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ISSN: 2329-6879
Occupational Medicine & Health Affairs
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Assessment of knowledge, attitude and practice towards post exposure prophylaxis for HIV among health care professionals in Lahore

Gurdeep Singh1, Mansur UD Din Ahmad1, Shazia Muneer1, Najam ul Sabah1, Wajeeha Baig2and Amjad Khan1,*

1Department of Epidemiology and Public Health, University of Veterinary and Animal Sciences Lahore, Pakistan

2Department of Human Nutrition, University of Veterinary and Animal Sciences, Lahore, Pakistan

*Corresponding Author:
Amjad Khan
Department of Epidemiology and Public Health
University of Veterinary and Animal
Sciences Lahore, Pakistan
Tel:
+923154546715
E-mail:
[email protected]

Received date: July 04, 2015 Accepted date: July 29, 2015 Published date: August 15, 2015

Citation: Singh G, Din Ahmad MUD, Muneer S, Sabah NU, Baig W, et al. (2015) Assessment of Knowledge, Attitude and Practice towards Post Exposure Prophylaxis for HIV among Health Care Professionals in Lahore. Occup Med Health Aff 3:208. doi: 10.4172/2329-6879.1000208

Copyright: © 2015 Singh G, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

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Abstract

HIV infections in health care workers have become a major health problem especially in developing countries in these days. Most in poor resource setting HCWs dealing with large number of HIV infected patients. This situation raises the need for post exposure prophylaxis (PEP) for HIV exposed group really important. Considering this a cross sectional survey was conducted in general and governmental hospitals of district Lahore Pakistan to asses Knowledge, attitude and practice of HCWs regarding PEP for HIV. Response regarding Knowledge, attitude and practice of 609 HCWs were entered on a predesigned self explanatory questionnaire. Descriptive analysis of the data showed that almost half of the HCWs have never heard about PEP. 68% of HCWs were of the opinion that PEP guidelines should not be listed in the working area or they responded with no idea regarding PEP. A good number of HCWs almost 47.2% believed PEP non protective against HIV or either did not have knowledge about it. Significant proportion (>50%) of the respondents were found having in adequate knowledge and improper attitude towards PEP. 35.3% of the respondents were placed on PEP after exposure while rest of the HCWs were not or either did not have idea about PEP. It was concluded that knowledge and attitude of HCWs about HIV for PEP was just satisfactory, consequently formal training for HCWs about PEP for HIV is recommended.

Keywords

HIV; Health care workers; Post exposure prophylaxis; Respondents and descriptive

Introduction

HIV/AIDS (Acquired Immuno Deficiency Syndrome) a disease that damages person’s facility to fight against diseases, exposing the body to various normally innocuous infections and a few forms of cancers. HIV (human Immuno deficiency virus) infects several types of leukocytes, primarily CD4 (helper cells) and macrophages/monocytes. These cells disruption are the core functionary components of immunodeficiency which characterizes AIDS (Anonymous). HIV is no more fatal in prompt treated cases; it has turn into a chronic controllable illness. But in developing and third world countries the situation is significantly different, where almost 95% cases of AIDS occurs [1]. As 33.2 million people throughout the world reported in 2007 infected with AIDS and HIV. Amongst which 2.1 million mortalities occurred due to AIDS and this number is increasing due to lack of effective therapy in these countries [2].

Health care workers (HCWs) form the foremost chunk of different cadres in most countries of the health care personnel. Their job demands a forefront caring role, bringing them in direct and close contact with the patients’ other body fluids and blood. Which puts them at higher risk of the occupational exposure to HIV/AIDS and other infections? According to the World Health Organization (WHO) 2.5% of the total HIV global cases are due to occupational exposure among health care workers [3]. Considering this occupationally acquired HIV poses greater psychosocial challenges to the HCWs and other professional’s due to associated discrimination and stigma. Such types of accidents are allied with a few, but pose momentous risk to the HCWs and professional’s health, families, health and to the patients also under their care [4]. Avoidance of blood and other body fluids exposure through the safer practices, precautions, safer needle devices, barriers and supplementary innovations are the preeminent ways to avert HIV and additional blood borne pathogens [5,6]. Worldwide safety measures for all HCWs comprises using gloves and other safety barriers while touching blood or other body fluids, mucous membranes or non intact skin of all the patients; evasion of injuries from needles, blades or other sharp instruments.

