Working with risk: Occupational safety issues among healthcare workers in Kenya

Abstract

The objective of this study was to explore knowledge of, attitudes towards and practice of post-exposure prophylaxis (PEP) among healthcare workers (HCWs) in the Thika district, Kenya. We used site and population-based surveys, qualitative interviews and operational research with 650 staff at risk of needlestick injuries (NSIs). Research was conducted over a 5-year period in five phases: (1) a bio-safety assessment; (2) a staff survey: serum drawn for anonymous HIV testing; (3) interventions: biosafety measures, antiretrovirals for PEP and hepatitis B vaccine; (4) a repeat survey to assess uptake and acceptability of interventions; in-depth group and individual interviews were conducted; and (5) health system monitoring outside a research setting. The main outcome measures were bio-safety standards in clinical areas, knowledge, attitudes and practice as regards to PEP, HIV-sero-prevalence in healthcare workers, uptake of interventions, reasons for poor uptake elucidated and sustainability indicators. Results showed that HCWs had the same HIV sero-prevalence as the general population but were at risk from poor bio-safety. The incidence of NSIs was 0.97 per healthcare worker per year. Twenty-one percent had had an HIV test in the last year. After one year there was a significant drop in the number of NSIs (OR: 0.4; CI: 0.3–0.6; p<0.001) and a significant increase in the number of HCWs accessing HIV testing (OR: 1.55; CI: 1.2–2.1; p=0.003). In comparison to uptake of hepatitis B vaccination (88% of those requiring vaccine) the uptake of PEP was low (4% of those who had NSIs). In-depth interviews revealed this was due to HCWs fear of HIV testing and their perception of NSIs as low risk. We concluded that Bio-safety remains the most significant intervention through reducing the number of NSIs. Post-exposure prophylaxis can be made readily available in a Kenyan district. However, where HIV testing remains stigmatised uptake will be limited—particularly in the initial phases of a programme.

Acknowledgements

This paper is published with the kind permission of the Director of KEMRI (Kenya Medical Research Institute). We are grateful to the District Health Management Team and staff of Thika district in Kenya and also to Nduku Kilonzo, Eunice Kuria, Charity Mbugua and Drs Colin Speight and Anthea Klufio who were involved in the running and data collection for Phase 5 of follow-up. We would like to thank Dr Peter Tukei and the laboratory technologists of the KEMRI Centre for Virology Research. The HIV/AIDS Knowledge Programme, Liverpool School of Tropical Medicine is a collaborative programme funded by the Department For International Development to develop ‘knowledge for action’ in the field of HIV/AIDS prevention and care and funded Dr Suckling's salary for eight months. Tulane University funded Caitlin Meredith's internship.