Safety of health care paraprofessionals at peripheral health centers in the era of task shifting for HIV treatment

There have been renewed calls in favor of “task-shifting” for HIV treatment. Yet infection control practices by health care paraprofessionals and beneficiaries of such delegation schemes have not yet been assessed. Given the escalation of HIV infection in Africa and its alleged association with unsafe medical care, we assess the extent of access to training in universal precautions (UPs) and compliance with infection control standards of paraprofessionals in Eastern Kasai (Congo). Methods: Survey of 279 health workers in 2005 provided, among other things, data on training in UPs, knowledge of HIV infection control, involvement in risky procedures, exposure to blood and body fluids (BBFs), fear to provide HIV care, and needle stick experience. We focus on data provided by 66 workers posted at peripheral primary health care centers (24%). Results: We find (a) only 42.9% of health workers trained in UPs; (b) a 65% incidence rate of needle stick injuries; (c) a high level of fear in HIV care provision (scale of 1-5); (d) greater involvement in risky procedures in health centers; (e) an equality in terms of knowledge of infection control concepts; and (f) a more frequent exposure to BBFs in health centers than in referral hospitals. Conclusions: Given widespread infection control inefficiencies at peripheral primary health care centers, greater efforts should also be devoted to medical care cleanness and continuing education in UP as task-shifting schemes for HIV treatment are envisioned.