Pakistan being a developing country where the HCWs are the high risk groups exposed occupationally to HIV. Therefore an understanding of their professional performance is decisive to assess and minimize the risk of occupational exposure to HIV amongst them. Considering this the present study was undertaken to evaluate knowledge, attitude, and practice about HIV post exposure prophylaxis among HCWs of king Edward University myo Hospital, Jinnah hospital, services hospital of Lahore, Pakistan.

Materials and Methods

Study design

A cross sectional descriptive study was conducted amongst 609 HIV care health professionals in different governmental hospitals in district Lahore Punjab province of Pakistan. Through simple random sampling technique study subjects were selected. These hospitals have hundreds of beds capacity with large number of health care professionals taking care of patients in the same time.

Study area

The present study was conducted in government hospitals of district Lahore from 25th April to 20th May 2015, Lying between 31°15′-31°45′ N and 74°01′-74°39′ E. it’s the second largest city of Pakistan in terms of population (12.21 million).

Sample size and data collection

Using the Yamane formula the sample size was calculated,

n=N/1+ (Ne2)

Where n=sample size, N=Size of population, e=level of precision [7].

The minimum sample size was 531 HCWs. After informed consent was obtained, the researchers distributed questionnaires to 700 HCWs, and got completed 609 questionnaires back, which was a 87% response rate. A self-administered questionnaire was used to collect data. The questionnaire was design and developed based on literature review with four major parts: socio demographic characteristics, Knowledge, attitude and practice towards post exposure prophylaxis for HIV.

Statistical analysis

The statistical analysis was performed by using SPSS programme Version 22. Descriptive analysis of the data was performed. Data was represented in the form frequencies and percentage in tables.

Results

The present study was conducted in government hospitals of district Lahore of province Punjab Pakistan. Data regarding demography of respondents, knowledge, attitude and practices towards post exposure prophylaxis (PEP) were obtained on a predesigned self administered questionnaire from 25th April- 25th May 2015. The results showed that most health care workers (HCWs) were female 312(51.2%), between 31 to 45 years old (38.0%). Regarding professional rank, 26.3% were MBBS doctors, 23.3% nurses, 24.0% lab technician and Health technicians (26.4%) having 6-10 years of work experience as professionals. Most of the HCWs enrolled were diploma holders 208(34.2%), details given in Table 1.

Variables Details N (%)
Age of respondent(Years) 20-30 179(29.3)
31-45 232(38.0)
>46 198(32.5)
Sex Male 297(48.8)
Female 312(51.2)
Occupation Doctors 160(26.3)
Nurse 142(23.3)
Laboratory Technician 146(24.0)
Health Technician 161(26.4)
Educational Status MBBS 205(33.7)
Diploma 208(34.2)
Inter 196(32.2)
Work Experience 1-5 270(44.3)
6-10 242(39.3)
11-12 96(15.7)

Table 1: Sociodemographic description of HCWs in government hospitals at Lahore, Pakistan 2015.

HIV Knowledge in HCWs

Analysis of data regarding Knowledge towards PEP amongst HCWs showed that large portion of HCWs were of the opinion that they never heard about PEP though 53.4% replied that they have heard about PEP. In which most of them got information about PEP through friends. Significant numbers of HCWs (27.6%) were of the belief that PEP must be indicated after any needle prick or injury. 27.3% HCWs suggested that after 12 hours of exposure PEP must be taken and 28.1% recommended PEP 48 hours delay after exposure. 22.0% HCWs thinks for PEP with 100% effectiveness while 18.1% were having believe of 20- 30% effectiveness regarding PEP. Most of the HCWs (34.8) did not have any idea regarding PEP training as shown in Table 2

