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 Table of Contents    
ORIGINAL ARTICLE  
Year : 2015  |  Volume : 5  |  Issue : 1  |  Page : 30-34
Knowledge, attitude and practices toward post-exposure prophylaxis for human immunodeficiency virus among dental practitioners in Pune, India


1 Department of Oral Medicine and Radiology, Rural Dental College, Loni, India
2 Department of Oral Medicine and Radiology, Dr. D. Y. Patil Dental College, Pune, India
3 Department of Community Medicine, Rural Medical College, Loni, Maharashtra, India
4 Department of Prosthodontics, Rural Dental College, Loni, India

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Date of Web Publication3-Mar-2016
 

   Abstract 

Background: As India has third largest number of people affected with human immunodeficiency virus (HIV), dental practitioners are more likely to encounter such patients for dental management.
Aim: The aim was to evaluate the knowledge, attitude, and practice regarding post-exposure prophylaxis (PEP) for HIV among dental practitioners in Pune, India.
Materials and Methods: A cross-sectional study was conducted among 218 dental practitioners who attended Maharashtra State Zonal Conference organized by Indian Dental Association, Pimpri Chinchwad Branch in July 2013. Data related to HIV PEP was collected by predesigned, pretested, self-administered questionnaire. Data was analyzed using Microsoft Office Excel 2007 and results were expressed in percentage.
Results: Majority of the participants (69.7%) were found to be in the private practice for <10 years. Though <΍ of the dental practitioners (44.9%) had ever treated known HIV patients, majority of them had a positive attitude for treating these patients (83.9%). About 72.8% of them were aware of the concept of HIV PEP. Majority of them knew the best timing for commencement of HIV PEP drug regimen (58.2%), the antiretroviral drugs to be used (67.8%), timing of antibody testing to rule out infection to health care workers (72%) and from where to avail PEP drug regimen (86.6%). Dental practitioners had poor knowledge regarding the duration of PEP drug regimen (28.4%) and the reason for discontinuation of the same (26.1%). 89.9% of dental practitioners thought that the topic was not well covered in Bachelor of Dental Surgery (BDS) curriculum and 46.7% of them had gained knowledge on the subject through seminars or workshops.
Conclusion: The results of this survey showed that though dental practitioners had adequate knowledge of HIV PEP, but an elaboration of this topic is required in BDS curriculum.

Keywords: Dental practitioners, human immunodeficiency virus post-exposure prophylaxis, knowledge

How to cite this article:
Kasat VO, Chavan M, Giri PA, Ladda R, Diwan N. Knowledge, attitude and practices toward post-exposure prophylaxis for human immunodeficiency virus among dental practitioners in Pune, India. J Educ Ethics Dent 2015;5:30-4

How to cite this URL:
Kasat VO, Chavan M, Giri PA, Ladda R, Diwan N. Knowledge, attitude and practices toward post-exposure prophylaxis for human immunodeficiency virus among dental practitioners in Pune, India. J Educ Ethics Dent [serial online] 2015 [cited 2019 Aug 17];5:30-4. Available from: http://www.jeed.in/text.asp?2015/5/1/30/178031



   Introduction Top


India has 2.09 million human immunodeficiency virus (HIV) infected patients out of the 34 million patients affected globally, and ranks third as far as global HIV burden is concerned. [1],[2] Maharashtra ranks sixth among the high HIV prevalence states of India with 4.2 lakhs people affected. [2] Health care workers (HCWs) have a small but significant risk of acquiring HIV by occupational exposure to blood or through other body fluids. [3] There have been reports of transmission of HIV from an infected dentist to patient [4] and in the same way it can be transmitted to dentist from an infected patient. [2] In addition, such exposures cause fear and stress among HCWs and their families. [3] It is estimated that 90% of HIV infections among HCWs occur in the developing countries because of neglected occupational safety. [5]

In India, National AIDS Control Organization has formulated guidelines for post-exposure prophylaxis (PEP), according to the recommendations given by Centre for Disease Control to prevent occupational HIV transmission. [2] Hence, it is important that HCWs should be aware about these guidelines. Studies on awareness regarding HIV PEP have been conducted in medical and paramedical fields like on family physicians, [6] anesthetists, [7] general surgeons, [7] general practitioners, [8] medical interns, [9] nurses, and health assistants, [10] but no study is conducted in dental field except the one reported by us. [2]

In India, there are 324 dental colleges graduating 28,000 dentists/year. [11] Considering such a large number of dentists entering into private practice who are likely to encounter HIV patients, it is important that they should be aware of HIV PEP. Hence, this study was planned to assess the knowledge of dental practitioners regarding HIV PEP in Pune city of India and in turn raise awareness among dental fraternity regarding this issue.


