Evaluation of the involvement of HIV positive patients in the decision to commence antiretroviral therapy at Oshakati Hospital, Namibia

Mavhunga, Farai (2009-12)

Thesis (MPhil (Industrial Psychology))--University of Stellenbosch, 2009.

Thesis

ENGLISH ABSTRACT: The increase in treatment options for HIV positive people has contributed to an increase in the number of people willing to be tested for HIV since there are now tangible benefits associated with a confirmed HIV positive diagnosis. In Southern Africa the trend towards increased numbers of people who know their HIV status has been more noticeable in women than in men (Muula, et al., 2007), possibly due to the greater health seeking behaviour of women compared to men as well as the access that women have to HIV testing during pregnancy as part of countries' efforts towards preventing mother-to-child transmission of HIV. In Namibia there has been a massive increase in the number of patients commenced on antiretroviral therapy (ART) (MOHSS, 2007). It is important to ensure that increases in the number of patients being started on treatment are accompanied by a proportional improvement in the quality of care being provided to the patients. One important concept that has been promoted in recent years is the Greater Involvement of People Living with HIV/AIDS (GIPA). This concept promotes the inclusion of HIV infected individuals in the decision making process when making decisions regarding the welfare of People Living With HIV (PLHIV). One important caveat specific to ART is the high levels of adherence required for sustained effectiveness of the medicines. Involvement of patients in the design of their treatment has been shown to be a facilitator of adherence to treatment. This study design was a cross-sectional survey whereby a sample of individuals who are registered at Oshakati Communicable Disease Clinic and were receiving ART were interviewed to determine who they perceived to have been the principal decision maker for them to be commenced on ART. The responses were categorized according to the responses from the patients and the frequencies calculated to find the percentage of the patients on ART who considered themselves to have been involved in the decision making process. Having the majority of the patients perceiving themselves as having not been involved in the decision making process was thought to have an important bearing on the counselling which was done prior to starting treatment. This can therefore inform initiatives to improve case management and the involvement of patients in designing their treatment regimens and in making important decisions about their treatment. This ultimately helps to improve the adherence of these patients to their treatment, thereby improving the treatment outcomes and reducing the rate of development of resistance to the antiretroviral medicines (ARVs).

AFRIKAANSE OPSOMMING: Agtergrond: Die verhoging in die behandeling opsies vir MIV positiewe mense het bygedra tot verhoogde syfers van die mense gewillig om getoets te word vir MIV, omdat daar voordele is geassosieer met die bevestigde MIV positief diagonose. In Suider- Afrika word die patroon teen die verhoogde syfers of mense wat hulle MIV status ken meer gekenmerk in vroumense as mans; dit is moontlik weens die feit dat vroumense se gedrag teenoor gesondheidraadpleging goed is in vergelyking met die mans, en die vroumense het toegang tot MIV toetse gedurende die swangerskapperiode as deel van die land se poging vir die voorkoming van moeder tot kind transmissie of MIV. In Namibie is daar geweldige verhoogde syfers in pasiente wat met MIV behandeling/terapie begin (ART) het. Die verhoogde syfers of pasiente wat met behandeling begin het moet gesien word in verhouding tot die proporsie van verbetering in kwaliteitsorg voorsien aan pasiente. Een van die belangrikste konsepte wat gedurende afgelope jare bevorder is, is die Betrokkenheid van Mense Leef met MIV wat aanmoedig dat die individuele mense wat met MIV Leef ingesluit word in besluitnemings. Betrokkenheid van pasiente in die gebruik van hulle behandeling is 'n bewys van hulle toewyding tot hulle behandeling. Studiemetode: Die studie uitleg was n "cross-sectional" ondersoek waar geregistreerde individue by Oshakati Communicable Disease Clinic, wie MIV behandeling ontvang, ondervra is om vas te stel wie was hulle hoofbesluitnemer vir hulle om met hierdie MIV behandeling te begin. Die terugvoering is gekategoriseer volgens die bevindings van die pasiente oor hulle betrokkenheid en die besluitneming van hulle behandeling. Uitslae: Die meerderheid van die pasiente (83%) het terugvoering gegee dat hulle tot 'n sekere mate in die besluitneming omtrent hulle behandeling betrokke was. Dit geld vir mans en vroumense. Afsluiting: Die meederheid van die pasiente neem aan dat hulle betrokke is in die proses van die besluitneming, wat 'n positiewe invloed op die toewyding tot hulle medikasie het; en stel voor dat daar wel berading vir pasiente gegee word voor hulle met behandeling begin.

Please refer to this item in SUNScholar by using the following persistent URL: http://hdl.handle.net/10019.1/1004
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