AFRICA INLAND CHURCH OF TANZANIA
MIMIHAPA COLLEGE OF HEALTH SCIENCES
DEPARTMENT OF CLINICAL MEDICINE
NTA LEVEL 6 SEMESTER I
RESEARCH PROPOSAL
STUDY ON THE USE OF ANTIRETROVIRAL THERAPY
TO PEOPLE LIVING WTH HIV AT NYAMAGANA CTC
RESEARCHER NAME: BONIPHACE OLANGA
CANDIDATE NUMBER: NS0578/0128/2014
SUPERVISOR Mr. PAULO ALEXANDER
Date of submission: December 2019
DECLARATION
I declare that this is my original work and that it has not been submitted for similar Diploma Medicine research proposal
NAME OF STUDENT: SIGNATURE:
BONIPHACE OLANGA ……………………….……….
CERTIFICATION
The undersigned certify that they have read my proposal and recommended by DEPARTMENT OF CLINICAL MEDICINE AT MIMIHAPA COLLEGE a research tittle “STUDY ON THE USE OF ANTIRETROVIRAL THERAPY TO PEOPLE LIVING WTH HIV AT NYAMAGANA CTC” in partial fulfilment of ordinary diploma in clinical medicine
SUPERVISOR NAME Mr. PAULO ALEXANDER
SUPERVISOR SIGNATURE ……………………………….
Table of Contents
1.2.1 Global overview of HIV/AIDS and ARVs
1.2.3 Antiretroviral Therapy (ARV) Programs
CHAPTER TWO: RESEARCH OBJECTIVES
CHAPTER THREE: RESEARCH METHODOLOGY
Table 3.1 The Sample Size of the Study
3.6 Types and Sources of Data Collection Methods
3.7.1 Data Collection Procedure
3.8 Data Analysis and Presentation
CHAPTER FOUR: work plan and budget
ACKNOWLEDGEMENT
First of all, I would like to thanks God for giving me good health and blessings to accomplish of my research report
Second thanks go to MimiHapa college of health sciences for excellence knowledge, much appreciation to my research tutor Mr. Alex for his training skills on research report. Also my principal Mr Shiluka for giving me chance of conducting my research study, other tutor, my fellow students of level 6.
Also I would like to thanks the district medical officer, doctors, nurses and other health workers of Nyamagana district hospital for their support. Also my family for much support that they showed me during my research study
Last but not least thanks to my supervisor Mr. Alex for his great support to my research study
LIST OF ABBREVIATIONS
CTC =Care and Treatment Centre
AIDS = Acquired Immune Deficiency Syndrome
AMREF = African Medical and Research Foundation
ART = Antiretroviral Therapy
GFATM = Global Fund to Fight AIDS, Tuberculosis and Malaria
HIV = Human Immunodeficiency Virus
IEC = Information Education Communication
INRUD = International Network of Rational Use of Drugs
NGO = Non-Governmental Organization
NIMR = National Institute of Medical Research
PLWHA =People Living with HIV/AIDS
TFDA = Tanzania Food and Drugs Authority
DEFINITION OF TERMS
Knowledge
The knowledge possessed by a community refers to their understanding of that topic. In this study, knowledge refers to the ability of the people of Nyamagana district to know what is ARTs, what is required in the use of ARTs, its importance and where to use it.
Correct use
Refers to exactly use of drugs according to instructions and prescriptions as prescribed by the health professional
Research
This is a careful and systematic process of inquiry to find answers to problem of interest
Proposal: A well written report that describes your current thinking about your research interest.
Sampling:
Process of selecting a number of study units from a defined study population
Study population: Collective of study units for which the values of the varieties of interest could possibly be determined
Variables: A characteristic of a person, object or phenomenon, which can take on different values. These may be in the form of numbers (e.g. age) or non-numerical characteristics (e.g. sex)
Data collection techniques refer to a variety of methods which are used to gather information for the study
Attributes: Are characteristics or qualities that describe an object or categories that make up a variable
SUMMARY
The study bases on the use of Antiretroviral therapy to people living with HIV at Nyamagana district hospital.
The study was conducted from November 2019 up February 2020 at Nyamagana hospital. The study will take about 55000/= from its beginning up to its end.
