Impact of hiv aids training prog [compatibility mode]
Impact of Training Programme on Care of the PLWHA among the Nurses Working in BPKIHS Mehta RS, Karki P, Rijal S B. P. Koirala Institute of Health Sciences
IntroductionEverybody is at risk of getting HIV. However certainPersons have high risk.
Cumulative HIV infection by sub group and sex (July 2007) New case in Sub - groups Male Female Total Ashad 2064 Sex Workers (CSWs) 684 684 4 Clients of SWs/ STD 4445 104 4549 67 Housewife 1996 1996 65 Blood or organ recipients 17 6 23 0 Injecting Drug Use 1916 34 1950 33 Men who have sex with 20 20 2 men Children 294 173 467 18 Sub-group NOT identified 50 17 67 35 Total 6742 3014 9756 224
HIV/AIDS---- Nepal• UNAIDS- Nepal has a concentrated HIV/AIDS epidemic with an estimated 62,000 people living with the virus.• AIDS could be the leading cause of death by 2010, if the current rate of infection continues to increase.
Some Facts about HIV/AIDS• 4th biggest killer world wide• More than 95 % cases in low & middle income countries• Symptom free period up to 10 years or More• HIV transmission is 10 times more on STIs• ART Cost: very expensive
• About 1/3 are aged 15-24 years• Most people do not know they are infected• Gravity of Different mode of Transmission: * Sexual intercourse = 80-90 % * Blood Transfusion = 3-15 % * Injecting Drug users = 5 -10 % * Equipments/Needles = < 0.1 % * Perinatal = 0.1%
HIV positive to AIDS – 33 % = Only develop AIDS – 64 % = Till death live without Symptoms – 5-10- 20 yrs = A symptomaticConcentrated epidemic:Sex workers (4%), Migrant Population (4-10%) & IVDUs(51%)
Estimated number of people living with HIV globally, 1990– 1990–2007 40 Millions 30Numberof people 20livingwith HIV 10 0 199019911992199319941995199619971998199920002001200220032004200520062007 Year This bar indicates the range
Estimated number of adult and child deaths due to AIDS globally, 1990–2007 1990– 3.0 Millions 2.5Number 2.0of adultand child 1.5deaths dueto AIDS 1.0 0.5 0 199019911992199319941995199619971998199920002001200220032004200520062007 Year This bar indicates the range
No of Reported Cases ( HIV Infection)1st case in Nepal --July 1988Since then increasing1988 - 41992 - 771996 - 1352000 - 7002004 - 44422007 - 10546 Dec.15th
Objectives of the study:• To assess the Knowledge, Attitude and Practices (KAP) regarding the care of PLWHA among the nurses working in BPKIHS.• To prepare an education intervention package & provide training on care of PLWHA.• To evaluate the effectiveness of implemented HIV/AIDS training programme.
Null hypothesis:There is no significant difference in theKAP regarding care of PLWHA among thenurses working in BPKIHS before andafter education intervention.
Research Design and Methodology:The quasi-experimental research designwas adopted to carry out the study, usingsingle group pre-test post-test researchdesign.This research study was conducted amongthe nurses (ANMs and Staff Nurses)working in BPKIHS.
The nurses working in maternity units,tropical unit and OPDs were not included,because the nurses working in maternityunits are involved in VCT, ART, Directpatient care and the nurses working inOPDs are not involved in care of admittedpatients
All the indoor wards were divided in to strataaccording to the specialty i.e. Medical(Medical-I, Medical-II, Medical- III, Derma,and Psychiatric), Surgical (Surgical-I,surgical-II, surgical- III, Orthopedics, Eye,ENT and Paying), Operation theater(Routine, Emergency, Gynecology and DayCare OT), Critical care ( ICU/CCU/Dialysisand NICU, PICU, MICU ,Nursery) andPediatric ( Unit I and II ) .
Using stratified random samplingtechnique wards that is medical unit-II,Surgical unit-I, Orthopedic unit,ICU/CCU, Dialysis, Routine OT, andpediatric unit-I was selected and 30nurses were selected form these wardsusing population proportionate randomsampling method.Using pre-tested tools the pretest surveywas conducted in intervention group.
• Based upon the available literature and pre-test findings the education package on care of patients with HIV/AIDS was prepared and content validity was established with the concerned experts.• The main contents in education package are: epidemiology, pathophysiology, signs and symptoms, investigations, staging, treatment, complications, PEP, nursing care, stigma management, and services available at BPKIHS.
• After the pre-test, the education intervention training was provided using the prepared training module.• This training was 3 hours 3 days sessions excluding refreshment time.• During the training session lecture, discussion, role play, brain storming, video show was arranged for better results.
• The current practioners and experts of the field were utilized as a trainer.• Training module prepared was given to each participant. Various visual aids and posters were used during the training course.
