Treatment Education Workshop for PLWHA: Improving Adherence to Antiretroviral Therapy in Bali.
TREATMENT EDUCATION WORKSHOP FOR PEOPLE LIVING WITH HIV;
IMPROVING ADHERENCE TO ANTIRETROVIRAL THERAPY
IN BALI
Septarini NW1,2, Wirawan DN1,3, Sawitri AAS1,3, Rowe E3 ,
Pidari DMP3, Suyetna DN3
1 School
of Public Health, Faculty of Medicine, Udayana University, Denpasar, Bali
s
University Australia; 3Kerti Praja Foundation, Denpasar, Bali
Contact: septa_rn@yahoo.com
2 Curtin
PAPER NUMBER : 102
ISSUES
THE PROJECT
Kerti Praja Foundation (KPF) has been offering STI screening since 1992, especially for
Female Sex Workers (FSW). Since 2000 KPF began offering VCT in their clinic, Klinik
Amerta (KA), and then ARV therapy in 2002. As of 31st January 2009 the number of clients
seeking VCT services at KA reached 5,667 individuals, 735 (13%) of whom tested was HIV
positive.
Of the aforementioned 735, as few as 208 have taken ARV therapy. Adherence to ARV therapy
among HIV+ clients is poor, especially among the HIV+ female sex workers (FSW). Zero
survey conducted by KPF in 2009, found that 23.2% of FSWs in Denpasar were HIV +. Only 3
of 55 HIV+ FSW adhered to ART. This could be owing to the negative impact of side effects
and a lack of comprehensive understanding of HIV and ARV regimes. This lack of
understanding may bring about a sense of foreboding about starting therapy, especially for
those with CD 4 counts under 200.
Knowledge concerning HIV and ARV treatment among PLHIV remains very limited, and in
order to facilitate adherence there is a very pressing need for the development of a
comprehensive and suitable Treatment Education Program applicable to a number of diverse
contexts.
GOAL :
To increase knowledge levels and the number of PLHIV adhering to ARV treatment through
comprehensive treatment education workshop
SPECIFIC OBJECTIVES:
To increase number of PLHIV participating in TE and knowledge concerning ARV
To increase the number of PLHIV who start ARV treatment
To increase ARV adherence and reduce drop out
ACTIVITIES:
TE training was conducted monthly over 2 days, covering information about Living with
HIV, HIV treatment (ART), Side effects of ARV, Opportunistic infections, Adherence to ARV,
Resistance, HIV and women, PMTCT, HIV and TB, HIV and Hepatitis and HIV stops with
me principles. The TE was structured around fostering commitment to ARV adherence.
Doctors and counselors of KPF provided pre-ARV counseling for those with CD4 counts less
than 200, disseminating knowledge on treatment preparedness.
RESULT
Activities
Result
1. Treatment education workshops
1. TE training carried out 12 times (163 PLHIV)
2. One hundred and seventy nine PLHIV are beginning ARV treatment (if CD 4 levels are below 200)
2. Pre-ARV counseling by YKP’s doctors
One hundred and seventy nine PLHIV’s have knowledge on treatment preparedness
3. Treatment education workshops focusing on adherence
One hundred and eighty three PLHIV adhere to use ARV and 6 discontinuing treatment
Participants characteristics
Pre-test and post-test result
Paired Samples Statistics
Mean
Result
Post-test
Paired Samples Correlations
15.61
4.043
11.20
5.383
Pre-test
Paired Samples Test
Paired Differences
Std.
Deviation
Correlation
Post-test result &
Pre-test result
.699
Sig.
.000
Post- test result –
Pre-test result
Mean
Std.
Deviation
Std. Error
Mean
4.367
3.86
0.434
95% Confidence
Interval of the
Difference
Lower Upper
3.502
5.232
t
df
Sig. (2tailed)
10.055
78
.000
SUCCESS STORIES
1. Most of the participants lacked information about HIV and ART. From the evaluation, it was evident that they found the training very beneficial, particularly with regards to increasing their
knowledge levels. For example: those with feelings of trepidation about beginning ARV, indicated a change in mindset.
2. The participants became aware of the importance of regularly checking their CD4 as an indicator of their general health (the viral load test is expensive for PLHIV in Bali/Indonesia). Prior to
training, few of the participants regularly checked their CD4 count as were not aware of the benefits. After the training they immediately asked KPF doctors to conduct CD4 testing.
3. Post-training a number of participants expressed an interest in joining KPF’s public speaking/testimony program that was conducted in order to increase their capability and capacity as
PLHIV, especially female sex workers who are trying to stop sex work.
4. Treatment Education is an effective strategy to improve HIV and ART knowledge, most especially with regards to increasing their ARV adherence.
CHALLENGES
o It is not easy to design a program, especially related to HIV+ individuals, owing to stigma and discrimination that is still a serious
concern in Indonesia.
o Positive behavior change is not possible through one training session but needs continual follow-up training to be effective.
Acknowledgement:
The authors thank to HIV Collaborative Fund for the
funding and Prof . Dr. D.N. Wirawan, MPH for all the
never ending supports.
