Antiretroviral Care and Treatment Service for PLWHA under National Health Security Program, Thailand for 2 Years

Abstract

          This research was to investigate anti-retroviral (ARV) care and treatment of people living with HIV/AIDS (PLWHA) after being integrated into national health security program for 2 years on health care providers’ perspectives including accessibility to ARV, care and treatment, laboratory investigation, counseling on ARV, data recording and reporting system, referral system and follow-up.

          Participants comprised of physicians, nurses, pharmacists, counselors, laboratory technicians, data recording personnel and HIV/AIDS coordinators of 44 public hospitals of Ministry of Public Health and provincial health offices in 4 provinces participating in ARV project. Selected provinces were Petchaboon, Surin, Supanburi and Suratthani. They were selected based on number of patients
and hospital size. In addition, 4 hospitals were randomly selected for collecting qualitative data. Quantitative data were collected using self-administered questionnaire and qualitative data by indepth interview using interview guideline. Descriptive statistic was applied and described as percent. Content analysis was performed for qualitative data.

          Result. Of 44 health care facilities, majority was community hospital (87.5%) and had ARV clinic (92.5%) opened twice a month. There were 50 clients on average in each time. Health care providers were multi-disciplinary including physician, nurse, pharmacist, counselor, laboratory technician, data recording personnel and HIV/AIDS coordinator. Majority of coordinators was nurse who was in-charge of management as well as counseling, recording and referring case. Majority was female except physician which three of four were male. There was one personnel in each professional except counselors that there were 2. All health care providers shared task on health education to HIV/AIDS patient. Besides, some also provided counseling service. More than half had confidence at fair level to perform counseling which was corresponding with around half having 1-5 years experiences on HIV/AIDS service. Regarding training, HIV/AIDS coordinators and counselors mostly attended training course during 2008-2009. Meanwhile, only one-third of laboratory technicians were trained.

          Ninety percents of health care facilities had ARV adherence assessment systematically. Pill count (72.5%) was mostly used followed by interview (60%). Follow-up cases were either by health care provider team (77.5%) or HIV peer group (67.5%) or both. For laboratory investigation, majority (80%) sent the specimens to other health care facilities.

          Ninety percent of health care facilities had established HIV peer group or holistic care center. Of the total health care facilities, 85% had HIV peer group or holistic care center participating in providing services. Counseling (65%) was major role of the HIV peer group or holistic care center. For referring, 57.5% of health care facilities referred cases according to types of health care insurance followed by side effects (37.5%) and changing drug formula (35%). For service coverage, the least service coverage was anti-HIV test (67.5%) whereas the highest was CBC and SGPT test (97.5%).

          Comparing outcome of ARV care and treatment before and after integrated into national health security program, positive sides were reported on quality of service according to guideline and management in particular service coverage and policy and budgeting support. In addition, there were 106 ARV clients on average in each health care facility with little changes on numbers of new HIV/AIDS patients, whereas numbers of ARV clients were increased. Trend on increased drug resistant cases was also observed.

          Regarding heath care providers’ perspective, they agreed to integrate ARV into national health security program even though there were increased registered HIV/AIDS patients. Majority of them were pleased to provide services. Subsequently, work loads of all professionals were reportedly increased
in particular HIV/AIDS coordinator. Improvements were reported on systematic consultation of specialist and replacing NAPHA recording program with national AIDS program (NAP). However, both NAPHA program and NAP program were run in some health care facilities as the former was still very helpful
for appointment and follow-up cases.

          In conclusion, majority of the health care providers agreed that ARV care and treatment should be integrated into national health security program in addition to observe that there were changes of management system as well as services operated according to guideline increasingly.
However, the most important consequence was increased ARV clients which resulted in increased work load, in particular, data recording. It is suggested that data recording program and data utilization at local and national level should be improved.