Article
Research
Prevalence of occupational exposure to HIV and
utilization of HIV post-exposure prophylaxis among
health staff at Bule Hora General Hospital, Bule Hora,
Ethiopia
Girish Degavi, Shiferaw Gelchu Adola, Hazaratali Panari, Shivaji Pawar, Chala Wata Dereso
Corresponding author: Girish Degavi, Department of Nursing, College of Health and Medical Science, Bule Hora
University, Hagere Maryam, Ethiopia. girishdegavi1984@gmail.com
Received: 21 Aug 2020 - Accepted: 07 Nov 2020 - Published: 10 Dec 2020
Keywords: Occupational exposure, HIV, Bule Hora Hospital, nurses
Copyright: Girish Degavi et al. Pan African Medical Journal (ISSN: 1937-8688). This is an Open Access article distributed
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Cite this article: Girish Degavi et al. Prevalence of occupational exposure to HIV and utilization of HIV post-exposure
prophylaxis among health staff at Bule Hora General Hospital, Bule Hora, Ethiopia. Pan African Medical Journal.
2020;37(333). 10.11604/pamj.2020.37.333.25680
Available online at: https://www.panafrican-med-journal.com//content/article/37/333/full
Prevalence of occupational exposure to HIV and
utilization of HIV post-exposure prophylaxis
among health staff at Bule Hora General Hospital,
Bule Hora, Ethiopia
Girish Degavi1,&, Shiferaw Gelchu Adola1, Hazaratali
Panari2, Shivaji Pawar3, Chala Wata Dereso4
Institute of Medicine and Health Sciences, Debre
Berhan University, Debre Berhan, Ethiopia,
3
Krishna Institute of Medical Sciences University,
Krishna Institute of Nursing Sciences, Karad,
Maharashtra, India, 4Bule Hora University, Hagere
Maryam, Ethiopia
&
1
Department of Nursing, College of Health and
Medical Science, Bule Hora University, Hagere
Maryam, Ethiopia, 2Department of Nursing,
Corresponding author
Girish Degavi, Department of Nursing, College of
Health and Medical Science, Bule Hora University,
Hagere Maryam, Ethiopia
Girish Degavi et al. PAMJ - 37(333). 10 Dec 2020. - Page numbers not for citation purposes.
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Abstract
Introduction
Introduction: occupational risk of HIV and low
utilization of post-exposure prophylaxis (PEP)
among nurses has become a global public health
concern. According to the International Labor
Organization estimates, 2.02 million people die
each year from work-related accidents or diseases.
More than 317 million people suffer, and there are
an estimated 337 million fatal and non-fatal workrelated accidents per year. WHO report indicates,
more than 59 million health care workers around
the world are exposed to biological hazards and
about 10% of HIV among health workers is the
result of needle stick injury. This study focused on
assessing the prevalence of occupational exposure
to HIV post-exposure prophylaxis among nurses at
Bule Hora Hospital. Methods: institutional based
cross-sectional study design was conducted from
March 2019 to April 2019. In this study, 306 study
participants were involved in the study data was
collected using a structured and semi-structured
questionnaire. The cleaned data (edited) was
entered into Epi-Data version 4.4.3.1 and exported
to SPSS Statistics Version 20 for analysis.
Results: high incidence (61.6%) of occupational
exposure to HIV was found in this study. The two
leading types of exposure were blood splash 40.5%
and needle stick 37.8% injury followed by giving
injection 27% and uncooperativeness 21.6%
subsequently. About 35.1% of nurses were found
to be not using personal protective equipment’s
while being exposed to HIV infection while on
work. Conclusion: occupational exposure to HIV is
quite common among nurses in Bule Hora
Hospital. Blood splash exposure and exposure to
needle stick injury are believed to be the
commonest types of workplace risks. Nearly 29.7%
of nurses have no training on infection prevention
and management while at work. Nearly 50% of the
exposed nurses didn’t report the incident to the
concerned authorities. One fourth of the sources of
exposure were unscreened and among the
screened sources of exposure 42.9% were found to
be HIV positive.
