https://orcid.org/0000-0001-9504-4679
Abstract
Introduction
In high-HIV burden settings, such as Nigeria, HIV self-testing and post-exposure prophylaxis (PEP) are often recommended, but not widely practiced. This study aims to identify the predictors of PEP utilization and preferences for HIV self-testing among healthcare workers in Nigeria.
Methods
A total of 403 healthcare workers from a tertiary hospital in Nigeria completed questionnaires. Adjusted odds ratios were derived from logistic regression models.
Results
Among the respondents, 141 (35.0%) reported experiencing at least one workplace exposure incident, with 72 (51.1%) of them receiving PEP. The majority of healthcare workers (n = 354, 87.8%) expressed a preference for HIV self-testing over traditional HIV testing and counseling. The occurrence of exposure incidents was predicted by the respondent’s sex (adjusted odds ratio [aOR] = 1.25; 95% confidence interval [CI]: 1.15-3.08, female vs. male), age (aOR = 0. 16; 95% CI: 0.03-0.92, >40 vs. <30 years), profession (aOR = 1.88; 95% CI: 1.18-4.66, nurse/midwife vs. physician), work unit (aOR = 0.06; 95% CI: 0.02-0.23, obstetrics/gynecology vs. surgery), and previous HIV testing and counseling (aOR = 0.01; 95% Cl: 0.004-0.03, no vs. yes). Respondent’s profession, work unit, and previous HIV testing and counseling independently predicted a preference for HIV self-testing.
Conclusion
Further exploration of the feasibility of implementing HIV self-testing as an alternative to traditional HIV testing and counseling for workplace exposures is warranted.
Background
West and Central Africa have a high incidence of new HIV infections (16%) despite a relatively low HIV prevalence (1.9%).Citation1 In addition, a significant proportion (48%) of individuals living with HIV in this area are unaware of their status.Citation2 This situation puts healthcare workers at an elevated risk of acquiring HIV in their workplace.Citation1 A recent 12-year retrospective review conducted in a tertiary hospital in northern Nigeria highlighted a concerning number of needlestick injuries (74.8%), with approximately half of the source patients (46.1%) testing positive for HIV.Citation3 To mitigate the risk of HIV transmission after an exposure, post-exposure prophylaxis (PEP) is recommended. PEP involves a comprehensive set of services, including first aid, counseling, risk assessment, relevant laboratory investigations (with the consent of both the exposed individual and the source), provision of a 28-day course of antiretroviral therapy, and monitoring.Citation4 Although the efficacy of PEP is difficult to quantify, evidence suggests an 81% reduction in HIV transmission odds among HCWs who received zidovudine as PEP if initiated promptly after exposure.Citation5,Citation6 Additionally, a meta-analysis of animal studies in 2015 demonstrated an 89% lower risk of HIV infection in animals receiving PEP compared to controls.Citation7
Sub-Saharan Africa faces additional challenges as it relates to the risk of HIV exposure. These challenges include limited human resources, inadequate adherence to universal precautions, overcrowding, a lack of basic safety equipment, low perception of risk, and the reuse of contaminated instruments.Citation8 Moreover, the availability and utilization of personal protective equipment, safety devices, effective post-exposure management, injury surveillance, and relevant legislation are often insufficient in these settings.Citation7 Another obstacle to post-exposure management is the reluctance of healthcare workers to undergo HIV testing and counseling.Citation9,Citation10 This reluctance stems from various reasons, such as anxiety surrounding HIV testing, misconceptions about the low risk of needlestick injuries, concerns about confidentiality breaches, and stigma from colleagues who may wrongly assume that they are HIV positive.Citation9,Citation10
To address these challenges, HIV self-testing has emerged as a potential alternative to traditional HIV testing and counseling.Citation9 While HIV self-testing still requires confirmatory testing, it offers the convenience of testing at the point-of-care, allowing individuals to establish their baseline HIV status and monitor the effectiveness of PEP. In certain settings, HIV self-testing has shown promising results, doubling the uptake and frequency of HIV testing, while posing minimal risk.Citation9 By increasing accessibility and empowering individuals to take control of their own testing, HIV self-testing has the potential to improve early detection, linkage to care, and overall HIV management. There are, however, drawbacks associated with HIV self-testing, including the risk of self-harm and partner violence.Citation11 This study determined healthcare workers’ exposure to blood and body fluids, knowledge of PEP, post-exposure management, and HIV testing preferences in a tertiary center in northern Nigeria.
Methods and materials
Study area and population
The study was conducted at Aminu Kano Teaching Hospital (AKTH) in Kano, Nigeria from 1st to 14th of December 2021. AKTH is a large tertiary hospital with 750 beds, catering to the healthcare needs of over 13 million people in northern Nigeria. The hospital employs a total of 2188 healthcare workers and offers a wide range of services, including outpatient consultations, inpatient care, and specialized HIV treatment, care, and support. The study population consisted of healthcare workers from various professional backgrounds, including physicians, nurses/midwives, and laboratory scientists.