• After the 2 weeks of training programme post test was conducted.• The collected data was analyzed using SPSS-11.5 soft ware package.• The descriptive statistics i.e. mean, Percentage, range and SD were used to analyze the data.• The study was conducted in the months of October 2006.
• The content validity of the prepared tool was established with the experts of concerned field.• Pre-testing of the tool was done among 6 nurses of the similar setting in BPKIHS.• Ethical clearance was obtained from the concerned authority.• Anonymity of the subjects was maintained.• The subjects were assured of the confidentiality of their information.
Details of Training Programme:• Using preplanned schedule and Package 3 days training was arranged.• An incentive was provided for participants as well as resource persons so that motivate them for active participation and better outcome.• At the end of the training programme written feedback was obtained in a semi- structured Performa and collected data was analyzed.
Demographic profile of the subjects:• The mean age of nurses was 24.8 yrs with SD 3.88 and range 20-35 years.• Majority of the nurses (90%) were Hindu.• About 60% of the nurses were from Sunsari (20%), Morang (20%) and Kathmandu (16.7%).
• Majority of nurses were from village 76.7%, working in the post of staff nurse (86.7%), unmarried (63.3%) and none of them (100%) had taken the training related to AIDS previously.
Table- I Knowledge Profile of the Subjects (N=30) Post-test (%) Pre-test (%) Difference (Pre-Post)S (%) Knowledge Profile of the SubjectsN1 What is AIDS? a. Life threatening disease 63.3 26.7 -36.6 b. Preventable disease 6.7 60.7 +54 c. Contagious disease 20 13.3 -6.7 e. I do not know 10 0 -102 HIV infection is diagnosed by blood test 70 86.7 +16.7
3 Knowledge about confirmation of diagnosis by lab test a. Yes 30 100 +70 b. No 43.3 0 -43.3 c. Do not know/Not sure 26.7 0 -26.74 Presence of HIV virus a. Saliva and tears 10 16.7 +6.7 b. Blood 80 96.7 +16.7 c. Semen/Vaginal Secretion 80 100 +20
5 Blood cells damaged by HIV virus a. Basophil 6.7 13.3 +6.6 b. Esonophil 6.7 0 -6.7 c. T-Lymphocytes 73.3 86.7 +13.4 d. I do not Know 13.3 0 -13.3 c. Do not know 20 0 -20
6 Ways of Transmission of HIV/AIDS a. shaking hands, 40 26.7 -13.3 hugging, kissing b. Eating from same plate 20 6.7 -13.3 c. If one is transfused with HIV 93.3 100 +6.7 positive blood. d. Making tattoos on the body 56.7 53.3 -3.4 e. Children born to HIV infected 80 86.7 +6.7 mothers f. By the bite of mosquito 23.3 16.7 -6.3 g. Using common syringes 76.7 93.3 +21.7 h. Sharing utensils and clothes 23.3 10 -13.3
7 Symptoms of HIV/AIDS a. Anorexia/Wt. Loss 93.3 96.7 +3.4 b. Fatigue/Weakness 13.3 93.3 +80 c. Pain 3.3 90 +86.7 d. Shortness of Breath 23.3 80 +56.7 e. Nausea/Vomiting 16.7 83.3 +66.6 f. Cough 23.3 83.3 +60
8 Who/When it is more likely to contact HIVV/AIDS a. Those having sexually transmitted diseases 90 100 +10 b. Migrant worker 56.7 90 +33.3 c. Unprotected vaginal sex 90 100 +10 d. Blood transfusion 90 100 +10 e. Unprotected oral/anal sex 56.7 90 +33.39 HIV virus survive in body fluids inside living human 63.3 100 +36.7 body
Table- IIWays to prevent ourselves from getting HIV/AIDS (N=30) Pre- Post- DifferenceSN Knowledge Profile (+ Responses) test test (%) (%) (%) (Pre-Post)1 Applying the principles of Universal Precautions 100 100 02 Use and administer blood and blood products only after screening 96.7 90 -6.73 Not touching the infected person 10 10 04 Not sharing the needles, razors and blades 96.7 96.7 05 Not to conceive if one has HIV/AIDS 80 96.3 +13.36 Practice safe sex 93.3 100 +6.77 Be faithful to the partners 90 100 +10
Table - III Knowledge about HIV/AIDS and its Care (N=30) Pre- Post- DifferenceSN Knowledge About HIV/AIDS test test (%) (%) (%) (Pre-Post)1 Heared about the term highly active anti- 33.3 90 +56.7 retroviral therapy ( HAART) ( yes)2 AIDS patients are more prone to develop 66.7 90 +23.3 opportunistic illness ( yes)3 Vaccine is available against HIV (yes) 23.3 56.7 +33.44 Knowledge about post exposure 36.7 100 +63.3 prophylaxis (PEP)5 Bleaching/Chlorine is used to clean blood 86.7 100 +13.3 spillage on surface ( Yes)6 Linen of AIDS patients should be send to laundry only after disinfection on in 83.3 100 +16.7 chlorine/bleaching (yes)
