High post-exposure prophylaxis uptake but low completion rates and HIV testing follow-up in health workers, Harare, Zimbabwe

Abstract

Introduction: Health care workers (HCWs), especially from sub-Saharan Africa, are at risk of occupational exposure to HIV. Post exposure prophylaxis (PEP) can reduce this risk. There is no published information from Zimbabwe, a high HIV burden country, about how PEP works. We therefore assessed how the PEP programme performed at the Parirenyatwa Hospital, Harare, Zimbabwe, from 2017-2018.
 Methodology: This was a cohort study using secondary data from the staff clinic paper-based register. The chi square test and relative risks were used to assess associations.
 Results: There were 154 HCWs who experienced occupational injuries. The commonest group was medical doctors (36%) and needle sticks were the most frequent type of occupational injury (74%). The exposure source was identified in 114 (74%) occupational injuries: 91% of source patients were HIV-tested and 77% were HIV-positive. All but two HCWs were HIV-tested, 148 were eligible for PEP and 142 (96%) started triple therapy, all within 48 hours of exposure. Of those starting PEP, 15 (11%) completed 28 days, 13 (9%) completed < 28 days and in the remainder PEP duration was not recorded. There were no HCW characteristics associated with not completing PEP. Of those starting PEP, 9 (6%) were HIV-tested at 6-weeks, 3 (2%) were HIV-tested at 3-months and 1 (< 1%) was HIV-tested at 6-months: all HIV-tests were negative.
 Conclusions: While uptake of PEP was timely and high, the majority of HCWs failed to complete the 28-day treatment course and even fewer attended for follow-up HIV-tests. Various changes are recommended to promote awareness of PEP and improve adherence to guidelines.

HIV/AIDS post‐exposure prophylaxis knowledge and uptake among health professionals in Africa: Systematic review and meta‐analysis

“…The 37 studies [22–59] included 6482 participants. All of the included studies were cross‐sectional studies and the sample size ranged from 66 [35] to 401 [45].…”

Vivências pós-acidente com material biológico por profissionais de saúde de um serviço especializado em HIV/Aids: contribuições para Educação Permanente

“…O medo do estigma esteve presente na maioria das narrativas dos participantes. Esse aspecto também é destaque em estudos que tratam de acidentes de trabalho com material biológico e risco de infecção ao HIV e da profilaxia pós-exposição 25,26 .…”

“…(P1) Embora P2 tenha se sentido apoiada pelo cônjuge, o seu relato apontou medo do preconceito, pois decidiu contar sobre a situação do acidente apenas para seu círculo de amizades após ter certeza de que não havia se infectado, o que permite identificar que houve, por algum tempo, um silenciamento de sua parte como uma forma de autoproteção. Mushambi et al 25 referem o medo dos profissionais de saúde que vivenciam essa situação em relação à possibilidade da falta de confidencialidade, do estigma e da discriminação no local de trabalho. Njemanze 26 destaca ainda que esse medo do estigma e do preconceito após um acidente com material biológico com risco de infecção do HIV também pode interferir na prática da PEP pelo profissional acidentado.…”

Post-accident experiences with biological material by health professionals of a specialized HIV/Aids service: contributions to Continuing Education

“…Fear of stigma was present in most of the participants' narratives. This aspect is also highlighted in studies dealing with accidents at work involving biological material with a risk of HIV infection and post-exposure prophylaxis 25,26 .…”