DRAFT Actions to take for exposure to bloodborne pathogens (HIV, Hep C) Do you still suspect source HIV positive? No /UNK Submit additional blood sample from potential source to a laboratory for verification. Blot a sample of Blood onto filter-paper and seal in plastic bag (See Blood Collection and Shipping Instructions) Sample will travel with Soldier during EVAC to Germany and shipped via FedEx using account or be shipped DHL to WRAIR Submit additional blood sample from potential source to a laboratory for verification. Blot a sample of Blood onto filter-paper and seal in plastic bag (See Blood Collection and Shipping Instructions) Sample will travel with Soldier during EVAC to Germany and shipped via FedEx using account or be shipped DHL to WRAIR No Yes No Yes Educate Soldier and unit on Risk Factors and Avoidance EXPOSURES with increased risk: Needle Stick, Contact with infected or suspected person's fluids, OR contact with assailant body fluid via mucous membrane, non-intact skin or bite; OR unknown exposure (e.g, drug assisted) [AFRICA is considered High Risk] EXPOSURES with increased risk: Needle Stick, Contact with infected or suspected person's fluids, OR contact with assailant body fluid via mucous membrane, non-intact skin or bite; OR unknown exposure (e.g, drug assisted) [AFRICA is considered High Risk] NO RISK EXPOSURES: Exposures where skin remains intact where there is no anal, vaginal, or oral penetration; no contact with source body fluids via mucous membrane, NO RISK EXPOSURES: Exposures where skin remains intact where there is no anal, vaginal, or oral penetration; no contact with source body fluids via mucous membrane, Conduct RDT (Rapid Diagnostic Test) on Source: 1 each, HIV, Hep B, Hep C [do not use saliva, use blood] Conduct RDT (Rapid Diagnostic Test) on Source: 1 each, HIV, Hep B, Hep C [do not use saliva, use blood] Is Source RDT Positive? Yes HIV IMMEDIATELY: Begin Soldier Treatment PEP: Delay of PEP administration greater than 48 hours significantly diminishes efficacy of treatment regime. Begin Coordinating for EVAC to Landstuhl: Due to limited PEP supply on hand, evacuation should be completed within 72 hours. IMMEDIATELY: Begin Soldier Treatment PEP: Delay of PEP administration greater than 48 hours significantly diminishes efficacy of treatment regime. Begin Coordinating for EVAC to Landstuhl: Due to limited PEP supply on hand, evacuation should be completed within 72 hours. Use Triple Drug Therapy, currently the best combination: Dolutegravir x 1 tab per day, plus Truvada (two drug combo) X1 Tab per day Pre-treat w/Zofran or Phenergan to offset nausea/vomiting from meds Use Triple Drug Therapy, currently the best combination: Dolutegravir x 1 tab per day, plus Truvada (two drug combo) X1 Tab per day Pre-treat w/Zofran or Phenergan to offset nausea/vomiting from meds Points of Contact: - LTC Lynch, SOCAF Surgeon (all MEDEVACs) DSN: COMM: +49 (0) SVOIP: (80) NIPR: SIPR: SOCAFRICA JOC: - DSN /3370; / RED: AFRICOM ID consultant Points of Contact: - LTC Lynch, SOCAF Surgeon (all MEDEVACs) DSN: COMM: +49 (0) SVOIP: (80) NIPR: SIPR: SOCAFRICA JOC: - DSN /3370; / RED: AFRICOM ID consultant HIV Post Exposure Prophylaxis Regimen Note: Continued Treatment and consultation required, Testing will be required at 1, 3, 6 and 12 months Is Contact Source HIV Negative? Is Source available for RDT ( Rapid Diagnostic Test) ?

