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 Table of Contents  
ORIGINAL ARTICLE
Year : 2016  |  Volume : 14  |  Issue : 3  |  Page : 130-133

Impacts of HIV/AIDS health facilities in the care and management of HIV clients at Kaduna state, Nigeria


1 Department of Medical Microbiology, University of Abuja Teaching Hospital, Abuja, Nigeria
2 Department of Medical Laboratory Services, University of Abuja Teaching Hospital, Abuja, Nigeria
3 National Open University of Nigeria, Special Centre, Nigerian Immigration, FCT Abuja, Nigeria
4 Department of Laboratory Services, Garki Hospital, Abuja, Nigeria

Date of Submission10-Aug-2016
Date of Acceptance18-Sep-2016
Date of Web Publication15-Feb-2017

Correspondence Address:
Noel O Sani
Department of Medical Microbiology, University of Abuja Teaching Hospital, PMB228 Gwagwalada, FCT Abuja
Nigeria
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1687-1693.200152

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  Abstract 

Background
In the last two decades, nongovernmental organizations have played tremendous roles in the prevention and control of HIV infections in developing countries.
Objective of the study
This prospective study evaluated the impacts of an HIV/AIDS health facility and its roles in care, treatment, and management of HIV-infected clients at the Centre for Integrated Health Programmes Kwoi, Kaduna state, Nigeria.
Materials and methods
This study involved staff (technical, operations, and managerial) and HIV/AIDS clients. Out of 2259 clients who attended a pretest counseling session, 997 (44.1%) of them came individually, 1251 (55.4%) as groups, and 11 (0.5%) as couples. All staff (n=54) and 200 randomly selected HIV clients were administered structured questionnaires to collect data on their perception toward services provided by the facility.
Results
Findings from the staff revealed that HIV counseling, testing, care, and treatment were fully functional. However, the center had only 40% staff strength and 55% availability of service equipment; 70% of the clients were contacted for HIV voluntary counseling and testing through outreach, whereas 30% were contacted through routine outpatient visit. The facility managerial staff revealed that there was 60% funding of the healthcare center and these were wholly by the US government/international nongovernmental organizations. Out of the 200 clients interviewed, 70% accepted that the center was accessible, 85% were satisfied with the care provided by the center, and 100% consented to the fact that the services were 100% free; 90% of the clients suggested the need for more funding of the facility, and 96.7% of the clients requested for improvement in the quality of services provided.
Conclusion
The HIV healthcare facility has essentially assisted in the care, treatment, and management of HIV infected persons. However, there is need for more support (possibly from host government) by providing resources needed for adequate and efficient execution of HIV healthcare services.

Keywords: HIV care services, HIV/AIDS, voluntary counseling, voluntary testing


How to cite this article:
Sani NO, Nasir IA, Iyadi KC, Njor OM. Impacts of HIV/AIDS health facilities in the care and management of HIV clients at Kaduna state, Nigeria. Al-Azhar Assiut Med J 2016;14:130-3

How to cite this URL:
Sani NO, Nasir IA, Iyadi KC, Njor OM. Impacts of HIV/AIDS health facilities in the care and management of HIV clients at Kaduna state, Nigeria. Al-Azhar Assiut Med J [serial online] 2016 [cited 2017 Aug 22];14:130-3. Available from: http://www.azmj.eg.net/text.asp?2016/14/3/130/200152


  Introduction Top


HIV transmission has increased disproportionally over the years, especially in sub-Saharan Africa [1]. HIV is transmitted through contact with HIV-contaminated semen, vaginal secretions, blood, and other bodily fluids. This virus enters the body through vaginal and anal sexual intercourse, oral sex, blood transfusions, use of unsterilized hypodermic needles, and mother-to-child transmission [2].

HIV infects specific T cells called T-helper cells [3]. It has been observed that when a person is infected with HIV, he or she may not become ill for a period of time; however, they can infect others from the day they have contracted the virus [4].

According to ‘HIV/AIDS in Rural America’, in 2009, 7.7% of new HIV diagnoses were in rural areas. Living with HIV/AIDS in rural areas of developing countries creates serious socioeconomic challenges. These may include having to travel long distances for HIV/AIDS care, close-knit social networks that make it difficult to get tested, and availability of a few local resources for healthcare [5]. Although treatment for HIV infections is accessible with varying degrees of success, prevention is the key, mainly through mass education. Through early intervention and education, school teachers, community activists, and healthcare providers can work together to mitigate this devastating disease [5].

In Tanzania, the Health Sector HIV and AIDS Strategic Plan 2008–2012 built on the National HIV and AIDS Care and Treatment Plan for People Living with HIV and AIDS (PLHAs), which was developed in 2003. Between 2004 and 2006, a total of 204 health facilities, mainly hospitals, started providing care and treatment. From 2007 onwards, the program rolled out to include additional 500 health centers and dispensaries. The Health Sector HIV and AIDS Strategic Plan calls for the provision of quality HIV and AIDS care and treatment services at all healthcare facilities across the country. Setting standards in the provision of care and treatment will require the establishment and organization of effective Care and Treatment Clinics at all healthcare facilities. Different tools for the assessment and certification of healthcare facilities, the training of healthcare workers, conducting supportive supervision, and clinical mentoring, as well as for monitoring the patients and the program, should be developed to facilitate the provision of quality care to PLHAs [6].

