Self-management of adults living with HIV on antiretroviral therapy in North-west Ethiopia
Date
2021
Authors
Areri, Habtamu Abera
Editors
Advisors
Wiechula, Rick
Harvey, Gillian
Marshall, Amy
Harvey, Gillian
Marshall, Amy
Journal Title
Journal ISSN
Volume Title
Type:
Thesis
Citation
Statement of Responsibility
Conference Name
Abstract
Background: As a result of the introduction of antiretroviral therapy (ART), human immunodeficiency virus (HIV) is becoming a long-term condition requiring effective self-management behaviour to maintain physical health and well-being. In Ethiopia, treatment guidelines have been revised to encourage individual engagement in self-management behaviours. However, HIV-related complications remain common. There is no established evidence on the self-management behaviour of adults living with HIV (ALWHIV) on ART in Ethiopia. Aim: The overall aim of this study was to determine the daily self-management behaviours and influencing factors among adults living with HIV on ART in Ethiopia and the most effective interventions to improve these behaviours. Methods: Individual and Family Self-Management Theory guided the studies included in this thesis. The study employed a systematic review and sequential explanatory mixed methods. A systematic review of experimental studies addressing interventions to improve self-management of adults living with HIV on ART was also conducted. The reviewed papers’ methodological quality was assessed using the Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument (JBI SUMARI). The JBI SUMARI standardized data extraction tool was used for data extraction. Finally, a narrative synthesis was undertaken for the included studies; due to study heterogeneity, it was not possible to conduct a meta-analysis. The study employed sequential explanatory mixed methods. A quantitative study on a sample of 415 adults living with HIV on ART was carried out to identify the level of self-management (SM) and influencing factors in the study population. A face-to-face survey tool was used, and the data were entered and analysed using SPSS version 25.0. A qualitative study, informed by the survey findings was conducted to explore the key findings of the survey in greater depth. Eleven interviews were conducted to explore the self-management (SM) behaviours. The participants volunteered to be contacted during the preceding quantitative study. The audio-recorded interview data and field notes were transcribed and translated into English. Data were entered into NVivo 12 for data management and analysis. The interview data were coded inductively and subjected to thematic analysis. Results: The survey findings indicated a low level of SM behaviours amongst the study population compared to global studies. Factors influencing self-management were interconnected and included educational status, residence, self-efficacy, spiritual practices, income, medication adherence support, disclosure of HIV status, and experiences of stigma and discrimination. The systematic review identified multi-component interventions to improve self-management behaviours. Skills training with phone counselling, counselling with a symptom management manual, and technology-assisted interventions were commonly identified as effective interventions to enhance self-management behaviours. Conclusions: This study set out to add to the understanding of SM of ALWHIV in the Ethiopian context and identify feasible interventions that could be implemented to address known barriers to SM. The barriers have been mapped to contextually appropriate, evidence-informed interventions to generate policy and practice recommendations that could help to address the SM challenges faced by ALWHIV in Ethiopia. The thesis has elucidated the complex, inter-related factors at the individual, socio-demographic, disease-related and health care level that influence an individual’s ability to self-manage their HIV condition. Multi-component practical interventions are suggested for HIV care providers.
School/Discipline
Adelaide Nursing School
Dissertation Note
Thesis (Ph.D.) -- University of Adelaide, Adelaide Nursing School, 2022
Provenance
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