TITLE: ASSESSMENT OFFACTORS CONTRIBUTING TO POOR ADHERENCE

ON ART AMONG PEOPLE LIVING WITH HIV AT GEITA CTC CLINIC

RESEACHER’S NAME: SALUM JABILI

SUPERVISOR’S NAME: MADAM GRORY

“RESEARCH PROPOSAL SUBMITTED FOR A PARTIAL FULLFILMENT OF THE

REQUIREMENT FOR THE ORDINARY DIPLOMA IN NURSING AND MIDWIFERY”.

YEAR, 2023

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Table of Contents
Acknowledgement.....................................................................................................................iii
Acronyms and abbreviations.....................................................................................................iv
Abstract.......................................................................................................................................v
CHAPTER ONE.........................................................................................................................1
1.0 Introduction..........................................................................................................................1
1.1 Background...........................................................................................................................1
1.2 Statement of the problem......................................................................................................2
1.3 Rationale of the study...........................................................................................................4
1.4 Research objectives..............................................................................................................4
1.5 Research Questions...............................................................................................................4
1.6 Research variables................................................................................................................4
1.7 Hypothesis formulation:.......................................................................................................5
CHAPTER TWO........................................................................................................................6
2.0 Literature review...................................................................................................................6
CHAPTER THREE....................................................................................................................8
3.0 Research methodology.........................................................................................................8
3.1 Study design.........................................................................................................................8
3.2 Study area.............................................................................................................................8
3.3 Study population...................................................................................................................8
3.4 Sampling procedure..............................................................................................................8
3.5 Sample size...........................................................................................................................8
3.6 Plan for data collection and technique..................................................................................8
3.7 Data management and analysis.............................................................................................9
3.8 Dissemination of results.......................................................................................................9
3.9 Ethical consideration............................................................................................................9
3.8 Pre-test..................................................................................................................................9
3.9 Limitations of the study........................................................................................................9

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APPENDICES..........................................................................................................................10
Appendix 1; Work plan schedule.............................................................................................10
Appendix 2; study design budgeting........................................................................................10
Appendix 3; Quantitative Data Collection Tool (Structured Questionnaire)...........................11
References................................................................................................................................16

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Acknowledgement
It not easy to complete research proposal without the help of God and supportive contribution from
others. Special thanks to the ministry of health for introducing research as project in training
process for Clinical Medicine as this will help to widen our knowledge, thanks to all staff of Geita
Hospital for their support during my study and special thanks to Mr. Kiswebe who taught and
directed me on how to write the research proposal as well as Madam Grory who is my supervisor
during the research study.

Lastly, I would like to thank my fellow students who helped me in one way or another in writing
my research proposal.

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ACRONYMS AND ABBREVIATIONS
AIDS- Acquired Immune Deficiency Syndrome
ART- Anti-Retroviral Therapy
ARV - Anti- retroviral
CD4+ - Cluster of Differentiation
HAART-Highly Active Anti-retroviral Therapy
HIV- Human Immuno-Deficiency Virus

CCT - Comprehensive care and treatment

NNRTIs - Non-nucleoside reverse transcriptase inhibitors

NRTIs - Nucleoside reverse transcriptase inhibitors
PIs - Protease inhibitors
WHO - World Health Organization
PLHIV - People living with HIV

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CHAPTER ONE

1.0 Introduction
Antiretroviral therapy (ART) is the recommended treatment for HIV. ART involves taking
a combination of anti-HIV medications (a regimen) every day. Anti-HIV medications which
are also called antiretroviral are grouped into six drug classes according to how they fight
HIV. The six classes are non-nucleoside reverse transcriptase inhibitors (NNRTIs),
nucleoside reverse transcriptase inhibitors (NRTIs), protease inhibitors (PIs). These are also
commonly referred to as HAART a regimen that is Highly Active AntiretroviralTherapy.

ART are used to keep HIV infections under control. This because, these drugs tend to
suppress the growth and development of the Human Immunodeficiency Virus in the HIV
infected patient and help in reducing disease progression hence reduces the HIV related
mortality.

There drugs reduce the viral load that is the amount of virus in the bloodstream. In some
people viral load can become so low that it is undetectable by the viral load test but this does
not mean that the all virus is gone and does not mean that the person is cured of HIV
infection. However, these people are less likely to transmit HIV infection to others.

