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Shrestha S, Chataut S, Kc B, Acharya K, Pradhan SK, Shrestha S. Knowledge, Attitude, Practice, and Adherence to Antiretroviral Therapy among People Living with HIV in Nepal. AIDS Res Treat 2023; 2023:7292115. [PMID: 37492128 PMCID: PMC10365915 DOI: 10.1155/2023/7292115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 06/25/2023] [Accepted: 07/06/2023] [Indexed: 07/27/2023] Open
Abstract
Introduction Patient's knowledge and attitude towards their treatment avert stereotypical misconceptions about the disease and its treatment, as well as aid in attaining optimal adherence. This study investigated the knowledge, attitude, practice, and adherence of antiretroviral therapy (ART) clients in Nepal. Method A cross-sectional study was conducted among 165 ART clients visiting five ART sites in the far western region and the capital city of Nepal. The convenience sampling method was employed, and the data were collected through interviews with ART clients using a validated questionnaire. Binary logistic regression was used to identify associated factors. Result Approximately 80.7% had adequate knowledge and 55% had a positive attitude towards ART. Stigmatization was associated with ARV by only 4.2%. Half of the participants (50.3%) revealed that they had surreptitiously stored their ART medication, diverging from the recommended storage guidelines. A significant proportion of respondents (33.3%) chose to repackage the medication as a strategy to prevent unintended disclosure of their HIV status. Many (59.3%) believed that ART does not prolong life. Nevertheless, they advocated the regular use of ART rather than taking it only when the health deteriorates (81.8%). The majority (97.6%) were found to be adherent to their ART. There was a significant association of age with a level of knowledge and attitude (p < 0.05). A significant association was also found between knowledge and attitude towards ART (p < 0.05). None of the variables had a significant association with adherence (p > 0.05). Conclusion Overall, adequate knowledge was demonstrated, whereas efforts are still needed to improve the attitude of ART clients towards ART. A need for counseling regarding the storage practices of ART is needed. A focus on ensuring the perfect translation of adequate knowledge and a positive attitude to the practice of ART clients is essential. Whether adequate ART knowledge and attitude scores will lead to near-perfect ART adherence needs further investigation.
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Affiliation(s)
- Sweta Shrestha
- Department of Pharmacy, School of Science, Kathmandu University, Dhulikhel, Kavre, Nepal
| | - Subodh Chataut
- Department of Pharmacy, School of Science, Kathmandu University, Dhulikhel, Kavre, Nepal
| | - Badri Kc
- Department of Pharmacy, School of Science, Kathmandu University, Dhulikhel, Kavre, Nepal
| | - Khagendra Acharya
- Department of Management Informatics and Communication, School of Management, Kathmandu University, Dhulikhel, Kavre, Nepal
| | - Sait Kumar Pradhan
- Department of Clinical Physiology, Maharajgunj Medical Campus, Institute of Medicine, Kathmandu, Nepal
| | - Sunil Shrestha
- School of Pharmacy, Monash University Malaysia, Subang Jaya, Selangor, Malaysia
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Mantell JE, Zech JM, Masvawure TB, Assefa T, Molla M, Block L, Duguma D, Yirsaw Z, Rabkin M. Implementing six multi-month dispensing of antiretroviral therapy in Ethiopia: perspectives of clients and healthcare workers. BMC Health Serv Res 2023; 23:563. [PMID: 37259098 DOI: 10.1186/s12913-023-09549-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Accepted: 05/14/2023] [Indexed: 06/02/2023] Open
Abstract
BACKGROUND Multi-month dispensing (MMD) of antiretroviral therapy (ART) is an integral component of differentiated HIV service delivery for people living with HIV (PLHIV). Although many countries have scaled up ART dispensing to 3-month intervals, Ethiopia was the first African country to implement six-month dispensing (6-MMD) at scale, introducing its Appointment Spacing Model (ASM) for people doing well on ART in 2017. As of June 2021, 51.4% (n = 215,101) of PLHIV on ART aged ≥ 15 years had enrolled in ASM. Since little is known about the benefits and challenges of ASM perceived by Ethiopian clients and their healthcare workers (HCWs), we explored how the ASM was being implemented in Ethiopia's Oromia region in