Preparation for Long-term Study and Results of Study on Service Provision According to Policy on Care and Treatment for People Living with HIV/AIDS

Abstract

The study was part of a pilot study of the multi-centered study on the Implementation of National Policy on Treatment and Care for People Living with HIV/AIDS (PLWHA) and Its Long Term Impacts on Behavioral, Economic and Social Conditions, aiming to prepare all concerned agencies for a long-term study and to examine the process of care and treatment services provided to PLWHA. The sample sites included all regional, general, community and health promotion hospitals in 4 provinces, one in each region, including Rachaburi, Nong Khai, Nakorn Sawan, and Songkla. Data were collected by interview, assessing the information from hospital records, observing services and exit interviews. The sampled sites and population were; 57 hospitals, 33 high-level administrators, 154 health staff, 74 PLWHAs after receiving services and 63 observations at 24 service sites. The study was carried out during September 2004-September 2005, of which 6 months were for preparing the concerned agencies. Findings included; high-level administrators and hospital staff agreed that Anti-Retroviral Therapy (ART) should be included in the universal coverage scheme, with concerns on financial and personnel burden. Shortages of personnel, particularly physicians were main challenges. Professional nurses were key service providers. Services for PLWHA were managed differently as one-stop services, special clinics on specific day and integrated in daily out-patients services. Pre-test counseling for ANC clients and patients prescribed by physicians was to ask for consent rather than counseling. It took 1-7 days to report blood test results. Various methods other than stated in the manual were used to confirm anti-HIV tests. Meanwhile treatment and care for PLWHA on ART seemed to be fully implemented according to national guidelines, care for PLWHA not on ART included only the appointment for CD4 tests every 6 months. There were no linkages of HIV testing registration to care services. So called counseling seemed to be just giving information. Existing services were not responsive to PLWHA who were still not ready to disclose them selves, while those joining PLWHA clubs received knowledge and mental support from their friends. The exit interviews revealed that PLWHA mostly felt satisfied with service providers, especially nurses. Recommendations based on the findings were; 1) improve services by consultations among high-level administrators and staff, considering on differences of PLWHA, i.e. disclosures status, on ART as well as linkages from HIV testing registration to care services, 2) improve pre-test and post-test counseling, 3) review the practices on HIV testing for diagnosis, 4) improve counseling services toward comprehensive biological, mental, social and economic dimensions, 5) assess roles of PLWHA clubs and 5) improve service recording system for the use of the hospitals.