ARTs are used to people with HIV but some patients do not want to use them and others use them incorrectly the thing that lead them to opportunistic infections this is due to low knowledge and tiredness of using drugs for life also others have negative attitudes on these drugs and this disease that others thinks that this is the witch disease
The study aimed to increase the correct use of antiretroviral therapy at 99% among people living with HIV within 6 months through provision of health education at Nyamagana hospital CTC
The target population for the study involved People Living with HIV/AIDS attending ARVs at Nyamagana district hospital CTC
The questionnaire is the method used to collect data at Nyamagana district Hospital to the people living with HIV
The study also identified several barriers to access were mentioned by the respondents including stigma & discrimination, hunger, poverty. These has been barriers in the effectiveness utilization, accessibility to ARV. Some of PLWHA had negative views about ARVs; think that these ARVs are not good and that it is one way of eliminating people or reducing on the population. The study found that a majority of the respondents suggested for private rooms for consultation during counseling, government and NGOs should provide loan facility to help them to improve the social economic activities and insisting on frequently backstopping seminars.
CHAPTER ONE: INTRODUCTION
1.0 Background information
Nyamagana district is one among eight districts in Mwanza region. Nyamagana district hospital is located at right hand side of nyegezi road when moving from town (sahara). It’s the hospital that provides health service to people from Igogo, Bugarika, Nyegezi., Buhongwa and others who are nearby it. Nyamagana CTC provides the health service to people living with HIV/AIDS daily to more than 100 people daily. HIV/AIDS is a global pandemic disease. Globally it is approximated that 34 million people have HIV, of which 17.2 million are men, 16.8 million are women, and 3.4 million are children less than 15 years old (UNAIDS, 2011). In the African continent the first AIDS case was reported in early 1980s. By 1987 the epidemic had become concentrated in most of countries in Sub-Saharan Africa. Of the estimated 33.6 million cases of HIV infection in the world about 23 million cases are in Sub-Saharan Africa. In sub-Saharan Africa, about 23 million adults aged 15 to 49 are infected, with 57 per cent- 13.1 million - of them women. The region has just over 10% of the world population but it is home to 67% of all people living with HIV and for 75% of AIDS deaths in 2007. HIV prevalence varies considerably across this region ranging from less than 1% in Madagascar to over 26% in Swaziland (WHO 2008)
In Tanzania HIV epidemic is highly heterogeneous. HIV prevalence in Tanzania in urban areas is much higher than in rural areas, in fact almost twice as high at 8.7% (NACP, 2011). However, in the island of Zanzibar, HIV prevalence is far lower. among the general population 0.6% and the epidemic is concentrated, primarily affecting female sex workers among whom prevalence is estimated to be 11% men who have sex with men 10% and injecting drug users 15% (UNDP,2011). The survey conducted by TACAIDS in 2007, indicates that 7.4% of the Tanzania adults age 15-64 are infected with HIV. According to the survey more than 1.4 million people in Tanzania were living with HIV. However, the prevalence remains high in Coastal zone at 15.3%, than national prevalence estimate, including Dar es Salaam (9%), Coast (7.9%), and Tanga (7.0%). Prevalence in Eastern is 4.7% and in Central, 3.8% of the adult population is infected (TACAIDS, 2007). The highly spread of HIV/AIDS created the world health challenge in many countries. Through combined efforts of affected countries and international partners, there was substantial ongoing progress towards HIV interventions in low and middle income countries. One of the major interventions the use of antiretroviral therapy for HIV infected people although few people were able to access. Despite this progress, global access to antiretroviral therapy remains low. Only 31% of people in need of ARV treatment in the world were receiving it in 2007 and an estimated 2.5 million people were newly infected with HIV in the same year. In 2003 due to concerns of limited access to ARV, the WHO “3 by 5” initiative was launched as a strategy for ensuring that 3 million people living with HIV/AIDS in low- and middle income countries have access to ARVs treatment by the end of 2005 which meant meeting 50% of the estimated need (WHO 2007). This ARV treatment service in Sub-Saharan Africa including Tanzania the emphasis was been on initiating people on ARV to prolong their life’s. In the beginning many people responded to the ARVs treatment programs. In Tanzania only 65% of HIV positive adults and children are known to be on ARV drugs a year after beginning therapy (NACP, 2010). However, the rate of people taking ARVs treatment started to