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PEP – Treatment in fear of exposure to HIV

The following is a translation and edit of an article on www.aidsisrael.org.il. For more information see the full article [Hebrew] by clicking here

PEP

PEP – Treatment given in cases of fear of exposure to the HIV virus. Your condom is torn during sexual intercourse; Are you afraid of being exposed to HIV? There are some things that everyone needs to know:

What is PEP?

POST 

EXPOSURE 

PROPHYLAXISpreventive treatment 

PEP is a treatment given after exposure to HIV and its goal is to minimize the risk of infection.

Is  PEP  a new invention?

For years, PEP has been used to prevent HIV infection in cases of high-risk exposure. For example, if a medical staff member is exposed to a contagious fluid (for example, stabbed from a syringe containing HIV positive blood), he or she is offered the preventive treatment that should significantly reduce the chances of contracting the virus. This treatment is also offered in hospitals to victims of sexual assault or to partners of HIV positive people if the condom is broken. PEP is actually a drug that is taken for 28 days and is based on the combined drug therapy that people living with HIV take throughout their lives.

In what situations should I consider PEP ?

If one of the following conditions occurs:

1. Almost certain exposure to the virus, for example, you are HIV negative and in a relationship with someone who is positive. Although you are always careful about protected sex – something happens and the condom breaks at the time of penetration.

2. Possible exposure to the virus, such as having unprotected sex with a partner whose HIV status is unknown, and a condom rupture during penetration.

3. Having unprotected sex that involves penetration with a partner whose HIV status is unknown or known to be positive.

Some clear cases in which treatment is recommended: 

  1. A needle stabbing from a person living with HIV (mainly occupational exposure).
  2. People who have been penetrated without a condom by a person living with HIV and whose therapeutic status is unknown.  
  3. Victims of sexual assault. (If a call to the ER is made up to 72 hours).

How do you get and who decides on it?

If you are concerned about HIV, contact the emergency room of one of the listed hospitals below as soon as possible (and no later than 72 hours after exposure). Treatment can be requested 24 hours a day, 7 days a week.

Where can I get the treatment?

In each of the following seven emergency rooms (24 hours a day, 7 days a week):

  • Soroka, Beer Sheva
  • Kaplan, Rehovot
  • Hadassah Ein Karem, Jerusalem
  • Sheba, Tel Hashomer
  • Ichilov, Tel Aviv
  • Meir, Kfar Saba
  • Rambam Medical Center, Haifa

Remember: the treatment is not given to anyone who wants it, and the decision is made by the doctor in the emergency room.  The doctor will decide whether or not to prescribe the treatment, only after consulting an infectious disease specialist or an HIV doctor from the hospital’s AIDS center, since this is a treatment with rare but life-threatening side effects, the doctor will try to see if the risk of infection in your case justifies the chances The doctor will ask you some questions related to your sex habits and the last time you have unprotected sex.

Can I go directly to the emergency room or need a referral?

A visit to the hospital must be paid by a fee, unless there is a commitment from the health fund (hitchayvut/Form 17), or in cases defined in advance by the Ministry of Health and in the regulations of the health funds. HIV prevention is not one of these cases, so in order to be exempt from a screening visit, you must have a hitchayvut. How do you do this? One way is to visit a family doctor and ask for a referral to the ER. It may be a cumbersome way of scheduling or trying to get into a doctor without a queue because of an emergency, and time is pressing. The simplest and fastest way would be to call the HMO call center and ask to speak to the nurses’ center. If the nurse at the center approves the need for an emergency appointment, the telephone call is recorded on the computer and is considered according to the fund’s regulations as a liability of the fund for all intents and purposes. In some cases the nurse may require you to visit your GP. In such a situation, you must clarify the urgency of the matter and insist on receiving a referral from the call center.

In any case, remember: Arriving at the ER without a commitment from a doctor or a nurses’ center will cost you NIS 715, even if the visit is medically justified.

What happens to a caller when he arrives at the ER?

