Non-Occupational Post-Exposure Prophylaxis To HIV

Abstract

Background: Non-occupational exposure to Human Immunodeficiency Virus (HIV) poses a significant risk in the transmission of the HIV from one person to the other and hence can contribute to the rise of new HIV infections in our communities. The use of PEP helps to reduce the rate of HIV transmission by 81%, which shows that the use of PEP is significant after an exposure. Therefore there is an importance in understanding the concept of non-occupational exposure and its treatment so as to reduce the number of new HIV infections countrywide. Aim: To determine the knowledge, attitude and practices of health care providers in providing PEP for non-occupational exposure to HIV in primary health care facilities. Methods: A cross-sectional study was conducted in Dar es Salaam region among randomly selected primary health care facilities from February to April 2014. Structured questionnaire was used to health care providers of different cadres at the health care facilities. Data analysis and management was done using SPSS program version 20.0. Descriptive analysis has been used to determine frequencies in socio-demographic characteristics. Univariate and Multivariate logistic regression analyses were used to determine factors associated with knowledge, attitude and practices on PEP among health care workers. Results: A total of 384 participants participated in the study with a response rate of 100%. Overall mean age of participants was 40 years. Among the participants females constituted 274(71.4%) and males 110(2.6%). Three hundred and forty four (89.6%) were married and 232(60.4%) had attained college education. One seventy six (45.8%) were nurses and 128(33.35%),the remaining percentage being other cadres. One hundred and four (27.1%) HCWs attended patients with non-occupational exposure to HIV with only 79/104(75.9%) providing PEP to patients who required it. Knowledge on non-occupational PEP was limited in several aspects. However most HCWs had a positive attitude towards treating non-occupationally exposed patients as an emergency and for referral for further management. In univariate analysis, Duty station (p=0.0001), cadre (p=0.0001) and working experience (p=0.000) were significantly associated with provision of PEP to patients. With regards to this 41.8% (33 HCWs) and 37.9%( 30 HCWs) among the 79 health care workers who provided PEP came from OPD department and CTC department respectively. Also among the 79, 13 nurses (16.5%) and 20 doctors (25.3%) provided PEP to clients whom they attended. Thirty- three Health care providers (41.8%) with more than 16 working years’ experience and 22(27.8%) with 11- 15 years of working experience provided PEP among the 79 health care workers who provided PEP. With multivariate analysis, cadre was shown to be significantly associated with provision of PEP to patients who have non-occupational exposure to HIV. Conclusion and Recommendations: HIV/AIDS being a disease of public health priority and as it may result into great morbidity and mortality; knowledge on PEP provision for HIV is crucial among health care providers. Clinical mentorship for HCWs and supportive supervision in health care facilities regularly is necessary in ensuring proper management is given to non-occupationally exposed patients.