Title: HIV-related knowledge, attitude, and practice of nurses towards people living with HIV in Singapore: A Cross-sectional Survey

Title: HIV-related knowledge, attitude, and practice of nurses towards people living with HIV in Singapore: A Cross-sectional Survey
Abstract
Background: Healthcare workers' knowledge, attitude, and practice regarding HIV significantly influence the quality of care provided to people living with HIV. Understanding these factors is crucial for developing targeted interventions to improve HIV care delivery and reduce stigma.
Objective: To assess HIV-related knowledge, attitude, and practice among nurses in Singapore and identify factors associated with optimal HIV care delivery.
Design: Cross-sectional survey study.
Setting(s): Two tertiary healthcare institutions in Singapore: Tan Tock Seng Hospital and National Centre for Infectious Diseases.
Participants: 350 registered nurses across various clinical disciplines and professional levels.
Methods: Participants completed validated questionnaires assessing HIV knowledge (27 items), attitude towards people living with HIV (15 items), and HIV care practice (9 items). Sociodemographic data were collected including education level, work environment, clinical discipline, years of experience, HIV training history, and frequency of care. Pearson correlations examined relationships between knowledge, attitude, and practice domains. Multiple linear regression models identified factors associated with each domain.
Results: Nurses demonstrated satisfactory HIV knowledge (mean 18.27±4.16 out of 27), favourable attitudes (mean 35.37±4.47 out of 45), and appropriate practices (mean 6.64±1.66 out of 9). Knowledge correlated moderately with attitudes (r=0.383, 95% CI: 0.290-0.470) and practices (r=0.394, 95% CI: 0.302-0.479). Critical knowledge gaps included understanding of undetectable equals to untransmittable concepts (32.9% correct) and disinfectant effectiveness (30.6% correct). Stigmatising attitudes persisted, with 30.3% associating HIV acquisition with promiscuity. In multivariable analysis, master's degree holders scored 4.16 points higher in knowledge than certificate holders (95% CI: 0.49-7.83, p=0.026). Infectious diseases nurses outperformed surgical nurses by 2.55 points (95% CI: 1.28-3.82, p<0.001). Prior HIV training was associated with 1.94 points higher knowledge scores (95% CI: 1.07-2.82, p<0.001). Knowledge score was the sole significant predictor of attitudes (β=0.36, 95% CI: 0.23-0.49, p<0.001) and practices (β=0.13, 95% CI: 0.08-0.18, p<0.001).
Conclusions: Despite overall satisfactory knowledge, attitude, and practice scores, targeted interventions addressing concept of undetectable equals to untransmittable knowledge gaps and persistent stigmatising attitudes are needed. The strong association between knowledge and both attitudes and practices suggest that evidence-based ongoing education programmes should be prioritised to enhance HIV care quality and reduce stigma among healthcare workers.