SCHOOLE OF MEDICINE AND COLLAGE OF HEALTH SCINCE DEPARTMENT OF

NURSING

KNOWLEDGE, ATTITUDE, AND PRACTICE TOWARDS POST

EXPOSURE PROPHYLAXIS FOR HIV/AIDS INFECTION
ANDASSOCIATED FACTORSAMONG HEALTH CARE WORKERS IN
DEBREMARKOS REFERRAL HOSPITAL WEASTERN ETHIOPIA,
2017

BY:
Mulusew Guanche
Muluken Sirie
Asrie Tilahun

ADVISOR
Fasil Wagnew (BSC, Msc)
Rahel Asires (Bsc,)

A Senior essay proposal to be submitted to Debre Markos University,

School of medicine and college of health Science department of Nursing, in
partial fulfillment of the requirement of Bachelor of Science Degree in
Nursing

JANUARY 2017 DEBRE MARKOS, ETHIOPIA

ACKNOWLEDGEMENT
We are sincerely great full to our advisor Mr. Fasil Wagnew (BSC, MSC) and Mr. Rahel
Asres (Bsc,) for his help, advice and encouragement in preparation of the research proposal
effectively.
We would like to address our appreciation to Debre Marko’s University College of medicine
and health science department of nursing for the provision of substantial chance to
developing research proposal.
Lastly, we would like to thanks to Debre Marko’s Referral Hospital for giving necessary
information.
SUMMARY
Background: - The first case of HIV/AIDS reported in 1984 and HIV/AIDS declared as
public health emergency in 2002 in Ethiopia. Health workers are at risk of acquiring
infections, because of occupational exposure to blood and other body fluids. The first case of
documented sero conversion after specific exposure to HIV was reported in 1984(1). Post
exposure prophylaxis is a short-term antiretroviral treatment to reduce likely hood of
HIV/AIDS infection. It has been associated with an 80% of reduction in the risk of HIV
infection among HWs exposed to HIV/AIDS on work (3).
Objectives:- To assess the knowledge, Attitude and practice of health workers about PEP for
HIV/AIDS infection and associated factors among health care workers in Debremarkos
Referral Hospital ,Ethiopia.
Methods: - A cross sectional study design will be carried out from September 15, to January
05, 2017. A total of 380 health care workers will be participated in the study at Debremarkos
referral hospital. Data will be collected using pre tested self-administered questionnaire and
analyzed manually by tallying method and scientific calculator.
WORK PLAN: The research will be conducted based up on the prepared time table. .
WORK BUDGET: the overall cost required for this study will be 1490 birr.
KEYWORDS:knowledge,attitude,andpractice,post,exposure,prophylaxis,HIV,AIDS,Debrema
rkos Referral Hospital.
TABLE CONTENTS
Contents...............................................................................................................................................i

1. INTRODUCTION.......................................................................................................................1

1.1 Back Ground................................................................................................................1

1.2. Statement of the Problem............................................................................................1

1.3 Significance of the Study.............................................................................................2

1.4 Justification of the study..............................................................................................2

2. LITERATURE REVIEW............................................................................................................3

2.5. Conceptual framework................................................................................................4

3. OBJECTIVES OF THE STUDY................................................................................................5

3.1 General Objective:.......................................................................................................5

3.2 Specific Objectives.......................................................................................................5

4. METHODS AND MATERIALS.................................................................................................5

Page | 2
 4.1 Study Area and Study Period.......................................................................................5

4.2 Study Design................................................................................................................5

4.3.1 Source Population.....................................................................................................5

4.3.2 Study Population.......................................................................................................5

4.4 Inclusion and Exclusion criteria...................................................................................5

4.4.1 Inclusion criteria........................................................................................................5

4.4.2 Exclusion criteria......................................................................................................5

4.5 Sample Size and Sampling technique..........................................................................6

4.5.1 Sample Size Determination.......................................................................................6

4.5.2 Sampling Technique..................................................................................................6

4.5.3 Sampling procedure..................................................................................................6

4.6 Study Variable............................................................................................................6

4.6.1 Dependent variables..................................................................................................6

4.7 Data Collection Instruments and Procedures...............................................................7

4.7.1 Data collection instruments.......................................................................................7

4.8 Data quality control......................................................................................................7

4.9 Data Processing and Analysis......................................................................................8

4.10 Ethical Consideration.................................................................................................8

4.11 Dissemination of the Findings....................................................................................8

4.13 Operational Definition...............................................................................................8

5. WORK PLAN.............................................................................................................................9

6. BUDGET...................................................................................................................................10

7. References.................................................................................................................................10

8. Annexes:....................................................................................................................................11

Page | 3
 LIST OF ABREVATION
3TC- Lamivudine
AIDS - Acquired Immune Deficiency Syndrome
ARV - Anti Retroviral
ART - Anti Retroviral Therapy
EFZ - Efavirenz
HWS - Health Workers
HCWs-Health care workers
HIV - Human Immunodeficiency Virus
KAP - Knowledge, Attitude and Practice
NNRTIS – Non Nucleoside Reverse Transcriptase Inhibitors
NRTIS - Nucleoside Reverse Transcriptase Inhibitors
NSI - Needle Stick Injury
OE -occupational Exposure
PI - Protease Inhibitors
SRP - Student Research Program
UP - Universal Precaution
UNAIDS - Joint United Nation Program on HIV/AIDS
WHO- World health organization
ZDV – Zidovudine