September 2019. METHODS Using a parallel convergent mixed-methods study design, we conducted 6 focus groups with ASM-eligible enrolled clients, 6 with ASM-eligible non-enrolled clients, and 22 in-depth interviews with HCWs. Data were audio-recorded, transcribed and translated into English. We used thematic analysis, initially coding deductively, followed by inductive coding of themes that emerged from the data, and compared the perspectives of ASM-enrolled and non-enrolled clients and their HCWs. RESULTS Participants enrolled in ASM and HCWs perceived client-level ASM benefits to include time and cost-savings, fewer work disruptions, reduced stigma due to fewer clinic visits, better medication adherence and improved overall health. Perceived health system-level benefits included improved quality of care, decongested facilities, reduced provider workloads, and improved record-keeping. Although non-enrolled participants anticipated many of the same benefits, their reasons for non-enrollment included medication storage challenges, concerns over less frequent health monitoring, and increased stress due to the large quantities of medicines dispensed. Enrolled participants and HCWs identified similar challenges, including client misunderstandings about ASM and initial ART stock-outs. CONCLUSIONS ASM with 6-MMD was perceived to have marked benefits for clients and health systems. Clients enrolled in the ASM and their HCWs had positive experiences with the model, including perceived improvements in efficiency, quality and convenience of HIV treatment services. The concerns of non-ASM enrolled participants suggest the need for enhanced client education about the model and more discreet and efficiently packaged ART and highlight that ASM is not ideal for all clients.
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Affiliation(s)
- Joanne E Mantell
- New York State Psychiatric Institute and Department of Psychiatry, HIV Center for Clinical and Behavioral Studies, Gender, Sexuality and Health Area, Columbia University Irving Medical Center, New York, New York, United States of America.
| | - Jennifer M Zech
- ICAP at Columbia University, New York, NY, United States of America
| | - Tsitsi B Masvawure
- Health Studies Program, Center for Interdisciplinary Studies, College of the Holy Cross, Worcester, MA, United States of America
| | | | | | - Laura Block
- ICAP at Columbia University, New York, NY, United States of America
| | | | | | - Miriam Rabkin
- ICAP at Columbia University, New York, NY, United States of America
- Departments of Medicine and Epidemiology, Columbia University Irving Medical Center, New York, NY, United States of America
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Kuo AP, Roche SD, Mugambi ML, Pintye J, Baeten JM, Bukusi E, Ngure K, Stergachis A, Ortblad KF. The effectiveness, feasibility and acceptability of HIV service delivery at private pharmacies in sub-Saharan Africa: a scoping review. J Int AIDS Soc 2022; 25:e26027. [PMID: 36285619 PMCID: PMC9597376 DOI: 10.1002/jia2.26027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 09/28/2022] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION Private pharmacies are an understudied setting for differentiated delivery of HIV services that may address barriers to clinic-delivered services, such as stigma and long wait times. To understand the potential for pharmacy-delivered HIV services in sub-Saharan Africa, we conducted a scoping review of the published and grey literature. METHODS Using a modified Cochrane approach, we searched electronic databases through March 2022 and HIV conference abstracts in the past 5 years for studies that: (1) focused on the delivery of HIV testing, antiretroviral therapy (ART) and/or pre-exposure prophylaxis (PrEP) at private pharmacies in sub-Saharan Africa; (2) reported on effectiveness outcomes (e.g. HIV incidence) or implementation outcomes, specifically feasibility and/or acceptability; and (3) were published in English. Two authors identified studies and extracted data on study setting, population, design, outcomes and findings by HIV service type. RESULTS AND DISCUSSION Our search identified 1646 studies. After screening and review, we included 28 studies: seven on HIV testing, nine on ART delivery and 12 on PrEP delivery. Most studies (n = 16) were conducted in East Africa, primarily in Kenya. Only two studies evaluated effectiveness outcomes; the majority (n = 26) reported on feasibility and/or acceptability