|Year : 2015 | Volume
| Issue : 1 | Page : 45-48
Knowledge and self-reported practice of people living with Human immunodeficiency virus, with regard to antiretroviral therapy (ART) in Mangalore, India
Sonia Sequera, Irene TR Alvares
Department of Community Health Nursing, Father Muller College of Nursing, Mangalore, Karnataka, India
|Date of Web Publication||8-Dec-2014|
Department of Community Health Nursing, Father Muller College of Nursing, Mangalore, Karnataka
Source of Support: None, Conflict of Interest: None
Context: The goal of universal access to antiretroviral therapy (ART) by 2010 was set at 80%, but most countries could not meet the target. In 2011, the international community recommitted the goal of universal access to ART by 2015. The Millennium Development Goal included halting and beginning to reverse the spread of human immunodeficiency virus (HIV) by 2015. Aim: To assess the knowledge and self-reported practice with regard to ART among HIV-positive people, to find the relationship between the knowledge and self reported practice, to find the relationship between knowledge and self-reported practice and to associate the knowledge and practice with the selected demographic data. Setting and Design: The ART Centre, Mangalore, descriptive correlational survey design. Materials and Methods: A Structured Interview Schedule on 60 patients who were on ART for >2 months. Statistical Analysis: Frequency, Mean, SD, mean percentage, Karl Pearson's Correlation Coefficient, and Chi-square for association. Result: The majority (78.3%) had good knowledge, 15% had very good knowledge, and a few had average knowledge (6.6%). Most had a safe practice 76.7%) and a few had a very safe practice (23.3%). The Karl Pearson's correlation coefficient ((r = 0.22), P value (0.82) > 0.05 level) revealed no significant correlation. Association was found between the knowledge level and type of family and reason for HIV testing. Conclusion: Pooled results showed that the overall knowledge and ART practice were good and safe.
Keywords: Anti-retroviral therapy, knowledge, self-reported practice
|How to cite this article:|
Sequera S, Alvares IT. Knowledge and self-reported practice of people living with Human immunodeficiency virus, with regard to antiretroviral therapy (ART) in Mangalore, India. Muller J Med Sci Res 2015;6:45-8
|How to cite this URL:|
Sequera S, Alvares IT. Knowledge and self-reported practice of people living with Human immunodeficiency virus, with regard to antiretroviral therapy (ART) in Mangalore, India. Muller J Med Sci Res [serial online] 2015 [cited 2021 Mar 2];6:45-8. Available from: https://www.mjmsr.net/text.asp?2015/6/1/45/146424
| Introduction|| |
The management of human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) typically includes the use of antiretroviral drugs. The World Health Organization (WHO) and the Joint United Nations Program on HIV/AIDS (UNAIDS), in 2011, estimated that at least 15 million people were in need of ART, however, only 8 million people had access to ART in the low and middle income countries. Although the goal of universal access to ART by 2010 was set at 80%, most countries could not meet the target. In 2011, the International Community recommitted the goal of universal access by 2015.  A census conducted by the ART Centre of the District Wenlock Hospital, Mangalore, Dakshina Kannada, in December 2012, revealed that out of 3,836 cases, only 2,218 patients were on regular ART, 126 belonged to the 'stopped treatment' status, and 117 patients were lost to follow-up from the last three months.  A survey conducted at six public and private sites in India, to assess the knowledge, attitude, and practice of ART among people with HIV, revealed that 36% had heard of ART and 19% reported that ART could cure HIV. The majority of the barriers in taking ART were the cost, inaccessibility, lack of knowledge on ART, and deferral by the physician.  Another study at Vellore, India, revealed that many of the patients turned to providers of the Indian System of Medicine (ISM), because they believed HIV could be cured with this. ISM also had negative impacts, including side effects and unchecked progression of the disease. Only 46% of Indian women tend to have less knowledge about HIV and HIV treatment.  Some researchers assert that health behavior modification like antiretroviral adherence requires knowledge, skill, and self-efficacy. Many studies have reported that knowledge, understanding of medication, and effectiveness are associated with better adherence, while inadequate knowledge, forgetfulness, inaccessibility, stigma, and confusion were associated with low adherence. 