Page | 4
← 1. INTRODUCTION

← 1.1 Back Ground

HIV is a chronic infection caused by human immune deficiency virus, type 1 and type 2,
which infect human only. The major transmission was sexual contact, but various mode of
transmission may be classified as occupational and non-occupational. Occupational exposure
is when someone work in health care setting is potentially exposed to material infected with
HIV. (2,3)
Health care workers are at risk of acquiring infection with HIV, because of occupational
exposed to blood and other body fluids. In some health facilities in Addis Abeba, 38.2% of
health care workers experienced at least one needle stick injury in their life time and 19%
experienced needle stick injury within a year. (5, 6, 7).
To prevent transmission of HIV to HWs in the work place CDC offers prevention strategies
such as building better prevention program, administrative efforts and infection control
precautions, which includes routinely using PPE, immediate washing of hands and skin
surface after contact with blood or body fluids, and care full handling and disposing of sharp
instruments. Although the most important strategy for reducing the risk of occupational
transmission is, to prevent exposures, plans for post exposure management of HWs should be
in place. (3, 4)
Post exposure prophylaxis (PEP), is a short term ARV treatment applied to reduce like hood
of HIV infection after potential exposure to HIV either occupational or non-occupationally,
with in the health sector PEP should be provided as a compressive universal precaution
package; that reduce staff exposure to infectious hazards at work place. PEP has been
associated with 80% reduction in the risk of HIV infection among health workers exposed on
Job. (3)

← 1.2. Statement of the Problem

HIV is a serious health problem costing the lives of many people is including the health
workers (HCWs).UNAIDS is the main advocate for accelerated, comprehensive and
coordinated global action on the HIV/AIDS.UNAIDS seeks to prevent the HIV/AIDS
epidemic from becoming a sever pandemic. As of 2012global HIV/AIDS burden report, 34
million peoples living with HIV/AIDS globally, about half do not know their status. (10, 11)
In Ethiopia while the epidemic has stabilized in the past decade, HIV/AIDS was continued to
be major development challenges. In 2010 approximately 1.5 Ethiopians living with HIV
AIDS and adult prevalence rate was estimated to be 1.5 percent in 2011. The government of
Ethiopia is making great efforts to respond to epidemic and nationally the incidence of HIV
infection declined by over 25% between 2001 and 2009. In 2011 percentage of HIV infected
adults taking (Receiving) ART was 86%. Currently the response was guided by the second
multi sartorial strategic plan (SPMII) (2009- 2014). (11, 12, 13)
Health workers are facing a number of unique challenges to stay healthy in the face of the
generalized HIV/AIDS epidemic. This is also becoming synergistic by the occupational risk
to the virus. HIV is probably the most serious, and causes of anxiety among HCWs. Currently
there is a significant increase in the number of people living with HIV infection as a result,
more people with HIV coming into contact with health care services. Which increasing
potential for workplace accidents that may expose workers to HIV-infected fluids, in many
countries including Ethiopia, each day thousands of HCWs around the world suffered
accidental exposure to blood borne pathogens; the HIV was being one of such pathogens.
According to WHO, every year there are approximately 3 million percutaneous exposures

5|Page5
among HCWs worldwide. These exposures estimated to be result in 200-5000 HIV
infections. (5, 6, 10, 14)
According to WHO study discussion paper on PEP for occupational HIV exposure and
factors that associated with PEP individuals have acquired HIV following occupational
exposure despite the use PEP included ,in-service training, educational status, year of
experience, clarity of protocols ,fear of side effect, fear of stigmatization and discrimination,
high work load and lack of protective barriers. In its study WHO classified 14 countries
Africa, in to two sub groups, Ethiopia is one of those countries included under sub groups of
E, according to this discussion paper, in this sub region, out of total population the proportion
of health care workers was 0.30% and 19400 HCWs are exposed to at least one percutaneous
injury with sharp object contaminated with HIV, 620 infections of HIV among HCWs
attributed to sharp injuries. (15)
Preventing the occurrence of HIV infections resulting from such accidental exposures are
very serious, Due to lack of knowledge attitude and practice towards occupational exposure
to blood born infection ,including HIV infection ,via accidental occurs frequently among
health care personnels .It has nearly one million health care workers suffer needle stick
injury each year. (16, 17)
Although exposure through occupational injuries can usually be avoided by following good
working practices, HCWs should consider the implications of taking PEP. Available data
from developing countries show that adherence to the “standard precaution” and
documentation of occupational exposures are suboptimal and the knowledge about PEP
among HWs is poor. (7, 14)

← 1.3 Significance of the Study

The risk of acquiring HIV infection in occupational exposure becomes increasing. Despite
the PEP for occupationally exposed HWs, reduces the risk of infection and ensures work
place safety. But, the use of PEP is depending on knowledge, attitude and practices of HWs
about it.
Therefore, continually assessing, clearly and deeper understanding of the knowledge, attitude
and practice of HWs about PEP, is one of the key prerequisite information required in
designing, relevant, affective programs on prevention of occupational exposure and reduction
of risk of infection.
In addition to these, the study could provide information for those who are working on
prevention and controlling of HIV/AIDS to focus on occupational risk of infection. The study
findings also will help as a secondary data, as base line for future study conducted regarding
the KAP of HWs about PEP in this local area, other parts or even outside the country

← 1.4 Justification of the study

This explanatory study will be performed to provide baseline information refill the gap on
KAP towards occupational PEP. This study aimed to evaluate KAP towards the availability of
access to use occupational exposure PEP and to describe barriers to the access use of
occupational PEP and evaluate the association between specific knowledge items and self
reported knowledge occupational PEP.