Nurses encounter various work-related risks in the
form of injuries or infection due to the nature of
the workplace and their obligations towards their
job that put them in the forefront of occupational
related hazards [1]. Medical doctors and nurses
are considered at most risk group of needle-stick
injuries as compared to other health service
workers [2]. Accordingly, they are handily
presented with transferable illnesses including
hazardous blood borne microorganisms which are
transmitted by means of needle stick injury, blood,
and body liquid splash. Study directed in Iran
shows that the prevalence of exposure to
workplace risk among nursing and maternity
specialists were 50.7% and another data revealed
in Serbia uncovered that the highest prevalence
68.6% of work-related accidents was among
medical caretakers [3, 4].
In sub-Saharan Africa, the prevalence of
occupational exposure to HIV is also high. Study
conducted in Tanzania showed that 50.6% health
care workers participated in the study experienced
harmful occupational exposure [5]. In Kenya 50%
of nurses reported that they were exposed to
percutaneous injuries [6]. Study´s conducted in
Ethiopia revealed that the overall prevalence of
blood/body fluid exposure and sharp injury was
78.3% [7]. Among sub-Saharan Africa, the
prevalence of occupational exposure is higher in
Ethiopia, where the prevalence of HIV infection is
also very high [8, 9]. The use of HIV PEP brings
significant efficacy by preventing HIV seroconversion. Studies done on animals shows risk of
sero-conversion among animals exposed to PEP
were lowered by 89% [10]. Immediate use of HIV
post-exposure prophylaxis is believed to reduce
occurrence HIV infection by 80% [11]. Despite an
increased occupational hazard in the health care
settings, there is improper practice guidelines and
motives among the health care force to protect
themselves from HIV risk exposure evidenced by
negligent utilization of HIV post-exposure
prophylaxis among nurses [12]. In general,
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occupational exposure is becoming a serious
problem, but it was not getting adequate focus
and needed concern. Therefore, this crosssectional study was conducted to assess the
prevalence of occupational exposure and
determine the magnitude of utilization of PEP
among health care staff including nurses at Bule
Hora General Hospital.
Methods
An institution based cross-sectional study design
was incorporated on 306 staffs at Bule Hora
General Hospital which is located in Bule Hora
town, which is the capital city of West Guji Zone.
Bule Hora General Hospital (BHH) is the largest
hospital of all hospitals included in this study area.
These hospitals were selected due to its
accessibility for the present study.
Staff nurses and doctors working in Bule Hora
Hospital were included in the study. Through
literature search the prevalence studied at Jima
public hospital (78.3%) were taken as
reference [7]. Using a 78.3% as prevalence rate,
incorporating precision value of 0.05 and a Z-value
of 1.96, the formula yielded a minimum sample
size of 261 adding (10%) of null respondents, the
final sample size was decided to be 306.
The study participants were selected using
systematic random sampling using first ‘k th’ value
in the overall health staff list of the study area
obtained from local public health office. Health
staff who were giving direct care to the patients
were the study participants of whom (26%) were
medical doctors including 7 specialists, (64%)
general nursing staff and (10%) midwifery nursing
staff. All participants possessed with different
levels of qualification in their respective field. The
dependent variables included in the study were
exposure to occupational hazards related to HIV
and utilization of PEP. The independent variables
were socio-demographic factors such as age, sex,
educational status, marital status, work
experience, and position/title in hospital.
Organizational factors, Nurse and patient
behavioral factors were studied on use of personal
protective equipment, Organization and nurse
related factors including stigma/discrimination,
fear of drug side effects, awareness on HIV PEP,
availability of PEP drugs, and availability of HIV PEP
protocol. Patient factors include HIV status.
The data were collected from March 2019 to April
2019 for 2 consecutive months. The assessment
was done using pretested, semi structured
administered questionnaires. The questionnaire
had three part
one: Sociodemographic
characteristics of the nurses, part two: Prevalence
of occupational exposure and part three:
Utilization of HIV-PEP medications. Prior to the
actual data collection, pre-testing was done on 5%
of the total study participants at Kerch Hospital in
West Guji Zone, Ethiopia. which were not included
in the actual study and based on the findings
necessary, amendment was made regarding its
consistency, clarity, and logical adequacy. The data
was coded, checked for error, missing value must
dealt with and cleaned data (edited) will be
entered into Epi-Data version 4.4.3.1 and exported
to SPSS statistics version 20 for analysis.
The statistical analysis focused on quantity and
quality, summarizing, analyzing and assessing and
bringing out conclusions of the collected data. The
results of descriptive statistics were summarized
and presented by tables, charts, and graphs.
