Occupational Exposure to HIV among Health CareWorkers in PMTCT sites in Port Harcourt, Nigeria, 2017


 Background

Rivers State is one of the states with high HIV prevalence rate in Nigeria. Occupational exposure to pathogen infecting blood and or body fluids of HIV/AIDS patients is attributable to HIV infections among healthcare workers. We identified the determinants of occupational exposures to HIV among healthcare workers in PMTCT sites within Port Harcourt metropolis in Rivers State.

Methods

Adescriptive cross-sectional study was conducted and multi-stage sampling technique was used to select 341 healthcare providers from 22 public and 22 private health facilities in PMTCT sites in the Port Harcourt metropolis. Data were analysed using descriptive statistics, Chi-square and logistic regression models (p-value = 0.05).

Results

Respondents’ mean age was 35.9±SD8.4 years, 270 (80.1%) and 171(50.7%) were females and from public health facilities respectively. Prevalence of occupational exposure of healthcare workers to HIV in the past 12 months was 153 (45.0%) and 96 (63.3%) experienced such exposure more than once. Contact with potentially infectious body fluid accounted for the largest proportion 51 (33.3%) followed by needle stick prick 49 (32.6%). About 189 (56.1%) had safety information at their disposal that serves as areminder on safety precautions. The likelihood of occupational exposure was significantly higher among doctors (AOR=2.22, 95% C. I=1.16-4.25,) but lower among Environmental health workers (AOR=0.10, 95% C. I=0.02-0.46,) than Nurses/Midwives when other factors were included in the model.

Conclusion

Occupational exposure to blood and body fluids remains a frequent occurrence among healthcare workers in PMTCT sites in the study area. Adherence to universal precaution strategies should target all health care workers.

healthcare workers in PMTCT sites in the study area. Adherence to universal precaution strategies should target all health care workers.

Background
HIV/AIDS is one of the infectious diseases that threaten human survival world over [1].
Nigeria accounts for the 9.0% of the global HIV/AIDS burden and the national prevalence rate of 3.2% with 3.1 million people living with the disease [2]. Nigeria has the 2nd largest number of people living with HIV/AIDS (PLHA) in Africa continent (UNAIDS Fact Sheet, 2017), with a huge impact on the health system [3]. Report of HIV research in Nigeria showed that Rivers State has the highest HIV prevalence (15.2%) among the states in the country (National AIDS Reproductive Health survey, 2013) but latest National HIV/AIDS indicator survey places her in third position in prevalence amongst 36 states and federal capital territory (Federal Ministry of Health,2019). Health care workers are exposed to infection-causing organisms, including HIV as a result of caring for patients in the health care settings which often place them at risk of infection [4]. Body fluids are encountered during different medical intervention in the healthcare setting and over the years; healthcare workers have become infected with HIV [5] through a percutaneous injury (needle stick or cut with a sharp object), contact of mucous membrane, or contact of skin (especially when the exposed skin is chapped, abridged, or afflicted with dermatitis [6] [7][8] [9]. It is known that adherence to safety procedures in developing countries is challenged by the unavailability of protective equipment and or health worker's refusal to use safety equipment were available [10]. There is a global emphasis on achieving universal access to treatment as a strategy for addressing HIV/AIDS without addressing disproportionate health worker to patient ratio. This implies an increase in the turnover of patients seeking care and further increase the risk of health care workers to occupational exposure and infection to HIV by exhaustion and fatigue.
This study focuses on health care workers at higher risk of occupational infection compared to other health care workers with lower risk of occupational HIV infection [11].
It also focuses on specialized care centre as Prevention of Maternal to Child Transmission of HIV (PMTCT) sites in public and private setting. This is because PMTCT sites are designated sites for HIV patients; and the care they receive during labour and child delivery almost certainly entail revealing body fluids which can infect a health worker.
There is a paucity of information on occupational exposure in private health care setting and in HIV designated care centres in the available literature.
The objectives of this study are; to determine the prevalence of occupational exposure to HIV infection among health careworkers in PMTCT sites; assess risk perception to occupational exposure, the practice of standard precaution procedure and use of personal protective equipment by health careworkers in PMCT sites.Other objectives are to determine the availability of safety protocol/regulation or standard on HIV prevention in PMTCT sites and identify factors associated with the risk of occupational exposure to HIV infection among health careworkers in PMTCT sites [4]. The information and recommendation from this study would draw attention to the plight of health careworkers and strengthen infection prevention activities. Study design: We conducted a cross-sectional health facility-based study.

Methods
Study population: The study population was made up of health careworkers whose daily activities require caring for HIV infected patients such as doctors, nurses/midwives, laboratory scientist/technicians and environmental workers.
Inclusion criteria: Health careworkers in the selected health facility who were included in this study are doctors, nurses and midwives, laboratory scientist or technicians and environmental workers who were on duty and present at the time of visit; and gave their consent.
Exclusion criteria: Trainee healthcare workers, health care workers that had assumed administrative responsibility and those who are less than 6 months into posting at present workplace were excluded from the study.

Sample size Calculation
The sample size of 341 was calculated using the formula, [Due to technical limitations, this equation is only available as a download in the supplemental files section.] Where, n = the minimum sample size Z α = the standard normal deviate corresponding to level of significance of 5% = 1.96 d = the desired level of precision, 0.05 p = proportion of HCW exposed to needle stick injury in Northern Uganda = 0.28 [12] q = 1-p = 0.72 10% non-response rate brings n = 341 Sampling Technique We used multiple stage sampling technique to select the study subjects.