   Materials and Methods Top


A cross-sectional analytical study was conducted among dental practitioners who attended Maharashtra State Zonal Conference organized by Indian Dental Association, Pimpri Chinchwad Branch in July 2013. A 17-item questionnaire in English language was used to assess dental practitioner's knowledge and practice regarding HIV PEP and their attitude toward HIV patients [Appendix [Additional file 1]]. The questionnaire was adapted from our previous similar study [2] on dental students with the addition of four new questions.

Institutional Ethical Committee approval was obtained for the study. All subjects provided written informed consent to participate in the study. The participation was voluntary and confidentiality was assured. The questionnaires were distributed to 300 dental practitioners randomly and collected by the investigators after 20 min. Few questions were objective in nature with "yes" or "no" options whereas others had multiple choices. To assess awareness, participants were asked if they had heard of HIV PEP. Knowledge was assessed through questions on saliva as a risk fluid, first-aid measures to employ in case of accidental exposure, best timing to start HIV PEP drug regimen following exposure, the antiretroviral drugs used and their duration, from where to avail these drugs, common reasons for not completing the course, and timing of antibody testing to rule out infection to HCWs.

Attitude of participants toward HIV patients was assessed by knowing their willingness to provide dental treatment to HIV patient. They were also asked whether they had treated HIV patients in their practice. Furthermore, history of personal needle stick injuries was obtained and their response to the injury was noted by asking them whether HIV PEP consultation was sought or not. Their opinion regarding coverage of this topic in Bachelor of Dental Surgery (BDS) curriculum was taken. E-mail addresses of all the participants were noted and correct answers were E-mailed to them at the end of the study.

Statistical analysis

Data was were analyzed using Microsoft Office Excel 2007 and the results were expressed in percentage.


   Results Top


Of 300 distributed questionnaires, 218 were returned giving a response rate of 72.6%. In this study, there were 133 males and 85 females with the age range of 23-72 years. Majority of the participants (69.7%) were found to be in the private practice for <10 years. Most of them (86.6%) thought HIV as one of the maximum risk hazards a dentist would encounter in practice. Though less than half of them (44.9%) had ever treated a HIV patient, majority of them (83.9%) were willing to provide dental treatment to these patients (83.9%) [Table 1]. Surprisingly, only 27.9% of dentists knew that HIV can't be transmitted through uncontaminated saliva and nearly half of them (45.3%) considered saliva as a low or high-risk fluid. About three fourth of dental practitioners (77%) correctly stated the first aid measures to be taken in case of needle stick injury. None of the dentists ever had needle stick injury while treating a HIV patient.

Majority of the dentists (72.8%) were aware of the concept of HIV PEP for high risk occupational exposures. Among all participants, nearly half (46.7%) had gained knowledge on this topic through seminars or workshops and majority (89.9%) thought that this subject is not well covered in BDS curriculum. More than half of them (58.2%) knew that HIV PEP should commence within an hour of exposure. Surprisingly, only 28.4% of dental practitioners knew the correct duration of HIV PEP, whereas 44% of them overestimated the duration (8 weeks), and 22.9% underestimated the duration (1-week). About 90.7% of them knew the ideal PEP drug regimen for low and high-risk exposures and 73.4% knew from where to avail these drugs, but only 26.1% knew the common cause for discontinuation of drugs. Nearly three-fourth of dental practitioners (72%) knew the correct timing of antibody testing after cessation of PEP to confirm that HCW is not infected following exposure to HIV-infected material [Table 2].
Table 1: Participant's attitude toward HIV patients and practice regarding PEP for HIV

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Table 2: Knowledge about PEP for HIV among study population

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   Discussion Top


Hepatitis B and HIV are two main diseases of concern for a practicing dentist as far as occupational transmission is concerned. As vaccine is available for hepatitis B and majority of dentists avail it, the concern remains more for HIV which is also revealed in this study (86.6% of the participants considered HIV as a major risk hazard for practicing dentist). In spite of taking universal precautions, if incidence like needle stick injury occurs while treating HIV patient, then PEP for HCW is recommended. [12] HIV PEP is the prescription of one or more antiretroviral drugs to reduce the risk of transmission of HIV following a known or possible exposure. [2]

