Blood and body fluids exposure, post-exposure prophylaxis, and HIV self-testing among healthcare workers in northern Nigeria

Figures & data

Table 1. Characteristics of healthcare workers, Aminu Kano Teaching Hospital, Kano, Nigeria.

Characteristics	Frequency No. (%) N = 403
Sex
Male	258 (64.0)
Female	145 (36.0)
Age group
<30	80 (19.9)
30–39	178 (44.1)
≥40	145 (36.0)
Ethnicity
Hausa/Fulani	306 (75.9)
Others*	97 (24.1)
Religion
Islam	354 (87.8)
Christianity	49 (12.2)
Marital status
Single	63 (15.6)
Ever married	340 (84.4)
Professional category
Physician	183 (45.4)
Nurse/Midwife	152 (37.7)
Laboratory Scientist	68 (16.9)
Years of experience
<5	87 (21.6)
5–9	127 (31.5)
≥10	189 (46.9)
Hospital Unit
Surgery	113 (28.0)
Pediatrics	86 (21.3)
Obstetrics & Gynecology	80 (19.9)
Medicine	61 (15.2)
Others**	63 (15.6)
Previous PEP Training
Yes	230 (57.1)
No	173 (42.9)

Others* include Yoruba, Igbo, Kanuri, Egbira, Igala.

Others** Laboratories, Accident & Emergency.

Table 2. Knowledge of post-exposure prophylaxis and response to accidental exposure to blood or body fluids among HCWs, Kano, Nigeria (N = 403, unless stated otherwise).

	Frequency n (%)
Knowledge of PEP
Had heard of PEP	391 (97.0)
Sources of information^*
Seminar/workshop	261 (64.8)
Lectures	244 (60.6)
Textbooks	113 (28.0)
Internet	84 (20.8)
Ward rounds	79 (19.6)
Friends & colleagues	78 (19.4)
Media	46 (11.4)
PEP is prophylactic antiretroviral medication for exposed seronegative individuals	317 (78.7)
High risk body fluids for transmission
Blood^a	403 (100.0)
Breast milk^a	325 (80.7)
Peritoneal fluid^a	220 (54.6)
Cerebrospinal fluid^a	208 (51.6)
Saliva	185 (45.9)
Synovial fluid^a	113 (28.0)
Urine	86 (21.3)
Faeces	--
Indications for initiation of PEP
Needlestick injury	383 (95.0)
HIV exposed infants	379 (94.0)
Rape	352 (87.3)
Blood/body fluid splash on mucosal surface	346 (85.9)
The source patient is at high risk for HIV	144 (35.7)
The HIV status of the source patient is unknown	110 (27.3)
All needlestick injuries in the work place	60 (14.9)
Even when source patient recently tested negative to HIV	28 (7.0)
Commencement of PEP
PEP should be commenced within 1 h	208 (51.6)
Maximum delayed commencement within 72 h	232 (57.6)
Three antiretroviral drugs are used for PEP	226 (56.1)
The duration of antiretroviral drugs for PEP is 4 weeks	141 (35.0)
Knowledge of PEP
Adequate knowledge	198 (49.1)
Inadequate knowledge	205 (50.9)
Accidental exposure
Ever had accidental exposure	141 (35.0)
Exposed during last 12 months	8 (7.9)
Type of exposure (n = 141)
Needlestick injury	76 (53.9)
Blood/body fluid splash	61 (43.2)
Both needlestick and blood/body fluid splash	4 (2.9)
Circumstances of exposure (n = 141)
Obtaining blood sample	59 (41.8)
During surgery	27 (19.1)
Setting up intravenous line	16 (11.3)
Needle recapping	12 (8.5)
Assisted delivery/injection	3 (2.1)
Postexposure HIV screening and prophylaxis (n = 141)
Post-exposure HIV screening	67 (47.5)
Received PEP	72 (13.2)
Completed 4 week PEP course	37 (26.2)
Aware of HIV self-testing
Yes	278 (69.0)
No	125 (31.0)
Preferred HIV testing method
HIV testing and counseling (HTC)	49 (12.2)
HIV self-testing (HIVST)	354 (87.8)

*Multiple responses.

^aHigh risk body fluids for HIV transmission.

Figure 1. Preference for HIV self-testing (HIVST) vs. HIV testing and counseling (HTC) among healthcare workers in northern Nigeria.

Table 3. Accidental exposure to blood and body fluids, knowledge of PEP, and preference for HIV self-testing by respondent characteristics, Kano, Nigeria (N = 403).

