IMPACT OF EDUCATION
INTERVENTION PROGRAMME ON
CARE & SUPPORT TO THE PEOPLE
LIVING WITH AIDS RECEIVING ART
AT BPKIHS
Mehta ...
Everybody is at risk of
getting HIV.
However certain
Persons have high risk.
Introduction
3
HIV/AIDS in the World
Adults and children
living with HIV
33.2 million
Adult and child deaths
from AIDS
2.1 million
Adul...
•In world about 50,000
HIV infection in each
year
5
HIV Situation in Asia
• 8.3 million infected
• 1.1 million new infections in 2005
• ½ million deaths in 2005
• Most Asia...
Situation in Nepal
• First case detected in 1988
• Total HIV infection reported as of 16th
July 2010
- Male = 10,497
- Fem...
Summary of PLWHA Enrolled in ART
Centers of Eastern Nepal,
(Till 2067, Asadh Masant)
ART Centers
Total Number of
Enrolled
...
Vital Information RT HIV/AIDS of Nepal
8
• Total VCT (CT) Centers (till 2009) = 179
• Total ART centers (till 2009) = 23
•...
AIDS is an unprecedented global crisis. It
requires an unprecedented response from each
and every one of us. Turning back ...
Care & Support Programme Includes:
• Symptom & pain management
• Hospital referral
• Treatment support
• Nutrition support...
Objectives:
• To assess the Knowledge and Practices
regarding the care & support to the People
living with AIDS receiving ...
Methodology
• Pre-experimental, single group, Pre-
test Post-test research design was
used to conduct the study among
PLWA...
• Total 80 Subjects were included
in the pre-test using purposive
sampling technique and 70 in
Post-test.
• After pre-test...
• The education intervention was
provided using Pamphlets, Charts,
Graphs, Poster and Provided
information booklet individ...
Home Based Care to the People Living with AIDS (PLWA)
Pr) cfO{) eL) ;+s|ldtsf nflu 3/kl/jf/df
cfwfl/t ;]af
-;xof]uL k'l:ts...
HBC Programme: AV aids
HBC Training
HBC training
HBC training at BPKIHS
HBC training at BPKIHS
• After 3 months of education
intervention programme post
test was conducted.
• The collected data was
analyzed using Exce...
Results
Socio-demographic Characteristics of the Subjects
SN
Socio-
demographic
Characteristics
Responses
Pre-Test (%) Pos...
Continue……
Socio-demographic
Characteristics
Responses
Pre-Test
(%)
Post-Test
(%)
N=80 N=70
Education Level
a. Illiterate ...
Socio-demographic Characteristics
Socio-demographic
Characteristics
Responses
Pre-Test
(%)
Post-Test
(%)
N=80 N=70
Marital...
Socio-demographic Characteristics
Socio-demographic
Characteristics
Responses
Pre-Test (%) Post-Test (%)
N=80 N=70
Occupat...
Socio-demographic Characteristics
Participant
Responses
Pre-Test
(%)
Post-Test
(%)
N=80 N=70
a. PLWA 71.3 62.9
b. Caregive...
Socio-demographic Characteristics
District
Responses
Pre-Test
(%)
Post-Test
(%)
N=80 N=70
a. Sunsari 48.8 55.7
b. Morang 2...
HBC & Related Informations
HBC & Related Informations
of PLWA
Responses
Pre-Test (%) Post-Test (%)
N=80 N=70
Duration of r...
Monthly Expenditure RT Management of PLWA
a. 400- 2000 25 47.1
b. 2000 – 4000 25 18.6
c. 4000- 8000 3.3 24.3
d. > 8000 18....
Knowledge about HIV/AIDS & HBC
SN
Knowledge about HIV/AIDS &
HBC
Responses
P-value
Pre-
test
(%)
Post-
test
(%)
Differ
enc...
