Occupational percutaneous exposure to human immunodeficiency virus (HIV); a decision analysis from a Caribbean perspective - abstract

ABSTRACT

A decision analysis was conducted to examine whether short-term (42 days) zidovudine should be recommended for Caribbean health care workers (HCWs), following percutaneous exposure to blood, as well as to determine the value of testing "donor" (patient's) blood. The results were compared with a similar analysis based on a North American model. The options analyzed were "TREAT ALL", "TREAT NONE"; and "TEST". In the "TREAT ALL" option, all HWCs receive short-term zidovudine immediately after exposure, "TREAT NONE" option no one receives zidovudine and in the "TEST" option, "donor" blood is tested, and if HIV-positive, zidovudine is given. Each outcome was expressed as a utility; this is a method of quantifying the values that individuals place on health states. The results showed that the "TEST" option is preferred. The value of testing "donor" blood is derived from the fact that the vast majority of HCWs would be reassured by a negative test. Sensitivity analyses indicated that even if the risk of seroconversion or the effectiveness of zidovudine is zero, this option is preferred; thus confirming the above value of testing, rather than merely identifying HCWs who should receive zidovudine. If HIV-seropositivity exceeds 42 per cent, the "TREAT NONE" option is preferred. This was found to be due to the fact that increased numbers of HCWs would be told that they were exposed to HIV-positive blood. The "worrying factor" associated with such an exposure is such that above 42 per cent HIV seropositivity, the "TREAT NONE" option is preferred. In summary, the real value of testing "donor" blood is in identifying those persons who could be told that they were exposed to HIV-negative blood; that is reducing their "worry factor" to zero. If the risk of HIV-positivity exceeds 42 per cent, in particular groups of Caribbean patients, the "TREAT NONE" option is preferred. Because AIDS is a fatal disease, and given that zidovudine is the only available prophylactic agent at present, the drug has a role to play if its effectiveness is greater than zero. In this regard, the approach should be similar to that adopted for developed countries (AU)