This study will be used to an awareness of PEP scanty, to assessing occupational exposure
and health workers will be chose as the target population for this study because they are
high risk of both occupational and non-occupational HIV infection.

← 2. LITERATURE REVIEW

6|Page6
The number of peoples living with HIV/AIDS rose from around 8 million in 1990 to 34
million at the end of 2011. The overall epidemics growth has been stabilized in recent years.
For instance, he rates of new infections decreased by half in the 25 counties of the world in
the past decade due to significant increase in people receiving ART. In addition to these the
number of AIDS related deaths has been also deceased with 63 percent of all peoples living
with HIV/AIDS residing in sub-Saharan Africa, for which the regions carry the greater
burden of epidemics. Despite the encouraging progress in stopping new infections remains
high two and half million peoples were infected in 2011. (11, 13)
According to the WHO, every year approximately there are three million percutaneous
exposures among Health care workers, worldwide. These exposures are estimated to be
resulted in 200 to 5000 HIV infections, Although the exact number of people experiencing
occupational HIV exposures and infections in Ethiopia is not available, approximately
estimated number of Ethiopians living with HIV/AIDS were 1.2 million in 2010. Ethiopia
represents a stable low level, generalized epidemic, with national adult prevalence estimated
at 1.5 percent and marked regional variation driven by most at risk populations. (1, 14)
The study conducted in London to asses’ level of knowledge and experience of PEP among
Junior doctors shows that most them had heard PEP (93%), but fever was aware that most
them had heard PEP (93%), but fewer was aware that it reduced the rate of HIV transmission
(76%). Only eight percent could name the drug recommended in the guidelines and fourth
three percent couldn’t name any. Almost one third (29%) did not know with what period PEP
should be administered. Majority of respondents (76%) had experienced high risk exposure to
potentially infectious materials at some stage in their carriers, however about 18% only had
sought advice about PEP following exposures. (21)
A survey conducted in India to asses’ level of PEP guidelines awareness among 70 health
care workers reveal that 20% of respondents were aware time risk of transmission, about one
third identified all high risk exposures correctly, (78%) of them correctly stated initial stapes,
washing of the site with water and soap. Sixty-four percent correctly stated PEP should be
initiated within one hour of injury. Name knew axially which drugs to be taken, 42% were
aware of the use of one drug (ZDV) only. Only 6% knew correct duration of PEP. (22)
Another survey done in china on Yuan province on 33 HCWs shows that, 52% consider
themselves as high risk, 10% believes that occupational exposures was un avoidable, while
15% believes risk was minimized by using care full following of universal precaution.
Working in surgery department, gynecology department, Emergency room was considered by
respondents to confer highest risk for occupational exposure. Fifty percent reported
occupational exposure. Four of respondent even not take HIV screening test after exposure.
Only 24.2% took PEP medication after exposure, only 1 respondent’s finish full course of
treatment. Reason for not taking PEP after exposure were, not considering PEP as effective,
ignorance of risk of potential of infection, lack of knowledge of PEP, lack of opportunity,
unavailability of service and fear of side effects of drugs. (18)
Study done on assessment of knowledge and awareness of PEP in Nigeria among 186 family
physicians shows that. Ninety-eight percent of respondents were aware of concepts of PEP.
Eighty-two percent had aware of existing PEP protocols in their work facilities. One hundred
fifty-eight (91.3%) reported that they were aware at risk of accruing HIV from work place.
Sixty-nine percent had history of needle stick injury. Only 21% of those had injury had
received PEP, around half (51.4%) correctly identified risk of transmission after NSI to be
around three in thousands injures. Majority (81.7%) and 88.5% identified muccocutaneous
exposure and percutaneous exposures were high risk. (23)
Combination of cohort and cross sectional survey done in Kenya, at Kenyatta national
hospital showed that, majority of suffered from occupational exposure the cohort study was
females (65.5%). Majority of those who suffered were Nurses (54%). Doctors (24%), Lab

