Survey of the knowledge, attitude and practice of Nigerian surgery trainees to HIV-infected persons and AIDS patients

Surgical Outcomes of Human Immunodeficiency Virus-positive Patients Undergoing Lumbar Degenerative Surgery

STUDY DESIGN

This was a retrospective cohort studying using a national administrative database.

OBJECTIVE

The objective of this study was to determine the postoperative complications and quality outcomes of the human immunodeficiency virus (HIV)-positive patients undergoing surgical management for lumbar degenerative disease (LDD).

METHODS

This study identified patients with who underwent surgery for LDD between 2007 and 2016. Patients were stratified based on whether they were HIV positive at the time of surgery. Multivariate regression was utilized to reduce the confounding of baseline covariates. Patients who underwent 3 or more levels of surgical correction were under the age of 18 years, or those with any prior history of trauma or tumor were excluded from this study. Baseline comorbidities, postoperative complication rates, and reoperation rates were determined.

RESULTS

A total of 120,167 patients underwent primary lumbar degenerative surgery, of which 309 (0.26%) were HIV positive. In multivariate regression analysis, the HIV-positive cohort was more likely to be readmitted at 30 days [odds ratio (OR)=1.9, 95% confidence interval (CI): 1.2-2.8], 60 days (OR=1.7, 95% CI: 1.2-2.5), and 90 days (OR=1.5, 95% CI: 1.0-2.2). The HIV-positive cohort was also more likely to experience any postoperative complication (OR=1.7, 95% CI: 1.2-2.3). Of the major drivers identified, HIV-positive patients had significantly greater odds of cerebrovascular disease and postoperative neurological complications (OR=3.8, 95% CI: 1.8-6.9) and acute kidney injury (OR=3.4, 95% CI: 1.3-7.1). Costs of index hospitalization were not significantly different between the 2 cohorts ($30,056 vs. $29,720, P=0.6853). The total costs were also similar throughout the 2-year follow-up period.

CONCLUSION

Patients who are HIV positive at the time of LDD surgery are at a higher risk for postoperative central nervous system and renal complications and unplanned readmissions.

Attitude of women in a Nigerian local government to reproductive health following health education intervention

BACKGROUND

Health Education on reproductive health issues is indispensible in fostering safe sexual and reproductive health more so in rural populations. This study aimed at reflecting the role of health education in improvement of attitude of women to reproductive health in a rural Nigerian Local Government (LG).

METHODS

There was a pre-intervention, intervention and post-intervention stages in this cross-sectional study. Baseline data was collected from study and control groups after which health education was only administered to study group. Post-intervention data was collected thereafter. Chi-square Test was used to test for any significant differences while multiple regression analysis was done for factors affecting reproductive health.

RESULTS

We found a statistically significant increase in parameters relating to study respondents' attitude to reproductive health post intervention, (p = 0.000 for condoms use and concern about risk of STIs). This was not same for the control group.

CONCLUSION

A significant number of women proved a better and positive attitude to reproductive health after intervention such as improved use of condoms to evade risks associated with unprotected sex, concern about risk of HIV and STIs.

Inpatient Outcomes After Elective Lumbar Spinal Fusion for Patients with Human Immunodeficiency Virus in the Absence of Acquired Immunodeficiency Syndrome

BACKGROUND

To our knowledge, no prior study has evaluated outcomes after elective lumbar spinal surgery in human immunodeficiency virus (HIV) patients without acquired immunodeficiency syndrome (AIDS). This review investigated the impact of HIV-positive status (without AIDS) on outcomes after elective lumbar fusion for degenerative disc disease (DDD).

METHODS

Adult patients registered in the Nationwide Inpatient Sample (2002-2011) undergoing elective lumbar fusion for DDD were extracted. Multivariable regression techniques were used to explore the association of HIV positivity with outcomes after lumbar fusion.

RESULTS

This cohort included 612,000 hospitalizations (0.07% were HIV positive) of lumbar fusion for DDD. Compared with HIV-negative patients undergoing lumbar fusion, HIV-positive patients were younger (47 vs. 55 years), male (61% vs. 42%), largely insured by Medicare (30% vs. 5%), and had higher rates of chronic obstructive pulmonary disease (23.7% vs. 14.6%) (all P < 0.001) but had lower rates of obesity, hypertension, and diabetes (all P < 0.001). Multivariable models demonstrated HIV positivity to be associated with higher odds for an adverse event (odds ratio [OR], 1.92; P < 0.001), in-hospital mortality (OR, 39.91; P < 0.001), wound complications (OR, 2.60; P = 0.004), respiratory (OR, 5.43; P < 0.001) and neurologic (OR, 1.96; P = 0.039) complications, and higher costs (7.1% higher; P = 0.011) compared with non-HIV patients. There were no differences in thromboembolic events, cardiac or gastrointestinal complications, discharge disposition, or length of stay.