In a speech at the Nineteenth International AIDS Conference on 6 July, 2012, WHO's Director of the HIV Department, Dr Gottfried Hirnschall, confirmed that their aim was to achieve the target of delivering ART to 15 million people by 2015. He highlighted the need for thinking beyond this target, emphasizing the strategic use of ART in view of ending the epidemic, and stated that as the program continued to expand it was important to understand their knowledge, attitude, and practice concerning ART. 
Objectives of the Study
- To determine the level of knowledge regarding ART among HIV-positive individuals.
- To assess the self-reported practice regarding ART among HIV-positive individuals.
- To find out the relationship between the level of knowledge and self-reported practice toward ART among HIV-positive individuals.
- To associate the level of knowledge with the selected demographic variables.
- To associate the level of self-reported practice with the selected demographic variables.
| Materials and Methods|| |
A descriptive survey approach was employed to study the knowledge and self-reported practice regarding ART. The purposive sampling technique was used. The study was performed at the ART Centre, Wenlock Hospital, Mangalore. The tool was developed after an intensive review of literature, consultation, and discussion with experts, and also with the personal experience of the researcher. A blueprint was prepared, which showed the distribution of items according to the content areas. Tools of data collection consisted of baseline proforma. The knowledge variables included two domains, the basics of ART and positive living with ART. This section comprised of 32 items, 'yes/no' type, with a 'do not know' option. A five-point rating scale was used to assess the self-reported practice and covered two domains - management of illness-treatment and follow-up and positive living with ART. There were a total of 22 items. The validity and reliability of the tool was ascertained. The tool was also pre-tested. Permission was obtained from the Karnataka State AIDS Prevention Society, Bengaluru. Ethical clearance was obtained from the concerned institution. The investigator conducted a pilot study from 24 September to 29 September, 2012, on 10 HIV-positive individuals who satisfied the inclusion and exclusion criteria. The main study was conducted on 60 HIV-positive individuals from 1 October 2012 to 31 October, 2012, as per the duration assigned for data collection. Informed consent was obtained from the subjects and the confidentiality was assured. The interview technique was used to collect baseline information, knowledge, and self-reported practice. The interview of each subject lasted 30 to 45 minutes. A maximum four subjects could be interviewed per day. The inclusion criteria included patients above 18 years and those taking ART for more than two months. Critically ill patients were excluded from the study. Maintaining privacy during the interview was the main concern.
| Results|| |
The data was analyzed using SPSS version 20. A majority of the subjects had good knowledge of ART (78.33%) and a few had an average level of knowledge (6.66%).
[Table 1] shows the area-wise mean, standard deviation, and mean percentage of knowledge of ART. The mean knowledge score was higher in the area of 'Positive living with ART' (81.76%) than in the area of 'Basics on ART' (76%). The overall mean knowledge score was considered to be good (77.29%).
|Table 1: Area-wise mean, standard deviation, and mean percentage of the knowledge score|
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Less than half had very safe practice (23.3%), whereas, the majority had a safe practice of ART (76.7%).
[Table 2] depicts the area-wise mean, standard deviation, and mean percentage of self-reported practice. The mean percentage of the practice score was highest in Area A, that is, in the management of illness, treatment, and follow-up (88.99%), whereas, Area B (positive living on ART) showed a mean percentage score of 74.54%. The overall mean percentage of the practice score was 82.38%, indicating safe practice.
|Table 2: Area-wise mean, standard deviation, and mean percentage of self-reported practice score|
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There was a positive relationship between knowledge and practice as depicted by the Karl Pearson correlation coefficient (r = 0.22). The computed P-value was 0.82 (>0.05). There was no statistically significant relationship between knowledge and the practice score. The P-value computed between knowledge and type of family (0.02) and reason for HIV testing (0.04) was <0.05. This shows the knowledge score toward ART had a significant association with the type of family and reason for HIV testing. No significant association was found between the self-reported practice score toward ART and the sample characteristics, at P < 0.05.
Out of the 60 patients interviewed, the majority were in the age group of 31-40 years and the maximum were males. A few were illiterates. More than half were currently married and one-third were widowed. A small percentage of the subjects were unemployed and had no income. Half of the subjects were diagnosed in private hospitals. Apart from two subjects, all the others were not taking any alternative medicine for HIV treatment and almost every subject was supported either by their spouse or family members.
