Evaluating the knowledge-adherence of couples' voluntary HIV counseling and testing counselors: implications for patient management in Lusaka, Copperbelt and Southern Province, Zambia Open Access

Visoiu-Knapp, Ana Maria (2014)

Permanent URL: https://etd.library.emory.edu/concern/etds/zc77sq737?locale=en
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Abstract

Objective: To evaluate knowledge adherence at the nurse counselor level in government clinics in Lusaka, Copperbelt and Southern Province, Zambia.

Design: Analysis of knowledge, attitudes and practices regarding Couples' Voluntary HIV Counseling and Testing (CVCT) standard operating procedures (SOPs) among CVCT nurse counselors was conducted on results yielded by cross-sectional quantitative surveys.

Methods: Using content and thematic analyses of 23 qualitative interviews and semi-structured observations, a quantitative survey was developed, piloted and administered to 71 nurse counselors. Descriptive statistics (counts and percentages for categorical variables; means and standard deviations for continuous variables) were calculated for survey results stratified by geographic region. Post hoc bivariate analyses were conducted on survey variables.

Results: 71 surveys were administered to government clinic CVCT nurse counselors in Lusaka, Copperbelt and Southern Province. Survey questions pertained to resources and trainings, CVCT service delivery and follow-up, performance-based incentives, and the integration of Long Acting Reversible Contraceptive methods (LARC) and CVCT in Under-5 and Family Planning clinics. Knowledge-adherence findings: Most Knowledge, Attitudes and Practice (KAP) variables did not predict adherence (i.e. though counselors report flip charts to be useful, most did not use them consistently). Knowledge of incentive scheme: Despite ZEHRP emphasis on performance-based incentive scheme, counselors exhibited low knowledge about monthly performance measurement metrics. Only 35% of counselors knew that changes to the performance-based incentive scheme occur on a monthly basis; knowledge about purpose of monthly changes was below 60%. Knowledge of CVCT follow-up referrals for discordant couples was only 79%. Regional differences: low use of refresher trainings and low appreciation of incentive scheme in Copperbelt Province.

Conclusion: Provider-level adherence to SOPs designed to improve client management, increase client retention and decrease barriers to follow-up needs to undergo a process of continuous quality improvement. Regional differences are important to understand when identifying and addressing counselor knowledge-adherence issues.

Table of Contents

Chapter 1

Introduction………………………………………………………………………………………………………………………………….......1

Chapter 2

Literature Review ………………………………………………………………….………………….……………………………………....4

Zambia Sociopolitical Context …………………………………………………………………………………………………………….4

Zambia HIV Statistics ………………………………………………………………………………………………………………………….4

Zambia Fertility Statistics …………………………………………………………………………………………………………………..5

Other Comorbidities and Health Infrastructure Challenges………………………………………………………………...7

Zambia-Emory HIV Research Project ………………………………………………………………………………………………….8

Client-level Barriers to HIV Care…………………………………………………………………………………………………………12

Provider-level Barriers to HIV Care ……………………………………………………………………………………………………13

Chapter 3

Methods........................................................................................................................21

Ethical Considerations ………………………………………………………………………………………………………………………..21

Participant Recruitment ……………………………………………………………………………………………………………………..21

Study Design ……………………………………………………………………………………………………………………………………...23

Figure 1: Flow of Study Procedures towards Survey Development…………………………………………………...23

Figure 2: Social Cognitive Theory (Bandura, 2001)…………………………………………………………………………….24

Observations ……………………………………………………………………………………………………………………………………...24

In-Depth Interviews ……………………………………………………………………………………………………………………………28

Quantitative Surveys ………………………………………………………………………………………………………………………….29

Measurement and Analysis ………………………………………………………………………………………………………………...31

Results..........................................................................................................................32

Table 1 ……………………………………………………………………………………………………………………………………………….32

Table 2 ……………………………………………………………………………………………………………………………………………….38

Table 3 ……………………………………………………………………………………………………………………………………………….42

General Information …………………………………………………………………………………………………………………………...45

Resources and Training ………………………………………………………………………………………………………………………46

Performance-Based Incentive Scheme ………………………………………………………………………………………………48

CVCT Service Delivery ……………………………………………………………………………………………………………………….49

Follow-Up …………………………………………………………………………………………………………………………………………..50

Referrals ……………………………………………………………………………………………………………………………………………..51

Barriers to LARC Methods ……………………………………………………………………………………………………………..……52

Integration of LARC and CVCT in Under-5 and Family Planning Clinics (Table 3)……………………………….53

Chapter 4

Discussion …………………………………………………………………………………………………………………………………………..54

Limitations…………………………………………………………………………………………………………………………………………...61

Conclusion and Recommendations.......................................................................................64

Additional Pages

References.....................................................................................................................65

Appendices....................................................................................................................71

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