The education intervention programme on care and support for people living with HIV/AIDS receiving antiretroviral therapy at BPKIHS was effective in improving knowledge and practices. A pre-test and post-test study of 80 participants found statistically significant increases in knowledge about HIV transmission, treatment, and home-based care after an 8-week programme using pamphlets, booklets, and discussion sessions. Participants' ability to assess physical symptoms and manage opportunistic infections correctly increased. The programme was well evaluated, with participants finding the materials and content useful for daily life. Suggestions focused on adding dietary guidance and occupation planning to future programmes.

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. Everybody is at risk of
getting HIV.
However certain
Persons have high risk.
Introduction

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. •In world about 50,000
HIV infection in each
year

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. 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. 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. 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. 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. 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. 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. 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. • 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. • 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. 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. HBC Programme: AV aids

17. HBC Training

18. HBC training

19. HBC training at BPKIHS

20. HBC training at BPKIHS

21. • After 3 months of education
intervention programme post
test was conducted.
• The collected data was
analyzed using Excel and
SPSS software package.

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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. Knowledge about HIV/AIDS & HBC
Key: c – Using MacNemar Chi-squire test S = Significant at 5% Level of significance

34. Knowledge about drugs used in the
management of OIs

36. 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

37. 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

38. 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

39. 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

40. 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

41. 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

42. 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

43. 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

44. 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

45. 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

46. 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.

47. 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.

48. 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.

49. 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.

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54. THANK-YOU
Stop AIDS:
Keep the Promise

55. Some Video Clips