Experiences of Patients and Registered Nurses regarding the Antiretroviral Therapy Programme

Abstract

The purpose of this study was to explore and to describe the experiences of nurses and HIV-positive patients regarding the antiretroviral therapy (ART) programme in primary healthcare (PHC) settings in Lesotho. A descriptive qualitative design was used to collect data which were analysed using a constant comparative analysis. Purposive sampling was used to select participants who participated in focus group discussions. Five themes and 19 sub-themes emerged from the data analysis, namely the ART programme, ART service delivery, unavailability of antiretrovirals (ARVs), staff providing ART services, and satisfaction with ART. The results showed that many HIV-positive individuals accessed ART in PHC settings. Nurses symptomatically managed patients, while patients used alternative healthcare providers owing to inadequate resources and malfunctioning equipment. Even though the nurses were proficient in ART service provision, they were few resulting in work overload and provision of inadequate services. The time taken to provide ART services was dependent on conditions of service providers, the number of patients and the availability of basic utilities such as water. Follow-up care was inadequate for HIV-positive individuals who worked in South Africa. Multiple testing was evident owing to the lack of adequate counselling and untoward incentives. ARVs purported hunger, while stigma was still evident. Conclusively, to ensure effective delivery of ART, retention in care is vital. PHC facilities must therefore be equipped adequately with sustainable equipment, and have scaled-up routine monitoring and evaluation for the effective implementation of the ART programme.

Antiretroviral Treatment (ART) Recipients’ Knowledge, Attitudes, Beliefs and Treatment Outcome Nexus

“…The South African government's effort in reaching a large population spectrum with ART, owes its success to the grassroots-based methods and systems employed by the Health Department. This is similar to the approach of the neighbouring country, Lesotho, where HIV/AIDS treatment is integrated into the Primary Health Care (PHC) delivery (Nyangu and Nkosi 2019;Nyaphisi and Obioha 2015;Obioha and Molale 2011;Odeny et al 2013). Interestingly, Namibia has recorded remarkable success in ART and is on track to achieve UNAIDS 90-90-90 targets by 2020 with its "treat all" campaign, where "76.7% of people [are] living with HIV on ART, 87% of those on ART [are] virally suppressed" and "HIV incidence [has] declined by 21% since 2010" (Agolory et al 2018, 1).…”

“…Adherence to antiretroviral treatment (ART) has been largely problematic, as many factors such as beliefs and attitudes of people (living with or affected by HIV/AIDS) may contribute to a violation of a treatment regimen, especially in low income, undeveloped societies. Patel et al (2012), Tabatabai et al (2014), Nyangu and Nkosi (2019) have documented various reasons for patients' dissatisfaction and violation of ART regimes in southern African countries. These range from personal, logistical, drug interactions, and healthcare provider reasons, among others.…”

A simple tool to evaluate the antiretroviral therapy programme in primary health care setting of Lesotho

“…The prevalence of HIV is estimated to be 25.6% (LePHIA, ), which is an estimation of about 340,000 people living with HIV, and of these, 61% were on ART in 2018 (UNAIDS, ). Antiretroviral therapy is the lifelong medical treatment used in the management of HIV/AIDS (Nyangu & Nkosi, ; ). It remains the best choice of treatment for HIV as it improves the health of people living with the disease (Nyangu & Mokwena, ).…”

“…In Lesotho, primary health care (PHC) settings, which are mostly managed by nurses as an initiative allowed by the Government of Lesotho due to the insufficiency of medical doctors (Nyangu & Nkosi, ; ), continue to be the main health care service delivery points. Services provided include activities of surveillance, screening, case finding, case management and treatment, consultation, referral and follow‐up, health teaching, counselling and outreach services (Nyangu, ).…”

“…Lack of supportive supervision has been cited as resulting in an incoherent monitoring and evaluating system for the ART programme (Nyangu, ). Furthermore, poor tracking of patients due to the unavailability of ART registers and cards also resulted in a monitoring and evaluation system that was not effective (Nyangu & Nkosi, ; ). Supporting clinic‐based efforts towards the inclusion of ART services into PHC services could improve the monitoring and evaluation of the ART programme.…”