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Article Dans Une Revue AIDS Care Année : 2008

Working with Risk: Occupational Safety Issues among Health Care Workers in Kenya

Ruth Suckling
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Patrick Nguku
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Caitlin Meredith
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Josephine Kibaru
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Jeremiah Muhwa Chakaya
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Hadley Muchela
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C. Gilks
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Résumé

Objective: To explore knowledge of, attitudes towards and practice of post exposure prophylaxis (PEP) among health care workers (HCWs) in a Kenyan district. Design: Site and population-based surveys, qualitative interviews and operational research Setting: Thika district, Kenya Participants: 650 staff at risk of needlestick injuries (NSIs) Methods: Research was conducted over a 5-year period in phases: i. Bio-safety assessment. ii. Staff survey. Serum drawn for anonymous HIV testing. iii. Interventions: biosafety measures, antiretrovirals for PEP and hepatitis B vaccine. iv. Repeat survey to assess uptake and acceptability of interventions. In-depth group and individual interviews conducted. v. Health system monitoring outside a research setting. Main outcome measures: Bio-safety standards in clinical areas, knowledge, attitudes and practice as regards to PEP, HIV sero-prevalence in health care workers, uptake of interventions, reasons for poor uptake elucidated, sustainability indicators. Results: 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 health care 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 needlestick injuries as low risk. Conclusion: Bio-safety remains the most significant intervention through reducing the number of needlestick incidents. PEP 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.

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Dates et versions

hal-00513430 , version 1 (01-09-2010)

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Miriam Taegtmeyer, Ruth Suckling, Patrick Nguku, Caitlin Meredith, Josephine Kibaru, et al.. Working with Risk: Occupational Safety Issues among Health Care Workers in Kenya. AIDS Care, 2008, 20 (03), pp.304-310. ⟨10.1080/09540120701583787⟩. ⟨hal-00513430⟩

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