1. Low uptake of occupational post exposures’ management among health care workers: An experience from three healthcare facilities (Morogoro, Mwanayamala and Tumbi Regional Referral Hospitals) in Tanzania J. Hokororo 4, E. Eliudi 4, M. Lahuerta 1,2, D. Selenic 3, G. Kassa 1, G. Mwakitosha 1, H. Ngonyani 4, S. Basavaraju 3, C. Courtenay-Quirk 3, Y. Liu 3, D. Simbeye 5, N. Bock 3,J. Boshe 1, G. Antelman 1, R. Mbatia 6, K. Kazura 5, Angela Heimburger 3, Patmaja Patnaik 1,Dr. M. Lahuerta 1 1.ICAP-Columbia University, Mailman School of Public Health, NY, USA, 2.Department of Epidemiology, Mailman School of Public Health, Columbia University, NY, USA 3.Divisions of Global HIV/AIDS, Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA, 4.Ministry of Health and Social Welfare, Dar es Salaam, Tanzania, 5.US Centers for Disease Control and Prevention (CDC), Dar es Salaam, Tanzania 6.Tanzania Health Promotion Support (THPS)

2. Introduction: Globally, approximately 90% of needle stick injuries occur in developing countries, and half of BBP exposure related deaths occur in sub-Saharan Africa. It has been estimated that more than three million HCWs experience PI with a contaminated sharp object each year In sub-Saharan Africa, bloodborne pathogens exposure (BPE) is a serious risk to health care workers (HCW). The risk can be the result of percutaneous injuries (PI) (i.e., needle stick or other sharps injuries), or other exposures of contaminated blood or body fluids onto mucous membranes or non-intact skin. In 2000, BBP exposures resulted in an estimated 16,000 Hepatitis C infections, 66,000 Hepatitis B infections, and approximately 1,000 HIV infections, cumulating in approximately 1,100 cases of death and disability.

3. Introduction: In South Africa, 91% of junior doctors in a hospital reported sustaining a needle stick injury, and 55% of these injuries came from source patients who were HIV- positive One study from Kenya found a needle stick injury rate of 0.97 per HCW per year. A high rate of needle stick injuries (4.18 per person-year) was also observed among the nursing staff at a national referral hospital in Uganda; Reporting BPE is necessary for effective post-exposure prophylaxis (PEP) management. Management of exposures is important element of workplace safety of the health care workers in health facilities.

4. Introduction: The efficacy of available post-exposure prophylaxis (PEP) regimens is ~ 81% for HIV and 85-95% for Hepatitis B virus (HBV); using a combination of Hepatitis B Immune Globulin (HBIG)and vaccine series. However, BBP exposures are frequently not reported. A meta-analysis of 15 studies from the US, Canada and Italy found reporting rates ranging from as low as 4 to 82%. The study conducted in 6 hospitals in the United States, only 54% of PIs were reported to hospital surveillance systems.

5. Objectives: 1.To document existing practices regarding occupational BBP exposure reporting and case management at the facility level. 2.To determine HCWs reporting rates of occupational BBP exposures, BBP reporting and case management system before

6. Methodology Study design A cross-sectional study was conducted to assess the experiences of occupational Blood Pathogen Exosures, history reporting, and use of PEP among HCWs at three hospitals in Tanzania between August and November 2012. The three hospitals were selected using convenience sampling from amongst hospitals operating at the secondary level of care with sufficient HCW at risk for occupational BBP exposure. Study population All HCW at risk for occupational exposure to blood-borne pathogens at these three facilities who were able to provide informed consent and ≥18 years old were eligible to participate. These were any person employed or receiving training at the facility, such as nurses, doctors, clinical officers, dentists, janitors, interns, students, mortuary workers, incinerator operators, cleaners, waste handlers and laundry workers.

7. Methodology Data collection Eligible HCW were interviewed using Audio-Computer Assisted Self-Interview (ACASI). The closed-ended questions on HCW characteristics and experiences with occupational exposures, reporting, and post-exposure care were used. ACASI data were collected using coded password-protected tablets that had been programmed using the Questionnaire Development System (QDS) software. Data collected was automatically saved into a coded and password-protected database and backed up daily onto a secure external hard drive. Data were checked periodically for completeness and duplicate entries prior to final analysis. Review of reporting documents and data abstraction was also done The availability and content of facility-level documents related to BPE were reviewed using a standardized checklist documenting the availability at the facility of the national tools, SOPs, algorithms and registers as well as the adequacy of these tools through detailed document review. Abstraction of BPE reported data from the six months prior to the survey in all the identified sources of information was conducted to determine the documented number of BPE reported.

8. Methodology Statistical analysis Statistical analyses were carried out using SAS, version 9.3 (SAS Institute, Cary, NC). (Univariate) Simple descriptive analyses were conducted on data aggregated from the three facilities. Among these descriptive analyses the numbers were quantified in terms of percentages of HCW who experienced occupational BPE. (Bivariate): Variables associated within a) having and exposure in the past 6 months and b) reporting a BPE were assessed using logistic regression. (Multivariate)Variables significant at the 0.10 level during bivariate were included in the multivariate analysis and controlled for a range of relevant factors (eg, by cadre, duration of employment).

9. Results Of the 1,102 eligible HCW, 973 (88%) completed the interview. Of these, 690 (71%) were female and 387 (40%) were nurses. Of 357 HCW who had a BPE in the previous 6 months, 120 (34%) reported it. Among these 120 reported exposures who reported, 93 (78%) HCW reported within 2 hours of exposure, 98 (82%) received pre- and post-HIV test counseling, and 70 (58%) were offered PEP; 68 (97%) of these 70 HCWs completed PEP. Independent factors associated with reporting BPE were being female (adjusted odds ratio (AOR)=2.0 [95% confidence interval (CI) 1.2-3.5), having received BPE training (AOR=2.0, CI 1.2-3.5), HIV testing within the past year (AOR=2.3, CI 1.2- 4.4).

10. Conclusion: Despite the significant proportion of HCW with a recent BPE, only one in three reported it for PEP management. These results highlight the importance of appropriate strengthening on the prevention and reporting of occupational exposure to increase acceptance and access to PEP against HIV and HBV after BPE. The PEP guidelines, registers and reporting tools developed by MoHSW as part of the new Infection Prevention Control guidelines at the facility, district and national level will likely contribute to the prevention of bloodborne pathogen infection among HCW through occupational exposures. HSIQAS of MoHSW is in the process to liaise with HMIS unit to make sure all the data of PEP is captured through DHIS

12. Recommendations We recommend all facilities where ARVs are available to provide PEP services. The facility HMTs and partners to ensure the available new PEP guidelines is used in PEP management of all cases All the cases both occupational and non occupational should be documented in the developed tools HBV vaccine is now available in the country the HMTs have to link up with RIVOs and DIVOs ensure that the HCWs are vaccinated.

13. Ethical considerations This study was approved by the National Ethics Review Committee of the Tanzanian National Institute for Medical Research. The Columbia University Medical Center Institutional Review Board (IRB) The United States Centers for Disease Control and Prevention (IRB). Verbal consent was obtained from each participating HCW. No identifying information was collected during the interview. No incentives were provided for participation.

15. THANK YOU