In the area of knowledge, less than half (13.4%) stated that there was no need for any laboratory testing once they were on ART and 3.3% stated that ART reduced the quality of life. Almost all (98.3%) subjects agreed that weight gain was one of the factors to be monitored for the success of ART and 93% said they could skip ART if sick.
In the area of practice, very few (3.3%) managed the side effects of the drug by themselves, 6.7% did not share their experience with other HIV-positive individuals, 1.7% did not disclose the HIV status to the spouse and family. A majority (81.9%) of the subjects concluded that the ART regimen interfered with their job.
| Discussion|| |
The overall mean knowledge score (77.29%) showed that the subjects had good knowledge and the mean percentage of practice score (82.38%) indicated safe practice. The results of the investigation indicated that the patients on ART had good knowledge about ART and also had safe self-reported practice.
Half of the subjects stated that ART could not cure HIV, whereas, a handful of them believed that traditional healers provided more effective treatments than ART. More than half did not know that ART caused any side effects, but a majority agreed that ART should be continued even after feeling better. The results showed that almost all the subjects (90%) never shared their drugs with their family members or friends, and ART rarely interfered with their jobs. Less than half of the subjects carried enough medicines when they traveled long distances. All the subjects availed medicines from the public sector, which confirmed that none had the issue with the cost of the drug, unlike the studies conducted in other countries, which stated that the cost of the drug had been a barrier for adherence to the drug. None of them experienced any stigma and were taken care of by their family members/spouses, which showed that the acceptance level for HIV positive individuals was improving.
Some of the findings of this study support the information available from the existing studies. A cross-sectional survey conducted at the healthcare centers of the Association 'Espoir Vie Togo' in Togo, West Africa, to assess the knowledge and adherence level to ART, among 99 adults, living with HIV/AIDS, revealed that all had good knowledge of the treatment schedule. The average adherence rate was 89.8%. However, 34.9% patients reported forgetting, 25.5% reported travel, 13.9% reported cost of treatment, and 11.6% reported side effects, as the main factors for missing the regular intake of anti-retroviral drugs. 
A cross-sectional survey conducted at six public and private sites to assess the knowledge, attitude, and practice of ART among 1,667 patients with HIV, in India, also showed that 609 (36%) had heard of ART and 19% reported that ART could cure HIV. Major barriers in taking ART were the cost (33%), inaccessibility, lack of knowledge on ART, (41%) and deferral by physician (30%). 
A study on the knowledge, attitudes, beliefs, and practices toward HIV and ART was conducted in Soweto, South Africa, on 105 HIV-positive individuals. Out of this 70% were not on ART, 89% had good knowledge about the cause of HIV infection. The majority (83%) knew about the modes of transmission, 59% were not worried about the side effects of ART, 65% agreed that the missed doses of ART lead to disease progression, 80% reported that if they took ART their HIV status would be revealed to their family members, 49% believed that ART could cure HIV. Knowledge was associated with a low education level. 
In the present study, attendance to adherence counseling regarding ART was 100% and subjects had received the information regarding ART from the doctor/health personnel.
The present study throws light on the wholeness of services provided by the ART Center, especially the healthcare team (the medical officer, counselor, and nurse), which motivates the patients to take ART when their CD 4 count is below 350 cells/mm 3 , and provides them knowledge and counseling to maintain their adherence to the drug and maintain their quality of life. All subjects were aware of the availability of free drugs in the public sector, which removed the cost barrier, unlike in the previous studies conducted in India and other countries.
Pre-treatment counseling and the duration of taking ART may influence the results. Further studies with a better methodology are required to draw definite conclusions. The study could be replicated on a larger sample for generalizing the findings. Replication of the same study could be done on the general population or other population segments, such as, caregivers. Extensive research could be conducted to find out healthcare practices related to the treatment of HIV, other than ART.
This study aims at measuring the knowledge and self-reported practice regarding ART, which could be used as a measure to improve their adherence level and quality of life. The present study can be used as a baseline to plan and implement programs, which in turn would contribute to the goal of Universal Access by 2015.
| Acknowledgment|| |
The authors would like to acknowledge the support and help of Father Muller College of Nursing Mangalore, KSAPS Bengaluru, ART centre Mangalore, to conduct the study, participants of the study for their whole-hearted participation. The principal, teaching faculty for material help and general support, experts for their guidance. The family members and well-wishers for their prayers and encouragement..
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[Table 1], [Table 2]