A number of tests are performed at the ER. First, an HIV test that checks whether there has been past infection (and then any unnecessary preventive treatment). In addition, a blood count is performed and a liver and kidney function test is performed to determine a health condition that does not allow taking the treatment. In addition, in case of exposure to sexual relations, antibiotic treatment was provided to cover other sexually transmitted diseases (gonorrhea and chlamydia). At the end of the tests, and after the consultation of the emergency doctor with a physician aids are given in sorting out several doses of treatment for the next day or two. During the course of the treatment, the person is instructed to perform additional tests, the most important of which is, of course, HIV testing after three weeks of treatment. Which prevents, to ensure that no adhesion occurred.

What would they ask me in the emergency room? 

The questions that the doctor will ask you in the emergency room can be very personal and cause a feeling of discomfort. You will be asked to talk about the partner with unprotected sex, you will be asked about the sexual act, when was, what included what was your role in sex and whether there was ejaculation inside or outside. Remember that the doctor asks for all this information not to satisfy his curiosity but to make the right decision about your health. In any case, all the information you tell your doctor needs medical confidentiality so that you can be calm. The more accurate information you provide, the more appropriate a decision can be made by your doctor regarding the need for preventive care and its composition.

So take or not take?

Whether to take or not to take lies in the benefit of treatment versus its risks. Treatment is not easy in many cases and sometimes even life-threatening. Another important fact is that the side effects of the treatment may be difficult. Usually more severe than the side effects experienced by people living with HIV and taking the treatment for many years. For these reasons, complex therapeutic protocols have been written that weigh the risk of infection compared with the risk of side effects, according to which the AIDS doctors decide whether to give the treatment or not. 

When should I seek treatment?

The faster the better! The efficacy of the treatment depends on the time that has passed since the exposure: the closer the treatment is to the time of exposure, the more effective it is. If 72 hours have elapsed since the exposure, PEP will not be given in any case because treatment is no longer effective.

It has recently been shown that taking the treatment more than 48 hours after exposure reduces its effectiveness significantly, so in situations where PEP is recommended, this should be done as soon as possible !!!

Some things to know about  PEP :

– PEP is not a “day after” pill and is definitely not a substitute for condom use.

Treatment reduces the chances of HIV infection but is not 100% effective.

– Treatment must commence as soon as possible as of the date of exposure, and in any event not later than 72 hours from the moment the incident occurred.

– The treatment is not given to anyone who asks, and in any case, it is possible to receive it only in emergency rooms with the instruction of a specialist.

– Treatment is based on some of the combined drug therapy taken by people living with HIV.

Treatment has short- and long-term side effects. Sometimes these are serious phenomena. (And therefore, as noted, can not be given to any person who requests it and under the instruction of a specialist doctor only).

So now I know there is a PEP, why should I continue using the condom?

Well, simply because PEP is not a protective measure and it certainly is not a substitute for a condom. This is not a “day after” pill, but a complex drug treatment with side effects that can be determined by an emergency room doctor. In the case of PEP, the doctor will decide for you. They have the full professional authority to refuse you.

Accident Insurance and What to Do When a Child Gets Hurt

By Aviva Yoselis
Our strict contributed content guidelines ensure useful, informative and non-solicitous submitted content. Opinions expressed in this article are the author’s own.


Active Children Get Hurt

kid scraped kneeThe other day, I realized that there are actually people living in Israel who’ve never been to the Emergency Room, who’ve never had to take a bleeding child to the extended hours clinic to be stitched up, who’ve never looked at the chip in their child’s tooth after a fall from a slide and said, ‘yep, that tooth is gonna have to be fixed’. Now, before you stop reading in horror and say, my goodness what a negligent mother, let me just inform you that I have active boys. Three of them. Really active. And active girls who play with the active boys. We’ve been stitched, glued, x-rayed, bandaged…

So here are some important facts to know if your child, grandchild, niece, nephew or little neighbor gets hurt:

Accident Insurance for School Aged Children

Teeth

If a school age child (pre-K through 12th grade) has any type of tooth injury, chipped, knocked out, cracked,…treatment is covered by the school insurance, even if it didn’t happen on school property or during school hours. This means, that yes, the eight year old girl who was chasing her brother around the house, tripped, and cracked her two newly grown front teeth in half, can get full reconstruction of those teeth for free.

To go about this, you need to call the national insurance company (not connected to your kupah): 1-800-44-33-44 [in Hebrew only], give them your child’s information and they will call you back with a number and a list of eligible dental clinics. With that number and a letter from the school secretary saying your child is a student, you can make an appointment and go to one of the approved clinics.

