Assessment of HIV/AIDS information among preclinical and clinical medical students

Introduction

By the end of 2015, UNAIDS reported that 0.1% of general population aged 15-49 years was living with HIV-AIDS and 4000 deaths were related to this disease in Iran (1). According to World Health Organization (WHO) estimation, almost half of new HIV cases are in 15-24 age groups, so the youth are at the core of educational and preventing programs (2, 3). Due to effective antiretroviral therapy and increased number of HIV/AIDS patients, more physicians from all branches of medicine will encounter these patients. This means all physicians should have sufficient and correct information and proficiency about routs of transmission to manage the patients regardless of their fear, stigma, and misconception.

Among this medical students, because of their future role as health care practitioners and also their special age group, are in critical situation. Medical students must be aware of the different aspects of disease like proper prevention methods such as post exposure prophylaxis, hospital safety protocols, and effective counselling method for HIV/AIDS patients. They should achieve disease information from different sources and also different views (patient view, health system view, medical view and community view) to become familiar with community knowledge and belief, so that they can deal with this developing epidemic. A study conducted in Malaysia showed insufficient knowledge in 80% of medical students (4). There are few studies on this important issue in Iran, most of them were community based survey (5, 6) and some studies involve undergraduate students (7), dental students, (8) and nurses (9).

The aims of this study were to assess the medical students' information about HIV/AIDS and the essential information which they want to know about this disease, also to determine the source of information they use to acquire knowledge about AIDS. The results of the study can act as a guide for medical students’ educational curriculum in order to find effective strategies for community based interventions.

Methods

This descriptive analytical study was carried out using a stratified random sampling method on medical students studied in different course of medical education in 2015-2016.

The sample size of 220 was obtained according to the following assumption: a 5% margin of error, 95% confidence interval and an expected knowledge level of 84% according to the similar study was done on pharmacy students (10).  Every student in each course (as a strata) had the same probability of being sampled:

Group (1): 100 medical students in basic science course and in physiopathology course (preclinical group)

Group (2): 100 medical students in externship and internship courses (clinical group)

All medical students who studied in Mashhad University of medical sciences and desired to fill the questionnaire enrolled the study. Exclusion criteria included unwillingness to participate in the study and also those who filled out the questionnaire incompletely. The study instrument was extracted from a WHO questionnaire developed to assess HIV/AIDS related knowledge, attitudes, and practice. (11-13) Questions about sociodemographic characteristics included age, gender, marital status (married, single, widowed, and divorced), incomes, and lodging status (Student dormitory, living with parents). Also, the individuals' source of information on HIV/AIDS and also their informational needs about the different aspects of the disease were added to the first part of the questionnaire. The instrument was validated in pervious study and the Cronbach’s Alfa was 0.81 (6).

The same researcher distributed the questionnaires in two study groups. The purpose and method of the study were described to participants and all those agreeing to take part in the study were provided by a written consent. All questionnaires were anonymous and respondents were completely voluntary to take part in the study. The study was approved by the Mashhad university medical faculty ethics committee (IR.MUMS.fm.REC.1394.561).

Categorical variables were reported as number and percent among participants and the quantitative variable were the mean ± and standard deviation (SD). In order to compare quantitative variables, STUDENT T,test or Man-Witney U test was used according to the results of normality test.  Pearson’s Chi-square was used to evaluate categorical variables between groups. A P-value of less than 0.05 was considered significant. Data analysis was performed using SPSS (version 11.5; SPSS, Inc., Chicago, IL, USA).

Results

A total of 198 complete questionnaires were obtained. This is very a good response rate (90%) in questionnaire based study. The mean age of the participants was 22.31+2.97 years and ranged from 16 to 45 years. Most of them were female 130 (65.7%) and 154 (77.4%) were single. Most of the students were living in student dormitory 116 (58.9%).  A summary of participants’ characteristics is presented in Table 1.

HIV/AIDS basic and transmitted information of medical students in two study groups were presented in table 2 (The correct answers were shown as N (%)). There is no statistically significant difference in mean and SD (standard deviation) of information between preclinical and clinical students (22.11+1.66 vs 22.08+1.70, p value=0.91).