ART also prevents onward transmission of HIV to sexual partner and mother to child
transmission. Huge reductions have been seen in rates of death and infections when the use is
made of a potent ARV regimen, particularly in early stages of the disease.

1.1 Background
According to the world organization, antiretroviral therapy (ART) is combination of
several drugs which was introduced in the management of patients living with HIV or
AIDS. As of December 2017, an estimated 21.7 million people globally were receiving
antiretroviral therapy. This represented an increase of 2.3 million people over the number
receiving such treatment 12 months earlier. Of all persons living with HIV 59% [44−73%]
had obtained antiretroviral therapy in 2017.
In the WHO African Region, 60% [45−73%] of people living with HIV were able to
access life-saving medicines in 2017. Similarly, 66% [48−84%] in the Region of the
Americas, 18% [12−26%] in the Eastern Mediterranean Region, 54% [43−62%] in the
European Region, 51% [34−70%] in the South-East Asia Region and 62% [45−82%] in
the Western Pacific Region were accessing such treatment. It is increasingly clear that
everyone infected with HIV will eventually need treatment. With an estimated 36.9
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million [31.1–43.9 million] million people now living with HIV globally, this represents a
significant need to scale up HIV testing and treatment, while continuing to invest in
prevention and other programmes to combat new infections.
Overall antiretroviral therapy coverage among children was lower than among adults.
Children represented 4% of the people receiving antiretroviral therapy and also
approximately 5% of the people living with HIV. Of the 1.8 million [1.3–2.4 million]
children estimated live with HIV, 52% [33–70%] had access to treatment versus 59% [44–
73%] of adults.
Access to ART has increased rapidly since 2005 from just 2.1 million to 21.7 million by
the end of 2017. The estimated ART global coverage increased from 7% in 2005 to 59%
in 2017. The greatest increase occurred in WHO African Region, where ART was
uncommon up to 2005 (758 000 people on ART) and increased to 15.4 million in 2017.
Regions that have made less progress are those in which the epidemic is predominantly
concentrated in populations with lower access and utilization of services, such as sex
workers, injecting drug users, and men who have sex with men.

1.2 Statement of the problem

Poor adherence of ART to the HIV or AIDS patient is define as failure or refusal of the HIV
or AIDS patient to take the ARV drugs that is antiretroviral drugs with the right dose, at the
right time, in the right frequency, in the right way every day and exactly as agreed between
the health care provider, the patient and the care giver.

According to WHO, the HIV or AIDS patient who adhere well to the prescribed ART can
achieve viral suppression as a benefit of ART such as immune restoration, prolonged
survival, reduce resistance, improve quality of life and treatment as prevention.

However, despite of the education provided to the HIV or AIDS patient as well as the care
giver on the benefits of ART compliance, there are some patients who still fail to take ARV
drugs as directed by the health care provider by leaving behind the course of treatment and
others tend to refuse to initiate the HIV treatment regimen after being diagnosed as HIV
infected.

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1.3 Rationale of the study
 This study aims to identify possible factors related to poor adherence of ART among
people living with HIV (PLHIV) and to find their solutions as well as to expand
knowledge about effective compliance of ART regimen as this can make people aware
of the importance of effective use of ART.

1.4 Research objectives

Broadobjective

 To determine factors contributing to poor adherence of ART to the HIV/AIDS

patients at Geita CTC Clinic

Specific objectives

 To assess the knowledge of ART adherence among the patient living with HIV or
AIDS at GEITA CTC CLINIC
 To determine acceptance on ART among patient living with HIV or AIDS.
 To establish perceptions towards adherence to ART among AIDS patients.
 Identify accessibility of ART to the patients living with HIV or AIDS at GEITA CTC
CLINIC
 1.5 Research Questions
 How does poverty influence to poor-adherence of ART among HIV/AIDS patients?
 Does patients’ perception towards ART hinders adherence to the ARV regimen
among HIV/AIDS patients?
 How do accessibility of ARV influence adherence to ART regimen among HIV/AIDS
patients?
 1.6 Research variables
The variables of this study are:

 Dependent variable which is non-compliance of ART to the HIV/AIDS patient

 Independent variables which are Accessibility of ARTs, Patient's perceptions towards
ARV, Stigma and discrimination, Social economic problems such as poverty

 1.7 Hypothesis formulation:
 ART ADHERENCE awareness at GEITA has increased and leads to reduced of cases
of HIV related deaths at Geita Hospital but people don’t take serious into
consideration on factors contributing to Poor on ART Adherence

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  CHAPTER TWO

2.0 Literature review

The literature review in this study will be based on books articles studies done in the
different parts of the world and within the country. The study based on the factors
contributing to poor adherence of art to the HIV/AIDS patient at CTC in Geita Hospital.