Accident Injury

The insurance that you purchase at the beginning of each school year (mandatory~75 NIS), covers your school age child for all kinds of accidents (except for car and terrorist events-that’s through Bituach Leumi). If your child is hurt falling out of a tree, falling off a bike, injured on the playground, even if it didn’t happen on school property or during school hours, your child is eligible for insurance coverage. If they have a temporary disability, they may also receive coverage for that. Contact the secretary of the school for relevant phone numbers of the insurance.

Things to Remember

Head/facial wounds bleed, a lot

If the child comes in from the outside with blood running down their cheek, take a deep breath and wash the wound off first. Sometimes even small cuts look massive in the beginning.

If the injury looks deep, take the child to the nearest extended hours clinic of your kupah (not the ER unless it’s after midnight). Make sure you know where this clinic is before there’s an accident, so you don’t have to call around in the moment of panic. Put the number and address up on your fridge so it’s accessible. If there is an injury around the eye, or the cut is especially deep, know that the extended hours clinic or Terem may end up sending you to the ER to be stitched; you still need to go to the kupah clinic first, and then go to the ER with a referral, in order for the ER fee to be covered by the kupah.

[Editor’s note: If the situation is truly urgent, and wasted time contributes to the danger, do not pause for preliminary concerns. Click here to read more about Medical Attention Any Time and in Emergencies.]

Possible concussions

If the child is unconscious or loses consciousness, feels dizzy or vomits after a falling injury, take the child to the ER immediately.


Aviva Yoselis, MPH, founder and director of Health Advize and Viva Research Institute, is an expert in the field of health research, health behavior modification and shared medical decision making. She has over 20 years of experience facilitating seminars and teaching classes on health behavior and health system navigation. Aviva is skilled in identifying key points in complex situations, and looking at a range of possible solutions. Feel free to download her free guide on navigating the Israel Health Care system at http://healthadvize.com/contact-us/.

Stroke Victims – Benefits and Support in Israel

Individuals who have been diagnosed has having had a stroke are hospitalized for treatment and monitoring. After hospitalization, they undergo either out-patient or in-patient rehabilitation in order to best regain their functioning capacity.

Depending on the severity of the stroke, the rehabilitation process and other factors, a variety of benefits and support options are available to stroke victims in Israel. 

As part of our on-going collaboration with Kol-Zchut, we are proud to have translated and published this easy-to-read, critical and unique resource of information that was not previously available in English. You can either view the guide below or click here to follow an external link. 

 

Related information:

 

Not familiar with AACI’s Shira Pransky Project?

AACI’s Shira Pransky Project was founded to help English speakers in Israel better navigate the Israeli healthcare system and make use of the rights and services that are out there.

 

If this information was helpful to you, please enable us to help others by supporting the project:
Donate Now!

 

 

To your health ! לבריאות

Home Care from the Kupat Cholim

home_heart

About this Benefit

All of the kupot cholim (health plans) offer home care services to patients who can’t get all of the medical services they need due to difficulty leaving the home. A full range of medical services are provided with home visits from doctors, nurses, and social workers, as well as paramedical providers, like physiotherapists, occupational therapists, speech therapists, and others.

Who is Entitled

Home care services are intended for patients who are confined to their homes temporarily or permanently due to their medical/physical condition and are not able to receive services in the kupat cholim branches.  For Example: 

  • Patients with chronic illness
  • Patients returning home after hospitalization
  • Oncology patients
  • The elderly

How to Get it

Individuals may be referred to the Home Care Unit (יחידה לטיפול בית or יחידה להמשך טיפול)  by hospital staff, a family doctor, local social services or by contacting the unit directly. Contact information can be obtained from your local branch secretary or your kupat cholim’s information hotline.

Cancer patients may be entitled to additional home care through the Israel Cancer Association. Click here for more information.

Resources

 

If this information was helpful to you, please enable us to help others by supporting the project:
 www.shirapranskyproject.org/donate/ 

Info for Those Injured in an Automobile Accident

Automobile accidents can occur in an instant and can make life difficult both physically and emotionally, in addition to the financial costs. In order to ease your hardship and ensure your rights as a victim, it is necessary to take care of the more technical side of things. It is therefore recommended to refer to a lawyer that specializes in damages who can assist you.