Study design, sample size, and sampling
This study was a retrospective survey of healthcare workers’ exposure to blood and body fluids over their entire work experience. The sample size was determined using Fisher’s formula, which is commonly used for estimating proportions in health studies.Citation12 The calculation considered several factors: a 95% confidence level, a prevalence rate derived from a previous study (56.5%),Citation13 and a tolerable margin of error of 5%. Based on these parameters, the minimum required sample size was computed to be 378 participants. To account for potential non-response, the sample size was increased by 10%, resulting in a final sample size of 420 participants.
Participant recruitment and sampling
We employed a two-stage sampling method. In the first stage, we stratified healthcare workers based on their professional category, which included physicians, nurses/midwives, and laboratory scientists. We allocated sample sizes to each category in proportion to their respective sub-populations. In the next stage, we used systematic sampling to select respondents from each professional category. To identify the first respondent within each group, we utilized a simple ballot system, where a number between 1 and the sampling interval for that specific category was drawn. Subsequent participants were chosen based on their serial numbers, which equaled the sum of the previous respondent’s serial number and the sampling interval. Healthcare workers were enrolled in the study after providing informed consent.
Data collection and measures
Data were collected using a structured self-administered questionnaire, which was adapted from previous studies.Citation14,Citation15 The questionnaire consisted of four sections. The first section comprised nine items that gathered sociodemographic information. The second section, consisting of 16 items, assessed the prevalence of accidental exposure to blood and other body fluids. It inquired about past occurrences of accidental exposure, including the frequency of exposure within the previous year, circumstances surrounding the exposure, and the actions taken following the most recent exposure. Additionally, information was collected regarding HIV screening of the source patient and the respondent, utilization of PEP, the interval between exposure and commencement of PEP, and completion of the prescribed regimen. The third section, consisting of 25 items, focused on determining the participants’ knowledge of PEP. It explored whether they had heard about PEP, identified their sources of knowledge, assessed if they had received training on PEP, and evaluated their understanding of various aspects, such as what to do in case of exposure, indications for PEP, and different PEP regimens for HIV. The final section, comprising 11 items, aimed to assess the respondents’ awareness of HIV self-testing. It also inquired about their previous experiences with HIV testing and counseling (HTC), their preferences between HTC and HIV self-testing, their willingness to undergo testing at home or in a clinic, and their readiness to self-test with a partner.
The questionnaire underwent a pre-testing phase on 40 healthcare workers at Abdullahi Wase Specialist Hospital in Kano, Nigeria, to ensure clarity and cultural sensitivity. Content validity was evaluated by infectious disease specialists and community physicians affiliated with Bayero University, Nigeria. Reliability estimates were obtained using Cronbach’s alpha values. The sections on exposure to BBF, knowledge of PEP, and HIV testing preferences showed high levels of reliability, with Cronbach’s alpha values of 0.86, 0.84, and 0.87, respectively.
The study had three main outcomes: (1) accidental workplace exposure to blood or body fluids, (2) knowledge of post-exposure prophylaxis (PEP), and (3) preference between HTC and HIV self-testing. Accidental exposure was defined as contact with blood or body fluids through specific routes such as eyes, mouth, mucous membranes, non-intact skin, or injection.Citation16 Knowledge questions were answered with options ‘Yes,’ ‘No,’ or ‘Don’t know,’ with correct responses scoring 1 and incorrect or ‘don’t know’ responses scoring 0. Total knowledge scores were categorized as inadequate (0–12) or adequate (13–25). The explanatory variables for the three main outcomes in multivariate models included socio-demographic factors (sex, ethnicity, religion, and residence), profession, years of experience, work unit, previous HIV testing, and PEP training.
Procedures
The Ethics Committee of Aminu Kano Teaching Hospital, Nigeria, approved the study protocol. Prospective participants were informed about the study during departmental and hospital clinical meetings. Trained research staff individually contacted healthcare workers whose serial numbers were selected through the sampling process. These workers were provided with information about the study’s objectives, inclusion criteria, sampling process, and participation requirements. They were assured of confidentiality and informed that participation was voluntary.
Signed informed consent was obtained from healthcare workers who agreed to participate, and they were given a paper questionnaire in an envelope. The research staff later collected the completed questionnaires at an agreed time. To ensure data accuracy, the completed questionnaires were checked and independently entered by two data clerks into a password-protected database in the Department of Community Medicine, Bayero University, Kano, Nigeria. Measures were implemented to protect privacy and confidentiality. The research staff received training on protecting the rights of human research participants, and no personal identifiers were collected.