Patients’ perception towards ART A number of interview-bases studies exploring

patients’ reasons for refusing HAART have identified the potential importance of patients’
beliefs about antiretroviral treatment. Patients reported a number of negative perceptions
about HAART, including fears about side effects, concerns about the need for strict
adherence, inconvenience and practical problems associated with the regimen, distrust of
conventional medicines, fear of long-term damage to body organs, and the perception that
there is no reason to start in the absence of symptoms. Similar beliefs have emerged in studies
of adherence, where non-adherence was linked to doubts about treatment efficacy, concerns
about side effects and long-term toxicities, scheduling demands and personal capacity to
adhere, concerns about the impact of HAART on self-identity, and the possibility that taking
treatment might lead to disclosure of the individual’s HIV status. Indeed, one reason why
previous interventions to facilitate adherence have met with only limited success is that they
have failed to utilize theory based methods for identifying and addressing the main perceptual
barriers (e.g. beliefs, attitudes). (Lipincott& Wilkins, 2007).
Accessibility to ART
Accessibility factors that impact on adherence include: proximity to the patients’ home or
place of work; the expense of getting there (Nakiyembaet al., 2005). Long distances to health
facilities impact on adherence. Despite the fact that adherence is said to be 90% amongst
people taking ART in Sub-Saharan and Africa, transportation over long distances from/ to
health facilities remains an important barrier to sustain adherence to medications (Charuratet
al., 2010; Rougemontet al., 2009; Ware et al., 2009; Bennetet al., 2008). A study done in
Addis Ababa found that it took up to two hours for patients to walk to the nearest health
facility to receive treatment (Demisse, Lindtjorn&Berhane, 2002). Transportation difficulties,
according to Mills et al. (2006), were often the major interference to adherence.
An average clinic visit in South Africa consumes a full working day, oftentimes even longer
because patients tend to attend clinics far away from their homes so as to minimize the
likelihood of being identified by community members. For those who can afford to lose a
day’s paycheck and can also afford the transportation costs (which present a larger burden for
those who live in rural areas compared to urban areas), it is often hard to negotiate time off

4
from work to get prescriptions, mainly because they do not want to disclose their HIV status
to employers out of fear of discrimination. With soaring unemployment rates (24% as of
2014) and widespread food insecurity, few patients are willing to risk their jobs, especially
when only one in five households in the country currently meets its dietary energy needs.

Poverty

There is a relationship between food and medication that extends even further beyond the
income argument. Some classes of antiretroviral drugs (such as Saquinvair and Nelfinavir)
actually cause adverse side effects when taken without food, such as nausea, vomiting, and
stomach pain. On the other hand, other classes of drugs (such as Didanosine and Indinavir)
cause side effects when taken with food, such as increased appetite. For patients living in
poverty, reducing these negative side effects naturally become priorities in the context of
scarce food and income. In this case, non-adherence seems more convenient and
advantageous to the patient.

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CHAPTER THREE

3.0 Research methodology.

3.1 Study design

Descriptive cross sectional study will be conducted at Geita Hospital at CTC to find out factor
contributing to poor adherence of art to the HIV/AIDS patients at CTC in Geita Hospital.

3.2 Study area

The study will be conducted at Geita Hospital in CTC with regular activities of clinical follow
up of HIV infected patients in which during this process the HIV infected patient receive their
regular medication that is the ARVs and other care important for their wellbeing.

3.3 Study population

The study population of 17509 involve both women and men who HIV infected at Geita CTC
Clinic

3.4 Sampling procedure

The sampling method which will be used during investigation is non probability which is
random sampling.

