aids2008_thpe0840_oloriegbe iy, adirieje ua (nigeria) 1 aids2008 presentation no. thpe0840 by:...

AIDS2008_THPE0840_Oloriegbe IY, Adirieje UA (Nigeria)

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AIDS2008 Presentation no. THPE0840

by:

Oloriegbe IY, Adirieje UA

Health Reform Foundation of Nigeria

[HERFON], Abujahttp://www.herfon.org/docs/AIDS2008poster_THPE0840_Oloriegbe_IY_Adirieje_UA_HERFON_Nigeria.ppt


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TITLE

Quality of life of women on Nigeria’s antiretroviral therapy (ART) programme


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INTRODUCTION

Nigeria developed a 5-year ART scale-up plan to provide treatment and improve the quality of life of one million PLWHAs especially women by 2009. The provision of ART is the most pragmatic approach to improving the quality of life of PLWHAs. Midway into the scale-up, it became necessary to assess its impact on the quality of life of beneficiaries.


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METHODS

This study was conducted during year 2007, using a combination of qualitative and quantitative methods (questionnaires, interviews, focus group discussions, round table meetings, on-the-spot observations and secondary data); as part of a larger study of the impact, challenges and long-term implication of the ART programme in Nigeria. It covered 14 ART sites and 5 selected HIV Counselling and Testing (HCT) centres in the country’s six geopolitical zones and Federal Capital Territory (FCT). PLWHAs were asked if they fill that their quality of life improved with ART.

Gender Distribution of PLHA on ART


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Figure 10: Gender Distribution of PLHAs on Antiretroviral Therapy

39%61%

Males Females

ART Centres in Nigeria & HIV Burden


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Adamawa

Abia

Oyo

Ogun

Lagos

Osun

Ekiti

Ondo

Kwara

Edo

Delta

BayelsaRivers

Akwa Ibom

CrossRiverImo

An

amb

ra

Enugu

Ebonyi

Kogi

Benue

Nasarawa

Niger

Plateau

Taraba

GombeBauchi

Y obe

Borno

Kaduna

Kebbi

Zamfara

Sokoto

Katsina

Kano

Jigawa

FCT

Emergency Plan Focus States

2.1 – 4.0%

KEY

6.1 – 8.0%

>8.0%

1.0 – 2.0%

4.1 – 6.0%

Figure 1: ART Centres Across Nigeria / Burden of HIV in the States

ART Sites

Overview of Tuberculosis Related Services

ART and TB services Available in facilities

Score (%)

TB Adherence 17 89.5Access to X-Ray 16 84.8TB doses missed 6 31.8Hand hygiene 16 84.8TB HCT/ART serve 15 79.5TB health history taken 14 74.2Latent TB Prophylaxis 7 37.1Medication to 1st line TB toxicity 12 65.6Post treatment smear positive 15 79.5TB privacy/confidentiality 15 79.5TB patient weighed 9 47.7TB referrals 14 74.2TB side effect management 14 74.2TB smear available 15 79.5TB SOPs 13 68.9TB staff courteous 15 79.5TB treatment medication 15 79.5Treatment of active TB 16 84.8


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Deaths & Losses to follow up among PLHAs on ART


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Figure 14: Deaths and Losses to

Follow up Among PLHAs on ART

Transfers Deaths1st line

Deaths2nd line

Defaulters

Cost of Antenatal and Delivery Services


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DATA/RESULTS

144 PLWHAs on ART (all literate) were studied - 89 females and 55 males, which agrees with the 3:2 ratio of women to men seen in other sites in Sub-Saharan Africa. All reported improvement in quality of life while on ART. About 50% do not have enough money to eat, a place to stay in especially when they travel long distances to access the ARTs, or money for transportation to access ART. 45.2% total deaths and 22.7% defaults to ART adherence were recorded, with 2 in 5 (40%) individuals dying while on first line regimen – higher than 10–15% seen in other parts of Africa.

ARTs and regimens used


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Availability of ART Monitoring Tests


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Figure 7: Availability of ART Monitoring Tests

100

100

25

71.4

15.8

81.8

85.7

55.7

78.6

0

42.9

100

100

75

25

30

25

36.4

0

53.8

0

0

14.3

Rapid HIV testing

*Double Rapid

*D/Rapid/Tie breaker

Sputum microscopy

**TB culture

Full blood count

Hepatitis B

Hepatitis C

Serum chemistry

Resistance testing

Viral Load

CD4+ Count

Ca

teg

ory

of

lab

. te

sts

HCT Centres

ARTS Sites

Availability and Turn-around Time for Lab Results

Availablein

Facilities

ART Sites HCT Centres

TAT(hrs./wks)

Avail.(%)

TAT(hrs.)

