Trnavská univerzita V Trnave Fakulta zdravotníctva a sociálnej práce Sprachkompetenz in der Wissenschaft Language Competence in the Science

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TRAINING OF HEALTH WORKERS IN PROVIDING ANTIRETROVIRAL THERAPY HIV POSITIVE PATIENTS IN MATUGA SUB-COUNTY
KATARÍNA DUDÁKOVÁ, KRISTÍNA GRENDOVÁ

Slovakia, Trnava University in Trnava, Faculty of Health Sciences and Social Work, Department of Public Health

[e-mail]

Abstract

Introduction: Knowledge and the low number health of workers in low and middle-income countries significantly influences providing of health care to HIV positive patients. It is so also in the field of providing antiretroviral treatment to HIV positive patients, when health workers in facilities have insufficientknowledge in providing the complex health care to HIV positive patients.

Aim: The aim of the study was to evaluate needs for on-going education in the area of antiretroviral treatment of health workers, who provide health care to HIV positive patients in Matuga- Sub-county.

Methods: The tool for areas of on-going education assessment of HWs was a questionnaire which was distributed to 63 HWs in 20 Government facilities in Matuga Sub-county. Data collection was done from 19^th of March to 26^th of March 2015.

Results: From the total sum of health workers, 27% took part in the trainingof providing antiretroviral treatment to children and 43% in the field of providing antiretroviral treatment to adults. 62% of health workers work according to ART Guideline from 2011, 5% of health workers work according to ART Guideline 2014 and 33% health workers can’t follow any of the available ART Guidelines.

Health workers considered the main barriers in providing health care the inadequate knowledge, motivation, salary and the workplace equipment.

Conclusion: The lack of knowledge in the field of HIV infection influences the quality of provided health care to HIV positive patients. We want to point out the need of ongoing education for HWs and subsequently provide better quality of care for HIV patients taking into account the conditions they live in.
Key words:

Education. Health workers. HIV positive patients.

Introduction
UNAIDS (Joint United Nations Programme on HIV/AIDS) states in their report from 2015, that globally estimated 36,9 (34,3 - 41,4) million people lived with HIV in 2014. Since 2000, 38,9 million people were infected by the HIV infection and 25,3 million people died due to AIDS. In 2014, 2 (1,9 – 2,2) million new HIV infections have been recorded and at the same time 35% decline in the number of new HIV infections was recorded when compared the year 2000. In 2014, 25,8 (24,0 – 28,7) million people with HIV infection lived in the Sub-saharan Africa and women made up more than half of the total number of people living with HIV. The number of new infections in 2014 was 1,4 million and 39% decline in the number of newHIV infections was recorded between years 2000 and 2014. 70% of the new HIV infections from the total global number occur in the Sub-saharan Africa (UNAIDS, 2015).

Effective care for HIV positive patients includes antiretroviral therapy (ART). The main effect of ART is to suppress viral replication, allowing the individual’s immune system to recover and protecting patients from the development of AIDS and death (Annison et al., 2013). It is demonstrated that ART therapy prolongs life and it is associated with low morbidity, mortality and increases levels of CD4 lymphocytes in HIV positive patients (Diniz et al., 2011).

In most sub-Saharan countries, decisions to initiate and monitor ART rely on clinical and immunological assessment and viral load, though the data is missing due to resource limitations and insufficient equipment in the facilities (Annison et al., 2013).

The big challenge for improving access to ART is also the lack of trained health workers. Some specialist recommend delegating the task from doctors to nurses or from clinical workers to community health workers. World Health Organization (WHO) also states that the specific tasks in health care are moved from highly qualified health workers to health workers, who attended a short training and have lower qualification in order to more efficiently use available human resources.

Methods

The need for on-going education of HWs in the area of providing health care to HIV positive patients was examined in 20 Government facilities (1 sub-county hospital (Kwale hospital), 3 Health centers (Tiwi, Mkongani and Shimba Hills) and 6 Dispensaries (Vyongwani, Mbuguni, Kiteje, Ng'ombeni, Waa, Matuga, Magodzoni, Mazumalume, Msulwa, Mwapala, Mwaluvanga, Kibuyuni, Lukor, Mkundi, Kiziba and Mwaluphamba) in in Matuga Sub-county in Kenya.

The data was collected from 19^th until 26^th of March 2015. The data was collected from the respondents using a non – standardized questionnaire. The questionnaire included questions concerning the profession of HW, his current tasks in providing health care to HIV positive patients, attending training in the areas of providing health care, work with current Guidelines for treatment of patients with HIV and areas in which the HWs would like to attend further training.

The questionnaire was pilot tested in Kinango by five HWs. 63 questionnaires were distributed and the response rate was 100%. HWs were informed about the anonymity of our questionnaire.

Results

In 2014 health care was provided to 1560 HIV positive patients in Matuga Sub-county. From the total number of HIV positive patients, 1222 (78,3%) were provided HAART and 338 patients were given prophylaxis Cotrimoxazole. In reality, the number of HIV positive patients is a lot higher, but as a result of stigma and discrimination many patients don’t admit their disease and refuse treatment.

The observed group of health workers was made up of 41% of men and 37% of women and the average time of providing health care was 119 months.

Most often the position of health workers were: nurses 64%, laboratory technicians, 13% and a clinical officers 8% and not one doctor. 95% of health workers received training for providing of health care to HIV positive patients.

27% received training in providing antiretroviral treatment to children and 43% in the field of providing antiretroviral treatment to adults.

62% of health workers work according to ART Guideline from 2011, 5% of health workers work according to ART Guideline 2014 and 33% health workers can’t follow any of the available ART Guidelines (Graph 1).

Graph 1: Guidelines for providing health care to HIV positive patients

HWs reported as the most frequent barriers to providing health care: lack of knowledge 59%, motivation to work and salary 52% and the technical equipment 52% (Graph 2).
In many health facilities, the machine forCD4 count and viral load is missing. Patients with HIV are treated based on weight and not on the number of CD4 lymphocytes, as indicated in ART Guideline published by WHO.

Graph 2: Barriers of health workers when providing health care to HIV positive patients

Health workers statedthe need for on-going education in the following areas: ART in children and adults (65%), monitoring ART (59%) and management opportunistic infection (64%).
Conclusion
In our work we pointed to the need for on-going education of health workers mainly in the area of providing antiretroviral therapy to HIV positive patients. Another area in which it is necessary to educate HWs is management opportunistic infections. Antiretroviral therapy is set according to the levels of CD4 lymphocytes. In many facilities it is impossible to measure levels of lymphocytes and the treatment is given based on the weight of the HIV positive patients. It is one of the barriers mentioned by health workers that is not easily influenced.

Therefore, it is important to focus on keeping patients on the treatment and educate health workers in the area of management of opportunistic infections.

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