CONCLUSIONS

Even in this selected cohort of well-controlled HIV patients, there were high complications, with concerning rates of death and respiratory complications. These data shed new light on elective spine surgery in HIV patients and may influence the treatment algorithm of surgeons who are familiar with older papers.

HIV-related knowledge, attitude and practices of healthy adults in Cross River State Nigeria: a population based-survey

INTRODUCTION

Human Immunodeficiency Virus (HIV) remains a global health problem disproportionately distributed across Nigeria. Cross river state (CRS), a tourist state, located in the Niger delta, has one of the highest prevalence rates. There is evidence that poor knowledge and stigmatization are obstacles to achieving universal access to HIV prevention programs. The objective of this study was to determine the Knowledge, Attitude and Practice (KAP) of HIV among adults resident in CRS, Nigeria.

METHODS

A cross sectional descriptive survey design was employed. A total of 1,620 healthy adults were recruited. KAP towards HIV was assessed using a structured pre-tested questionnaire. Categorical variables were described as frequencies and continuous variables as median and interquartile range. Kruskal-Wallis test was used to determine relationship between variables and median KAP scores. P value < 0.05 was considered significant. All analyses were performed using Stata 12 statistical package.

RESULTS

A total of 1,465 respondents completed the questionnaire correctly giving a response rate of 91%. The M: F ratio was 1:1.8. The median age was 38 years. Majority was married and had formal education. Knowledge of HIV and common routes of transmission was high (>80%). However, misconception that HIV can be transmitted through hugging, hand shake, mosquito bites and witch craft was also common (> 60%). The overall attitude and practice towards persons living with HIV infection was poor.

CONCLUSION

This study showed misconceptions in the knowledge and consequences of HIV infection which is associated with negative attitude towards persons living with HIV.

National trends and in-hospital outcomes in HIV-positive patients undergoing spinal fusion

STUDY DESIGN

A retrospective analysis of population-based national hospital discharge data collected for the Nationwide Inpatient Sample.

OBJECTIVE

To examine the trends and in-hospital outcomes of patients with human immunodeficiency virus (HIV) infection undergoing spinal fusion on a national level.

SUMMARY OF BACKGROUND DATA

Highly active antiretroviral therapy has provided healthier lives and prolonged the life expectancy of HIV-positive patients. However, few previous studies have reported trends and outcomes of HIV-positive patients undergoing spinal surgery.

METHODS

Clinical data were derived from the US Nationwide Inpatient Sample between 2000 and 2009. Patients who underwent spinal fusion were identified. Data regarding HIV, patient- and health care system-related characteristics, comorbidities, in-hospital complications, and mortality were retrieved and analyzed. In-hospital outcomes were compared between HIV-positive and -negative patients and analyzed with the use of multivariate logistic regression.

RESULTS

A total of 5,070 HIV-positive patients underwent spinal fusion in the United States during the last decade. From 2000 to 2009, population-adjusted incidence of HIV-positive patients who underwent spinal fusion has increased more than 3-fold (0.094 per 100,000 in 2000 to 0.303 per 100,000 in 2009; P < 0.001). Comparison between HIV-positive and -negative patients showed that HIV-positive patients had a significantly higher respiratory complication rate (6.2% vs. 3.2%), wound-related complication rate (2.7% vs. 1.7%), overall in-hospital complication rate (12.2% vs. 9.5%), and in-hospital mortality rate (1.6% vs. 0.3%), as well as longer hospital stay (6.6 d vs. 4.2 d). The risk of in-hospital mortality was 3.53 times higher in HIV-positive patients after controlling for other factors (95% confidence interval, 2.02-6.14; P < 0.001).

CONCLUSION

During the last decade, the incidence of HIV-positive patients undergoing spinal fusion has increased in the United States. In this study, HIV infection was an independent risk factor for in-hospital mortality in patients undergoing spinal fusion.

LEVEL OF EVIDENCE

3.

Cancer burden among HIV-positive persons in Nigeria: preliminary findings from the Nigerian AIDS-cancer match study

BACKGROUND

Although Nigeria has a large HIV epidemic, the impact of HIV on cancer in Nigerians is unknown.