Knowledge questions Response Frequency (%) Standard deviation
Have you heard of PEP? Yes 325(53.4) 0.499
No 284(46.6)
From what source you get the information? Training 125(20.5) 1.406
Mass media 103(16.9)
friends 142(23.3)
journals 119(19.5)
others 120(19.7)
When you would think PEP should indicate Patient at high risk 157(25.8) 1.149
Patient known with HIV 146(24.0)
HIV with unknown 138(22.7)
Any needle stick injury during work 168(27.6)
What is the maximum time to delay the PEP 24 hours 141(23.2) 1.100
48hours 171(28.1)
72 hours 146(24.0)
12 hours 15
1(24.8)
What is preferable time to take PEP? Within hour 152(25.0) 1.119
After 6 hour of exposure 138(22.7)
After 12 hour of exposure 166(27.3)
After 72 hour of exposure 153(25.1)
What is the effectiveness of PEP 100% 134(22.0) 1.420
80%-100% 117(19.2)
60-70% 114(18.7)
30-50% 134(22.0)
10%-30% 110(18.1)
What is the length of time to take PEP 28 days 157(25.8) 1.11
40 days 149(24.5)
6month 161(26.4)
Life time 142(23.3)
Have you attend any training about PEP? yes 307(50.4 0.500
no 302(49.6)
Do you know about the PEP guide lines yes 201(33.0) 0.818
No 202(33.2)
I don’t know 206(34.8)

Table 2: HCWs response to various questions regarding knowledge about PEP in governmental Hospitals, Lahore, Pakistan 2015.

Attitude towards PEP

Result analyses of attitude questions asked from HCWs showed that small portion of the professional were of the opinion that PEP is needed and its role. While rest of them either did not considers it important or did not have any idea of it. 35.0% agreed that PEP guidelines must be there in working areas while other disagreed or did not have any knowledge of it. 35.0% HCWs agreed on the effectiveness of the PEP in HIV prevention while the other HCWs were of the belief that PEP is not effective in HIV prevention as given in Table 3, 25.9% HCWs agreed on that PEP must be indicated on any kind of sharp injuries regardless of source. Most of the HCWs belief that PEP is not important if the patient exposed with is not truly positive for HIV infection and the remaining either disagreed or responded having no idea regarding PEP (Table 3).

Attitude questions Response Frequency (%) Standard deviation
Do you think PEP is important? yes 216(35.5) 0.815
no 204(33.5)
I don’t know 189(31.0)
Do you believe that training of PEP is important for behavioral change? agree 213(35.0) 0.826
disagree 194(31.9)
I am not sure 202(33.2)
Do you think there should be PEP guidelines in work areas? disagree 194(31.9) 1.131
I am not sure 202(33.2)
agree 213(35.0)
disagree 194(31.9)
I am not sure 202(33.2)
Do you believe PEP reduce like hood of being HIV positive Yes 158(25.9) 0.816
no 132(21.7
I don’t know 155(25.5)
Do you believe PEP to prevent further infection? agree 217(35.6) 1.114
Disagree 203(33.3)
I am not sure 189(31.0)
How do you see that PEP is indicated for any type of sharp injuries agree 147(24.1) 0.805
disagree 158(25.9)
Partially agree 150(24.6)
I am not sure 154(25.3)
What is your opinion on the believe that PEP is not important if the exposure is not with patient of known HIV positive agree 203(33.3) 0.810
disagree 215(35.3)
I am not sure 191(31.4)

Table 3: Attitude about post exposure prophylaxis in HCWs in Lahore government hospitals Pakistan 2015.

Preventive practices to avoid PEP

The majority of nurses, doctors and other health care professionals provided the information that their health departments and organization have not yet developed any policies in neither vocal nor written form. 31.0% professionals use their personnel safety materials while dealing with patients blood or other body fluids while rest of the included subjects are not using any safety equipments or either did not know about it. A good number (34.2%) of HCWs did not practice hand washing after coming in contact with patients. 37.1% HCWs did not knew about the proper handling of equipments after and before use of the HIV potential risk associated sharp equipments.