Reviews of HIV interventional studies in low-income and middle-income countries suggest that dissemination of written guidelines is often ineffective, as well as training and retraining of staff, supervision, and auditing with feedback. In view of these findings, multifaceted interventions other than single intervention programs are needed to address these problems [7]. For decades it has been reported that poor staff performance is not only due to inadequate knowledge and skills. As a result, most interventions concentrated on training resulted in disappointing outcomes [8]. There is therefore the need to go beyond the old paradigm that most performance problems can be solved by training alone.

Assessment as an intervention deserves special attention because of the following reasons: (a) it determines the need to improve performance, (b) if appropriately done, it could be a mechanism for providing professional development and improve health workers’ job satisfaction and motivation; (c) encourages district supervisors coming in contact with primary health workers in remote villages and other healthcare systems; (d) facilitates a platform where most policymakers and managers provide supportive measures as valuable ways of HIV control [8]. Conversely, the main challenges associated with HIV healthcare facilities are inadequate quality services, less supervision of primary health workers, and unavailability of cost–benefit evaluation.

Rapid increase in the number of patients in need of comprehensive HIV healthcare services in the early 2000 was the major driving forces behind refocusing major global and local priorities for HIV sciences [9].

It has been established that care and management of people living with HIV/AIDS is largely significant in the prevention and control of this global pandemic; it becomes necessary to assess HIV/AIDS healthcare centers to ascertain how efficiently they have rendered these services and how they have contributed to the control and prevention of HIV/AIDS and the challenges that have mitigated their services, so that possible solutions can be provided.

In view of necessity for periodic assessment of HIV healthcare programs, this study sought to evaluate the impacts of a non-governmental organization (NGO) healthcare facility in providing counseling, testing, and management services to its clients.


  Materials and methods Top


Study design

This was a questionnaire-based prospective study carried out at the Centre for Integrated Health Programmes (CIHP) of general hospital, Kwoi, Jaba Local Government of Kaduna state, Nigeria.

Study population

The present study involved 54 staff (technical, operation, and managerial) and HIV/AIDS clients of the center. Two units of the center were accessed and evaluated, which included the HIV voluntary counseling and testing (VCT) unit and the antenatal/prevention of mother-to-child transmission of HIV unit. Moreover, subjects’ sociodemographic data were collected from records of the units under study.

Study area and procedure

The researchers sought permission and ethics approval from the CIHP to recruit their staff and use healthcare records of their 2259 clients from three units before embarking on the study. Informed consent of the participants was also obtained. The study was appropriately explained to all clients thereafter, and they individually gave verbal consent for voluntary participation. A total of 200 HIV-infected clients were randomly selected for self-administered questionnaires. All data were analyzed anonymously throughout the study.


  Results Top


A total of 2259 attended the counseling section. Among them, 997 (44.1%) of them attended as individuals, 1251 (55.4%) as groups, and 11 (0.5%) as couples ([Table 1]). Voluntary counseling, testing, and treatment were functional in the study area. However, the staff of the center reported that there was only 40% staff strength and 55% availability of service equipment. More (70%) clients were contacted for HIV VCT through outreach than routine outpatient visit to centers (30%). The managerial staff of the facility revealed that there was 60% funding of the healthcare center, which was wholly by the US government/international NGOs ([Table 2]).
Table 1 Monthly distribution of clients for HIV precounseling

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Table 2 Findings from staff perception towards services provided by the healthcare facility

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Seventy percent of the clients accepted that the center was accessible, 90% said there were no financial expenses for transportation to the center, 85% of the clients were satisfied with the services provided at the center, and 100% agreed to the fact that the services were 100% free; 90% clients suggested the need for more funding of the facility, and 96.7% of the clients requested for improvement in the quality of services provided ([Table 3]).
Table 3 Findings from HIV clients’ perceptions towards services provided by the healthcare facility

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  Discussion Top


Nigeria is one of the countries with a large number of HIV-infected persons; thus, there is need for urgent interventional strategies that can minimize/halt the transmission and expansion of this disease. This study uniquely reported that NGO HIV/AIDS healthcare centers led to improvements in detecting HIV-infected individuals and appropriate management of diagnosed infected persons.

HIV VCT are considered the entry point to HIV care, including access to prophylaxis and antiretroviral treatment. Reductions in morbidity, mortality, HIV incidence, and transmission are the ultimate goal of large-scale efforts at counseling and testing, as people may likely enroll for HIV care if they know that they are HIV infected. Persons who had access to VCT were most likely to begin appropriate treatment for HIV.

Findings from staff evaluations indicated that the center had only 40% staff strength and 50% equipment strength for rendering services; 70% of the clients came for HIV VCT through outreach sources, and they enjoyed 60% funding wholly from the US government and NGOs.

