Busisiwe P. Ncama

Social support and medication adherence in HIV disease in KwaZulu-Natal, South Africa

BACKGROUND A supportive social environment is critical for those with HIV/AIDS. In KwaZulu-Natal, in South Africa, antiretroviral therapy is available to some HIV-positive individuals. Antiretroviral adherence is an important issue for limiting HIV infection. Adherence to therapy may be linked to social support, particularly amidst the stigma prevalent in HIV. OBJECTIVE The purpose of this study was to examine characteristics related to social support and antiretroviral medication adherence. DESIGN This cross-sectional, descriptive study explored the nature of the relationships among social support and other selected variables, including sociodemographic variables, quality of life, and adherence. SETTINGS After ethical review board approval, the sample of HIV-infected individuals who received care in outpatient clinics were recruited and completed the self-report instruments. PARTICIPANTS The sample included English and/or isiZulu-speaking (n=149) individuals over the age of 18 years receiving treatment for HIV/AIDS. A total of 149 patients with a diagnosis of HIV/AIDS agreed to participate and completed questionnaires after completing informed consent procedures. The study participants were recruited at four outpatient settings in Durban, KwaZulu-Natal province of South Africa. METHODS A descriptive, exploratory, cross-sectional design was utilized to explore the research questions: What are the characteristics of social support and the relationship to antiretroviral adherence in KwaZulu-Natal, South Africa? Descriptive statistics and regression analyses were used to answer the research questions. RESULTS Data analyses indicated that social support scores on the Medical Outcomes Study Social Support Survey were moderate (M=64.4; S.D.=14.7) among the study participants. The number of close friends and family were significantly correlated with a greater sense of social support. Despite this, the lowest scores on the quality-of-life measure using the Medical Outcomes Study Short Form 36 item survey were reported on the Social Functioning Scale. CONCLUSIONS In summary, the study findings suggest that a supportive social network is essential for those living with HIV/AIDS. However, social functioning and quality of life amidst the stigma of living with HIV in South Africa may be a concern and require further investigation.

Quality of life and physical functioning in HIV-infected individuals receiving antiretroviral therapy in KwaZulu-Natal, South Africa

KwaZulu-Natal province, South Africa, accounts for 28.7% of the HIV infection total and one-third of infections among youth and children in South Africa. The purpose of this study was to examine the variables of HIV/AIDS symptoms, social support, influence of comorbid medical problems, length of time adhering to antiretroviral therapy medications, quality of life, adherence to antiretroviral medications, and physical functioning in HIV-infected individuals. Based on our model, the combination of these variables was found to determine physical functioning outcomes and adherence to HIV medications. Significant relationships were observed between physical functioning and the dependent variables of length of time on medications, comorbid health problems, and social support. A linear regression model was built to determine the degree to which these variables predicted physical functioning. In total, these predictor variables explained 29% of the variance in physical functioning. These results indicate that those individuals who reported a greater length of time on medications, fewer comorbid health problems, and greater social support had better physical functioning.

Symptoms experienced by HIV-infected Individuals on antiretroviral therapy in KwaZulu-Natal, South Africa

Symptom management in HIV/AIDS is a critical issue that influences the quality of life of those living with the disease. Although the goals of treating the numbers living with HIV/AIDS have not yet been achieved, availability of antiretroviral therapies (ARVs) has been expanded to many clinical settings in KwaZulu-Natal, the epicenter of HIV infection in South Africa. The South African Department of Health (2007) estimates indicate that 5.54 million South Africans are living with HIV/AIDS, whereas UNAIDS (2007) estimates suggest that 18.8% of the population in South Africa is affected. Because the symptom experience may influence adherence to ARVs and quality of life, this study focused on the prevalence of symptoms reported by patients (N = 149) diagnosed with HIV/AIDS and adherence to medications and appointments. Self-report data were obtained from this community-based sample of HIV-infected patients who received care in outpatient clinics in Durban, KwaZulu-Natal, South Africa. With an average of three side effects, the most frequently reported by the study participants were fatigue/tiredness (41%), rashes (40%), headaches (32%), insomnia (31%), sadness (24%), disturbing dreams (23%), numbness (22%), pain (22%), and self-appearance (20%). On a scale of 1 to 10 (10 being worst possible), those with symptoms reported an average intensity of 4.2 (SD = 2.0), and the degree to which symptoms affected activity levels was 3.2 (SD = 2.2). Although intensity of symptoms and effects on activity levels were strongly correlated (r = .78, p < .001), there were no significant relationships between adherence and the intensity of symptoms or the relationship of symptoms with activity levels. Logistic regression analyses indicate that the presence of a greater number of symptoms was not associated with greater adherence (odds ratio = 2.27, 95% confidence interval = 0.60-8.70, ns). However, those who reported higher adherence were 1.5 times more likely to report greater physical health than low adherers (p = .04). High adherers were also 1.6 times more likely to report greater psychological health than low adherers (p = .03). This suggests that further study is needed to investigate adherence motivations for those living with HIV/AIDS in South Africa because adherence seems not to be linked to the frequency of symptoms or limitations on activity related to symptoms.

