I certify that this thesis entitled "Predictors and outcomes of participation in community antiretroviral therapy refill groups among people living with human immunodeficiency virus, Seke District, Zimbabwe, 2019" is my original work and submitted for the Master of Public Health Program . Stigma, HIV status disclosure and awareness were prominent themes regarding barriers to participation in CARGs. 30 Table 5: Client-related factors associated with participation in CARGs, Seke District, 2019 31 Table 6: The effect of non-disclosure of HIV status to people other than spouse/.
- Introduction
- HIV burden in Zimbabwe and DSD models
- Background of CARGs model in Zimbabwe
- Formation of CARGs and how they function
- Benefits of CARGs
- Problem statement
Zimbabwe is one of the countries with the highest HIV prevalence in sub-Saharan Africa at 13.3%. CARG members take turns collecting drugs for themselves and the other members of the group. In addition, Epworth Outpatient Clinic in Seke District has been one of the trial sites for the CARG model since 2014, thanks to the support of Doctors Without Borders (MSF), but only a few PLHIVs have joined CARGs, both in the facility and in the whole district.
- Literature review
- Literature search strategy
- Socio-demographic factors
- Health care factors
- Client related factors
- Outcomes of participation in CARGs
- Justification
- Research questions
- Study Hypotheses
- Study Objectives
- Broad objective
- Specific Objectives
Another study in South Africa found no association between education level and participation in community ART support groups (16). There is still conflicting evidence regarding the effects of participation in CARG and suppression of viral load and behavioral outcomes. There is conflicting evidence on the effects of CARG participation on viral load suppression and behavioral outcomes in the region.
- Materials and Methods
- Study design
- Quantitative component
- Qualitative component
- Study setting
- Study participants
- Determination of sample size
- Sampling
- Inclusion criteria and exclusion criteria
- Data collection
- Quantitative data
- Qualitative data
- Records Review
- Key Informants
- Data management and analysis
- Quantitative data analysis
- Qualitative data analysis
- Knowledge assessment
- Study Variables
- Dependent variables
- Independent variables
- Permission to proceed
- Ethical considerations
- Validity and reliability
The study population was PLMIV and over 18 years who started ART from 1 January 2013 to 31 December 2016 with ART at Epworth polyclinic in Seke District. Key informants who included the provincial HIV focal person, District Medical Officer, district HIV focal person, OI/ART nurses and sister in charge (SIC) were also recruited into the study. PLHIV who started ART between 1 January 2013 and 31 December 2016 and were participating in CARGs were randomly selected for the study.
After the FG guide was developed in English, it was then translated into Shona, the local language for the study participants. 25 Table 1: Independent variables for the study of predictors and outcomes of participation in CARGs among PLHIV, Seke District, 2019. Permission to conduct the study was obtained from the District Medical Officers (DMO) for the Seke district and the Provincial Medical Director (PMD). ), Mashonaland East province.
Approval and permission to proceed with the study was obtained from the Medical Research Council of Zimbabwe (MRCZ). The purpose of the study was explained and participants were informed that they could withdraw at any time during the interview. Confidentiality was ensured by not referring the study results to individual study participants.
Internal validity of the study was ensured by understanding the content of the questionnaire and evaluating the data collection process during and after each field visit.
- Results
- Quantitative Results
- Socio demographic factors associated with participation in CARGs
- Health care related factors associated with participation in CARGs
- Client related factors associated with participation in CARGs
- Stratified analysis: Non-disclosure of HIV status to other people other than spouse/
- Independent predictors of participation in CARGs
- Knowledge of cases and controls on CARGs
- Treatment and behavioural outcomes of participation in CARGs
- Qualitative results
- Demographic characteristics of FGD participants, Seke District, 2019
- Themes
- Findings from key informants, Seke District, 2019
There was no statistically significant association between the perception that clinic staff were friendly and welcoming (OR 0.89, 95% CI) perceived familiarity at the health center (OR 0.65, 95% CI) and participation in CARGs. The effect of not -disclosure of HIV status) persons other than spouse/guardian within 6 months of diagnosis on participation in CARGs stratified by age is shown in Table 6 below. Therefore, the effect of non-disclosure of HIV status to persons other than spouse/guardian within 6 months of diagnosis whether participation in CARG was neither confounded nor modified by age.
Failure to disclose HIV status to persons other than spouse/caregiver within 6 months of diagnosis (AOR 0.43, 95% CI) was an independent factor associated with clients being less likely to participate in CARG. Shown in Table 9 below are the barriers to CARG participation as reported by non-CARG members. Nine themes related to barriers and motivators for CARG participation emerged during the data analysis.
Participants answered the question of why people living with HIV do not want to join and participate in CARG. Perceived benefits of CARG participation, perceived peer support, continuing education, and the introduction of family-based and male-only groups were themes that emerged from CARG participation facilitators. The majority of key informants in direct contact with PLHIV cited disclosure as the main barrier to CARG participation: “The main reason why people do not want to join CARG is fear of disclosure, especially discordant couples and young couples, who do not want laws to know their status.” Some key informants revealed that clients feared stigma and discrimination in the community. "Another reason is the issue of stigma and discrimination in the community."
Despite low participation in CARG, key informants indicated that they perceived some benefits of CARG.
Discussion
The odds of participation were five times higher among customers who perceived privacy in CARG than among those who did not. This observation was supported by the fact that those who did not disclose within six months were 57% less likely to participate in CARG compared to those who would have disclosed. Clients who feared inadequate monitoring by health workers were 72% less likely to participate in CARG.
PLHIV who were more than 40 years old were more likely to participate in CARG. Clients who are knowledgeable about CARGs are more likely to engage and participate in CARGs because of their understanding of the benefits. The study also examined changes in behavior and treatment outcomes of CARG participation.
