Occupational Exposure and Post-Exposure Prophylaxis (PEP) for HIV among Healthcare Workers: A Five-Year Retrospective Analysis of DHIS2 Data in Tanzania

Every day, healthcare workers in hospitals and clinics perform tasks that keep people alive, from drawing blood to administering injections. Yet, these essential acts carry a hidden risk: the accidental exposure to blood or body fluids that might contain dangerous viruses like HIV. When a needle prick or a splash of fluid breaches the skin or mucous membranes, the clock starts ticking. Medical science has developed a powerful tool to stop the virus from taking hold after such an accident. This tool is a course of medication known as post-exposure prophylaxis, or PEP. If taken correctly and started quickly after the incident, these drugs can prevent infection. However, the effectiveness of this safety net depends entirely on a chain of human actions: the worker must report the accident, get tested, start the medication, and then finish the full course of pills. If any link in this chain breaks, the protection fails.

In Tanzania, a team of researchers set out to examine how well this safety net functions across the country's health system. They looked at five years of records, from 2021 to 2025, gathered from nearly three hundred health facilities ranging from small dispensaries to large hospitals. Their goal was not to test the drugs themselves, but to trace the journey of the workers who had been exposed. They wanted to see how many accidents were reported, who was getting hurt, and whether those workers were successfully moving through the steps needed to stay safe. By analyzing data from the national health information system, they painted a picture of the real-world challenges and successes in protecting the people who protect others.

The researchers found that occupational exposure is a frequent occurrence. Over the five-year period, they identified more than fourteen thousand reported cases of HIV exposure across the country. Of these, nearly four thousand three hundred were work-related accidents involving healthcare staff and other workers in the facility. The data showed a clear upward trend; the number of reported incidents grew steadily each year, rising from just over five hundred cases in 2021 to more than twelve hundred in 2025. This increase likely reflects better reporting systems and greater awareness among staff rather than a sudden surge in accidents. The majority of these exposures happened in hospitals, and the workers most frequently affected were nurses and clinicians. The most common cause was a hollow needle stick, which accounted for seventy-one percent of all reported injuries, followed by solid needle sticks and splashes of fluid.

When the researchers followed the path of the healthcare workers who reported these accidents, they found a system that is largely working, though not perfectly. Out of the two thousand two hundred seventy-one healthcare workers who reported an exposure, nearly all of them were tested for HIV. The vast majority, about eighty-nine percent, agreed to start the preventive medication. This high rate of acceptance suggests that when workers know they have been exposed, they are eager to use the protection available to them. However, the journey becomes more difficult as time goes on. While most started the treatment, only about seventy-five percent of those who began the course managed to finish the full twenty-eight days of medication.

The study also revealed who is most likely to complete the treatment and where the gaps exist. Workers in larger hospitals were more likely to start the medication than those in smaller dispensaries, but surprisingly, workers in health centers were the most likely to finish the full course. Men were slightly more likely to start the treatment than women, but the difference was small. The researchers also looked at how many workers tested positive for HIV after the PEP period. They found that about fourteen percent of those who completed the course tested positive. This number appeared to rise over the years, but the researchers suspect this is not because the drugs stopped working. Instead, they believe the data may be flawed. It is possible that some workers who did not take the medication at all, or who did not finish it, were incorrectly recorded as having completed the course and as having tested positive. In other studies from different countries, the rate of infection after taking PEP is usually much lower, often close to zero. The high numbers in this Tanzanian dataset likely point to errors in how the information was recorded rather than a failure of the medicine.

Despite the data challenges, the overall picture is one of a robust system that is improving. The fact that nearly all exposed workers were tested and almost nine out of ten started treatment shows that the infrastructure for safety is in place and trusted. The researchers concluded that the program is highly acceptable to the workforce. To make the system even stronger, they suggest focusing on the reasons why people stop taking the medication before the month is up, which often involves side effects. They also recommend better training to prevent the accidents in the first place, such as teaching workers not to recap needles, and improving the data recording systems to ensure that the numbers accurately reflect who is taking the medicine and who is getting sick. The study confirms that while accidents happen, the medical community in Tanzania has built a strong defense, and with a few refinements, that defense can become even more reliable.