IDENTIFYING NURSES APPROACHES TO HIV NUTRITIONAL EDUCATION AND THE CHALLENGES THEY FACE

Abstract

Nutrition is a vital component in the management of HIV/AIDS, especially considering the fact that this condition which impairs the ability of the immune system to play its role has no cure.

This means providing nutrition education becomes a vital component of nursing management for these patients.

This study thus sought to explore nurses’ approach to nutrition education for these patients as well as the nurses’ and patients’ challenges in the process. The objectives of this study were to find out the nurses’ approach to HIV nutrition education and barriers faced by nurses and HIV patients in the process.

Using a qualitative design, 10 nurses and 10 patients were selected purposively to take part in semi-structured interviews. Interviews were tape-recorded, transcribed, and analyzed with the aid of Alas.ti version 5.2.

Three themes and thirteen categories emerged from the data. The main themes included: nurses’ approach to nutrition education, challenges faced by nurses and patients in the education process.

The results showed that there were two major approaches to nutritional education; done as a routine activity and when there was a need. The findings again showed that nurses were responsible for deciding the nutrition topics and content to be taught.

The process of teaching was basically deciding the topic and content, using lectures and/or discussions, to transmit the knowledge, use questions and feedback to evaluate patients learning. Lack of formal teaching guides, inadequate knowledge, insufficient teaching aids, heavy workload, etc were all identified challenges nurses faced in the nutritional education process.

Lack of supplementary reading materials, low retainment level and superficial teaching, etc were all identified challenges faced by patients in the education process.

Further education opportunities for nurses, availability of teaching guides, provision of supplementary materials, etc will help to improve nutritional education.

This study can guide nurses, patients, and the hospital to work collaboratively in improving nutritional education in treatment centers.

CHAPTER ONE

INTRODUCTION

1.0 Introduction

Nutritional care has recently come to the forefront as a critical component of any comprehensive treatment, care, and support package for people living with HIV/AIDS (PLWHA). This research revolves around this concept with a focus on education.

In chronic diseases such as HIV, patients are involved in the care. Patients are expected to be involved in self-care management in order to promote health and delay disease progression.

Making proper food choices, the timing of eating and so many other nutritional factors are relevant in self-care management by the patient. We would all agree with the opinion that, a patient cannot make proper decisions about nutrition if he/she is not knowledgeable about what it entails.

Now, health professionals come in to make sure that patients are been taught so that they will acquire this knowledge, skills, and attitudes. However, nurses will be more inclined to educate these patients by virtue of their professions. Nursing is all about care, and caring for someone who is sick also involves teaching this person to make proper health choices.

1.1 Background

1.1.1 Historical background

The earliest known case of infection with HIV-1 in a human was detected in a blood sample collected in 1959 from a man in Kinshasa, the Democratic Republic of the Congo. (How he became infected is not known.) Genetic analysis of this blood sample suggested that HIV-1 may have stemmed from a single virus in the late 1940s or early 1950s1.

In the 1980s and 1990s, prevention, care and treatment programs were launched through missions around the world using approaches that fit within the social context of each country and targeted the most vulnerable populations. The proliferation of the disease across sub-Saharan Africa prompted us to intensify our focus on this region2.

In 2000, USAID convened the first agency-sponsored international meeting on male circumcision and HIV prevention. We also began some of the first prevention of mother-to-child transmission programs with the Elizabeth Glaser Pediatric AIDS Foundation2.

It was quickly realized that fighting this disease would require more than just new medication and care. In 2001, we forged a partnership with the International AIDS Vaccine Initiative (IAVI) to invest in research and development for an effective vaccine.

To date, IAVI has made a number of groundbreaking discoveries, including several potent new antibodies to HIV, adding more vitality to this game-changing effort. In the same year, USAID commenced three pilot trials of antiretroviral treatment in Kenya, Rwanda, and Ghana2.

In 2003, President Bush announced an unprecedented initiative to ramp up the U.S. Government’s commitment to HIV/AIDS in the developing world.

The President’s Emergency Plan for AIDS Relief (PEPFAR) continues to be the largest bilateral AIDS program in the world, touching millions of lives through prevention, care, and treatment. Through our global network of missions and partners, USAID currently implements more than half of all PEPFAR programs2.

Through PEPFAR, USAID has contributed to saving lives through a variety of voluntary prevention interventions, counseling, testing and care programs. In 2011, there were more than 3.2 million people receive lifesaving treatment through the support2.

As the HIV pandemic enters its fourth decade of existence, the drive for ‘integrated’, HIV and nutrition programming continues to gain momentum3. Over the past decade, the integration agenda has been a priority for NGOs, host- governments and bi-lateral and multi-lateral donors alike.

This global conversation began (at scale) with the landmark, April 2005 WHO consultation on Nutrition and HIV/AIDS, held in Durban, South Africa, with participation from all of the major UN agencies, the World Bank, and NGOs, HIV networks, regional groups and donors from 20 countries across southern and east Africa.

