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Introduction: Pharmacists play an important role in HIV post-exposure prophylaxis. This study compared the knowledge, attitude, and practice (KAP) of HIV post-exposure prophylaxis (PEP) among pharmacists practicing in two Nigerian teaching hospitals. Methods: This survey, which adopted a cross-sectional design, was conducted among pharmacists at Ahmadu Bello University Teaching Hospital (ABUTH) and the University of Nigeria Teaching Hospital (UNTH). Seventy-seven eligible pharmacists completed the standard questionnaire, which was analysed using SPSS Version 25 with appropriate descriptive (frequencies, percentages, mean) and inferential (t test) statistics. The structured questionnaire which was self-administered had four sections: Sect. 1 evaluated the sociodemographic characteristics of the participants, Sect. 2 evaluated their knowledge of HIV PEP, Sect. 3 evaluated their attitude towards HIV PEP, and Sect. 4 evaluated their practice of HIV PEP. A student's t test was used to compare the knowledge scores of the respondents of the two hospitals. The same comparison was done for the attitude scores. Study participants were divided into two groups for each domain based on the group mean scores for each population: good versus poor knowledge and good versus poor attitude. Pharmacists scoring at or above the group mean in each domain were categorised as "good," while those scoring below were categorised as "poor". For all analyses, the confidence interval was set at 95%, with p values, less than 0.05 considered statistically significant. Results: There was a 100% response rate for the questionnaire. Pharmacists aged 26–35 years in ABUTH were 32 (60.4%), while those aged 36–45 years in UNTH were 11 (47.8%). B.Pharm/PharmD was the only qualification of 47 (87%) pharmacists in ABUTH, while 10 (43.5%) had the same qualification in UNTH. The mean knowledge of PEP scores for ABUTH and UNTH were 53.70 ± 1.90 and 56.52 ± 2.85 respectively. The mean knowledge of PEP score in both hospitals was 54.54 ± 1.59%. The mean attitude towards PEP scores for ABUTH and UNTH were 84.22 ± 1.54 and 85.12 ± 2.06 respectively. Their overall mean attitude of PEP score was 84.51 ± 1.23%. For the practice of PEP, 32 (41.56%) of the 75 pharmacists in both hospitals had never dispensed PEP drugs. In ABUTH, 3 (5.8%) pharmacists changed patients' PEP drugs without consulting the prescriber. Conclusion: While about half of the pharmacists in ABUTH had a good knowledge of PEP, only a few of their colleagues at UNTH had poor knowledge of PEP. However, the majority of the pharmacists at both hospitals had a good attitude and practice towards PEP, although pharmacists from UNTH performed better. [ABSTRACT FROM AUTHOR]

The attainment of the global target of zero dog‐mediated human rabies by 2030 depends on functional rabies programmes. Nigeria, a rabies‐endemic country, and the most populous country in Africa has a very poor rabies control strategy with a score of 1.5 out of 5 based on the Stepwise Approach towards Rabies Elimination (SARE). In this article, we report a scoping review that we conducted to highlight the strengths, weaknesses, opportunities and threats as well as situational analysis of rabies control in Nigeria and suggest a timeline for key activities that are needed to ensure zero by 30. Our findings reveal that rabies is grossly under‐reported as only 998 human and 273 dog‐suspected rabies cases were reported across Nigeria between 2017 and 2022. Our literature review also demonstrates a paucity of information on rabies in both human and animal health sectors. A total of 49 studies on dog rabies in Nigeria, with a predominance of reports from the North Central geopolitical region (48%, n = 23) were therefore included in this study. Currently, only 16.2% (n = 6/37) of Nigerian states have available data related to the estimated dog populations, the dog ownership rates, the vaccination status of dogs or the incidence of dog bites. Based on a dog‐to‐human ratio of 1:16.3, we estimated that the dog population in Nigeria was 12,969,368 (95% CI: 12,320,900‐13,617,836). Thus, to attain herd immunity and dog rabies control in Nigeria, at least 9.1 million dogs must be vaccinated annually. Our review reveals that, despite the strengths and available opportunities to achieve rabies control in Nigeria by 2030, the weaknesses and challenges will make the attainment of zero by 30 very difficult or impossible. Nigeria's best‐case scenario by the year 2030 is SARE stage 3–4 (control–elimination) out of 5. Otherwise, the rabies control programme might not surpass SARE stages 2–3. To attain zero by 30, Nigeria must re‐strategize its current rabies control programme by funding and implementing the national strategic plan for rabies control, creating a rabies desk office in the 37 states (FCT inclusive), rigorously conducting mass vaccination campaigns, providing post‐exposure prophylaxis, prioritizing mass enlightenment with a focus on responsible pet ownership and conduct baseline national rabies surveillance in the animal and human health sectors. [ABSTRACT FROM AUTHOR]