Percentage frequency and mean was been
calculated. To enable participants to disclose and
respond openly, 4 BSc nurses for data collection
and 2 MSc nurses for supervision of data collection
were recruited in this study. The study assistants
were trained for one day intensively on the study
instrument and data collection procedure that
includes the relevance of the study, objective of
the study, confidentiality of the information, and
informed consent.
Operational definition
Occupational exposure to HIV: doctors and
Nurses who were exposed to needle stick cuts,
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blood or other body fluid splashes occurring at the
workplace during performing procedures.
Post-exposure prophylaxis use: is the timely
provision of anti-retroviral (ARV) medication
following exposure to potentially infected blood or
other body fluids to minimize the risk of acquiring
infection; The drugs should be provided within 72
hours, daily for 28 days; recommended drugs for
low-risk HIV exposure are a combination of
Tenofovir (TDF) + Lamivudine (3TC) or Zidovudine
(AZT) + Lamivudine (3TC) while for high risk
exposures triple therapy should be used i.e.
Tenofovir (TDF)/Zidovudine (AZT) + Lamivudine
(3TC) and Efavirenz (EFV).
Ethical approval: ethical clearance was obtained
from Bule Hora University, College of Health and
Medical Science, an institutional review board
(BHU-IRB)
of
the
research
committee.
Respondents were informed about the purpose
and objective of the study. The information was
collected after obtaining verbal consent from each
participant. Verbal consent was wanted from all
the informed respondents before the start of each
interview. Respondents were allowed to refuse or
discontinue or participation at any time they want.
Information was recorded anonymously and
confidentiality and beneficence were assured
throughout the study.
Results
Socio-demographic characteristics of participants:
the study was conducted among 306 staffs with a
response rate of 97%. The response rate is 100%.
Majority (60%) of participants were female. The
age of the study participants ranged from 22 to 57
with 28 median ages. About 57% were single in
marital status and all most all 93% were staff
nurses. In addition, 63.3% were Diploma holders.
Regarding the departments they are working, 15%,
20%, and 18.3% of nurses were working in
outpatient department, emergency, and medical
wards, respectively (Table 1).
Prevalence of occupational exposure to HIV
among nurses at BHH, 2020: the prevalence of
occupational exposure to HIV among the 306
study participants is 37 (61.6%). About 40.5%,
37.8%, 13.5%, and 8.1% nurses experienced blood
splash, needle sticks, had more than two
exposures, and mucus slash, respectively. Giving
the injection 27% and uncooperativeness of
patients 21.6% were among the common activities
that exposed nurses to occupational exposure to
HIV. Majority (46%) of nurses had experienced
one-time exposure to HIV in the past 12 months.
Non availability of equipments and negligence
were the reasons for not using personal protective
equipment; 70.3% of nurses have taken training
on infection prevention and more than half
(62.2%) of the injuries occurred at daytime. Most
sources of exposures were screened (73.7%), and
42.9% were HIV positive (Table 2).
Utilization of HIV-PEP medications among nurses
at BHH: overall, among 61.6% who had
occupational exposure to HIV, 24.3% used HIVPEP. Of this, 91.9% heard about PEP but more than
half (62.2%) have not taken training on PEP.
Majority of nurses reported as PEP medication is
available and 40.5% of the participants know that
PEP services are provided 24 9mm hours and
59.5% do not know the availability of the service
at BHH. Of the 42.9% participants exposed to HIV
positive sources, 5 nurses did not use PEP
immediately (> 2 hours), 3 used PEP immediately
and 1 did not use PEP at all. The mean time to
initiate the first PEP drug after exposure was 8.88
+ 7.97 SD. Among those who started PEP, 77.7%
completed. However, 22.3% did not complete PEP
medication and the main reason for
discontinuation of the PEP was fear of adverse
drug effects (Table 3).
Discussion
This study assessed the prevalence of occupational
exposure to HIV post-exposure prophylaxis among
nurses at Bule Hora Hospital. This study detected
high levels of occupational exposure to HIV,
61.6%. This finding is in line with studies
Girish Degavi et al. PAMJ - 37(333). 10 Dec 2020. - Page numbers not for citation purposes.
