Evaluating The Knowledge And Attitude Of Community Pharmacists Toward HIV Infected Patients
In most communities, the first level of healthcare visit is usually the community pharmacies hence, has the chance to detect HIV for the provision of early intervention for HIV services. Consequently, if access to HIV care, treatment and prevention services is enhanced at the level of community pharmacies, the burden of HIV/AIDS in Nigeria will be reduced significantly. The study assessed the knowledge of community pharmacists regarding HIV/AIDS and its management and their level of standard precautions practice. Out of 242 community pharmacists in Abuja Municipal Area Council (AMAC), Federal Capital Territory, a total of 155 registered community pharmacists who had valid practicing license were randomly selected. A questionnaire specifically designed for this study was self-administered to these participants. SPSS was used for the analysis, a P-value of less than 0.05 was regarded as significant and Chi-square tests were applied for inferential analysis. Within the 155 community pharmacists sampled, complete response were obtained from 104 (67%) community pharmacists. The mean age of the participants was 44.3 years (SD ± 2.47). There were 72.1% males. 80.8% of the participants had only Bachelor of Pharmacy degree, 79.8% of participants reported correctly that HIV can be transmitted through with blood and semen and this was significantly associated with level of education (p = 0.002). Most of the participants (92.3%) did not know the HIV transmission rate from mother to child in the deficiency of antiretroviral drugs in developing countries and only 37.8% of community pharmacists keep stock of antiretroviral drugs for post exposure prophylaxis. Many of the participants (83.0%) had good knowledge of the concept of standard precaution and 76.0% knew the conditions of which standard precautions should be practiced. 57.5% of the participants wash their hands with soap and water always after any direct contact with patients, 63.2% recap used needles after giving injections or drawing blood from the patients. Only 26.9% had been vaccinated against Hepatitis B. The finding of this study revealed that the knowledge and practice of community pharmacists in HIV/AIDS is relatively poor especially mother–to-child transmission. In as much as the knowledge of community pharmacists on standard precaution was good, there were paucities in their practice of standard precaution especially in the area of handling and disposal of used needles, poor availability of HIV post exposure prophylaxis drugs and vaccination against Hepatitis B. Management of HIV/AIDS should be integrated into the curriculum for continuing professional development for pharmacists. The implementation of adherence to the principles of standard precaution through consistent monitoring and supervision is highly recommended.
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.
1.2 Statement of the Problem
In Nigeria, the prevalence rate of HIV is estimated to be 1.47% amongst ages 15-49 years (United Nations Program on HIV/AIDS 2014:13). An estimated 250 000 of the population living with HIV and 10 000 deaths per annum makes it a public health problem in Nigeria (UNAIDS 2014:14; Nigeria AIDS Commission 2014:10). Hospitals are still struggling to deal with the issues of stigma and discrimination towards patients with HIV amongst their staff.
Although some studies have been conducted in Nigeria on extant knowledge, attitudes and practices towards people living with HIV, those which show any interest in the status of community pharmacists in this regard are hard to come by. community pharmacists as frontline health professionals play a pivotal role in the care of HIV infected patients (Van Bekkum & Hilton 2013:2) and as peer educators in their communities. Though community pharmacists‘ role as peer educators in their communities is largely recognised in Nigeria (Baatiema, Sumah, Tang & Ganle 2016:7), there is no known published study regarding Nigeriaian registered community pharmacists‘ knowledge, attitudes and practices (KAP) regarding HIV, despite numerous studies in other Sub-Saharan African countries. However, information about KAP regarding HIV is needed in order to devise appropriate educational program for community pharmacists to alleviate community pharmacists‘ anxiety about caring for patients with HIV positive and also alleviate the fear in their communities.
1.3 Objective of the Study
The study assessed the knowledge of community pharmacists regarding HIV/AIDS and its management and their level of standard precautions practice.
The specific objectives of this study were to:
- Assess community pharmacists‘ HIV/AIDS-related knowledge;
- Ascertain community pharmacists‘ attitudes towards patients living with HIV and AIDS;
- Investigate the current practices of community pharmacists towards patients living with HIV and AIDS; and
- Provide recommendations for addressing gaps and misconceptions identified.