Table- IVExtent of knowledge about HIV/AIDS Related services available at BPKIHS Pre-test Difference (%)SN Knowledge Profile Post-test (%) (%) (Pre-Post)1 VCT a. Adequate 6.7 86.7 +80 b. Inadequate 16.7 16.7 0 c. Not at all 76.7 0 -76.72 PMTCT a. Adequate 6.7 83.3 +76.6 b. Inadequate 16.7 16.7 0 c. Not at all 76.7 0 -76.73 ART a. Adequate 10 86.7 +76.7 b. Inadequate 10 13.3 +3.3 c. Not at all 80 0 -80
4 STIs/IDCs a. Adequate 13.3 83.3 +70 b. Inadequate 20 60.7 -3.3 c. Not at all 66.7 0 -66.75 CD -4 count a. Adequate 13.3 86.7 +73.4 b. Inadequate 10 13.3 +3.3 c. Not at all 76.7 0 -76.76 HIV test a. Adequate 53.3 93.3 +40 b. Inadequate 26.7 6.7 -20 c. Not at all 20 0 -207 ART Drug availability a. Adequate 30 86.7 +56.7 b. Inadequate 20 13.3 -6.7 c. Not at all 50 0 -50
8 PEP a. Adequate 10 93.3 +83.3 b. Inadequate 20 6.7 -13.3 c. Not at all 70 0 -709 Infection control protocol of BPKIHS a. Adequate 36.7 69.0 +32.3 b. Inadequate 23.3 27.6 +4.3 c. Not at all 40 3.4 -36.6
10 Counseling Services a. Adequate 46.7 86.7 +40 b. Inadequate 36.7 13.3 -23.4 c. Not at all 16.7 0 -16.711 Role of NGOs & INGOs a. Adequate 30 83.3 +53.3 b. Inadequate 20 16.7 -3.3 c. Not at all 50 0 -50
Table-VWays to prevention of HIV/AIDS Pre- Post- DifferenceSN Knowledge Profile test test (%) (%) (%) (Pre-Post)1 Using condom during sex 100 100 02 Having no sexual relationship with multiple partners 93.3 96.7 +3.43 Having sex with single faithful husband and wife 96.7 96.7 04 Avoiding homosexual activities 86.7 96.7 +105 Not having sex with commercial sex workers 86.7 96.7 +106 Receiving safe blood transfusion 100 100 07 Using of disposable or sterilized syringe only 96.7 100 +3.38 Avoid to use common syringe by intravenous drug abuser 96.7 93.3 -3.4
Table – VI Pre and Post differences in the percentage of participants who scored most desired answer on the knowledge sections of the questionnaire (T= True) P. SignificanceSN Statement: Knowledge profile % Difference Value (at 0.05)1 HIV is diagnose by blood test (T) +16.7 0.250 NS2 Steps of confirmation of HIV by lab test (T) +70 0.000 S3 HIV is found in saliva (F) +6.7 0.687 NS4 HIV is found in blood (T) +16.7 0.125 NS5 HIV is found in semen/vaginal secretions (T) +20 0.31 NS6 HIV damage T- lymphocytes (T) +13.4 0.289 NS7 HIV is communicable disease (T) +20 1.000 NS
HIV is transmitted by having8 +3.3 0.454 NS multiple sexual partners (T) HIV may be transmitted by9 +10 1.000 NS blood transfusion (T) HIV may be transmitted by10 +20 0.250 NS kissing HV can be transmitted using11 +3.4 0.000 S same cloths of clients. (F) (NS= not significant, S= significant, at 5% level of significance)
HIV can be transmitted by12 -3.3 0.000 NS drinking from same glass (F) HIV only survive in body fluids13 +36.7 1.000 NS inside living human body (T)14 HIV is a curable disease (T) +3.3 .001 S15 Knowledge about HAART (T) +56.7 1.00 NS AIDS patients are more prone16 +23.3 0.001 S to opportunistic infections (T)
Table – VII Pre and Post differences in the percentage of participants who scored most desired answer on the attitude sections of the questionnaire (P= Positive, N= Negative)SN Statement: Attitude %Differe nce P. Significa (Pre – Value nce Post)1 AIDS is caused by curse of God. (N) +3.4 0.39 NS2 Person affected should not be allowed to stay in community. (N) +86.7 0.500 NS3 All the young people / students should know about HIV/AIDS infection. (P) -16.7 1.000 NS4 It is alright for women and men to have premarital sexual relation. (N) -13.4 0.125 NS5 If one of my friends gets AIDS I shall continue my normal social relationship with here or her. (P) +30 1.000 NS
6 Health education is necessary for woman and men to have safe 0.50 +10 NS sex. (P) 07 AIDS is real threat of human +70 .031 S population. (N)8 Knowing there is no cure for AIDS this is no point in caring for 1.00 +90 NS AIDS patients. (N) 09 It is not good for married men and woman to have extra marital +23.3 0.18 NS sexual relationship. (P) 0