decline with little reports of death among the PLWHA. This indicated that the new problem of poor utilization of the treatment started to crop within PLWHA (Berg& Ornstein, 2004). This was against of efforts and policies insisting on access of ARVs rather than the PLWHA adherence/retention to medication. This is necessary for sustained health benefits and to safeguard public health against the risk of drug resistance caused by incorrect use to the antiretroviral drugs (WHO 2006). Tanzania became the first country in Sub Saharan Africa to give free ARV treatment to her people living with HIV/AIDS (PLWHA) in 2004 through a comprehensive "National HIV/AIDS Care and Treatment Plan 2003-2008". The programme serves as a guide to the implementation and management of ARVs in the country. Country profile on HIV/AIDS posits that in 2005, a total number of 23,951 patients were on Anti-Retroviral Treatment and by end of October 2006
1.1 STATEMENT OF THE PROBLEM
Antiretroviral therapy: are the drugs used for treatment of HIV disease in Nyamagana and Tanzania. These drugs were introduced in order to decrease the viral load and increase the CD4 count of an individual with HIV/AIDS
In Nyamagana district most people with HIV does not want to be known that they are HIV positive that most of them they are hiding even when they go to take their medication at Nyamagana CTC for example you may find a husband and his wife both are HIV positive and they are in medication but no one knows about the status of the other they are using medication in secret way
ARTs once used correctly they have big role in health status of individual with HIV that it prevents an individual to get an opportunistic infection that may be due to HIV and especially those who are in irregular medication like cryptoccocal meningitis, HIV encephalopathy. Also the economic status of an individual and national will increase because an individual will be able to perform his/ her daily activities as usual. Also orphans rate and street children rate will be reduced due to death of their parents because HIV leads to death.
ARTs once not used correctly it may lead to decrease in CD4 count hence decrease in body immunity that lead to easy to the body to get recurrent infections that after 2 to 3 weeks a person gets upper respiratory tract infections
Some of individual do not want to use these drugs because these are drugs for life so some people use them for sometimes and stop using them until they start facing bad conditions its where they start using them and most of these people end up to death because good use of these drugs is to use them for the rest of life
There is a lack of proper documentation on ARV treatment adherence and possible factors contributing to ARV un use at Nyamagana district. Studies in other districts have described a range of factors affecting ARV treatment uses at various levels, i.e. at individual, community and health facility levels. Such factors can be grouped into: • Structural factors e.g. poor support services, low accessibility to service etc. For example, it may be important to review how easy or difficult it is for a patient to come to clinic. Does he need to pay for transportation? Who will mind the children when she comes for an appointment? Do the clinic hours make care and treatment inaccessible? Are providers very friendly and caring? • Disease and treatment factors e.g. seriousness of the disease and adverse drug reactions and side effects etc.
1.2 LITERATURE REVIEW
Introduction
This chapter presents review of literature. It highlights the global trend over HIV/AIDS and concerns over ARVs. The chapter also provides some information on the status of HIV/AIDS in Tanzania and efforts to deal with the problem. The theoretical explanation governing HIV/AIDS related services including access to ARVs is also provided. According to Amico, Rivet & Harman, (2007) use of medication has been defined as the degree of concurrence between the client’s behavior (taking medicine, sticking to diet, taking the right dose and at the right time) and following medical advice on medication regimens.
1.2.0 Conceptual Frameworks
The study conceptual framework is guiding research discussion and clearly identifies the fundamental issues to be examined. A number of factors have been associated with utilization to ARVs and are commonly divided into five intersecting categories (Reiter et al., 2003) namely: patient variables, treatment regiments, disease characteristics, patient provider relationship and clinical setting. In this study a four dimensional conceptual framework of factors affecting good compliance is considered. The factors are divided into individual, health facility, community and national levels This study aimed at assess ARVs use among HIV/AIDS patients in Nyamagana district Hospital in Mwanza Tanzania by using individual, health facility, community and national levels variables impacts to timing of ARV doses and keeping of clinic appointments for prescription refill as key indicators.
