Evaluation of the involvement of HIV positive patients in the decision to commence antiretroviral therapy at Oshakati Hospital, Namibia

[摘要] ENGLISH ABSTRACT: The increase in treatment options for HIV positive people has contributed to an increase in the number of people willing to be tested for HIV since there are now tangible benefits associated with a confirmed HIV positive diagnosis. In Southern Africa the trend towards increased numbers of people who know their HIV status has been more noticeable in women than in men (Muula, et al., 2007), possibly due to the greater health seeking behaviour of women compared to men as well as the access that women have to HIV testing during pregnancy as part of countries' efforts towards preventing mother-to-child transmission of HIV. In Namibia there has been a massive increase in the number of patients commenced on antiretroviral therapy (ART) (MOHSS, 2007).It is important to ensure that increases in the number of patients being started on treatment are accompanied by a proportional improvement in the quality of care being provided to the patients. One important concept that has been promoted in recent years is the Greater Involvement of People Living with HIV/AIDS (GIPA). This concept promotes the inclusion of HIV infected individuals in the decision making process when making decisions regarding the welfare of People Living With HIV (PLHIV). One important caveat specific to ART is the high levels of adherence required for sustained effectiveness of the medicines. Involvement of patients in the design of their treatment has been shown to be a facilitator of adherence to treatment.This study design was a cross-sectional survey whereby a sample of individuals who are registered at Oshakati Communicable Disease Clinic and were receiving ART were interviewed to determine who they perceived to have been the principal decision maker for them to be commenced on ART. The responses were categorized according to the responses from the patients and the frequencies calculated to find the percentage of the patients on ART who considered themselves to have been involved in the decision making process. Having the majority of the patients perceiving themselves as having not been involved in the decision making process was thought to have an important bearing on the counselling which was done prior to starting treatment. This can therefore inform initiatives to improve case management and the involvement of patients in designing their treatment regimens and in making important decisions about their treatment. This ultimately helps to improve the adherence of these patients to their treatment, thereby improving the treatment outcomes and reducing the rate of development of resistance to the antiretroviral medicines (ARVs).

[发布机构] Stellenbosch University