4 Knowledge about highest
risk of HIV transmission
route. (Anal)
12.5 62.9 55.03
<0.0001c
(S)
5 Transmission of HIV
throug...
SN
Knowledge about
HIV/AIDS & HBC
Responses
P-valuePre-test
(%)
Post-test
(%) Differe
nce (%)
N=80 N=70
7 Knowledge about
...
Knowledge about HIV/AIDS & HBC
Key: c – Using MacNemar Chi-squire test S = Significant at 5% Level of significance
Knowledge about drugs used in the
management of OIs
Differences in ability to assess the vital status among
the subjects after education intervention
SN
Assessment of
Physica...
SN
Assessment of
Physical Findings
Correct Responses
Remark
Pre-
test
(%)
Post-test
(%)
Difference
s (%)
P-value
7 Cyanosi...
Differences in knowledge and practices on using
preventive measures after education intervention
SN
Preventive
measures
Co...
SN Preventive measures
Correct Responses
Remark
Pre-test (%)
Post-test
(%)
Differences
(%)
P-
value
4 Knowledge about PEP
...
Ability to manage symptoms correctly
SN
Common OI
symptoms
Ability to manage symptoms correctly
RemarkPre-test
(%)
Post-te...
Suggestions given by caregiver to
improve HBC at their home
SN Suggestions Number Percentage
1 No response 32 45.7
2 Finan...
Evaluation of the education intervention programme
(Post-test Evaluation)
SN Responses of the programme
Responses
Number
P...
3 Evaluation of the contents used in the booklet
a. Very good 39 55.7
b. Good 29 41.4
c. All right 2 2.9
d. Poor 0 0
4 Use...
SN Responses of the programme
Responses
Number
Percentag
e (%)
5 Three liked activities of the
programme
a. No Response 30...
7 Suggestions/Feedback to
improve the programme in
future
Number Percentage (%)
a. No suggestions 37 52.9
b. Financial sup...
Conclusion
• HIV/AIDS has severe social
consequences that primarily affects
those who are already poor and
socially disadv...
Conclusion
• On the basis of findings of the study, it
is clear that care and support services
are essential service to PL...
Recommendations:
• Similar study can be conducted at other
ART centers of Nepal
• NGOs and INGOs needs to pay
attention fo...
Problem Faced During the Study:
• Few respondents were hesitating to give the
answers of the question.
• It was found diff...
References:
1. UNAIDS Report (2006). Understanding the latest estimation of 2006 report on the global AIDS epidemic
2. Hun...
THANK-YOU
Stop AIDS:
Keep the Promise
Some Video Clips
Hiv aids care & support training effectiveness
Hiv aids care & support training effectiveness
Hiv aids care & support training effectiveness
Hiv aids care & support training effectiveness
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Hiv aids care & support training effectiveness

  1. 1. IMPACT OF EDUCATION INTERVENTION PROGRAMME ON CARE & SUPPORT TO THE PEOPLE LIVING WITH AIDS RECEIVING ART AT BPKIHS Mehta RS, Karki P B. P. Koirala Institute of Health Sciences
  2. 2. Everybody is at risk of getting HIV. However certain Persons have high risk. Introduction
  3. 3. 3 HIV/AIDS in the World Adults and children living with HIV 33.2 million Adult and child deaths from AIDS 2.1 million Adults and children newly infected with HIV 2.5 million
