1. Impact of Training Programme on
Care of the PLWHA among the
Nurses Working in BPKIHS
Mehta RS, Karki P, Rijal S
B. P. Koirala Institute of Health Sciences

2. Introduction
Everybody is
at risk of
getting HIV.
However
certain
Persons have
high risk.

3. Cumulative HIV infection by sub group
and sex (July 2007)
New case in
Sub - groups Male Female Total Ashad
2064
Sex Workers (CSWs) 684 684 4
Clients of SWs/ STD 4445 104 4549 67
Housewife 1996 1996 65
Blood or organ recipients 17 6 23 0
Injecting Drug Use 1916 34 1950 33
Men who have sex with 20 20 2
men
Children 294 173 467 18
Sub-group NOT identified 50 17 67 35
Total 6742 3014 9756 224

4. HIV/AIDS---- Nepal
• UNAIDS- Nepal has a concentrated
HIV/AIDS epidemic with an estimated
62,000 people living with the virus.
• AIDS could be the leading cause of
death by 2010, if the current rate of
infection continues to increase.

5. Some Facts about HIV/AIDS
• 4th biggest killer world wide
• More than 95 % cases in low & middle
income countries
• Symptom free period up to 10 years or
More
• HIV transmission is 10 times more on STIs
• ART Cost: very expensive

6. • About 1/3 are aged 15-24 years
• Most people do not know they are infected
• Gravity of Different mode of Transmission:
* Sexual intercourse = 80-90 %
* Blood Transfusion = 3-15 %
* Injecting Drug users = 5 -10 %
* Equipments/Needles = < 0.1 %
* Perinatal = 0.1%

7. HIV positive to AIDS
– 33 % = Only develop AIDS
– 64 % = Till death live without
Symptoms
– 5-10- 20 yrs = A symptomatic
Concentrated epidemic:
Sex workers (4%), Migrant Population (4-10%) &
IVDUs(51%)

8. Estimated number of people living with HIV globally,
1990–
1990–2007
40
Millions
30
Number
of people
20
living
with HIV
10
0
199019911992199319941995199619971998199920002001200220032004200520062007
Year
This bar indicates the range

9. Estimated number of adult and child deaths
due to AIDS globally, 1990–2007
1990–
3.0
Millions
2.5
Number 2.0
of adult
and child 1.5
deaths due
to AIDS 1.0
0.5
0
199019911992199319941995199619971998199920002001200220032004200520062007
Year
This bar indicates the range

10. No of Reported Cases
( HIV Infection)
1st case in Nepal --July 1988
Since then increasing
1988 - 4
1992 - 77
1996 - 135
2000 - 700
2004 - 4442
2007 - 10546 Dec.15th

11. Objectives of the study:
• To assess the Knowledge, Attitude and
Practices (KAP) regarding the care of
PLWHA among the nurses working in
BPKIHS.
• To prepare an education intervention
package & provide training on care of
PLWHA.
• To evaluate the effectiveness of
implemented HIV/AIDS training
programme.

12. Null hypothesis:
There is no significant difference in the
KAP regarding care of PLWHA among the
nurses working in BPKIHS before and
after education intervention.

13. Research Design and Methodology:
The quasi-experimental research design
was adopted to carry out the study, using
single group pre-test post-test research
design.
This research study was conducted among
the nurses (ANMs and Staff Nurses)
working in BPKIHS.

14. The nurses working in maternity units,
tropical unit and OPDs were not included,
because the nurses working in maternity
units are involved in VCT, ART, Direct
patient care and the nurses working in
OPDs are not involved in care of admitted
patients

15. All the indoor wards were divided in to strata
according to the specialty i.e. Medical
(Medical-I, Medical-II, Medical- III, Derma,
and Psychiatric), Surgical (Surgical-I,
surgical-II, surgical- III, Orthopedics, Eye,
ENT and Paying), Operation theater
(Routine, Emergency, Gynecology and Day
Care OT), Critical care ( ICU/CCU/Dialysis
and NICU, PICU, MICU ,Nursery) and
Pediatric ( Unit I and II ) .

16. Using stratified random sampling
technique wards that is medical unit-II,
Surgical unit-I, Orthopedic unit,
ICU/CCU, Dialysis, Routine OT, and
pediatric unit-I was selected and 30
nurses were selected form these wards
using population proportionate random
sampling method.
Using pre-tested tools the pretest survey
was conducted in intervention group.

17. • Based upon the available literature and
pre-test findings the education package on
care of patients with HIV/AIDS was
prepared and content validity was
established with the concerned experts.
• The main contents in education package
are: epidemiology, pathophysiology, signs
and symptoms, investigations, staging,
treatment, complications, PEP, nursing
care, stigma management, and services
available at BPKIHS.

