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Impact of HIV Occupational Exposure Education on Post-Exposure Prophylaxis Practices among Healthcare Workers in Nigeria

Abstract

Occupational exposure to HIV remains an important occupational health and public health concern among healthcare workers because contact with infected blood and other potentially infectious body fluids may occur during patient care, injections, blood collection, surgical procedures, laboratory activities, and the handling of contaminated sharps and instruments. Needle-stick injuries, sharps injuries, and mucous membrane exposure may place healthcare workers at risk of HIV infection, particularly when appropriate exposure prevention and post-exposure measures are not promptly implemented. HIV occupational exposure education provides healthcare workers with knowledge and practical skills relating to occupational HIV transmission risks, exposure prevention, recognition and reporting of occupational exposures, immediate first-aid measures following exposure, risk assessment, timely access to HIV post-exposure prophylaxis (PEP), adherence to PEP regimens, follow-up testing, confidentiality, and appropriate referral procedures. Post-exposure prophylaxis practices refer to the actions undertaken by healthcare workers following potential occupational exposure to HIV, including immediate reporting of exposure, prompt risk assessment, timely initiation of PEP when indicated, adherence to prescribed PEP, completion of the recommended regimen, follow-up care and testing, and appropriate documentation. In Nigeria, limited awareness of occupational HIV exposure protocols, fear of stigma, concerns about confidentiality, delayed reporting, inadequate access to PEP services, insufficient occupational health systems, and limited training may affect healthcare workers' use of appropriate post-exposure prophylaxis. Effective HIV occupational exposure education may improve healthcare workers' knowledge, confidence, response skills, and adherence to recommended PEP practices. Against this background, this study investigates the impact of HIV occupational exposure education on post-exposure prophylaxis practices among healthcare workers in Nigeria. The study is anchored on Social Cognitive Theory, the Health Belief Model, and Protection Motivation Theory. Social Cognitive Theory emphasizes the interaction between knowledge, self-efficacy, behavioural capabilities, social influences, and environmental conditions in shaping healthcare workers' occupational health behaviour. The Health Belief Model explains preventive health behaviour through perceived susceptibility, perceived severity, perceived benefits, perceived barriers, and cues to action, providing a basis for understanding healthcare workers' decisions to report occupational exposures and seek PEP. Protection Motivation Theory explains how perceived health threats, response efficacy, self-efficacy, and perceived response costs influence individuals' adoption of protective actions following occupational exposure. Collectively, these theoretical perspectives provide a suitable framework for explaining how HIV occupational exposure education may influence post-exposure prophylaxis practices among healthcare workers in Nigeria. The study will adopt a quantitative quasi-experimental research design. Primary data will be collected from healthcare workers in selected public and private healthcare facilities in Nigeria using a structured self-administered questionnaire, HIV occupational exposure knowledge assessment, and a post-exposure prophylaxis practices checklist. A multistage sampling technique will be employed to select states, local government areas, healthcare facilities, departments or units, and eligible healthcare workers. Where feasible, selected healthcare facilities or healthcare worker groups will be assigned to intervention and comparison groups. Healthcare workers in the intervention group will receive structured HIV occupational exposure education covering occupational HIV transmission risks, prevention of needle-stick and sharps injuries, recognition of potential exposure, immediate first-aid procedures, prompt reporting, exposure risk assessment, indications for HIV PEP, timely initiation of PEP, adherence and completion of PEP, follow-up testing and care, confidentiality, and appropriate referral procedures. Post-exposure prophylaxis practices will be assessed using indicators such as timely reporting of occupational exposure, immediate appropriate first aid, prompt risk assessment, timely initiation of PEP when indicated, adherence to the prescribed PEP regimen, completion of PEP, follow-up testing, attendance at follow-up appointments, and appropriate documentation of occupational exposure. Where feasible, relevant occupational health or PEP records will complement self-reported information to improve measurement accuracy. Descriptive statistics will be used to summarize healthcare workers' sociodemographic and professional characteristics, HIV occupational exposure knowledge, exposure to education, and PEP practices. Inferential statistical techniques, including chi-square tests, paired-sample tests, independent-sample tests, and logistic or multiple regression analysis, will be used to determine the impact of HIV occupational exposure education on PEP practices. Where appropriate, pre-intervention and post-intervention practice measures will be compared. Diagnostic tests will also be conducted to assess the reliability of the research instruments, model assumptions, goodness of fit, and robustness of the findings. The study is expected to find that HIV occupational exposure education has a significant positive impact on post-exposure prophylaxis practices among healthcare workers in Nigeria. Healthcare workers exposed to structured occupational HIV exposure education are expected to demonstrate improved knowledge of occupational HIV risks and greater adherence to recommended PEP procedures. Education may improve prompt reporting of occupational exposures, immediate first-aid response, risk assessment, timely initiation of PEP when indicated, adherence to prescribed medication, completion of PEP, follow-up testing, and appropriate documentation. It may also reduce misconceptions regarding occupational HIV transmission and improve healthcare workers' confidence in accessing PEP services promptly and confidentially. However, education alone may not guarantee appropriate PEP practices because healthcare workers may continue to face barriers such as limited availability of PEP services, delays in risk assessment, concerns about confidentiality and stigma, shortages of medicines, inadequate occupational health services, and weak institutional reporting systems. Consequently, HIV occupational exposure education is expected to be most effective when supported by readily accessible PEP services, clear occupational exposure protocols, confidential reporting systems, adequate medication supplies, trained occupational health personnel, and regular monitoring of workplace exposure incidents. The study is expected to contribute to the literature on occupational HIV prevention, post-exposure prophylaxis, occupational health, healthcare worker safety, infection prevention and control, health education, HIV prevention, and public health in Nigeria by providing empirical evidence on the impact of HIV occupational exposure education on PEP practices among healthcare workers. The findings will provide useful information to the Federal Ministry of Health and Social Welfare, Nigeria Centre for Disease Control and Prevention, National Primary Health Care Development Agency, state ministries of health, hospital management authorities, occupational health departments, infection prevention and control committees, healthcare professional associations, HIV programme managers, public health practitioners, development partners, and policymakers regarding strategies for preventing occupational HIV transmission. The study will also provide evidence-based recommendations for strengthening HIV occupational exposure education, improving access to confidential PEP services, establishing clear exposure reporting and response protocols, ensuring adequate PEP medication supplies, strengthening occupational health systems, improving follow-up services, and promoting timely and appropriate post-exposure prophylaxis practices among healthcare workers in Nigeria.

Keywords: HIV occupational exposure education, post-exposure prophylaxis practices, healthcare workers, HIV prevention, occupational exposure, HIV PEP, occupational health, infection prevention and control, healthcare worker safety, health education, post-exposure management, public health, Nigeria.