  4. 4. •In world about 50,000 HIV infection in each year
  5. 5. 5 HIV Situation in Asia • 8.3 million infected • 1.1 million new infections in 2005 • ½ million deaths in 2005 • Most Asian epidemics are fueled by interplay between IDU and commercial sex work
  6. 6. Situation in Nepal • First case detected in 1988 • Total HIV infection reported as of 16th July 2010 - Male = 10,497 - Female = 5,561 - Total = 16, 138 • Estimates around 70,000 HIV-positive
  7. 7. Summary of PLWHA Enrolled in ART Centers of Eastern Nepal, (Till 2067, Asadh Masant) ART Centers Total Number of Enrolled PLWHA Total Number of PLWA on ART BPKIHS 528 205 KZH 91 50 MZH 77 36 SZH 26 8 Grand Total 722 299
  8. 8. Vital Information RT HIV/AIDS of Nepal 8 • Total VCT (CT) Centers (till 2009) = 179 • Total ART centers (till 2009) = 23 • Total PMTCT centers (till2009) = 17 • Total PLWA on First line ART (till 2009) = 3,423 • Total PLWA on Second line ART (till 2009) = 17 • Total Death (15 Nov 2009) = 450 Source: NCASC, 2009
  9. 9. AIDS is an unprecedented global crisis. It requires an unprecedented response from each and every one of us. Turning back the HIV/AIDS epidemic is a task beyond individual effort, no matter how outstanding or heroic. It requires communities, nations and regions to come together in a concerted, coordinated action. - Kofi Annan, UN Secretary General, UNAIDS, 2001
  10. 10. Care & Support Programme Includes: • Symptom & pain management • Hospital referral • Treatment support • Nutrition support • Emotional support • Spiritual support • Social services • End-of-life care • Future planning for self/family
  11. 11. Objectives: • To assess the Knowledge and Practices regarding the care & support to the People living with AIDS receiving ART at BPKIHS. • To prepare and provide an education intervention package on care and support. • To evaluate the effectiveness of implemented education intervention programme.
  12. 12. Methodology • Pre-experimental, single group, Pre- test Post-test research design was used to conduct the study among PLWA receiving ART for more than 3 months at BPKIHS ART Center.
  13. 13. • Total 80 Subjects were included in the pre-test using purposive sampling technique and 70 in Post-test. • After pre-test, planned education intervention programme was arranged at ART clinic regularly for 8 weeks on clinic days (Mon/Wed/Fri) at BPKIHS from 1st February to 30th March 2010.
  14. 14. • The education intervention was provided using Pamphlets, Charts, Graphs, Poster and Provided information booklet individually, containing the required information and along with the interaction sessions.
  15. 15. Home Based Care to the People Living with AIDS (PLWA) Pr) cfO{) eL) ;+s|ldtsf nflu 3/kl/jf/df cfwfl/t ;]af -;xof]uL k'l:tsf_ Home Based Care Programme B.P. Koirala Institute of Health Sciences Dharan, Sunsari, Nepal
  16. 16. HBC Programme: AV aids
  17. 17. HBC Training
  18. 18. HBC training
  19. 19. HBC training at BPKIHS
  20. 20. HBC training at BPKIHS
  21. 21. • After 3 months of education intervention programme post test was conducted. • The collected data was analyzed using Excel and SPSS software package.