Discussion

The results of the present study revealed that HCWs have the in adequate knowledge about post exposure prophylaxis (PEP) for HIV. These results concords with the study [8] conducted in Vietnam, demonstrating the same situation. The lack of awareness and having less knowledge regarding PEP for HIV in Pakistan due to the lack of proper protocols and guidelines addressed ever in these institutions. Little portion of the HCWs in our study showed proper attitude towards PEP for HIV that is accordance with the results of ref. [9] this is may be attributed to the fact that most of them used their own equipments to protect themselves from getting HIV infections as a precautionary measure (Table 3). Proper disposal of used needles and other equipments capable of HIV transmission as risk factors unfortunately were not practiced at the most. More than half of the HCWs suggested use of PEP as soon as after 12 hours (Table 2) while others affirmed initiating PEP with delayed timing as protective. Half of the HCWs would start PEP after exposure while the remaining responded, having no idea regarding PEP for HIV [10,11].

In the present study the attitude and knowledge about PEP for HIV in adequate fully in agreement as previously reported in studies [12] this may be due to the agedness of the HCWs having no interest and in younger HCWs the improper attitude towards PEP for HIV reported is due to the lack of interest from the organization and health care centers for having no planned policy concerning PEP for HIV up to date. The higher prevalence of HCWs of getting occupational HIV (Table 4) in Pakistan may be attributed to the lack of knowledge, stigmatizing attitude and improper practice amongst the HCWs. In this study we assessed the knowledge, attitude and practice of PEP for HIV in health care workers. In conclusion, the results indicated no satisfactory to satisfactory knowledge, attitude and practice concerning PEP for HIV in general hospitals amongst HCWs. Therefore need of more educational initiatives explaining PEP for HIV for HCWs as an important strategy in preventing occupational HIV infections transmission.

Preventive practices Questions Response Frequency (%) Standard Deviation
Does your organization developed and distributed written policies for the management of occupational exposure? Yes 187(30.7) 0.812
Have you use personal protective equipments when anticipating contact with patient blood and body fluid? no 208(34.2) 0.812
I don’t know 214(35.1)
Yes 189(31.0)
Is hand washingin your practice routine after contactwith infected patients no 207(34.0) 0.825
I don’t know 213(35.0)
Yes 193(31.7)
Is there proper handling and disposing of sharp instrument after and before use? no 208(34.2) 0.815
I don’t know 208(34.2)
Yes 190(31.2)
Have you ever been placed on HIV PEP after needle stick injury? no 193(31.7) 0.82
I don’t know 226(37.1)
Yes 203(35.3)
no 205(33.7)
I don’t know 201(33.0)

Table 4: Preventive practices to avoid post exposure prophylaxis.

Conclusion

It was concluded that most of the HCWs at the general and governmental hospitals have inadequate knowledge regarding PEP for HIV and having improper attitude towards PEP. Mass media can play major rule in highlighting of this issue as well as developing awareness in HCWs relating PEP for HIV.

Recommendations

Recommendations for preventing the transmission of the human immunodeficiency virus (HIV) in health care settings emphasis those workers should regard all patients as potentially infected and adhere rigorously to infection control procedures for minimizing the risk of exposure to blood and body fluids. The following points are recommended

1. Training on risk management and individual responsibilities regarding safety can improve infection control.

2. There must be proper and adequate policies for PEP for HIV planned by the organizations and health centers.

3. Electronic media can play a vital role in the awareness and importance of PEP for HIV among the HCWs as well as general population.

4. Adequate resources and facilities must be assured at hospitals to the HCWs.

Acknowledgements

The authors are highly thankful to HCWs for their cooperation and patience’s.

Ethical Considerations

All prospective respondents were evidently advised that participation in the study was voluntary. The study secured ethical clearance from Department of Epidemiology and Public Health (EPH). The HCWs were registered to participate after they obtained explanation about the objectives of the study and a written consent was signed at the same time from them. Confidentiality of the study subjects was maintained.

Study Limitations

This study was based on a sample of HCWs in a single District Hospitals in Punjab Province, Pakistan, which limits the generalization of the results. Despite the consequences, these findings raise concerns about HCWs’ knowledge, attitudes and Knowledge in providing care to the HIV patients.

References

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