Introduction: An appropriate economic evaluation of post-exposure prophylaxis (PEP) should consider the effectiveness of different regimens prescribed for patients. Studies have not evaluated the comparative effectiveness of different PEP antiretrovirals (ARVs) based on their costs. Therefore, the aim of the present study was to determine the cost-effectiveness of ARVs regimens used for PEP in Nigerian tertiary hospitals. Material and methods: This cross-sectional study collated patients' demographic and clinical data from PEP databases of United States' President Emergency Plan for AIDS Relief - AIDS Prevention Initiative in Nigeria hospitals. Costs of ARVs were obtained from donors' price list. Effectiveness was measured as the percentage of human immunodeficiency virus (HIV)-negative patients one-month post-PEP. Average cost-effectiveness ratios (ACERs) were computed as the unit cost of the regimens/HIV infection averted (HIA). Probabilistic sensitivity analysis was conducted using 1,000 iterations using Monte-Carlo simulation. Results: Out of 575 patients identified, 198 (34.4%) had non-occupational exposure. Of the 14 regimens, tenofovir (TDF) + lamivudine (3TC) + ritonavir-boosted atazanavir (ATV/r) was prescribed for 230 (40.00%) patients. HIV-negative results were documented in 129 (22.4%) of the 185 patients with post-PEP test. Zidovudine (AZT) + 3TC + ATV-r was the most effective (95.5%, n = 63 of 66) regimen, while TDF + emtricitabine (FTC) + ritonavir-boosted lopinavir (LPV/r) was the most expensive ($23.66). With an ACER of $8.110/HIV infection prevented (95% CI: $8.052-$8.168), TDF + 3TC + efavirenz (EFV) was the most cost-effective regimen. Conclusions: AZT + 3TC + LPV/r was the most effective regimen, while TDF + FTC + ATV/r was the most expensive. However, TDF + 3TC + EFV combination was the most cost-effective regimen used in providing PEP service to HIV patients in Nigerian hospitals. [ABSTRACT FROM AUTHOR]

In high-HIV burden settings, such as Nigeria, HIV self-testing and post-exposure prophylaxis (PEP) are often recommended, but not widely practiced. This study aims to identify the predictors of PEP utilization and preferences for HIV self-testing among healthcare workers in Nigeria. A total of 403 healthcare workers from a tertiary hospital in Nigeria completed questionnaires. Adjusted odds ratios were derived from logistic regression models. Among the respondents, 141 (35.0%) reported experiencing at least one workplace exposure incident, with 72 (51.1%) of them receiving PEP. The majority of healthcare workers (n = 354, 87.8%) expressed a preference for HIV self-testing over traditional HIV testing and counseling. The occurrence of exposure incidents was predicted by the respondent's sex (adjusted odds ratio [aOR] = 1.25; 95% confidence interval [CI]: 1.15-3.08, female vs. male), age (aOR = 0. 16; 95% CI: 0.03-0.92, >40 vs. <30 years), profession (aOR = 1.88; 95% CI: 1.18-4.66, nurse/midwife vs. physician), work unit (aOR = 0.06; 95% CI: 0.02-0.23, obstetrics/gynecology vs. surgery), and previous HIV testing and counseling (aOR = 0.01; 95% Cl: 0.004-0.03, no vs. yes). Respondent's profession, work unit, and previous HIV testing and counseling independently predicted a preference for HIV self-testing. Further exploration of the feasibility of implementing HIV self-testing as an alternative to traditional HIV testing and counseling for workplace exposures is warranted. [ABSTRACT FROM AUTHOR]