Statistical analysis
Data were coded, sorted, and processed using SPSS Statistics for Windows (version 22, IBM Corp., Armonk, NY). After data cleaning, continuous data were summarized using means with standard deviation or median with range. Categorical data were presented as frequencies and percentages. Pearson’s chi-square or Fisher’s exact test was used for bivariate associations (p < 0.05 considered statistically significant). Fisher’s exact test was used for 2 × 2 tables with expected frequencies <5 in over 20% of cells.Citation17 Variables with p < 0.10 in bivariate analysis were included in multivariate logistic regression models.Citation18 Adjusted odds ratios (OR) and 95% confidence intervals (CI) were computed using a stepwise approach for each of the three main outcomes (‘accidental workplace exposure to blood or body fluids,’ ‘knowledge of PEP,’ and ‘preference between HTC and HIV self-testing’). Model fitness was assessed using Hosmer-Lemeshow statistic and Omnibus tests, with p > 0.05 considered a good fit.Citation19
Results
Out of 420 approached healthcare workers, 403 (96.0%) completed the questionnaires. The respondents included 183 physicians, 152 nurses/midwives, and 68 laboratory scientists. The mean age of the respondents was 37.3 ± 8.20 years. Most of the respondents were men (64.0%), of Hausa/Fulani ethnicity (75.9%), Muslim (87.8%), and ever married (84.4%). In total, 230 healthcare workers (57.1%) had received previous PEP training ().
Table 1. Characteristics of healthcare workers, Aminu Kano Teaching Hospital, Kano, Nigeria.
The majority of respondents (93.3%, n = 376) expressed a perceived risk of HIV infection in the workplace, and 141 (35.0%) reported at least one instance of exposure to blood or body fluids over their entire work experience. Needlesticks (53.9%, n = 76) and splashes on mucosal surfaces (43.2%, n = 61) were the most common modes of exposure. Blood sample collection (41.8%, n = 59) and surgical procedures (19.1%, n = 27) were the primary circumstances of exposure. Only 47.5% of those exposed reported the incidents to a supervisor or designated officer. Among the 141 participants exposed, less than half (47.5%, n = 67) underwent HIV testing post-exposure (). Among those who were not tested (n = 74), the majority (83.8%, n = 62) assumed that the source patient was HIV-negative. Out of the 141 participants exposed, 72 (51.1%) received PEP. The main reasons for non-receipt of PEP were the HIV-negative status of the source patient (47.8%, n = 33) and unfamiliarity with the hospital protocol (42.0%, n = 29). Among those who received PEP, the majority (95.8%, n = 69) initiated it after 24 h of exposure, and only half (50.7%, n = 37) completed the full 28-day course.
Table 2. Knowledge of post-exposure prophylaxis and response to accidental exposure to blood or body fluids among HCWs, Kano, Nigeria (N = 403, unless stated otherwise).
Nearly all the respondents (97.0%) were aware of PEP, and 187 (78.7%) correctly defined PEP. Based on knowledge scores, 49.1% of the respondents (n = 198) had adequate knowledge of PEP. Specifically, only 7.0% of the healthcare workers correctly identified the proportion of needlestick injuries that could lead to HIV transmission (<1%). They correctly recognized blood (80.7%), peritoneal fluid (54.6%), and cerebrospinal fluid (51.6%) as high-risk fluids for HIV transmission, while a significant number erroneously considered saliva (45.9%) and urine (21.3%) as high-risk fluids.
The majority of respondents correctly recognized needlestick injury (95.0%, n = 383), HIV-exposed infants (94.0%, n = 379), rape (90.8%, n = 366), and blood or body fluid splash on mucosal surfaces (85.9%, n = 346) as indications for PEP. A smaller proportion (27.3%, n = 110) mentioned a source patient with unknown HIV status as an indication. In terms of the PEP drug regimen, more than half of the respondents (56.1%, n = 226) mentioned the expanded 3-drug regimen. Specific drugs used in PEP were accurately identified by the respondents, including zidovudine (63.8%), nevirapine (60.8%), and lamivudine (30.5%). Approximately one-third (35.0%, n = 141) of the healthcare workers correctly reported the duration of PEP as 4 weeks.
Approximately half of the healthcare workers (51.5%, n = 221) reported previous HIV testing and counseling (HTC). Among those who had not been tested, the majority assumed they did not have HIV (49.2%, n = 91) or cited a lack of opportunity for testing (32.4%, n = 60). Two-thirds of the respondents (67.0%, n = 278) were familiar with HIV self-testing, with all of them having heard of using blood samples from a finger prick and only a small fraction (3.6%) aware of using oral fluid/saliva. The majority of healthcare workers (87.8%, n = 354) preferred HIV self-testing over HTC for future tests, citing privacy (64.1%, n = 227) and elimination of waiting time (22.3%, n = 79) as the main advantages. Almost all respondents (97.3%, n = 392) expressed their desire to receive training for self-testing ().