In this study, 72.8% of dental practitioners were aware of the concept of HIV PEP for high risk occupational exposures which is comparable to that reported by Kasat et al. [2] in dental students (68.8%), Ooi et al. [8] in general practitioners (68.8%), but less than that reported by Agaba et al. [6] in family physicians (97.7%). Exposure to blood carries the highest risk of HIV transmission, but other body fluids like saliva, sweat, tears, urine, nasal secretions are not considered infectious unless they are visibly bloody. [2] This fact about saliva was known to only 27.9% of dentists in our study which is similar to the results reported by Ryalat et al. [5] in dental students (15.5% of 3 rd year and 18.5% of 5 th year students gave the correct reply). Our participants had poor knowledge on this aspect of saliva than reported by Uti et al. [13] (where 59.2% Nigerian dentists) and Kasat et al. [2] (where 73.4% dental interns and 87.5% dental postgraduate (PG) students knew the correct answer.

The knowledge regarding commencement of HIV PEP after exposure was better in our participants (58.2%) than reported by Kasat et al. [2] in dental students (20.4% interns vs. 42.2% PGs), Chacko and Isaac [9] in medical interns (31.6%), comparable to that reported by Chogle et al. [7] in surgical and anesthetic residents (64.0%), but less than that reported by Agaba et al. [6] in family physicians (93.9%). The maximum benefit of PEP is obtained when started within an hour of exposure. It may be delayed up to 48-72 h, but after that it becomes less effective in preventing infection. [2],[7]

In the present study, the correct duration of HIV PEP was known to only 28.4% of dental practitioners. This is more than that reported by Chogle et al. [7] in surgical and anesthetic residents (6.0%), comparable to that reported by Kasat et al. [2] in dental students (23.4% interns vs. 25% PGs) but significantly less than that reported by Agaba et al. [6] in family physicians (83.3%). It is recommended to continue PEP for 4 weeks following occupational exposure to HIV, but it is often discontinued due to the side effects of drugs. Knowledge of this study population (77% dental practitioners) regarding the first aid measures to be taken immediately after needle stick injury is similar to that reported by Chogle et al. [7] in surgical and anesthetic residents (78.0%) and Kasat et al. [2] in dental students (73.4% interns vs. 93.7% PGs). First aid measures after needle stick injury include promoting active bleeding from the wound and washing the site with water and soap. [2]

In this study, about 90.7% of the participants knew the ideal PEP drug regimen for low and high-risk exposures. Thus, in this aspect they had much better knowledge than reported by Agaba et al. [6] in family physicians (57.0%), Chacko and Isaac [9] in medical interns (50.0%) and Kasat et al. [2] in dental students (48.4% interns vs. 43.7% PGs). In a study by Chogle et al. [7] none of the participants knew drugs other than zidovudine. HIV PEP is available either as basic regimen consisting of two nucleoside reverse transcriptase inhibitors (zidovudine and lamivudine) for low risk exposures or expanded regimen in which one protease inhibitor is added to basic regimen for high risk exposures (zidovudine, lamivudine, and indinavir or nelfinavir). [2],[7],[12] In the present study, 73.4% of the dental practitioners knew from where to avail these drugs, whereas 26.6% were under the wrong impression that they are available in medical stores. In 2004, Government of India initiated free anti-retroviral therapy (ART) program under the National AIDS Control Program, in which drugs were distributed through ART centres set up mainly in the Government Medical Colleges (Department of Medicine) and Government Hospitals (district, sub-district and area hospitals). [14] Till March 2014, there were 425 functional ART centres across the country. [14]

Infection to HCW following exposure to HIV-infected material can be ruled out after 6 months, as in 95% of cases seroconversion occurs within 6 months. [2] This was known to 72% of the participants in this study which is more than reported by Kasat et al. [2] in dental students (23.5% interns vs. 36% PGs). The positive attitude of our participants in treating HIV patient (83.9%) was more than that reported by Ryalat et al. [5] in BDS students (60.8% 3 rd year vs. 73.7% 5 th year), but less than that reported by Kasat et al. [2] in dental students (98.4% interns vs. 100% PGs). Among all participants, nearly half (46.7%) had gained knowledge on this topic through lectures or seminars which is significantly more than reported by Kasat et al. [2] where none of the interns and only 3.2% of PG students had attended lectures, workshops or seminars about PEP. Majority of our participants (89.9%) thought that topic is not well covered in BDS curriculum. The difference in the knowledge regarding HIV PEP found in this study participants and other studies may be related to the differences in the curriculum, profession, and experience of participants, HIV prevalence in the study area, etc.