Background: Clinical students are at increased risk of exposure to blood-borne pathogens. However, little has been documented about their exposure to blood and body fluids and their knowledge of post-exposure prophylaxis (PEP) in high-HIV burden settings, such as Nigeria. Objective: To determine the prevalence and predictors of BBF exposure and knowledge about PEP among medical and allied health students in northern Nigeria. Methods: In a cross-sectional study, 273 clinical students were asked to complete structured questionnaires. The prevalence of BBF exposure was determined. Binary logistic regression was used to determine the independent predictors of BBF exposure. Results: The majority of the respondents (98.2%) had heard about PEP; 26.0% (n=71) had adequate knowledge about PEP. 76 (27.8%) of the 273 respondents reported accidental exposure to HIV. 230 (84.2%) respondents had positive attitude toward HIV PEP. Of those who had had accidental exposure to HIV (n=76), only 13% (n=10) received PEP. The level of knowledge about PEP was predicted by previous training (aOR 0.43, 95% CI 0.23 to 0.80 ["no" vs "yes"]), year of training (aOR 4.10, 95% CI 1.60 to 10.47 [6th vs 4th year]), course of study (aOR 4.69, 95% CI 2.06 to 10.68 ["allied health" vs "clinical medicine"]) and religion (aOR 5.39, 95% CI 1.40 to 20.71 ["non-Muslim" vs "Muslim"]). Similarly, accidental exposure was independently predicted by respondents' sex (aOR 2.55, 95% CI1.36 to 4.75 ["female" vs "male"]), age (aOR 2.54, 95% CI 1.06 to 6.15 ["25--29" vs "20--24" years]), ethnicity (aOR 2.15, 95% CI1.10 to 5.14 ["others" vs "Hausa/Fulani"]), course of study (aOR 0.06, 95% CI 0.01 to 0.38 ["allied health" vs "clinical medicine"]), and previous PEP training (aOR 0.39, 95% CI 0.20 to 0.78 ["no" vs "yes"]). Conclusion: One in four clinical students reported exposure to BBF. Most students expressed a positive attitude toward PEP, but knowledge and uptake of PEP was sub-optimal. We recommend strengthening training curricula for infection control and prevention and enhancing protocols for timely post-exposure evaluation and follow up for all exposure incidents. [ABSTRACT FROM AUTHOR]

Rationale For Systematic Review: Lassa fever is the most common cause of imported haemorrhagic fevers cases in non-endemic countries. As a disease with a high case fatality rate that has regularly caused clusters of nosocomial transmission in endemic areas, prompt diagnosis is vital. We conducted a systematic review of imported cases of the last 50 years with the aim of defining the clinical and epidemiological characteristics that will enhance early diagnosis, prompt initiation of treatment and an appropriate public health response to Lassa fever cases.Methods: We performed a retrospective, systematic review of 36 primary and two secondary cases of Lassa fever in non-endemic countries outside West Africa by searching the PubMed database. This yielded 56 relevant publications that were included in our analysis.Results: The case fatality rate of 35.1% for imported cases was higher than that reported for endemic countries. The majority of patients showed clinical features consistent with Lassa fever and had a typical exposure. There was a considerable delay in diagnosis in imported cases with high associated numbers of contacts. Ribavirin was rarely used for post-exposure prophylaxis. Only two secondary transmissions occurred. Thirty-one percent of patients received Lassa fever-specific treatment and five required intensive care.Conclusions: Although importation of Lassa fever to non-endemic countries is a rare event, it has repeatedly happened over five decades. Suspicion of Lassa fever should be based on careful consideration of clinical features and exposure history in order to assist early diagnosis in returning travellers from West Africa. [ABSTRACT FROM AUTHOR]

