BET 2: HYDROXYCHLOROQUINE IN THE TREATMENT OF COVID-19

A short-cut review of the literature was carried out to examine whether the use of hydroxychloroquine is effective in the treatment of patients presenting with confirmed COVID-19. Nine papers were identified as relevant using the reported search strategy. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of the best papers are tabulated. It is concluded that hydroxychloroquine has not been proven to be an effective treatment for COVID-19.

BET 1: LOPINAVIR-RITONAVIR AND COVID-19

A short-cut review of the literature was carried out to examine whether the use of lopinavir-ritonavir leads to improved outcomes in patients admitted to hospital with COVID-19. Five papers were identified as clinically useful using the reported search strategy. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of the best papers are tabulated. It is concluded that there is no current evidence to support the use of lopinavir-ritonavir in COVID-19 to improve clinical outcomes.

PEP in the city - A new way of delivering post-exposure prophylaxis from the Emergency Department

Introduction: We present our contingency plan for the management of patients presenting to our Emergency Department (ED) requiring HIV (Human Immunodeficiency Virus) Post-Exposure Prophylaxis (PEP) during the COVID-19 pandemic. Method: The pre-COVID pathway relied on patients who needed PEP being dispensed a 5 day supply of PEP. A generic leaflet was included in each PEP pack. This contained a large amount of medical jargon and no contact details for local services. A handwritten fax referral was sent to Genitourinary Medicine (GUM) who would recall the patient for face to face (F2F) review in order to obtain baseline screening and supply an additional 23 days of medication. F2F follow up testing was arranged at 2 weeks and 8-12 weeks post-PEP. Results: An electronic PEP referral was introduced and the ED Clinical Decision Support Guideline (CDGS) was redesigned. Pharmacy was able to supply 28 days of PEP meaning that if a patient was required to self-isolate, they would have an adequate supply of treatment at home. The patient information leaflet was rewritten using simple terminology and details of local GUM services were included. Baseline bloods were taken within ED removing the need for F2F appointments. Upon receipt of the PEP referral, a Health Advisor would call the patient and arrange for confirmatory home testing kits to be sent at the required window period. Patients attending ED who were non-Manchester residents were eligible for the same service thus reducing unnecessary F2F contact at other clinics. 16 patients were successfully referred from ED to GUM between May/June 2020. Discussion: Our new pathway has helped us to substantially mitigate risk for patients requiring PEP via the ED. Following the success of this collaborative project, we have decided to adopt this pathway permanently as we predict demand for PEP will increase as the UK begins to ease lockdown restrictions.