METHODS

We conducted a registry linkage study using a probabilistic matching algorithm among a cohort of HIV positive persons registered at health facilities where the Institute of Human Virology Nigeria (IHVN) provides HIV prevention and treatment services. Their data was linked to data from 2009 to 2012 in the Abuja Cancer Registry. Match compatible files with first name, last name, sex, date of birth and unique HIV cohort identification numbers were provided by each registry and used for the linkage analysis. We describe demographic characteristics of the HIV clients and compute Standardized Incidence Ratios (SIRs) to evaluate the association of various cancers with HIV infection.

RESULTS

Between 2005 and 2012, 17,826 persons living with HIV (PLWA) were registered at IHVN. Their median age (Interquartile range (IQR)) was 33 (27-40) years; 41% (7246/17826) were men and 59% (10580/17826) were women. From 2009 to 2012, 2,029 clients with invasive cancers were registered at the Abuja Cancer Registry. The median age (IQR) of the cancer clients was 45 (35-68) years. Among PLWA, 39 cancer cases were identified, 69% (27/39) were incident cancers and 31% (12/39) were prevalent cancers. The SIR (95% CI) for the AIDS Defining Cancers were 5.7 (4.1, 7.2) and 2.0 (0.4, 3.5), for Kaposi Sarcoma and Cervical Cancer respectively.

CONCLUSION

The risk of Kaposi Sarcoma but not Cervical Cancer or Non-Hodgkin's Lymphoma, was significantly increased among HIV positive persons, compared to the general population in Nigeria.

Association of knowledge of HIV and other factors with individuals' attitudes toward HIV infection: a national cross-sectional survey among the Japanese non-medical working population

Background

The stigma of and discrimination because of HIV has been described as the most important obstacle to prevention and treatment efforts. The purpose of this study was to investigate negative attitudes and prejudice toward HIV among the Japanese non-medical working population and to explore contributing factors.

Methods

An online anonymous nationwide survey involving approximately 3,000 individuals was conducted in Japan. Questions ranged from background information and HIV knowledge to individuals’ attitudes towards HIV infection in the workplace. Descriptive statistics and logistic regression were applied for analysis.

Results

Thirty-three percent of participants feared transmission of HIV from infected colleagues, 34% tended to avoid contact with them and 40% had prejudiced opinions about HIV infection. Despite a relatively high level of knowledge of HIV/AIDS overall (11.9±3.3 from 15 points), only 50% of individuals were aware of some issues. Greater knowledge was associated with less negative attitudes towards HIV infection (OR 0.39, 95% CI 0.31–0.48 for prejudiced opinion, high compared with low level of knowledge), whereas greater health consciousness was inversely related to attitude (OR 1.97, 95% CI 1.50–2.58 for prejudiced opinion, high compared with low health consciousness).

Conclusion

Knowledge neutralizes peoples’ negative attitudes towards HIV infection, whereas greater health consciousness may worsen them. Educational programs should balance knowledge with health consciousness to improve the efficacy of HIV interventions.

Exploration of healthcare workers' perceptions on occupational risk of HIV transmission at the University of Gondar Hospital, Northwest Ethiopia

BACKGROUND

HIV/AIDS has several means of transmission. Exposure to blood and other body fluids is a very important means of transmission. Healthcare workers are exposed to this disease mainly due to the nature of their work. This is an exploration of the perceptions of healthcare workers of the University of Gondar Hospital.

METHODS

Based on purposive sampling seven healthcare workers were selected from different departments in the hospital so that they could reflect on their perceptions. The selected healthcare workers were asked about the risks related to their work, their experience of HIV related hazards and their general views on the transmission of HIV. The main themes were identified for analysis and the views were summarized under the themes.

RESULTS

All the respondents were aware of the risk of acquiring HIV in healthcare settings. Some had experienced accidents that made them take post-exposure prophylaxis, and most witnessed accidents like needle-stick injuries to their colleagues. They also expressed their feelings that their workplace was not the best place to work at.

CONCLUSION

Health professionals are well aware of the possibility of HIV transmission associated with their practice. Accidents like needle stick injuries are apparently common; and at the same time, the practice of healthcare workers towards using universal precautions looks poor.

Knowledge and attitudes of physicians in private practice towards HIV/AIDS in Mashhad, Iran

Being responsible for providing care for HIV/AIDS in a society, physicians should be knowledgeable and have favourable attitudes. We designed a cross-sectional study to assess knowledge and attitudes towards HIV/AIDS of private practicing physicians in Mashhad, Iran. A total of 346 general practitioners and specialists completed anonymous self-administered questionnaires with response rate of 91.1%. For knowledge questions, the mean proportion of correct responses was 53.5% (±13.2). Misconceptions about HIV transmission were the main areas of insufficient knowledge. Surprisingly only 20% knew how to manage a patient who had experienced sexual contact with an HIV-positive partner. While 84% disagreed that ‘HIV-infected individuals deserved to catch infection’ owing to high-risk behaviours, 38% sympathized less with people who were infected via extramarital sex. It seems that knowledge and attitudes towards HIV/AIDS among the studied physicians is not favourable and is an area that requires attention to enable effective management of the disease in Iran.