Introduction: Nigeria contributes a high fraction to the global burden of HIV infections. Post-exposure prophylaxis (PEP) is a proven strategy to prevent transmission of the virus. The aim of this study was to determine the clinical outcomes of PEP in Nigeria at four clinics funded by United States President's Emergency Plan for AIDS Relief and AIDS Prevention Initiative in Nigeria (PEPFAR-APIN): Ahmadu Bello University Teaching Hospital (ABUTH), Jos University Teaching Hospital (JUTH), University of Maiduguri Teaching Hospital (UMTH) and University College Hospital (UCH). Methods: This study adopted a multisite retrospective design using the site's databases (2006-2016). Retrieved data was exported into SPSS version 25 for statistical analysis. Outcomes were measured as a proportion of HIV infections averted after PEP. Frequencies and percentages were used to describe the findings, while binary logistic regression was used to determine the sociodemographic predictors of clinical outcomes. Results: The average age of the 575 PEP patients whose data were retrieved was 30.45 (SD ±9.50 years), with 344 (59.8%) being females. Out of 545 patients,157 (28.8%) indicated their job status as students. Out of 273 patients, 198 (72.5%) reported their exposure type was non-occupational. The HIV status of 129 (22.4%) patients was negative after completing PEP. Prescribed regimen (β = -0.048, 95% CI -0.095 to -0.001, p = 0.045) and type of exposure (β = 0.351, 95% CI 0.042-0.660, p = 0.027) were predictors of post-PEP HIV status in JUTH and ABUTH respectively. Conclusion: There was a high rate of lost-to-follow-up among the PEP patients, but the incidence of seroconversion was low in those who were tested after PEP. The right choice of regimen and presenting with non-occupational exposure affected the outcome of the service.

Background: Human Immunodeficiency Virus (HIV) post-exposure prophylaxis (PEP) has been documented to be effective in preventing HIV in exposed individuals. World Health Organization (WHO) recommends that every individual exposed should be treated within 72hours. We aimed to assess the utilization of PEP among clients in a tertiary facility in Northwest, Nigeria., Methods: A retrospective study was conducted in Barau Dikko Teaching Hospital (BDTH), a tertiary hospital in Kaduna, Nigeria involving all clients who assessed HIV PEP between January 2016 - December 2019. Data collection sheet was used to document the sociodemographic parameters of clients, sources/circumstances of infection, client HIV status, source HIV status and the interval between exposure and commencement of PEP. Analysis of data was done using IBM SPSS version 23., Results: Analysis of 136 complete records was done, mean age was 31.97± 10.24 years, 77 (56.6%) were females, 102 (75%) were due to occupational exposures involving mostly nurses and medical and nursing students while 26 (76.5%) of non-occupational exposures were attributed to rape. The PEP service was assessed by 119 (87.5%) under 72hours but 120 (88.2%) never returned for follow-up. Source of exposure and HIV status of source were significantly associated with the time of assessing PEP. Statistical significance is determined by a p value of < 0.05., Conclusion: A major proportion of those that assessed PEP did so in less than 72 hours which is the recommended time by WHO but follow-up and rescreening was poor. There is need for active follow-up of clients that assess the service and increased public health enlightenment on availability and effect of PEP when assessed at the appropriate time., Competing Interests: The Authors declare that no competing interest exists, (Copyright © 2021 by West African Journal of Medicine.)

Background and Objectives: Healthcare workers are exposed to accidental infections from contaminated body fluids in the course of their duties. HIV post-exposure prophylaxis (PEP) is the measure instituted to manage exposure to potentially contaminated body fluids and prevent HIV infection. Ignorance of the appropriate measures to take may increase the risk of acquiring HIV infection from accidental exposure. This survey was conducted to assess the knowledge, attitude and practice of HIV PEP among doctors in a tertiary hospital., Methods: This was a cross-sectional survey. A pretested structured questionnaire was administered on randomly selected doctors from all clinical departments of a tertiary hospital. The questionnaire assessed the knowledge, attitude and practice of HIV PEP according to the WHO guidelines. A score of > 75% was adequate for each area., Results: Fifty-one completed questionnaires were returned out of 56 giving a response rate of 91%. The total knowledge score was 60.0 ± 10.2% (mean ± SD). The total score in attitude towards PEP was 66.5 ± 12.2% while for practice it was 47.5 ± 27.0%. There was a significant correlation between participant's knowledge and practice (rho = 0.316, p <0.05) as well as between attitude and practice (rho= 0.393, p< 0.01). There was no significant difference in scores in relation to the cadre or department., Conclusion: This study reveals that the knowledge, attitude and practice of HIV PEP among doctors is generally not adequate. Enhanced education will reduce the risk of accidental HIV infection among doctors.