as shown in Figure 1.1
| Individual Factors Awareness, education employment, income, literacy; psychosocial factors |
| Health facility Factors Availability, side effects, metabolic changes, accessibility |
| Community factors Stigmatization, degree of social support, social stability, |
| National level factors Policy, Food Insecurity, timely distributions and equipments |
| ARVs utilization |
Source Researcher 2014
1.2.1 Global overview of HIV/AIDS and ARVs
According to Word Health Organization (2012), globally there are now 17 million women and 18.7 million men between the ages of 15 and 49 living with HIV/AIDS Since 1985; the percentage of women among adults living with HIV/AIDS has risen from 35 per cent to 48 per cent. Of particular concern are the dramatic increases in HIV infection among young women, who now make up over 60 per cent of 15- to 24-year-olds living with HIV/AIDS. WHO also describe that, young women are more vulnerable as they 1.6 times more than young man affected and living with HIV/AIDS in the world. According to WHO accounted that more than 33.4 million people were living with HIV/AIDS in 2008. The disease accounted for approximately 2.0 million people death while over 2.7 million people were reported to be newly infected with HIV in the same year
In countries with both generalized and concentrated HIV/AIDS epidemic, young people are at its center. Young people also tend to lack sufficient information and understanding of HIV/AIDS, including their vulnerability to it, how to prevent it, and the self-confidence necessary to protect them. The devastation of the HIV/AIDS pandemic provides a vivid example of the need for investing in young people. In areas where HIV/AIDS is subsiding or even declining, there has been a genuine commitment to HIV prevention, particularly among young people. We now know that if young people are given the information, services and support necessary to adopt new safe behaviors, they can make responsible decisions about their health. We also know that with support, young people can help educate and motivate others to make similar safe decisions.
1.2.3 Antiretroviral Therapy (ARV) Programs
Medically Antiretroviral drugs (ARVs) slow the progression of HIV/AIDS. They extend life span for person living with HIV/AIDS. They prolong the survival of the HIV-infected person, preserve, enhance, or reconstitute the immune system. Therefore, reduce opportunistic infections, suppress HIV replication, prevent disease progression, and reduce the morbidity and improve quality life of PLWHA (Berg& Aronstein, 2004
CHAPTER TWO: RESEARCH OBJECTIVES
2.1 GENERAL OBJECTIVES
To increase the correct use of antiretroviral therapy at 99% among people living with HIV within 6 months through provision of health education at Nyamagana CTC
2.2 SPECIFIC OBJECTIVES
To determine the proportion of patients who use and do not use ARVs treatment in Nyamagana CTC
To identify factors (structural, socio-economic, and cultural) contributing to un use of ARTs
To assess the quality of the operating structures for provision of ARVs in Nyamagana CTC
To assess the quality of the processes involved for ARVs consumption among patients at Nyamagana hospital
(v) To document suggestions and proposals for improving ARVs treatment use
from users, healthcare providers and support groups
2.3 HYPOTHESIS FORMULATION
Lack of knowledge on ARTs use, irregular use of ARTs, Daily intake of ARTs drugs is a tough work to people with HIV/AIDS
2.4 RESEARCH QUESTION
1.What are the factors contributing to incorrect use of ARTs among HIV people attending Nyamagana CTC?
2. What is the magnitude of people living with HIV at Nyamagana district hospital?
3. What is the general knowledge about the use of ARTs at Nyamagana district hospital?
4. What are the possible solutions to reduce the incorrect use of ARTs?
2.5 STUDY LIMITATION
The study was conducted at Nyamagana hospital from 4/11/2019 up to 10/2/2020 from 10am to 2pm through passing to various individual living with HIV at Nyamagana CTC and others to know their views on ARTs and to take their opinions on what should be done to solve this problem
2.6 SIGNIFICANCE OF THE STUDY
Taking ARV medicines is not an easy task since it is a life treatment. It is hoped that the findings generated from this study will make several contributions to both knowledge and understandings of what is one the worst calamities to hit the world The qualitative and quantitative data collected in this study will be made available to health planners such as Ministry of Health and is hoped that this will lead to better designed, better directed and more culturally sensitive intervention programs to deal with Socio-cultural problems associated with un use of ARTs. In addition, findings will assist the Ministry of Health in efforts to develop a scheme for rational use of ARVs, and also serve as a resource for research teams developing new protocols on the use of ARTs
CHAPTER THREE: RESEARCH METHODOLOGY
3.1 Introduction
This chapter provides an explanation on how the study was conducted. The chapter describes the methodology employed during fieldwork. It describes research design, study area, study population, sample size, sampling procedure, and source of data, data collection methods, data collection procedures, data analysis and ethical consideration.
