Evaluation of factors affecting the implementation of HIV/AIDS treatment guidelines in Lesotho

Abstract

Lesotho has the second-highest prevalence of HIV-infection in the world (MOH, 2017).The successful implementation of HIV/AIDS treatment guidelines has a potentially optimal impact on HIV/AIDS management (Kripke et al., 2016). Therefore, there is a need to evaluate the factors affecting the implementation of the fifth edition of the 2016 HIV/AIDS treatment guidelines by focusing on the implementation process, drivers and barriers in Lesotho (Damschroder et al., 2009:50; Fixsen et al., 2005). It is also essential to formulate an implementation framework to implement the HIV/AIDS treatment guidelines suitable for Lesotho and other resource-limited settings. The specific research objectives of the study include: * To explore current HIV/AIDS treatment guideline implementation processes in Lesotho. * To investigate how the implementation drivers may affect the implementation of current HIV/AIDS treatment guidelines in Lesotho. * To identify barriers to the implementation of HIV/AIDS treatment guidelines in Lesotho. * To develop a framework for the implementation of HIV/AIDS treatment guidelines in resource-limited countries such as Lesotho. A cross-sectional study was implemented in the public healthcare sector of Lesotho. The study population consisted of healthcare professionals from the HIV/AIDS programme (N=5), the District Health Management Team (DHMT) (N=30) and the primary healthcare (PHC) facilities (N=330). Researcher-designed, structured questionnaires were completed during face-to-face interviews with the HIV/AIDS programme and DHMT healthcare professionals. Self-administered questionnaires were completed by healthcare professionals at the PHC facilities. Data collection took place between May and December 2018. A total of five healthcare professionals at the HIV/AIDS programme, 27 at the DHMT and 116 at the PHC facilities participated in the study. Process-related results indicate that an implementation plan was available, as reported by all healthcare professionals at the HIV/AIDS programme (n=5), DHMT 9 (33.3%) and PHC facilities 8 (9.4%). PHC managers also indicated that they had copies of the 2016 HIV/AIDS treatment guidelines 70 (80.5%) and reported daily use 60 (69.0%). The results show that PHC managers 50 ( 57.5%) confirmed that patient care and treatment were given according to the HIV/AIDS treatment guidelines. The results related to implementation drivers show that all healthcare professionals at the HIV/AIDS programme (n=5), 55.6% (n=15) at the DHMT and 75.9% (n=22) at the PHC level as well as 52.3% (n=45) of PHC managers were trained regarding changes made to the 2016 HIV/AIDS treatment guidelines. Healthcare professionals at the HIV/AIDS programme (n=5) indicated that they supervised DHMT healthcare professionals on a quarterly basis. DHMT healthcare professionals 23 (88.5%) indicated that they supervised PHC managers at the PHC facilities. PHC managers 52 (61.2%) also supervised healthcare professionals regarding the treatment of HIV/AIDS through the use of treatment guidelines. Feedback was provided after every supervision at all levels; this was confirmed by healthcare professionals at the HIV/AIDS programme (n=5) and the DHMT 23 (85.2%), and PHC managers 54 (65.9%). The following implementation barriers were identified by healthcare professionals at all levels: personnel-related (lack of different types of personnel at PHC facilities), knowledge and competency (insufficient management skills and insufficient communication skills), resource-related (no or unreliable internet access and no or unreliable e-mail services) and financially-related (lack of funds to acquire highly technologic health information systems and lack of budget for new posts for healthcare personnel). It can, therefore, be concluded that there was an implementation plan, even though it was not fully distributed – PHC managers confirmed that patient care and treatment was carried out according to the HIV/AIDS treatment guidelines. It can also be concluded that training regarding changes made to the 2016 HIV/AIDS treatment guidelines took place at all levels; however, not all healthcare professionals at the DHMT and the PHC were trained. It can also be concluded that supervision and feedback were provided, which is a strength that can be built on. The implementation barriers identified in Lesotho will assist decision-makers in future healthcare planning to prevent possible barriers to the implementation of forthcoming HIV/AIDS treatment guidelines. Decision-makers will have to focus specifically on identified personnel-related, knowledge and competency, resource-related and financially-related barriers. An implementation framework was also formulated based on the literature and the empirical results of the implementation processes, drivers and barriers.