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Adherence in swaziland

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Adherence in ART in Swazilandia . Multidimensional Analysis - Systems thinking
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HIV ANTIRETROVIRAL ADHERENCE IN SWAZILAND Understanding the Issue: Putting Systems Thinking to Work. Lomkhosi Tengetile Dlamini. Alexander Bermudez RubashkynMaster of Health Care Administration. TAIPEI MEDICAL UNIVERSITY
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Page 1: Adherence in swaziland

HIV ANTIRETROVIRAL ADHERENCE IN SWAZILAND

Understanding the Issue: Putting Systems Thinking to Work.

Lomkhosi Tengetile Dlamini.Alexander Bermudez Rubashkyn∴

Master of Health Care Administration.TAIPEI MEDICAL UNIVERSITY

Page 2: Adherence in swaziland

Outline

• Background.– Swaziland.– HIV in Swaziland.– Health System.

• HIV Treatment in Swaziland.• Adherence.– Adherence in Swaziland.

• Dimensions of Adherence in Swaziland.• Relation Between Dimensions. (System)

Page 3: Adherence in swaziland

Swaziland

• Population: 1,386,914 (2012) • Life expectancy at birth: 49,9 years9

• Physicians density: 2 physicians available for every 10,000 people (2009)9

• Geography: mostly mountains and hills; some moderately sloping plains9

• Unemployment rate: 40% (2006 est.)9

• Health expenditure: 6,3% GDP (2009)9

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HIV Situation in Swaziland

Variable Value

Life expectancy9 2008 49.9 years

Prevalence of HIV% in (15 - 49 yr old)2 2011 26.3%

Prevalence of TB2 1262 / 100.000

TB patients infected with HIV2 79,80%

Estimated deaths by HIV 20112 6.760

Page 5: Adherence in swaziland

Adherence

• Adherence is defined as the extent to which a person’s behavior in terms of taking medications, following a diet, and executing lifestyle changes or follows agreed recommendations from a health care provider (WHO 2003). In the case of ART this implies taking the drugs in the right quantities, at the right time, and following dietary and other lifestyle changes for a lifetime.

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Adherence in Swaziland• About 184.116 people are living with HIV and

about 86.220 of them are eligible for ART

RegionAdherence Condition 2011

Non - Adherence Adherent

Hhohho 7653 19571Lubombo 2685 11956Manzini 5797 21631

Shiselweni 4425 12677Total 20560 65835

• The Non Adherence is considered as LFU (Lost Following Up) and Stopped treatment.

Page 7: Adherence in swaziland

Dimensions of Adherence in Swaziland.

Adherence

Socio – Cultural and Geographical

factors

Patient related factors

Therapy related Factors

External factors

Health Care System

RelationshipPatient - Provider

Page 8: Adherence in swaziland

Socio Cultural and Geographical Factors• There are several factors, and elements

affecting adherence directly and indirectly .

It is not easy to draw how these factors affect the adherence (that it’s why we use the systems thinking), anyway it is important to say that the Social Stigma is one of the most important factors that can affect the Adherence in a multidimensional way (integrating the other dimensions) so the social Stigma is set from the Education, Religion, Lay Beliefs and the final output will directly affect the the Psychological behavior and the motivation of the individual with HIV.

Page 9: Adherence in swaziland
Page 10: Adherence in swaziland

Patient Related Factors• The Physical and Psychological well-being is determinant. The

adherence can be motivated, as a rewards mechanism for the individual. This means, if the individual after being ill, can improve his/her quality of life after medication, so he/she will be able to adhere to ART treatment strongly.

• Several elements affect in multiples ways the Physical and the Psychological well being. (The systems thinking description can be the tool to show the relationship among those elements)

Page 11: Adherence in swaziland

?

Page 12: Adherence in swaziland

Therapy Related Factors

• The Quality of the medication can be determinant to reach the well being in the individual, the Side effects on the other hand can affect the adherence dramatically.

Page 13: Adherence in swaziland
Page 14: Adherence in swaziland

Relationship Patient – Health Provider• The Relation between Health Provider and Patient is a key

factor, because it can indirectly affect the Health Literacy in the Community, and directly encourage or discourage the adherence to the patient, Several factors and elements contribute in this dimensions, different paths lead to ensure the adherence. The Health System and the Education are the ones mostly surrounding this dimension.

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Health System

• The Health System provides the Infrastructure, the Human Resource, Physical Resources, etc… So the Health System is the framework of the delivery of health services that can also work as an aid in Adherence, the consulting, the counseling, the follow up, the health education on Adherence and etc… by last the management of the resources, for example for the acquisition of ART medications.

Page 16: Adherence in swaziland
Page 17: Adherence in swaziland

External Factors

• Other systems that affect the Adherence, they can be implicit in each dimension, however several elements were identified as a important part of the Adherence because they affect strongly the lack of continuity in treatment: Resources, Supply, etc… as well as also affect indirectly the System, whenever the resources are supporting the treatment, and Adherence itself is the HIV treatment.

Page 18: Adherence in swaziland

Lets going to check again the dimensions of Adherence in Swaziland.

Adherence

Socio – Cultural and Geographical

factors

Patient related factors

Therapy related Factors

External factors

Health Care System

RelationshipPatient - Provider

Page 19: Adherence in swaziland

The next slide explain the System, please don't panic.

Are you ready??...MMM… LET ME CHECK YOUR

“SYSTEM THINKING”

Page 20: Adherence in swaziland

Adherence Motivation

Geographical distancesGood-EfficientCommunicationProvider and patient

Good relationProvider-Patient

Lack of continuity Of care

CommunityHealth Literacy

Good expectationToward treatment

Pharmaceutical Follow up

Language barriers

Professional’sKnowledge aboutPatient Adherence

Health ProfessionalEducation

LayBeliefs

Social/FamiliarSupport

UnqualifiedHealth professionals

Adequate Number andQualified Human Resources inHealthAdequatePolicies inHealth addressed to treatment

EconomicResources for Health HIV Treatment

AdequateInventory in Medications

AccessHealthDelivery

Infrastructure

High expenditure in Health

High costOf medication

LongQueue timesLack of Staff support

Lack of medicationNo supply

SocialStigma

Psychological disorders

Other Physical diseases

PsychologicalWell being

PhysicalWell being

Good livingsconditions

Perception ofLack of effectivity of Medication

No timeliness inThe medication

Natural progress Of HIV

Bad quality Medication

Side Effects

Effectiveness inHIV Therapy

Duration oftherapy

Complexity of Medication

Changes inmedication

FakePerception Of complete wellbeing

Patientconfusion

Irrational uses Of health resources

No resources For Health

Supply problems

PatientReckless carelessness

Health Care System

RelationshipPatient - Provider

Socio – Cultural and Geographical

factors

External FactorsTherapy related

Factors

Patient related factors

System Elements Relationship

Negative influencePositive influence

Patient Confidence

Incorrect Medication labelingIncorrect dispensing

Page 21: Adherence in swaziland

SIYABONGA – KAKHULU THANK YOU VERY MUCH


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