Effectiveness of Planned Teaching Program on Knowledge Regarding Antiretroviral Therapy (Art) and its Compliance Among People Living with HIV/Aids

Mr. Shivagouda B. Patil¹, Mrs. Sangeeta Moreshwar²

¹Lecturer, Br. Nath Pai College of Nursing, Kudal, Sindhudurg, Maharashtra.

²Associate Professor and HOD Community Health Nursing,K.L.E. University’s Institute of Nursing Sciences, Belgaum, Karnataka

Corresponding Author Email: shivagoudap@yahoo.in

ABSTRACT:

A study was conducted on 60 people living with HIV/AIDS in support community care centre Belgaum. To evaluate the effectiveness of planned teaching programme on knowledge regarding antiretroviral therapy (ART) and its compliance among people living with HIV/AIDS and to associate the knowledge of people living with HIV/AIDS with selected socio-demographic variables. HIV is now considered not only as a health problem, but also a developmental and security threat. HIV is the human immunodeficiency virus. It is the virus that can lead to acquired immune deficiency syndrome, or AIDS. AIDS is the late stage of HIV infection, when a person’s immune system is severely damaged and has difficulty fighting diseases and certain cancers. One of the treatment available for combating with HIV is Antiretroviral therapy (ART). Antiretroviral therapy means treating viral infections like HIV with certain drugs. However, they slow down the growth of the virus but do not kill the virus. The subjects were selected by using non-probability purposive sampling technique. Data collection was done through structured knowledge questionnaire. The study was conducted by utilizing one group pre-test and post-test research design with an evaluative approach. Data obtained was tabulated and analyzed in terms of objectives of the study using descriptive and inferential statistics. A study revealed that in pre-test knowledge scores of people living with HIV/AIDS, 39(65%) had average knowledge and 13 (22%) had good knowledge, and 8(13%) had poor knowledge, whereas in post test 26(44%) had good knowledge and 23(38%) had average knowledge and 11(18%) had poor knowledge scores. The mean post-test knowledge score (36.95) was higher than the mean pre-test knowledge score (18.78). The mean and median in both pre-test (mean18.78, median19) and post-test (mean36.95, median 37) were found. The post-test knowledge score of people living with HIV/AIDS on antiretroviral therapy (ART) and its compliance was significantly higher at P>0.05 level of significance. There was significant association between age, gender, religion, marital status, educational status, occupation, and parity of people living with HIV/AIDS and pre-test knowledge scores.

KEY WORDS: Effectiveness, Planned teaching programme, Antiretroviral therapy (ART) and its compliance,

INTRODUCTION:

“It is bad enough that people are dying of AIDS, but no one should die of ignorance’’- Elizabeth Taylor

HIV/AIDS is without doubt the worst epidemic to hit humankind since the Black Death. India is the second largest country in the world, and third largest number where the people living with HIV/AIDS are more. HIV is now considered not only as a health problem, but also a developmental and security threat. HIV is the human immunodeficiency virus. It is the virus that can lead to acquired immune deficiency syndrome, or AIDS. AIDS is the late stage of HIV infection, when a person’s immune system is severely damaged and has difficulty fighting diseases and certain cancers.¹

As per the statistics provided by the International Secretariat and NACO, for the year 2009-2011, there are 2.4 million people living in India with HIV, out of which 4.45% of cases are reported to be children less than 15 years. Karnataka has the third rank among Indian states, in reference to the number of people living with HIV and has 11,000 children living with HIV positive status.²

Antiretroviral therapy means treating viral infections like HIV with certain drugs. However, they slow down the growth of the virus but do not kill the virus. When anti-HIV drugs are taken regularly, the amount of virus in the blood will be reduced. If viral load is very low, the individual won’t develop any AIDS-related illnesses. Significant advances in antiretroviral therapy have been made since the introduction of zidovudine (AZT) in 1987. With the advent of Highly Active Antiretroviral Therapy (HAART), HIV-1 infection is now manageable as a chronic disease in patients who have access to medication and who achieve durable virologic suppression.³

The strongest risk factors for excess mortality were viral load greater than 400 copies/mL, CD4⁺ count less than 200 cells/mL, and cytomegalovirus retinitis. The CD4+ cell count thresholds for HAART initiation were recently raised from 350 to 500 cells/mL in the United States and from 200 to 350 cells/mL in mid- and low-income countries. Data suggest that these recommendations mean a substantial increase in the number of patients who will require treatment and need early HIV testing.⁴