3.2 Research Design
A descriptive cross-sectional study design facilitated a data collection on the problem under discussion and related risk factors on accessibility of ARVs of PLWHA to measure at a specific point in time for a defined population. Secondly the design provides a portrait of information at single point in a time across target groups and collects data to make inferences about a population of interest (universe).
It is also relatively inexpensive and takes up little time to conduct; Also the design can easily estimate prevalence of outcome of interest because sample is usually taken from the whole population The design also is useful for public health planning, understanding disease etiology and for the generation of hypotheses;
3.3 Study Area
This study was conducted at Nyamagana District in Mwanza region, which has an area of square km 183 and has the population of males 177812 and female 185640 according to census of 2012
3.4 Study Population
The target population for the study will involve 400 People Living with HIV/AIDS attending ARVs treatment at Nyamagana district Hospital. These are the main group are highly practicing the ARVs underutilization hence facing poor health. Moreover, the study also will involve the service providers at hospital which included Doctors, nurses and counselors who testing, counseling and designing for treatment plan. Furthermore, are the one who making follow up to PLWHA.
3.4.1 Sample size
Sampling is normally done for the purpose of measuring the elements of population characteristics and making conclusion, regarding the entire population (Cohen, et al., 2004 My sample size will be 40 respondents that will be taken from the population to represent others in the study.
The main criteria inducing the choice of a sampling technique will base on the sampling frame. This involved a list of the units comprising the study population. Therefore, the study make sample of these two groups using a sampling formula provided by Yamane (1967) when population/sample frame is less than 100 individuals. This is stated here under.
Where ‘n’is the sample size, ‘N’ is the population size or sample frame and ‘e’is the degree of precision that the selected population is the right one. The sample was calculated at 90% level of confidence. But due to the time limit the study did not manage to obtain exactly required number of respondents. Table 3.1 below show required sample and obtained sample in the field.
Table 3.1 The Sample Size of the Study
| No | Category of respondents | Number of the Respondents | Percent |
| 1. | Clinical and community health Officials (Clinicians, counselors, pharmacists, nurses, social workers, nutritionists, receptionists) | 35 | 35% |
| 2. | People Living with HIV/AIDS | 65 | 65% |
| TOTAL | 100 | 100% | |
3.5 Sampling Techniques
In this study researcher will use combination of simple random techniques and purposive sampling technique to select members from Nyamagana Hospital.
3.5.1 Purposive Sampling
It is from this ground that purposive sampling technique will select 40 respondents 30 (75%) females and 10 (25%) respondents who utilize ARVs at Nyamagana Hospital. Also methods use to select 10 service providers that involves Counselors, Pharmacists, Nurses, Social Workers, Nutritionists, and Receptionists, dealing direct with ARVs treatment.
3.5.2 Simple Random Sampling
Is a probability sampling whereby all members in the population have equal chance of being selected (Adam, 2007) It was applied due to its strength of giving research data that can be generalized to a large population as well as providing equal opportunity of selections for elements of population.
3.6 Types and Sources of Data Collection Methods
In order to achieve the set objectives and complete the work within the planned timeframe, different methods of collecting information were used. The following instruments were applied in data collection. Two types of data were collected, namely primary and secondary data. Both qualitative and quantitative data was collected and used.
3.6.1 Primary Data
In the field, primary data was collected through interviews which were conducted to the social workers, clinician, nurses, pharmacist and nutritionists, by using questioner were the open and close ended questions were applied. This technique was employed to capture information and determine the perceptions of patients who infected by HIV/AIDS towards the services and ARVs utilization.
3.6.2 Secondary Data
This data was obtained from various publications such as journals, books, internet, and policies, Literature review assisted in getting more information. Annual/quarterly reports, work plans, strategic plan documents and conference/workshop presentations were reviewed among others. Review of patients’ records helped to determine level of adherence and gather clinical data of patients. Records for all patients interviewed were retrieved to back up information regarding ARVs use and adherence. All data available were used.
3.7 Data Collection Methods
Data was collected by using two main tools, which are structured questionnaire and semi structured interview:
3.7.1 Data Collection Procedure
Data collection was conducted from two months. Participants were given detailed information, in the introductory part of the questionnaire that describes the nature of the study, their rights as participants and the responsibilities of the researcher. Participant were informed that their responses would be kept anonymous and confidential, and that they could not skip or omit any of the questions.