18. • After the pre-test, the education
intervention training was provided using
the prepared training module.
• This training was 3 hours 3 days sessions
excluding refreshment time.
• During the training session lecture,
discussion, role play, brain storming, video
show was arranged for better results.

19. • The current practioners and experts of the
field were utilized as a trainer.
• Training module prepared was given to
each participant. Various visual aids and
posters were used during the training
course.

20. • After the 2 weeks of training programme
post test was conducted.
• The collected data was analyzed using
SPSS-11.5 soft ware package.
• The descriptive statistics i.e. mean,
Percentage, range and SD were used to
analyze the data.
• The study was conducted in the months of
October 2006.

21. • The content validity of the prepared tool
was established with the experts of
concerned field.
• Pre-testing of the tool was done among 6
nurses of the similar setting in BPKIHS.
• Ethical clearance was obtained from the
concerned authority.
• Anonymity of the subjects was maintained.
• The subjects were assured of the
confidentiality of their information.

22. Details of Training Programme:
• Using preplanned schedule and Package
3 days training was arranged.
• An incentive was provided for participants
as well as resource persons so that
motivate them for active participation and
better outcome.
• At the end of the training programme
written feedback was obtained in a semi-
structured Performa and collected data
was analyzed.

23. Data Analysis and
Interpretations:

24. Demographic profile of the
subjects:
• The mean age of nurses was 24.8 yrs with
SD 3.88 and range 20-35 years.
• Majority of the nurses (90%) were Hindu.
• About 60% of the nurses were from
Sunsari (20%), Morang (20%) and
Kathmandu (16.7%).

25. • Majority of nurses were from village
76.7%, working in the post of staff nurse
(86.7%), unmarried (63.3%) and none of
them (100%) had taken the training related
to AIDS previously.

26. Table- I
Knowledge Profile of the Subjects (N=30)
Post-test (%)
Pre-test (%)
Difference
(Pre-Post)
S
(%)
Knowledge Profile of the Subjects
N
1 What is AIDS?
a. Life threatening disease
63.3 26.7 -36.6
b. Preventable disease
6.7 60.7 +54
c. Contagious disease
20 13.3 -6.7
e. I do not know 10 0 -10
2 HIV infection is diagnosed by blood test 70 86.7 +16.7

27. 3 Knowledge about confirmation of
diagnosis by lab test
a. Yes
30 100 +70
b. No
43.3 0 -43.3
c. Do not know/Not sure 26.7 0 -26.7
4 Presence of HIV virus
a. Saliva and tears 10 16.7 +6.7
b. Blood 80 96.7 +16.7
c. Semen/Vaginal Secretion
80 100 +20

28. 5
Blood cells damaged by HIV
virus
a. Basophil 6.7 13.3 +6.6
b. Esonophil 6.7 0 -6.7
c. T-Lymphocytes 73.3 86.7 +13.4
d. I do not Know 13.3 0 -13.3
c. Do not know 20 0 -20

29. 6 Ways of Transmission of
HIV/AIDS
a. shaking hands, 40 26.7 -13.3
hugging, kissing
b. Eating from same plate 20 6.7 -13.3
c. If one is transfused with HIV 93.3 100 +6.7
positive blood.
d. Making tattoos on the body 56.7 53.3 -3.4
e. Children born to HIV infected 80 86.7 +6.7
mothers
f. By the bite of mosquito 23.3 16.7 -6.3
g. Using common syringes 76.7 93.3 +21.7
h. Sharing utensils and clothes 23.3 10 -13.3

30. 7 Symptoms of HIV/AIDS
a. Anorexia/Wt. Loss
93.3 96.7 +3.4
b. Fatigue/Weakness
13.3 93.3 +80
c. Pain
3.3 90 +86.7
d. Shortness of Breath
23.3 80 +56.7
e. Nausea/Vomiting
16.7 83.3 +66.6
f. Cough
23.3 83.3 +60

31. g. Anxiety/Depression
76.7 90 +13.3
h. Skin Breakdown
10 83.3 +73.3
i. Diarrhoea
86.7 93.3 +5.7
j. Confusion/Dementia
6.7 66.7 +60
k. Constipation
23.3 60 +36.7
l. Fever
83.3 93.3 -10