7|Page7
staff (11.5%) and support staff (10.5%). Sixty-two percent has knowledge on universal
precaution. Reporting practice was poor among cohort 74.2% participants reported to wrong
(unauthorized) person; but in cross sectional study 86.3% reported to right (authorized)
person. Less than half (40.2%) of exposed, accessing PEP and 36.8% starts ARVS and only
19.5 % completed recommended 25 days of therapy. (19)
Looking at study done in Ethiopia, one survey done on the assessment of HCWs,
occupational exposure to HIV and PEP on Health centers and Hospitals in Addis Ababa
shows 38% of the HCWs experienced at least one NSI, in their life time and 19% of
respondent, experienced at least once a year. The factors being associated with occurrence of
injuries where being a Nurse (15.39), having work experience more than one year (2.68),
working for long hours (1.90) and least was non-consistent use of PPE (1.67). Seventy of
respondents had knowledge about HIV PEP. (24)
Another study done, at Jimma the study done among HCWs in governmental Health
institution in Jimma zone, showed that 83.9% participants had in adequate knowledge about
PEP of HIV, around half (55.5%) knew measures to be taken after encountering NSI; 36.6%
measure to be taken after exposed to blood. PEP reduces likely hood of HIV infection after
exposure were answered by 72% and 27.6% answers a procedures of PEP. The majority
sustained Needle prick or cut by sharps (60.3%), exposed to blood (44.3%), and 39.1%
exposed to patient body fluids. (20).
The study done in Gondar reported majority 63.1% of respondents had adequate knowledge
about PEP for HIV. Among all of the respondents 33.8% were exposed for HIV risky
condition and among those exposed 74.2% took PEP. Among the respondents who took PEP
46.9% started at exact time of initiation. (25)
As the literatures suggests that majority of HCWs had heard about PEP, but had insufficient
knowledge, and most of them did not starts to use PEP, while few were completing
recommended course of treatment. Most of the HCWs are exposed to risk condition, while
nurses are the more exposed Health care personals. The HCWs have unfavorable attitude
towards PEP as a result, few of the starts to use PEP. Therefore, this study was aimed to
assess the burden of occupational exposure knowledge towards PEP and risk condition,
attitude towards PEP and reported practice of health care workers after potential exposures.

← 2.5. Conceptual framework

As shown in the following conceptual framework (Figure 1), awareness of PEP against HIV
infection usually influenced as a result of many factors, which have different level and degree
of influence.
Different socio-demographic factors, which are indicated in one part of the framework, are
most likely to act through a number of other interrelated factors, including Educational status,
job category and work experience and other factors like as information factors that indicated
at the bottom of the framework

SOCIODEMOGRAP
HIC
ENVIRONMENTAL
FACTORS
FACTOR
Age
Sex Work place

Educational status Work load

Department 8|Page8 Utilization
Job category
Awareness PEP service
Work experience
←
INFORMATIONAL FACTORS
← Guidelines /protocols

← Trainings/seminars
Reading materials
←
Instructions,
← rules/regulation/policy

← 3. OBJECTIVES OF THE STUDY

← 3.1 General Objective:

To assess the knowledge, Attitude and Practice of HWs about post exposure prophylaxis
against HIV/AIDS infection in Debremarkos referral hospital.

← 3.2 Specific Objectives

To determine the level of knowledge about post exposure prophylaxis among HWs in Debre
Marko’s referral hospital.
To determining the attitude of HWs towards PEP in Deber Marko’s referral hospital.
To determine the practice of using post exposure prophylaxis among HWs in D ebremarkos
referral hospital.
To identify factors associated with PEP among HCWs in Debremarkos referral hospital.

← 4. METHODS AND MATERIALS

← 4.1 Study Area and Study Period

The study will be conducted on HWs Debremarkos referral hospital, from September 15, to
January 05, 2017. Debremarkos is found Amhara regional state and located at about300km in
north east of capital city, Addis Ababa and 265km far to Bahir Dare city .In Debre Marko’s
town 1 referral hospital,4 health center and 18 private health institution. According to the
statics obtained from the hospital total 380 health workers. It has 7 kebeles.
←

← 4.2 Study Design

9|Page9
Facility based cross sectional study design will be employed, to assess the knowledge,
attitude and practice of Health workers.
4.3 Population

← 4.3.1 Source Population

All health care workers, who attend PEP in Debre Marko’s referral hospital.

← 4.3.2 Study Population

All selected health care workers (professionals) who attend PEP in Debremarkos referral
hospital.

← 4.4 Inclusion and Exclusion criteria

← 4.4.1 Inclusion criteria

All health workers who were currently working in Debre Marko’s Referral Hospital.

← 4.4.2 Exclusion criteria

Those who have no direct contact with patient and health care workers those are not available
at the time of the study were not include.

← 4.5 Sample Size and Sampling technique

← 4.5.1 Sample Size Determination

The sample size will be determined by using single proportion formula using the
assumptions: 5% marginal error (d), 50% expected prevalence of HIV PEP use since there is
no similar study in the study area (p), 95% confidence level. Using this formula
n= (Za/2)2 p (1-p)/ d2
n=1.96*1.96*0.5(1-0.5)/0.05*0.05
n=384
we consider that the non-response rate will be10% of the respondent, then n total=n+NRR
NRR=10/100*192=19 then sampling size=192+19=211
We obtained 384 to be sample size. Since the total number of source population is less than
10,000 we need use correction formula of nf =nₒ ⁄ (1+nₒ ̸ N), where nf is corrected or final
sample size, N is total number of all the source population which is 380 using this calculation
we obtained 192 to be final sample size. But since study population is too low
all health workers, fulfilling the inclusion criteria will include in the study.

