Perceptions of professional nurses about the barriers and enhancers to the implementation of isoniazid preventative therapy amongst HIV positive adults

Agenbag, Sonet E. (2017-03)

Thesis (MCur)--Stellenbosch University, 2017.

Thesis

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.

AFRIKAANSE OPSOMMING : Agtergrond: Tuberkulose (TB) en die menslike immuniteitsgebreksvirus (MIV) is die twee infeksies met die hoogste sterftesyfer in die wereld. Die voorkoming van TB onder persone met MIV, is van kardinale belang. Een van die maniere om TB te verhoed onder die MIV-geinfekteerte bevolking is om TB voorkomende terapie te verskaf. Ten spyte van goeie bewyse dat isoniasied voorkomende terapie (IPT) die voorkoms van TB verminder onder mense wat met MIV leef, is die implementering van hierdie behandeling laag. Hierdie studie is gedoen om die persepsies van professionele verpleegkundiges oor die versterkers en hindernisse tot die implementering van hierdie behandeling onder MIV-positiewe volwassenes te verken in die Matzikama sub-distrik, Weskus. Metode: ‘n Beskrywende kwalitatiewe benadering is gevolg. Tien professionele verpleegkundiges wat verantwoordelik is vir die voorskryf van IPT in primere gesondheidsorg klinieke asook professionele verpleegkundiges in bestuursposte in die sub-distrik is doelbewus gekies. Die data is ingesamel deurmiddel van individuele onderhoude. Data is geanaliseer met behulp van die ses stappe beskryf deur Creswell. Betroubaarheid van die studie is verseker deur die beginsels van objektiwiteit, bevestiging, veralgemening en neutraliteit. Resultate: Versterkers wat geidentifiseer was, was duidelike protokolle en die beskikbaarheid van voorraad, veral isoniasied. TB sifting op alle pasiente, gereelde opleiding van gesondheidswerkers, monitering van registers en leers om IPT statistieke te verbeter en beraders wat pasiente identifiseer vir IPT, was gesondheidstelsel en verskaffer verwante versterkers. Hindernisse wat geidentifiseer was, was gereelde verandering van protokolle en die gebrek aan kommunikasie. Mantoux toetse en piridoksien wat nie in voorraad was en die lees van die Mantoux toetse binne 72 uur was hindernisse. Die vrees vir INH weerstandheid en newe-effekte, onsekerheid oor die duur van die behandeling en onvoldoende kennis van IPT is geidentifiseer onder gesondheidsorgwerkers. Die behandeling nakoming van pasiente was ‘n groot probleem wat toegeskryf kan word aan onvoldoende kennis of probleme om kliniekbesoeke na te kom. Die landelike konteks het dit moeilik gemaak om 'n gereelde diens te lewer aan plaasgemeenskappe, behandeling te monitor en versuimers op te spoor. Deelnemer aanbevelings sluit in 'n standaard protokol, diensintegrasie en gereelde opleiding. Deurlopende ondersteuning en betrokkenheid van gemeenskappe en werknemers sal implementering van IPT verbeter. Slotsom: Dit is bewys dat MIV-positiewe volwassenes baat vind by IPT. Die studie het etlike leierskap, gesondheidstelsel, verskaffer-verwante en pasient-verwante versterkers en hindernisse aan die lig gebring, waarvan sommige spesifiek in ‘n landelike konteks van toepassing is.Die aanspreek van hindernisse en die bevordering van versterking strategiee kan die kwaliteit van lewe vir mense wat met MIV leef verbeter.

Please refer to this item in SUNScholar by using the following persistent URL: http://hdl.handle.net/10019.1/101326
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