32. 8 Who/When it is more likely to
contact HIVV/AIDS
a. Those having sexually
transmitted diseases 90 100 +10
b. Migrant worker
56.7 90 +33.3
c. Unprotected vaginal sex
90 100 +10
d. Blood transfusion
90 100 +10
e. Unprotected oral/anal sex
56.7 90 +33.3
9 HIV virus survive in body
fluids inside living human 63.3 100 +36.7
body

33. Table- II
Ways to prevent ourselves from getting HIV/AIDS (N=30)
Pre- Post- Difference
SN Knowledge Profile (+ Responses) test test (%)
(%) (%) (Pre-Post)
1 Applying the principles of Universal
Precautions 100 100 0
2 Use and administer blood and blood
products only after screening 96.7 90 -6.7
3 Not touching the infected person 10 10 0
4 Not sharing the needles, razors and blades
96.7 96.7 0
5 Not to conceive if one has HIV/AIDS 80 96.3 +13.3
6 Practice safe sex 93.3 100 +6.7
7 Be faithful to the partners 90 100 +10

34. Table - III
Knowledge about HIV/AIDS and its Care (N=30)
Pre- Post- Difference
SN Knowledge About HIV/AIDS test test (%)
(%) (%) (Pre-Post)
1 Heared about the term highly active anti-
33.3 90 +56.7
retroviral therapy ( HAART) ( yes)
2 AIDS patients are more prone to develop
66.7 90 +23.3
opportunistic illness ( yes)
3 Vaccine is available against HIV (yes) 23.3 56.7 +33.4
4 Knowledge about post exposure
36.7 100 +63.3
prophylaxis (PEP)
5 Bleaching/Chlorine is used to clean blood
86.7 100 +13.3
spillage on surface ( Yes)
6 Linen of AIDS patients should be send to
laundry only after disinfection on in 83.3 100 +16.7
chlorine/bleaching (yes)

35. Table- IV
Extent of knowledge about HIV/AIDS Related
services available at BPKIHS
Pre-test Difference (%)
SN Knowledge Profile Post-test (%)
(%) (Pre-Post)
1 VCT
a. Adequate 6.7 86.7 +80
b. Inadequate 16.7 16.7 0
c. Not at all 76.7 0 -76.7
2 PMTCT
a. Adequate 6.7 83.3 +76.6
b. Inadequate 16.7 16.7 0
c. Not at all 76.7 0 -76.7
3 ART
a. Adequate 10 86.7 +76.7
b. Inadequate 10 13.3 +3.3
c. Not at all 80 0 -80

36. 4 STIs/IDCs
a. Adequate 13.3 83.3 +70
b. Inadequate 20 60.7 -3.3
c. Not at all 66.7 0 -66.7
5 CD -4 count
a. Adequate 13.3 86.7 +73.4
b. Inadequate 10 13.3 +3.3
c. Not at all 76.7 0 -76.7
6 HIV test
a. Adequate 53.3 93.3 +40
b. Inadequate 26.7 6.7 -20
c. Not at all 20 0 -20
7 ART Drug availability
a. Adequate 30 86.7 +56.7
b. Inadequate 20 13.3 -6.7
c. Not at all 50 0 -50

37. 8 PEP
a. Adequate 10 93.3 +83.3
b. Inadequate 20 6.7 -13.3
c. Not at all 70 0 -70
9 Infection control protocol
of BPKIHS
a. Adequate 36.7 69.0 +32.3
b. Inadequate 23.3 27.6 +4.3
c. Not at all 40 3.4 -36.6

38. 10 Counseling Services
a. Adequate 46.7 86.7 +40
b. Inadequate 36.7 13.3 -23.4
c. Not at all 16.7 0 -16.7
11 Role of NGOs & INGOs
a. Adequate 30 83.3 +53.3
b. Inadequate 20 16.7 -3.3
c. Not at all 50 0 -50

39. Table-V
Ways to prevention of HIV/AIDS
Pre- Post- Difference
SN Knowledge Profile test test (%)
(%) (%) (Pre-Post)
1 Using condom during sex 100 100 0
2 Having no sexual relationship with multiple partners 93.3 96.7 +3.4
3 Having sex with single faithful husband and wife 96.7 96.7 0
4 Avoiding homosexual activities 86.7 96.7 +10
5 Not having sex with commercial sex workers 86.7 96.7 +10
6 Receiving safe blood transfusion 100 100 0
7 Using of disposable or sterilized syringe only 96.7 100 +3.3
8 Avoid to use common syringe by intravenous drug
abuser 96.7 93.3 -3.4