The Durban consultation reviewed the evidence and declared the urgent need for the integration of nutrition into an essential package of care, treatment and support for people living with HIV and AIDS .

Less than a year later, the NGO community moved the integration agenda forward with the Africa Forum, held in Zambia in 2006, and again in Malawi in 2009. These two Forums brought together 170 HIV, food security and nutrition practitioners from 17 sub-Saharan African countries, both to share promising practices in integrated HIV, food security and nutrition programming; and, as importantly, to make recommendations to donors and policymakers about the importance of integration3.

In September 2006, the U.S. Government (USG) responded to these calls with the release of PEPFAR Policy Guidance on the Use of Emergency Plan Funds to Address Food and Nutrition Needs. The Guidance was approved and disseminated to country PEPFAR teams to guide food security and nutrition programming3.

Finally, in the 2008 Authorization Bill, Congress stipulated that a group “is directed to provide not less than $100,000,000 for programs that address short-term and long-term approaches to food security as components of a comprehensive approach to fighting HIV/AIDS, and is encouraged to support programs that address the development and implementation of nutrition support, guidelines, and care services for people living with HIV/AIDS.3

This small but significant step towards ‘mandating integration’ contributed to the proliferation of Food by Prescription (FBP) programming in southern and east Africa. At the time, FBP programming claimed its place as a critical component of nutrition assessment, education and counseling (NAEC), highlighting the need to view food as medicine in the context of HIV and acute malnutrition3.

With the expansion of FBP programming underway, concern soon arose that food was being overly prioritized within the Care and treatment package and that nutrition assessment and counseling should be in place before specialized food products were rolled out. It was felt that a more nuanced, balanced approach was required. NACS emerged in this context, with ‘assessment’ and ‘counseling’ placed at the forefront, and with food representing only one aspect of the ‘support’ component3.

Different countries are currently at different stages of NACS programming. Kenya, Malawi and Uganda were early adopters and have implemented NACS for several years. Ethiopia and Tanzania began in 2010, and in 2012, a total of 15 countries are using the NACS approach.

While the core set of NACS services is similar across countries, different approaches to the model are being tried, with variations in government ownership, community linkages and implementing partner configurations3.

In September of 2010, the first international conversation around NACS programming took place in the form of a four- day meeting entitled ‘Nutrition Assessment, Counseling, and Support in HIV Services: Strategies, Tools, and Progress’. Held in Jinja, Uganda, the meeting brought together 98 participants from a variety of government ministries and agencies, UN agencies, and implementing and technical assistance partners. The meeting was organized by FANTA, in collaboration with URC/Nulife, the Regional Centre for Quality Health Care and the Uganda Ministry of Health and funded by USAID’s Office of HIV/AIDS, Bureau for Global Health3.

The theme of integration has been high on the agenda for a Group fighting HIV/AIDS for some time, and this meeting was an effort by HIV Technical Working Group (TWG) and Nutrition TWG to demonstrate that integration should not only occur programmatically, but likewise through the creation of collaborative processes for discussion, debate and learning.

Finally, the involvement of the Technical and Operational Performance TOPS and the Food Security and Nutrition (FSN) Network underscored the interest of the US NGO community in deconstructing the funding and operating silos that have built up around HIV, health and nutrition over time, and replacing them with mechanisms that reach across sectorial boundaries. In this vein, participants of this SOTA meeting included the TOPS FSN Network, along with other key nutrition and HIV audiences3.

1.2 Problem Statement

Good nutrition in HIV increases resistance to infection, slows disease progression, improves energy, and makes ARVs work better80. From the above importance of nutrition in HIV/AIDS, proper nutritional education is an essential component of nursing care.

Nutrition education needs to be planned, delivered in a systematic manner, evaluated for understanding and implementation76. Cameroon’s ministry of public health opened HIV treatment centers across the country where nurses and other health professionals provide focused care.

By virtue of their proximity to, and duration of interaction with the patients, nurses play a key role in the health education process. It is their approach to this that determines whether patients learn and implement proper nutritional habits necessary for their condition.

It was therefore important to study the nutritional education process and barriers to effective teaching and learning in our HIV treatment centers so as to provide recommendations for enhancement and improvements.

1.3 Justification

Studying the nutritional education process would provide information on the strengths or areas of weakness of the process.

Nurses and other care providers can now use this to consolidate the positive aspects of nutritional education and to make improvements in the areas where necessary. This research finding may also raise the need for further research.

1.4 Research Goal

The goal of this research was to explore the nurse-led nutritional education process.

1.5 Research Questions

1. How do nurses in HIV treatment centers provide nutritional education?
2. What are nurses’ challenges in the nutritional education process at treatment centers?
3. What are patients’ challenges in the nutritional education process at treatment centers?
4.