Self-Reported Occupational Exposure to HIV and Factors Influencing its Management Practice: A Study of Healthcare Workers in Tumbi and Dodoma Hospitals, Tanzania.

Blood borne infectious agents such as hepatitis B virus (HBV), hepatitis C virus (HCV) and human immune deficiency virus (HIV) constitute a major occupational hazard for healthcare workers (HCWs). To some degree it is inevitable that HCWs sustain injuries from sharp objects such as needles, scalpels and splintered bone during execution of their duties. However, in Tanzania, there is little or no information on factors that influence the practice of managing occupational exposure to HIV by HCWs. This study was conducted to determine the prevalence of self-reported occupational exposure to HIV among HCWs and explore factors that influence the practice of managing occupational exposure to HIV by HCWs in Tanzania. Self-administered questionnaire was designed to gather information of healthcare workers' occupational exposures in the past 12 months and circumstances in which these injuries occurred. Practice of managing occupational exposure was assessed by the following questions: Nearly half of the HCWs had experienced at least one occupational injury in the past 12 months. Though most of the occupational exposures to HIV were experienced by female nurses, non-medical hospital staff received PEP more frequently than nurses and doctors. Doctors and nurses frequently encountered occupational injuries in surgery room and labor room respectively. HCWs with knowledge on the possibility of HIV transmission and those who knew whom to contact in event of occupational exposure to HIV were less likely to have poor practice of managing occupational exposure. Needle stick injuries and splashes are common among HCWs at Tumbi and Dodoma hospitals. Knowledge of the risk of HIV transmission due to occupational exposure and knowing whom to contact in event of exposure predicted practice of managing the exposure. Thus provision of health education on occupational exposure may strengthen healthcare workers' practices to manage occupational exposure

Healthcare workers’ knowledge, attitudes, practices on post exposure prophylaxis for HIV in Dar es Salaam

Background : Access to HIV care and treatment has improved over the past several years, but safety standards and precautions have not improved in the same proportions leading to increased risk of exposure to and transmission of HIV through occupational injury, mainly via needle stick injury. This hospital based study of 316 health care workers (HCW) in Dar Es Salaam aimed to investigate the knowledge, attitude and practices on post exposure prophylaxis for HIV exposure. Results: Occupational exposure to HIV was common among HCWs, affecting 169 out of 316 workers surveyed. The affected workers included nurses and doctors. Of the 169 HCWs exposed, 41 had taken post exposure prophylaxis (PEP). Only about one third knew the initial steps to be followed after exposure as recommended in National Guidelines. Hospitals were the major source of information on PEP. Most of the HCWs had satisfactory knowledge on PEP. Approximately fifteen percent of HCWs had used PEP and the mean time to start use of PEP was 13.5 hours. Approximately forty percent failed to use PEP for the full length of time prescribed; the main reason for the shorter duration was adverse affects associated with the antiretroviral drugs. Conclusion: There is a need to intensify education on PEP among HCWs to increase their awareness and knowledge and train HCWs to practice universal safety precautions to decrease risk of HIV transmission. Key words: Post-exposure prophylaxis, HIV, Healthcare workers, resource poor setting

Is there a future for TNF promoter polymorphisms?

The in vitro study of TNF promoter polymorphism (SNP) function was stimulated by the numerous case-control (association) studies of the polymorphisms in relation to human disease and the appearance of several studies claiming to show a functional role for these SNPs provided a further impetus to researchers interested in the role of TNF in their disease of interest. In this review we consider case-control studies, concentrating on the autoimmune and inflammatory diseases rheumatoid arthritis, multiple sclerosis, ankylosing spondylitis, and asthma, and on infectious diseases including malaria, hepatitis B and C infection, leprosy and sepsis/septic shock. We also review the available evidence on the functional role of the various TNF promoter polymorphisms. In general, case-control studies have produced mixed results, with little consensus in most cases on whether any TNF polymorphisms are actually associated with disease, although results have been more consistent in the case of infectious diseases, particularly malaria. Functional studies have also produced mixed results but recent work suggests that the much studied -308G/A polymorphism is not functional, while the function of other TNF polymorphisms remains controversial. Studies of the TNF region are increasingly using extended haplotypes that can better capture the variation of the MHC region