HIV PEP Kit Contents Sealable rugged container: Otter/Pelican approx 5W"x7W"x3D" – Labeled on Outside, HIV Exposure Kit Kit Contents with pertinent expiration date Last inspection date and initials Drugs (should medics fill separate in case of expiration date? – Dolutegravir – Truvada Rapid Test - HIV RDT, (verify no special handling instructions or expiration) – Include extra lancet for blood sample – Ensure each kit has pipette if applicable (some RDTs have pipets separate) SOP/Flow Chart/shipping instructions - 5x7 laminated printout Blood Sample Kit – FTA Micro Card (x2) – alcohol wipe – sterile lancet – adhesive bandage – gloves, – Multi-Barrier Pouch (strong ziplock to hold the blood sample) – mailing envelope – tamper-proof tape for the mailing envelope, – Desiccant – clear outer bag (labeled with code number and expiration date Gloves Pre-Printed labels Desicant bag - keep moisture out

Blood Sample Kit Blood Sample Collection Instructions 5x7 laminated FTA Micro Card (x2) alcohol wipe sterile lancet adhesive bandage gloves, Multi-Barrier Pouch (strong ziplock to hold the blood sample) mailing envelope tamper-proof tape for the mailing envelope, Desiccant clear outer bag (labeled with code number and expiration date

Actions to take for exposure to bloodborne pathogens (HIV, Hep C) Is Contact Source HIV Negative? Conduct RDT on Source Is Source RDT Positive? Do you still suspect source HIV positive? No /UNK Is Source available for RDT? Always submit additional blood sample from the potential source to a laboratory for verification. Blot a sample of Blood onto filter- paper and seal in plastic bag Sample will travel with Soldier during EVAC and turned into lab Always submit additional blood sample from the potential source to a laboratory for verification. Blot a sample of Blood onto filter- paper and seal in plastic bag Sample will travel with Soldier during EVAC and turned into lab Yes No Yes No Yes Educate Soldier and unit on Risk Factors and Avoidance HIGH RISK EXPOSURES: Needle Stick, Contact with infected or suspected person's fluids, OR contact with assailant body fluid via mucous membrane, non-intact skin or bite; OR unknown exposure (e.g,, drug assisted) [AFRICA] HIGH RISK EXPOSURES: Needle Stick, Contact with infected or suspected person's fluids, OR contact with assailant body fluid via mucous membrane, non-intact skin or bite; OR unknown exposure (e.g,, drug assisted) [AFRICA] NO RISK EXPOSURES: No anal, vaginal, or oral penetration; No contact with assailant body fluid via mucous membrane, non-intact skin or bite Contact with fluids of non-infected person NO RISK EXPOSURES: No anal, vaginal, or oral penetration; No contact with assailant body fluid via mucous membrane, non-intact skin or bite Contact with fluids of non-infected person HIV IMMEDIATELY: Begin Soldier Treatment PEP: Delay of PEP administration greater than 48 hours significantly diminished efficacy of treatment regime. Begin Coordinating for EVAC to Landstuhl: Due to limited PEP supply on hand, evacuation should be completed within 72 hours. IMMEDIATELY: Begin Soldier Treatment PEP: Delay of PEP administration greater than 48 hours significantly diminished efficacy of treatment regime. Begin Coordinating for EVAC to Landstuhl: Due to limited PEP supply on hand, evacuation should be completed within 72 hours. Use Triple Drug Therapy, currently the best combination: Daltegravir x 1 tab per day, plus Truvada (two drug combo) X1 Tab per day Pre-treat w/Zofran or Phenergan to offset nausea/vomiting from meds Use Triple Drug Therapy, currently the best combination: Daltegravir x 1 tab per day, plus Truvada (two drug combo) X1 Tab per day Pre-treat w/Zofran or Phenergan to offset nausea/vomiting from meds Points of Contact: -LTC Lynch, SOCAF Surgeon (all MEDEVACs) DSN: COMM: +49 (0) SVOIP: (80) NIPR: SIPR: AFRICOM ID consultant Points of Contact: -LTC Lynch, SOCAF Surgeon (all MEDEVACs) DSN: COMM: +49 (0) SVOIP: (80) NIPR: SIPR: AFRICOM ID consultant HIV Post Exposure Prophylaxis Regimen Note: Continued Treatment and consultation required, Testing will be required at 1, 3, 6 and 12 months