  22. 22. Results Socio-demographic Characteristics of the Subjects SN Socio- demographic Characteristics Responses Pre-Test (%) Post-Test (%) N=80 N=70 1 Age group a. < 30 31.3 32.9 b. 30-40 57.7 64.2 c. 40-50 8.7 2.9 d. >50 2.3 0 Mean 32.57 32.34 SD 6.513 5.018 Range 18-51 18-46 2 Gender a. Male 68.8 70
  23. 23. Continue…… Socio-demographic Characteristics Responses Pre-Test (%) Post-Test (%) N=80 N=70 Education Level a. Illiterate 5.0 10 b. Literate/Primary 48.8 42.9 c. Secondary 38.8 35.7 d. Higher Secondary & above 7.5 11.4
  24. 24. Socio-demographic Characteristics Socio-demographic Characteristics Responses Pre-Test (%) Post-Test (%) N=80 N=70 Marital Status a. Married 82.5 88.6 b. Unmarried 17.5 11.4 Residence a. VDC 41.3 47.1 b. NP 58.8 52.9
  25. 25. Socio-demographic Characteristics Socio-demographic Characteristics Responses Pre-Test (%) Post-Test (%) N=80 N=70 Occupation a. Farmer 18.8 18.8 b. Service 3.8 0 c. Business 17.5 16.3 d. Housewife 10 7.5 e. Labour 7.5 6.3 f. Social worker 7.5 5.0 g. Unemployed 35 33.8
  26. 26. Socio-demographic Characteristics Participant Responses Pre-Test (%) Post-Test (%) N=80 N=70 a. PLWA 71.3 62.9 b. Caregiver 28.8 37.1
  27. 27. Socio-demographic Characteristics District Responses Pre-Test (%) Post-Test (%) N=80 N=70 a. Sunsari 48.8 55.7 b. Morang 23.8 25.7 c. Jhapa 20 15.7 d. Others 7.5 2.9
  28. 28. HBC & Related Informations HBC & Related Informations of PLWA Responses Pre-Test (%) Post-Test (%) N=80 N=70 Duration of receiving ART a. < 6 Months 15.0 32.8 b. 6-12 Months 42.5 40.0 c. 12-24 Months 21.3 2.4 d. > 24 Months 29.2 5.8 Mean 15.20 10.44 SD 12.688 9.172 Range 3-48 3-38
  29. 29. Monthly Expenditure RT Management of PLWA a. 400- 2000 25 47.1 b. 2000 – 4000 25 18.6 c. 4000- 8000 3.3 24.3 d. > 8000 18.7 10 Mean 4868.75 36876.14 SD 4620.520 4019.875 Range 500-20,000 400-20000
  30. 30. Knowledge about HIV/AIDS & HBC SN Knowledge about HIV/AIDS & HBC Responses P-value Pre- test (%) Post- test (%) Differ ence (%) N=80 N=70 1 Knowledge about National CHBC Programme 20 67.1 65.1 <0.0001c (S) 2 HIV is Communicable disease. 45.0 91.4 50.2 0.050C (S) 3 Knowledge about life cycle of HIV a. Fully 88.8 30.0 21.2 <0.0001c (S) b. Partially 47.5 54.3 6.8 c. Do not know 43.8 15.7 -28.1
  31. 31. 4 Knowledge about highest risk of HIV transmission route. (Anal) 12.5 62.9 55.03 <0.0001c (S) 5 Transmission of HIV through open skin wound with infected body fluids (T) 66.3 82.9 16.6 0.029c (S) 6 Certainty (100 %) of transmission of HIV with the sexual contact with HIV infected person 15 62.9 47.9 <0.0001c (S) SN Knowledge about HIV/AIDS & HBC Responses P-value Pre- test (%) Post- test (%) Differe nce (%)N=80 N=70
  32. 32. SN Knowledge about HIV/AIDS & HBC Responses P-valuePre-test (%) Post-test (%) Differe nce (%) N=80 N=70 7 Knowledge about number of CD-4 count in healthy individual 40 62.9 22.9 0.024c (S) 8 Knowledge about number of CD-4 count to become AIDS ( N > 200) 30 77.1 47.1 <0.0001c (S)
  33. 33. Knowledge about HIV/AIDS & HBC Key: c – Using MacNemar Chi-squire test S = Significant at 5% Level of significance
  34. 34. Knowledge about drugs used in the management of OIs
  35. 35. Differences in ability to assess the vital status among the subjects after education intervention SN Assessment of Physical Findings Correct Responses RemarkPre- test (%) Post-test (%) Differences (%) P-value 1 Temperature 27.5 57.1 29.6 0.002c S 2 Pulse 17.5 55.7 45.95 <0.0001c S 3 Respiration 10.0 40.0 30.0 0.864c S 4 Blood pressure 2.5 43.3 40.8 <0.0001c S 5 Anemia 7.5 34.3 26.8 0.002c S 6 Jaundice 20.0 47.1 27.1 0.004c S
