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Human Immunodeficiency Virus (HIV) and its disease Acquired Immunodeficiency Syndrome (AIDS) appeared, initially, in the early years of 1980s. Since then, the disease has become one of the most important health challenges for researchers from around the world. It is considered as one of the most important killers of humans since its first diagnosis in the U.S. in 1981. The number of newly infected cases of AIDS is increasing every year. Absence of knowledge about the disease is one of the key issues leading to AIDS. Moreover, it has been found that people keep on engaging in HIV/AIDS related behaviors, in spite of getting the infection. Moreover, the problem of exposure of healthcare workers to HIV/AIDs, and the coexistence of other diseases are also important issues in aggravating the problem. This is not only harmful for the people living with the disease, but it is also harmful for people in the surrounding areas as they can also be infected.
Epidemiology of HIV/AIDS
According to reports, about 36.9 million people in the world were living with HIV infection in the year 2014, and nearly 2.0 million newly infected cases were reported in the same year. Approximately, 1.2 million AIDS-related deaths were reported in the year 2014. Most of the cases of HIV infection were reported in Sub-Saharan Africa, i.e. 25.8 million cases, followed by Asia and the Pacific having approximately 5.0 million cases (UNAIDS, 2015).
In a study, researchers reported that about 2.1 million adolescents in the age range of 10 to 19 years were infected with HIV infection in 2012. Moreover, in the generalized epidemic countries HIV prevalence was significantly higher in adolescent females as compared to adolescent males. A huge number of HIV infections are transmitted through sex (Idele et al., 2014). However, injury through a needle or other sharp objects, the splash of blood and/or other such body fluids into the eyes, mouth or nose, or contact of infected blood with non-intact skin can also result in the spread of infection (Beyera & Beyen, 2014).
Conflicting findings related to the topic
Literature is showing conflicting findings regarding the prevalence of cerebrovascular and cardiovascular disease events in patients of HIV along with Hepatitis-C virus infection (HCV). For example, one research shows that HIV/HCV-coinfected individuals have higher chances of getting cerebrovascular and cardiovascular disease (Bedimo et al., 2010) as compared to HIV-monoinfected patients, whereas the other research shows conflicting results regarding the connection between HIV/HCV coinfection, and their relation to cardiovascular diseases (Sosner, Wangermez, Chagneau-Derrode, Le Moal, & Silvain, 2012).
The research by Bedimo at al., dealt with the study of the effect of coexistence of HCV infection along with HIV infection on the cardiovascular outcomes (2010). In the study, researchers evaluated the events of cardiovascular diseases and acute myocardial infarction in the patients. Researchers started working with 19,424 patients of HIV infection, and 31.6% of whom were coinfected with HCV (i.e. HIV/HCV). They found that the rates of developing hypercholesterolaemia were lower in coinfected patients as compared to HIV-monoinfected patients. However, the rates of hypertension, type 2 diabetes mellitus, and smoking were higher in co-infected patients. Moreover, the events of cardiovascular diseases and acute myocardial infarction were substantially higher in coinfected patients as compared to HIV- monoinfected patients. In the study, researchers concluded that HCV coinfection in HIV patients could significantly increase the chances of cardiovascular diseases (Bedimo et al., 2010). This study was performed while considering the use of drugs for the treatment of HIV infection, and that could be a contributing factor showing the difference in the presence of cardiovascular events in different patients.
Similarly, the research by Sosner et al. dealt with the study of the effect of coexistence of HICV infection along with HIV infection on the cardiovascular outcomes (2012). However, their results were conflicting to the first one. In the study, researchers considered the influence of HCV infection on the risk of developing atherosclerosis in patients of HIV infection. For the study, researchers took 18 HCV–HIV co-infected patients and compared them to 22 HIV-only patients. Researchers found that HCV chronic infection and hypercholesterolemia are independently associated with early atherosclerosis. They concluded in the study that HCV infection could be an independent cardiovascular risk factor in coinfected patients, i.e. HCV infection has no relation to aggravate cardiovascular problems along with HIV infection (Sosner et al., 2012). This study was done in small number of people, thereby requiring further research.
Hypothetical research study
In a hypothetical study, research can be done on healthcare workers, who would be exposed to the risky conditions of HIV/AIDS in healthcare settings. In any healthcare setting, healthcare workers are usually exposed to body fluids as well as blood, placing them under high risk of blood-borne infections. Among the most important causes behind the spread of infection, include percutaneous injury such as injury through a needle or other sharp objects, mucocutaneous injury such as the splash of blood and/or other such body fluids into the eyes, mouth or nose, or contact of infected blood with non-intact skin. Among the important factors that are involved in increasing overall chances of occupational exposures to blood-borne pathogens, include the number of patients of AIDS in the population as well as the number and types of blood contacts. Healthcare workers in different areas of a healthcare institution such as laboratories, and delivery, operating, and emergency rooms have higher chances of getting the infection. Moreover, certain other workers such as waste collectors and cleaners, whose duties include handling of blood-contaminated products, are also at higher risk of getting the infection (Beyera & Beyen, 2014).
