Page 317 - HIVMED_v21_i1.indb

Page 3 of 7 Original Research

was achieved through the two researchers independently whereas that for a DMO and/or City Health Director is a
analysing all emerging codes and issues across interviews degree.
and FGDs, and later discussing them to ensure that the
results were grounded on data rather than the researchers’ Findings from key informant interviews
perceptions. Thematic analysis of qualitative data was
performed in NVivo version 12®, involving familiarisation Key themes that emerged from key-informant interviews
with the data, generation of initial codes, searching of themes pointed on issues to do with how HTN and DM were being
managed, and the capacity of ART sites to screen, diagnose
within the codes, reviewing, defining and naming themes. and treat HTN and DM. The themes and subthemes emerging
Findings were presented according to emerging themes, from each FGD are summarised in Table 2.
using verbatim quotes to illustrate and support the analysis.

Findings Management of hypertension and diabetes
mellitus
Participant characteristics Findings from key informants consistently concurred on how
A total of eight interviews were conducted with key screening services for HTN and DM were being offered:
informants, whereas 12 FGDs were conducted with PLWH ‘Ministry [of Health] regulations require vital observations
concurrently diagnosed with HTN and/or DM (Table 1). (including blood pressure, pulse rate, weight, and temperature
The basic requirement for a Nurse-in-Charge is a diploma, measurements) to be done at every consultation as part of routine
screening, to all patients regardless of HIV status …. However,
TABLE 1: Interview and focus group discussion participants’ characteristics. the regulations require targeted screening for diabetes mellitus
Participants’ characteristic Number % where random blood sugar (RBS) measurements are done only
Key informant interviews (n = 8) when a patient presents with signs and symptoms suggestive of
Age diabetes mellitus.’ (Male, 45 years old, Health Executive)
30–49 years 7 87.5
> 50 years 1 12.5 It was found that both BP and RBS measurements were being
Sex offered as part of the consultation process at all ART sites,
Male 3 37.5 where HIV-negative people pay a consultation fee equivalent
Female 5 62.5 to USD$1, and PLWH do not pay any consultation fee in
Highest level of education urban sites. In rural sites, both HIV negative and PLWH do
Diploma 4 50 not pay any consultation fee.
Degree 4 50
Focus group discussions (n = 72) Nurses-in-Charge for all the study sites consistently
Age
30–49 years 36 50 mentioned existence of Community ART Review Groups
> 50 years 36 50 (CARGs):
Sex ‘There are CARGs, of 7–10 PLWH per group. Through CARGS,
Male 24 33.3 only one group member collects medication on behalf of other
Female 48 66.7 group members, thereby reducing transport cost for collection of
Highest level of education ART medication. This is useful especially when the patient does
Secondary 45 62.5 not require other services like viral load measurements, HTN/
Tertiary 27 37.5 DM screening or other consultation services.’ (Female, Nurse-in-
Charge, with over 10 years’ experience)

TABLE 2: Saturation grid of themes and subthemes emerging from key informant interviews.
Themes and subthemes Interview number
1 2 3 4 5 6 7 8
Management of HTN and DM
• Routine screening of HTN on every consultation x x x x x x x x
• Targeted screening of DM based on signs and symptoms x x x x x x x x
Capacity to screen for HTN and DM
• Adequate number of staff capable of screening for HTN and DM in place x x x x x x x x
• Have at least one BP and RBS machine x x x x x x x x
• Reported dysfunctional BP machine x x x x x x x x
• Reported battery or power challenges for BP machine x x x x x x x x
• No glucostrips in stock x x x x x x x x
• Inadequate funding for NCD management x x x x x x x x
Capacity to treat HTN and DM
• HTN drugs out of stock x x x x x x x x
• DM drugs out of stock x x x x x x x x
• HCT sometimes available x x x x x x x x
DM, diabetes mellitus; HCT, hydrochlorothiazide; HTN, hypertension; NCD, non-communicable diseases.

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