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conducted in Serbia (68.6%) [4] and WHO report
of 21 African countries 65.7% [13] and lower than
similar studies conducted in Jima zone public
hospitals and Debre Berhan town in which the
prevalence of occupational exposure to HIV were
78.3% [7] and 88.6% [14] respectively. The finding
of this study is higher than studies done in
Tanzania (50.6%) [5], Kenya (50%) [6], Nigeria
(51.0%) [15], Southeast Iran (34.7%) [16],
in Gondar town (33.8%) [17] and Hawassa
(46%) [18].
In this study, the two leading types of exposure
were blood splash 115(40.5%) and needle stick
14(37.8%) injuries. This result is comparable with
study in Tanzania which is blood splash 57(47.1)
and Needle stick cut 45(37.2%) [5]. But lower than
study done in Jima Zone in which body fluid
exposure and needle stick injury were 62.6% and
58.8% respectively [7]. According to this study,
giving injection 27% and uncooperativeness 21.6%
of patients were among the common activities
that exposed nurses to occupational exposure to
HIV. This finding is in agreement with studies
conducted in Hawassa that Emergency situation
(28.6%), sudden movement of the patient
(23.8%) [18]. In this study, the majority of nurses
17 (46%) had one-time occupational exposure to
HIV in their professional performance. this finding
is in line with study done in Cameroon that
twenty-nine (53.7%) of nurses exposed one time in
their working time [12].
In this study, 35.1% nurses did not use personal
protective equipment´s during time of exposure.
This finding is lower than the study done in North
western Tanzania that 45.3% of the participants
were not used PPE at the time of exposure [19].
The result of this study showed that nonavailability of personal protective equipments
(54.5%), reasons for not using was non-availability.
This result is lower than the study conducted in
Tamil Nadu that the reasons for inappropriate use
of PPE was non-availability of PPE 562, 78% [20].
The findings of this study revealed that 70.3% of
nurses have taken training on infection
prevention. This finding is comparable with a study
conducted in Debre Berhan Town, 94(76.4%)
nurses were trained on infection prevention [14].
In this study, 51.4% nurses among the exposed
reported the accidents to the responsible person.
This result is lower than the study done in
Tanzania with 68.6% [5] and Uganda 74% [21].
However, higher than the study conducted in
Serbia, 40.2% [4]. According to this study, among
61.6% exposures, 24.3% nurses used HIV-PEP. This
result is comparable with the study done in Kenya
out of 305 reported exposures, only 20% (n=83)
took PEP against HIV [6]. However, higher than
studies done in Tanzania that 212 reported
incidents of NSIs and splash exposure, only 16.7%
of exposed HCWs received post-exposure
prophylaxis for HIV [19].
This study revealed, most nurses, 91.9% heard
about HIV- PEP. This finding was almost similar
with a study conducted in Eastern Ethiopia,
Hiwotfana hospital that 97.4% of the study
participants were aware of HIV PEP [22]. In this
study, the majority of nurses 75.7% reported as
PEP medication is available and 40.5% of the
participants knew that PEP service provided
24hours. This finding in line with similar study
conducted in Tanzania that 74.9% reported that
the HIV PEP was available at their workplace and
more than half 58.1% reported to have a person
available to administer the HIV PEP, 24 hours
a day [5].
The results of the present study revealed that
33.3% nurses used PEP immediately. This finding is
comparable with study done in Eastern Ethiopia,
Hiwotfana Hospital that Timely initiation of PEP
26.3% [22] and lower than study conducted in
Uganda 58% study participants [21]. The results of
this study showed that 77.7% study participants
completed PEP among those who started HIV-PEP.
This finding is higher than the WHO report of
2018, that 57% of people completed the full
course of PEP [8]. As per this study, 22.3% nurses
did not complete PEP and the major reason for
discontinuation of HIV- PEP among those who
used the drug was fear of adverse effects of PEP.
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The results were in agreement with the study
conducted in Mekele town that 19.4%
discontinued PEP and 83.3% of those who
discontinued were due to adverse effect of the
drugs [23], Gaborone 26.6% did not completed
PEP, with 71.4% quitting because of adverse drug
effects [24]. The reason for the observed
difference might be due to the difference in study
setting, study population (this study did only
among nurses and doctors), study time, and
awareness level of study participants regarding
the implementation of the universal precaution
protocol.
Conclusion
Occupational exposure to HIV is common among
health care professionals. Blood splash exposure
and 37.8% nurses had exposure to needle stick
injury, common activities that put nurses to HIV
exposure. Majority of nurses ignore the
importance of infection prevention and postexposure reporting and necessary screening.