1.4 Research Questions
- What knowledge do community pharmacists in the Abuja Metropolis have on HIV and AIDS?
- Does the community pharmacists level of knowledge reflect on their attitudes and practice?
- What are the attitude of community pharmacists towards persons living with HIV and AIDS?
- Are the community pharmacists‘ attitude favourable or unfavourable?
- What are the current practices of community pharmacists towards persons with HIV and AIDS?
- Do community pharmacists adhere to the standard universal precautions on infection prevention and control?
1.5 Significance of the Study
Community pharmacists being health professionals at the forefront of the HIV/AIDS epidemic are well acknowledged globally. It is therefore essential to identify some gaps and misconceptions relating to occupational HIV transmission, disease presentation, and HIV risk prevention among community pharmacists. This study will contribute towards providing a baseline analysis of the mentioned gaps and misconceptions in order to make recommendations for addressing these, to enhance community pharmacists‘ training. This, in turn, will lead to the development of policies and training programmes aimed at capacitating community pharmacists, and improving the effective management and relation with HIV/AIDS patients.
1.6 Scope of the Study
The target population for this study was all registered community pharmacists working at HIV units/wards/ departments in five selected hospitals providing ART services within the AMAC. Using a simple random sampling technique, a representative sample of 242 willing registered community pharmacists within the study sites were selected for the study.
1.7 Definitions of Key Concepts
Acquired Immune Deficiency Syndrome is a spectrum of diseases caused by infection with the human immunodeficiency virus (HIV) (WHO 2018a:1). In this study, AIDS will refer to a disease and illness associated with stigma, discrimination and prejudice at the clinical setting.
The extent of an individual‘s show of a positive or negative behaviour towards a particular object (Wilson & Scior 2015:2). In this study, attitude will refer to a display of a negative or an optimistic behaviour towards a patient infected with HIV.
The human immunodeficiency virus is a type of virus that attacks the cells of the immune system, destroying or impairing their function (WHO 2018a:1). In this study, HIV will refer to the viral organism responsible for the signs and symptoms of AIDS
Familiarity gained through experience or learning (Limaye, Sullivan, Dalessandro & Hendrix-Jenkins 2017:3). In this study, knowledge will refer to the facts, information, and skills acquired on HIV and AIDS through experience and education.
Prevention mechanisms/exercises aimed at reducing risk (Basini 2013:39). In this study, practice will refer to repeated exercises by community pharmacists caring for persons living with HIV and AIDS in a hospital setting.
6. Primary Health Care:
This is an essential form of health care based on scientific knowledge and skills and is made universally accessible to individuals and families in the community (Canadian community pharmacists‘ Association 2018:1). In this study, primary health care will refer to the healthcare facility where HIV management service is provided to the general public.
Discussion, Conclusion and Recommendation
The results obtained from this study are interesting and provide an insight into community pharmacists’ knowledge of HIV/AIDS and standard precautions and their practices. There are a number of trends which are evident, some of which are not surprising, while others are rather worthy of note.
Majority of pharmacists in community practice are male and majority have only Bachelor of Pharmacy degree. Respondents have excellent knowledge of the causative agent of HIV and assigned relatively high scores to non-preventive measure of HIV/AIDS, the transmission routes of HIV and also Tuberculosis as the most common opportunistic infection in HIV-infected patients. This is expected because they are basic information about HIV/AIDS. However, majority did not know the transmission rate from mother to child in the absence of antiretroviral drugs in developing countries and also did not know that the chief predictor of heterosexual transmission of HIV is plasma viremia. The lack of knowledge about the transmission rate was associated with participants’ level of education and years of experience and could be attributed to participants not updating their knowledge with current issues.
