Awareness and low uptake of post exposure prophylaxis for HIV among clinical medical students in a high endemicity setting

Knowledge, attitudes and beliefs regarding HIV among medical students in Zagreb, Croatia

BACKGROUND

Medical students, as future health-care providers (HCPs) play a significant role in shaping attitudes towards people living with HIV/AIDS (PLWHA) and should possess adequate knowledge of this infection. The study aim was to assess knowledge about HIV among medical students of the University of Zagreb School of Medicine, and to determine the level of discriminatory attitudes towards PLWHA.

METHODS

We assessed knowledge about epidemiology, treatment, and prevention of HIV by using closed-ended and multiple-choice questions. Likert-scale questions were employed to determine attitudes towards PLWHA. Bivariate and multivariate ordinal logistic regression was used to assess correlates of certain discriminatory attitudes.

RESULTS

561 medical students participated, with 46.7% attending preclinical courses. Overall, 42.1% of students think they received sufficient information on HIV/AIDS during elementary and high school education. Among clinical students, 42.6%, 20.8% and 11.8% estimated accurately transmission risk after a needle injury, unprotected vaginal, and anal intercourse, respectively. 66.8% of clinical students were aware that treatment can prevent AIDS, while 58.7% and 69.8% were familiar with the rationale of using pre-exposure (PrEP) and post-exposure prophylaxis (PEP). In the multivariate analysis, individuals lacking infectology course attendance (aOR = 1.45; CI: 1.00-2.09) and those unaware of transmission routes (aOR = 1.49; CI: 1.06-2.09) showed higher odds of advocating HIV status disclosure compared to those who did not yet attend an infectology course. Students supporting extra protection for handling PLWHA bodily fluids were more likely to support refusal to treat PLWHA (aOR = 1.80; CI: 1.22-2.69) compared to those who did not support that opinion. Males were more inclined to state that they would refuse to treat PLWHA (aOR = 1.66; CI: 1.11-2.50) and disclose their HIV status (aOR = 1.62; CI: 1.17-2.27) than females. Overestimating needle injury transmission risk raised treatment refusal likelihood (aOR = 2.22; CI = 1.29-3.92) compared to those accurately informed of this risk.

CONCLUSION

Results indicate lack of knowledge of HIV transmission risks after specific exposures and about PrEP, PEP and treatment effectiveness. Gender and knowledge about HIV transmission risks influence students' attitudes towards PLWHA. Medical education should be focused on fostering correct attitudes and addressing stigma, which undermines prevention and treatment outcomes of PLWHA.

Occupational post-exposure prophylaxis among healthcare workers: a scoping review of factors affecting optimal utilization

INTRODUCTION

Post-exposure prophylaxis (PEP) is an efficacious prevention method when initiated promptly after an HIV exposure. Yet, PEP has been underutilized, even among healthcare workers (HCWs) with occupational exposure in sites with PEP policies and procedures and access to PEP medications. It is important to understand the dynamics of uneven PEP use in what appears to be an optimal context to better protect the health and wellbeing of HCWs.

METHODS

We conducted a scoping review to elucidate factors influencing HCWs' use of PEP after occupational exposure. We searched PubMed, PsychInfo and Google Scholar for peer-reviewed literature published in English from 2014 to 2022 using the terms HIV, postexposure/post-exposure prophylaxis, acceptability, healthcare workers, and values and preferences. An inductive narrative review of the resulting 53 studies identified core themes.

RESULTS

Nearly all studies (96%) with various HCW types and settings occurred in low- and middle-income countries (LMICs) in Africa and Asia. Identified themes arrayed along a trajectory of PEP use experience: awareness/knowledge; acceptability; availability/access; uptake/use; adherence/completion. Across studies, awareness of PEP for HIV prevention was high, knowledge about drug regimens and healthcare facility policies was moderate to low; acceptability of PEP was moderate to high; PEP's perceived accessibility/availability was inconsistent and varied by geographic location and setting; HCWs' uptake of PEP was low, affected by not knowing how to report an exposure and being unaware of PEP availability; and adherence/completion of PEP regimens was moderate to low, impeded by side effects and a belief that completing regimens was unnecessary to avert seroconversion. HCWs consistently expressed concern about HIV stigma.