What is known about this topic
• Even after taking necessary measures by
the regulatory and administrative agencies,
occupational HIV exposure remains a major
health risk among nurses and doctors;
• Needle stick injury and blood splash has
become the commonest cause of
occupational exposure to HIV among
nurses and physicians.
What this study adds
• Adhering to the utilization of HIV postexposure prophylaxis is corner stone of
prevention of occupational exposure to
HIV;
• Appropriate standing orders related to
occupational exposure to HIV is needed for
health professional’s safety in workplace.
Authors' contributions
GD conceived and designed the study, HP analyzed
the data, GD and CD wrote the manuscript, SG, SP
drafted the report and advised the whole research
paper and were involved in the interpretation of
the data and contributed to manuscript
preparation. All authors have read and approved
the final version of the manuscript.
Acknowledgments
We would like to thank all study participants and
data collectors for their contribution to the
success of our work.
Tables
Table 1: socio-demographic characteristic of
participants, Bule Hora Hospital, 2020
Table 2: prevalence of occupational exposure to
HIV among health staff at BHH, 2020 (n = 306)
Table 3: utilization of HIV-PEP medications among
health staff at BHH, 2020 (n = 306)
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Competing interests
The authors declare no competing interests.
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Table 1: socio-demographic characteristic of participants, Bule Hora Hospital, 2020
Variable
Response
Frequency (N)
Percent (%)
Sex
Male
122
40
Female
183
60
Age
≤ 30
229
75
31-40
56
18
>40
20
7
Marital status
Single
173
57
Married
132
43
Title in the hospital
Staff nurse
285
93
Head nurse
20
7
Education level
Diploma
194
63.3
Bsc degree
97
31.7
Master degree
15
5
Working ward
Pediatric ward
420
6.7
Medical-ward
56
18.3
Gynecology ward
15
5
Surgical ward
41
13.3
Operating theatre
35
11.7
Outpatient department
15
25
Emergency ward
61
20
Service year
≤5 years
204
66.3
>5 years
102
33.7
* Significant association at p < 0.05
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Table 2: prevalence of occupational exposure to HIV among health staff at BHH, 2020 (n = 306)
Variable
Response
Percent (%)
Exposed activities
Giving injections
27
Recapping needles
5.4
During surgery
13.5
Sudden movement of the patient 21.6
Collection of wastes
10.9
≥2 activities
21.6
Time of last exposures experienced
Within 3 months
21.6
Within 6 months
27
In the past 12 month
46
Greater than a year
5.4
Use of personal protective equipment at time of exposure Yes
59.5
No
35.1
I don’t remember
5.4
Reason for not using personal protective equipment
Equipment not available
54.5
Negligence
45.5
Training on infection prevention including PEP
Yes
70.3
No
29.7
Working shift at exposure time
Day
62.2
Night
37.8
Total working hour/week
<=40
51.4
>40
48.6
Reporting the accident
Yes
51.4
No
48.6
Post-exposure screening of the source of exposure
Yes
73.7
No
26.3
HIV status of the source of exposure
Positive
42.9
Negative
57.1
Mean working hours per week
49.2 + 11.15 SD
* Significant association at p < 0.05
Girish Degavi et al. PAMJ - 37(333). 10 Dec 2020. - Page numbers not for citation purposes.
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Article
Table 3: utilization of HIV-PEP medications among health staff at BHH, 2020 (n = 306)
Variables
Response
Percent (%)
Ever used HIV-PEP
Yes
24.3
No
75.7
Ever heard about HIV-PEP
Yes
91.9
No
8.1
Ever had training PEP
Yes
37.8
No
62.2
HIV-PEP medications availability
Yes
75.7
No
24.3
24 hours HIV-PEP medications administered
Yes
40.5
No
59.5
Immediately start HIV-PEP medications post-exposure Yes
33.3
No
55.6
Not used PEP at all
11.1
Time lapse from exposure to which PEP was received Within 2hrs
44.4
After 2hrs
55.6
Complete your HIV-PEP medications
Yes
77.7
No
22.3
Reason for discontinuation of the drug
Fear of adverse effect 100
Mean time initiation of HIV PEP
8.88 + 7.97SD
* Significant association at p < 0.05
Girish Degavi et al. PAMJ - 37(333). 10 Dec 2020. - Page numbers not for citation purposes.
11