Date Published: February 22, 2018
Publisher: Public Library of Science
Author(s): Chindo Ibrahim Bisallah, Lekhraj Rampal, Munn-Sann Lye, Sherina Mohd Sidik, Normala Ibrahim, Zubairu Iliyasu, Michael Ochigbo Onyilo, Alberto García-Basteiro.
The risk of development of active TB in HIV-infected individuals is 20–37 times higher than those that are HIV negative. Poor knowledge of TB amongst people living with HIV has been associated with high transmission.
To determine the effectiveness of a new health education intervention module in improving knowledge, attitude, and practice (KAP) regarding tuberculosis among HIV patients in General Hospital Minna, Nigeria.
A randomized control trial was carried out from July 2015 to June 2017. A random number generating program was used to allocate 226 respondents into 2 groups. The intervention group received health education regarding tuberculosis using the developed module. The control group received the normal services provided for HIV patients. Data were collected from December 2015 to September 2016 at baseline, immediate post intervention, three, six and nine months. The outcome measures were knowledge, attitude, and practice.
There was no significant difference with respect to socio-demographic characteristics, KAP of the respondents in the intervention and control group at baseline. However, there was significant improvement in knowledge in the intervention group compared to the control group, group main effect (F = (1,218) = 665.889, p = 0.001, partial ἠ2 = 0.753, d = 5.4); time (F = (3.605, 218) = 52.046, p = 0.001, partial ἠ2 = 0.193, d = 1.52) and interaction between group with time (F = (3.605, 218) = 34.028, p = 0.001, partial ἠ2 = 0.135, d = 1.23). Likewise, there was significant improvement in attitude, group main effect (p = 0.001, d = 1.26) and time (p = 0.001, p, d = 0.65). Similarly, there was improvement in practice, group main effect, time, and interaction of group with time (p < 0.05). The health education intervention program was effective in improving KAP regarding tuberculosis among HIV patients.
Tuberculosis (TB) is the commonest cause of death in acquired immune deficiency syndrome (AIDS) patients . The rising incidence of TB among human immunodeficiency virus (HIV) patients in Nigeria poses a great threat to TB control. The risk of development of active TB in HIV-infected individuals is up to 20–37 times higher than those that are HIV negative [2, 3]. In 2015, out of 87,211 TB cases in Nigeria, 14,846 HIV-positive TB patients were registered for treatment and care . Poor knowledge of TB amongst people living with HIV is associated with high transmission and delay in health-seeking behavior . The effect of health education intervention program has not been evaluated in Nigeria. There is no structured health education intervention program on behavior modification that is directed and specific for HIV patients regarding tuberculosis in Nigeria. Advocacy, Communication, and Social Mobilization (ACSM), a component of TB control program in Nigeria was evaluated in 2012 and found to be largely ineffective . The objective of this study was to develop and implement a new health education intervention manual and evaluate its effectiveness in improving knowledge, attitude and practices regarding tuberculosis among HIV patients enrolled for treatment in General Hospital Minna, Nigeria.
The present study utilized information, motivation and behavior based intervention program and treatment fidelity as strategies to improve knowledge, attitude and practice regarding TB among HIV patients in the intervention group. The results of this study provide evidence that significant improvement in knowledge, attitude, and practice regarding TB among HIV patients can be achieved through a structured health education intervention. We believe that the observed changes in the outcomes can be attributed to the effect of the intervention delivered. However, studies that evaluated the effect of health education intervention on knowledge, attitude and practice regarding TB among HIV patients are scarce. We were therefore constrained in comparing the effect sizes of our intervention with other studies among HIV patients. Further research is required to evaluate the effect of health education program regarding TB especially in countries with high HIV prevalence with increasing burden of TB among HIV patients.
This study has shown that the health education intervention program is effective in improving knowledge, attitude, and practice regarding tuberculosis among HIV patients. The module developed is recommended to be included as a strategy in the National tuberculosis control guidelines in the training and sensitization of HIV patients on tuberculosis prevention at health facility level.