AHF Nepal ART Coordinator Dharma Raj Bhattarai: My Experience on Post-Exposure Prophylaxis as a Healthcare Professional

I was uneasy when a lab technician repeatedly punctured the veins of a boy living with HIV/AIDS (CLWHA) in an attempt to collect a blood sample for a CD4 count. With the permission of the technician, I successfully drew the boy’s blood and put it into a vial. As I recapped the vial, I pricked my left thumb. Although recapping is not recommended, I forgot in the moment…

(Read more about Dharma’s PEP experience by clicking here)

It was the first time this had happened to me in my career. I was surprised and scared. I took off my gloves and washed my hands with soap and water. I called Dr. Nandu Pathak, a renowned ART clinician at the Lumbini Zonal Government Hospital, where AIDS Healthcare Foundation (AHF) helps deliver quality ART services in collaboration with the state. He advised me to immediately take a tenofovir/lamivudine/ritonavir-boosted lopinavir-based (TDF/3TC/L/r) post-exposure prophylaxis (PEP) regimen. Because Dr. Pathak was on leave, I started PEP and baseline investigations the next day.

I experienced the fear, pain, commitment and perseverance of adhering to ART. I had trouble adhering to the 12 hour-interval timing of 8 a.m./p.m. and started to use an alarm clock as a reminder. I was irritated that I had to take pills on a daily basis. I was nauseous and dizzy. I couldn’t tolerate the pills after a week and researched the drug’s side effects and interactions with other drugs.

I consulted via Skype with Medical Advisor Dr. Men Pagnoroat at the AHF Asia Bureau in Cambodia, who informed me that the lopinavir/ritonavir (L/r) causes glucose intolerance, and because I am diabetic my body could not handle L/r. Moving forward I took only TDF/3TC. Thus far I’ve completed 28 days of PEP but still fear the tests I may have to endure over the coming months.

I had a conversation with the father of the HIV positive child when he brought him back for evaluation the following day. The father has been very happy with the services provided to him and his son at the Butal Hospital’s ART Center. Three years ago the boy was admitted to the hospital; he weighed in at just 25 kg and his CD4 count was at 250. Since then, he’s been a regular and active client. Though he has suffered oral candidiasis and other opportunistic infections (OIs) at the time of admission, he now weighs 65 kg and his last CD4 count came back at 680.

He refused the Children Affected By AIDS (CABA) educational allowance provided by The Global Fund “Save the Children” program in Nepal because he feared the stigma it would bring, if his community or the Village Development Committee (VDC) discover that he and his son are HIV-positive. He was hesitant to ask the VDC for a recommendation letter, which is compulsory in order to receive the educational allowance. He is grateful that he has treatment options with AHF, because the discrimination from the community is enough to keep him from applying for CABA.