Predictors of HIV Infection Risk among Health-Care Workers in Sub-Saharan Africa: A Systematic Review


David Nzioka Mutisya


HIV infection, Health Care Workers, Predictors of HIV Infection Risk, Sub-Saharan Africa


The study set out to investigate the determinants of HIV infection risk among healthcare workers in SSA through a systematic review. The aim of the study was to identify, collect and systematically review and synthesize existing literature articles on the determinants of HIV infection risk among healthcare workers in SSA. The objectives of the study were to: determine the prevalence of health care workers' exposure to HIV risky conditions in health care settings in SSA; identify selected determinants of HIV infection risk among Health care workers in SSA (major focus in Nigeria, South Africa, and Tanzania) and apply effective strategies to prevent issues associated with HIV infection risk among Health care workers.  The study conceptualizes that HCWs in the SSA region are at risk of HIV infection due to factors related to lack of healthcare resources, their knowledge, attitude and practice, and barriers to reporting. The combined effect of these factors is that hoped to determine the propensity of HCWs to be infected by HIV/AIDS.  The key themes guiding the systematic review were:  risk to exposure to HIV among HCWs; lack of health care resources and facilities. The findings of the study confirmed all the three alternative study hypotheses that: there is a significant relationship between lack of health care resources and facilities and the risk of HIV infection among HCWs in SSA; there is a significant relationship between HCWs’ knowledge, attitude, and practice on HIV and their risk of HIV infection in SSA and; there is a significant relationship between barriers to reporting and the risk of HIV infection among HCWs in SSA. In this regard, the study found out that HCWs in SSA are at high risk of HIV exposure whilst working. In this regard, this is a result of lack of enough equipment, poor practices at work and barriers to reporting, including stigmatization and lack of well-stipulated reporting guidelines.  As such, the following recommendations were made:: there is a need to increase funding in the health care sector to enhance access to the right equipment, microbicides, vaccination, and PEP for HCWs; there is a need for psychosocial support systems to make it easy for HCWs to report infection with ease and that; the government should adopt recommended global best standards to enhance protection of HCWs while at work in SSA. Two areas for further study were also recommended. As such, there is a need for studies on each of the study objectives, and; there is a need for a descriptive study on the topic under investigation in this study for correlation purposes. 

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[1] Agbulu, R., Udofia, O., Udofia, O., Ekott, M., Ekott, M., Peters, E., Peters, E., Imananagha, K., Imananagha, K., Oyo-Ita, A., Oyo-Ita, A., Agbulu, P., Agbulu, P., Chuku, I. and, Chuku, I. (2013) 'Knowledge, attitude and practice of Post-Exposure Prophylaxis (PEP) to HIV among doctors in a Nigerian Tertiary Health Institution', Global Journal of Pure and Applied Sciences, 19(1). Available at: [Accessed 18 February 2018].

[2] Altree, P. (2005) 'Parenting support in the context of poverty: A meta-synthesis of the qualitative evidence', Health and Social Care in the Community, 13, pp. 330-337. Available at: [Accessed 15 February 2018].

[3] Bekele, T., Gebremariam, A., Kaso, M. and, Ahmed, K. (2017). Attitude, reporting behavour and management practice of occupational needlestick and sharps injuries among hospital healthcare workers in Bale zone, Southeast Ethiopia: a cross-sectional study, 10 (1). Available at:[Accessed 11 February 2018].

[4] Beyera, G. and, Beyen, T. (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). Available at: [Accessed 14 February 2018].

[5] Bott, S., Neuman, M., Helleringer, S., Desclaux, A., Asmar, K. and, Obermeyer, C. (2014) 'Rewards and challenges of providing HIV testing and counselling services: health worker perspectives from Burkina Faso, Kenya and Uganda', Health Policy and Planning, 30(8), pp.964-975. Available at: [Accessed 14 February 2018].

[6] Brown, J.L., Sales, J.M. and, DiClemente, R.J. (2014) 'Combination HIV Prevention Interventions: The Potential of Integrated Behavioral and Biomedical Approaches', Current HIV/AIDS reports, 11(4):363-375. Available at: [Accessed 09 February 2018].

[7] Cohen M.S., Chen Y.Q. and, McCauley, M. (2011) 'Prevention of HIV-1 infection with early antiretroviral therapy', N Engl J Med, 365(6), pp. 493-505. Available at: [Accessed 09 February 2018].

[8] Dasimah, O., Siti, N.N. and, Subramaniam, A.L.K. (2012) 'Clinical waste management in District hospital of Tumpat, Batu Pahat and Taiping', Procedia Social and Behavioral Sciences, 68, 134- 145. Available at: [Accessed 16 February 2018].

[9] David, E. (2013) 'Promoting sexual health and well-being: the role of the nurse', Nursing Standard, 28. 53-57. Available at: [Accessed 05 February 2018].