Antiretroviral drugs are usually used in combinations of three or more drugs from more than one class, this is called combination therapy. Combination therapy works better than using just one ARV alone, it also helps prevent drug resistance. Combinations of antiretroviral create multiple obstacles to HIV replication to keep the numbers of offspring low and reduce the possibility of a superior mutation. If a mutation that conveys resistance to one of the drugs being taken arises, the other drugs continue to suppress reproduction of that mutation.⁵

NEED FOR THE STUDY:

Acquired immune deficiency syndrome o acquired immunodeficiency syndrome (AIDS) is a disease of the human immune system caused by the human immunodeficiency virus (HIV). The illness interferes with the immune system making people with AIDS much more likely to get infections, including opportunistic infections and tumors that do not affect people with working immune systems. This susceptibility gets worse as the disease continues.⁶

HIV is transmitted in many ways, such as anal, vaginal or oral sex, blood transfusion, contaminated hypodermic needles, exchange between mother to baby during pregnancy, childbirth, breastfeeding and also it can be transmitted by any contact of a mucous or the bloodstream with a bodily fluid that, has the virus in it; such as the blood, or breast milk from an infected person.⁷

In 2009, the World Health Organization (WHO) estimated that there were 33.4 million people worldwide living with HIV/AIDS, with 2.7 million new HIV infections per year and 2.0 million annual deaths due to AIDS. According to UNAIDS 2009 report, worldwide some 60 million people have been infected since the start of the pandemic.⁸

India is one of the largest and most populated countries in the world, with over one billion inhabitants. Of this number, it's estimated that around 2.4 million people are currently living with HIV. The states with high HIV prevalence rates include Manipur (1.40%), Andhra Pradesh (0.90%), Mizoram (0.81%), Nagaland (0.78%), Karnataka (0.63%) and Maharashtra (0.55%).⁹

Karnataka is one of the six HIV/ AIDS high prevalence states in India, with over one half million adults infected with the virus. Karnataka has a population of 53 million and is a diverse state. In Karnataka 10lakhs pregnancies are estimated per year. Of these, 26000 pregnancies are expected to be HIV positive, out of which 30% vertical transmission from mother to child may result in 7800 children being born with HIV infection.¹⁰

According to the WHO, An estimated 6.6 million people in low- and middle-income countries were receiving antiretroviral therapy (ART) for HIV/AIDS in the year 2010, of which 4,20 000–4,60 000 were children. This progress represents the largest ever annual increase in the number of people accessing HIV treatment–1.4 million more than a year ago.¹¹

NACO launched the free public ART program in April 2004 in eight government hospitals located in six high HIV prevalence states. Today services are provided in 217 fully functional ART Centers. ART Technical Guidelines for Adults (both first line and second line) were developed and distributed to all ART Centers.¹²

The Third phase of National AIDS Control Program (NACP III) targets provision of free ART services to 300,000 adults through 250 ART centers and 650 Link ART centers by 2012. Link ART centers (LAC) have been established in existing health facilities at district and sub-district level to make the treatment services more accessible and facilitate delivery of ARVs to PLHIV.¹³

The southern state of Karnataka (population 52.7 million) was one of the states selected for the first phase of the ART roll-out. Along with Andhra Pradesh and Maharashtra, it is one of the worst affected states in India, with an estimated 500,000 positive people. Though the HIV prevalence among female sex workers is on a decline (21.60% in 2004 to 18.39% in 2005), it is rising among men who have sex with men (10.00% in 2004 to 11.61%) and STD clinic attendees (12.00% in 2004 to 13.60% in 2005). The HIV prevalence among antenatal clinic attendees has remained steady at 1.25%.2 Eighteen out of the state’s 23 districts have a generalised epidemic. The poor are particularly affected by the HIV epidemic. Illiteracy is considered a risk factor for HIV.¹⁴

The state HIV and AIDS control programme used to be managed by the Karnataka State AIDS Control Society (KSACS) and the India-Canada Collaborative HIV/AIDS Project (ICHAP). Currently, the programme is run by KSACS and the Karnataka Health Promotion Trust (KHPT). These organisations function independently to support NGOs in their respective areas. KSACS works in nine districts and KHPT in 18 districts.¹⁵

There are currently 6 major classes of antiretroviral drugs available 1.Nucleoside Analogue Reverse Transcriptase Inhibitor (NRTI). 2. Nonnucleoside Reverse Transcriptase Inhibitor (NNRTI). 3. Protease Inhibitor (PI) 4.Fusion Inhibitor. 5. Chemokine Coreceptor Antagonist. 6. Integrase Inhibitor.¹⁶

Antiretroviral therapy has altered the nature of HIV disease, transforming an almost uniformly fatal illness into a chronic but apparently stable condition. How effective treatment can be made available to the great majority of people with HIV/AIDS is an urgent issue of global significance. Even where such treatment is available, however, its use is complicated by a number of factors, including side effects, drug-drug interactions, and the selection of drug-resistant virus.¹⁷

STATEMENT OF THE PROBLEM:

“A study to evaluate the Effectiveness of Planned Teaching Program on knowledge regarding antiretroviral therapy (ART) and its compliance among people living with HIV/AIDS in selected Community Care Centers in Belgaum.”

