Acquired Immune Deficiency Syndrome (AIDS) is one of the most serious public health problems costing the lives of many people, particularly in sub-Saharan Africa where even health care workers (HCWs) are at affected and at risk [
Occupational exposure to blood and body fluids is a serious concern for HCWs and presents a major risk for the transmission of infections such as Human immunodeficiency virus (HIV), Hepatitis B virus (HBV), and Hepatitis C virus (HCV) [
Although some studies reported favorable knowledge about PEP, there remains a knowledge gap among health care workers [
Currently, there is no data regarding PEP knowledge among HCWs in Harar, Eastern Ethiopia. Thus, this study was conducted to assess knowledge, attitude, and practice on occupational PEP to prevent HIV infection among health care workers of Hiwot Fana Specialized University Hospital (HFSUH), an eastern Ethiopia regional referral hospital.
A hospital based cross-sectional study was conducted from February to March 2016 including 311 health care workers of HFSUH. The hospital is one of the six governmental teaching hospitals in Ethiopia that provides health care service to greater than 300,000 inhabitants. The hospital has 402 healthcare workers. The participants in this study were permanent employees of HFSUH who were routinely involved health care delivery during the study period.
Data collection was conducted using a structured self-administered questionnaires prepared in English based on WHO postexposure prophylaxis guidelines and relevant published articles [
A convenience sampling technique was employed. Of the 342 eligible workers, 311 HCWs were included in the study.
Respondents who scored greater than or equal to 6 correct answers (75%) from 8 equitably scored knowledge questions were considered to have “adequate knowledge”. Similarly, respondents scored greater than or equal to 75% (6 out of 8 questions) of attitude questions were considered to have “positive attitude”. To determine the practice of respondents’, those answered greater than or equal to six out of eight questions (≥ 75%) were considered as practicing PEP for HIV. The practices were evaluated based on correct responses on practices stipulated by guidelines at the time.
Data was cleaned, coded, and entered into the STATA 12 software. The results were summarized in frequencies and percentages.
Ethical clearance to conduct this study was secured and obtained from the ethical review board of college of Health and Medical Sciences of Haramaya University. Participants provided an explanation of the study aims and were included in the study after they provided their written and oral consent to the study. The confidentiality of the study participants was maintained by assigning unique study identifiers during data collection and analysis.
A total of 311 HCWs were involved, of which 157 (50.5%) were males and 154 (49.5%) were females. Most of the respondents, 283 (91%), were in the age group of 20 to 30 years with a mean age of 26.2 years. The majority of the participants were nurses (76.1%), of whom 41.8% had less than one year of experience as shown in Table
Sociodemographic characteristics of HCWs at Hiwot Fana Specialized University Hospital, 2016.
Variables | N (%) |
---|---|
| |
20-30 year | 283 (91.0) |
31-40 year | 26 (8.4) |
41-50 year | 1 (0.3) |
>50 | 1 (0.3) |
| |
Male | 157 (50.5) |
Female | 154 (49.5) |
| |
Married | 85 (27.3) |
Single | 223 (71.7) |
Divorced | 3 (1) |
| |
Doctor | 20 (6.4) |
Medical Laboratory | 22 (7.1) |
Nurse | 246 (76.1) |
Health officers | 3 (1) |
Midwives | 20 (6.4) |
| |
Diploma | 9 (2.9) |
First degree | 282 (90.7) |
MD | 16 (5.1) |
MSC or Specialist | 4 (1.3) |
| |
<1 | 146 (47) |
1-3 | 116 (37.3) |
4-5 | 32 (10.3) |
>5 | 17 (5.5) |
In the current study, 258 (83%) of the participants had good knowledge about PEP for HIV. Although the entire respondents heard about PEP for HIV infection, only 37 (22.42) workers knew the meaning of PEP. The main source of the information was formal training, 127 (40.8%). The majority of the study participants knew the preferred time to initiate PEP, 272 (87.5%), and the maximum acceptable delay prior to initiating PEP for HIV, 266 (85.5%). As shown in Table
Knowledge about PEP for HIV among healthcare workers in Hiwot Fana Specialized University Hospital, 2016.
| N (%) |
---|---|
| |
Yes | 311 (100.0) |
No | 0 |
| |
| |
Yes | 37 (22.4) |
No | 128 (77.6) |
| |
| |
Yes | 311 (100.0) |
No | 0 |
| |
| |
When the source patient is at high risk for HIV | 94 (30.2) |
When the source patient is known to be HIV positive | 161 (51.8) |
When the HIV status of the source is unknown | 36 (11.6) |
For any needle stick injury in the work place | 20 (6.4) |
| |
| |
12 hours | 10 (3.2) |
24 hours | 19 (6.1) |
48 hours | 16 (5.1) |
72 hours | 266 (85.5) |
| |
| |
Within an hour | 272 (87.5) |
After 6hours | 20 (6.4) |
After 12hours | 10 (3.2) |
After 72hour | 9 (2.9) |
| |
| |
For 28 days | 284 (91.3) |
For 40 days | 20 (6.4) |
For six months | 5 (1.6) |
For life time | 2 (0.6) |
| |
| |
Yes | 198 (63.7) |
No | 113 (36.3) |
Greater than half, 176 (56.6%), of the study participants had a positive attitude about PEP. The majority of the respondents, 288 (92.6%) and 250 (80.4%), agreed on the benefit of PEP and availability of PEP guidelines in their work place, respectively. The majority of individuals (72.0%) strongly believed that PEP can reduce the likelihood of acquiring HIV after being exposed and 51.8% of the respondents agreed that PEP prevents further infection. However, only 118 (37.9) of the participants believed that PEP should be indicated for any type of sharp object injuries. As indicated in Table
Attitude of HCWs about PEP at Hiwot Fana Specialized University Hospital, 2016.
