Table of Contents
Title Page i
Approval Page ii
Certification iii
Acknowledgements iv
Table of Contents vi
List of Table viii
List of Figure ix
Abstract x
Chapter One: Introduction 1
Background of the Study 1
State of the Problem 8
Purpose of the Study 9
Research Questions 9
Hypotheses 10
Significance of the Study 10
Scope of the Study 12
Chapter Two: Review of Related Literature 13
Conceptual Frame work 13
•HIV & AIDS 13
•Antiretroviral drugs 21
•Availability and utilization of health services 27
•Demographic factors associated with ARV drugs availability
and utilization 31
Theoretical Framework 34
•Mechanics general theory of help seeking 34
•Suchman’s theory on stages of illness and medical care 35
•Health belief model 36
•Choice making model 37
Empirical studies on Availability and utilization of ARV Drugs in the
Treatment of HIV & AIDS 38
Summary of Review of Related Literature 44
Chapter Three: Methods 45
Research Design 45
Area of Study 45
Population for the Study 46
Sample and Sampling Techniques 46
Instrument for Data Collection 47
•Validity of Instrument 47
•Reliability of Instrument 47
Method of Data Collection 48
Method of Data Analysis 48
Chapter Four: Results and Discussions 49
Results 49
Discussion of Major Findings 58
Chapter Five: Summary, Conclusion and Recommendation 64
Summary 64
Conclusion 66
Recommendations 67
Limitation of the study 68
Suggestion for further studies 68
References 69
Appendices 76
List of Tables
Table 1 – Mean ratings of available ARV drugs in health facilities 49
Table II – Mean ratings on client utilization of ARV drugs by health providers. 50
Table III – Mean on utilization of ARV drugs based on gender 51
Table IV – Mean ratings of extent of utilization of ARV drugs based on PLP age 51
Table V – Mean on extent of utilization of ARV drugs based level of education 52
Table VI – Mean on extent of utilization ARV drugs based on level of income 52
Table VII – Mean on extent of utilization of ARV drugs based on marital status. 53
Table VIII – Mean rating of available ARV drugs based on location 53
Table IX – T-test on extent of availability of ARV drugs according to location 54
Table X – T –test on extent of utilization of ARV drugs according to gender 54
Table XI – ANOVA on extent of utilization of ARV drugs according to age 55
Table XII – ANOVA on extent of utilization of ARV drugs according to level
of income. 56
Table XIII – ANOVA on extent of utilization of ARV drugs according to level
of education 56
Table XIV – ANOVA on ARV drugs utilization base on marital status. 57
List of Figures
Figure I – Human Immunodeficiency – Virus Structure 17
Figure II – Diagrammatic Schema Showing conceptual frame work of
availability and utilization of ARV drugs in treatment of HIV/AIDS 33
Figure III – Diagrammatic Schema showing theoretical frame work of
availability and utilization of ARV drugs 38
Abstract
This study sought to determine the availability and utilization of ARV drugs in the treatment of HIV & AIDS in designated hospitals in Anambra State. Eight specific objectives with corresponding research questions were posed to guide the study. Literature pertinent to the study was reviewed. Descriptive survey research design was adopted for the study. Population for the study was 15,816 PLP and 88 health providers in the eight designated hospitals in Anambra State. Multi stage sampling and probability sampling techniques were used for the study. The sample size for the study was 520 respondents (476 PLP and 44 health providers). Two self structured questionnaires were used for the study; questionnaire for people living positive (PLP) and questionnaire for the health providers (QHP). Validation of instrument were done by three experts from the department of Health and Physical Education. Crobanch Alpha statistics was used to establish the internal consistency of the instrument and a reliability index of .88 was obtained. The data was analysed using mean and standard deviation for answering the research questions, t-test and ANOVA were used to test the hypotheses at 0.05 level of significance. The result showed that: ARV drugs were rarely available in the facilities, clients utilize ARV drugs to a high extent, Male PLP ( 1.94) utilize the ARV