TREATMENT EDUCATION WORKSHOP FOR PEOPLE LIVING WITH HIV;
IMPROVING ADHERENCE TO ANTIRETROVIRAL THERAPY
IN BALI
ISSUES
Kerti Praja Foundation (KPF) has been offering STI screening since 1992, especially for Female Sex Workers (FSW). Since 2000 KPF began offering VCT in their clinic, Klinik Amerta (KA), and then ARV therapy in 2002. As of 31st January 2009 the number of clients seeking VCT services at KA reached 5,667 individuals, 735 (13%) of whom tested was HIV positive.
Of the aforementioned 735, as few as 208 have taken ARV therapy. Adherence to ARV therapy among HIV+ clients is poor, especially among the HIV+ female sex workers (FSW). Zero survey conducted by KPF in 2009, found that 23.2% of FSWs in Denpasar were HIV +. Only 3 of 55 HIV+ FSW adhered to ART. This could be owing to the negative impact of side effects and a lack of comprehensive understanding of HIV and ARV regimes. This lack of understanding may bring about a sense of foreboding about starting therapy, especially for those with CD 4 counts under 200.
Knowledge concerning HIV and ARV treatment among PLHIV remains very limited, and in order to facilitate adherence there is a very pressing need for the development of a comprehensive and suitable Treatment Education Program applicable to a number of diverse contexts.
CHALLENGES
oIt is not easy to design a program, especially related to HIV+ individuals, owing to stigma and discrimination that is still a serious concern in Indonesia.
oPositive behavior change is not possible through one training session but needs continual follow-up training to be effective.
THE PROJECT
GOAL :To increase knowledge levels and the number of PLHIV adhering to ARV treatment through comprehensive treatment education workshop
SPECIFIC OBJECTIVES:
To increase number of PLHIV participating in TE and knowledge concerning ARV To increase the number of PLHIV who start ARV treatment
To increase ARV adherence and reduce drop out ACTIVITIES:
TE training was conducted monthly over 2 days, covering information about Living with HIV, HIV treatment (ART), Side effects of ARV, Opportunistic infections, Adherence to ARV, Resistance, HIV and women, PMTCT, HIV and TB, HIV and Hepatitis and HIV stops with me principles. The TE was structured around fostering commitment to ARV adherence. Doctors and counselors of KPF provided pre-ARV counseling for those with CD4 counts less
than 200, disseminating knowledge on treatment preparedness.
s
Septarini NW
1,2, Wirawan DN
1,3, Sawitri AAS
1,3, Rowe E
3,
Pidari DMP
3, Suyetna DN
31School of Public Health, Faculty of Medicine, Udayana University, Denpasar, Bali 2Curtin University Australia;3Kerti Praja Foundation, Denpasar, Bali
Contact: septa_rn@yahoo.com
PAPER NUMBER : 102
Acknowledgement:
The authors thank to HIV Collaborative Fund for the funding and Prof . Dr. D.N. Wirawan, MPH for all the
never ending supports.
Activities Result 1. Treatment education workshops 1. TE training carried out 12 times (163 PLHIV)
2. One hundred and seventy nine PLHIV are beginning ARV treatment (if CD 4 levels are below 200) 2. Pre-ARV counseling by YKP’s doctors One hundred and seventy nine PLHIV’s have knowledge on treatment preparedness
3. Treatment education workshops focusing on adherence One hundred and eighty three PLHIV adhere to use ARV and 6 discontinuing treatment
RESULT
Participants characteristics
Pre-test and post-test result
Result
Pre-test result .699 .000
Paired Samples Correlations Post- test result–
Pre-test result 4.367 3.86 0.434 3.502 5.232 10.055 78 .000
Paired Samples Test
1. Most of the participants lacked information about HIV and ART. From the evaluation, it was evident that they found the training very beneficial, particularly with regards to increasing their knowledge levels. For example: those with feelings of trepidation about beginning ARV, indicated a change in mindset.
2. The participants became aware of the importance of regularly checking their CD4 as an indicator of their general health (the viral load test is expensive for PLHIV in Bali/Indonesia). Prior to training, few of the participants regularly checked their CD4 count as were not aware of the benefits. After the training they immediately asked KPF doctors to conduct CD4 testing. 3. Post-training anumber of participants expressed an interest in joining KPF’s public speaking/testimony program that was conducted in order to increase their capability and capacity as
PLHIV, especially female sex workers who are trying to stop sex work.