outcomes. The limited effectiveness data (n = 2 randomized trials) suggest that pharmacy-delivered HIV services can increase demand and result in comparable clinical outcomes (e.g. viral load suppression) to standard-of-care clinic-based models. Studies assessing implementation outcomes found actual and hypothetical models of pharmacy-delivered HIV services to be largely feasible (e.g. high initiation and continuation) and acceptable (e.g. preferable to facility-based models and high willingness to pay/provide) among stakeholders, providers and clients. Potential barriers to implementation included a lack of pharmacy provider training on HIV service delivery, costs to clients and providers, and perceived low quality of care. CONCLUSIONS The current evidence suggests that pharmacy-delivered HIV services may be feasible to implement and acceptable to clients and providers in parts of sub-Saharan Africa. However, limited evidence outside East Africa exists, as does limited evidence on the effectiveness of and costs associated with pharmacy-delivered HIV services. More research of this nature is needed to inform the scale-up of this new differentiated service delivery model throughout the region.
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Affiliation(s)
- Alexandra P. Kuo
- Department of PharmacyUniversity of WashingtonSeattleWashingtonUSA
| | - Stephanie D. Roche
- Public Health Sciences DivisionFred Hutchinson Cancer CenterSeattleWashingtonUSA
| | | | - Jillian Pintye
- School of NursingUniversity of WashingtonSeattleWashingtonUSA
| | - Jared M. Baeten
- Department of Global HealthUniversity of WashingtonSeattleWashingtonUSA
- School of NursingUniversity of WashingtonSeattleWashingtonUSA
- Department of EpidemiologyUniversity of WashingtonSeattleWashingtonUSA
- Department of MedicineUniversity of WashingtonSeattleWashingtonUSA
- Gilead SciencesFoster CityCaliforniaUSA
| | - Elizabeth Bukusi
- Department of Global HealthUniversity of WashingtonSeattleWashingtonUSA
- Centre for Microbiology ResearchKenya Medical Research InstituteNairobiKenya
- Department of Obstetrics and GynecologyUniversity of WashingtonSeattleWashingtonUSA
| | - Kenneth Ngure
- Department of Global HealthUniversity of WashingtonSeattleWashingtonUSA
- Department of Community HealthJomo Kenyatta University of Agriculture and TechnologyNairobiKenya
| | - Andy Stergachis
- Department of PharmacyUniversity of WashingtonSeattleWashingtonUSA
- Department of Global HealthUniversity of WashingtonSeattleWashingtonUSA
| | - Katrina F. Ortblad
- Public Health Sciences DivisionFred Hutchinson Cancer CenterSeattleWashingtonUSA
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Semvua SK, Kim CY, Muiruri C, Peter TA, Mmbaga BT, Bartlett JA, Zullig LL, Jazowski SA, Knettel BA, Karia FP, Ramadhani HO. Predictors of Self-repackaging of Antiretroviral Therapy in Northern Tanzania. Am J Health Behav 2022; 46:124-133. [PMID: 35501963 DOI: 10.5993/ajhb.46.2.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Objectives: In this study, we explored determinants of "researcher-observed" patient-initiated antiretroviral therapy (ART) repackaging practices among people living with HIV (PLHIV) in Northern Tanzania. Methods: We used a quasi-experimental design to describe the prevalence of ART self- repackaging; we conducted face-to-face surveys to determine factors associated with ART self- repackaging practices. Data collection sites included the Kilimanjaro Christian Medical Centre and the Mawenzi Referral Hospital. We used study-specific numerical identifiers assigned to ARTs packaging to determine self-repackaging behavior. Self-repackaging was defined as a binary variable where participants who discarded antiretroviral drugs packaging in at least 2 clinic visits were classified as self- repackagers. We used multivariable logistic regression to assess the determinants of patient-initiated repackaging practices. Results: Among 590 study participants, 57.6% self-repackaged based on researcher observation and 55.6% self-repackaged based on patient report. Researcher-observed self- repackaging was associated with gender (AOR = 1.590; 95% CI: 1.011, 2.502), employment status (AOR = 0.475: 95% CI; 0.239, 0.942), and study site (AOR = 0.218; 95% CI: 0.134, 0.355). Conclusions: A substantial proportion of patients self-repackage their ARTs for various reasons. Health system interventions should focus on addressing the attributes of repackaging among men and unemployed patients.