| N (%) |
---|---|
| |
Yes | 288 (92.6) |
No | 10 (3.2) |
I am not sure | 13 (4.2) |
| |
| |
Yes | 223 (71.7) |
No | 32 (10.3) |
Neutral | 56 (18.0) |
| |
| |
Agree | 250 (80.4) |
Disagree | 61 (19.6) |
| |
| |
Agree | 224 (72.0) |
Disagree | 22 (7.1) |
| |
| |
Agree | 161 (51.8) |
Disagree | 150 (48.2) |
| |
| |
Agree | 118 (37.9) |
Disagree | 99 (31.8) |
I am not sure | 94 (30.2) |
| |
| |
Agree | 155 (49.8) |
Disagree | 77 (24.8) |
I am not sure | 79 (25.4) |
| |
| |
Agree | 219 (70.4) |
Disagree | 23 (7.4) |
I am not sure | 69 (22.2) |
One in four workers (24.8%) does not agree that PEP is important if the exposure is not with patient blood of known HIV positive.
Of the 53 (17.0%) individuals who had exposures for HIV risky conditions, 42 reported their exposure to program runner and 38 (71.7%) took PEP. However, 15 (28.3%) of the exposed respondents did not take PEP. Among the individuals who took PEP, 21/38 (55.3%) were exposed to blood from patients with known HIV infection, whereas the remaining 15/38 (39.5%) were exposed to blood from source patients of unknown HIV status.
Among all the respondents who took PEP, two individuals initiated outside of the ideal time-frame (after 72 hours). Ten (26.3%) individuals started within an hour of exposure. Of the 38 respondents who took PEP, 26 (68.4%) had completed taking PEP correctly, but the rest 12 of the individuals failed to complete PEP. The main reason for the discontinuation of PEP was found to be fear of the adverse effects (7 individuals) and doubt of its efficacy (4 individuals) as shown in Table
Practice of PEP for HIV among HCW in Hiwot Fana Specialized University Hospital, 2016.
| N (%) |
---|---|
| |
Yes | 53 (17.0) |
No | 258 (83) |
| |
| |
Yes | 42 (79.3) |
No | 11 (20.8) |
| |
| |
Supportive and maintained confidentiality | 33 (78.6) |
Confidentiality was not maintained | 6 (14.3) |
Did not show concern about my accidental exposure | 3 (7.1) |
| |
| |
Received | 38 (71.7) |
Not received | 15(28.30) |
| |
| |
Exposure to blood from known HIV positive patients | 21 (55.3) |
Exposure to blood from patient whose HIV status is unknown | 15 (39.5) |
Injury from any sharp object | 2 (5.3) |
| |
| |
Within 1 hour | 10 (26.3) |
After 2-6 hours | 16 (42.1) |
After 6-10 hours | 10 (26.3) |
After 72 hour | 2 (5.3) |
| |
| |
For 3 days | 5 (13.2) |
For 15 days | 7 (18.4) |
For 28 days | 26 (68.4) |
| |
| |
Yes | 26 (68.4) |
No | 12 (31.6) |
| |
| |
Fear of adverse effects | 7 (58.3) |
Assuming that it was enough | 1 (8.3) |
Assuming that the drug was not effective | 4 (33.3) |
Adherence to the universal precaution guidelines is fundamental for the prevention of accidental acquisition of HIV infection in healthcare settings. Furthermore, the appropriate management of exposed individuals plays a crucial role in control and prevention of the infection [
We found that, only 17% of the HCWs had poor knowledge of PEP for HIV. This is lower than similar studies from Gondar University Hospital (36.9%) [
In the current study, all the participants had heard about PEP for HIV, 40.48% via training. This level of awareness among our study participants was higher than similar studies from Gondar University Hospital (92.8%) [
Data from animal studies suggest that the efficacy of postexposure prophylaxis in preventing transmission is time dependent [
The majority of our study participants had a positive attitude towards PEP. A study conducted at the Gondar University Hospital [
Of the 311 study subjects, 53 (17.2%) of the participants have been exposed to HIV risky conditions. This finding is less than the result found in the research done in the Jimma zone on government HCWs (68.50%) [
Among 38 HCWs on ART for PEP, 21 (55.3%) of them exposed to blood of known HIV positive patients, which is comparable to study from the Gondar University Hospital (57.1%) [
The expected limitations to this study are unwilling of HCWs in the hospital to participate in the study and the absence of HCWs at the time of data collection. Our statistical analysis was descriptive and we are unable to determine association of independent variables with the outcome. The convenience sampling technique was also the major limitation of the present study.
Most of HCWs have good knowledge about occupational risk of HIV/AIDS exposure and had a good attitude towards occupational risk of HIV infection. The findings of this study revealed the attitude and practice of HCWs towards PEP for HIV is inadequate. A significant proportion of HCWs have had exposure that would warrant the use of PEP. This compounded by low PEP completion rates shows that the practice of PEP for HIV in this study area needs improvement.
The data used to support the findings of this study are available from the corresponding author upon request.
The authors declare that they have no conflicts of interest.