Certiicate
of Attendance
International
Union against Sexually
Transmitted Infections
World Congress 2012
This is to certify that
dr. Ni Wayan Septarini
B
E
b
attended the
International Union Against Sexually Transmitted Infections
World Congress 2012 in Melbourne, Victoria, Australia
on
15–17 October 2012
IMPROVING ADHERENCE TO ANTIRETROVIRAL THERAPY
IN BALI
Septarini NW1,2, Wirawan DN1,3, Sawitri AAS1,3, Rowe E3 ,
Pidari DMP3, Suyetna DN3
1 School
of Public Health, Faculty of Medicine, Udayana University, Denpasar, Bali
s
University Australia; 3Kerti Praja Foundation, Denpasar, Bali
Contact: septa_rn@yahoo.com
2 Curtin
PAPER NUMBER : 102
ISSUES
THE PROJECT
Kerti Praja Foundation (KPF) has been offering STI screening since 1992, especially for
Female Sex Workers (FSW). Since 2000 KPF began offering VCT in their clinic, Klinik
Amerta (KA), and then ARV therapy in 2002. As of 31st January 2009 the number of clients
seeking VCT services at KA reached 5,667 individuals, 735 (13%) of whom tested was HIV
positive.
Of the aforementioned 735, as few as 208 have taken ARV therapy. Adherence to ARV therapy
among HIV+ clients is poor, especially among the HIV+ female sex workers (FSW). Zero
survey conducted by KPF in 2009, found that 23.2% of FSWs in Denpasar were HIV +. Only 3
of 55 HIV+ FSW adhered to ART. This could be owing to the negative impact of side effects
and a lack of comprehensive understanding of HIV and ARV regimes. This lack of
understanding may bring about a sense of foreboding about starting therapy, especially for
those with CD 4 counts under 200.
Knowledge concerning HIV and ARV treatment among PLHIV remains very limited, and in
order to facilitate adherence there is a very pressing need for the development of a
comprehensive and suitable Treatment Education Program applicable to a number of diverse
contexts.
GOAL :
To increase knowledge levels and the number of PLHIV adhering to ARV treatment through
comprehensive treatment education workshop
SPECIFIC OBJECTIVES:
To increase number of PLHIV participating in TE and knowledge concerning ARV
To increase the number of PLHIV who start ARV treatment
To increase ARV adherence and reduce drop out
ACTIVITIES:
TE training was conducted monthly over 2 days, covering information about Living with
HIV, HIV treatment (ART), Side effects of ARV, Opportunistic infections, Adherence to ARV,
Resistance, HIV and women, PMTCT, HIV and TB, HIV and Hepatitis and HIV stops with
me principles. The TE was structured around fostering commitment to ARV adherence.
Doctors and counselors of KPF provided pre-ARV counseling for those with CD4 counts less
than 200, disseminating knowledge on treatment preparedness.
RESULT
Activities
Result
1. Treatment education workshops
1. TE training carried out 12 times (163 PLHIV)
2. One hundred and seventy nine PLHIV are beginning ARV treatment (if CD 4 levels are below 200)
2. Pre-ARV counseling by YKP’s doctors
One hundred and seventy nine PLHIV’s have knowledge on treatment preparedness
3. Treatment education workshops focusing on adherence
One hundred and eighty three PLHIV adhere to use ARV and 6 discontinuing treatment
Participants characteristics
Pre-test and post-test result
Paired Samples Statistics
Mean
Result
Post-test
Paired Samples Correlations
15.61
4.043
11.20
5.383
Pre-test
Paired Samples Test
Paired Differences
Std.
Deviation
Correlation
Post-test result &
Pre-test result
.699
Sig.
.000
Post- test result –
Pre-test result
Mean
Std.
Deviation
Std. Error
Mean
4.367
3.86
0.434
95% Confidence
Interval of the
Difference
Lower Upper
3.502
5.232
t
df
Sig. (2tailed)
10.055
78
.000
SUCCESS STORIES
1. Most of the participants lacked information about HIV and ART. From the evaluation, it was evident that they found the training very beneficial, particularly with regards to increasing their
knowledge levels. For example: those with feelings of trepidation about beginning ARV, indicated a change in mindset.
2. The participants became aware of the importance of regularly checking their CD4 as an indicator of their general health (the viral load test is expensive for PLHIV in Bali/Indonesia). Prior to
training, few of the participants regularly checked their CD4 count as were not aware of the benefits. After the training they immediately asked KPF doctors to conduct CD4 testing.
3. Post-training a number of participants expressed an interest in joining KPF’s public speaking/testimony program that was conducted in order to increase their capability and capacity as
PLHIV, especially female sex workers who are trying to stop sex work.
4. Treatment Education is an effective strategy to improve HIV and ART knowledge, most especially with regards to increasing their ARV adherence.
CHALLENGES
o It is not easy to design a program, especially related to HIV+ individuals, owing to stigma and discrimination that is still a serious
concern in Indonesia.
o Positive behavior change is not possible through one training session but needs continual follow-up training to be effective.
Acknowledgement:
The authors thank to HIV Collaborative Fund for the
funding and Prof . Dr. D.N. Wirawan, MPH for all the
never ending supports.
Certiicate
of Attendance
International
Union against Sexually
Transmitted Infections
World Congress 2012
This is to certify that
dr. Ni Wayan Septarini
B
E
b
attended the
International Union Against Sexually Transmitted Infections
World Congress 2012 in Melbourne, Victoria, Australia
on
15–17 October 2012