← 4.5.2 Sampling Technique

All health care workers, fulfilling the inclusion criteria during study period, the current
study by using simple random sampling technique.

10 | P a g e 10
← 4.5.3 Sampling procedure
Debre Marko’s Referral Hospital will be selected since it is the only Hospital in the town. Also
the ART will be established for the first time in the area and it contains large number of staffs
who are high risk to accidental exposure to HIV infection. To select study subject purposive
sampling will be used. Criteria to select the sample will be used those health care personnel
will be working in high risk areas. Final sample will be calculated from each of the health
care personnel as follows.

← Profession ← Total number ← Sample size

involved

← Physicians ← 35 ← 20

← Health officer ← 15 ← 5

← Nurse ← 210 ← 136

← Midwife ← 35 ← 20

← Libratory ← 35 ← 15

← Pharmacy ← 30 ← 10

← ← ←

← Others ← 20 ← 5

← Total ← 380 ← 211

← 4.6 Study Variable

← 4.6.1 Dependent variables

- Knowledge
- Attitude
- Practice
4.6.2 Independent variables

-Age
-Sex
- Religion
-Ethnicity
-Professional qualification
level
- Income

-Profession

4.7 Data Collection Instruments and Procedures

11 | P a g e 11
← 4.7.1 Data collection instruments
Data will be collect through self-administered structured questionnaire that could assess
the knowledge, attitudes and practice towards PEP in HIV/AIDS was prepared in English
version translated in to Amharic in order to easily communicate. The data collected tolls will
be through open and closed ended question.

← 4.8 Data quality control

The prepared questionnaire will be pre tested on 5% of the total study population HWs in
Debre Marko’s Referral Hospital. Some modification will done on questions that will have
found with any ambiguity and affect the consistency of data. In addition prior to starting data
collection, brief explanation will be given for HWs on how to fill the questionnaire and the
principal investigators(group members) give onsite technical support and close supervision,
to avoid any ambiguity and to clarify any misconception.

12 | P a g e 12
4.9 Data Processing and Analysis
The collected data will be check at the end of each data collection day for their completeness
and consistency; data analysis will be done manually by tallying and using scientific
calculator .Data will be analyzed by incorporate descriptive statistic. Finally obtained result
will be summarized by percentage and presented using frequency table.
Statically analysis is a component of data analysis in the context of business intelligence
statically analysis involves collecting and scrutinizing every data sample in asset of items
from which samples can be drawn. A sample in statistics is a representative selection drawn
from a total population.
Descriptive statistics intend to describe a big hunk of data with summary charts and tables,
since charts, graphs and tables are primary components of descriptive statistics makes it
easier to understand and visualize the raw data.
Among some of the useful data that comes from descriptive statistics includes mode, median
and mean as well as range, variance and standard deviation.

← 4.10 Ethical Consideration

The proposal will be submitted to Debre Marko’s University College of medicine and health
science, department of nursing. In addition the brief explanation of the study objective will be
given for HWs, in order to avoid ambiguity and misunderstanding. The process of data
collection start after the willingness of the HWs asked, and the formal written and or verbal
consent will be obtained from each health worker under study, for this purpose one page of
short explanation and consent format will attach to the first page of each questionnaire.
Confidentiality will be insured and maintain by data collector. Because of observed
stigmatization of others.

← 4.11 Dissemination of the Findings

After the completion of the study, the finding report after being defended at Debre Marko’s
University, it will be submitted to Debre Marko’s university SRP office, and department of
nursing. The copy will also be given to advisors of the project to approve it and where the
study will be conducted through soft and hard copy after presentation.

← 4.13 Operational Definition

Exposure to HIV risk condition: - Health workers exposure to HIV risk conditions such as
blood, patient body fluids; needle prick injury or sharp injury at work place.
HIV Post-exposure prophylaxis: an anti-retroviral therapy, given in different forms after an
occupational exposure to HIV and will be given to HCWs if there is:
A percutaneous injury (for example, needle-stick or cut with a sharp object)
Contact with mucous membrane or non-intact skin (for example, skin chapped or abraded or
dermatitis)
Prolonged contact with skin or contact that involves an extensive area of skin.
Health workers: - a person (professionals) who are working in health care sets who have
potential exposures to infections materials.
Good Knowledge: -when a respondent correctly answers greater or equal to 75% of
knowledge questions. (19)
Poor knowledge: - when respondents correctly answers only <75% of knowledge questions.
(19)
Favorable attitudes: - when respondents’ attitudes favorable or correct answers for greater
or equal to 75% of attitudes questions. (19)
Unfavorable attitudes: - when respondents’ attitudes favorable or correct answers for <75%
of attitudes questions. (19)
13
Regimen: - a course of treatment, possibly combing drugs, exercises; diets’ etc. designing to
bring about important improve in health
Universal precautions: - universally adopted measures taken before medical procedure 70
avoid risk of exposures while on work
PEP use / practice/ - reporting as they have practiced using PEP of HIV at least once.(19)

← 5. WORK PLAN
Responsibl Aug sept octo nov dece jan
e body ust e
Activities
1 Topic selection and
submission

2 Formulating the
research problem,
objective and
literature review
3 Draft proposal
development
4 submission of
proposal to the
school
5 proposal
submission ethical
review committee
and receive
feedback
6 D a ta co ll ec t io n
7 Data processing,
analysis and write
up report.
8 Submission of final
research paper to
the school.
9 External defense
1 0 Monitoring the
research paper.

