NEEDS ASSESSMENT FOR A TUBERCULOSIS (TB) AND HUMAN IMMUNODEFICIENCY VIRUS/ACQUIRED IMMUNODEFICIENCY SYNDROME (HIV/AIDS) COLLABORATIVE PROGRAM IN SASKATCHEWAN
Date
2019-03-26
Authors
Journal Title
Journal ISSN
Volume Title
Publisher
ORCID
Type
Thesis
Degree Level
Doctoral
Abstract
ABSTRACT
The purpose of this thesis is to assess the need for TB/HIV collaborative programming in Saskatchewan through a needs assessment process.
Globally, the occurrence of Tuberculosis (TB) and Human Immunodeficiency Virus/Acquired Immunodeficiency Deficiency Syndrome (HIV/AIDS) in a population has always turned out to be a deadly combination with each disease entity potentiating the prevalence, morbidity and death rate of the other. According to the World Health Organization (WHO, 2012) this syndemic and synergistic interaction between both diseases resulted in one-third of people living with HIV/AIDS worldwide being infected with TB. HIV-positive people are nearly twenty times more probable to develop TB when compared to HIV- negative people (WHO, 2012). Thus, both diseases acts in synergy to potentiate the deterioration of immunological functions thereby leading to an elevated mortality rate. According to the Public Health Agency of Canada (PHAC), in 2015, the prevalence of TB and HIV in Saskatchewan was two times the national average, and the Indigenous peoples were over-represented in incidence and prevalence (PHAC, 2016). Therefore, these infections are of significant public health importance for Saskatchewan and require urgent intervention.
The needs assessment employed qualitative research methods by conducting semi-structured interviews with 19 participants who were either administrators or clients in either the TB or HIV programs in Saskatchewan. Participants were interviewed using questions derived from the PRECEDE framework of the PRECEDE-PROCEED model. A combination of both deductive and inductive analytical processes using the PRECEDE model as the framework were utilized to analyze and interpret the results with apriori themes derived from the PRECEDE model, and emergent themes from the data.
The results show that the PRECEDE model was effective as a needs assessment tool for TB and HIV co-programming. The PRECEDE model allowed development of an effective assessment tool including appropriate range of interview questions and apriori and emergent evaluation codes within the areas of social, epidemiologic, behavioral, environmental, educational, ecological, administrative, and policy. The results enunciated cultural, socio-economic, behavioral and administrative factors that increase the transmission of TB and HIV in Saskatchewan, particularly among the Indigenous peoples. The socioeconomic conditions identified were poverty, adverse effects of residential school system, low level of education, and abuse (physical, sexual and emotional). Behavioral factors of importance included a highly mobile population; living chaotic lifestyles as a result of drug addiction, prostitution, alcoholism; unprotected sex; and needle sharing. Environmental factors that were identified included the large geographical area in Saskatchewan and a large patient population in the rural and remote areas of the province. Educational factors identified were comprised of predisposing, reinforcing and enabling factors. The predisposing factors were related to inadequate knowledge about the mode of transmission of TB and HIV. Stigmatization was a significant reinforcing factor of importance such that patients received minimal support from peers and community members. Enabling factors for consideration included inadequate qualified health personnel and a poor staffing situation made worse by large turnover. Furthermore, recruitment of specialists to work in rural and remote areas of Saskatchewan is very challenging. Therefore, health facilities depend mostly on visiting specialists. The financial resources are inadequate, and this situation is compounded by multijurisdictional funding in off/on reserve communities in northern Saskatchewan. Appointments to see service providers or specialists are difficult to arrange due to chaotic lifestyle, high mobility, lack of telephone services and homelessness. Diagnosis of administrative and policy factors reveal areas of gaps in the implementation of present programs. Gaps enumerated by participants are lack of coordination between separate TB and HIV programs, especially in data gathering. Other gaps are different locations of TB and HIV laboratories in Saskatchewan, difficulty with transportation in rural and remote areas, and difficulty getting TB and HIV medication.
There is a consensus among the participants about the desirability of establishing at least some form of TB/HIV collaborative program in Saskatchewan, but the ideal model of collaboration is not established. Program officers favored the referral model while patients in the study favored the integrated model (one-stop). No matter the model, the desired goal of all participants was to reduce TB and HIV in Saskatchewan. To achieve this end, the results reveal that it is vital that there is effective coordination between TB and HIV programs to ensure that patients can access the care they need from both services. It is recommended that the various social, epidemiological, educational, behavioral and administrative factors that affect the epidemiology of TB and HIV in Saskatchewan, as identified in the PRECEDE model, be taken into consideration in the design of appropriate intervention and evaluation strategies. Furthermore, the entire planning and implementation of collaborative programming should follow WHO’s (2012) guidelines on TB/HIV collaborative services. A Saskatchewan TB/HIV collaborative program that addresses the unique nature of the two diseases in the province, which is well designed, implemented, adequately funded, and purposefully evaluated, would result in a sustainable reduction of TB and HIV diseases in Saskatchewan.
Description
Keywords
TB, HIV, PRECEDE-PROCEED model, Needs Assessment
Citation
Degree
Doctor of Philosophy (Ph.D.)
Department
Medicine
Program
Health Sciences