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Affiliation(s)
- Seleman Khamis Semvua
- Seleman K. Semvua, Kilimanjaro Christian Medical University College, Moshi, Tanzania;,
| | - Christine Yaeree Kim
- Christine Yaeree Kim, Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, United States, and Department of Health Policy and Management, University of North Carolina at Chapel Hill, Chapel Hill, NC,
United States
| | - Charles Muiruri
- Charles Muiruri, Kilimanjaro Christian Medical University College, Moshi, Tanzania, and Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, United States, and Duke Global Health Institute, Duke University,
Durham, NC, United States
| | - Timothy Antipas Peter
- Timothy Antipas Peter, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Blandina T. Mmbaga
- Blandina T. Mmbaga, Kilimanjaro Christian Medical University College, Moshi, Tanzania, and Duke Global Health Institute, Duke University, Durham, NC, United States
| | - John A. Bartlett
- John A. Bartlett, Kilimanjaro Christian Medical University College, Moshi, Tanzania, and Duke Global Health Institute, Duke University, Durham, NC, United States
| | - Leah L. Zullig
- Leah L. Zullig, Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, United States, and Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, United States
| | - Shelley A. Jazowski
- Shelley A. Jazowski, Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, United States, and Department of Health Policy and Management, University of North Carolina at Chapel Hill, Chapel
Hill, NC, United States
| | - Brandon A. Knettel
- Brandon A. Knettel, Duke Global Health Institute, Duke University, Durham, NC, United States, and School of Nursing, Duke University, Durham, NC, United States
| | - Francis P. Karia
- Francis P. Karia, Kilimanjaro Christian Medical University College, Moshi, Tanzania, and Duke Office of Clinical Research. Duke University School of Medicine, Durham, NC, United States
| | - Habib O. Ramadhani
- Habib O. Ramadhani, Kilimanjaro Christian Medical University College, Moshi, Tanzania, and Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, United States
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Ndege RC, Okuma J, Kalinjuma AV, Mkumbo J, Senkoro E, Fue G, Samson L, Mapesi H, Shabani S, Glass TR, Battegay M, Paris DH, Vanobberghen F, Weisser M. Failure to return pillbox is a predictor of being lost to follow-up among people living with HIV on antiretroviral therapy in rural Tanzania. HIV Med 2021; 23:661-672. [PMID: 34964236 PMCID: PMC9306592 DOI: 10.1111/hiv.13223] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 11/22/2021] [Accepted: 12/06/2021] [Indexed: 11/28/2022]
Abstract
Objectives Pill count is used to assess drug adherence in people living with HIV (PLHIV). Carrying a pillbox is associated with fear of concealment and stigma and might indicate poor adherence and predict someone who will be lost to follow‐up (LTFU). We therefore assessed the association between pillbox return and being LTFU in rural Tanzania. Methods This is a nested study of the Kilombero and Ulanga Antiretroviral Cohort (KIULARCO). We included PLHIV aged ≥ 18 years enrolled in KIULARCO between January 2013 and March 2019 with follow‐up through January 2020, who were on antiretroviral treatment (ART) for ≥ 6 months. Baseline was defined as the latest ART initiation or KIULARCO enrolment. We determined the association between time‐dependent failed pillbox return updated at every visit and LTFU using Kaplan–Meier estimation and Cox models. Results Among 2552 PLHIV included in the study, 1735 (68.0%) were female, 959 (40.3%) had a WHO stage III/IV and 1487 (66.4%) had a CD4 cell count < 350 cells/µL. The median age was 38.4 years [interquartile range (IQR): 31.7–46.2]. During a median follow‐up of 33.1 months (IQR: 17.5–52.4), 909 (35.6%) participants were LTFU, 43 (1.7%) died and 194 (7.6%) had transferred to another clinic. The probability of being LTFU was higher among PLHIV with failed pillbox return than among those who returned their pillbox [30.0%, 95% confidence interval (CI): 26.8–33.2% vs. 19.4%, 95% CI: 17.4–21.6%, respectively, at 24 months (hazard ratio = 1.67, 95% CI: 1.46–1.90; p < 0.001)]. Conclusions Failed pillbox return was associated with a higher risk of being LTFU and could be used as a simple tool to identify PLHIV for appropriate interventions to reduce their chance of being LTFU.