← 6. BUDGET
S. Budget category U n i t Multiplying factor Total cost
No c o s t
1 personnel Daily wage Number of worker*working day*unit cost
Data collector 60 3*60=180*3 540

2 Supply
Pen 5 6*5 30
Paper 0.50 100*0.5 50
Printing question 1/page 60page 60
Questionnaire duplication 0.50/page 3/one questionnaire 3*230 690
14
3 Transport Cost/km No of KM* No of travel* cost* day
Bajaj 4K.M 4*3*2*5 120
Contingence 10% 1490 birr
Total

7. References
1. U NAIDS/Country profile/ UNAIDS/Ethiopia 2011. UNAIDS /Ethiopia riverside. 2011.
2.Federal ministry of health(2011) infection prevention and patient safety Reference manual
for service provider and management in health care facility of Ethiopia,Addise Abeba.
3.Adelisa et al. Updated US Public Health Service Guidelines For The Management Of
Occupational Exposure to HIV and Recommendations for PEP.
http://www. cdc.gov /mmwr/preview/mmwrhtml/rr5409al.html acced on dec.20,2013
4.US. Department of Health and Human Service; Post Exposure Prophylaxis: 2011. (Updated
on 05/19/20011)
http://www. aids.gov/hiv.aids-basics/preveition/post exposure prophylaxis.
5.Taeget mayer M.et al .Occupational Safety Issues Among Health Care Workers In Kenya:
AIDS Care: 2008:20:304 - 310
6.Jointed United Nations Program on HIV/AIDS (UNAIDS) World Health Organization.
7. Prus-ustun. A. Rapitit E. Hytin G. Global Burden of Disease Attributable To Contaminated
Sharp Injuries. Among Health Care Workers. Am J Med, 2005: 48:482-90
8.Standard Treatment Guidelines for General Hospital. Drug Administration and control of
Ethiopia, 2nd edi, DACA Addis Ababa Ethiopia, January 2010: 12-13
9.Guidelines for management of opportunistic infection and Anti retroviral Treatment in
Adolescents and Adults in Ethiopia, HIV/AIDS prevention and control office MO, Addis
Ababa Ethiopia, March 2005: 67 - 75.
10.Julin G. Moggy T. Occupational Post Exposure Prophylaxis For HIV/AIDS: in Australia
2005:
11.UNAIDS, Joint UN program on HIV/AIDS, Report on Global HIV Epidemics 2012: The
HIV: Rate of New Infection Drops by Half In The 25 Countries of The World: United
Nations, Geneva Switzerland 2012.
12.Joint UN program on HIV/AIDS. Global: UNAIDS report on the Global AIDS
epidemics: 2010, Geneva, Switzerland: 2011
13.WHO, UNAIDS; UNICEF; Global HIV Response: Epidemic update and Health sector
progress towards universal Access; 2011: 2011.
14.WHO; the world health report 2002; reducing risk, promoting halt life: (June 30, 2006)
http://www. who.int/where/2002/en/indexation/.
15.Julian G. Maggy T. Occupational PEP for HIV/ AIDS Discussion paper: albion street
center for WHO, Geneva Switzerland. WHO, 2005; 11-20
16.Occupational and non occupational post exposure prophylaxis for HIV infection joint
ILO/WHO, Technical meeting for development of policy and Guidelines. Geneva,
Switzerland. 2005
17.Disease prevention and control department of Antiretroviral therapy: in Ethiopia: Addis
Ababa Ethiopia: 2005: P 15
18.Lin CH. Li L. Wu Z. Wu S. and Jia M. Occupational Exposure To HIV Among Health
Care Providers; Qualitative Study In Yunnan, Chinas J Int Assoc physician AIDS care (chic).
2008 march: 7(1): 35 - 41 PMCID: PC 2791920.
19.Eumice W. Factors Contributing for the Uptake and Compliance With HIV PEP At
Kenyatta National Hospital Nairobi Kenya June; 2011.

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20.TebeJe B, Hailu CH. Assessment Of HIV PEP Uses Among HCWS Of Governmental
Health Institution In Jimma Zone. Oromia Region, South Western Ethiopia. EJH Sci. March
2010: 20(10): 55 - 64
21.Cherry M. Fox G. Rogers AC. Post Exposure Prophylaxis to Prevent HIV Infection,
Knowledge and Experience of Junior Doctors: J sex Trans Inf. 2001: 77:444-5. [pubMed].
22.Chogle NI. Chogle MN. Devotion JU. Dasgunta D. Awareness Of PEP Guidelines Against
Occupational Exposure to HIV In Mumbai Hospital. Nat Med. J India 2002: 15(2) 169 - 72.
23.Patrice et al Awareness and Knowledge of HIV post Exposure Prophylaxis Among
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Ethiopia: 2012.