Please note that a lawyer’s fee is paid as a percentage of the compensation and is usually paid by the insurance company as part of a legal settlement. A deeper familiarity with the subject will allow you to receive a higher compensation from the insurance company who is financially liable for the incident and will assist you through the rehabilitation process and dealing with the insurance company.

Payment for Evacuation from the Accident Site and Transportation to the Hospital

The health plan (kupat cholim) is responsible to pay the related bills for anyone evacuated from an accident who is hospitalized as a result, or for anyone that is not hospitalized, but was evacuated via an intensive care ambulance (Natan/Atan). You must go to a branch with hospital release papers and a report from Magen David Adom.

The liable insurance company pays when someone is evacuated to the emergency room in a regular ambulance but is not hospitalized in the end  (some companies pay directly to Magen David Adom and some reimburse the victim for expenses).

Assistance to Families of Automobile Accident Victims

The Ministry of Welfare (Misrad Harevacha) operates assistance centers for families affected by road accidents to assist  during the difficult period following the accident. More information (in Hebrew) and phone numbers for centers around the country are found on the program’s web page.

Medical Treatment after the Injury

In January of 2010, responsibility for treatment of those injured in an automobile accident was transferred to the Kupat Cholim. Accordingly, someone who is injured in an automobile accident is eligible to receive the medical treatment included in the healthcare basket (as detailed in the second addition to the National Health Insurance Law) paid for by the Kupat Cholim to which he/she belongs.

Someone who is injured in an automobile accident is eligible for exemption from payment of copayments for the medical treatment included in the healthcare basket, for treatment stemming from the accident, regardless of the date of the accident. See a health plan branch for details about receiving reimbursement for these payments.

The insurance company liable for the accident is responsible for payment of medical treatment that is not included in the healthcare basket (hospital nursing care, nursing assistance at home, purchasing of wheelchairs and appliances, dental treatments, etc.).

This information was translated and adapted from content provided by The Society for Patients’ Rights in Israel.

Rights of Patients After a Cardiac Event

After a heart attack or surgery, patients feel vulnerable and anxious and are sometimes afraid of losing their ability to function; they do not always know what action is required in their situation. To alleviate these problems, heart rehabilitation programs have been developed, which are designed for those who suffer from one of the following:

  • Patients who have had a heart attack
  • Patients who have undergone coronary artery bypass surgery
  • Patients with Class II-III heart failure and/or LVEF < 35% decrease in left ventricular functionality with intermediate severity and above
  • Patients who have undergone pacemaker/defibrillator implantation

Before Implantation or Open Heart Surgery

The Ministry of Health requires that before a transplant or open heart surgery, the patient must undergo a comprehensive dental examination and treatment of all of the infections found in the patient, as well as preventive action against infections in the patient.

Recovery and Rehabilitation in a Convalescent Home

Included in the health basket is eligibility for five days of recovery in a convalescent home that has an agreement with the kupat cholim, without any co-payment. In order to obtain the service contact a kupat cholim representative in the hospital before being released or in a kupat cholim branch within 24 hours of being released from the hospital and present a medical recommendation from a cardiologist. As part of a stay in the convalescent home, the patient is entitled to medical oversight, instruction and follow-up, nutritional lectures and supervised exercise.

Also note that every kupat cholim offers an extended stay in the convalescent home in their supplemental health services plan (Shaban). Contact a representative for the details of your plan.

Rehabilitative Exercise

Anyone is who is insured is eligible to receive rehabilitative exercise services for a period of 4 months, with a co-payment. The program includes supervised physical activity with monitoring and follow-up by a cardiologist, a Holter stress test, relaxation and anxiety reduction, plus lectures on proper nutrition and risk factors.

Also note that every kupat cholim offers  an extended program for an additional period in their supplemental health services plan (Shaban). Contact a representative for the details of your plan.

Heart Rate Monitoring/Follow-up

Included  in the health basket is eligibility for receiving a personal monitoring device (cardiobeeper)  for 6 weeks, allowing the E.K.G to be broadcast directly to the medical center which is manned at all times.

Also note that every kupat cholim offers an extension of the service for an additional period of approximately one year  in their supplemental health services plan (Shaban). Contact a representative for the details of your plan.

This information was translated and adapted from content provided by The Society for Patients’ Rights in Israel.