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Determinants of appropriate knowledge on human immunodeficiency virus postexposure prophylaxis among professional health‐care workers in Sokoto, Nigeria

Introduction: The prevention of human immunodeficiency virus (HIV/AIDS) among health‐care workers (HCWs) has remained a major topical issue worldwide. Accidental transmission of HIV infection to HCWs during occupational exposure is a real threat today. The study aimed to assess the knowledge, attitude, and practice of postexposure prophylaxis (PEP) among HCWs in a tertiary health institution in Sokoto, Northwestern Nigeria. Methodology: The study was carried out at Usmanu Danfodiyo University Teaching Hospital, Sokoto, through a cross‐sectional descriptive study design; a total of 156 participants were recruited using a stratified sampling technique. Data were collected using a semi‐structured, self‐administered questionnaire and analyzed using SPSS computer software after obtaining ethical clearance from the Health Ethics and Research Committee of the teaching hospital. Results: A total of 87.2% (136) of the respondents had heard of PEP and 71.8% (112) thought that HIV/AIDs could be prevented through PEP. A total of 71.2% (111) had good knowledge about PEP, whereas 86.8% (118) had a positive attitude toward PEP. Conclusion: Although the study demonstrated high knowledge and positive attitude toward PEP, the observance of safety measures against needlestick injuries that could result in HIV infections was abysmally low. There is the need to create more awareness and strengthen the use of PEP protocol by all cadres of health workers as this will go a long way in minimizing blood‐borne infections.


Introduction
Health-care workers (HCWs) are key players in the prevention and management of blood-borne infections including human immunodeficiency virus (HIV). [1,2] Accidental transmission of HIV infection to HCWs during occupational exposure is a real threat today, [3][4][5][6] approximately 3 million HCWs experiencing percutaneous exposure to blood-borne viruses (BBVs) each year. This results in an estimated 16,000 hepatitis C, 66,000 hepatitis B, and 200-5000 HIV infections annually. [7,8] It is postulated that >90% of these infections are occurring in low-income countries, and most are preventable. [7] HCWs have increased chances of acquiring blood-borne pathogens through occupational exposure in developing countries due to a combination of increased risk and fewer safety precautions. [9] Since the loss of workers can seriously undermine developing health systems, it is important that risks of exposures are minimized. There are many difficulties faced by developing countries in minimizing the risks of occupational exposure. Efforts have been made to address these problems both on national and international levels. It is imperative that all HCWs are protected to prevent the loss of such a crucial component Determinants of appropriate knowledge on human immunodeficiency virus postexposure prophylaxis among professional health-care workers in Sokoto, Nigeria of developing health-care systems. [9] Adequate knowledge about the disease and practice of safety measures are our best bet to reduce such transmissions. [3] The study aimed to determine the knowledge, attitude, and practice of HIV postexposure prophylaxis (PEP) among HCWs in a tertiary health institution in Sokoto, Northwest Nigeria.

Methodology
The study was carried out at the Usmanu Danfodio University Teaching Hospital (UDUTH), Sokoto, which is a tertiary health facility/referral center that serves Sokoto, Zamfara, and Kebbi states all located in Northwestern Nigeria. The hospital has an 860-bed capacity and provides services for HIV infection and AIDS care among a myriad of other specialist services. The services include HIV counseling services, medication adherence, treatment support services, home-based care, consultation services, and ART drugs dispensing services. The facility presently provides these specialist services for over 4500 clients in the region. A cross-sectional descriptive study design was used. Using the formula for cross-sectional studies, a sample size of 156 was calculated after correcting for study population < 10,000. HCWs working in the clinical departments of UDUTH for at least 6 months were considered eligible to participate in the study (inclusion criteria).
A two-staged (multi-stage) sampling method was employed.
Stratified sampling was done to allocate questionnaires to the various cadres of HCWs. Systematic sampling was applied to the sampling frame of each cadre of HCWs to recruit respondents into the study after obtaining informed consent. Participants' data were collected using self-administered, semi-structured questionnaire. The data were collected by six trained research assistants under direct supervision of the principal investigator.
The data collected were entered into and analyzed using Microsoft excel and SPSS version 20. Descriptive statistics were used to summarize sociodemographic characteristics, knowledge, attitude, and practice questions. Correct answers to questions on knowledge and attitude were scored one (1) and incorrect ones and no response were awarded no scores (0), and these were converted to percentages. Respondents with scores ≥50% were adjudged as having good knowledge and positive attitude, respectively, while those with scores <50% were said to have poor knowledge and negative attitude respectively. Bivariate analysis was used to determine the factors associated with the knowledge, attitude, and practice of PEP. P < 0.05 was considered statistically significant. Ethical clearance was sought from the Ethical Committee of UDUTH, Sokoto, while informed consent was obtained from the HCWs before data collection.

Results
The ages of the respondents ranged from 20 to 59 years with a modal class of 30-39 years constituting 57.1% (89) Table 3].