Perceived quality of HIV treatment and care services in Wolaita Zone of southern Ethiopia: a cross-sectional study.

Objective To investigate the levels and factors affecting the perceived quality of HIV/AIDS treatment and care services. Design A cross-sectional study. Setting The study was conducted in Wolaita Zone of southern Ethiopia in one hospital and five health centres providing antiretroviral therapy (ART) and pre-ART. Participants 481 persons infected with HIV on outpatient care, 408 (83.8%) on ART and 73 (16.2%) on pre-ART care. Results 324 (71.4%) of the participants perceived the quality of HIV care as ‘good’, while 130 (28.6%) stated that it was ‘not good’; 219 (46.2%) and 255 (53.8%) were satisfied and not satisfied with the services, respectively. In the multivariate analysis, a unit increase in the doctors subscale of multidimensional health locus of control-form c score resulted in a 1.27 (1.04 to 1.55) increase in the odds of perceived good quality of care (p<0.05). Similarly, a unit increase in the responsiveness, perceived financial fairness, and perceived transportation convenience scores was associated with a 1.03 (1.01 to 1.05) (p<0.05), 1.08 (1.05 to 1.15) (p<0.01), and 1.07 (1.05 to 1.18) (p<0.05) increase in the odds of perceived good quality of HIV care, respectively. In terms of client satisfaction with services, a 1 km increase in the distance from health facilities, and unemployment were associated with a 4.64 (2.61 to 8.25) (p<0.001), 1.02 (1.01 to 1.04) (p<0.05) and 2.23 (1.30 to 4.54) (p<0.01) times, respectively, increase in the perceived quality of HIV treatment and care services. Conclusions The majority of the participants reported perceptions of good quality HIV care and satisfaction with the services. Satisfaction with services; responsiveness; health locus of control; perceived financial fairness; perceived transportation convenience; employment status; and distance from the health facility were predictors of the perceived quality of HIV care. Thus, improving quality of HIV treatment services may require addressing the above factors.

Community impact of HIV status disclosure through an integrated community home-based care programme

The integration of HIV-prevention activities into care has received little attention within or outside formal healthcare settings. The contribution of community home-based care services in facilitating disclosure of HIV status and reducing stigma have also not been described. This study examines the community impact of an integrated community home-based care (ICHC) programme on HIV-prevention efforts and disclosure of status. Quantitative data was collected from 363 people living with HIV (PLHIV) and 1 028 members of their micro-communities; of these, 211 and 586, respectively, were in the ICHC programme (thus representing the ICHC-served group) and 152 and 442, respectively, were not in the programme (representing the non-served or control group). The micro-community group served by the ICHC programme reported significantly more positive attitudes towards HIV, better knowledge of HIV, fewer instances of sexually-transmitted infections, a tendency for fewer sexual partners, and less perceived risk of acquiring HIV than the non-served micro-community group. Also, the micro-community served by the programme did not show significantly better uptake of voluntary counselling and testing than did the non-served micro-community. There was no difference in condom-use between the two groups.

Fulbright Scholar opportunities for global health and women's health care in HIV/AIDS in sub-Saharan Africa

This article addresses global health opportunities related to HIV/AIDS and womens health care in sub-Saharan Africa through Fulbright Scholar and Fulbright Student Awards. Although many universities offer a gateway to the J. William Fulbright awards, some disciplines and areas of specialization, including nursing and womens health, have had fewer scholars or students as recipients of these awards. Resource-limited countries, including the countries of sub-Saharan Africa, offer rich opportunities for cross-cultural exchange and advancement of global health. Amidst the context of the shortage of health care workers, the increasing prevalence of HIV/AIDS and other infectious and chronic diseases in sub-Saharan Africa, and the challenges of public health, this article addresses an example of partnerships in global nursing that can be developed through the Fulbright programs.

Client satisfaction: correlates and implications for improving HIV/AIDS treatment and care services in southern Ethiopia

INTRODUCTION Satisfaction with services is a qualitative but important measure of the fit between clients and care providers and is also a measure of the outcome of treatment. This study investigated the level and correlates of client satisfaction with HIV care. METHODS A cross-sectional questionnaire-based study was conducted on 485 people using HIV/AIDS treatment and care services in six health facilities in Wolaita Zone of Ethiopia from November 2014 to March 2015. RESULTS A total of 222 (45.8%) and 263 (54.2%) of the participants attended care at the health centers and hospital, respectively; 192 (39.6%) visited traditional medical practitioners. Seventy-five (15.5%) of the participants suffered probable mild to major mental depression. In total, 342 (70.7%) said that the quality of care was good and 224 (46.4%) were satisfied with the services. In multivariate analysis, probable mental depression, health system responsiveness, perceived quality of care and type of health facility were independently associated with satisfaction with HIV care (p<0.05). CONCLUSIONS Healthcare systems need to improve the responsiveness and quality of HIV care, and integrate a mental health care component to achieve higher client satisfaction. Further studies on the types of health facilities (between health centers and hospitals) in relation to satisfaction with services are recommended.