DISCUSSION

Findings are limited by the inconsistent use of constructs across studies and a lack of clarity about reporting exposure events. Multi-level approaches are needed to address the interplay of individual, social and structural barriers that diminish HCWs' PEP use. Improved training, incident reporting, 24-hour access to non-stigmatizing PEP services and monitoring of adherence/completion are essential to optimizing HCWs' PEP use.

CONCLUSIONS

Lessons from HCWs' experience in LMICs may inform understanding of PEP under-use among people in these settings with non-occupational exposures.

Knowledge, Attitude, Practice, and Perceived Barriers for the Compliance of Standard Precautions among Medical and Nursing Students in Central India

OBJECTIVES

The aim of this study was to assess and compare (a) the knowledge, attitude, and practice of standard precautions (SPs), (b) the knowledge of post-exposure management, and (c) the perceived barriers underlying the noncompliance with SPs among future healthcare professionals (HCPs), i.e., students of medical and nursing courses in Central India.

SETTING AND PARTICIPANTS

A cross-sectional study was conducted in 2017-2018 among students of a medical and a nursing college using a pretested and modified questionnaire. Data were collected during 23 face-to-face sessions. Responses were scored according to standard guidelines of the Centers for Disease Control and Prevention and WHO, where each correct response was given a score of 1.

RESULTS

Among 600 participants, 51% of medical students and 75% of nursing students could not select the correct definition of SPs from the given options. Sixty-five percent of medical students (275/423) and 82% of nursing students (145/177) were unaware of the term post-exposure prophylaxis. Overall, knowledge about personal protective equipment and hazard symbols was poor (<25%). Furthermore, although theoretical knowledge about hand hygiene was good (510/600; 85%), its implementation was poor (<30%). Sixty-four percent of participants believed that the use of hand rub replaced the need for handwashing, even for visibly soiled hands. Some of the participants believed that the use of PPE might offend patients (16%). High workload and poor knowledge were other significant barriers underlying the noncompliance with SPs.

CONCLUSIONS

A suboptimal translation of participants' knowledge into practice is evident and signifies the presence of the know-do gap. Poor knowledge and inappropriate presumptions about the use of SPs discourage the practice of SPs. This results in increased healthcare-associated infections, increased treatment costs, and a suppressed social economy. The inclusion of a dedicated curriculum with repeated hands-on and practice-based training on SPs is suggested to minimize this know-do gap among future healthcare workers.

Occupational Exposure to Blood and Body Fluids and Knowledge of HIV Post-Exposure Prophylaxis among Medical and Allied Health Students in Northern Nigeria

Background:

Clinical students are at increased risk of exposure to blood-borne pathogens. However, little has been documented about their exposure to blood and body fluids and their knowledge of post-exposure prophylaxis (PEP) in high-HIV burden settings, such as Nigeria.

Objective:

To determine the prevalence and predictors of BBF exposure and knowledge about PEP among medical and allied health students in northern Nigeria.

Methods:

In a cross-sectional study, 273 clinical students were asked to complete structured questionnaires. The prevalence of BBF exposure was determined. Binary logistic regression was used to determine the independent predictors of BBF exposure.