10 AIDS awareness is one of the important advices of parents for -3.3 0.754 NS their children. (P)11 AIDS patient need live, support -6.7 0.250 NS and affection. (P)12 Major responsibility of adolescents is to participate in HIV/AIDS prevention programme 0 1.000 NS to being community awareness to control HIV/AIDS. (P)13 If one of my family members gets AIDS I will be ready to care -10 0.500 NS him / her. (P)14 We should not tell others if one -30 0.625 NS has HIV/AIDS. (N)
15 Individuals with HIV/AIDS infection must be treated with love and belonging. (P) -13.3 0.180 NS16 Individuals with HIV/AIDS infection must be assessed for any potential infection. (P) -10 0.125 NS17 HIV/AIDS patient should be treated properly. (P) -10 0.250 NS18 I feel that, counseling plays an important role for an HIV/AIDS infected clients. (P) -10 0.250 NS19 I am willing to assist with the delivery of a baby born to a mother with HIV/AIDS. (P) -10 0.250 NS20 I am willing to assist an operation on a patient with HIV/AIDS. (P) -6.7 0.250 NS (NS= not significant, S= significant, at 5% level of significance)
Table- VIII Level of Preparation to provide care for the PLWA Pre- Post- DifferenceSN Knowledge Profile test test (%) (%) (%) (Pre-Post)1 Fully Prepared 43.3 86.7 +49.152 Adequately prepared 23.3 13.3 -103 Somewhat prepared 13.3 0 -13.34 Not prepared 20 0 -20
Table -IX Responses Regarding Various Aspects of the Training Programme (Evaluation of the Training Programme) ResponsesSN Item / Particular Adequate All right Inadequate (good) (Average) (Poor)1 Topics covered 93.3 6.7 002 Contents covered 86.7 13.7 003 Teaching learning 83.3 16.7 00 methods used4 Time allotted 60.0 40.0 005 Refreshment 90.6 10.0 006 Training Materials 66.7 33.3 007 Seating 86.7 13.3 00 arrangements
P e r c e n ta g e 0 5 10 15 20 25 30 35 40 45 50 T e ac h in g 47 L e arn in g M e th o d s U s e d T o p ic s 37 C o v ere d T im e 33 m an ag em en t C o n te n ts 30 C o v e re d T ra in in g 27 M a te r i a l s S u p p lie d 20Liked Items P r e -te s t ta k e n U p d a te 17 I n fo r m a ti o n s 13 A r r a n g e m e n ts Most Liked Things about the Training Programme 10 T e am S p irit 7 P r e s e n ta ti o n s
P e r c e n ta g e 0 5 10 15 20 25 30 35 G ro u p 30 w o r k s /in te r a c ti ons P la n fo r a ll 27 n u rs e s T im e c a n 23 in c r e a s e C e r tific a te o f 13 tr a in in gSuggetions/feedback 10 S o u n d S y s te m Suggestions to incorporate in futrue training C o n tin u e in 10 fu tu r e
Discussion:Chi squire test was applied in the selectedvariables of knowledge profile and attitudecomponents to investigate the differences aftereducation intervention. It was found that inknowledge components i.e. steps of confirmationof HIV by laboratory test is highly significant(0.000), similarly there is significant changes inthe knowledge on HIV can be transmitted bydrinking from same glass (false statement) andAIDS patients are more prone to opportunisticinfections (0.001). In remaining componentsthere is no change statistically at 5% level ofsignificance.
Similarly, in attitude components there issignificant difference in post test in AIDS isreal threat to human population (negativestatement) at 5% level of significance andon other attitude components there is nodifference statistically at 5% level ofsignificance.
Conclusions:• HIV/AIDS is rapidly spreading in countries of Asia including Nepal.• It could cause major socio-demographic impact in the country.• It obviously has many health implications.• To minimize the risk of transmission, adequate knowledge about HIV infection is important.
• We believe that such programs should be mandatory for all health care workers; however, education campaigns should be carefully structured and specifically tailored to a particular setting.• Finally, the effectiveness of targeted education programs on HIV/AIDS should be repeated by evaluated in the future.
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Acknowledgement:We want to express our heart feltthanks to ASIA LINK PROJCTco-ordinator Prof. Prahlad Karkiand project expert Prof. SumanRijal for providing the fund toconduct the training programme.
THANK-YOU The Theme. “Stop AIDS: Keep the Promise -2007” “Take leadership-2008”