← 8. Annexes:
Questionnaires
DMU
COLLEGE OF MEDICINE AND HEALTH SCIENCES
DEPARTMENT OF NURSING
Questionnaire prepared for Health workers, to assess knowledge attitudes and practice
towards post exposure prophylaxis for HIV/AIDS infection among Health Workers in Debre
Marko’s Referral Hospital.
Dear responder!
My name is …………………………….., I am the graduating students of DMU with
Bachelor of Science degree in nursing. The purpose of this study is to assess the knowledge
attitudes and practice towards post exposure prophylaxis for HIV/AIDS infection among
health workers in Debre Marko’s Referral Hospital about the post exposure prophylaxis
(PEP) for HIV/ AIDS. You are not requested to write your name on this form in order to keep
the anonymity of the information. The information you give never be used in connection with
others and never be transferred to anybody. You may end this questionnaire at any time and at
any point you want to. However your cooperativeness’ and honest answers you give great
value for successfulness of the study and also will help for better understanding of the
problem that would eventually help in designing appropriate interventions to solve the
problem. So you are kindly requested to answer each question honestly. So read the
questions carefully and give your answer accordingly by encircling your choice
Yes___________________ No, ________________ Date _____________________
Part I- Socio demographic characteristics
Name of facility ____________________
1. Age ( )
2. Sex A. Male B. female
3. Ethnicity
A. Amhara B. Oromo C. Tigrie D. Other (specify)
4. Religion
A. Orthodox B. Muslim C. Protestant D. Catholic E. Other (Specify)
5. Marital status
A. Married B. Single C. Divorced D. Widowed E. Other (Specify)
6. Professions
A. Doctor B. Nurse C.lab technician D. Midwife E.Public health F. Other (Specify)
7. Year of service ( )
8. Current Level of qualification
A. BSc B. Diploma C. General practitioner D. Other (Specify)
9. Current Monthly income ( )
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Part II- Questions related to Knowledge
2.1. From what source you got the information about post exposure prophylaxis (PEP)?
(Possible more than one answer)
A. Training B. Friends C. Journals D. Mass media E. Others(Specify)
2.2. Do you know about the risk of occupational exposure of HIV/AIDS?
A. yes B. No
2.3. If yes to 2.2 what risks do you know? / More than one answer is possible
A. Sharp cut B. Needle prick C. mucosal contact D. Skin contact E. Others (specify)
2.4._Do you know about universal safety precaution procedures for decreasing risk of
exposure?
A. Yes B. No
2.5. If yes to 2.4 what safety precautions did you know? More than one answer is possible
A. Hand washing before and after procedure
B. Use of protective barriers like gloves, gnaws, mask
C. Correct handling of sharp instruments
D. Disinfection and sterilization of reusable materials
E. Proper disposal of needles, F. Others (specify) ________
2.6. Do you ever know about post-exposure prophylaxis for HIV/AIDS?
A. Yes B. No
2.7. If yes to Q- 2.6 is it available in your Hospital/ Health Center?
A. yes B. No
2.8. In your opinion how many drugs used to be combined to use for PEP? More than one
answer is possible
A. One drug only B. Two C. Three D. More than three
2.9. Did you list those regimens currently used for PEP according to national guidelines?
a.___
2.10. What is the optional period of initiation of PEP after exposure? More than one answer is
possible
A. < 24 hours B. 24-72 hours C. >72 hours D. In one week
2.11. For how long duration it will be given?
A. <2 weeks B. 2 weeks C. 3 weeks D. 4 weeks E. >4 weeks
2.12. What is the maximum delay to take post exposure prophylaxis (PEP)?
A. One day B. Two day C. Three day D. Half day
2.13. What is the preferable time to take post exposure prophylaxis (PEP)?
A. Within an hour B. After 6 hour of exposure C. After 12 hour of exposure D.
After 72 hour of exposure
2.14. What is the effectiveness of post exposure prophylaxis (PEP)?
A.100% B. 80-100% C. 60-70% D. 30-50%
2.15. Have you attended any training regarding post exposure prophylaxis (PEP)?
A. Yes B. No
2.16. Do you know the presence of post exposure prophylaxis (PEP) guideline?
A. Yes B. No
2.17. Is there currently licensed antiretroviral drug for post exposure prophylaxis (PEP)?
A. Yes B. No C. I don t know
2.18. If the answer Yes in Q 2.17 which drugs?
A. ZDV+3TC B. ZDV+3TC+EFV C. ZDV+3TC+LPV/r D. TDF+3TC+EFV
2.19. Which one of the following is false about post exposure prophylaxis (PEP) drugs?
A. Unpleasant to take B. Has side effects C. Has toxic effects D. Comfortable to take
2.20. What is the reason that provider to take post exposure prophylaxis (PEP)?
(Possibly more than one answer)
A. Exposure to blood from known HIV positive pt
B. exposure to blood from pt whose HIV status is unknown
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 C. injury from any sharp objects
D. contact with pts body fluid
Part III- Attitude related Questions
3.1HIV would be acquired occupationally.
A. Agree B. Disagree C. Strongly agree D. strongly disagree E. Neutral
3.2. You are one of those, at risk of acquiring HIV occupationally.
A. Agree B. Disagree C. Strongly agree D. strongly disagree E. Neutral