3.8 Data Analysis and Presentation
The great part of data collection has been organized and analyzed qualitatively and quantitatively manually. The qualitative data from the semi structured interview were transcribed using content analysis, while the quantitative data collected from the field were analyzed using the Excel programs.
3.8.1 Data presentation –The analyzed data presented using statistical graphs, pie charts, tables and frequencies (percentages) so as to make the information self-elaborative and easily understood.
3.8.2 Pre-Testing
Research assistants will be selected looking at their education level, gender balance and preferably non-medical staff. Training of research assistants will be done for 2 days and will be followed by pre-testing of the research tools/instruments with a selected sample of the target population not from the actual targeted study facilities. The pre-testing will be done prior conducting the actual main study and necessary adjustments/corrections of the research tools will be made accordingly
3.9 ETHICAL CONSIDERATION
Permission to conduct the study will be requested from Ethical Clearance Committee of Nyamagana district hospital.
CHAPTER FOUR: work plan and budget
4.0 WORK PLAN
This is the schedule, chart or graph that summarizes the different components of a research project and how they will be implemented in a coherent way within a specific time-span. My work plan shall be conducted from November 2019 to February 2020 at Nyamagana district hospital in Mwanza region
Time frame
| TASK TO BE DONE | RESPONSIBLE | DATE |
| Preparing to write research proposal | Researcher | 04/11/2019 |
| Writing research proposal and finalizing research proposal | Researcher | 13/12/2019 |
| Submitting research proposal to supervisor for assessment | Researcher | 18/12/2019 |
| Receiving feedback from the supervisor | Supervisor | 20/01/2020 |
| Presenting research proposal | Researcher | 14/2/2019 |
The table above shows the work plan of my research proposal how was it done from beginning of its preparation up to the end, its submission and presentation to the department of clinical medicine at MimiHapa college of health sciences. Writing of proposal and submission of it was done by myself and the feedback after certification will be given by MR Alex who was my supervisor
The presentation was done on 14/2/2020 under supervision of the tutors of department of clinical medicine at MimiHapa college of health sciences
4.1 BUDGET
This table includes items, and total cost for the research tools that used in order to accomplish my research study. The budget was very important to Plan for strict control of project expenditures, such as Secretarial works and paying people who will help me in data collection, fair and meal for the whole week that I was using to collect my data at Nyamagana district hospital in Mwanza
| ITERMS | COSTS (TSHS) |
| Secretarial works | 10000.00 |
| Printing research proposal | |
| Photocopy questionnaire | 8000.00 |
| Pencil, ruler, pen | 2000.00 |
| Data collectors | 15000.00 |
| Fair | 5000.00 |
| Meal | 15000.00 |
| Total | 55000.00 |
The above table shows how I used for accomplishment of my research proposal. I used 10000/= for printing of my research proposal. I used 8000/= for photocopying the questionnaire that used in data collection at Nyamagana district hospital to people living with HIV
I used 2000/= for buying pencil pen and ruler used in writing drawing and data writing. 15000/= will be used to pay other people who will help me in data collection. I used 5000/= as fair to and from Nyamagana district hospital and 15000/= for breakfast and lunch during data collection for one week that will be used during data collection. This will takes total cost of 55000/= Tshs
REFERENCES
· ACCORD, (2007), ARVs accessibility and implication in selected sites. The study of Communities’ Perspective and Policy Environments in Tanzania.
· ACORD, (2011). Free ARV Programs in Tanzania: The Teething Challenges. Nairobi, Kenya and Leonard Street, UK.
· Amico K, Rivet J, Harman Efficacy of Antiretroviral Therapy Adherence Interventions A Research Synthesis of Trials, 1996 to 2004.
· Andersen, R. M. (1995), Revisiting the behavioral model and access to medical care: does it matter? J Health Social Behavior 1995; 36:1-10.
· Bangsberg D R, Perry, S. (2001).Non-adherence to highly active antiretroviral therapy predicts progression to AIDS. 2001, 15(9):1181-1183.
· Berg, K. M. Arnsten, J. H. (2004). Gender Differences in Factors Associated with Adherence to Antiretroviral Therapy. Journal Gen Intern Med19:1111-1117
· CIA, The World Fact book, (Tanzania), available at http://www.cia.gov/cia/publications/factbook/geos/tz.html (Accessed on 15/01/2013).
· Irunde, L. (2005), A study on antiretroviral adherence in Tanzania: a pre-intervention perspective, 2005.
