ABSTRACT
Background: Patient factors that affect proper usage of antiretrovirals include knowledge, attitudes and practices of the patient towards antiretroviral therapy (ART). Effective management of HIV/AIDS will not be achieved where knowledge and practice of ART are poor or patients have negative attitudes towards their medications.
Objectives: This study was aimed at determining the knowledge, attitudes and practices towards ART among People Living with HIV/AIDS (PLWHAS) attending clinic at University of Nigeria Teaching Hospital, Ituku-Ozalla of Enugu State South-east of Nigeria.
Methods: A cross sectional study of nine hundred and sixty-two (962) adult PLWHAS receiving antiretroviral medications was conducted in 2013. Quantitative data were collected using interviewer-administered, semi-structured questionnaire while qualitative data were collected using focus group discussions (FGD) held among the research participants for in-depth information. Chi-square and regression analysis were used to determine the association between the variables.
Results: The respondents were predominantly female (male to female ratio of 1:2). Majority (80.8%), were aged 15 to 49 years and 94.5% had formal education. Respondents were essentially self employed (59.1%) and have been on treatment for less than 5 years (56.3%). A sizeable proportion (64.0%) of PLWHAS had good knowledge of ART, 64.6% demonstrated positive attitudes towards ART and only 555.2 had good practice towards ART. Predictors of good knowledge were higher education (R= 0.152, p< 0.001) and male gender while being male and on ART for longer period were predictors for positive attitudes (R= 0.114, p< 0.01). Gender of respondents, educational qualification and occupation were significantly associated with good knowledge; gender, age range and duration on ART were significantly associated with positive attitudes towards ART; only gender was significantly associated with good practice towards ART. Majority of FGD participants reported not hiding from their family or friends to take their drugs but hid the identity of the drugs under the disguise of taking multivitamins or antidiabetic medications because of stigmatization. Majority (90.8%) of respondents and FGD participants got information on ART from health care professionals at the HIV clinic. Overall participants demonstrated good knowledge of and positive attitudes towards ART but poor practice towards ART.
Conclusion: Improving the knowledge, attitudes and practices of PLWHAS towards ART requires a multidisciplinary approach of all the health care professionals involved in HIV/AIDS program. This can be achieved by medication information and health education.
CHAPTER ONE
1.0 INTRODUCTION AND LITERATURE REVIEW
1.1 Background to the study
There has been progress in the battle against the human immunodeficiency virus (HIV) that causes acquired immune deficiency syndrome (AIDS). 1 Into the fourth decade of the AIDS epidemic, the world has begun to reverse the spread of HIV – thus achieving the Millennium Development Goal 6.A. However, for many years to come, the impact of HIV will remain with man. Global efforts at confronting the AIDS epidemic have yielded encouraging results in recent years such as: expanding access to treatment, improved prevention works and significant scale up of antiretroviral therapy (ART) over the past few years.2 In Nigeria, there is an ongoing scale up of treatment programs. From initial 20 service sites, there has been a scale-up of ART and PMTCT site to 446 and 675 sites 2010 respectively as at 2009.3, 4 The attitude, belief, knowledge and practice of patients of chronic medical conditions have significant impact on both disease outcome as well as adherence to medication.5
1.2 Statement of problem
The problem of HIV and AIDS cannot be solved by the mere fact that those on ART have access to their medications. 6 There is a wide gap between Africa and the developed countries on the level of knowledge of ART among its users. Fewer people on ART are aware of the various classes of ARV.7 There is wrong belief among Africans that ARV can cure HIV which has been associated with poor adherence and high HIV-seroprevalence. Trading their ARV for money is among attitudes observed with people living with HIV/ AIDS (PLWHA) in Africa.8, 9, 10
A small study in Western Nigeria showed good knowledge of and positive attitude towards ARV therapy.11The study however still indicated a small group with poor attitudes such as hiding the ARV medications and wrong beliefs that there are potent alternatives to ART and that ART can cure HIV.
1.3 Justification of study
To understand non-adherence of chronic medication users, it has been suggested that it is important to carryout medication belief assessment.12 Good knowledge of ARV therapy and positive attitude towards it are necessary for effective HIV therapy.13
While the knowledge of and attitude to ART among PLWHA in a Western state of Nigeria with a low prevalence rate is known to be satisfactory, such data are not available for other parts of Nigeria.11 Therefore, this study will:
- Provide information on the knowledge of and attitude towards ART among PLWHA in Eastern Nigeria.
- Assess the practice of PLWHA towards ART.
1.4 Research questions
The following questions will be explored in this study:
1. What is the level of knowledge of ART of PLWHA?
2. What is the attitude of PLWHA towards ART?
3. What practices exist among PLWHA towards ART?
4. What demographic factors influence knowledge, attitude and practice of PLWHA towards ART?
5. What are the sources of information of ART for PLWHA?
1.5 Study hypothesis
The following null hypotheses were set for the study:
1. There is no significant difference in the level of knowledge of ART among PLWHA on medication.
2. There is no significant difference in the attitude pattern among PLWHA towards ART.
3. There is no significant difference in the practice that exists among PLWHA towards ART
4. There are no factors that influence knowledge, attitude and practice of PLWHA towards ART.
1.6 Scope of the study
The scope of this research work will be in South-Eastern Nigeria in University of Nigeria Teaching Hospital (U.N.T.H), Ituku-Ozalla, Enugu State. The content of the study is to assess the knowledge, attitude and practice towards ART among adult PLWHA attending the hospital’s HIV clinic. The clinic is called AIDS Prevention Initiative in Nigeria – Center for Disease Control U.N.T.H. site (APIN-CDC UNTH site). The center has the largest number of patients accessing treatment and care in the South-east region of Nigeria. The patients attending the clinic are both urban and rural dwellers from within and outside Enugu State.
1.7 Significance of the study
Investigating the knowledge, attitude and practice of PLWHA towards ART will
- Through scientific evidence that will be obtained, assist both health care providers, HIV program managers and health policy makers in addressing problems associated with patient education.
- Contribute to existing literature on the KAP of ART among PLWHA.
- Be useful to patients in knowing what constitute good knowledge, positive attitude and good practice towards ART and improve on areas where they need to.
- Aid the clinic staff (Doctors, Nurses, Pharmacists, Phlebotomists and Counselors) that come in contact with patients in improving on their ART related patient education.
1.8 LITERATURE REVIEW
1.8.1 Introduction
The following areas will be covered under literature review: treatment, management of HIV/AIDS, patient KAP of ART, patient education and focus group discussion among other things. As at the time of this work, there is no published evidence indicating that a similar work has been done in the South-Eastern Nigeria. Literature search was done using PubMed, Google search engine, pharmaceutical journals, medical journals, University of Nigeria Library and other resources accessible.