OBJECTIVES OF THE STUDY:

1. To assess knowledge regarding antiretroviral therapy (ART) and its compliance among people living with HIV/AIDS.

2. To evaluate the effectiveness of planned teaching program on knowledge regarding antiretroviral therapy (ART) and its compliance by comparing mean pre-test and post-test knowledge scores.

3. To find out the association between pre test knowledge scores with the selected demographic variables.

OPERATIONAL DEFINITIONS:

Effectiveness: In this study, it refers to the impact of planned teaching program on knowledge regarding antiretroviral therapy (ART) and its compliance among people living with HIV/AIDS.

Knowledge: In this study, knowledge refers to the interpretation of correct responses made by the respondents as elicited through self administered knowledge questionnaire

Compliance: In this study it refers to intake of ARV pills in the correctly prescribed doses at the right time and in the right way without missing a single dose by the people living with HIV/AIDS.

Planned Teaching Programme: It refers to the information provided through systematically organized teaching program on antiretroviral therapy (ART) and its compliance.

HIV: In this study HIV refers to Human Immunodeficiency Virus (HIV) which is a retrovirus that causes AIDS by infecting helper T cells of the immune system.

AIDS: In this study it refers to a progressive immune deficiency caused by infection of CD4+ T cells by the Human Immunodeficiency Virus (HIV), and whose CD4 count is less than 250 cells per micro liter.

Antiretroviral Therapy: In this study it refers to pharmacological treatment given for the people living with HIV/AIDS.

Community care centre’s: In this study it refers to the centre’s where people with HIV/AIDS gets admitted for the treatment of opportunistic infections and were given counseling, guidance, psychological, support, education to regain their lost confidence and live a quality life.

HYPOTHESIS:

H1: There will be significant difference between pre test and post test knowledge scores regarding antiretroviral therapy (ART) and its compliance among People Living with HIV/AIDS in selected Community Care Centers in Belgaum at 0.05 level of significance.

H2: There will be significant association between pretest knowledge scores with the selected socio-demographic variables at 0.05 level of significance.

ASSUMPTIONS

1. The people living with HIV/AIDS will have some knowledge regarding antiretroviral therapy (ART) and its compliance.

2. Planned Teaching Programme will improve knowledge regarding antiretroviral therapy (ART) and its compliance among people living with HIV/AIDS.

PROJECTED OUTCOME:

The people living with HIV/AIDS may gain knowledge regarding antiretroviral therapy (ART) and its compliance.

DELIMITATION:

The study is delimited to the people living with HIV/AIDS in selected Community Care Centers in Belgaum.

CONCEPTUAL FRAMEWORK:

The Stufflebeams CIPP evaluation model [2003] for this study identifies knowledge regarding antiretroviral therapy (ART) and its compliance among people living with HIV/AIDS.¹⁸

RESEARCH METHODOLOGY:

Research Approach:

An evaluative research approach was adopted in this study.

Research Design:

Pre-experimental one group pre-test and post-test design was adopted to carry out the present study.

Research Setting:

The setting selected for the present study was Support Community Care Centre Belgaum, Karnataka

Variables under study:

In the present study the independent variable is Planned Teaching Programme on knowledge regarding antiretroviral therapy (ART) and its compliance among people living with HIV/AIDS and gain in knowledge score is the dependent variable.

Population: In the present study the target population comprised of people living with HIV/AIDS in selected Community Care Centers in Belgaum.

Sample and Sample Size:

In the present study, sample consisted of 60 people living with HIV/AIDS in selected Community Care Centers, Belgaum.

Sampling Technique:

The sampling technique used for the study was purposive sampling which is a type of non-probability sampling.

Description of the tool:

Structured knowledge questionnaire was prepared on 40 items:

Section I: Structured knowledge questionnaire

a) Knowledge regarding HIV/AIDS –16 questions.

b) Knowledge regarding HIV Preventive Measures -7 questions.

c) Knowledge regarding Antiretroviral Therapy -8 questions.

d) Knowledge regarding Adherence to ART -9 questions.