· Kamuzora, W. (2011), Constraints to effective supply chain of ARVs in Tanzania. Pharma link: A Publication of Ecumenical Pharmaceutical Network Effective pharmaceutical supply chains, Vol. 11: Issue 1 - November 2011.
· Ministry of Health and Social welfare strategy report (2003-2008).
· Mugyenyi, P. (2001), Joint Clinical Research Center, Kampala Uganda. National AIDS Policy Tanzania 2001
QUESTIONNAIRE
This questionnaire is designed to assessment of ARVs adherence among PLWHA in Nyamaganadistrict hospital in Mwanza.The study respondents include PLWHA, Public Health Officials such as Clinicians, Nurses, Pharmacists, Counselors, and Social Workers. The information provided in this questionnaire will be treated confidentially and for the purpose of this study only.
Appendix I: Research Questionnaire
Q 1 What is your age?
a) 15-20 ( )
b) 21-35 ( )
c) 36-54 ( )
d) 55-65 ( )
e) 66 and above ( )
Q 2 What is your Gender?
a) Male ( )
b) Female ( )
Q 3 What is your religion?
a) Muslim ( )
b) Christian ( )
c) Other religion ( )
d) None ( )
Q 4 What is your Level of Education?
a) No education ( )
b) Primary school education ( )
c) Secondary school education ( )
d) Certificate level ( )
e) Diploma level ( )
f) Master level ( )
Q 5 What is your marital?
a) Married ( )
b) Widow ( )
c) Divorce ( )
d) Single ( )
Q.6 what is your Occupation?
a) Famer ( )
b) Self-employed ( )
c) Employed ( )
d) None ( )
Q 7 What is your income per month?
a) 1,000-50,000 ( )
b) 51,000- 150,000 ( )
c) 151,000 -300,000 ( )
d) 301,000 – 500,000 ( )
e) 501,000-800,000 ( )
f) 801,000 and above ( )
C: Awareness, knowledge and attitude of PLWHA on ARV uses in Mwanza.
Q 8 Are you aware of ARVs?
a) Yes ( )
b) No ( )
If YES, to what extent and what is it?
..................................................................................................................................
……..............................................................................................................................................................................................................................................................................................................................................................................................
Q 9 What is the attitude of PLWHA towards ARV uses?
a) Positive attitude ( )
b) Negative attitude ( )
Please explain your response
……............................................................................................................................................................................................................................................................
Q 10 Are you aware of the processes prior accessing ARVs and the duration for up taking?
a) Yes ( )
b) No ( )
Please explain in brief
..................................................................................................................................
……............................................................................................................................................................................................................................................................
D: The effectiveness of ARVs uses to PLWHA in Nyamagana hospital
Q 11 In your view, do the ARVs use effective to PLWHA in Nyamagana Hospital?
a) Yes ( )
b) No ( )
Please explain why
………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………
E: ARVs accessibility to PLWHA in Nyamagana Hospital
Q 12 Are ARVs easily accessible to PLWHA in Nyamagana Hospital?
a) Yes ( )
b) No ( )
Please explain your response
………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………
F: Barriers towards accessing ARVs to PLWHA in Nyamagana district hospital
Q 15 What is the barriers of utilization of ARVs to PLWHA in Nyamagana hospital?
……………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………
G: Recommendations on ARVs accessibilities to PLWHA
Q 16 What do you recommend on ARVs accessibilities to PLWHA?
………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………
Q 17 Do you have any other general recommendation?
………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………
APPENDICES
BONIPHACE OLANGA,
P.O.BOX 16,
MIMIHAPA,
10/12/2019.
DEPARTIMENT OFFICER,
NYAMAGANA HOSPITAL,
P.O.BOX ,1333
MWANZA
C/O
PRINCIPAL’S OFFICE
MIMIHAPA COLLEGE,
P.O.BOX 16,
SHINYANGA.
RE: REQUEST TO CONDUCT A RESEARCH IN NYAMAGANA HOSPITAL.
Refer to the heading above; I am Boniphace Olanga a third year student of clinical medicine from MimiHapa College. I hereby to ask for a permission to conduct a research on the use of antiretroviral drugs among people living with HIV at Nyamagana hospital from November 2019 up to February 2020.The process of data collection will take 1 Week.
It is my expectation that my concern will be considered
Yours,
B. Olanga
BONIPHACE OLANGA
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