3.3. Post exposure prophylaxis (PEP) is important?
A. Yes B. No
3.4. Do you believe that post exposure prophylaxis (PEP) use to prevent further infection?
A. Agree B. Disagree C. Strongly agree D. strongly disagree E. Neutral
3.5. Universal precaution methods are protective.
A. Agree B. Disagree C. Strongly agree D. strongly disagree E. Neutral
3.6 Occupational exposure is avoidable.
A. Agree B. Disagree C. Strongly agree D. strongly disagree E. Neutral
3.7. ARV drugs are may effective of after occupational exposure.
A. Agree B. Disagree C. Strongly agree D. strongly disagree E. Neutral
3.8. PEP initiation after 72 hours of exposure would be effective.
A. Agree B. Disagree C. Strongly agree D. strongly disagree E. Neutral
3.9. Staffs should start PEP even if they are not willing to have an HIV test after occupational
exposure
A. Agree B. Disagree C. Strongly agree
D. Strongly disagree E. Neutral
3.10. PEP should be indicated after sexual exposure (sexual intercourse)
A. Agree B. Disagree
C. Strongly agree D. strongly disagree E .Neutral
3.11. Do you think that the injured person should complete the prescribed drug of post
exposure prophylaxis (PEP)?
A. Yes B. No
3.12. Do you think that lab professionals have a higher risk of being infected to HIV
compared to other health professionals?
A. Yes B. No
3.13. If someone accidentally acquires an injury by any means of contact to blood/other body
fluid, would you like to advice him/her to have screened for HIV-infected?
A. Yes B. No
3.14. HIV positive health care workers should have practicing ART medicine?
A. Agree B. Disagree
C. Strongly agree D. strongly disagree E. Neutral
Part IV-Practice related Questions
4.1. Have you ever had any exposure while at work?
A. Yes No
4.2. If yes to Q-4.1 for how many times you encountered?
A. Once B. Twice C. Three times D. More than three times
4.3. What type of exposure have you ever encountered? (More than one answer is possible).
A. needle stick B. Sharp cut C. Mucus membrane
D. Others (specify)…………
4.4. Have you reported the occurrence of injury?
A. Yes B. No
4.5. What was the serostatus of source patient?
A. Positive B. Negative C. Unknown
4.6. If positive / unknown, have you tried to get PEP service?
A. Yes B. No
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4.7. If yes have you started to use PEP?
A. Yes B. No
4.8. If yes to Q. 4.7 how much time later after exposure you start to use PEP?
A. < one hour B. 6-24 hour
C. 24-72 hours D. > 72 hour E. Not remember
4.9. Have you completed according to prescription?
A. Yes B. No
4.10. If yes to Q 4.9 have you test/check your status after treatment?
A. Yes B. No
4.11. If no to Q 4.9 what was the reason not to start PEP?
A. because of side effects B. Because of social stigma.
C. lack of information on the existence of service
D. lack of support on the procedure E. Others (specify)
4.12. After exposed to injuries by any means of contact did you take first aid services?
A. Yes B. No
4.13. After exposed to injuries by any means of contact did you test your blood for HIV?
A. Yes B. No
4.14. If you say yes how was the result?
A. positive B. Negative
4.15. If you say no did you repeat your blood test for HIV after 3 months?
A. yes B. No
4.16. If you say yes how was the result?
A. Positive B. Negative
4.17. How do you wear the glove?
A. single pair B. double pair C. single pair for every pt
4.18. Have you any on service or off service training on PEP?
A. Yes B. No
4. 19.For how long did you take the training?
A. One days B. Three days C. One week D. Two weeks
PART V-Observational checklist
Number Question Yes No
5.1 Which of the following are applied in your laboratory?
A. putting foods and cosmetics in the refrigerator
B. cutting nail with teeth
C holding pens by mouth
D Always cover the end of blood collection tubes or point them
away from anyone face when opening.
E Wear protective face shields or masks and goggles.
F Use puncture resistant, leak proof containers for sharps.
5.2 Circle your practice of sharps dispose (syringe needle) method
after collection of body fluids for analysis?
A Recapping
B Bending
C Breaking or hand manipulates used needles.
D Place used sharps in a disinfectant container at appoint of use.
5.3 Are there sufficient hand washing materials available?
A Is there hand washing sink in each laboratory room.
B are hot and cold water, soap and towels provided
5.4 Are sufficient PPE materials available?
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 A Gown
B Glove
C Goggle
D face mask
5.5 Are there first aid kit materials available?
A Alcohol
B Iodine
C Plaster
D Bandage
5.6 How about laboratory premises?
A Are the premises clean?
B Are there any structural defects in floors?
C Are floors and stairs uniform and slip resistant?
D Is the working space adequate for safe operation?
E Are the circulation space and corridors adequate for the
movement?
5.7 Is there an occupational health service provider assigned for PEP?
5.8 Is there an access of PEP drugs in the hospital?
5.9 Is there HIV testing pikt available in the laboratory?
5.10 Waste disposal method, is there?
A Safety box?
B Disinfectants for blood$ other body fluids?
C Biohazard bags or container?
5.11 Is there sufficient laboratory staff numbers?

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