The most important finding was that those who participated in CARGs were less likely to contract STIs. Although not significant, this study found that single clients were more likely to participate in CARGs than couples on bivariate analysis. Clients participating in CARG's activities were more likely to adopt positive sexual behaviors than those who did not.
Those who participated in CARG were above the state's 90% viral load reduction goal (3) compared to nonparticipants.
Study limitations
This finding may be due to the ongoing education provided to the non-participants at the health facility during their refill visits and to peer education among the participants. The majority of study participants reported receiving adherence education during their visits. This study also found no difference between participants and non-participants in terms of viral load suppression and the acquisition of tuberculosis.
This may be attributed to high adherence of CARG participants compared to non-participants. A meta-analysis comparing community versus health facility-based interventions in LMICs also found no differences in ART adherence, viral load suppression, and all-cause mortality ( 27 ).
Further research
Conclusion and recommendations
- Conclusion
Factors associated with attendance and non-attendance of support groups among HIV-positive adults attending a community antiretroviral clinic at Ekurhuleni District, South Africa. People living with HIV infection who attend and do not attend support groups: A pilot study of needs, characteristics and experiences. Barriers to participating in support groups for people living with HIV: A qualitative study with men receiving antiretroviral treatment in an HIV clinic in Mthatha, South Africa, 2012 [Internet].
Perceived barriers to participation in HIV support groups among people living with HIV and AIDS in Katlehong Township - South Africa, 2011. Effect of community ART groups on maintenance of care among patients with ART in Tete Province, Mozambique: a cohort study. Four-year retention and risk factors for outflow among members of community ART groups in Tete, Mozambique.
The impact of HIV support groups on the survival of women living with HIV: a pilot study. Community-based ART has resulted in excellent retention and can promote community empowerment in rural Lesotho, a mixed methods study. A community-based ART distribution system can effectively facilitate long-term program maintenance and low rates of death and virologic failure in rural Uganda.
ART community groups support ART access and retention among HIV-positive dependent children in rural Tete, Mozambique.
Annexes
- Annex 1: English client consent form
- Annex 2: Shona client consent form
- Annex 3: Questionnaire for Cases and Controls
- Annex 4: Shona Questionnaire for cases and controls
- Annex 5: English Focus Group Discussions guide
- Annex 6: Shona Focus Group Discussions guide
- Annex 7: English interview guide for key informants
- Annex 8: Shona interview guide for key informants
- Annex 9: English key informant consent form
- Annex 10: Shona key informant consent form
- Annex 11: Medical Research Council of Zimbabwe approval
- Annex 12: Joint Research Ethics Committee approval
- Annex 13: Permission letter
NYAYA YOKUTSVAKA: Zvikonzero zvinoita kuti vanhu vanorarama neutachiona hweHIV vade kupinda uye kuti chii chinoitika kana vapinda muzvikwata zveCommunity Antiretroviral Therapy Refill Groups (CARG) mudunhu reSeke. Tinokukumbirai kuti mupinde muongororo yekuona zvikonzero zvinoita kuti vanhu vanorarama neutachiona hweHIV vade kupinda muchirongwa ichi uye kuti chii chinoitika kana vapinda muzvikwata zveCommunity Antiretroviral Therapy Refill Groups (CARG) mudunhu reSeke. Vanhu vazhinji vanorarama neutachiona hweHIV mudunhu rekwaSeke havapinde muzvikwata zvevagari vemunharaunda vachitsvaga mishonga yemaAntiretroviral therapy patsva. Saka zvakakosha kuziva zvikonzero zvinoita kuti vanhu vade kupinda muCommunity Antiretroviral Therapy Refill Groups.
Ndiri kuita ongororo yezvinofembera uye zvakabuda mukupinda mumapoka emunharaunda pachirongwa chekuzadza mishonga yemaAntiretroviral therapy kuvanhu vanorarama nehutachiona hwehuman immunodeficiency virus mudunhu reSeke. Tiri kuferefeta mafungidziro uye zvakabuda muchirongwa chechirongwa che antiretroviral therapy refill pakati pevanhu vanorarama nehutachiona hwehuman immunodeficiency virus mudunhu reSeke. Zvakaonekwa nekuchema-chema nevakuru vezvehutano kuti vanhu vazhinji vanorarama neutachiona hweHIV havadi kupinda mumapoka anonzi maCARG.
Munofunga kuti ndezvipi zvikonzero zvinoita kuti vanhu vanorarama neHIV vasade kupinda muCARGs……. Munofunga kuti vanhu vanorarama neHIV vakasununguka here kuudza vamwe vanhu pavamire paHIV? Chinangwa cheongororo iyi ndechekuona zvinofembera uye zvakabuda muchikamu cheCommunity Antiretroviral Therapy Replenishment Groups pakati pevanhu vanorarama nehutachiona hwehuman immunodeficiency virus mudunhu reSeke.
Nekudaro zvakakosha kunzwisisa zvikonzero zvinoita kuti vanhu vade kupinda muCommunity Antiretroviral Therapy Refill Groups. Wakasarudzwa kuti upinde muchidzidzo ichi nekuti uri mutungamiri uye unoshanda kubatsira vanorarama neHIV muno, Seke. Kupinda musarudzo kunogona kukusuwisa nekuda kwezvakaitika zvausingade zvine chekuita nekubatsira kwaunoita vanhu vanorarama neutachiona hweHIV. Nekupinda muchidzidzo ichi, muchaziva zvakanakira vanhu vane HIV kupinda muCommunity Antiretroviral Therapy Refill Groups.