Figure 1. Preference for HIV self-testing (HIVST) vs. HIV testing and counseling (HTC) among healthcare workers in northern Nigeria.
At the bivariate level, workplace exposure to blood or body fluids was associated with sex, age group, marital status, profession, years of experience, work unit, and previous HTC (). In the multivariate analysis, sex, age group, profession, work unit, and previous HTC remained independent predictors of exposure. Female healthcare workers had a 25% increased odds of accidental exposure compared to males (adjusted Odds Ratio, aOR = 1.25, 95% confidence interval, CI: 1.15–3.08). Older respondents (≥40 years) had an 84% lower likelihood of exposure compared to younger healthcare workers (<30 years) (aOR = 0.16, 95%CI: 0.027–0.92). Nurses/midwives had an 88% increased risk of workplace exposure compared to physicians (aOR = 1.88, 95%CI: 1.18–4.66). Healthcare workers who had been previously tested had a 99% increased likelihood of reporting accidental exposure to blood and body fluids compared to those who had not undergone HTC (aOR = 0.01, 95%CI: 0.00–0.023, ).
Table 3. Accidental exposure to blood and body fluids, knowledge of PEP, and preference for HIV self-testing by respondent characteristics, Kano, Nigeria (N = 403).
Table 4. Logistic regression model for predictors of occupational exposure, knowledge of PEP and acceptability of HIV selftesting among healthcare workers, Kano, Nigeria (n = 403).
Sex, profession, and previous PEP training independently predicted adequate knowledge of PEP (). Female healthcare workers were 98% more likely to have adequate knowledge of PEP compared to males (aOR = 1.98, 95%CI: 1.20–4.08). Laboratory scientists had over six-fold increased odds of having adequate knowledge of PEP compared to physicians (aOR = 6.79, 95%CI: 1.26–26.15). Healthcare workers with previous PEP training had two-fold increased odds of having adequate knowledge of PEP (aOR = 2.00, 95%CI: 1.34–2.99).
Preference for HIV self-testing was independently predicted by profession, work unit, and previous HTC. Nurses/midwives had a 29% increased likelihood of preferring HIV self-testing compared to physicians (aOR = 1.29, 95%CI: 1.14–3.95). In contrast, laboratory scientists were 85% less likely to prefer HIV self-testing than physicians (aOR = 0.15, 95%CI: 0.03–0.84). Healthcare workers in medical, pediatric, and obstetrics and gynecology units were 58–75% less likely to prefer HIV self-testing compared to those in surgical units. Additionally, workers without prior HTC had a two-fold increased odds of preferring self-testing compared to those who had previously been tested for HIV (aOR = 2.08, 95%CI: 1.16–6.70) ().
Discussion
Healthcare workers are at risk of acquiring HIV and other bloodborne pathogens through exposure to BBF.Citation20 It is therefore important to regularly assess their exposure, knowledge, and post-exposure management to minimize this risk and improve PEP uptake. Our findings revealed that over one-third of healthcare workers had experienced exposure incidents, with inadequate knowledge reported by half of them. In addition, less than half underwent HTC post-exposure, and only half received PEP. Interestingly, a significant number of healthcare workers expressed a preference for HIV self-testing, and this preference was predicted by their profession, work unit, and previous receipt of HTC services.
The prevalence of occupational exposure to BBF (35.0%) was higher than the figures reported from some Nigerian institutions (5.2–33.3%),Citation21–24 but lower than others (46.3–69.4%).Citation25–30 In sub-Saharan Africa, our figure was lower than the pooled annual prevalence in 21 countries (46.6%).Citation31 Specifically, it was similar to the figures from Ethiopia (33.2–33.8%),Citation32,Citation33 but lower than those reported from Cameroon (50.9–67.5%),Citation4 Ghana (83.2%),Citation34 and Tanzania (48.6–57%).Citation35–37 Further, our numbers were higher than reports from Mali (12.1%)Citation38 and South Africa (10.6%).Citation39 The main circumstances of the exposure and types of exposure were similar to those in other NigerianCitation13,Citation20 and African health facilities.Citation38 For needlestick injuries, our prevalence (53.9%) was within the reported lifetime prevalence in Africa (22–95%).Citation40
The proportion of healthcare workers reporting exposure incidents (47.5%) exceeded rates in other Nigerian centers (20%),Citation41 Cameroon (0%),Citation42 and Tanzania (32.1%).Citation35 This may be due to inadequate knowledge, unfamiliarity with post-exposure protocols, and concerns about HIV status disclosure and stigma in our center and elsewhere in sub-Saharan Africa.Citation40 The proportion of healthcare workers perceiving a risk of HIV infection at work (93.3%) aligned with some Nigerian centers (91.3–96.2%),Citation27,Citation43 but surpassed reports from other centers in Nigeria (67.6–80.8%),Citation13,Citation44 and sub-Saharan Africa (85.0–96.8%).Citation4,Citation15 Variations in risk perception may stem from HIV prevalence and knowledge of transmission risks. Accurate risk perception is crucial for adherence to precautions and post-exposure behavior, including PEP uptake. A significant proportion of healthcare workers (87.8%) also lacked awareness of seroconversion risk from BBF exposure, higher than reports from Ghana (65.9%).Citation34 Addressing this knowledge gap should be prioritized in future training programs.
