Effectiveness of Focused Intervention on ART Adherence Nutritional status and Quality of Life of HIV Infected Children attending ART Clinic

Shankar Shanmugam, R (2012) Effectiveness of Focused Intervention on ART Adherence Nutritional status and Quality of Life of HIV Infected Children attending ART Clinic. Doctoral thesis, The Tamilnadu Dr. M.G.R. Medical University, Chennai.

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Abstract

The management of HIV requires not only ART treatment but it needs a holistic approach for its management. The physician does not have adequate time to provide holistic care to the HIV infected People. Counsellors are also providing counseling services which is inadequate. The introduction of Task sharing strategy to involve Nurses in the management of HIV care has given promising and effective results in African countries. Such effort has not been done in India inspite of having more number of HIV/AIDS clients. Hence it was planned to conduct a research about effectiveness of Focused (Nursing) intervention on ART adherence, Nutritional status and Quality of life among HIV infected children attending ART clinic involving Nurses. This research findings will give us an insight about the role of a nurse pertaining to ART adherence, Nutritional counseling and strategies that increases the quality of life of children living with HIV/AIDS. Data was collected from 500 children attending ART clinic, Institute of Child health & Hospital For Children, Egmore, Chennai – 600 008 using structured Questionnaire and scales to assess the ART adherence, Nutritional Status and quality of life among children attending ART clinic. A study sample of 500 were enrolled and this study sample was divided into 2 groups as experimental & Control group. This subjects were interviewed during 1st day (Baseline), 3rd month & 6th Month to collect necessary data from the children and Care giver in both experimental & Control group. The experimental group received the Focused (Nursing) Intervention during baseline & 3rd month after collecting the required data. In the Control group, Care giver does not receive any intervention from the interviewer / Researcher. Data collection was started from October 2009 to September 2011 & 5 -7 care givers & children were interviewed per day. The Main finding of the study as follows: The main finding of this study comprises of the effectiveness of focused (Nursing) intervention on ART adherence, Nutritional status and quality of life among HIV infected children on ART. * Most of Children were in the age group of 10 - 12 years in both Experimental (53.4%) & Control Group (53.2%). * Male children were the dominant group compared to female counterparts in both Experimental (56.80) & Control Group (54.8%). * Most of the Caregivers were in the age group of 20-60 years in both Experimental (96.8%)& Control Group(96.8%) Most of the Care givers were Females compared to males in both Experimental (64 %)& Control Group(67.2 %). * Most of the care givers were Parents (Father/Mother) in both Experimental (76.4%) & Control Group (77.2%). * Most of Parents were alive to both Experimental (82.8%) & Control Group (83.6%). * Most of the HIV infected children were living with Biological parents in both Experimental (81.2%) & Control Group( 82.4%). * Most of the children were attending schools (1-6 std) in both Experimental (95.6%) & Control Group (96%). * Most of the Care givers finished middle level schooling to Collegiate level in both Experimental (74.2%)& Control Group (76.8%). * Most of the Children had more than 1 year on HAART in both Experimental (86.4%) & Control Group (87.2%). * Most of the care givers earn more than Rs 5000/pm in both Experimental (64.4%) & Control Group (64.4%). * 11% of the HIV infected children are taking TB drugs in both Experimental & Control Group. * Most of the Children are in the Clinical stage I (66%) in both Experimental & Control Group. * The common symptoms experienced by the HIV infected children were Fatigue, pain, Fever, Nausea, sleep disturbances, Cough, Occasional Diarrhea, Skin manifestation and had ear aches. * The common reasons stated by the Care giver for missing doses were forgot, Ran out of pills, financial constraints, sick, side effects of the Drugs, Travelling away from home. Busy with other things and other reasons. * There was no change in Control group on the level of ART adherence (88.58% to 89.83%).The level of ART adherence after Focused Intervention among the HIV infected children were increased from 88.13% to 95.08% in the experimental group. It was statistically significant (p=0.001). * On Comparing the ART adherence level between Experimental group & Control group, there was no change in the baseline adherence level in both