Results:

The majority of the respondents (98.2%) had heard about PEP; 26.0% (n=71) had adequate knowledge about PEP. 76 (27.8%) of the 273 respondents reported accidental exposure to HIV. 230 (84.2%) respondents had positive attitude toward HIV PEP. Of those who had had accidental exposure to HIV (n=76), only 13% (n=10) received PEP. The level of knowledge about PEP was predicted by previous training (aOR 0.43, 95% CI 0.23 to 0.80 ["no" vs "yes"]), year of training (aOR 4.10, 95% CI 1.60 to 10.47 [6^thvs 4^th year]), course of study (aOR 4.69, 95% CI 2.06 to 10.68 ["allied health" vs "clinical medicine"]) and religion (aOR 5.39, 95% CI 1.40 to 20.71 ["non-Muslim" vs "Muslim"]). Similarly, accidental exposure was independently predicted by respondents’ sex (aOR 2.55, 95% CI1.36 to 4.75 ["female" vs "male"]), age (aOR 2.54, 95% CI 1.06 to 6.15 ["25–29" vs "20–24" years]), ethnicity (aOR 2.15, 95% CI1.10 to 5.14 ["others" vs "Hausa/Fulani"]), course of study (aOR 0.06, 95% CI 0.01 to 0.38 ["allied health" vs "clinical medicine"]), and previous PEP training (aOR 0.39, 95% CI 0.20 to 0.78 ["no" vs "yes"]).

Conclusion:

One in four clinical students reported exposure to BBF. Most students expressed a positive attitude toward PEP, but knowledge and uptake of PEP was sub-optimal. We recommend strengthening training curricula for infection control and prevention and enhancing protocols for timely post-exposure evaluation and follow up for all exposure incidents.

Post Exposure Prophylaxis for Occupational Exposures to HIV and Hepatitis B: Our Experience of Thirteen Years at a Rural Based Tertiary Care Teaching Hospital of Western India

INTRODUCTION

Health Care Workers (HCWs) are at risk of occupational transmission of HIV, Hepatitis B and Hepatitis C, which can be minimized by following guidelines for standard precautions as well as taking Post Exposure Prophylaxis (PEP) measures. There are limited studies from India documenting details of PEP for HIV and Hepatitis B.

AIM

We aimed to study the efficacy, tolerance, details of PEP regimens used among HCWs exposed to HIV and Hepatitis B as well as vaccination status and (Anti-Hepatitis B Surface Antigen) anti-HBS Antibody Titre Level Among HCWs exposed Hepatitis B.

STUDY DESIGN

This retrospective observational study was done at a rural based tertiary care teaching centre of Western India.

MATERIALS AND METHODS

Hospital Infection Control Committee of our institute was maintaining a record of all reported incidences of HIV and Hepatitis B positive exposures since 2003. We analysed reported incidences of exposures to HIV and Hepatitis B positive source occurred during the period of January 2003 to December 2015.

RESULTS

Of the total 96 exposures, 48 were to HIV and 48 were to Hepatitis B. Of the 48 exposures to HIV, PEP was warranted in 39. Of 39 exposures, only 14 (35.9%) received PEP within two hours. Basic regimen was used in 22 and expanded in 17 exposures. Only 12 (31.6%) reported side effects to PEP. Zidovudine based regimen was less well tolerated. All side effects were reported by female HCWs only. Of the 48 exposed to Hepatitis B, 33 (68.6%) were completely vaccinated. Out of 33, titre result was not available for eight. Three (12.0%) of remaining 25 were having low titre (<10mIU/ml) of anti-HBS antibody. Five of six with incomplete vaccination status demonstrated anti HBS antibody titre > 100mIU/ml. Of the 48, in 17 (35.4%) incidences no action was required; 23 (47.9%) were managed with booster dose of Hepatitis B vaccine and eight (16.7%) with Hepatitis B immunoglobulin. No cases of sero-conversion was reported either for HIV or Hepatitis B from available data.

CONCLUSION

Inspite of high incidences of exposures to HIV or Hepatitis B positive source, good efficacy of PEP was observed with no sero-conversion. PEP for HIV was well tolerated; female HCWs were less tolerant. Study emphasized the need for creating awareness about timely reporting of incidence, achieving maximum vaccination against Hepatitis B for all HCWs and need for anti-HBS antibody titre.