[10] Delobelle, P., Rawlinson, J., Ntuli, S., Malatsi, I., Decock, R. and, Depoorter, A. (2009) 'HIV/AIDS knowledge, attitudes, practices, and perceptions of rural nurses in South Africa', Journal of Advanced Nursing, 65(5), pp.1061-1073. Available at:;jsessionid=2D7BAF749FD9E67AAE649FD721D8D1C3.f01t02?userIsAuthenticated=false&deniedAccessCustomisedMessage=[Accessed 08 February 2018].

[11] Duarte, A. and Hancock, J. (2017) 'An Exploration on HIV/AIDS Funding in South Africa', SAGE Open July-September 2017, pp. 1-5. Available at: [Accessed 05 February 2018].

[12] Feyissa, G.T., Abebe, L., Girma, E. and, Woldie, M. (2012), 'Stigma and discrimination against people living with HIV by healthcare providers, Southwest Ethiopia', BMC Public Health, 12, p. 522. Available at: [Accessed 11 February 2018].

[13] Horn, T., Sherwood, J., Remien, R. H., Nash, D. and, Auerbach, J.D and the Treatment Action Group and Foundation for Aids Research HIV Prevention Continuum Working Group. (2016), 'Towards an integrated primary and secondary HIV prevention continuum for the United States: a cyclical process model', Journal of the International AIDS Society, 19(1). Available at: [Accessed 12 February 2018].

[14] Jones, A, Cremin, I. and, Abdullah, F. (2014) 'Transformation of HIV from pandemic to low-endemic levels: a public health approach to combination prevention', Lancet.

384, pp. 272-279. Available at: [Accessed 16 February 2018].

[15] Kalhorn, W. (2011) 'Analysis and Interpretation of Factors Leading to Increased AIDS Prevalence in Sub-Saharan Africa', Environmental Studies Undergraduate Student Theses, 53, Available at: [Accessed 18 February 2018].

[16] Kebede, G., Molla, M. and, Sharma, H.R. (2012) 'Needle sticks and sharps injuries among health care workers in Gondar city, Ethiopia', Saf Sci, 50 (4), pp. 1093-1097. Available at: [Accessed 21 February 2018].

[17] Khan, K.S., Kunz, R., Kleijnen, J. and, Antes G. (2003) Systematic Reviews to Support Evidence-Based Medicine. How to Review and apply findings of Health Care Research. London: RSM Press.

[18] Kijakazi, O. Mashoto, G., Mubyazi, M., Makundi, E., Mohamed, H. and, Malebo, H. (2013) 'Estimated risk of HIV acquisition and practice for preventing occupational exposure: a study of healthcare workers at Tumbi and Dodoma Hospitals, Tanzania', BMC Health Serv Res, 13: 369. Available at: [Accessed 17 February 2018].

[19] Kombo, D.K. and, Tromp, C.A. (2006) Proposal and thesis writing: An introduction. Nairobi: Paulines Publications.

[20] Maselobe A.L. (2016) Assessment of Knowledge, Attitudes, and Utilisation of HIV Post-Exposure Prophylaxis among Adults, Roma, Lesotho. Master of Arts in Nursing Science Thesis. The University Of South Africa. Available at: [Accessed 21 February 2018].

[21] Maswanya, E.S., Mutalemwa, P.P., Shayo, E.H., Kisoka, W.J., Kilima, S.P., Mbilinyi, D.R., Munga, M.A., Kamugisha, M.L. and, Kisinza, W.N. (2010) Drivers of HIV/AIDS Epidemics in Tanzania Mainland: Case Study of Makete, Temeke, Geita, Lindi, Kigoma & Meru Districts. Tanzania Commission for AIDS (TACAIDS). Tanzania. Available at: [Accessed 18 February 2018].

[22] Matsubara, C., Sakisaka, K, Sychareun, V., Phensavanh, A. and Ali, M. (2017) 'Prevalence and risk factors of needle stick and sharp injury among tertiary hospital workers, Vientiane, Lao PDR', J Occup Health, 59(6):581-585. Available at: [Accessed 12 February 2018].

[23] Mbaisi, E.M, Ng'ang'a, Z., Wanzala, P. and, Omolo, J. (2013) 'Prevalence and factors associated with percutaneous injuries and splash exposures among health-care workers in a provincial hospital, Kenya, 2010', Pan Afr Med J. Available at: [Accessed 12 February 2018].

[24] Mbilinyi, D., Daniel, M. and Lie, G. (2011) 'Health worker motivation in the context of HIV care and treatment challenges in Mbeya Region, Tanzania: A qualitative study', BMC Health Services Research, 11:266, Available at: [Accessed 19 February 2018].

[25] Mishta, P.H., Banerjee, P. and, Gosain, H. (2014) 'Study of Healthcare-Associated Infections', Merit Research Journal of Biochemistry and Bioinformatics, 2(2):38-48. Available at: [Accessed 14 February 2018].

[26] Mponela, M., Oleribe, O., Abade, A. and, Kwesigabo, G. (2015) 'Post exposure prophylaxis following occupational exposure to HIV: a survey of health care workers in Mbeya, Tanzania, 2009-2010', Pan Afr Med J, 21: 32, Available at: [Accessed 17 February 2018].