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Affiliation(s)
- Robert C Ndege
- Ifakara Health Institute, Ifakara Branch, Ifakara, Tanzania.,St. Francis Referral Hospital, Ifakara, Tanzania
| | - James Okuma
- Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Aneth V Kalinjuma
- Ifakara Health Institute, Ifakara Branch, Ifakara, Tanzania.,School of Public Health, Faculty of Health Sciences, Department of Epidemiology and Biostatistics, University of the Witwatersrand, Johannesburg, South Africa
| | - Julius Mkumbo
- Ifakara Health Institute, Ifakara Branch, Ifakara, Tanzania
| | - Elizabeth Senkoro
- Ifakara Health Institute, Ifakara Branch, Ifakara, Tanzania.,St. Francis Referral Hospital, Ifakara, Tanzania
| | - Gideon Fue
- St. Francis Referral Hospital, Ifakara, Tanzania
| | - Leila Samson
- Ifakara Health Institute, Ifakara Branch, Ifakara, Tanzania
| | - Herry Mapesi
- Ifakara Health Institute, Ifakara Branch, Ifakara, Tanzania.,Swiss Tropical and Public Health Institute, Basel, Switzerland
| | - Siraji Shabani
- Ministry of Health, National AIDS Control Program, Dar es Salaam, Tanzania
| | - Tracy R Glass
- Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Manuel Battegay
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Basel, Switzerland
| | - Daniel H Paris
- Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Fiona Vanobberghen
- Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Maja Weisser
- Ifakara Health Institute, Ifakara Branch, Ifakara, Tanzania.,Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland.,Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Basel, Switzerland
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Belay YA, Yitayal M, Atnafu A, Taye FA. Patients' preferences for antiretroviral therapy service provision: a systematic review. COST EFFECTIVENESS AND RESOURCE ALLOCATION 2021; 19:56. [PMID: 34461939 PMCID: PMC8404280 DOI: 10.1186/s12962-021-00310-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 08/16/2021] [Indexed: 11/25/2022] Open
Abstract
Background Achieving global targets of adherence to treatment, retention in care, and treatment success remains a challenge. Health system investment to make antiretroviral therapy services more responsive to patients’ needs and values could address these impediments. Appropriate resource allocation to implement differentiated HIV treatment services demands research evidence. This study aimed to provide an overview of the patients’ preferences for antiretroviral therapy service delivery features. Methods Electronic databases (PubMed, Web of Science, Embase, and CINAHL) and search engines (Google and Google Scholar) were searched. This review has followed a convergent segregated approach to synthesis and integration. Data from the included studies were systematically extracted, tabulated, and summarised in a narrative review. Studies that analysed preferences for antiretroviral therapy regardless of the method used and published in the English language in any year across the world and HIV positive clients who were 15 years and above on 4th February 2021 were included for this review. The quality of the included studies was assessed using the mixed methods appraisal tool. A thematic synthesis of the data from the findings section of the main body of the qualitative study was undertaken. ATLAS.ti software version 7 was used for qualitative synthesis. Results From the 1054 retrieved studies, only 23 studies (16 quantitative, three qualitative, and four mixed-methods) fulfilled the inclusion criteria. The median number of attributes used in all included quantitative studies was 6 (Inter Quartile Range 3). In this review, no study has fulfilled the respective criteria in the methodological quality assessment. In the quantitative synthesis, the majority of