Post on 30-Oct-2014
description
HIV ANTIRETROVIRAL ADHERENCE IN SWAZILAND
Understanding the Issue: Putting Systems Thinking to Work.
Lomkhosi Tengetile Dlamini.Alexander Bermudez Rubashkyn∴
Master of Health Care Administration.TAIPEI MEDICAL UNIVERSITY
Outline
• Background.– Swaziland.– HIV in Swaziland.– Health System.
• HIV Treatment in Swaziland.• Adherence.– Adherence in Swaziland.
• Dimensions of Adherence in Swaziland.• Relation Between Dimensions. (System)
Swaziland
• Population: 1,386,914 (2012) • Life expectancy at birth: 49,9 years9
• Physicians density: 2 physicians available for every 10,000 people (2009)9
• Geography: mostly mountains and hills; some moderately sloping plains9
• Unemployment rate: 40% (2006 est.)9
• Health expenditure: 6,3% GDP (2009)9
HIV Situation in Swaziland
Variable Value
Life expectancy9 2008 49.9 years
Prevalence of HIV% in (15 - 49 yr old)2 2011 26.3%
Prevalence of TB2 1262 / 100.000
TB patients infected with HIV2 79,80%
Estimated deaths by HIV 20112 6.760
Adherence
• Adherence is defined as the extent to which a person’s behavior in terms of taking medications, following a diet, and executing lifestyle changes or follows agreed recommendations from a health care provider (WHO 2003). In the case of ART this implies taking the drugs in the right quantities, at the right time, and following dietary and other lifestyle changes for a lifetime.
Adherence in Swaziland• About 184.116 people are living with HIV and
about 86.220 of them are eligible for ART
RegionAdherence Condition 2011
Non - Adherence Adherent
Hhohho 7653 19571Lubombo 2685 11956Manzini 5797 21631
Shiselweni 4425 12677Total 20560 65835
• The Non Adherence is considered as LFU (Lost Following Up) and Stopped treatment.
Dimensions of Adherence in Swaziland.
Adherence
Socio – Cultural and Geographical
factors
Patient related factors
Therapy related Factors
External factors
Health Care System
RelationshipPatient - Provider
Socio Cultural and Geographical Factors• There are several factors, and elements
affecting adherence directly and indirectly .
It is not easy to draw how these factors affect the adherence (that it’s why we use the systems thinking), anyway it is important to say that the Social Stigma is one of the most important factors that can affect the Adherence in a multidimensional way (integrating the other dimensions) so the social Stigma is set from the Education, Religion, Lay Beliefs and the final output will directly affect the the Psychological behavior and the motivation of the individual with HIV.
Patient Related Factors• The Physical and Psychological well-being is determinant. The
adherence can be motivated, as a rewards mechanism for the individual. This means, if the individual after being ill, can improve his/her quality of life after medication, so he/she will be able to adhere to ART treatment strongly.
• Several elements affect in multiples ways the Physical and the Psychological well being. (The systems thinking description can be the tool to show the relationship among those elements)
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Therapy Related Factors
• The Quality of the medication can be determinant to reach the well being in the individual, the Side effects on the other hand can affect the adherence dramatically.
Relationship Patient – Health Provider• The Relation between Health Provider and Patient is a key
factor, because it can indirectly affect the Health Literacy in the Community, and directly encourage or discourage the adherence to the patient, Several factors and elements contribute in this dimensions, different paths lead to ensure the adherence. The Health System and the Education are the ones mostly surrounding this dimension.
Health System
• The Health System provides the Infrastructure, the Human Resource, Physical Resources, etc… So the Health System is the framework of the delivery of health services that can also work as an aid in Adherence, the consulting, the counseling, the follow up, the health education on Adherence and etc… by last the management of the resources, for example for the acquisition of ART medications.
External Factors
• Other systems that affect the Adherence, they can be implicit in each dimension, however several elements were identified as a important part of the Adherence because they affect strongly the lack of continuity in treatment: Resources, Supply, etc… as well as also affect indirectly the System, whenever the resources are supporting the treatment, and Adherence itself is the HIV treatment.
Lets going to check again the dimensions of Adherence in Swaziland.
Adherence
Socio – Cultural and Geographical
factors
Patient related factors
Therapy related Factors
External factors
Health Care System
RelationshipPatient - Provider
The next slide explain the System, please don't panic.
Are you ready??...MMM… LET ME CHECK YOUR
“SYSTEM THINKING”
Adherence Motivation
Geographical distancesGood-EfficientCommunicationProvider and patient
Good relationProvider-Patient
Lack of continuity Of care
CommunityHealth Literacy
Good expectationToward treatment
Pharmaceutical Follow up
Language barriers
Professional’sKnowledge aboutPatient Adherence
Health ProfessionalEducation
LayBeliefs
Social/FamiliarSupport
UnqualifiedHealth professionals
Adequate Number andQualified Human Resources inHealthAdequatePolicies inHealth addressed to treatment
EconomicResources for Health HIV Treatment
AdequateInventory in Medications
AccessHealthDelivery
Infrastructure
High expenditure in Health
High costOf medication
LongQueue timesLack of Staff support
Lack of medicationNo supply
SocialStigma
Psychological disorders
Other Physical diseases
PsychologicalWell being
PhysicalWell being
Good livingsconditions
Perception ofLack of effectivity of Medication
No timeliness inThe medication
Natural progress Of HIV
Bad quality Medication
Side Effects
Effectiveness inHIV Therapy
Duration oftherapy
Complexity of Medication
Changes inmedication
FakePerception Of complete wellbeing
Patientconfusion
Irrational uses Of health resources
No resources For Health
Supply problems
PatientReckless carelessness
Health Care System
RelationshipPatient - Provider
Socio – Cultural and Geographical
factors
External FactorsTherapy related
Factors
Patient related factors
System Elements Relationship
Negative influencePositive influence
Patient Confidence
Incorrect Medication labelingIncorrect dispensing
SIYABONGA – KAKHULU THANK YOU VERY MUCH