  36. 36. SN Assessment of Physical Findings Correct Responses Remark Pre- test (%) Post-test (%) Difference s (%) P-value 7 Cyanosis 12.5 43.3 30.8 0.0013c S 8 Oral thrush 20.0 42.9 22.9 0.009c S 9 Lymph node 17.5 47.1 29.6 <0.0001c S 10 Liver 5.0 43.3 29.3 <0.0001c S 11 Dehydration 20.0 35.7 15.7 0.052c S Key: c – Using MacNemar Chi-squire test S = Significant at 5% Level of significance
  37. 37. Differences in knowledge and practices on using preventive measures after education intervention SN Preventive measures Correct Responses Remark Pre-test (%) Post-test (%) Differences (%) P-value 1 Preparation of Bleaching Solution (CR) 7.5 31.4 23.9 0.004c S 2 Preparation of ORS properly (CR) 78.8 95.7 16.9 0.007c S 3 Wearing gloves properly (CR) 48.8 81.4 32.6 <0.0001c S
  38. 38. SN Preventive measures Correct Responses Remark Pre-test (%) Post-test (%) Differences (%) P- value 4 Knowledge about PEP a. Fully 5.0 8.6 81.17 0.007c S b. Partially 11.3 30.0 18.7 c. Not at all 83.8 61.4 -22.4 5 Knowledge about STIs a. Adequate 25 54.3 29.3 0.157a NS b. Little 31.3 15.7 -15.6 c. Do not know 43.8 30.0 -13.8
  39. 39. Ability to manage symptoms correctly SN Common OI symptoms Ability to manage symptoms correctly RemarkPre-test (%) Post-test (%) Differences (%) P-value 1 Fever 68.8 88.6 19.8 0.001c S 2 Diarrhea 71.3 91.4 20.1 <0.0001c S 3 Nausea/Vomiting 41.3 78.6 37.3 <0.0001c S 4 Itching 28.8 77.1 48.3 <0.0001c S 5 Oral thrush 16.3 48.1 32.3 0.017c S 6 Cough 48.8 71.4 22.6 <0.0001c S 7 Skin sores 36.3 68.6 32.6 <0.0001c S 8 Boadache 33.8 74.3 49.18 <0.0001c S Mean Score 34.5 52.37 17.87 0.007 S
  40. 40. Suggestions given by caregiver to improve HBC at their home SN Suggestions Number Percentage 1 No response 32 45.7 2 Financial support for investigation, diet and transport 9 12.5 3 Love, affection and reassurance 6 8.6 4 Regular free medication 6 8.6 5 Free investigations 5 7.1 6 Home care training 5 7.1 7 Community awareness activities to reduce stigma 2 2.9
  41. 41. Evaluation of the education intervention programme (Post-test Evaluation) SN Responses of the programme Responses Number Percentage (%) 1 Overall evaluation of the programme a. Very good 28 40 b. Good 34 48.6 c. All right 8 11.4 d. Poor 0 0 2 Evaluation of the Posters, Charts, Leaflets used a. Very good 16 22.9 b. Good 60 57.1 c. All right 14 20.0 d. Poor 0 0
  42. 42. 3 Evaluation of the contents used in the booklet a. Very good 39 55.7 b. Good 29 41.4 c. All right 2 2.9 d. Poor 0 0 4 Usefulness in the daily life a. very useful 31 44.3 b. useful 28 40.0 c. all right 11 15.7 c. not useful 0 0
  43. 43. SN Responses of the programme Responses Number Percentag e (%) 5 Three liked activities of the programme a. No Response 30 42.9 b. counseling/Information 4 5.7 c. Booklet/Leaflet 4 5.7 d. Awareness activities 4 5.7 6 Suggestions for inclusion of Contents/Items in the programme a. No suggestions 43 61.4 b. Diet menu 10 14.3 c. Occupation plan 10 14.3 d. Community awareness 10 14.3 e. Terminology familiar 3 4.3
  44. 44. 7 Suggestions/Feedback to improve the programme in future Number Percentage (%) a. No suggestions 37 52.9 b. Financial support 16 22.9 c. Public awareness 8 11.4 d. Nutrition support 8 11.4 e. Free Investigations 6 8.6 f. Stigma reduction programme 3 4.3
  45. 45. Conclusion • HIV/AIDS has severe social consequences that primarily affects those who are already poor and socially disadvantaged. • Home based care is recommended as an appropriate form of support for PLWHA.