participants more valued the outcome, whereas, in the qualitative synthesis, participants preferred more the structure aspect of antiretroviral therapy service. The thematic analysis produced 17 themes, of which ten themes were related to structure, three to process, and four to outcome dimension of Donabedian’s quality of care model. The findings from individual quantitative and qualitative syntheses complement each other. Conclusions In this review, participants’ value for antiretroviral therapy service characteristics varied across included studies. Priorities and values of people living with HIV should be incorporated in the policy, practice, research, and development efforts to improve the quality of antiretroviral therapy service hence avoid poor patient outcomes. Supplementary Information The online version contains supplementary material available at 10.1186/s12962-021-00310-7.
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Affiliation(s)
- Yihalem Abebe Belay
- Department of Public Health, College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia. .,Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
| | - Mezgebu Yitayal
- Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Asmamaw Atnafu
- Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Fitalew Agimass Taye
- Department of Accounting, Finance, and Economics, Griffith University, Brisbane, Australia
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Ngowi K, Pima F, Mmbaga BT, Aarnoutse RE, Reiss P, Nieuwkerk PT, Sprangers M, Sumari-de Boer M. "I Wish to Continue Receiving the Reminder Short Messaging Service": A Mixed Methods Study on the Acceptability of Digital Adherence Tools Among Adults Living with HIV on Antiretroviral Treatment in Tanzania. Patient Prefer Adherence 2021; 15:559-568. [PMID: 33727801 PMCID: PMC7955743 DOI: 10.2147/ppa.s290079] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 01/06/2021] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Digital Adherence Tools (DAT) to promote adherence to antiretroviral treatment (ART) for HIV are being increasingly adopted globally, however their effectiveness and acceptability in limited resource settings has been challenging. In this study, we examine the acceptability of DATs to improve adherence to ART. METHODS This study was part of a three-arm randomized controlled trial (REMIND) which investigated the effect of two different DAT's: SMS text messages (SMS) or real-time medication monitoring (RTMM) on treatment adherence; compared to standard of care. Exit interviews and in-depth interviews were conducted at 48 weeks follow-up, to collect data on their experiences (successes, challenges, and barriers) and behaviours regarding the implementation of the interventions. Translated transcripts, memos and field notes were imported to NVivo software version 12. We used a thematic framework analysis which drew from Sekhon's theoretical framework of acceptability (TFA), which comprises of seven constructs (affective attitude, perceived burden, perceived effectiveness, ethicality, self-efficacy, intervention coherence and opportunity costs). RESULTS Of the 166 participants enrolled, 143 (86%) were interviewed (68 in the SMS arm and 75 in the RTMM arm). Participants were highly satisfied (98%) with the DAT system and the majority of them reported it motivated them to take their medication (99%). The majority of participants reported they were confident in their ability to comply with the intervention and understood how the intervention worked (97%). Very few reported negatively about the devices (carrying the device), with only 6% reporting that they did not feel comfortable and 8% had ethical concerns with the SMS-content A few participants reported challenges with their connectivity/network and that the visits were too time-consuming. A few participants reported that they incurred extra cost for the sake of the study. CONCLUSION Overall, the acceptability of these DATs was high. However, several factors may hamper their acceptability including the content and number of SMS, carrying the devices and the network availability.