About the participant's sources of information, respondents were allowed to select more than one option. The most of the students reported that books 170 (85.85%) were their main source of getting information about HIV/AIDS, followed by friendship organization 65 (32.82%) and television 58 (29.29%). However, few participants received information from radio (3.03%).

The selection of books as the leading source of information was unchanged when compared among two study groups (Table 3).

Details about information needs in two groups of medical trainees were shown in table 4. Most students reported they need more information on treatment 118 (59.59%), as well as information on prevention 84 (42.42%), and modes of transmission 79 (39.89%).

 Discussion

The results of the study showed that most of the students were informed about the nature of the disease and the various ways of transmission and contamination of HIV infection. Over 95% of the preclinical students and 100% of clinical students had knowledge about the pathogenicity mechanism of the disease and they knew that the immune system has been targeted by HIV virus. The results of another study carried out on final year medical students in Vietnam had demonstrated that only 41% of students knew the TCD4 lymphocytes are the main target cells in HIV infection (14). Almost all of the students except a few, knew that the virus can be transmitted through sexual contact or infected surgical and dental instruments. Although in most of the questions, the students selected the correct answers but in some aspects they had specific deficiency. Generally, knowledge regarding transmission and contamination of HIV infection was not acceptable for medical students. This finding that 12% of our sample was concerned about the contamination of public places like pools or toilets indicates that medical students do not receive sufficient education to work safely with AIDS patients. It has been shown that one of the important factors in students’ negative perception about AIDS patients is the fear of contagion (15). In this study there was no statistically significant difference in basic and transmitted information among preclinical and clinical students. It might be due to the particular nature of the questions which cannot differentiate between two different courses in medical education, or it can be related to the deficits in our medical education program and HIV education and training. One can expect valid information about HIV/AIDS over the years of study in medical school to increase especially after entering the clinical courses.

As it was expected, the most common and valid means of receiving information about HIV/AIDS were books which was constant among preclinical and clinical students. On the contrary, similar studies carried out on medical students, nursing students, and other health science students in other countries indicated the students selected the popular media such as TV, radio, and newspaper as their most common choices (16-18). In a study performed among general public, TV, magazine, and newspaper were found to be the most popular sources of information (6). One can deduced that although the popular media are the best path for population based intervention but it seems in Iran they do not have played their particular task in constructing awareness of selective health problem as HIV/AIDS for all type of general population with different knowledge level. The results of the study showed that student organization was one important source of information in overall and particularly in preclinical students.

Most of the students wanted to know more about HIV/AIDS prevention and also different modes of transmission. Presented results are in correspondence with students’ basic and transmitted information which assessed in this study. These main trainings should be delivered to medical students early in their pre-clinical course and replicated later on a larger scale to strengthen their information, so that their practice in relation with patients, proper prevention method, and post exposure prophylaxis can be changed.

The first limitation of this study was the self-administrated instrument which might be disposed to bias, so the precision of the responses could not be checked. Secondly, the instrument was not designed to investigate in depth HIV training and educational program in medical university. Future study should explore this aspect in order to provide valuable evidence in relationship between undergraduate education, knowledge, and practice. Nevertheless, the study instrument was extracted from a specific standardized WHO questionnaire which developed to assess HIV/AIDS related knowledge, attitudes, and practice. Moreover the high response rate in this study showed respondent population was well excited and the survey was well-administrated. 

The present study showed that although medical students have knowledge about HIV/AIDS, there are some considerable misconceptions in their basic and transmitted HIV knowledge that require more attention to revise the HIV educational curriculum of the medical schools. The students used books, student organization, and television as their dominant sources of getting HIV information. Majority of students wanted to know more about treatment and prevention of the disease. It seems that organizing different congresses and meetings related to different aspects of HIV/AIDS, can prepare opportunity for medical students to become aware of the general precautions and different prevention methods such as post exposure prophylaxis and hospital protection protocols.