3.5 Sample size

The sample size which will be used for data collection during the study is about 30
respondents and it was estimated depending on the study population which include those who
are HIV infected attended for follow up clinics in CTC at Geita Hospital.

3.6 Plan for data collection and technique

During the study, the correspondent willinterviewed to obtain the information necessary
for the study and to meet the objectives. Data will collected by self-administered written
questionnaires to the respondents in order to get the information needed for the study and
confidentiality will be observed.

3.7Data management and analysis

The data will be processed manually where by all the information will categorized in data
master sheet. Analysis will be done to each question and the data will be presented using pie

6
charts, bar and line graphs and frequency tables. Descriptive statistics such as mean,
frequencies and percentages will be used to describe and summarize the data.

3.8Dissemination of results
At the end, the results will be disseminated to Care and Treatment Clinic (CTC) at Geita
Hospital, to Geita School of Nursing and Midwifery for the purpose of keeping references for
the College, and other remained to researcher.

3.9Ethical consideration
Letter for requesting permission to conduct research will be sent to managing medical
directors Geita Hospital for asking permission. Also permission will be requested from
respondents before interviewing them therewas no any names of respondents mentioned on
the questioner and hence confidential will be maintained.

3.8 Pre-test
This will be done to three HIV infected patients at medical ward at Geita Hospital.

3.9Limitations of the study

During the study, there will be several obstacles and limitation which were involved such as:
-

Language barrier; this hindered during data collection because some of the respondents use
local language hence facing difficulties when communicating with them during interviewing
or answering of questions, so for this case the researcher will be supposed to have a person
who can translate.

Time; time will be limited for data collection the analysing and interpreting of research
findings

Financial; lack of enough money will be a problem due to expensiveness during printing and
typing.

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References
Lipincott, W., & Wilkins.(2007). Patients Perception of HAART in relation to treatment
uptake and adherence. Epidemiology and Social Sciencies

Nakiyemba A., Aurugai D.A., Kwasa R., Oyobba T (2005). Factors that facilitate or constrain
adherence to antiretroviral therapy among adults in Uganda: A- Pre-Intervention Study

Corlien M. V., Pathmanathan, I & Brownlee, A. (2003). Designing and Conducting

Health System Research Projects (DCHSRP). Amsterdam: KIT Publishers.
Ebrahim, G.J. and Sullivan, K.R. (1995).Mother and Child Health Research Methods.
London.
Gibaldi, J. (1995). Handbook for Writers of Research Papers. New York: Modern
Language Association of America.
Kothari, C.R. (2004). Research Methodology (2nd ed.). India: New Age International
Lindsay, D. (1996). Guide to Scientific Writing. Australia: Addison & Wesley.
Yang.J., et al. (1996).An outline of Scientific Writing: For Researchers with English as a
Foreign Language.Singapore: World Scientific Publishing.

Briggs, C.L. (1992). Learning How to Ask. A Sociolinguistic Appraisal of the Interview in

Social Science Research (5th ed.).Cambridge: Cambridge University Press.

Lee, R.M. (1993). Doing Research on Sensitive Topics.London: Sage Publications.
Pretty, J.N, Guyt, I., Thompson, J., Scones, I.L. (1995).Participatory Learning & Action.
A Trainer’s Guide. London: International Institute for environment and Development
(IIED).
Rubin, H.J, Rubin, I.S. (1995). Qualitative Interviewing.The Art of Hearing Data.
Thousand Oaks: Sage.
Seidman, I, (1998), Interviewing as Qualitative Research. A Guide for Researchers in
Education and the Social Sciences.New York: Teachers College Press.
Spradley, J.P. (1979). The Ethnographic Interview.New York: Holt, Rinehart and
Winston.
Abramson, J.H. (1990). Survey Methods in Community Medicine (4th ed.). London:
Churchill Livingstone.
Grosskurth, H., Mosha, F., Todd, J., et al. (1995). Impact of Improved Treatment of
Sexually Transmitted Diseases on HIV Infection in Rural Tanzania: Randomized
controlled Trial. Lancet, 346: 530-53.
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Moser, C.A., Kalton, G. (1989).Survey Methods in Social Investigation (2nd ed.).UK:
Gower Publishing Company.
Patton, M.Q. (1990). Qualitative Evaluation and Research Methods (2nd ed.). Newbury
Park, USA: Sage Publications.
WHO, (2003).Designing and Conducting Health Systems Research Projects, Volume 1.
Amsterdam: KIT Publishers.
Hill, A.B. (1977). A Short Textbook of Medical Statistics. London: Hodder and
Stoughton.
Kirkwood, B. (1988). Essentials of Medical Statistics. Oxford: Blackwell Scientific
Publications.

