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3:1 INTRODUCTION
This chapter provides a detailed section of how the practicum was achieved
room number seven that is where ART initiation, change of regiments, reviews and resupply of medications takes place, and the outer open space where TB and opportunistic clinic are held for infection control reasons. The challenges and achievements that the organisation was having were also discussed. The challenges included the emergence of drug resistant TB and also multi drug resistant TB common among HIV patients and whose diagnosis and treatment are not easy due to lack of resources. The hospital diagnos TB per GeneXpert for drug resistance which does not qualify patients for TB drug resistance treatment. Confirmatory tests are required whose results take months to get back to the hospital, thereby increasing the risk of spread of that form of TB due to delay in accessing treatment. The practicum supervisor led the researcher to the hall in the outpatients where clients were gathered following mobilization by researcher through help by TB coordinators in the area. Notices were put in public places to call for a meeting on mobilisaton of community on TB prevention among HIV positive individuals. It was at this juncture that the sister in charge introduced the researcher to the clients/patients as a new member attached to the organisation for six weeks. Arrangements were made on when and how to start the practicum,a program was set which covers six weeks.
3:3 STUDY POPULATION A target population is defined as the population under study, The population generalize the research findings (Talbot 1995) Where as the target population for this practicum shall be people living with HIV and TB infection accessing treatment at Kwekwe general hospital.
Sampling is selecting some of the elements of the population so that the researchers can draw conclusions about the entire population. The population in research methodology is the total group of the subjects that need to be assessed if the views of everyone in a particular situation are to be measured, Grein et al (2004). In this practicum, the sample population was consisting of people living with HIV and TB aged between twenty to fifty years. The simple random sampling method was used where a total number of 30 participants were used. Three rooms were used to select the sample. Room two which is used for counseling, room seven which is used for antiretroviral therapy initiation and room eight where review and registration of
patients is done. Each room had about ten cards whereby every third client to enter the room was selected in the sample.
doing the counseling. The counselor gave information about HIV/AIDS and TB. The discussion included issues that aim at equipping clients/patients with knowledge about the possibility of contracting TB as an opportunistic infection. The researcher observed the way information was being delivered to the clients /patients. Non verbal cues were also being noted. The most important aspects that the primary care counselor was emphasizing to the participants were also jotted down. The use of teaching aids like charts, pamphlets and real objects like examples of drugs used to treat TB were demonstrated as clients took their drugs on DOT. The advantages of taking treatment whist a health worker was observing were given to the participants. Signing of the DOT card was also demonstrated to clients. Review dates ,adherence to treatment and to appointments were discussed and were said to promote treatment success. The nurse explained that treatment for both TB and HIV is available and is for free at the hospital. As a way of reinforcing the lessons each of the participants was given some written pamphlets with pictures that showed an individual with a cough and aerosols spreading in the air. At the end of the session a recap with participants to ensure understanding was done. Question and answer time was provided with all questions being answered correctly myth and misconceptions identified and corrected. Attitudes towards TB and HIV were also displayed. Most feared was stigma and discrimination which was making it difficult for people with HIV and TB to access health services freely. Other factors to do with problems in accessing health services were religious and traditional according to participants views. Some participants pointed out knowledge deficit as a major obstacle ,torwards accessing care and treatment. Participants highlighted that some health care givers do not provide correct information on TB and HIV.
3:4, 3 EXIT INTERVIEW Not all participants who were present on the first day managed to turn up for exit interview. A total of three participants could not make it due to unknown circumstances. Five female participants and two male participant managed to report for the interview. A set of questions based on the information given about HIV and TB sought to find out on what the participants had learnt about. The exit interview was conducted in such a way that one participant would be interviewed while others would be outside and a different exit was used to avoid the possibility of sharing the questions. t. The interview went on while a score sheet was filled for each participant. The participant was first asked the language that she or he was comfortable to be interviewed in.
Focus Group discussions FDGs, observations and exit interviews which were conducted by the researcher formed the basis upon which health education talks were derived. There were
knowledge gaps, myths, misconceptions, beliefs and practices that were identified. These were addressed through health education mobilization time. Health education was conducted on the fourth week of the practicum as per activity schedule. All the chosen participants managed to turn up for the health talks. As usual the health education talks are being done first thing every morning from Monday to Friday. The identified problems were mostly to do with lack of knowledge in HIV and TB prevention, stigma and discrimination, treatment regiments for TB and HIV as well as disclosure of HIV status to significant others. These topics were given to each speaker, the researcher, the primary care counselor and one of the senior nurses of the department. The researcher gave health education on the importance of disclosing HIV status to significant others and how it reduces stigma. The clients were taught about drug adherence and how it helps in reduction of drug resistance and prevent treatment failure the likes of multi drug resistant TB Participants also learnt about the mode of action, side effects of ARVS and TB drugs At last the primary care counselor took the opportunity to explain why it is very important to use condoms even when both people are HIV positive. It was explained to the participants that there are different strands of HIV which infect people and this is why even when both partners are HIV positive they still need to use condoms to prevent further exposure to other viral strands. It was clearly explained that while other strands may respond to the treatment the patient may be on. The other type may show signs of drug resistance. This may promote the use of other very expensive ARVs which may not be locally available. It was further explained that preventing oneself from HIV infection is protecting self from TB as it is one of the factors that impair immune system and predisposes people to TB.
Questions were asked on all matters that were under discussion and answers were provided. Participants who had indicated that they were having difficulties with issues of stigma were taken note of and follow up visits were arranged.
3:5 CONCLUSSION
The experience that the researcher got from this particular mobilisation practicum opened some avenues for further studies. It was realized that there are factors that stand in the way but of different backgrounds.The communities have to be continuously educated to prevent tuberculosis among TB and HIV individuals at Kwekwe hospital.