Factors Influencing Availability, Accessibility and Utilization of Post Exposure Prophylaxis of Hiv by Health Care Workers in Ainabkoi North Division, Eldoret East District

Abstract

 HIV/ AIDs is a global problem with estimated 33 million persons infected worldwide in 2007 and with 2.7 million new infections (UNAIDS/Global AIDs epidemic report 2008). 60% of this lives in Sub Saharan Africa. Exposure occur through needle sticks or cuts from other sharp instruments contaminated with an infected patient’s blood or through contact of the eye, nose, mouth, or skin with a patient’s blood. PEP of HIV if initiated within 72 hours of exposure have been shown to significantly reduce the risk of getting HIV. The risk for occupational exposure to HIV has been well characterized in the developed world, but limited information is available about this transmission risk in resourceconstrained settings facing the largest burden of Kenya infection. In addition, the availability and utilization of post-exposure prophylaxis (PEP) programs in these settings are unclear. Therefore, the study sought to examine the availability, accessibility and utilization of occupational exposure to HIV and the utilization of PEP among health care workers (HCW) in hospitals. The objectives of the study was to; determine the prevalence  and types of occupational exposure in health care centres, determine accessibility and availability of occupational PEP services and assess utilization of HIV PEP services by HCWs in public and private health facilities in Eldoret East district.  The study looked into the availability, accessibility and utilization of PEP of HIV by HCWs in both government and faith base health facilities in Eldoret East district. The study adopted exploratory research design, cross sectional and quantitative data for was collected. Structured questionnaire and in-depth interviews were used to collect the data. Data was sort, summarized and analyzed statistically. The study findings revealed that there is significant number exposure 19% annually as compared to the world 0.3%  which is a subject to development and resources. The level of awareness of PEP in the health centres is low due to lack of PEP drugs in the Eldoret East district. The study recommends that there is need for the health centres facilities to conduct extensive awareness compaign to inform the health care workers of the PEP drugs availability and how it can utilized to prevent HIV infection after exposure. The findings will contribute to suggest policy changes that may lead to improvement in compliance by HCWs to universal precautions and/or use of PEP of HIV.

TABLE OF CONTENTS 

Declaration ......................................................................... Error! Bookmark not defined. 

Acknowledgement  ............................................................ Error! Bookmark not defined. 

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List of Tables ................................................................................................................... viii 

List of Figures ..................................................................................................................... x 

Abbreviations ..................................................................................................................... xi 

Abstract ............................................................................................................................ xiii 

CHAPTER ONE ............................................................................................................... 1 

INTRODUCTION............................................................................................................. 1 

1.1 Background of the Study .............................................................................................. 1 

1.2 Statement of the Problem .............................................................................................. 2 

1.3 Study Objectives ........................................................................................................... 4 

1.4 Research Questions ....................................................................................................... 4 

1.5 Justification of the study ............................................................................................... 4 

1.6 Conceptual Framework ................................................................................................. 5 

CHAPTER TWO .............................................................................................................. 6 

LITERATURE REVIEW ................................................................................................ 6 

2.1 Introduction ................................................................................................................... 6 

2.1.1 Definitions .................................................................................................................. 6 

2.2 Review of Past Studies.................................................................................................. 6 

2.2.1 Epidemiology of HIV ................................................................................................ 7 

2.3 Occupational Hazards ................................................................................................. 10 

2.3.1 Principles of HCWs safety ....................................................................................... 11 

 vi 

2.3.2 Management of HIV Exposure among health workers ............................................ 12 

2.4 Risk Assessment and Management ............................................................................. 12 

2.5 Protection of health care workers in developing countries ......................................... 13 

2.6 The Costs of Protecting Healthcare Workers .............................................................. 14 

2.7 Post Exposure Treatment of HIV ................................................................................ 15 

CHAPTER THREE ........................................................................................................ 17 

RESEARCH DESIGN METHODOLOGY .................................................................. 17 

3.0 Introduction ................................................................................................................. 17 

3.1. Study Design .............................................................................................................. 17 

3.2 Study Site .................................................................................................................... 17 

3.3. Target Population ....................................................................................................... 18 

3.4. Smple Size ................................................................................................................. 19 

3.5. Sampling Technique .................................................................................................. 19 

3.6 Data Collection Tools ................................................................................................. 21 

3.6.1 Pilot study ................................................................................................................ 21 

3.6.2 Data collection ......................................................................................................... 21 

3.6.3 Validity of Research Instrument .............................................................................. 22 

3.6.4 Reliability of Research Instrument .......................................................................... 23 

3.7 Data Management and Analysis ................................................................................. 24 

3.8 Ethical Approval ......................................................................................................... 24 

3.8.1Confidentiality .......................................................................................................... 24 

3.8.2 Informed Consent ..................................................................................................... 25 

3.8.3 Dissemination of Reports ......................................................................................... 25 

3.8.4 Anticipated Risks ..................................................................................................... 25 

 vii 

CHAPTER FOUR ........................................................................................................... 26 

FINDINGS ....................................................................................................................... 26 

4.1 Overview ..................................................................................................................... 26 

4.2 Background Information of the Respondents ............................................................. 28 

4.3 The prevalence and types of occupational exposure in our healthcare centres .......... 31 

4.4 HIV Risk, Perception and PEP Utilization ................................................................. 38 

4.5 Utilization of HIV PEP services by HCWs in public and private health facilities ..... 50 

CHAPTER FIVE ............................................................................................................ 65 

CONCLUSION AND RECOMMENDATION ............................................................ 65 

5.0 Overview ..................................................................................................................... 65 

5.1 Background information ............................................................................................. 65 

5.2 The prevalence and types of occupational exposure in our health care centres ......... 68 

5.3 Utilization of HIV PEP services by HCWs in public and private health facilities ..... 70 

5.4 Conclusion .................................................................................................................. 70 

5.5 Recommendations ....................................................................................................... 71 

5.6 Recommendation for further Research ....................................................................... 71 

References ......................................................................................................................... 72 

APPENDICES ................................................................................................................. 74 

Appendix I: Questionnaire for Health Workers ................................................................ 74 

Appendix II: Key informant interview guide.................................................................... 79 

Appendix III: Informed Consent Form ............................................................................. 80