Only 50% of subjects of this study reported that healthcare was provided with high-level professionalism and with average attention during consultations. Seventy percent of them were satisfied with the services. In all, 96.7% of the subjects requested the need to improve on the quality of service provided by the healthcare facility. This is in contrast with a South African study. The evaluation process on implementation of the operational plan for the South African CCMT program during 2004–2007 showed that 93% of respondents indicated that the doctor demonstrated high level of professionalism [10].

A study on patient satisfaction conducted in the free state found significant differences in mean patient satisfaction with services provided by nurses across the province’s five districts. It was realized that human resource shortages, especially a shortage of professional nurses in the CCMT program, may be the reason behind the differences in mean patient satisfaction [10]. A patient satisfaction survey conducted in Singapore reported that patients were twice as likely to be satisfied if the doctors treated patients with courtesy and respect [11].

In this study, about 15% of patients were dissatisfied with HIV-specific services. The availability of HIV-specific material and educational activities for patients in healthcare settings assists in improving knowledge about ways in which the spread of HIV can be prevented. This is because of the fact that susceptibility to an HIV infection relates to a number of factors, including culture, poverty, and lack of education [12]. Eight-five percent were satisfied with the service provided by the healthcare center. This finding is similar to that of an Australian study. The Australian study reported that 85% of patients in a patient satisfaction survey in Melbourne were provided with sufficient privacy during the consultation [13]. Another study on satisfaction and association between patient satisfaction and physician services in primary healthcare centers found that a high level of customer satisfaction correlates well with a good relationship with the physician, and this boosts patient loyalty. This is important to, and vital for, patient satisfaction [13].


  Conclusion Top


The HIV healthcare facility has essentially assisted in the care, treatment, and management of HIV-infected persons. However, there is need for more support (possible from host government) by providing resources needed for adequate and efficient execution of HIV healthcare services.

Acknowledgements

The authors thank the Director and staff of the CIHP Kwoi, Kaduna state, Nigeria, for granting permission to publish this study. They also thank Pharm. Philip Kachiro, the focal person of the Kwoi CIHP Center, and Scientist Isiyaku Adamu, head of Laboratory Department, CIHP, Kwoi.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
World Health Organization. Towards universal access: scaling up priority HIV/AIDS interventions in the health sector. Geneva, Switzerland: WHO; 2008.  Back to cited text no. 1
    
2.
World Health Organization. Current and future directions of the HIV/AIDS pandemic. Geneva 2nd phase. Geneva, Switzerland: WHO; 2005.  Back to cited text no. 2
    
3.
Centres for Disease Control and Prevention. A glance at the AIDS epidemics. Atlanta, USA: US Department of Health and Human services; 2005.  Back to cited text no. 3
    
4.
Stokes A. Measuring impacts of HIV/AIDS on rural livelihood and food security. Sustainable development department. USA: Food and Agriculture Organisation; 2003.  Back to cited text no. 4
    
5.
Centres for Disease Control and Prevention. HIV/AIDS in rural America, health resources and services administration. Atlanta, USA: US Department of Health and Human services; 2013.  Back to cited text no. 5
    
6.
National AIDS Control Programme (NACP). National guidelines for the management of HIV and AIDS. 3rd ed. Abuja, Nigeria: Federal Ministry of Health Press; 2009.  Back to cited text no. 6
    
7.
UNESCO. Good policy and practice in HIV & AIDS education: effective learning. Paris, France: UNESCO Press; 2008.  Back to cited text no. 7
    
8.
Rowe AK, de Savingny D, Lanata CF, Victora CG. How can we achieve and maintain high-quality performance of health workers in low-resource settings? Lancet 2005; 366:1026–1035.  Back to cited text no. 8
    
9.
Smart R. AIDS care: why and how should industry respond? AIDS Anal Afr 2000; 10:13–14.  Back to cited text no. 9
    
10.
Wouters E, Heunis C, van Rensburg D, Meulemans H. Patient satisfaction with antiretroviral services at primary health-care facilities in the Free State, South Africa: a two-year study using four waves of cross-sectional data. BMC Health Serv Res 2008; 8:210.  Back to cited text no. 10
    
11.
Molina JA, Lim GH, Seow E, Heng BH. Effects of survey mode on results of a patient satisfaction survey at the observation unit of an acute care hospital in Singapore. Ann Acad Med Singapore 2009; 38:487–493.  Back to cited text no. 11
    
12.
Orrell C, Bangsberg D, Badri M, Wood R. Adherence is not a barrier to successful antiretroviral therapy in South Africa. AIDS 2013; 17:1369– 1375.  Back to cited text no. 12
    
13.
Saeed AA, Mohammed BA, Magzoub ME, Al-Doghaither AH. Satisfaction and correlates of patients’ satisfaction with physicians’ services in primary health care centers. Saudi Med J 2001; 22:262–267.  Back to cited text no. 13
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3]



 

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