PEP awareness in our sample was high (97%), and similar to Nigerian hospitals (96–98.5%),Citation19,Citation21,Citation24,Citation28 but higher than others (60.3–87%).Citation22,Citation23,Citation26,Citation30 Knowledge of the correct definition of PEP was also high (78.7%), comparable to Lagos, Nigeria (83.3%),Citation25 but greater than figures from Ethiopia (22.4%).Citation45 Approximately half of our respondents (49.1%) had adequate PEP knowledge, higher than some Nigerian centers (39.7–46.5%),Citation24,Citation29 but lower than others (60–68.5%).Citation22,Citation23,Citation30 The awareness of high-risk body fluids also surpassed figures from other Nigerian and African studies,Citation21,Citation22,Citation35 possibly due to efforts in eliminating mother-to-child transmission in the region. However, misconceptions about saliva (45.9%) and urine (21.3%) as high-risk fluids were reported in other Nigerian hospitals.Citation20,Citation25
Only 37.2% of respondents knew whom to contact after exposure, lower than in other African countries (65.4–79.3).Citation35,Citation45 Knowledge of PEP indications was similar to other Nigerian hospitals.Citation21,Citation26,Citation27 Differences may be attributed to training, staff orientation, and implementation of infection prevention policies. Capacity building within HIV programs could impact healthcare workers’ knowledge and practice environment in this and other Nigerian centers.
The proportion of healthcare workers with correct knowledge of the recommended interval for initiating PEP (51.6%) was similar to some Nigerian health centers (54%),Citation26 but lower than others (78.8%).Citation22 Knowledge of the 3-drug regimen (56.1%) was higher than in other Nigerian (30.9%)Citation21 and African centers (25.1–30%).Citation15,Citation45 Awareness of the duration of PEP (35.0%) was consistent with Abuja, Nigeria (30.9%)Citation21 and other parts of Africa (25.0–38.9%).Citation15,Citation45 This finding may reflect familiarity with hospital infection prevention protocols, as indicated by the proportion of healthcare workers who received prior PEP training (57.1%). In contrast to Asia, where self-learning and internet sources were prominent, respondents in Nigeria cited workshops, seminars, and lectures as their primary sources of knowledge.Citation21,Citation26 Variances in continuing professional education, pedagogy, and internet access may contribute to these differences.
The proportion of eligible respondents who received PEP (51.1%) was higher than in other Nigerian centers (21.6–36%).Citation20,Citation27,Citation30 In sub-Saharan Africa, our figure was higher than Cameroon (19.1%)Citation4 and Tanzania (22.5–39.0%),Citation36,Citation46 but lower than Ethiopia (71.7–74.2%)Citation4,Citation45,Citation47 and Botswana (74.8%).Citation48 PEP initiation within 24–72 h was prevalent in our sample (97.2%), compared to Ethiopia’s 94.7% within 10 h.Citation45 Prophylaxis completion in our sample (50.7%) was also higher than in Abuja, Nigeria (23.1%),Citation20 but lower than Ethiopia (44.8–79.6%)Citation4,Citation45 and Botswana (73.4%).Citation48 Reasons for not taking PEP (lack of awareness, ignorance of hospital procedures, belief in the source patient being HIV negative), along with concerns about stigma and side effects of ARV, have been mentioned in Nigerian studies.Citation21,Citation30 These reasons may stem from limited knowledge, lack of familiarity with institutional policies and procedures, and anxiety about HIV testing.
The uptake of HTC among healthcare workers in our sample (54.8%) was similar to some Nigerian studies (52.9–56.5%),Citation13,Citation24 but lower than others (74.0%).Citation25 Higher numbers have been reported from other institutions in Africa (75.2–94.4%).Citation36 Differences in HIV risk perception and access to counseling and testing services may contribute to these disparities. The preference for HIV self-testing (87.8%) aligns with data from other parts of Africa (80%).Citation49 Specifically, in Ethiopia and Kenya, 69.4% and 85% of HCWs self-tested for HIV, respectively.Citation10,Citation49 In the latter study, 86% of their partners also self-tested. The reasons for preferring HIV self-testing, including convenience, confidentiality, and promptness, are consistent with other studies.Citation9,Citation49 As over half (52.5%) of the healthcare workers in our sample remained untested for HIV after exposure, the high preference for HIV self-testing presents an opportunity to consider it as an alternative to HTC in order to improve PEP uptake.