groups. Before & after focused (Nursing) intervention showed there was an increase in the Adherence level in the Experimental group during 3rd (P=0.01**) & 6th (P=0.001***). onth when compared with the Control Group. It was statistically significant. ART adherence was increased drastically (≥95%) in Experimental group compared with Control group. * There was no difference in all the three anthropometric indices of the control group during 3rd & 6th Month. The percentage of Malnutrition indices ‘underweight’ has improved in the Experimental group ((p=0.04*). there is no remarkable change in the stunting and wasting in both groups during 3rd month. The percentage of underweight (p=0.01*) and stunting (p= 0.04*). has improved in the Experimental group and there was no remarkable change in the wasting indices of Experimental group at the end of 6th month. * No significant change in Control group during 3rd and 6th month when compared with Baseline Quality of life. All domains((General Health rating, Physical functioning, Psychological wellbeing, Social & Role functioning, Health care utilization & Symptoms[reduction]) in the Quality of life has improved significantly in the Experimental group in age group of 3-12 years during 3rd and 6th month. * The level of ART adherence was significantly associated with child age, Care givers relationship with child, Survival of parents, living with biological parents in the Experimental group and in the Control group, the level of ART adherence was associated with Survival of parents, Care givers Educational level and Child’s educational level. * The Malnutrition indices such as Underweight(WAZ), Stunting(HAZ) and Wasting(WHZ) has significant association with survival of the parents, Care giver’s educational level, and Income of the family in the Experimental group and in the control group, stunting & wasting has significant association with child age, care giver’s age, Child sex and duration of Child on ART. * The level of Quality of Life (QOL) has significant association with child’s age, care giver’s educational level and duration of Child on ART in the Experimental group and in the Control group, Care givers Educational level and duration of Child on ART has significant association with QOL of HIV infected Children. * In this study, there was a positive (fair) correlation between the post test ART adherence and the nutritional status in the Experimental group and in the control group, a poor correlation was found between the ART adherence and Nutritional status. * In this study, there was effectiveness of Focused (Nursing) intervention on ART Adherence among the Experimental group compared to Control group. The Net gain score was 6.96% in the experimental group when compared to the Control group score of 1.25%. From the above data, it can be concluded that the Focused (Nursing) intervention has got good impact over ART adherence, Nutritional status, and Quality of life for HIV/AIDS infected children in the Experimental group. Nurses play an essential role in the promotion of successful adherence, Nutritional Counseling, thereby Nurses can increase the QOL of the HIV infected Children. Research has shown a trusting Nurse-patient relationship, where a patient feels safe and comfortable. Nurse can promote ART adherence level, Nutritional status. etc. Many healthcare systems identify adherence as the nurse’s number one responsibility when treating a patient who is receiving ARV treatment. Nurses play a key role in creating the right environment: safe, non-judgmental, confidential. The Nurses Play a vital role in assessing the ART adherence and Nutritional status of the child infected with HIV/AIDS. Based on the findings, She is able to implement appropriate focused (Nursing) intervention measures to promote ART adherence, policy to assess and implement suitable Nutritional protocols for HIV/AIDS children. Subsequently the Quality of life of the HIV/AIDS Children will also be improved by following the Quality of life improving practices/strategies by focused (Nursing) intervention methods. Task sharing to Nurses have been proved successful in many African countries but still; in India it has not been implemented inspite of having more number of HIV/AIDS patients. For this Government should implement new training initiatives for Nurses and evaluate for its outcome.

Item Type: Thesis (Doctoral)
Uncontrolled Keywords: Effectiveness, Focused Intervention, ART Adherence Nutritional status, Quality of Life, HIV Infected Children, ART Clinic.
Subjects: NURSING > Paediatric Nursing
Depositing User: Subramani R
Date Deposited: 23 Jan 2022 14:39
Last Modified: 23 Jan 2022 14:39
URI: http://repository-tnmgrmu.ac.in/id/eprint/19073

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