The perception of health care workers and HIV-positive clients of HIV/AIDS care and treatment centres in Kogi state, North-central Nigeria, about the integrated model of HIV/AIDS service delivery

Abstract

Thesis (MPhil)--Stellenbosch University, 2012.ENGLISH ABSTRACT: The early response to the HIV/AIDS pandemic in Nigeria had supported the set-up of specialized stand-alone clinics as the major model of providing care and treatment service to PLWHA. Over time, several challenges have been linked with this model of service delivery for PLWHA including the exposure to HIV-associated stigma risks, the considerable burden on the already weak health system resources as well as the attendant costs of multiple referrals to clinics specializing in a small range of health services with increased potential for client loss to follow-up. In response to these issues and partly due to declining funding for HIV/AIDS programmes locally and internationally, public health practitioners are increasing advocating the use of the Integrated Clinic Model for HIV and AIDS service delivery. This model utilizes the same resources (focus on personnel, space and systems) to provide medical services to both HIV-positive clients and other patients accessing services in the hospitals. Despite opposing views expressed by advocates and opponents as regards the risk of HIV-related stigma to PLWHA, the ease of accessing or providing services and the patient outcomes of this model of service delivery, few studies have actually focused on the perceptions of those who utilize and operate this model. Hence, this study uses a simple questionnaire-based survey to assess the perceptions of health care workers and HIV-positive clients at the Kogi State Specialist Hospital in North-Central Nigeria, about the integrated model of HIV/AIDS clinic service delivery being practiced in the hospital along these three themes. Findings from the study shows that the clients and the health providers do not perceive the integrated clinic setting to increase the risk of exposure of PLWHA to HIV-related stigma but believe rather to the contrary that this model may actually reduce this risk. As regards the ease of accessing or providing services, the clients and health workers expressed a mutual belief that did not raise any major complications and actually reported a preference for this model. Also, both study groups identified positively with client outcomes of integrated clients. The main conclusion from this study is that the integrated HIV clinic model presents a workable alternative to standalone HIV and AIDS treatment clinics and can contribute to the reduction in HIV-related stigma targeted at PLHIV in the course of accessing treatment services. The major limitation of this study is the inability to compare the perceptions of clients and workers in the integrated clinics with that of similar populations in stand-alone clinics for comparative analysis.AFRIKAANSE OPSOMMING: Met die aanvanklike reaksionêre optrede teen die MIV/VIGS-pandemie in Nigerië is daar gesteun op gespesialiseerde, onafhanklike klinieke as diensleweringsmodel om behandeling en sorg aan mense wie met MIV/VIGS leef (PLWHA) te verskaf. Met verloop van tyd het verskeie vrae rondom die diensleweringsmodel vir PLWHA ontstaan, wat blootstelling aan MIV-geassosieerde stigma-risiko’s en aansienlike las op die swak gesondheidstelsel ingesluit het. Die bywoningskoste as gevolg van veelvuldige verwysings na klinieke, wat in ‘n klein reeks gesondheidsdienste spesialiseer en waar die potensiaal vir kliënteverlies aan die groei was, was ‘n bykomende uitdaging. In reaksie op dié aangeleenthede, onderskryf openbare gesondheidspraktisyns toeneemend die gebruik van die geïntegreerde Kliniese Model vir MIV- en VIGS-dienslewering. Dié model gebruik dieselfde hulpbronnne om geneeskundige dienste te bied aan MIV-positiewe kliënte, sowel as aan ander pasiënte wat dienste in hospitale benut. Ondanks opponerende sienings wat betref die risiko van MIV-verwante stigma vir PLWHA, die saak van benutting of voorsiening van dienste, asook die pasiënte-uitkoms van dié diensleweringsmodel, het min studies nog gefokus op die persepsies van diegene wat die model toepas. Dié studie gebruik ‘n eenvoudige vraag-gerigte opname om persepsies van gesondheidswerkers en MIV-positiewe kliënte aan die Kogi Staatspesialis-hospitaal in noord-sentraal Nigerië oor die geïntegreerde model van MIV/VIGS kliniekdienslewering te assesseer. Bevindinge van die studie dui daarop dat die kliënte en gesondheidsvoorsieners die geïntegreerde klinieksamestelling nie sien dat dit die risiko van blootstelling van PLWHA aan MIV-verwante stigma verhoog nie, maar dat dit eintlik so risiko verminder. Wat betref die benutting of voorsiening van dienste, het die kliënte en gesondheidswerkers ‘n gedeelde siening uitgespreek wat nie ernstige komplikasies na vore bring nie, en hulle het basies ‘n voorkeur vir hierdie model getoon. Albei studiegroepe het ook positief met die kliënte-uitkoms van geïntegreerde kliënte geïdentifiseer. Die vernaamste gevolgtrekking uit dié studie is dat die geïntegreerde MIV-kliniekmodel ‘n werkbare alternatief bied vir onafhanklike MIV- en VIGS-behandelingsklinieke en dat dit tydens die verloop van die assessering van behandelingsdienste tot die vermindering van die MIV-verwante stigma kan bydra. Die vernaamste tekortkoming van dié studie is die onvermoë om met die oog op mededingende analise die persepsies van kliënte en werkers in die geïntegreerde klinieke te vergelyk met diegene in onafhanklike klinieke