Similar findings of increased likelihood of exposure to blood and body fluids among females have been reported in Ethiopia.Citation50 This observation may be attributed to sex disparities in specialty, workload variations, and differential exposure risks across work units.Citation50 For instance, occupations such as obstetrics, pediatric specialties, and nursing/midwifery are predominantly female. Similarly, in some healthcare settings, certain tasks that involve handling sharp instruments or needles are traditionally assigned more often to female healthcare workers. For example, duties like administering injections or conducting venipuncture may be more commonly assigned to female nurses or healthcare providers, which can increase their risk of needlestick injuries.Citation50 Conversely, the decreased risk of exposure among older workers, as reported in Ibadan, Nigeria,Citation24 could be attributed to their experience and maturity. Older workers might be more cautious and more likely to adhere to protective measures.
The positive disposition of nurses/midwives towards self-testing relative to physicians could be due to heightened risk perception, particularly in resource-constrained settings with staffing shortages. In such settings, nurses/midwives often administer parenteral drugs, including blood transfusions.Citation10,Citation24 On the other hand, laboratory scientists’ preference for traditional HIV testing and counseling could be attributed to their capacity to confidentially test their own samples using more sensitive methods.Citation51 The higher risk of exposure among healthcare workers in surgical units might motivate their preference for self-testing, as it enables them to periodically check their HIV status and take necessary precautions. Prospective documentation of exposures, test results, and treatment outcomes among employees should be incorporated into institutional BBF exposure prevention policies.
Limitations
This study has limitations. First, it was conducted in a single tertiary health center, so generalizations should be made with caution. Second, reliance on self-recall for reporting occupational exposure and PEP uptake may introduce recall bias. Third, responses regarding post-exposure response and management could be influenced by social desirability bias. Finally, the study focused on physicians, nurses/midwives, and laboratory scientists, limiting the generalizability of the findings. Nevertheless, our findings serve as a baseline for informing training and interventions to promote a safe work environment.
Conclusion
In summary, we found that one in three healthcare workers experienced exposure to blood or body fluids in the workplace. Factors such as sex, age, profession, work unit, and previous HIV testing were associated with the likelihood of exposure. There were low rates of HIV testing, insufficient knowledge about PEP, and low uptake of PEP. Most respondents preferred HIV self-testing over conventional testing, and this preference was influenced by profession, work unit, and previous HIV testing. To address these issues, training, improved workplace safety, and adherence to universal precautions and post-exposure protocols are needed. Future studies should explore the feasibility of HIV self-testing as an alternative to conventional testing.
Acknowledgment
We acknowledge the assistance of management of the Aminu Kano Teaching Hospital, Nigeria.
Disclosure statement
No potential conflict of interest was reported by the author(s).
Additional information
Funding
References
- Joint United Nations Program on HIV/AIDS (UNAIDS). West and Central Africa. http://www.unaids.prg/en/regionscountries/westandcentralafrica Last Accessed May 21, 2022.
- Ekouevi DK, Bitty-Anderson AM, Gbeasor-Komlanvi FA, Coffie AP, Eholie SP. HIV self-testing: The key to unlock the first 90 in West and Central Africa. Int J Infect Dis. 2020;95:162–166.
- Abubakar S, Iliyasu G, Dayyab FM, et al. Post-exposure prophylaxis following occupational exposure to HIV and hepatitis B: an analysis of a 12-year record in a Nigerian tertiary hospital. J Infect Prev. 2018;19(4):184–189.
- Mathewos B, Birhan W, Kinfe S, et al. Assessment of knowledge, attitude and practice towards post exposure prophylaxis for HIV among health care workers in Gondar, North West Ethiopia. BMC Public Health. 2013;13(1):508.
- Cardo DM, Culver DH, Ciesielski CA, et al. A case-control study of HIV seroconversion in health care workers after percutaneous exposure. Centers for Disease Control and Prevention Needlestick Surveillance Group. N Engl J Med. 1997;337(21):1485–1490.
- Joyce MP, Kuhar D, Brooks JT. Notes from the field: occupationally acquired HIV infection among health care workers - United States, 1985–2013. MMWR Morb Mortal Wkly Rep. 2015;63(53):1245–1246.
- Irvine C, Egan KJ, Shubber Z, Van Rompay KK, Beanland RL, Ford N. Efficacy of HIV postexposure prophylaxis: systematic review and meta-analysis of nonhuman primate studies. Clin Infect Dis. 2015;160 Suppl 3(suppl_3):S165–S9.
- Kermode M, Jolley D, Langkham B, Thomas MS, Crofts N. Occupational exposure to blood and risk of bloodborne virus infection among health care workers in rural north Indian health care settings. Am J Infect Control. 2005;33(1):34–41.
- Kebede B, Abate T, Mekonnen D. HIV self-testing practices among Health Care Workers: feasibility and options for accelerating HIV testing services in Ethiopia. Pan Afr Med J. 2013;15:50.