   Conclusion Top


The results of this survey showed that though dental practitioners had adequate knowledge of HIV PEP, but an elaboration of this topic is required in BDS curriculum.

Acknowledgment

We sincerely thank all the participants of the study. This study was self-funded. The authors have no conflict of interest to report.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
   References Top

1.
Current Epidemiological Situation of HIV/AIDS. Annual Report 2013-14. New Delhi: Department of AIDS Control, National AIDS Control Organisation, Ministry of Health and Family Welfare, Government of India; 2014.  Back to cited text no. 1
    
2.
Kasat V, Saluja H, Ladda R, Sachdeva S, Somasundaram K, Gupta A. Knowledge, Attitude and Practices toward Post Exposure Prophylaxis for Human Immunodeficiency Virus among Dental Students in India. Ann Med Health Sci Res 2014;4:543-8.  Back to cited text no. 2
[PUBMED]  Medknow Journal  
3.
Gupta A, Anand S, Sastry J, Krisagar A, Basavaraj A, Bhat SM, et al. High risk for occupational exposure to HIV and utilization of post-exposure prophylaxis in a teaching hospital in Pune, India. BMC Infect Dis 2008;8:142.  Back to cited text no. 3
    
4.
Ciesielski C, Marianos D, Ou CY, Dumbaugh R, Witte J, Berkelman R, et al. Transmission of human immunodeficiency virus in a dental practice. Ann Intern Med 1992;116:798-805.  Back to cited text no. 4
    
5.
Ryalat ST, Sawair FA, Shayyab MH, Amin WM. The knowledge and attitude about HIV/AIDS among Jordanian dental students: (Clinical versus pre-clinical students) at the University of Jordan. BMC Res Notes 2011;4:191.  Back to cited text no. 5
    
6.
Agaba PA, Agaba EI, Ocheke AN, Daniyam CA, Akanbi MO, Okeke EN. Awareness and knowledge of human immunodeficiency virus post exposure prophylaxis among Nigerian Family Physicians. Niger Med J 2012;53:155-60.  Back to cited text no. 6
[PUBMED]  Medknow Journal  
7.
Chogle NL, Chogle MN, Divatia JV, Dasgupta D. Awareness of post-exposure prophylaxis guidelines against occupational exposure to HIV in a Mumbai hospital. Natl Med J India 2002;15:69-72.  Back to cited text no. 7
    
8.
Ooi C, Dayan L, Yee L. Knowledge of post exposure prophylaxis (PEP) for HIV among general practitioners in northern Sydney. Sex Transm Infect 2004;80:420.  Back to cited text no. 8
    
9.
Chacko J, Isaac R. Percutaneous injuries among medical interns and their knowledge & practice of post-exposure prophylaxis for HIV. Indian J Public Health 2007;51:127-9.  Back to cited text no. 9
[PUBMED]  Medknow Journal  
10.
Tebeje B, Hailu C. Assessment of HIV Post-exposure prophylaxis use among health workers of governmental health institutions in Jimma Zone, Oromiya Region, Southwest Ethiopia. Ethiop J Health Sci 2010;20:55-64.  Back to cited text no. 10
    
11.
Available from: http://www.dciindia.org.in/. Accessed November 17, 2014.  Back to cited text no. 11
    
12.
Shevkani M, Kavina B, Kumar P, Purohit H, Nihalani U, Shah A. An overview of post exposure prophylaxis for HIV in health care personals: Gujarat scenario. Indian J Sex Transm Dis 2011; 32:9-13.  Back to cited text no. 12
[PUBMED]  Medknow Journal  
13.
Uti OG, Agbelusi GA, Jeboda SO, Ogunbodede E. Infection control knowledge and practices related to HIV among Nigerian dentists. J Infect Dev Ctries 2009;3:604-10.  Back to cited text no. 13
    
14.
Care, Support and Treatment. Annual Report 2013-14. New Delhi: Department of AIDS Control, National AIDS Control Organisation, Ministry of Health and Family Welfare, Government of India; 2014.  Back to cited text no. 14
    

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Correspondence Address:
Vikrant O Kasat
Department of Oral Medicine and Radiology, Rural Dental College, Loni - 413 736, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0974-7761.178031

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