Rapid HIV test 19 0.45 100 0.45Western Blot 12 6 NA NA*Double Rapid 18 1 75 24*Double Rapid+ Tie breaker

17 24 25 24

Full blood count 16 24 25 72Hepatitis B 16 24 44.4 24Hepatitis C 10 48 0 24Pregnancy Test 15 1 -

Assessed for ART Sites only (n=14)Sputum microscopy 11 72 30 24Serum chemistry 11 72 53.8 84CD4+ Count 13 24-48 NA NATB culture 4 2 wks NA NAViral load 6 2 - 12 wks NA NADiagnostic PCR 5 2 - 4 wks NA NAResistance Testing 0 NA NA NAAIDS2008_THPE0840_Oloriegbe

IY, Adirieje UA (Nigeria)13

Legend: * Used as confirmatory tests;

TAT: Turn-around Time

Overview Pharmacy Services Indicators Score (%)ARVs (adult/Paediatric) 92.9Three months stock in the store 71.4ARVs expired in the last 6 months 53.8ARV stock out in the last 6 months 7.7Pharmacy orderly 60.0Clean Pharmacy 33.3Pharmacy counselling room available 62.5Drug withdrawal management 80.1Space for Pharmacy dispensing area 87.5Pharmacy stores 86.7Security maintained 92.9OI drugs available 87.5Palliative drugs available 81.5Antibiotics, Antiseptics, Antifungal --3 months stock 85.7Drugs procured from recognized and trusted suppliers

93.8

HIV, ART-related publications 75.0Functional AC/fans 100Temperature Control report maintained 47.3Fridge/Freezer 64.3Equipment maintained regularly 92.9Comply with government regulations 92.9Pharmacy forms available 100.0Drug adherence counselling 71.4SOPs, Wall charts 71.4Staff adhere to SOPs 71.4


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Multidisciplinary Staff @ ART & HCT Facilities


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Figure 8: Multidisciplinary Staff at ART and HCT Facilities

100

100

100

100

93.3

25

100

66.7

46.7

66.7

25

25

25

25

25

6.7

75

75

75

50

Prescribing clinician

Nurse

Counselors

Records clerk

Pharmacist

Lab. Specialist

Lab. Scientists

Volunteers

Nutritionist

Job aides Sta

ff Cate

gory

Adult/Paed. ART HCT Centre

Staff capacity & Training in Facilities


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14121515

157

148139

158148

158128

1581313

1511148

159

1515148

126146

117

Specialist Physician

Doctors (MBBS)

Nurses/Midwives

CHOs

CHWs

Lab. Scientists

Lab. technician

Pharmacist

Pharm. Assist.

Counselors

Program Mgrs.

Data Mgrs.

Social Workers

Med. Rec. Officers

Nutritionists

Clerical/Se. Staff

Cleaners

Drivers

Volunteer staff

Figure 9: Staff capacity and Training in ART

No in Facility No Trained


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CONCLUSIONS

ART improved the quality of life among women PLWHAs by decreasing AIDS-related morbidity and mortality, making them live longer; and enabling them to return to their jobs and families, as well as engaged in new socioeconomic endeavours.


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ACKNOWLEDGEMENTS

• Heads and staff of institutions/facilities in the various states and FCT where this study was conducted

• NACA, NASCP, USAID, FHI/GHAIN Project and NEPWAN

• State/local government action committees on AIDS (SACA/LACA)

• HERFON members across the country• DFID


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REFERENCES1. Federal Ministry of Health, Nigeria, in collaboration with PHRplus and WHO. 2003. “Instrument for Assessment of

ARV/PMTCT Centers in Nigeria, January 2002 to October 2003

2. WHO, Progress in scaling up access to HIV treatment in low and middle income countries, June 2006, 16th August 2006

3. Social development and poverty in Nigeria, Chapter 3 in Measuring poverty in Nigeria', Sofo, C.A. Ali-Akpajiak and Toni Pyke 2003, Oxfam Working. Paper www.oxfam.org.uk/what_we_do/where_we_work/nigeria/ resources.htm

4. WHO, Towards Universal Access: Scaling up priority HIV/AIDS interventions in the health sector, 17th April 2007

5. WHO, Progress in scaling up access to HIV treatment in low and middle income countries, June 2006, 16th August 2006

6. 'FHI 'GHAINS' new funds for HIV/AIDS, TB services in Nigeria', Family Health International,204, www.fhi.org/en/HIVAIDS/country /Nigeria/nigernews.htm

7. Nigeria may lose N11.2956 World Bank Grant' ThisDay, June 28, 2004 www. naijapost.com/news/publish/article_980.shtml

8. Mocroft A. et al. Changes in the cause of death among HIV positive subjects across Europe: results from the EuroSIDA study. AIDS, 2002,16(12):1663–1671.

9. Kombe, Gilbert, David Galaty, and Chizoba nwagbara. Scaling up Antiretroviral treatment in the public sector in Nigeria: A comprehensive analysis of resource requirements. Bethesda MD: The partners for Health Reformplus Project, Abt Associates Inc. February 2004

10. Federal Ministry of Health, Nigeria, in collaboration with PHRplus and WHO. 2003. “Instrument for Assessment of ARV/PMTCT Centers in Nigeria, January 2002 to October 2003

11. Njoku MO, Sirisena ND, Idoko JA, Jelpe D. CD4+ T-lymphocyte counts in patients with human immunodeficiency virus type 1(HIV-1) and healthy population in Jos, Nigeria Nigeria Postgradute Medical Journal 2003, 10(3): 135-9

aids2008_thpe0840_oloriegbe iy, adirieje ua (nigeria) 1 aids2008 presentation no. thpe0840 by:...

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