Exploring family-centered care for children living with HIV and AIDS in Nigeria

AIM To explored the role of family-centered care in supporting children living with HIV and AIDS in Nigeria. METHODS A qualitative research design was adopted for this study with a grounded theory approach. Children aged between 11 and 14 years living with HIV and AIDS, their caregivers, and nurse practitioners working in the HIV clinic were engaged in separate focus group discussions in two hospitals in Nigeria. RESULTS The findings showed that the value African families place on children plays a significant role in identifying their care needs and providing their basic necessities; hence, people around the sick child tend to make him feel better, as attested by nurse practitioners and caregiver participants. Nurse practitioner participants cited unified families as providing care support and love to the children and the support needed to alleviate their sicknesses. Children participants confirmed that family members/relatives were always at their disposal to provide supportive care in terms of administrating antiretroviral medication as well as other psychological care; although a few participants indicated that disruption in family structures in resource-poor settings, isolation and withdrawal, and deprivation of care due to poverty threatened the care rendered to the children. CONCLUSION The study highlighted the value attached to children in the African context as helping family members to identify the care needs of children living with HIV and AIDS; thereby providing succor to alleviate their sicknesses and enhance their quality of life.

Promotion of exclusive breastfeeding among HIV-positive mothers: an exploratory qualitative study.

BackgroundExclusive breastfeeding has the potential to reduce infant and under-five mortality, but research shows the practice is not widespread in resource-poor settings of sub-Saharan Africa. We explored factors influencing the decision to exclusively breastfeed among HIV-positive mothers accessing interventions for prevention of mother-to-child transmission of HIV in selected sites of Zambia.MethodsThis exploratory qualitative study was embedded in research conducted on: HIV and infant feeding; choices and decision-outcomes in the context of prevention of mother-to-child transmission among HIV-positive mothers in Zambia. Thirty HIV-positive mothers and six key informants were recruited from two health facilities providing mother-to-child HIV transmission prevention services. A semi-structured guide was used to conduct interviews, which were digitally recorded and simultaneously transcribed. Data coding and analysis was done with the support of QRS Nvivo 10 version software.ResultsDespite the known benefits of exclusive breastfeeding, gaps in understanding and potential for behaviour change remained. We found that information promoting exclusive breastfeeding may have been understood by mothers as instructions from the health care workers indicating how to feed their HIV-exposed babies rather than as an option for the mothers’ own informed-decision. This understanding influenced a mother’s perceptions of breast milk safety while on antiretroviral medicine, of the formula feeding option, and of the baby crying after breastfeeding. The meanings mothers attached to exclusive breastfeeding thus influenced their understanding of breast milk insufficiency, abrupt weaning and mixed feeding in the context of preventing mother-to-child transmission of HIV.ConclusionIn order to enhance feeding practices for HIV-exposed infants, our study suggests a broader health campaign supporting all mothers to exclusively breastfeed.

Minibus taxi drivers’ sexual beliefs and practices associated with HIV infection and AIDS in KwaZulu- Natal, South Africa

Risky sexual behaviours in South Africa are a major contributing factor to the spread of HIV infection and AIDS. HIV infection amongst minibus taxi drivers is a concern, because these people belong to an occupational group that exhibits risky behaviours due to the demands of their work. Given the high vulnerability of minibus taxi drivers, exploring the sexual beliefs and health-related sexual practices of this group will assist in planning targeted interventions. The objectives of this study were to assess the level of knowledge, beliefs and practices regarding HIV infection and AIDS amongst minibus taxi drivers. An exploratory descriptive study was conducted using a pre-tested questionnaire to explore and describe sexual beliefs and practices associated with HIV infection and AIDS in a convenience sample of 175 minibus taxi drivers. Permission to undertake the study was obtained from the KwaZulu-Natal Taxi Alliance and individuals who participated in the study. Data analysis were analysed using the Statistical Package for Social Sciences 13.0. The study revealed that minibus taxi drivers are one of the high- risk groups in the spread of HIV infection and AIDS; they lack necessary education and need attention in relation to control and prevention of the spread of HIV and AIDS. Multiple sexual partners are relatively common amongst the minibus taxi drivers. Violence against women and even forceful sexual intercourse in the belief that women should tolerate it to keep the family together was reported. There is a need for intervention programmes with a focus on minibus taxi drivers and similar high-risk groups. Prevention activities should incorporate the distribution of condoms amongst this group and HIV prevention educational programmes, as well as creating mechanisms for accessing circumcision by the minibus taxi drivers.