- Kalibala S, Tun W, Cherutich P, Nganga A, Oweya E, Oluoch P. Factors associated with acceptability of HIV self-testing among health care workers in Kenya. AIDS Behav. 2014;18 Suppl 4(Suppl 4):S405–S414.
- Wood BR, Ballenger C, Stekler JD. Arguments for and against HIV self-testing. HIV AIDS (Auckl). 2014;6:117–126.
- Lwanga SK, Lemeshow S. Sample size determination in health studies: a practical manual. Geneva: World Health Organization. 1991:29–32.
- Amoran OE. Occupational exposure, risk perception and access to prophylaxis for HIV/AIDS infection among health care workers in Northern Nigeria. BJMMR. 2013;3(2):275–287.
- Aminde LN, Takah NF, Dzudie A, et al. Occupational Post-Exposure Prophylaxis (PEP) against Human Immunodeficiency Virus (HIV) infection in a health district in cameroon: assessment of the knowledge and practices of nurses. PLoS ONE. 2015;10(4):e0124416.
- Makhado L, Davhana-Maselesele M. Knowledge and uptake of occupational post-exposure prophylaxis amongst nurses caring for people living with HIV. Curationis. 2016;39(1):1593.
- Siegel JD, Rhinehart E, Jackson M, Chiarello L. 2007 Guideline for Isolation Precautions: preventing transmission of infectious agents in health care settings. Am J Infect Control. 2007;35(10 Suppl 2):S65–S164.
- Kim H. Statistical notes for clinical researchers: Chi-squared test and Fisher’s exact test. Restor Dent Endod. 2017;42(2):152–155.
- Katz MH. Multivariable Analysis-a Practical Guide for Clinicians and Public Health Researchers. Cambridge, U.K.: Cambridge University Press; 2011.
- Hosmer DW, Lemeshow S. Applied Logistic Regression. New York: Wiley; 2013.
- Centers for Disease Control and Prevention. Occupational HIV transmission and prevention among health care workers. 2016. www.cdc.gov/hiv/workplace/healthcareworkers.html. Last accessed March 15, 2022.
- Owolabi RS, Alabi P, Ajayi S, et al. Knowledge and practice of post-exposure prophylaxis (PEP) against HIV infection among health care providers in a tertiary hospital in Nigeria. J Int Assoc Physicians AIDS Care (Chic). 2012;11(3):179–183.
- Adebimpe WO. Knowledge and practice of health care workers towards post exposure prophylaxis in the era of low and stable HIV prevalence in Southwestern Nigeria. Bull Fac Pharm Cairo Univ. 2018;56(1):104–108.
- Ogunlesi FB, Ogunlesi TA. Knowledge of health care workers in a Nigerian Tertiary Health facility on post-exposure prophylaxis for HIV infection. Nig Hosp Pract. 2013;12(1–2):42–49.
- Onuoha H, Omosivie M. Knowledge, attitude and utilization of HIV post-exposure prophylaxis among health care workers at HIV treatment centers in port-harcourt metropolis. AJMAH. 2019;14(1):1–12.
- Onadeko MO, Balogun MO, Onigbogi OO, Omokhodion FO. Occupational exposure, attitude to HIV-positive patients and uptake of HIV counselling and testing among health care workers in a tertiary hospital in Nigeria. SAHARA J. 2017;14(1):193–201.
- Ajibola S, Akinbami A, Elikwu C, Odesanya M, Uche E. Knowledge, attitude and practices of HIV post exposure prophylaxis amongst health workers in Lagos University Teaching Hospital. Pan Afr Med. 2014;19:172.
- Isara AR, Oguzie KE, Okpogoro OE. Prevalence of needlestick injuries among healthcare workers in the Accident and Emergency Department of a Teaching Hospital in Nigeria. Ann Med Health Sci Res. 2015;5(6):392–396.
- Agaba PA, Agaba EI, Ocheke AN, Daniyam CA, Akanbi MO, Okeke EN. Awareness and knowledge of human immunodeficiency virus post exposure prophylaxis among Nigerian Family Physicians. Niger Med J. 2012;53(3):155–160.
- Odinaka KK, Edelu BO, Nwolisa CE, Amamilo IB, Amamilo IJ. Post exposure prophylaxis against human immunodeficiency virus: awareness knowledge and practice among Nigerian Paediatricians. Nig J Paed. 2016;43(3):193–196.
- Uzochukwu Sibeudu FT, Ughasoro Okwuosa C, Onwujekwe OE. How do primary health care workers perceive and practice post exposure prophylaxis for HIV in Enugu State? J AIDS Clin Res. 2014;05(12):381. MD
- Okoh M, Saheeb BD. Assessment of knowledge, attitude and practice of post-exposure prophylaxis against blood-borne viral infection among dental surgeons in a teaching hospital. S Afr J Infect Dis. 2017;32(1):17–22.
