R 081845Z JAN 09
SUBJECT: HIV POST-EXPOSURE MANAGEMENT
A. COAST GUARD HUMAN IMMUNODEFICIENCY VIRUS (HIV) PROGRAM,
COMDTINST M6230.9
B. MY 101301Z OCT 08
1. RAPID HIV TESTS UPDATE -
A. COAST GUARD CLINICS, SATELLITES, AND AFLOAT INDEPENDENT DUTY
HEALTH SERVICES TECHNICIANS (IDHS) WHO PERFORM CLINICAL ACTIVITIES
THAT MAY PUT THEM AT RISK FOR A BLOODBORNE PATHOGEN (BBP) EXPOSURE
(E.G. IMMUNIZATIONS, BLOOD DRAWS, ETC) MUST HAVE THE CLEARVIEW
RAPID HIV 1/2 STAT PAK (PER REFERENCES A AND B). THE RAPID HIV TEST
KIT MUST BE USED AS DESCRIBED IN REF A FOR RAPID DETERMINATION OF
HIV STATUS OF THE SOURCE PATIENT.  EXCEPTIONS FOR USING CIVILIAN
PROVIDERS OR MILITARY TREATMENT FACILITIES FOR STAT HIV TESTING
WILL BE GRANTED BY MLC(K) IN COORDINATION WITH CG-1121 ON A CASE BY
CASE BASIS.
B. COAST GUARD ASHORE IDHS WHO ARE EXPOSED TO A BBP MUST SEND THE
SOURCE INDIVIDUAL TO THE NEAREST LOCAL HOSPITAL OR MILITARY
TREATMENT FACILITY TO OBTAIN A RAPID HIV ANTIBODY TEST NO LATER
THAN 1 HOUR AFTER THE BBP EXPOSURE. IF THE SOURCE IS A MILITARY
MEMBER, TESTING IS MANDATORY. IF THE SOURCE IS A CIVILIAN, CONSENT
FOR HIV TESTING MUST BE OBTAINED. IF THE CIVILIAN SOURCE REFUSES TO
BE TESTED, THIS FACT MUST BE DOCUMENTED APPROPRIATELY. EACH ASHORE
IDHS SHOULD HAVE A LOCAL HOSPITAL POINT OF CONTACT WHO CAN ASSIST
WITH OBTAINING STAT HIV RESULTS. THE ASHORE IDHS MUST ENSURE THAT
THEY ENGAGE THEIR DMOA FOR MEDICAL ADVICE AND OBTAIN COMPLETE
FOLLOW-UP ON THE STATUS OF THE SOURCE INDIVIDUAL (E.G. OBTAIN LAB
RESULTS, CLINICAL NOTES) IAW REF A.
2. POST-EXPOSURE PROPHYLAXIS (PEP) MEDICATIONS –
A.  ALL AFLOAT IDHS MUST STOCK 10 COMBIVIR CAPSULES (ONE UNIT DOSE
STRIP OF 10) AND 10 KALETRA CAPSULES. AFLOAT IDHS MUST CONTACT
THEIR AOR (COLLATERAL) PHARMACY OFFICER FOR BOTH THE COMBIVIR &
KALETRA CAPSULES. FOR ANY PHARMACEUTICAL THAT IS NOT UNIT DOSED THE
PHARMACY OFFICER SHALL REPACKAGE ACCORDING TO INDUSTRY GUIDELINES
(INCLUDING NAME AND STRENGTH OF AGENT, MANUFACTURER, LOT NUMBER,
EXPIRATION) IN USP EQUIVALENT TIGHT CONTAINER. A COPY OF THE
MEDICATION PACKAGE INSERT SHALL BE PROVIDED WITH THE MEDICATION.
B. CLINICS AND SATELLITES (WITH THE EXCEPTION OF THOSE SITES THAT
HAVE BEEN GIVEN A WAIVER BY THE MLC(K)) SHOULD PROCURE A LIMITED
SUPPLY OF BOTH COMBIVIR AND KALETRA. CG MEDICAL OFFICERS SHOULD
CONTACT THE CENTERS FOR DISEASE CONTROL (CDC) NATIONAL CLINICIAN'S
PEP HOTLINE (PEPLINE) AT 1-888-448-4911 FOR ADDITIONAL INFORMATION
ON MANAGING BBP EXPOSURES.
C. ASHORE IDHS ARE NOT REQUIRED TO STOCK PEP MEDICATIONS, RATHER
THEY ARE REQUIRED TO DISCUSS FURTHER EVALUATION AND TREATMENT
OPTIONS WITH THEIR DMOA.
3. THESE CHANGES WILL BE REFLECTED IN THE NEXT REVISION OF REF A.
4. FOR QUESTIONS REGARDING THIS MESSAGE CONTACT CAPT MARY FONG AT
MARY.FONG(AT)USCG.MIL OR (202)475-5181 OR CDR ERICA SCHWARTZ AT
ERICA.G.SCHWARTZ(AT)USCG.MIL OR (202)475-5172 OR HSCM KIRK WATSON
AT KIRK.T.WATSON(AT)USCG.MIL OR (202)475-5174.
5. CAPT MICHAEL J. BOQUARD, CHIEF, OFFICE OF HEALTH SERVICES SENDS.
6. INTERNET RELEASE AUTHORIZED.