TB/HIV INTERNATIONAL CONFERENCE

AND ANNUAL GENERAL MEETING

(AGM)

DATE: 15-17TH AUGUST 2019

VENUE: NIPAM (The Namibian Institute of Public

Administration and Management

PLACE: Windhoek, Namibia

PRESENTER: RN. TIGIST ABATE YALEW.

TITLE

EXPERIENCES OF PEOPLE’S ADHERENCE TO

ANTI-RETROVIRAL TREATMENT AT A CENTRAL

DISEASE CONTROL CLINIC AT THE KATUTURA

HOSPITAL, IN WINDHOEK, NAMIBIA.

DECLARATION

NO CONFLICT OF INTEREST

PERSONAL INTRODUCTION

Name: Tigist Abate Yalew

Qualifications: M.sc in Diagnosis & Management of

HIV/AIDS-International University of Management

(Namibia)

*Bsc Degree in Public Health (Debub University,

Ethiopia)

*Diploma in Clinical Nursing at University of Gondar,

Ethiopia

PERSONAL INTRODUCTION

Qualifications: (continued)

*Certificate in Basic and Advanced Life Support (American Heart Association)

*Certificate in HIV Counselling and Testing

*Certificate in Rapid Test Training

*Certificate in Secretarial & Administration, UK

*Certificate in Computer Science, Botswana.

Department; Cardiac Intensive Care Unit, Windhoek Central Referal Hospital, MOHSS, Namibia

Cell: +264-812784097

Email: yalewtigist@gmail.com

Author: Tigist Abate Yalew

International University of Management (IUM), Windhoek, Namibia.

BACKGROUND

Since 1981, more than 25 million people have died of HIV/AIDS. In 2007 alone, 2.5 million people were newly infected with HIV/AIDS. Although all parts of the world are affected by having an HIV/AIDS-infected populace, sub-Saharan Africa has been hit the hardest, with HIV/AIDS currently being the leading cause of death. More than two out of three adults and nearly 90% of children infected with HIV/AIDS live in sub-Saharan Africa, where the HIV/AIDS epidemic has spread over the past 30 years from East Africa (Uganda/Tanzania/Kenya) to Southern Africa, where the epidemic has exploded at an astonishing rate.

BACKGROUND (CONTINUED)

Although the first case of HIV/AIDS in Namibia was

reported in 1986, anti-retroviral treatment (ART) was

only introduced in 2003. In 2004, ART was piloted in

four of the country’s regions, and in 2006 the service

was rolled out to all district and regional hospitals in the

country, in order to make the service accessible to those

who needed it. Currently all three intermediate

hospitals, 34 district hospitals, and 84 health centers

provide ART services in Namibia.

STATEMENT OF THE PROBLEM

There is a lack of statistics regarding patient

adherence to ART in Namibia.

PURPOSE OF THE STUDY

The purpose of study was to Explore and describe

the experiences of people’s adherence to ART at

the Central Disease Control (CDC) Clinic at Katutura

State Hospital in Windhoek, Namibia.

OBJECTIVES OF THE STUDY

The objectives of the study were:

• to explore Experience of ART adherence amongst PLHIV at the CDC Clinic at the Katutura State Hospital in Windhoek, Namibia;

• to describe Experience of ART adherence amongst PLHIV at the CDC Clinic at the Katutura State Hospital in Windhoek, Namibia; and

• to identify factors leading to adherence amongst PLHIV at the CDC Clinic at the Katutura State Hospital in Windhoek, Namibia.

RESEARCH METHODOLOGY

A qualitative, explorative and descriptive research

design was used for this study

QUALITATIVE RESEARCH DESIGN

A qualitative approach was chosen to describe

patients’ experiences and to identify the obstacles

that influence adherence to ART.

EXPLORATORY RESEARCH DESIGN

An exploratory research involves gathering

preliminary information that will help to identify the

problem, to create the hypothesis and to lead for

further research (Hoa’s, 2011) .

AIM OF THE STUDY

The overarching aim of the study being to find out

more on the experiences of people’s adherence to

Anti-retroviral treatment at a CDC Clinic at the

Katutura Hospital, in Windhoek, Namibia.

DESCRIPTIVE RESEARCH DESIGN

A descriptive research is a scientific method which

involves as an in-depth study of an individual,

describe things such as mainly “emotions” (Maureen

& Lawrence, 2006).

The experiences of people’s adherence to Anti-

retroviral treatment, who are registered and taking

their treatment at CDC Clinic at the Katutura

Hospital, are described in this study.

STUDY POPULATION

The target population was all PLHIV who received

ART and were registered as defaulters as at April

2017 at the CDC Clinic at the Katutura

Intermediate State Hospital in Windhoek, which

comprised 139 individuals.

SAMPLING METHODS

The study used a non-probability purposive

sampling method that allowed the “investigator to

select participants who would provide the required

information”. This is a type of non-probability

purposive sampling in which participants are

selected because they are identified as

knowledgeable about the subject under

investigation (Creswell, 2014).