Introduction: Timely PEP after needle stick exposure to high risk body fluids can reduce the rate of occupational transmission significantly. Ignorance of this may increase the risk of seroconversion to HIV for healthcare workers. This study was conducted with the aim of demonstrating the current level of knowledge and practise of healthcare workers as regards PEP., Methods: This was a cross-sectional study, pretested questionnaire were self administered to 372 health workers from various clinical specialties. The responses were collated and analyzed; results were presented in frequency tables., Results: This study revealed a high level of awareness among the respondents as 83.3% were aware of PEP. Despite the high level of awareness, respondents still have an inadequate knowledge about PEP, only 32% of the respondents could name at least two of the recommended drugs for PEP, only 54.0% of respondents knew when to commence PEP following occupational exposure to HIV. There was a low level of practice of PEP among the respondents as only 6.3% of respondents had PEP despite occurrence of needle stick injury., Conclusion: This study revealed a general low level use of PEP despite the average knowledge of PEP and the favourable attitude towards HIV PEP amongst the respondents.

Introduction: Health care workers are exposed to the risk of blood-borne diseases such as HIV, Hepatitis B and C in their daily encounter with infected patients and materials through unsafe injections. This study determined the baseline and post-intervention knowledge and practice of modern injection safety standards among health care workers., Methods: The study population was the healthcare workers in a teaching hospital in southeastern Nigeria. Data was collected using a self-administered 37-item structured questionnaire assessing their knowledge and practice on injection safety. Collected data was analyzed using SPSS., Results: Nurses comprised 62.8% (98/156) of the population. While most had heard of injection safety only 67.2% (84/125) had previously had any form of training on it. Only 54% (81/150) had heard or seen color coded bins. The standard needle and syringe is still widely used and 45% (65/145) still recap needles on syringes after use irrespective of type of personnel. Half (50.6% =78/154) of our respondents had had a previous needle prick injury. Only 25.6% (20/78) with previous needle prick injury had post-exposure prophylaxis. All doctors and laboratory scientists always use gloves compared to 94.8% (91/96) nurses while handling patients or materials. Following the intervention, a significantly high number became aware of post-exposure prophylaxis and color coded bins and liners., Conclusion: There is a need for healthcare workers to be regularly updated on changing safety standards in their practice. Also hospitals must be encouraged to acquire and use internationally accepted standard materials in collection and disposal patient's samples.

Background: Rabies is a preventable zoonosis with the highest case fatality of any disease in the world. In the developing world, it is transmitted mainly by dog bites. In parts of southern Nigeria, dog meat is a delicacy., Objective: To highlight trade in stray dogs as a major risk factor for rabies in animals and humans in south-south Nigeria., Method: Patients admitted into the University of Calabar Teaching Hospital (UCTH) with a diagnosis of rabies between July and October 2012 were analysed for risk factors, post exposure prophylaxis (PEP), health seeking behaviour and outcome. Focused group interview were also conducted among traders/handlers of stray dogs., Results: Ten cases of rabies in subjects aged 3 to 52 years were recorded in these five months period. Eight of the cases were male and apparently got infected directly or indirectly through the trade in stray dogs for human consumption. None had proper PEP and all patients died., Conclusion: Stray dog trade, fuelled by eating of dog meat, is a risk factor for human and animal rabies in Calabar, southern Nigeria. Culling of stray dogs, control of stray dogs' trade and public enlightenment on PEP is recommended.

Objective: To assess the knowledge and practice of post exposure prophylaxis (PEP) against HIV infection among health care providers in University of Abuja Teaching Hospital (UATH)., Methods: A cross-sectional survey conducted on 230 health care providers in UATH., Results: Majority (97.0%) of the respondents have heard about PEP, but only a few (30.9%) of them could correctly identify the drugs used and duration of PEP. A third of respondents have had one form of accidental exposure or the other. HIV test was carried out in about two-thirds (64.8%) of the source patients. Thirteen (28.3%) of the source patients were HIV-positive. Of the 13 respondents that were exposed to HIV-positive patients, only 3 (23.1%) received PEP, and these three completed PEP, while majority, 10/13 (76.9%) did not receive PEP in spite of their exposure to HIV-positive sources., Conclusion: The study shows that the knowledge and practice of PEP among health care providers are very poor.