Every day, accidental exposure to the infection occurs to thousands of healthcare workers during their duties of caring for patients. These exposures could cause various distressing and serious outcomes such as huge level of anxious conditions to chronic diseases as well as premature death for the patients involved that can negatively impact not only healthcare workers, but also the family members and colleagues (Beyera & Beyen, 2014).
It has been reported that out of more than 35 million healthcare works in the world, over quarter a million of them are exposed to risky conditions of getting the infection in healthcare settings every year. Consequently, more than 1000 cases of HIV infection are reported in healthcare workers, who are exposed to the risky conditions of HIV/AIDS. Most of those cases of exposures and infections have been reported in developing countries, where the chances of blood-borne infections in the general population are more than the developed countries. Moreover, the access to protective equipments and safety devices is not up to the mark in developing countries. Due to the absence of systematic surveillance in most of the developing countries, comparatively little number of cases has been documented in these regions. It has also been estimated that over 4% of all cases of infection of HIV in healthcare workers are caused by occupational exposures, and nearly half of those cases are reported in sub-Saharan Africa. Although there is still more research required, studies show that, in African countries, the healthcare systems would lose about one-fifth of healthcare employees only due to the problem of HIV/AIDs in the next few years. Due to the importance of the healthcare workers against HIV/AIDS, potential loss of such number of healthcare employees every year could be a serious problem requiring urgent attention of healthcare researchers and policy makers (Beyera & Beyen, 2014).
In the developing countries, the information regarding the events surrounding the accidental exposure to the risky conditions for HIV/AIDS in the healthcare setups require more work. Especially, the occupational exposure to healthcare workers require further investigation not only in developing countries but also in developed countries. Therefore, the study has been done to mainly find the epidemiology as well as characteristics of exposure of healthcare workers to the risky conditions of HIV/AIDS. This study and its outcomes could help in the development of surveillance systems, educational programs, healthcare policies, and preventive guidelines.
Methods
This study was done while considering the epidemiologic methods such as study design and area, sample size and procedure of sampling, procedure of data collection, data processing as well as analysis, and ethical considerations.
Study design and Area. In this study, cross-sectional study was done in an institution to find the epidemiology of the exposure of healthcare workers to risky conditions of HIV/AIDS and their related factors in a healthcare setting.
Sample size and procedure of sampling. Sample size was estimated by using the equation for single population proportion by bearing in mind about 50% of prevalence of exposure to the risky conditions of HIV/AIDS, level of confidence of 95%, and margin of error of 5%.
In the city, five different public health institutions including three hospitals and two healthcare centers were considered having about 1543 healthcare workers. Those healthcare workers were employed in different settings including pediatric department, outpatient settings, maternity, medical, gynecology, orthopedic, and surgery wards, and dental, laboratory, operation, injection, ophthalmology and dressing rooms. The sampling frame having all healthcare workers in every healthcare institution were collected from the management of every healthcare institution. After that, new sampling frame was developed through compilation of the list of every healthcare worker into a single sampling frame. Then simple random sampling procedure was used to recognize the study subjects.
Procedure of data collection. Pre-structured as well as pre-tested questionnaire was used to collect data by interviewing the healthcare workers.
Data processing as well as data analysis. Collected data were entered into the statistical software including EPI INFO and analyzed through SPSS software. For most of the variables in the study, descriptive statistics such as means, percentages, and standard deviations were performed. Multivariable logistic regression analysis was performed to control the probable effects of confounders after performing bivariable logistic regression analysis by describing the exposure to the risky conditions of HIV/AIDS such as percutaneous injury that can be caused by cutting with an infectious sharp object or needle stick, or contact with mucus membranes and/or non-intact skin with infectious blood or other such body fluids. Eventually, variables having substantial connection with the exposure to the risky conditions of HIV/AIDS were recognized on the basis of AOR with 95% CI and p-value ≤ 0.05.
Ethical considerations. The study was performed after obtaining written permission from the ethical review board of the university. Informed consent was also taken from every healthcare institution as well as study participants, who were involved in the study. Moreover, confidentiality was confirmed for the collected information for every healthcare institution as well as participant of the study by removing the names from the questionnaires.
Results
Results of the study were obtained after thorough analysis and processing.
Socio-demographic characteristics. Out of 1543 healthcare workers, 1340 participated in the research study providing about 92% of response rate. Of the total study participants, about 764 (about 57%) were males. Age of the respondents vary from 20 years to about 60 years with a mean age of 28.5 years. Most of the study participants, i.e. 844 (constituting about 63%), were from the age range of 20 to 30 years.