[27] Ngatu, N., Phillips, E., Wembonyama, O., Hirota, R., Kaunge, N., Mbutshu, L., Perry, J., Yoshikawa, T., Jagger, J. and, Suganuma, N. (2012), 'Practice of universal precautions and risk of occupational blood-borne viral infection among Congolese health care workers', American Journal of Infection Control, 40(1), pp. 68-70.e1. Available at: [Accessed 17 February 2018].

[28] Odimegwu, C., Akinyemi, J. and, Alabi, O. (2017) 'HIV-Stigma in Nigeria: Review of Research Studies, Policies, and Programmes', AIDS Research and Treatment, 13. Available at: [Accessed 16 February 2018].

[29] Ogoina, D., Pondei, K., Adetunji, B., Chima, G. and, Isichei, C. (2015) 'Knowledge, attitude and practice of standard precautions of infection control by hospital workers in two tertiary hospitals in Nigeria', Journal of Infection Prevention, 16(1):16-22. [Accessed 20 February 2018].

[30] Okpala, P.U. and, Uwak, R. Ada, C. (2017) 'Nurses' knowledge and attitude to the care of HIV/AIDS patients in. South East, Nigeria', Int J Community Med Public Health. 4(2), pp. 547-553. Available at:'_knowledge_and_attitude_to_the_care_of_HIVAIDS_patients_in_South_East_Nigeria [Accessed 17 February 2018].

[31] Osaretin Owie, H. and, Apanga, P. (2016) 'Occupational Health Hazards Prevailing among Healthcare Workers in Developing Countries', Journal of AIDS & Clinical Research, 7(8). Available at: [Accessed 21 February 2018].

[32] Robbins GK, et al. (2012), 'Efficacy of a clinical decision-support system in an HIV practice: a randomized trial', Ann Intern Med, 157(11), pp. 757-766. Available at: [Accessed 21 February 2018].

[33] Saleh, A. and, Adamu, H.I (2015) 'Barriers to HIV/AIDS Treatment in Nigeria', American Journal of Health Research, 3 (5), pp. 305-309. Available at: [Accessed 11 February 2018].

[34] Senthil, A., Anandh, B., Jayachandran, P., Thangavel, G., Josephin, D., Yamini, R. and, Kalpana, B. (2014) 'Perception and prevalence of work-related health hazards among health care workers in public health facilities in southern India', International Journal of Occupational and Environmental Health, 21(1), Available at: [Accessed 16 February 2018].

[35] Sharma, R., Rasania, S. and, Verma, A., (2010) 'Study of Prevalence and Response to Needle Stick Injuries among Health Care Workers in a Tertiary Care Hospital in Delhi, India', Singh S Indian J Community Med, 35(1), pp. 74-7. Available at: [Accessed 14 February 2018].

[36] Shelton, J.D (2014) 'Evidence-based public health: not only whether it works, but how it can be made to work practicably at scale', Glob Health Sci Pract, 2, pp. 253-258. Available at: [Accessed 14 February 2018].

[37] Sørlie, P. A. (2017) A qualitative study of Health worker's perceptions on HIV incidence and risk factors in Ruhiira. Thesis submitted for the Masters' Degree in International Social Welfare and Health Policy. Oslo and Akershus University College of Applied Sciences, Faculty of Social Sciences. Available at: [Accessed 22 February 2018].

[38] Sultan, B., Benn, P. and, Waters, L. (2014) 'Current perspectives in HIV post-exposure prophylaxis, HIV/AIDS (Auckland, N.Z.)' PMID, 6, pp. 147-158. Available at: [Accessed 20 February 2018].

[39] Tirivanhu, C., Ancia, M. and Petronella, S. (2014). Barriers to infection prevention and control practice among nurses at Bindura provincial hospital, Zimbabwe. Journal of nursing and health science 1(3):69-73. Available at: [Accessed 20 February 2018].

[40] UNAIDS (2011). World AIDS Day Report 2011.

[41] UNAIDS, Prevention gap report, 2016, Available at: (Accessed 04 November 2017).

[42] UNAIDS. (2013) Epidemiological status. Available at: http:// 04 November 2017).

[43] United Nations Economic Commission for Africa (UNECA) (2015) Africa Regional Report on the Sustainable Development Goals: Summary. Available at: /report_on_the_sustainable_development_goals_summary_english_rev.pdf

(Accessed 11 February 2018).

[44] WHO (2017) Guideline on when to start antiretrovrial therapy and on pre-exposure prophylaxis for HIV. Available at: (Accessed 25 January 2018).

[45] World Health Organization. (2016) HIV/AIDS fact sheets. Available at: (Accessed 22 January 2018).

[46] Yenesew M.A. and, Fekadu, G.A. (2014) 'Occupational exposure to blood and body fluids among health care professionals in Bahir Dar town, northwest Ethiopia', Saf Health Work, 5(1), pp. 17-22. Available at: (Accessed 20 January 2018).

[47] Zamberia A.M. (2011) 'HIV related stigma and access to health care among people living with HIV in Swaziland', Dev South Afr, 28, pp. 669 80. Available at: (Accessed 19 January 2018).