The tool was found to have reliability of 0.78. The pilot study was done on 10 people living with HIV/AIDS who are admitted in Cardinal Gracias Community Care Center, Nirmal Nagar, Belgaum, in the month of 17/01//2013. The final study was conducted at Support Community Care Centre, Belgaum on 28/02/2013 to 06/03/13. Pre-test was conducted by administering structured knowledge questionnaire and PTP with the help of power point presentation. Post test was conducted after 7 days. For the 40 items on knowledge regarding antiretroviral therapy (ART) and its compliance, a score of ‘1’ was awarded to correct response, which a score of ‘(o)’ was awarded to an incorrect response. The data obtained was analyzed in terms of descriptive and inferential statistics.

RESULTS:

The data obtained was analyzed in terms of the objectives of the study using descriptive and inferential statistics. Experts in the field of nursing and statistics directed the development of data analysis plan which is as follows:

a. Organizing data on a master sheet.

b. Tabulation of the data in terms of frequencies, percentage, to describe the data.

Major Findings of the study were:

Section I: Distribution of subjects according to sample characteristics

TABLE 1: Frequency distribution of people living with HIV/AIDS according to Socio-demographic Data n=60

Socio demographic variables

Frequency

(f)

Percentage

(%)

1.Age in years

a) 10-20

b) 21-30

c) 31-40

d) 41 and above

07 %

33 %

38 %

22 %

2. Gender:

a) Male

b) Female

60 %

40 %

3. Religion:

a) Hindu

b) Muslim

c) Christian

d) Other

75 %

20 %

05 %

00%

4. Marital status:

a) Married

b) Unmarried

68 %

32 %

5. Educational Status:

a) No formal education

b) Primary education

c) Secondary education

d) University/college education

00%

28 %

52 %

20 %

6. Occupation:

a) Farmer

b) Housewife

c) Coolie

d) Business

e) Student

f) Others

20 %

37 %

18 %

25 %

7. Type of family

a) Nuclear family

b) Joint family

c) Extended family

52 %

48 %

00%

8. Type of Diet

a) Vegetarian

b) Non Vegetarian

c) Mixed

35 %

00%

65 %

9. Source of Information

a) Family members and relatives

b) Friends

c) Health personnel

d) News paper/TV

33 %

14 %

53 %

00%

10. Family Income:

a) 3001-6000

b) 6001-9000

c) 9001-12000

d) 12001 and above

00%

08 %

80 %

12 %

The data presented in the table 1 indicated that majority of subjects 23(38 %) of age group in between 31-40 years. Maximum subjects 36(60 %) were male. Maximum subjects 45(75%) were Hindus. Maximum subjects 41(68%) were Married. Maximum 31 (52%) of subjects had Secondary education. Maximum subjects 22(37%) were Housewife. Majorities are from nuclear family 31(52%). Maximum 39(65%) of subjects were having Mixed diet. Maximum subjects 32(53%) had source of information as a Health personnel. Maximum 48(80%) of subjects family income of Rs-9001-12000.

Graph 1: Cylinder graph showing percentage distribution of people living with HIV/AIDS according to Age.

Graph 2: Pie graph showing percentage distribution of people living with HIV/AIDS according to Gender

Graph 3: Cylindrical graph showing percentage distribution of people living with HIV/AIDS according to Religion.

Graph 4: Pie graph showing percentage distribution of people living with HIV/AIDS according to Marital status

Graph 5: Horizontal Bar graph showing percentage distribution of people living with HIV/AIDS according to Educational Status.

Graph 6: Pyramid graph showing percentage distribution of people living with HIV/AIDS according to Occupation.

Graph 7: Column graph showing percentage distribution of people living with HIV/AIDS according to type of family.

Graph 8: Cone graph showing percentage distribution of people living with HIV/AIDS according to Type of Diet.

Graph 9: Horizontal Bar graph showing percentage distribution of people living with HIV/AIDS according to Source of Information.

Graph 10: Column graph showing percentage distribution of people living with HIV/AIDS according to Family Income.

Section II: Finding on knowledge score of people living with HIV/AIDS regarding antiretroviral therapy (ART) and its compliance

Table 2: Mean, Median, Mode, and Standard Deviation and Range of knowledge score of people living with HIV/AIDS. n=60

Area of Analysis	Mean	Median	Mode	S.D	Range
Pre test (x)	18.78	19	18.34	2.48	12
Post test (y)	36.95	37	38	1.54	7
Difference	18.17	18	19.66	-0.94	-5

Table 2 reveals that in the pre-test mean was 18.78, standard deviation 2.48, where as in post-test mean was 36.95, and standard deviation was 1.54.

Graph 11: Line graph showing Mean, Median, Mode, Standard Deviation and Range of knowledge score of people living with HIV/AIDS.

