers can follow for follow-up testing for exposure to BBP (source testing, testing of the exposed at 6, 12, 24 weeks and so on). Can anyone share their versions of such "tables" with me? 
 
Although the creating of such a table/algorithm itself is non-problematic, I do not want to "overload" the page by too much information (planning to add items such as anti-HIV PEP best within 72 hours, etc.) and would appreciate seeing a few examples!
 
Thanks,
Abhijay
 
 
 
Abhijay P. Karandikar, MD, MPH, FACOEM
Medical Director - Occupational Medicine
CONNCare / Backus / BPS
Norwich, CT 06360. 


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