- Auta A, Adewuyi EO, Tor-Anyiin A, et al. Health-care workers’ occupational exposures to body fluids in 21 countries in Africa: systematic review and meta-analysis. Bull World Health Organ. 2017;95(12):831–841F.
- Ngwa CH, Ngoh EA, Cumber SN. Assessment of the knowledge, attitude and practice workers in Fako division on post exposure prophylaxis to blood borne viruses: a hospital-based cross-sectional study. Pan Afr Med J. 2018;31:108.
- Akinboro AA, Adejumo PO, Onibokun AO, Olowokere AE. Community health care workers’ risk perception of occupational exposure to HIV in Ibadan, South-west Nigeria. Afr J Prm Health Care Fam Med. 2012;4(1):338–348.
- Eticha EM, Gemeda AB. Postexposure prophylaxis against HIV infection among healthcare workers in Hiwot Fana Specialized University Hospital, Eastern Ethiopia. AIDS Res Treat. 2019;2019:7947086.
- Chalya PL, Seni J, Mushi MF, et al. Needle-stick injuries and splash exposures among health-care workers at a tertiary care hospital in north-western Tanzania. Tanz J Health Res. 2015;17(2):1–5.
- Kimaro L, Adinan J, Damian DJ, Njau B. Prevalence of occupational injuries and knowledge of availability and utilization of post exposure prophylaxis among health care workers in Singida District Council, Singida Region, Tanzania. PLoS ONE. 2018;13(10):e0201695.
- Kabyemera R, Kalolo A, Fernando G, Bergson S. Occupational exposures and utilisation of HIV post-exposure prophylaxis amongst health workers of three hospitals in Tanzania’s Lake Zone. Afr Eval J. 2015;3(2):152–160.
- Cissoko Y, Sidibé LN, Dembele JP, et al. Assessing five years of management of accidental exposure to blood at Gao Hospital, Mali. AJRID. 2019;2(4):1–7.
- Kabotho KT, Chivese T. Occupational exposure to HIV among nurses at a major tertiary hospital: reporting and utilization of post-exposure prophylaxis; a cross-sectional study in the Western Cape, South Africa. PLoS One. 2020;15(4):e0230075.
- Mossburg S, Agore A, Nkimbeng M, Commodore-Mensah Y. Occupational hazards among healthcare workers in Africa: a systematic review. Ann Glob Health. 2019;85(1):1–13.
- Ogoina D, Pondei K, Adetunji B, Chima G, Isichei C, Gidado S. Prevalence and determinants of occupational exposures to blood and body fluids among health workers in two tertiary institutions in Nigeria. Afr J Infect Dis. 2014;8(2):50–54.
- Nouetchognou JS, Ateudjieu J, Jemea B, Mbanya D. Accidental exposures to blood and body fluids among health care workers in a Referral Hospital of Cameroon. BMC Res Notes. 2016;9(1):94.
- Aluko OO, Adebayo AE, Adebisi TF, Ewegbemi MK, Abidoye AT, Popoola BF. Knowledge, attitudes and perceptions of occupational hazards and safety practices in Nigerian healthcare workers. BMC Res Notes. 2016;9(9):71.
- Babanawo F, Ibrahim A, Bahar OS, Adomah-Afari A, Maya E. Assessment of knowledge and usage of HIV post exposure prophylaxis among healthcare workers in a regional hospital in Ghana. Glob Health Rep. 2018;2:e2018028.
- Dhital PS, Sharma S, Poudel P, Dhital PR. Knowledge regarding postexposure prophylaxis of HIV among nurses. NRR. 2017;7:45–50.
- Mponela MJ, Oleribe OO, Abade A, Kwesigabo G. Post exposure prophylaxis following occupational exposure to HIV: a survey of health care workers in Mbeya, Tanzania, 2009–2010. Pan Afr Med J. 2015;21:32.
- Aschale B, Tamir Y, Alem G. Knowledge, attitude, practice and associated factors towards post exposure prophylaxis to HIV infection among health care professionals in Debre Markos town public health institutions, Northwest Ethiopia, 2017. Clin Pract. 2017;14(6):385–395.
- Bareki P, Tenego T. Assessment of knowledge, attitudes and practices of HIV post exposure prophylaxis among the doctors and nurses in Princess Marina Hospital, Gabarone: a cross-sectional study. Pan Afr Med. 2018;30:233.
- Madiba S, Segobola M, Mokgatle M. Assessing the acceptability and willingness to use HIV self-testing among student nurses in a private nursing college, Gauteng Province, South Africa. WJA. 2015;05(03):208–216.
- Dilie A, Amare D, Gualu T. Occupational exposure to needle stick and sharp injuries and associated factors among health care workers in Awi Zone, Amhara Regional State, Northwest Ethiopia, 2016. J Environ Public Health. 2017;2017:2438713.