Factors Contributing To The Uptake And Compliance With HIV post Exposure Prophylaxis (PEP) At Kenyatta National Hospital

Abstract

A study was done to determine the factors contributing to the uptake and compliance to HIV post exposure prophylaxis (PEP) at Kenyatta National Hospital, and, to find out the practices, attitudes, and knowledge of the HeWs regarding PEP for HIV in the medical settings. A cross sectional descriptive prevalence survey of needlestick injuries among the healthcare workers (Hf.Ws) at KNH was conducted, and the knowledge, attitudes and practices of the HeWs towards PEP were determined by use of a semi-structured questionnaire. A retrospective cohort study was done, where medical records of 136 Hf.Ws who got exposed to HIV through needle-stick injuries in the preceding fifty one(51) months were reviewed to evaluate acceptance and compliance on the part of the client, and correlates of acceptance and compliance, and the adherence to protocols by the staff who administered the PEP. This was done at the Kenyatta National Hospital between December 2007 and February 2008. Results: a hundred and thirty six HeWs reported at least one NS[ reported NSI in the cohort study, and 87 out of 336 HeWs reported at least one NSr during their work. The prevalence of NSI among healthcare workers at the Kenyatta National Hospital was 25.9%. Majority of those who suffered SI in the cross sectional surveys were females, forming 65.5%, while males were more (58.8%) in the cohort study. Males stood a higher risk of suffering NSI than females. Majority of those who su ffered NSI were nurses, constituting 54%, doctors/cl inical officers, 24.1 %, laboratory staff, 11.5% and support staff 10.3%. Majority of those who got NSI had college education (65.5%). The risk of suffering a NSI was highest among doctors/clinical officers, then the labortory staff, and was lowest among nurses and support staff Knowledge of source patients' HIV status was poor in both cohort and cross 5'- ctional survey. Knowledge of PEP protocols among KNH healthcare workers was equHy poor. The knowledge of the HeWs in the area of universal precautions was good with 62.1 % of participants having correct information on it. Gender, level of education and job cadre all had an association with knowledge of PEP, whereas years of service as a HeW did not have a similar association. Overall, majority of those who suffered NSI had positive attitudes towards PEP. More XVI negative attitude was witnessed among those who had never suffered the NSI. The practice of reporting the NSI was poor in the cohort study with 74.2% of participants reporting to the wrong persons. The situation was better in the cross sectional survey with 86.3% of the participants reporting the NSI to the right people. The practice of Universal Precautions was still wanting with practices such as non-gloving (10.3%) and recapping of needles (10.3%) still found among HCWs. The practice of accessing further care at KNH was below average (40.2%), and a lot of improvement is needed in this area. The practice of follow up was poor, with only 47.2% of those who suffered NSI going back to be seen at the CCC at least once, and only 7 out of the 35 who sought further care were officially discharged from the CCC by the doctor. Uptake of PEP was equally not impressive, with only 38.1 % of those who suffered a NSI accessing further care. Compliance with PEP was below average, with 36.8% of the HCWs who suffered NSI starting the ARVs, and only 19.5% completed the recommended 28 days therapy. Discussion & conclusion: There are still a lot of NSI that go unreported and hence unmanaged among healthcare workers. There is significant lack of adequate knowledge of the PEP protocols and what the hospital's guidelines regarding PEP say. Significant numbers of those who work directly with the patients still lack the much needed knowledge of how to deal with the injury. This lack of knowledge is related to the staff's job cadre, their gender and their level of education. The attitudes of the HCWs regarding PEP were mainly positive, but this did nor nave any positive effect on the uptake and compliance to PEP. There is a gap in the way patient data is captured in the medical records files. Apart from demographic characteristics, knowledge, and attitudes, it's apparent that there are other unknown factors, not captured in this study, that infiuence the practice (uptake and compliance) of PEP in Kenyatta National Hospital Recommendations: Documentation of a NSI in the patient's medical le needs to be improved for proper data keeping for future use. The protocols of PEP need to be emphasized to, and followed by, those who suffer NSl. Apart from developing eas; guidelines and protocols on PEP, the hospital needs to device a way of encouraging its staff to read and understand the PEP management. Education, monitoring, improved availability of resources, and disciplinary measures for poor compliance are necessary to improve infection control in KNH.