Walonick, D.S. (2005). Elements of a Research Proposal and Report. Retrieved from
http://www.statpac.com/research-papers/research-proposal.htm (date unknown).

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SALUM JABILI
SCHOOL OF NURSING AND MIDWIFERY
GEITA
P.O BOX 136
GEITA TC- GEITA
THE MANAGING MEDICAL DIRECTOR
GEITA REFERAL HOSPITAL
P. O. BOX
GEITA

UFS

THE PRINCIPAL
GEITA SCHOOL OF NURSING AND MIDWIFERY
P. O. BOX 40
GEITA

Dear Sir

REF: PERMISSION TO CONDUCT RESEARCH AT GEITA REFERAL HOSPITAL

As the above heading shows,
I request permission to conduct research study in GeitaReferal Hospital at CTC department.
I am nursing and midwifery student at Geita School of Nursing and midwifery, as
requirement towards Diploma in Nursing and Midwifery and submit the report to Geita
School of Nursing and midwifery.
The subject of my study is to determine factors contributing to poor adherence of ART to the
patients living with HIV or AIDS at CTC in GeitaReferal Hospital.
I hope my request will be considered

Your faithfully:
……………………………………
SalumJabili

Copy to:-
CTC In charge
10
 a. Research work plan and budget
b. 3.9.1 Research work plan

S/ Activity Responsible Timeframe Expected outcome

N person

1 Prepare proposal SALUM 6/12/2022to Proposal prepared

JABILI 5/1/2022 according to acceptable
format and guidance

2 Submit proposal to the SALUM 6/1/2023to Proposal will be

teacher, researcher, JABILI 11/1/2022 submitted to the
Supervisor Supervisor

3 To prepare dctionata colle SALUM 14/1/2023 to Data collection tools

tools and improve data JABILI 16/1/2023 will be prepared and
collection tools pretested

4 Travel to data collection site SALUM 17/1/2023 to Data collected;

JABILI 17/1/2023 collector will be
travelled to data
collection site

5 Pre-test and improve data SALUM 18/1/2023 to Data collection tools

collection tools JABILI 20/1/2023 pre-tested

6 Seek permission to conduct SALUM 21/1/2023 to Permission to conduct

study at Geita hospital. JABILI 23/1/2023 research will be
granted

7 Collect Data SALUM 24/1/2023 to Data collected

JABILI 30/1/2023

8 Process and analysis data SALUM 31/1/2023 to Data analysis processed

JABILI 2/2/2023 and analysed

9 Write Research report SALUM 3/2/2023 to Research report is

JABILI 10/2/2023 written

10 Bind and submit Research SALUM 11/2/2023 to Research report is

report JABILI submitted
15/2/2023

3.8.2. Research budget plan

ACTIVITY RESOURCES UNIT UNIT COST TOTAL
NO COST

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Prepare proposal A-4 papers Ream 1 @10000/= 10,000/=

Pens 2 @200/= 400/=

Total 10400/=

Submit proposal to the Binding 2 @2500/= @5000/=

teacher

Total 5000/=

Prepare data collection Questionnaire Copy 3 @300/= 900/=

tools
Total 900/=

Pre-test data collection Questionnaire Copy 35 @200/= 00/=

tools
Total 7000/=

Questionnaire Copy 20 @100/= 2000/=

Collecting data

Pencil Pcs 1 @100/= 200/=

Eraser Pcs 2 @200/= 400/=

Total 2,600/=

Process analysis data Data analysis Day 3 @2000/= 6,000/=

fees

Write Research report A-4 Ream 1 @12000/= 12,000/=

Binding and submit Binding fee Copy 2 @5000/= 10,000/=

Research report
Printing fee Copy 2 @5000/= 10,000/=

Photocopy fee Copy 2 @5000/= 10,000/=

Total 30,000/=

Total 73900/=

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