Epidemiology as well as characteristics of accidental exposure to the risky conditions of HIV/AIDS. Five hundred sixty two (about 42% of) healthcare workers included in the study reported minimum one history of accidental exposure to the risky conditions for HIV/AIDS in the last one year. Male workers mentioned most of the accidental exposures, i.e. 844 (about 63% of) cases of exposure, while the rest of the cases were those of females. Approximately, 630 cases (about 47%) of healthcare workers reported more than one time exposure, while the remaining cases were exposed only once. Most of the cases, i.e. 764 (about 57% of) cases, occurred as a result of percutaneous injury, followed by 737 (about 55% of) cases of exposure caused by contact of mucuous membranes as well as non-intact skin with blood, and 281 (about 21% of) cases of exposure occurred through the contact of mucus membranes and non-intact skin with tissue and/or other body fluids that can infect others. One of the leading causes of accidental exposure to the infections was heavy workload followed by the failure of using protective equipments and safety devices as well as absence of knowledge of utilizing standard precautions as reported by 858 (about 64%), 335 (about 25%), and 161 (about 12%) of cases respectively. More than half of physicians (about 54%) and about 46% of anesthetists were reportedly exposed to the risky conditions of HIV/AIDS in the last one year.
Among healthcare workers that were exposed to the risky conditions, 191 (about 34% of) cases reported the cases of infection, while the remaining 371 (about 66%) of healthcare workers were unable to report. Among the most important causes of not reporting included workload/busy schedule, i.e. 122 (about 33% of) cases; fear of discrimination or stigma, i.e. 85 (about 23% of) cases; absence of support from management, i.e. 60 (about 16% of) cases; reporting is time consuming process, i.e.59 (about 16% of) cases, and absence of awareness about the procedure of reporting, i.e. 45 (about 12% of) cases.
Characteristics in the healthcare institutions. A significant number of respondents, i.e. about 42% of respondents, reported that the workplace was without safety instructions. On a similar note, about 32% of the respondents reported that they were without any work guidance in the workplace. About 60% of the participants of the study, took training on the prevention of infection. Most of the respondents (about 66%) reported the lack of written protocol for reporting of exposure to the risky conditions for HIV/AIDS in the workplace.
Behavioral characteristics of healthcare workers. About 30% of the healthcare workers reported that they drink alcohol. Nearly, 15% reported that they smoke cigarette. About 57% of healthcare workers reported satisfaction with their job.
Factors related to the exposure to HIV/AIDS risky conditions. In bivariable logistic regression analysis, variables such as physician job hierarchy, male gender, prolonged working hours, absence of training, lack of precautionary measures, recapping needles after their use, dissatisfaction with the job, and lack of working guidelines were found to be significantly related to the contact to HIV/AIDS. On the other hand, in multivariable logistic regression analysis, absence of teaching on the prevention of infection, prolonged working hours, lack of working guidelines, work experience, and dissatisfaction with the job were found to be significantly related to the exposure to HIV/AIDS.
Discussion and Concluding Remarks
HIV/AIDs is among the most important healthcare problems of the modern world. Most importantly, its ability to spread by infecting others is a worth-considering problem for researchers. This disease is most commonly found in the developing areas of the world as those countries have less efficient programs or policies to manage the disease and treat the patients having the disease. Only HIV infection is not a problem but the coexistence of other diseases are also the problems requiring special consideration as, for example, coexistence of HCV infection with HIV infection could increase the chances of cardiovascular problems. Another important issue to consider in the spread of infection and its control is the exposure of healthcare workers to the disease causing factors. Studies clearly show that if a community wants to control the transmission of infection, they have to improve their healthcare system. Further studies are required to get knowledge about the affect of the coexistence of a disease with HIV. Moreover, further research would help in developing effective policies to control the exposure of healthcare workers and other people to the HIV/AIDs causing agents or situations.
References
Bedimo, R., Westfall, A., Mugavero, M., Drechsler, H., Khanna, N., & Saag, M. (2010). Hepatitis C virus coinfection and the risk of cardiovascular disease among HIV‐infected patients. HIV medicine, 11(7), 462-468.
Beyera, G. K., & Beyen, T. K. (2014). Epidemiology of exposure to HIV/AIDS risky conditions in healthcare settings: the case of health facilities in Gondar City, North West Ethiopia. BMC Public Health, 14(1), 1.
Idele, P., Gillespie, A., Porth, T., Suzuki, C., Mahy, M., Kasedde, S., & Luo, C. (2014). Epidemiology of HIV and AIDS among adolescents: current status, inequities, and data gaps. JAIDS Journal of Acquired Immune Deficiency Syndromes, 66, S144-S153.
Sosner, P., Wangermez, M., Chagneau-Derrode, C., Le Moal, G., & Silvain, C. (2012). Atherosclerosis risk in HIV-infected patients: the influence of hepatitis C virus co-infection. Atherosclerosis, 222(1), 274-277.
UNAIDS. (2015). Global epidemiology. Retrieved from http://www.unaids.org/sites/default/files/media_asset/20150714_epi_core_en.ppt