Characteristics	N	Accidental exposure to blood and body fluids	p-Value	Adequate Knowledge of PEP	p-Value	Preference for HIV self- testing	p-Value
Sex			0.001*		0.07		0.006*
Male	258	64 (24.8)		118 (45.7)		218 (84.5)
Female	145	77 (53.1)		80 (55.2)		136 (93.8)
Age group			0.002*		0.15		0.58
<30	80	41 (51.3)		47 (58.8)		71 (88.8)
30-39	178	59 (33.2)		82 (46.1)		153 (86.0)
≥40	145	41 (28.3)		69 (47.6)		130 (90.0)
Ethnicity			0.99		0.09		0.66
Hausa/Fulani	306	107 (35.0)		143 (46.7)		270 (88.2)
Others	97	34 (35.1)		55 (56.7)		84 (86.6)
Religion			0.12		0.74		0.98
Islam	354	119 (33.6)		175 (49.4)		311 (87.9)
Christianity	49	22 (44.9)		23 (46.9)		43 (87.8)
Marital status			0.01*		0.27		0.16
Ever married	63	31 (49.2)		35 (55.6)		52 (82.5)
Single	340	110 (32.4)		163 (47.9)		302 (88.8)
Profession			<0.001*		<0.001*		<0.001*
Physician	183	46 (25.1)		62 (33.9)		148 (80.9)
Nurse/Midwife	152	84 (55.3)		76 (50.0)		140 (92.1)
Laboratory Scientist	68	11 (16.2)		60 (88.2)		66 (97.1)
Years of experience			<0.001*		0.001		0.67
<5	87	47 (54.0)		49 (56.3)		78 (90.0)
5-9	127	29 (22.8)		45 (35.4)		109 (85.8)
≥10	189	65 (34.4)		104 (55.0)		167 (88.4)
Work unit			<0.001		0.002*		<001*
Surgery	113	33 (29.2)		42 (37.2)		84 (74.3)
Pediatrics	86	55 (64.0)		38 (44.2)		80 (93.0)
Obstetrics & Gynecology	80	25 (31.3)		47 (59.8)		76 (95.0)
Medicine	61	18 (29.5)		30 (49.2)		56 (91.8)
Others**	63	10 (15.9)		41 (65.1)		58 (92.1)
Ever exposed to blood and body fluids					0.79		0.003*
Yes	141	--	--	68 (48.2)		133 (94.3)
No	262	--	--	130 (49.2)		221 (84.4)
Ever tested for HIV			<0.001*		0.013*		<0.001*
Yes	221	130 (58.8)		121 (54.8)		207 (93.7)
No	182	11 (6.0)		77 (42.3)		147 (80.8)
Previous PEP training			0.76		0.001*		0.21
Yes	230	79 (34.4)		102 (44.3)		32 (13.9)
No	173	62 (35.8)		96 (55.5)		17 (9.8)
All respondents	403	141 (35.0)		198 (49.1)		354 (87.8)

Table 4. Logistic regression model for predictors of occupational exposure, knowledge of PEP and acceptability of HIV selftesting among healthcare workers, Kano, Nigeria (n = 403).

Characteristics	Adjusted OR (95% CI) Ever exposed to blood and body fluids	p-Value	Adjusted OR (95% CI) Adequate knowledge of PEP	p-Value	Adjusted OR (95% CI) Preference for HIV self-testing	p-Value
Sex
Male	Referent		Referent		Referent
Female	1.25 (1.15–3.08)	0.037^†	1.98 (1.20– 4.08)	0.004^†	0.47 (0.14–1.60)	0.16
Age group
<30	Referent
30–39	0.38 (0.084–1.73)	0.066	--		--
≥40	0.16 (0.027–0.92)	0.012^†	--		--
Ethnicity
Hausa/Fulani	--		Referent
*Others	--	--	1.77 (0.97–3.21)	0.28	--	--
Marital status
Single	Referent		--	--	Referent
Ever married	0.61 (0.17–2.21)	0.18	--	--	--
Profession
Physician	Referent		Referent		Referent
Nurse/Midwife	1.88 (1.18–4.66)	0.029^†	0.75 (0.37–1.51)	0.31	1.29 (1.14–3.95)	0.018^†
Laboratory scientist	0.58 (0.16–2.17)	0.55	6.79 (1.26–26.15)	0.001^†	0.15 (0.027–0.84)	0.023^†
Years of experience
<5	Referent		Referent		Referent
5–9	0.80 (0.21–3.06)	0.52	0.60 (0.29–1.26)	0.62	--	--
≥10	1.72 (0.42–7.04)	0.14	0.89 (0.47– 1.68)	0.46	--	--
Work unit
Surgery	Referent		Referent		Referent
Pediatrics	1.29 (0.42–3.93)	0.13	0.86 (0.41–1.82)	0.29	0.32 (0.11–0.93)	0.036^†
Obstetrics & Gynecology	0.06 (0.017–0.23)	0.001^†	1.50 (0.71–3.15)	0.25	0.25 (0.07–0.88)	0.029^†
Medicine	0.09 (0.03–0.34)	0.001^†	0.93 (0.40–2.15)	0.36	0.42 (0.11–0.79)	0.024^†
**Others	0.04 (0.01–0.19)	0.001^†	0.31 (0.079–1.24)	0.64	0.74 (0.17–0.98)	0.031^†
Ever tested for HIV
Yes	Referent		Referent		Referent
No	0.01 (0.004–0.03)	0.001^†	0.80 (0.46–1.38)	0.47	2.08 (1.16–6.70)	0.037^†
Previous PEP training
Yes	--		2.00 (1.34–2.99)	0.001^†	--
No	Referent		Referent		Referent

*Others = Yoruba, Igbo, Kanuri, Egbira, Igala.

**Others = Laboratories, Accident & Emergency.

^†Significant at p < 0.05; OR: Odds Ratio, CI: confidence interval.

The logistic model includes the following variables: sex, age group, ethnicity, marital status, profession, years of experience, work unit, ever tested for HIV, and previous PEP training.