Scarcity of healthcare worker protection in eight low- and middle-income countries: surgery and the risk of HIV and other bloodborne pathogens

OBJECTIVE

In view of the substantial incidence of bloodborne diseases and risk to surgical healthcare workers in low- and middle-income countries (LMICs), we evaluated the availability of eye protection, aprons, sterile gloves, sterilizers and suction pumps.

METHODS

Review of studies using the WHO Tool for the Situational Analysis of Access to Emergency and Essential Surgical Care.

RESULTS

Eight papers documented data from 164 hospitals: Afghanistan (17), Gambia (18), Ghana (17), Liberia (16), Mongolia (44), Sierra Leone (12), Solomon Islands (9) and Sri Lanka (31). No country had a 100% supply of any item. Eye protection was available in only one hospital in Sri Lanka (4%) and most abundant in Liberia (56%). The availability of sterile gloves ranged from 24% in Afghanistan to 94% in Ghana.

CONCLUSION

Substantial deficiencies of basic protective supplies exist in low- and middle-income countries.

Can media campaign messages influence change towards ecologically based rodent management?

Context In Asia, losses to rodents contribute to the undernourishment of smallholder families. Ecologically based rodent management (EBRM) has become the national policy for rodent management in rice-based agriculture in Indonesia, the Philippines and Vietnam. EBRM requires community action. Therefore we need to develop communication campaigns that increase community involvement in rodent management. Aims This study evaluates the effects of a campaign to promote EBRM in a community that suffers chronic rodent losses to their rice crop. We hypothesised that the campaign would create changes in rodent management by farmers based on key messages delivered. Methods We documented existing beliefs and management practices, and captured changes in knowledge, attitudes and behaviour of smallholder farmers after the campaign. We also document benefits to the community. We used qualitative tools to evaluate existing beliefs and management practices of rodents in nine villages in Zaragosa, one of which was a focus village for the campaign. Key results Farmers who were influenced by the campaign had significantly higher mean rank scores in knowledge and attitudes pertaining to key messages of the campaign, such as working together, proper timing of management actions, and that rodents can be controlled. Farmers who heard the campaign obtained yields that were higher by 0.7 t ha–1 compared with those with no exposure to the campaign. A year after the campaign, the increase in rice yield in Zaragosa was sufficient to feed 1375 adult Filipinos for a year. The campaign influenced policy on rodent management in Zaragosa and subsequently at the provincial level. Conclusions A media campaign with support from local leaders and extension staff is an effective way to disseminate EBRM, leading to positive economic benefits for smallholder farmers. A media campaign alone is less effective. Implications A communication campaign on EBRM with follow-up support from extension experts is a highly effective pathway for changing attitudes and practices of smallholder farmers on rodent management, and for effective dissemination of EBRM.

Challenges in treating malignancies in HIV in Nigeria

PURPOSE OF REVIEW

Sub-Saharan Africa has the largest population of people living with AIDS in the world, with Nigeria having the third largest after South Africa and India. With the advent of treatment programs, more people in Nigeria are now living with the virus but are at increased risk of cancer similar to the experience in other parts of the world. This review uses publications on HIV-associated cancers emanating from Nigeria in 2008 to map the current landscape of prevention, diagnosis and treatment of these conditions. The opportunities and challenges identified in this review will provide a template for designing appropriate clinical and public health intervention to stem another epidemic, this time of AIDS-associated malignancies.

RECENT FINDINGS

There is a paucity of literature on AIDS-associated cancers from Nigeria, and most reports are based on hospital or pathology case series. Poor case identification and diagnosis and rudimentary cancer registration militate against adequate quantification of the prevalence of AIDS-associated cancers in Nigeria. Several initiatives, working with the HIV treatment programs, governmental and nongovernmental local and international agencies, are rising to the challenge and creating new opportunities for cancer prevention, treatment and research that takes advantage of improved treatment infrastructure provided for people living with HIV/AIDS.

SUMMARY

Nigeria is about to witness substantial increase in the background incidence of cancers due to high prevalence of HIV and expanded treatment programs. Creative methods are needed to deploy effective prevention, case identification, registration and treatment programs that are consistent with the socioeconomic development of the country.

