Page 318 - HIVMED_v21_i1.indb

Page 4 of 7 Original Research

The capacity of antiretroviral therapy sites to Concerning the availability of drugs for HTN and DM, the
screen, diagnose and treat non-communicable interview findings revealed the partial availability of HTN
diseases drugs and the general non-availability of DM drugs. There
was a convergence of views from all the study sites in that
With regard to the capacity of ART sites to manage HTN and
DM, the availability of human, financial and material some hypertensive patients usually on hydrochlorothiazide
(equipment and drugs) resources for screening, diagnosis (HCT) drug sometimes had access to the drug. However,
and treatment was assessed at each ART centre. hypertensive patients may need more than one type of drug,
where some combinations might not include HCT. None of
the key informants reported having any diabetic medication
Human resources in stock:

All key informants confirmed that the general nurses present ‘Stock-outs for hypertensive and diabetic medication are
at all ART sites were capable of screening for HTN and DM, generally common due to limited funding for NCDs. Most
even though they lacked at least one speciality, namely patients usually get HCT from most of our health centres.’ (Male,
training in endocrinology. However, the lack of equipment Health Executive, with over 6 years’ experience)
remained a leading challenge:
While patients are unable to access screening services or
‘All the ART sites are manned by nurses who can screen for
hypertension and diabetes mellitus if they have the required medication for either HTN or DM or both, they are usually
equipment. However, we do not have specialised endocrinology referred to private pharmacies where they must pay
nurses for NCD care at any of ART sites in the district.’ (Male, transportation costs, and the cost of the screening service
District Health Executive, with over 6 years’ experience) and/or the medication costs:
‘If they can’t get medication here, we write them a prescription to
Material resources (equipment and drugs) purchase in town [in private pharmacies] if they have the funds.’
(Male, Nurse-in-Charge, with over 15 years’ experience at an
Screening for HTN requires a blood pressure (BP) machine, urban ART site)
whereas screening for DM requires a random blood sugar
(RBS) machine and glucostrips. Some BP machines used in Financial resources
the study sites were battery-powered, while others were
electric-powered. Random blood sugar machines at all study Responses pointed to limited financial resources for NCD
sites were battery-powered. All sites had at least one BP and management. Interviewees consistently reported that
RBS machine. funding was inadequate to meet the needs of people at risk of
or living with NCDs:
Interview findings from all study sites consistently found ‘The main source of funds for NCD management is the
that availability of screening services for HTN and DM was government of Zimbabwe (GoZ). Unlike the integrated HIV
generally limited and periodically interrupted by various and TB care programmes, which receive additional funding
challenges. These included running out of machine batteries from Non-governmental organizations (NGOs) like the
without timely replacement for HTN screening and frequent Global Fund and USAID, NCD programmes are funded
electrical power cuts that affected the use of electric-powered largely by the government, where the funding is usually
BP machines: limited. Funding is required for maintenance of equipment,
procurement of equipment, drugs and medical sundries, …
‘…. Yes, we have a BP machine here. But we have not been using even training and re-training of our healthcare workers on
it for the past 2 months, because it doesn’t have batteries.’ NCD management.’ (Male, Health Executive, with 5 years’
(Female, Nurse-in-Charge, at a rural ART site)
experience)
Another reported challenge was the dysfunctional BP
machines caused by the machine breakdowns. In three (two Focus group discussion findings from patients
urban and one rural site) of the six study sites, the availability A total of 12 FGDs (consisting of six participants each) were
of only one BP machine was insufficient to service all clinic conducted. More FGDs (n = 8) were conducted among
departments, including the outpatients and the maternity female participants than among male participants (n = 4).
departments. For targeted screening for DM, all the sites Other characteristics of FGD participants are shown in
reported that the service was generally not available, largely Table 3.
because of non-availability of glucostrips:
‘The major challenge affecting screening for diabetes mellitus is
the unavailability of glucostrips. There is a general shortage of TABLE 3: Characteristics of focus group discussions of people living with human
glucostrips in our health centres, so patients might not have their immunodeficiency virus and comorbid non-communicable diseases (n = 72).†
blood glucose levels checked when they require the service …. Characteristics Urban participants Rural participants
For hypertension screening, some health centres do not have Male Female Male Female
functional BP machines due to issues like machine breakdowns, Age (years) 30–49 ≥ 50 30–49 ≥ 50 30–49 ≥ 50 30–49 ≥ 50
electricity power cuts, and unavailability of batteries, among Number of FGDs 1 1 2 2 1 1 2 2
other reasons.’ (Male, District Health Executive, with 5 years’ †, Each focus group discussion (FDG) consisted of six participants, translating to a total of 72
experience) participants for the 12 FGDs.

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