An analysis of factors influencing the HIV and AIDS continuum of care and treatment in Chivuna, Zambia

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Ntalasha-Chipelya, Harriet M.
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University of Zambia
Background: There is still a dearth of literature in Zambia on the factors that influence the HIV and AIDS continuum of care and treatment. Aim: To explore factors influencing the HIV and AIDS continuum of care and treatment in Chivuna.. Specific objectives. Specific objectives were to: examine the prevailing HIV and AIDS services in Chivuna, explore factors that influence each stage of the HIV and AIDS continuum of care and treatment in Chivuna, determine the factors that permeate through the HIV and AIDS continuum of care and treatment in Chivuna, and suggest measures of addressing the identified influencing factors in order to improve the HIV and AIDS continuum of care and treatment. Methodology: The study adopted a mixed study design and was guided by the social-ecological model. An exploratory and descriptive study design was used to structure the study design. A total of twenty-four (24) Focus Group Discussions , sixty-seven (67) In-depth Individual Interviews , nineteen (19) Key Informant Interviews were conducted for the qualitative study and 653 respondents interviewed for the quantitative study. Qualitative data was managed and analysed using ATLAS TI version 6 while Special Package for Social Scientists (SPSS) was used for quantitative data. Results: In relation to objective one the study has revealed that though the HIV and AIDS services were available in Chivuna, most of the departments did not meet the WHO minimum standards. In relation to objective two and three, the study identified several limiting and facilitating factors some of which were specific for each stage while others permeated through the continuum of care and treatment. Among the cross-cutting limiting factors at health facility level were: distance to health facilities, confidentiality concerns for health staff, long waiting times, low staffing levels, inadequate infrastructure while counselling, provision of food supplements and role models acted as facilitators. At structural level cross-cutting limiting factors were: poverty and poor road network and provision of ARVs as the main cross-cutting facilitator. At community level those permeating through as facilitators included positive perceptions about ARVs, supportive social nets which included the family and support groups while, local illness beliefs and HIV and AIDS-related stigma, negative perceptions about ARVs, gender based violence were the main limiting permeated factors. Main negative influencing factors at medicine xiii level were anticipated and actual effects associated with the medicines such as efficacy of medication while side effects acted as limiting factors. At individual level cross-cutting facilitating factors included desire to live longer and seeing someone on ART recover. Factors influencing each stage in the continuum were: for VCT provision of mobile VCT and antenatal services at health facility level as motivating factors while VCT knowledge, perceived risk of HIV infection, health status (persistent poor health and feeling healthy) were the main facilitators at individual level. For linkage to care main limiting factors were: In effective referral and follow up/tracking system and lack of testing equipment at health facility level while at individual level these included feeling healthy at the time of diagnosis and lack of knowledge on the importance of linkage to care. For ART initiation, main factors were: lack of testing equipment and access to CD4 count results at health facility level while required CD 4 count levels and national guidelines on the initiation of ART were the structural level limiting factors. At individual level limiting factors were depression, fear of life- long treatment and possible side effects. For adherence, readily availability of ARVs was the main facilitating factor at health facility level while forgetting, drug fatigue, lack of health improvement after ART were the main limiting factors at individual level and having reminders while health improvement after ART, sero-status disclosure acted as facilitators at this level. These findings imply the need for strategies that target these multilevel factors. Thesis: Improvement of health outcomes for PLHIV requires adoption of strategies that target a multiplicity of influencing factors at each stage and throughout the HIV and AIDS continuum of care and treatment from multiple levels of influence as opposed to single level factors.
HIV/AIDS(Disease)-Chivuna, Zambia , HIV/AIDS(Disease)-Prevention-Chivuna, Zambia , Anti-retroviral treatment-Chivuna, Zambia