All the participants had valid practicing license and majority had audio-visual privacy to enable them counsel clients privately on one-on one. Most of these pharmacies do not stock antiretroviral drugs and only some of them provide services to HIV clients. This can be attributed to the fact that HIV drugs are given free to clients in the hospitals therefore are hardly bought and may expire on them causing loss. It is worthy to note that many of them have been trained on pharmaceutical care in HIV/AIDS, TB and STI.
All the pharmacies provide one or more HIV related services although not very strongly, such as HIV risk assessment and counseling, palliative care services, HTC services, TB services, and some common services that are very much provided in these pharmacies are malaria prevention, reproductive health services, malaria screening and treatment, STI treatment, provision of condoms and referral services. This is not unexpected since these activities are associated with the traditional functions of community pharmacists and since some community pharmacies in Nigeria are now used as palliative care and referral points to increase demand for HIV services in the community (Dorothy Oqua, 2011). Effective management of HIV/AIDS by community pharmacists is not dependent on their knowledge and practice of standard precaution. In general, this study has shown that the knowledge and practice of community pharmacists in HIV/AIDS management is not intense and hence agrees with the alternate hypothesis which says that effective management of HIV/AIDS by community pharmacists is dependent on their knowledge and practice of standard precaution.
The study shows that many of the community pharmacists have good knowledge of standard precaution concept and when hand washing is supposed to be performed; the level of these knowledge declines as the years of experience increased and as their level of education rose. Studies by Angelillo et al (1999) recommended that attending continuing educational modules about hospital infection had a positive effect on infection control procedures and compliance with barrier techniques (Angelillo et al;1999). Many of the participants indicated correctly all the potential ways of occupational exposure and becomes more significant as their years of experience and level of education increased. The knowledge of the conditions of which standard precautions should be practiced declined as the level of education rose. Education has a positive impact on retention of knowledge, attitudes and practices in all the categories of health professionals hence, there is a need to develop a system of continuous education for all the categories of health professionals (Suchitra J B and Lakshmi Devi N; 2007). Few of the respondents reported correctly that for HIV post exposure prophylaxis (PEP), HIV counseling & testing is done immediately after the exposure and PEP is given only to HIV negative test result conditions.
In answering questions relating to the practice of standard precaution, only 50% use a puncture proof container when discarding used needles and sharps and 63.2% recap used needles after giving injections or drawing blood from the patients and when compared with their level of education and their years of experience, the practice of standard precaution declined as the years of experience increased and as level of education rose which may be that the respondents in the course of their practice became careless in their practice regarding standard precaution. This therefore, agrees with the hypothesis that ‘Effective management of HIV/AIDS by community pharmacists is not dependent on their knowledge and practice of standard precaution’. Although there has been controversy about how much HIV transmission in Africa is due to healthcare practices (Gisselquist D, Potterat JJ. 2004, Schmid GP et al; 2004), eliminating all unsafe practices in health facilities should be an urgent priority for HIV prevention and for overall infection control.
The fact that a significant proportion practice standard precaution by always wearing gloves for contact with body fluids, non-intact skin and mucous membrane shows that wearing gloves is an important line of defense. Majority of participants always cover all cuts and abrasions with a water proof dressing when coming in contact with clients and have their sharps disposal containers are located as close as practical to the use area, however majority of the respondents do not have post exposure prophylaxis available and have not been vaccinated against Hepatitis B. Inadequate knowledge and unawareness of guideline for PEP management as well as unavailability of Hepatitis B vaccine may have contributed to these unsafe practices. Only 8.6 % have had needle stick injury in the last three months.
This study findings showed that the knowledge and practice of community pharmacists in HIV/AIDS is somewhat poor. Although the knowledge of community pharmacists on standard precaution was good, there were deficiencies in their practice of standard precaution especially in the area of handling and disposal of used needles, availability of post exposure prophylaxis and vaccination against Hepatitis B. Therefore, the null hypothesis which says that effective management of HIV/AIDS by community pharmacists is independent on their knowledge and practice of standard precaution is sustained. HIV/AIDS should be integrated into the curriculum for continuing professional development of pharmacists. The enforcement of adherence to the principles of standard precaution through regular monitoring and supervision is highly advocated.
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