Table 3: Frequency and percentage distribution knowledge score of people living with HIV/AIDS regarding antiretroviral therapy (ART) and its compliance. n=60

Knowledge Score	Pretest		Posttest
Knowledge Score	Frequency	%	Frequency	%
Good (Mean + SD) (21-40)	13	22	26	44
Average (Mean + SD) and (Mean – SD) (17-20)	39	65	23	38
Poor (Mean – SD) (0-16)	8	13	11	18

Table 3: reveals that in pre-test majority of people living with HIV/AIDS 39(65%) had average knowledge and 8(13%) had poor knowledge whereas, in post test 26(44%) had good knowledge and 23(38%) had average knowledge.

Graph 12: Column graph showing pre-test and post-test percentage distribution of people living with HIV/AIDS.

Table 4: pre-test and post-test knowledge score of people living with HIV/AIDS, regarding antiretroviral therapy (ART) and its compliance. n=60

Item

Total Score

Mean % of knowledge score people living with HIV/AIDS.

Item on knowledge, regarding antiretroviral therapy (ART) and its compliance.

2400

Pre-test

(x)

Post-test

(y)

Gain in Knowledge

(y-x)

18.78

36.95

18.17%

Table 4: Reveals that the mean percentage of post-test gain in knowledge was 36.95%. While in the pre-test gain in knowledge was 18.78%. The post test score were higher than the pre-test scores after administration of PTP. Hence gain in knowledge is evident.

Graph 13: Pie graph showing percentage distribution of pre-test, post-test and gain in knowledge scores of people living with HIV/AIDS.

CONCLUSION:

Based on the findings of the study the following conclusions were drawn:

Based on the findings of the study, there is an increase in the knowledge after administration of PTP. Thus it is inferred that PTP is the best teaching strategy as it enhance the knowledge regarding antiretroviral therapy (ART) and its compliance among people living with HIV/AIDS.

NURSING IMPLICATIONS:

The findings of this study have implications for nursing practice, nursing education, nursing administration and nursing research.

Implication of Nursing Practice:

Health promotion is one of the role of a nurse; hence its accountability has to be stressed. Nurses should put their effort to update their knowledge. Several implications can be drawn from present study for nursing practice. The education programme conducted by the nursing personnel in community care centre will help in imparting knowledge regarding antiretroviral therapy (ART) and its compliance.

Nursing Education:

Nursing education should prepare nurses with the potential for imparting management information effectively and assist community in developing self care potentials. Nursing student should be made aware of the role in management of ART side effects and care of people living with HIV/AIDS. The students learning experience should emphasis on the prevention of HIV/AIDS and knowledge on antiretroviral therapy (ART). Educational programmes on antiretroviral therapy (ART) and its compliance can be propagated through the use of mass media.

Nursing Administration:

Nurse administrator has a role in planning the policies for imparting education related to antiretroviral therapy (ART) to the target population. Nurse administrators need to organize education programmes for the nursing personnel and motivate them to conduct education and training programmes on antiretroviral therapy (ART) and its compliance which would benefit to community..

Nursing Research:

Research is a systematic enquiry that uses orderly disciplined methods to answer question or solve problems. The findings of the present study can be utilized by the nurse researchers in the future to conduct extensive studies to identify/assess the knowledge regarding antiretroviral therapy (ART) and its compliance. Present study would help the nurse to understand the level of knowledge of people living with HIV/AIDS on antiretroviral therapy (ART) and its compliance.

LIMITATIONS OF THE STUDY:

1. No broad generalization could be made due to the small size of sample and limited area of setting.

2. The study did not use any control group.

3. No attempt was made to control the extraneous variables.

4. Only a single domain that is knowledge is measured in the present study.

5. The tool used for the data collection was not standardized. It was designed by the investigator himself for the purpose of the present study based on the objectives of the study.

6. The sampling technique-non probability, purposive sampling does not give a representative sample. Randamization could not be done due to limited number of people living with HIV/AIDS in selected Community Care Centers in Belgaum.

RECOMMENDATIONS:

1. A similar study on large and wider sample for a longer period of time would be more pertinent in making broad generalization.

2. A similar study can be under taken with a control group design.

3. A comparative study can be conducted on community care center and ART center and findings can be compared.

4. A study can be conducted at ART centers by using the same teaching programme.

5. A SIM can be developed based on needs of people living with HIV/AIDS regarding antiretroviral therapy (ART) and its compliance.

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Received on 24.03.2015 Modified on 11.04.2015

Int. J. Nur. Edu. and Research 3(2): April-June, 2015; Page 172-182