INCLUSION CRITERIA

The people included in this study were those people

who were living with HIV/AIDS, and who were

registered to receive ART and defaulted in therapy

adherence in April 2017.

SAMPLE SIZE

In this study there were five defaulters interviewed

until the data was saturated.

RESEARCH SETTING

The study was conducted at the CDC Clinic at the

Katutura State Hospital in Windhoek, Namibia.

DATA COLLECTION

Data was collected by using face-to-face, in-depth interviews.

The interviews were conducted at the clinic during the period 30 August to 10 September 2017.

They signed the informed written consent after they agreed to be interviewed.

Audio tapes were used as well.

Code numbers were assigned in order to maintain confidentiality.

The door to the interview venue was kept closed during the interview.

DATA ANALYSIS

For this research, the data was analyzed with manual coding.

The researcher listened to the audio tape recordings and typed responses verbatim.

Then the researcher added the non-verbal responses. In this study.

Color codes were used to analyze the data and to establish concepts.

In addition, the researcher implemented coding techniques to find and mark the underlying ideas in the data

To group similar kinds of information together in categories.

Then to relate different ideas and key themes to sub themes.

Table 2.6: TRUSTWORTHNESS: CRITERIA AND STRATEGIES FOR THE TRUSTWORTHNESS OF A QUALITATIVE

APPROACH.

Criteria of trustworthness Strategies applied

Qualitative approach

Truth value Credibility

Applicability Transferability

Consistency Dependability

Neutral Confirmability

ETHICAL CONSIDERATIONS

The following ethical considerations were observed during all stages of the study:

Approval to conduct the study was obtained from IUM and from the Ministry of Health and Social Services Research Unit (Annexures 1 & 2)

To protect participants from harm, participants were informed of the potential risks and were advised of their freedom/right to withdraw at any stage of the study.

To ensure confidentiality, the labelling used in the report was totally different to that used during data collection and the organization thereof to prevent association.

Participation in the study was voluntary. A detailed explanation of the purpose of the study was provided to all participants, and they were requested to sign a form acknowledging their informed consent. The researcher assured the participants that the audiotapes would not be disseminated, and therefore no audiotapes were recorded without a subject’s consent. The researcher assured the participants that the study findings would be used to help improve the experiences of people adhering to their ART and to improve the service provided by the CDC Clinic.

RESULT

The key themes were categorized as follows:

1. Psycho-social issues with sub-themes:

Feelings of eagerness to take treatment

Feelings of rejection

Adherence

Alcohol usage

Support from family and friends

Secracy

Employment

Acceptence

2. Physical issues with sub-themes:

Difficulties with eating

The time of starting the treatment

CONCLUSIONS

The purpose of the study was to gain insight into and a comprehensive understanding of the experiences of PLHIV’s adherence to ART, which PLHIV attend the CDC Clinic at the Katutura Hospital in Windhoek. It is concluded that PLHIV who receive ART from the CDC Clinic at the Katutura Hospital in Windhoek are aware of the positive experiences the ART programme affords them. The study also revealed the gaps in the CDC Clinic staff complement, which needs to be remedied to ensure their quality of life is improved.

The participants identified psycho-social issues as their top priority, and this needs to be addressed.

LIMITATIONS

There were no limitations observed on this study.

RECOMMENDATIONS

It is recommended that the Katutura Intermediate State Hospital’s CDC Clinic should improve their ART programme and facilities to effectively implement the ART programme, by employing sufficient staff so that the patients do not have to wait for significantly long periods; and

At the Khomas regional level, the Ministry of Health and Social Service should implement six-monthly assessments regarding the effectiveness of the ART programme to ensure its success.

RECOMMENDATIONS FOR FUTURE RESEARCH

Further research is needed in the following areas:

• factors affecting the access of ART to PLHIV in

general community health care service centers,

especially at CDC Clinic centers; and

• the attitude of the community and the reasons

motivating families to get involved in support of

ART treatment.

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ACKNOWLEDGEMENTS

IUM (International University of Management), Post Graduate Department,

HIV/AIDS management.

Special thanks to my Supervisor, Dr. A. R. E. Kloppers (IUM)

MOHSS (Ministry of Health & Social Services of Namibia)

Katutura Intermediate State Hospital, Windhoek, Namibia

CDC Clinic at Katutura Intermediate State Hospital.

AT KATUTURA INTERMEDIATE

HOSPITAL, WINDHOEK, NAMIBIA.

WITH MY SUPERVISOR: DR.A.R.E.

KLOPPERS, AT IUM UNIVERSITY.

IN THE CONSULTATION ROOM

AT KATUTURA INTERMEDIATE STATE

HOSPITAL, WINDHOEK, NAMIBIA.

“Every great dream begins with a

dreamer!” “You have within you the strength, the patience, and the passion to reach for the stars to change the world!”

THANK YOU!