Knowledge on postexposure prophylaxis
Logistic regression was used to predict which variables fitted knowledge on HIV PEP among participants [Tables 4 and

Model on appropriate knowledge of postexposure prophylaxis
However, only three out of the five predictor variables, namely, sex, highest education level, received information on PEP during school days, and reading of journals/textbooks had significantly contributed to the model with P < 0.0001 [ Table 4]. Furthermore, the model indicated that participants who are nurses/midwives, laboratory scientists/technologists, and community health workers had appropriate knowledge on PEP compared to doctors and pharmacist with an odd ratio of 4 and 7, respectively [ Table 5].

Discussion
According to the World Health Organization's estimation, about 2.5% of all HIV cases among health workers worldwide are as a result of exposures to risky conditions. [10] Evidence suggests that treatment with antiretroviral drugs soon after occupational   This study revealed that majority of the respondents (91.7% and 87.2%) were aware of universal health precautions and HIV PEP, respectively. This is not unexpected given the respondents' educational background and occupational setting. This is similar though slightly higher than that reported among HCWs at Lagos University Teaching Hospital where 83.3% had prior awareness about PEP [11] but lower than the findings in another study among health workers where 97% were aware of PEP. [12] Our finding was also consistent with findings in Western Ethiopia where 92.8% of respondents had heard about PEP. [13] Among the respondents that are aware of PEP, only 46.2% got to know of it from their workplace. This may be a pointer to the lack of regular in-house trainings toward identification and control of workplace hazards which should be an important consideration at tertiary health facilities. HCWs are by virtue of their exposures be availed the opportunities of training and retraining on the prevention of accidental exposures which will in no small means reduce the incidents of blood-borne infections. The finding that almost three-quarters of the respondents (71.8%) were aware that PEP reduces the transmission of HIV following occupational exposure was corroborated by findings in previous studies done in Southwestern Nigeria (87.0%), [11] the United Kingdom, [14] and Spain. [15] The fact that up to 28.8% of the respondents had poor knowledge of PEP for HIV/AIDS underscores the need for every HCW to be aware of HIV PEP to prevent them from being infected should they accidentally have a needlestick injury with an HIV-infected patient. This is alarming considering the fact that slightly above a quarter of the respondents lack information on to what needs to be done when faced with a needlestick injury/exposure in the workplace. This finding is lower than that reported from West Ethiopia (36.9%) [13] and significantly lower than that reported in Zimbabwe (65%). [16] These findings from across the African region call for an immediate action to ensure refresher courses, training and retraining on infection prevention, and control measures in our health-care centers.
Expectedly, majority of the respondents (86.8%) had a positive attitude toward PEP. This means that they will accept the use of PEP after occupational exposure. This is not surprising since majority of the respondents are aware that HIV PEP reduces the transmission of HIV following occupational exposure, and more importantly, HIV/AIDS is a highly stigmatized infection with no known cure asides a management regimen aimed at suppressing the viral load.
Majority of the respondents (76.9%) took special precaution when carrying out procedures on HIV/AIDS patient with about 46% using a combination of safety measures which included the use of surgical or latex gloves and other protective wears. This will go a long way in preventing HIV infection.
The study further revealed a significant occurrence (22.4%) of needlestick injury among respondents during their practice. This is lower than those reported from previous studies done in Lagos, Nigeria (47.3%); [11] 74.5% reported in studies carried out in the southern part of India; [17] and 82.9% in studies done in Uganda though much higher than 11.3% reported from a study in Italy. [18] This relatively lower rate found in the study in Italy compared to the findings in other countries has to do with the improved quality of health-care services provided in their settings. This should be the aim of health-care systems in developing countries like Nigeria where this study was carried out. Each health-care service should also aim to have a comprehensive universal precaution package and improved disposal of sharps in the hospital to deter the continued occurrence of needlestick injuries among HCWs.
Furthermore, among those who experienced needlestick injury, only about a quarter (23%) reported it and was given PEP for HIV infection. This is consistent with findings in a study done in Uganda where only 21% of respondents reported needlestick injury [19] but significantly lower than what was found in another study done in Lagos, Nigeria (41%) [11] and Ethiopia (70%) revealing a very high level of underreporting of needlestick injury among HCWs. The findings from our study may not be unrelated to the high level of awareness and knowledge demonstrated by our study subjects

Conclusion and Recommendations
In general, the findings from this study showed a high level of awareness, knowledge, and attitude for HIV PEP among the study subjects. Although few (22.4%) of the HCWs experienced needle prick episodes, only a quarter of them reported the incidents, of which only a small proportion of them benefitted from PEP. This underscores the need for on-the-job training for HCWs in health facilities in Sokoto and Nigeria at large as well as identifying and addressing barriers of under-reporting and nonuse of PEP service. This will go a long way in reducing the incidence and prevalence of HIV in the country.

Financial support and sponsorship
Nil.

Conflicts of interest
There are no conflicts of interest.