Concerns, attitudes, and practices of orthopaedic surgeons towards management of patients with HIV/AIDS in Nigeria

The increasing number of people living with HIV/AIDS is causing concern among surgeons over risk of occupationally acquired HIV infection. This may influence their attitude to such patients. The purpose of this study was to develop a cross-sectional survey of orthopaedic surgeons to assess their concerns, attitudes, and practices towards management of HIV-positive patients in Nigeria. All respondents were males, 55 (73.3%) of them indicated concern over the risk of occupational acquisition of HIV infection and 37 (49.3%) had examined or operated on at least one HIV/AIDS patient. Sixty (79.9%) were willing to be tested for HIV and 51 (67.9%) were previously tested. Fifty-seven (75.9%) would order preoperative HIV screening of high risk patients, and 67 (89.3%) would operate on HIV-positive patients. Most orthopaedic surgeons in Nigeria would operate on HIV-positive patients.

Identifying what rural health workers in Malawi need to become HIV prevention leaders

Health workers have high potential as HIV prevention leaders, but health system and individual barriers limit their impact. This descriptive qualitative study identified the HIV prevention needs of rural health workers to use as a basis for tailoring an HIV/AIDS risk-reduction intervention. Data included interviews with 9 health administrators, 22 focus groups with 200 health workers, and 12 observations of caregivers in two rural districts. Health system barriers identified included lack of essential supplies, staff shortages, overcrowded facilities, and lack of training. Individual barriers included hopelessness, stigmatizing attitudes, knowledge gaps, and risky personal behaviors. Health workers also expressed willingness to be HIV prevention leaders and role models. Most results agree with previous African studies. Personal risky behaviors and willingness to be HIV prevention leaders have not been previously reported. Results provide insights for developing effective interventions and health policies to address health workers' HIV prevention needs.

Risk perception and attitudes towards HIV in Serbian health care workers

BACKGROUND

Health care workers (HCWs) are at risk of occupational exposure to human immunodeficiency virus (HIV).

AIM

To investigate the perception of professional risk from, and the knowledge, attitudes and practice of HCWs to HIV and AIDS in Serbia.

METHODS

Cross-sectional study of 1,559 Serbian HCWs using self-administered anonymous questionnaires. Chi-square testing and multiple logistic regression analysis were applied.

RESULTS

Eighty-nine per cent of HCWs believed that they were at risk of acquiring HIV through occupational exposure. The perception of professional risk was higher among HCWs frequently exposed to patients' blood and body fluids (OR 7.9, 95% CI 4.4-14.5), who used additional personal protection if the HIV status of patient was known (OR 2.6, 95% CI 1.5-4.6), who had experienced sharp injuries within the last year (OR 1.9, 95% CI 1.0-3.8) or who had been tested for HIV (OR 2.1, 95% CI 1.2-3.5), and among HCWs who had treated HIV-positive patients (OR 1.7, 95% CI 1.1-2.8). The majority of respondents had deficient knowledge about modes of HIV transmission. Attitudes towards HIV-positive patients were significantly different by occupation. Seventy per cent of HCWs used appropriate protection during their daily work with patients.

CONCLUSIONS

HCWs require specific educational programmes and training protocols to ensure that they are adequately protected when carrying out high quality care.

A descriptive, retrospective study of 567 accidental blood exposures in healthcare workers in three West African countries

We conducted a multi-centre study in West African hospital wards to document accidental blood exposure (ABE) risks in these settings, and assessed the incidence of ABE in participating healthcare workers (HCWs) retrospectively. In total, 1241 HCWs participated in the survey from 43 hospital wards. Among them, 567 (45.7%) had sustained at least one ABE with an estimated incidence of 0.33 percutaneous injuries (PCIs) and 0.04 mucocutaneous contacts (MCCs)/HCW/year in medical or intensive care personnel and 1.8 PCIs/HCW/year in surgeons. The ABE was a needlestick in 454 (80.1%) of 567 cases, a cut in 19 cases (3.4%), a splash or contact with non-intact skin in 87 cases (15.3%), and was undocumented in seven cases (1.2%). The source patient's human immunodeficiency virus (HIV) serostatus was positive in 74 cases (13.1%), negative in 65 cases (11.5%), and unknown in 416 cases (73.4%). The ABE was not notified in the ward in 392 cases (69.1%). Healthcare structures can improve HCWs' safety and reduce the stigma against HIV-infected patients by improving access to training, information, primary prevention (ABE prevention equipment) and secondary prevention (postexposure prophylaxis) of occupational infection risks.