Unlabelled: BACKGROUND/OBJECTIVE OF THE STUDY: Injection safety has over the years become important in view of the many diseases that are transmitted through unsafe injection practice. The objective was to assess the knowledge and practice of injection safety by nurses in mission hospitals in Benin City, Nigeria., Materials and Methods: A descriptive cross-sectional study was carried out. A structured interviewer-administered questionnaire was the tool for data collection. All the nurses (122) who gave their consent in the mission hospitals were studied. Data were analyzed using SPSS version 13., Results: The mean age of the respondents was 32.0 ± 8.9 years. The knowledge of injection safety among the respondents was poor (55.7%) while their practice of it was found to be good (48.4%) and excellent (47.5%). Knowledge was significantly influenced by the age, sex, and years of experience of the nurses. Twenty-eight (23.0%) and 40 (32.8%) respondents recap used needles regularly and sometimes respectively. Majority (71 [58.2%]) of the respondents had sustained needle stick injuries but only 4 (0.6%) respondents had a postexposure prophylaxis., Conclusion: This study showed that the knowledge of injection safety was poor among the nurses in mission hospitals in Benin City but their practice of injection safety was encouraging. There is need for the mission hospitals to organize regular training workshops on injection safety to improve the knowledge and practice of injection safety among their nurses.

Background: The mainstay of prevention of occupationally-acquired HIV infection is compliance with universal precautions. Appropriate post-exposure prophylaxis is an integral part of prevention, control and workplace safety. This study was undertaken to assess the level of knowledge of post-exposure prophylaxis (PEP) against human immunodeficiency virus (HIV) among doctors in Federal Medical Centre, Gombe, Nigeria., Materials and Methods: Ethical committee approval for the conduct of the study was obtained. Questionnaires were served to all cadres of doctors from house officers to consultants; it was completed and returned on anonymous basis., Results: Sixty six (88.0%) of the 75 distributed questionnaires were returned completed and formed the basis of further analysis. The overall knowledge level of post-exposure prophylaxis against human immunodeficiency virus infection was very low. About 62.1% are aware of the existence of PEP policy in the hospital. The level of knowledge concerning the high-risk fluid and three drugs used in PEP is high. Over 90% are not aware of the risk of sero-conversion following significant needle-sticks injury and mucous membrane exposure. The study also revealed poor knowledge concerning actions to be taken, how soon to commence the PEP treatment and the duration of medication following needle stick injury. More than 50% of the surveyed doctors had experienced significant exposure to potentially infective materials and none reported or sought PEP advice., Conclusion: There is the need to educate the doctors and other health workers about the PEP guideline policy, what to do in the event of injury, whom to contact and the importance of seeking urgent advice following injury or exposure.

Objective: To determine the occurrence of percutaneous injuries (PI) and accidental exposure to patients' blood (AEPB) in surgical residents in Enugu, Nigeria, their awareness of universal precautions (UP), and use of post-exposure prophylaxis (PEP)., Materials and Methods: Self-administered semi-structured pre-tested questionnaires were administered to 230 consenting trainee surgeons., Results: The rate of exposure to PI/ABE was 67.5%. The number of exposures ranged from 1 to 5 with a mean of 1.9 ± 0.99. Senior registrars had the highest rate of exposure (76.9%). In 89 exposures (63.6%) needle-prick injuries were reported. Adequate knowledge of the UP and PEP to HIV virus was only 41%. In most cases (72.1%) respondents subsequently disregarded the exposure., Conclusion: The high rate of exposure to PI/ABE, inadequate knowledge and poor practice of UP/PEP seen in this study underscore the need for creating high level of awareness about UP/PEP, the development of clear institutional guideline and the provision of adequate materials and supervision to ensure adherence with the guideline. The practice of UP and PEP in PI and AEPB are life saving and should be emphasized in residency training.

HIV infection from occupational and nonoccupational exposures can be prevented through risk assessment and management with antiretroviral drug therapy (ART). This study sought to examine the pattern of presentation and outcome of clients who were given postexposure prophylaxis (PEP) at the University College Hospital, Ibadan, Nigeria. A retrospective review of case notes of clients presenting for HIV PEP from January 2005 to December 2006 was carried out. A total of 48 clients with a mean age of 27.9 +/- 12.3 years underwent PEP during the period under review. Rape constituted 50% of reasons for PEP, while needle pricks and blood splash into mucous membranes constituted 25% each. Among those who received therapy, 10 (23.8%) could not complete drug therapy because of side effects. Although no client was HIV positive after the recommended 6 months of follow-up, 8 (16.7%) clients did not complete attendance to the clinic during the period.