Pre-testing of data collection tool
Pre-testing of the questionnaire was conducted on 30 health careworkers working in five health institutions that were not selected for the study before the actual data collection.
Modification of logical sequence, simplicity, and clarity of questionnaire was done using the findings at the pre-test.

Data collection
Data was collected using semi-structured interviewer-administered questionnaire. The questionnaire had three sections. Section A: socio-demographic characteristics of health care workers such as age, sex and occupation. Section B: Occupational risk exposure to HIV, and Section C: Determinant factors to occupational risk exposure to HIV infection.
The questionnaire was adopted from previous similar published works [1] [13].

Statistical analysis
Data were analysed using Epi info 7 and SPSS statistical software. Following a satisfactorily cleaned data, univariate analysis was done and expressed as percentages, mean and standard deviation. The frequency distribution of dependent and independent variables was organized by frequency tables, graphs, and charts. Chi-square test was used to determine the associations between dependent and independent categorical variables at 95% CI. Logistic regression was used to identify the factors associated with occupational exposure to HIV among healthcare workers at 0.05 levels of significance.

Ethical consideration
Approvals for the study were sought and obtained from the Scientific and Ethical  The data also depict that the overall prevalence of occupational exposure to HIV infection among the studied health care providers in PMTCT sites in Rivers State was 45.4% (Table   2). Among health care workers in the public health facilities, the prevalence of occupational exposure to HIV infection was 40.9% compared to 50% reported by those who work in the private health facilities.
From the respondents, the prevalence of occupational exposure to HIV infection was as high as 69.8% among doctors and as low as 20.4% among environmental health workers.
Higher prevalence was found among males (53.7%) than females (43.3%). The prevalence increased with the level of education from 23.8% among those with at most secondary education to 53.5% among those with higher education. It was lower among those with less than 10 years working experience (42%) compared to those with at least 10 years (51.2%).In terms of the number of working hours in a week, the prevalence of occupational exposure was higher for health care workers who worked less than 40 hours (50.5%) compared to those who worked 40 hours or more (43.5%) in a week.
With regards to the age of each respondent, the prevalence was 154.7% among healthcare workers aged at least 40 years which is 42.3% for those between the age of 30-39 years and 41.0% for those between the ages of 20-29 years.
[ Table 2 is here] In Figure 1, eleven safety and infection prevention parameters common among almost all categories of health workers were used to access practices of standard precaution procedures among the cadre of study participants. Firstly, on the use of hand gloves, 123(36.5%) of the health care workers always wear hand gloves in the course of their duty, while 185(54.9) wear hand gloves sometimes and 29(8.6%) never wear hand gloves.
Secondly, more than four-fifths (90.5%) of the health care workers said they wash their hands always, 22(6.5%) sometimes and 10(3.0%) never washes hands while on duty.
Thirdly, in the decontamination of instruments to prevent infection to other health users, 279(82.8%) always did decontaminate instruments they used, while 13 (3.9) decontaminates sometimes and 45(13.3%) of the study participants never decontaminated instruments immediately after use while Finally, the use of safety boxes is the appropriate practice in the health care environment and health care workers are expected to adhere to its use always.Among the studied participants,278(82.5) used safety boxes in the disposal of health waste always while 32(9.5) never used the safety box. Only 168 (49.0%), 29(8.6%) and 23 (6.8%) always wear; closed covered shoes, heavy duty gloves and heavy-duty aprons respectively.
[ Figure 1 is here] [ Figure 2 is here] In Table 3, the data show that the main predictors of occupational exposure to HIV were career cadre. Education and facility type which were not significantly related to occupational exposure. The likelihood of occupational exposure was significantly higher among doctors (AOR = 2.2, 95% C.I = 1.2-4.3, p<0.05) but lower among environmental health workers (AOR = 0.10, 95% C.I = 0.02-0.46, p<0.01) than nurses/midwives. Also, the risk of occupational exposure to HIV was 0.71(C.I = 0.44-1.12, p>0.05) times less among health workers who work less than 40 hours a week than those who work for at least 40 hours but this was not statistically significant.
[ Table 3 is here]

Discussion
Our findings indicate that about half of the health care workers had been exposed to HIV at their duty posts at one time or the other in the past one year prior this study. These In addition, we found that HCWs whose working hours was greater than 40 hours were at higher risk of sustaining occupational exposure to HIV through percutaneous injuries and muco-cutaneous contaminations compared with other HCW are not unique as the similar study reported same in Mongolia [21]. This is because fatigue and exhaustion could lead to lack of concentration and can further predispose the HCW to occupational exposure.
Lack of concentration will readily lead to negligence of infection prevention procedures and also predispose the HCW to occupational exposure to HIV virus. This has also been reported in similar studies from other developing countries where disparity in HCWs to patients that need medical attention ratio exist.() Some of the facilities studied had no established system for reporting and prevention of occupational exposures. This was similar to the situation reported in areas of comparable resource setting [17]. The findings were that a quarter of the participants received no         Figure 1 Practice of infection prevention procedures among health care workers in PMTCT sites Figure 2 Sharps disposal in PMTCT sites, PH Metropolis, Rivers State, 2016