drugs more than their female ( 1.92) counterpart, PLP of all ages utilize ARV drugs but highest utilization rate is within the age range of 36-40years ( 2.04) PLP of all level of education utilize the ARV drugs but utilization rate is higher amongst primary ( 1.98) and tertiary education level ( 1.98) PLP of various levels of income utilize the ARV drugs but those within the range of N11,000 – N20,000 have the highest utilization rate ( 1.98) PLP of various marital status utilize the ARV drugs but highest utilization rate was among the married PLP ( 1.99) urban location have higher availability of ARV drugs. Urban ( 2.66) rural ( 2.50), there was no significant difference in the extent of availability of ARV drugs based on urban-rural location (m=2.66) rural (m=2.5) t (282) = 1.663, P =.289 two tailed, T-test indicate that there was no significance difference in the extent of utilization of ARV drugs based on gender. Males (m=1.94), females (m=1.92) t (282) = .418 P=.676 two tailed, ANOVA on the extent of utilization of ARV drugs according to age of PLP indicated that there was no significant difference at the P<.05 level, scores for the age groups were f(5,283) = 1.657, P=145, there was no significance difference at the P<.05 level in the extent of utilization of ARV drugs based on income levels. Scores for the five levels of income group: F(4,283) =1.082, P=.366, there was significant difference at the P<.05 level in the extent of utilization of ARV drugs based on educational levels. Scores for the four groups: F (3,283) = 2.522, P = .058, ANOVA indicated that there was statistically significant difference at P<.05 level on the extent utilization of ARV drugs according to marital status. Score for six groups F (5,283) =3.026, P = .011. It was recommended amongst other things that health workers assigned to PLP hospitals in Anambra State should improve on health education being given to the PLP during clinics on proper utilization of ARV drugs given to them on every visit to reduce the mortality rate of PLP.
CHAPTER ONE
Introduction
Background to the Study
The twenty first century has witnessed the global health problem of Human Immune Virus and Acquired Immune Deficiency Syndrome (HIV & AIDS), that has produced the greatest challenge to mankind. The epidemic is a global crisis an unprecedented threat and formidable challenge to human development and social process.
Human immune virus is a precursor of acquired immune deficiency syndrome. This term was introduced by the Center for Disease Control and Prevention (CDCP) in 1982 to describe the syndrome. Three main transmission routes identified for HIV were: 1) sexual route, 2) blood or blood product route and 3) mother to child transmission. The status of any individual suspected of having HIV is ascertained through a HIV antibody test known as ELISA test or Polymerase Chain Reaction (PCR) test, both are effective and reliable (Soul City 2004 as in Kgomotso, 2009). Over the years HIV & AIDs have progressed to be one of the biggest killers, especially in sub-Saharan Africa where AIDs is the leading cause of death without limitations in terms of socio-demographic variables like age sex education, gender, marital status etc. People living positive with HIV were formerly regarded as PLWHA (People living with HIV & AIDs), recently the nomenclature changed to PLP (People living Positive) (UNAIDS/WHO 2007, as in Kgomotso, 2009)
The syndrome was first diagnosed globally in 1981 (Joint United Nations programmes 2006, as in Kgomotso, 2009) while in Nigeria it was diagnosed in a 13 year old girl in 1986 and has since then become one of the most destructive pandemics in recorded history (Idoko, Agbaji Pam, Taylor, Samson & Moses, 2005).
Anambra State was recently recorded as one of the “HIV hotspot” states with high prevalence rate of HIV infection (Peterson & Obileye, 2002 & Fatunmole, 2012). Anambra being one of the biggest commercial cities in Nigeria has a very big drug market and recent study have unveiled that a lot of substandard drugs manufactured both locally and abroad were in circulation in the state and country and this have links to high ARV and other drugs resistance and adverse effects (Peterson & Obileye, 2002).
