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CHAPTER ONE

INTRODUCTION

1.1     Background to the Study

The practice of HIV care has dramatically changed during the past two decades. Knowledge regarding HIV pathophysiology has quickly accumulated and has led to the development of new medications. In addition to knowledge updates, the attitudes of health care professionals toward current concepts about HIV care are even more critical. The core philosophy of modern HIV care puts emphasis on patient autonomy and optimal utilization of health care professionals’ different specialties. Research evidence derived from clinical, economic, and humanistic outcomes also strongly supports the importance of patient autonomy and a team approach to HIV care. Pharmacists’ knowledge and attitudes toward HIV can significantly influence patient outcomes (Hsiang-Yin, 2014).

Given the prevailing concept of a team approach toward HIV care, only when all health care providers share the same high level of knowledge and positive attitudes could the quality of patient care be ensured (Hsiang-Yin, 2014). Pharmacists are highly accessible to chronically ill patients such as those with HIV, especially when the disease becomes controlled and the patient only needs to visit a pharmacy to have their prescription refilled (Hsiang-Yin, 2014). Pharmaceutical care has significantly reduced the occurrence of drug-related problems and fulfilled the desired outcomes of drug therapy in other diseases and conditions such as anticoagulation, hyperlipidemia, and asthma (Jungnickel PW, 1997). Studies have also shown that pharmacists’ participation in the management of poorly controlled HIV patients resulted in better outcomes (Jungnickel PW, 1997).

This study is focused on the attitude and knowledge of community pharmacists on HIV infected which also received special mention in the WHO adherence report (WHO, 2013). HIV infected is a disease of pandemic proportions increasingly making its presence felt in the developing world where, it is predicted, most of the world’s HIV burden will in future be borne (King H, 1998). Furthermore, it is a disease where antiretroviral therapy and lifestyle modification play major roles in the treatment and management of the condition, (Chitre MM, 2016) and where health promoting interventions in both these therapeutic areas are accommodated within the pharmacist’s defined scope of practice (Wermeille J, 2014) (Kiel PJ, 2015) (Johnson LC, 1997).

Most, if not all, HIV patients make use of long-term antiretroviral therapy to manage their disease. The prescription refill dynamic provides for frequent personal and informed contact between the patient and the pharmacist and thus positions the community pharmacist for roles in HIV care beyond the traditional medicine dispensing role (Kiel PJ, 2015) (Johnson LC, 1997). Encounters of this nature present pharmacists with ideal opportunities to provide pharmaceutical care across a range of chronic diseases.

Today, 300 million people have HIV, mostly (that is 6.6% of the adult population) (Mbanya, 2009). Each year the number is increasing by 7 million (International HIV Federation, 2009). By 2030, 438 million people will have HIV (7.8% of the adult population), a rise of 54% in 20 years (Mbanya, 2009). This is more than the populations of Mexico, the United States and Canada combined.

HIV which was once considered a rare disease in sub-Saharan Africa has its prevalence rising rapidly (Mbanya, 2010). In 2010, over 12 million people in Sub-Saharan Africa were estimated to have HIV, and 330,000 people would die from HIV-related conditions.

Over the next 20 years, it is predicted that Sub-Saharan Africa will have the highest growth in the number of people with HIV of any region in the world – the 2010 estimate is predicted to almost double in 20 years, reaching 23.9 million by 2030(International HIV Federation, 2009).

There are widespread indications in sub-Saharan Africa that as many as 85% of cases have not been diagnosed, although the rate of diagnosis is increasing (Baldé, 2016).

A call for action against HIV in terms of advocacy, promotion of awareness, and public health policies that empower people to HIV self-management (Alla, 2008) a concept towards which community pharmacists are uniquely positioned to contribute cannot be over emphasized.

Patients’ empowerment and self-management mediated by education and motivation are very important (care, 2011). Logically, these would be more effective if support is delivered via readily accessible venues such as community pharmacies. Several models for involving community pharmacists in HIV care have been described elsewhere

(JR, 2012) though they are not widely practiced in less developed parts of the world (AlFadhel MA, 2012).

In Rivers State, Nigeria, a wide network of community pharmacies is available which could potentially undertake a valuable supporting role in HIV management and care. However, knowing the pharmacists’ own level of readiness (knowledge and motivation) is a prerequisite step for any future planning. This study, therefore, attempts to evaluate HIV-related attitudes of community-based pharmacists in Rivers State, Nigeria, and secondly to assess their basic knowledge of HIV that would help evaluate their ability to undertake a HIV educator role.

 

1.2     Statement of the Problem

Currently, the level of knowledge and attitude of community pharmacists   towards HIV in Rivers State, Nigeria, is not known. The research problem is subject to the influence of a number of factors including: the nature of the disease, accepted models of care in HIV infected, international evidence relating to pharmacist knowledge and attitude designed to promote outcome in HIV infected patients and, most importantly, the capacity of Nigerian community pharmacists to deliver HIV care given the dynamics of pharmacy practice in the country

 

1.3     Objectives of Study

The main objective of this study was to assess the Knowledge, Attitude, Demographic variables and their associations towards HIV infected patients in Rivers State, Nigeria. The specific objectives are;

1. To assess the knowledge and attitude of community pharmacists on HIV infected patients in Rivers State.
2. To identify demographic variables associated with the differences in community pharmacist’s knowledge and attitude towards HIV infected patients.
3. To determine any association between knowledge and attitude of community pharmacists towards HIV infected patients in Rivers State.

 

1.4     Research Questions

The following research questions were considered:

1. What is the knowledge and attitude of community pharmacists towards HIV infected patients?
2. What is the association of the demographic variables of community pharmacists with their knowledge and attitude towards HIV infected patients?
3. What is the association of the level of knowledge of community pharmacists with their attitude toward HIV infected patients?

 

1.5     Significance of the Study

The results for this study may influence public policy and help change the perceptions of patients and health care professionals about HIV care. Community pharmacies are ideally placed to contribute to disease state management (DSM) programmes and assist in the detection, education and referral of individuals at risk of HIV (Teh, 2011). They are widely accessible, available, in frequent contact with the public and able to access people who are apparently healthy (Jaber, 1996). The levels of the community pharmacists’ knowledge and attitudes towards HIV infected are not known in Nigeria, since literature research revealed that no study has been conducted and documented to establish the two concepts. A Pub med search using the search term, ‘community pharmacist knowledge or attitudes AND HIV infected AND Nigeria’, produced no results.

The existence of perceived differences or discrepancies between what exists and the ideal or desired situation in terms of levels of community pharmacists’ knowledge and attitudes towards HIV infected is eminent. The reasons for this discrepancy is currently unclear and this propelled the development of a research question which could have more than one possible solution. The findings of this study therefore will allow the policy makers come up with informed evidence based decisions on pharmaceutical care regarding HIV infected in our communities. This study will generate information regarding the current state of HIV care in community pharmacies and if need be help the policy makers improve sensitization hinged on health style modifications in preventing or delaying the complications of HIV. Therefore, the patient is an ultimate beneficiary in the communities to which all HIV patients belong. Furthermore, this study:

1. Will provide important data for informing people inside and outside the pharmacy profession about the knowledge of community pharmacists towards HIV infected.
2. Provide baseline information for investigating what is good and not for HIVs in our community pharmacies and
3. Enable assessment of whether community pharmacy services are meeting current health care needs regarding HIVs and identification of ways in which services should be improved.