40. Table – VI
Pre and Post differences in the percentage of participants who
scored most desired answer on the knowledge sections of the
questionnaire (T= True)
P. Significance
SN Statement: Knowledge profile % Difference
Value (at 0.05)
1 HIV is diagnose by blood test (T) +16.7 0.250 NS
2 Steps of confirmation of HIV by lab test (T) +70 0.000 S
3 HIV is found in saliva (F) +6.7 0.687 NS
4 HIV is found in blood (T) +16.7 0.125 NS
5 HIV is found in semen/vaginal secretions (T) +20 0.31 NS
6 HIV damage T- lymphocytes (T) +13.4 0.289 NS
7 HIV is communicable disease (T) +20 1.000 NS

41. HIV is transmitted by having
8 +3.3 0.454 NS
multiple sexual partners (T)
HIV may be transmitted by
9 +10 1.000 NS
blood transfusion (T)
HIV may be transmitted by
10 +20 0.250 NS
kissing
HV can be transmitted using
11 +3.4 0.000 S
same cloths of clients. (F)
(NS= not significant, S= significant, at 5% level of significance)

42. HIV can be transmitted by
12 -3.3 0.000 NS
drinking from same glass (F)
HIV only survive in body fluids
13 +36.7 1.000 NS
inside living human body (T)
14 HIV is a curable disease (T) +3.3 .001 S
15 Knowledge about HAART (T) +56.7 1.00 NS
AIDS patients are more prone
16 +23.3 0.001 S
to opportunistic infections (T)

43. Table – VII
Pre and Post differences in the percentage of participants who
scored most desired answer on the attitude sections of the
questionnaire (P= Positive, N= Negative)
SN Statement: Attitude %Differe
nce P. Significa
(Pre – Value nce
Post)
1 AIDS is caused by curse of God. (N) +3.4 0.39 NS
2 Person affected should not be allowed to stay in
community. (N) +86.7 0.500 NS
3 All the young people / students should know
about HIV/AIDS infection. (P) -16.7 1.000 NS
4 It is alright for women and men to have
premarital sexual relation. (N) -13.4 0.125 NS
5 If one of my friends gets AIDS I shall continue my
normal social relationship with here or her. (P) +30 1.000 NS

44. 6 Health education is necessary
for woman and men to have safe 0.50
+10 NS
sex. (P) 0
7 AIDS is real threat of human
+70 .031 S
population. (N)
8 Knowing there is no cure for
AIDS this is no point in caring for 1.00
+90 NS
AIDS patients. (N) 0
9 It is not good for married men
and woman to have extra marital +23.3 0.18 NS
sexual relationship. (P) 0

45. 10 AIDS awareness is one of the
important advices of parents for -3.3 0.754 NS
their children. (P)
11 AIDS patient need live, support
-6.7 0.250 NS
and affection. (P)
12 Major responsibility of
adolescents is to participate in
HIV/AIDS prevention programme 0 1.000 NS
to being community awareness
to control HIV/AIDS. (P)
13 If one of my family members
gets AIDS I will be ready to care -10 0.500 NS
him / her. (P)
14 We should not tell others if one
-30 0.625 NS
has HIV/AIDS. (N)

46. 15 Individuals with HIV/AIDS infection must be
treated with love and belonging. (P) -13.3 0.180 NS
16 Individuals with HIV/AIDS infection must be
assessed for any potential infection. (P) -10 0.125 NS
17 HIV/AIDS patient should be treated properly.
(P) -10 0.250 NS
18 I feel that, counseling plays an important
role for an HIV/AIDS infected clients. (P) -10 0.250 NS
19 I am willing to assist with the delivery of a
baby born to a mother with HIV/AIDS. (P) -10 0.250 NS
20 I am willing to assist an operation on a
patient with HIV/AIDS. (P) -6.7 0.250 NS
(NS= not significant, S= significant, at 5% level of significance)

47. Table- VIII
Level of Preparation to provide care for the PLWA
Pre- Post- Difference
SN Knowledge Profile test test (%)
(%) (%) (Pre-Post)
1 Fully Prepared
43.3 86.7 +49.15
2 Adequately prepared
23.3 13.3 -10
3 Somewhat prepared
13.3 0 -13.3
4 Not prepared 20 0 -20

48. Table -IX
Responses Regarding Various Aspects of the Training
Programme
(Evaluation of the Training Programme)
Responses
SN Item / Particular
Adequate All right Inadequate
(good) (Average) (Poor)
1 Topics covered
93.3 6.7 00
2 Contents covered 86.7 13.7 00
3 Teaching learning
83.3 16.7 00
methods used
4 Time allotted 60.0 40.0 00
5 Refreshment 90.6 10.0 00
6 Training Materials 66.7 33.3 00
7 Seating
86.7 13.3 00
arrangements

