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)
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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