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Affiliation(s)
- Kennedy Ngowi
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
- Amsterdam UMC, Location AMC, University of Amsterdam, Department of Medical Psychology, Amsterdam, The Netherlands
| | - Francis Pima
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
| | - Blandina Theophil Mmbaga
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
- Kilimanjaro Christian Medical Center, Moshi, Tanzania
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Rob E Aarnoutse
- Radboudumc, Radboud Institute for Health Sciences & Department of Pharmacy, Nijmegen, The Netherlands
| | - Peter Reiss
- Amsterdam UMC, Location AMC, University of Amsterdam, Department of Global Health, And Amsterdam Institute for Global Health and Development, Amsterdam, The Netherlands
- HIV Monitoring Foundation, Amsterdam, The Netherlands
| | - Pythia T Nieuwkerk
- Amsterdam UMC, Location AMC, University of Amsterdam, Department of Medical Psychology, Amsterdam, The Netherlands
| | - Mirjam Sprangers
- Amsterdam UMC, Location AMC, University of Amsterdam, Department of Medical Psychology, Amsterdam, The Netherlands
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Kihumuro RB, Muganzi DJ, Wandira EG, Alinaiswe R, Nanyunja JJ, Kugumisiriza R, Alele PE, Mubangizi V. Influence of boarding secondary school environment on HIV positive students in South Western Uganda. BMC Public Health 2021; 21:327. [PMID: 33563239 PMCID: PMC7874485 DOI: 10.1186/s12889-021-10380-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 01/28/2021] [Indexed: 12/03/2022] Open
Abstract
Background The number of human immunodeficiency virus (HIV) positive adolescents in secondary school has increased over the years. Little is known on how the students cope to the pressures and demands of their academic and health lives in the boarding secondary schools. This study explored the factors surrounding their anti-retroviral therapy adherence as well as their experiences. Methods We did a qualitative study that employed in-depth interviews amongst purposively selected 19 HIV positive adolescent students in boarding secondary school and seven key informants. Key informants were members of boarding secondary school staff directly taking care of the adolescents living with human immune virus and had spent at least two academic terms in that school. The study participants were recruited from four health facilities in Bushenyi district, southwestern Uganda, and key informants from five boarding secondary schools in Bushenyi. These were engaged in in-depth interviews using an interview guide. Data was transcribed, coded and the content analyzed thematically. Results Adolescents living with human immunodeficiency virus in boarding secondary school face challenges similar to adolescents outside boarding school settings. However, some challenges are unique to them. Students faced numerous barriers which made it difficult to adhere to their medication. Stigmatization in its different forms was also a major challenge amongst students. Willingness disclosure of serostatus was beneficial to the students since it guaranteed support while at school; facilitating adherence and better living. However, students were uneasy to disclose their status. Some students adopted negative coping mechanisms such as telling lies, escaping from school, and class to access medication. Conclusions Adolescents in boarding secondary schools face similar challenges as compared to their counterparts with some being unique to them. Few school mechanisms help these students to cope while at school. Limited disclosure has proven useful but some adolescents have opted not to disclose their status and hence used negative coping mechanisms. These challenges need to be addressed and a safe environment to encourage limited disclosure should be made.
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Affiliation(s)
| | - David Jolly Muganzi
- Mbarara University of Science and Technology, P.O. Box 1410, Mbarara, Uganda
| | | | - Racheal Alinaiswe
- Mbarara University of Science and Technology, P.O. Box 1410, Mbarara, Uganda
| | | | - Ruth Kugumisiriza
- Mbarara University of Science and Technology, P.O. Box 1410, Mbarara, Uganda
| | - Paul E Alele
- Mbarara University of Science and Technology, P.O. Box 1410, Mbarara, Uganda
| | - Vincent Mubangizi
- Mbarara University of Science and Technology, P.O. Box 1410, Mbarara, Uganda.
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