  46. 46. Conclusion • On the basis of findings of the study, it is clear that care and support services are essential service to PLHA and contributing to the national response by reinforcing ART adherence, improved referrals and follow-up, increased self- care and reduction of stigma and discrimination.
  47. 47. Recommendations: • Similar study can be conducted at other ART centers of Nepal • NGOs and INGOs needs to pay attention for CHBC programme, so that the problems of community clients can be solved. • Care & Support Programme at each ART center is essential.
  48. 48. Problem Faced During the Study: • Few respondents were hesitating to give the answers of the question. • It was found difficult to grade the knowledge level and perception level because different individual perceives differently.
  49. 49. References: 1. UNAIDS Report (2006). Understanding the latest estimation of 2006 report on the global AIDS epidemic 2. Hunt, C.K. (2003) Concepts in caregiver Research. Journal of Nursing Scholarships, 35(1): 27-32. 3. Bhardwaj, A., Biswas, R., & Shetty, K.J. (2001) HIV in Nepal: Is it rarer or the tip of an iceberg? Trop Doct, 31: 211-213. 4. NCASC (2061), AIDS News letter: Quarterly (Asoj). Women, Girls, HIV & AIDS, 53:13-17. 5. Underwood, C. (2006; July-18) HIV/AIDS burdens more than patients. Express News. 6. Donabedian, A. (1980) Explorations in Quality Assessment and Monitoring, Ann Arbor, MI, USA: Health Administration. 7. Choo, W.Y., Low, W.Y. & Karina, R. (2003) Social support and burden among caregivers of patients with dementia in Malaysia. Asia-Pacific Journal of Public Health; 15: 23–29. 8. Mwinituo Prudence, Mill JE. Stigma associated with Ghanian Caregivers of AIDS patients. Western Journal of Nursing Research. 2006; 28(4): 369-382. 9. Mushonga, R.P. (2001) Social support, coping, and perceived burden of female caregivers of HIV/AIDS patients in rural Zimbabwe. Unpublished doctoral dissertation, Case Western Reserve University, Ohio. 10. Chappell, N.L., Reid, R.C. (2002) Burden and well being among caregivers: Examining the distinction. Gerontologist; 42: 772–780. 11. Vithayachockitikhum, N. (2006) Family caregiving of persons living with HIV/AIDS in Thailand. Caregiver burden, an outcome measure. International Journal of Nursing Practice; 12(3): 123. 12. Zarit, S.H., Todd, P.A., & Zarit, J.M. (1986) Subjective burden of husbands and wives as caregivers: A longitudinal study. Gerontologist; 26: 260–266. 13. Reinhard, S.C. (1994) Living with mental illness: Effects of professional support and personal control on caregiver burden. Research in Nursing and Health; 17: 79–88. 14. Grafström, M., Fratiglioni, L., & Sandman, P.O. (1992) Health and social consequences for relatives of demented and non-demented elderly. A population-based study. Journal of Clinical Epidemiology; 45: 861–870. 15. Moffatt, B.C. (1986) When Someone You Love Has AIDS. New York: NAL Penguin. 16. Asian Development Bank (2005). Initial poverty and social assessment. ADF grant PNG: HV/AIDS prevention and control in rural development Enclaves.
  50. 50. THANK-YOU Stop AIDS: Keep the Promise
  51. 51. Some Video Clips

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