49. P e r c e n ta g e
0
5
10
15
20
25
30
35
40
45
50
T e ac h in g
47
L e arn in g
M e th o d s U s e d
T o p ic s
37
C o v ere d
T im e
33
m an ag em en t
C o n te n ts
30
C o v e re d
T ra in in g
27
M a te r i a l s
S u p p lie d
20
Liked Items
P r e -te s t ta k e n
U p d a te
17
I n fo r m a ti o n s
13
A r r a n g e m e n ts
Most Liked Things about the Training Programme
10
T e am S p irit
7
P r e s e n ta ti o n s

50. P e r c e n ta g e
0
5
10
15
20
25
30
35
G ro u p
30
w o r k s /in te r a c ti
ons
P la n fo r a ll
27
n u rs e s
T im e c a n
23
in c r e a s e
C e r tific a te o f
13
tr a in in g
Suggetions/feedback
10
S o u n d S y s te m
Suggestions to incorporate in futrue training
C o n tin u e in
10
fu tu r e

51. Discussion:
Chi squire test was applied in the selected
variables of knowledge profile and attitude
components to investigate the differences after
education intervention. It was found that in
knowledge components i.e. steps of confirmation
of HIV by laboratory test is highly significant
(0.000), similarly there is significant changes in
the knowledge on HIV can be transmitted by
drinking from same glass (false statement) and
AIDS patients are more prone to opportunistic
infections (0.001). In remaining components
there is no change statistically at 5% level of
significance.

52. Similarly, in attitude components there is
significant difference in post test in AIDS is
real threat to human population (negative
statement) at 5% level of significance and
on other attitude components there is no
difference statistically at 5% level of
significance.

53. Conclusions:
• HIV/AIDS is rapidly spreading in countries
of Asia including Nepal.
• It could cause major socio-demographic
impact in the country.
• It obviously has many health implications.
• To minimize the risk of transmission,
adequate knowledge about HIV infection is
important.

54. • We believe that such programs should be
mandatory for all health care workers;
however, education campaigns should be
carefully structured and specifically
tailored to a particular setting.
• Finally, the effectiveness of targeted
education programs on HIV/AIDS should
be repeated by evaluated in the future.

55. References:
1. UNAIDS (2004), ‘Report on the global AIDS epidemic’, Executive Summary, June 2004
2. AIDS News letter: Quarterly (2061; Asoj). Women, Girls, HIV & AIDS, 53:13-17.
3. Bhardwaj, A., Biswas, R., & Shetty, K.J. (2001) HIV in Nepal: Is it rarer or the tip of an iceberg?
. Trop Doct, 31: 211-213.
4. Aich TK, Dhungana M, Kumar A, Pawha VK. Demographic and clinical Profiles of HIV positive
cases: A Two-year study report from a tertiary teaching Hospital. JNMA, 2004,43(153).
5. Agrwal H, Mourya R, Shrestha RK, Agrwal S, Singh GK. Assessment of quality of life of HIV
positive individuals at Dharan Municipality, 13th annual celebrations scientific programme
abstract book, 2006, Dharn, Nepal.
6. Parakh P, Gupta G, Rizal S. HIV/AIDS related knowkedge, attitudes and risk perception
amongst health professionals in BPKIHS. 13th annual celebrations scientific programme
abstract book, 2006, Dharn, Nepal.
7. Asrath U, Sah S, Jha N etal. Awareness and high risk behaviours among migrant workers in
relation to HIV/AIDS- a study from eastern Nepal. SAARC Journals of tubrculosis , lung
diseases and HIV/AIDS. 2006; III(1): 5-12.
8. Gurubacharya DL, Mathura KC, Karki DB. Knowledge, attitude and practices among health
care workers on needle-stick injuries. KVMJ. 2003; 192): 91-4.
9. Mulligan R, seirawan H, Galligan J, Lemme S. The effect of an HIV /AIDS Educational
program on the knowledge, Attitude, and behaviour of dental professionals. Journal of Dental
Education. 2006; 70 (8): 857-868.
10. Williams AB, Wang H, Burgess J, Gong Y. Effectiveness of an HIV /AIDS educational
programme for Chinese nurses. J. Adv. Nurse. 2006; 53 (6): 710-20.

56. Acknowledgement:
We want to express our heart felt
thanks to ASIA LINK PROJCT
co-ordinator Prof. Prahlad Karki
and project expert Prof. Suman
Rijal for providing the fund to
conduct the training programme.

62. THANK-YOU
The Theme.
“Stop AIDS:
Keep the
Promise -2007”
“Take leadership-2008”