Masters Degrees (Nursing and Midwifery)

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Browsing Masters Degrees (Nursing and Midwifery) by Author "Agenbag, Sonet E."

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    Perceptions of professional nurses about the barriers and enhancers to the implementation of isoniazid preventative therapy amongst HIV positive adults
    (Stellenbosch : Stellenbosch University, 2017-03) Agenbag, Sonet E.; Crowley, Talitha; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Nursing & Midwifery.
    ENGLISH SUMMARY : Background: Tuberculosis (TB) and the Human Immunodeficiency Virus (HIV) are the two infections that have the highest mortality in the world. The prevention of TB among persons infected with HIV is crucial. One of the ways to prevent TB disease among the HIV-infected population is to provide TB preventative therapy. Despite good evidence that isoniazid preventative therapy (IPT) reduces the incidence of TB among people living with HIV, the implementation of IPT is low. This study was done to explore the perceptions of professional nurses about the enhancers and barriers to the implementation of IPT amongst HIV positive adults in the Matzikama sub-district of the West Coast, South Africa. Methods: A descriptive qualitative design was applied. Ten professional nurses who were responsible for prescribing IPT in rural primary health care clinics, as well as professional nurses in management positions in the sub-district, were purposefully selected. The data was collected through individual interviews. Data was analysed using the six steps described by Creswell. Trustworthiness was enhanced by adhering to the principles of credibility, conformability, transferability and dependability. Results: Enhancers included clear protocols and availability of stock, especially isoniazid. TB screening on all patients, regular training of healthcare workers, monitoring of registers and folders to improve IPT statistics, and counsellors that identified eligible patients for IPT, were health system and provider-related enhancers. Barriers that related to leadership and governance were frequent changes of protocols and lack of communication. Stock outs of Mantoux tests and pyridoxine and problems with reading the Mantoux test within 72 hours were health system barriers. Healthcare providers’ fear of INH resistance and side effects, uncertainty about the duration of treatment and inadequate knowledge of IPT were identified. Patient adherence was a major problem that could be attributed to a lack of knowledge or the difficulty of attending clinic appointments. The rural context made it difficult to provide a regular service to farm communities, monitor adherence and trace defaulters. Participant recommendations included one standard protocol, service integration and regular training. On-going patient support and engaging communities and employees may improve implementation of IPT. Conclusion: IPT has been shown to be beneficial for HIV positive adults. The study revealed several leadership, health system, provider-related and patient-related enhancers and barriers, some which are specific to the rural context. Addressing barriers and promoting enhancing strategies could improve the quality of life for people living with HIV.