A comparative analysis of community pharmacists’ involvement in HIV/AIDS services before and after training interventions in Nigeria

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This study evaluated community pharmacists' involvement in the delivery of HIV/AIDS services in community pharmacies in Nigeria before and after a training intervention and the value of the services added to community pharmacy practices. Methods: A before-and-after intervention study was conducted in 2019 among 45 selected community pharmacists in Oyo State, Nigeria. A semistructured questionnaire on a 5-point Likert scale was administered to assess their involvement, with 8 items for HTS and 9 items for ARV/MTM services before and after a training intervention. The data were analysed via descriptive and inferential statistics, and the p value was set at ≤ 0.05. Results: At the baseline survey, 17.8% of the respondents were involved in rapid HIV test services, while all the respondents were involved after training. The total mean total score for HTS after training was 31.80 ± 9.824, whereas it was 21.38 ± 16.542 before training (range 8–40, midpoint = 24, p ≤ 0.05). However, there was no significant difference in the number of ARV/MTM services offered before (23.27 ± 18.896) and after (23.71 ± 13.441) the training programme (range 9–45, midpoint = 27, p > 0.05). The barriers to integrating HIV/AIDS services into community pharmacy practices before and after the training program were significantly lower after training (p ≤ 0.05), with the exception of the absence of financial compensation (p > 0.05). The services increased and encouraged patronage and patient inflow into the pharmacy (33.3%), where more clients in the community were tested and aware of their status (11.1%). Community pharmacists became more relevant in the community and had an improved positive image (11.1%), whereas the activities increased the knowledge and skills of pharmacists of HIV services (8.9%), among others. Conclusion Community pharmacists’ involvement in HIV/AIDS services was low before training. However, training interventions have been shown to improve HIV test services. For improved service delivery, the government should consider the remuneration of community pharmacists and possibly incorporate them into the healthcare system and designate them as PHC centers. Antiretroviral therapy community pharmacists HIV/AIDS services HIV test services medication therapy management training intervention Introduction Pharmacists and other healthcare providers are constantly expanding their roles to ensure optimal patient care despite new challenges to successful care and prevention [ 1 ]. In addition to traditional laboratory settings, pharmacists perform several tests to enhance their clinical interventions [ 2 – 5 ]. Various point-of-care testing (POCT) kits with technological innovations are now available and have allowed for the assessment of laboratory tests at the point-of-care delivery in pharmacies [ 6 ]. Every day, the number of in-pharmacy rapid diagnostic tests continues to increase, thereby changing the face of patient care [ 7 ]. This expanding scope of pharmacy practice comes with an increased capacity for informed clinical decisions by pharmacists [ 8 ]. In the United States, pharmacists have long been recognized as important members of the patient care team for HIV [ 9 ]. Improved outcomes have repeatedly been associated with their involvement in managing HIV-infected patients. Pharmacists select individualized HIV treatment regimens [ 10 – 11 ]. They provide patient counselling, adverse drug event monitoring, evaluation of treatment regimens for potential drug‒drug interactions, and identification of opportunities to simplify the regimen. These interventions have been shown to reduce the viral load and improve CD4 + T lymphocyte responses and ART adherence while reducing medication errors [ 12 ]. The guidelines from the National Institute for Health and Care Excellence and Public Health England, 2015, also specified that pharmacies were allowed to make HIV testing available in England, where the condition was highly prevalent [ 13 ]. In a study conducted to assess the attitudes of pharmacists towards over-the-counter (OTC) sales of HIV rapid tests in pharmacies at Midwest among licenced community pharmacists, participants agreed that rapid HIV tests when offered on an over-the-counter basis would significantly increase the level of awareness of their HIV status among people in the community [ 14 ]. Previous surveys suggested that the majority of pharmacists would also be willing to act as providers of HIV testing [ 15 – 20 ] and that community pharmacists may be distinctively located to facilitate the critical link to HIV care. Purpose of the Study A baseline assessment of community pharmacists’ involvement in HIV/AIDS testing services (HTS) and ARV/MTM service delivery in Southwest China, Nigeria, by researchers revealed that few community-based pharmacists were previously involved in HTS and ARV/MTM [ 21 ]. The baseline assessment was followed by training interventions for the same respondents [ 22 ] and further implementation and monitoring of HIV test services (HTSs) in community pharmacies [ 23 ]. The main goal of the service is to expand the uptake of HIV testing and reduce the viral load in HIV-positive clients through medication therapy management. To determine if there is an improvement in the services provided after training, implementation strategies, and monitoring, this study evaluated the HIV test services and ARV/MTM services provided by community pharmacist respondents before and after training intervention and implementation strategies. Hence, this study aimed to compare HIV/AIDS services provided by community pharmacists before and after training interventions. This is to ascertain if training has effects on the services offered and to determine if there is any value added to the community pharmacy practice in the State. Methods Study Design The study was a "before and after" intervention study and was conducted among 45 registered community pharmacists in Oyo State, Nigeria, from January to December 2019. The study is the last stage of a longitudinal study whereby community pharmacists in Oyo State at baseline assessment were surveyed on the HIV test and ART/MTM services they provided [ 21 ] and were trained in HIV test services [ 22 ]. The researchers also monitored the services during a four-month implementation stage [ 23 ]. Study Area All community pharmacists in Oyo State, Nigeria, who registered with the Pharmacists Council of Nigeria (PCN) were covered in the study [ 24 ]. Oyo State is ranked 14th in size and 5th in population in Nigeria [ 25 ]. The state is divided into five zones [ 26 ]. Among the 36 states in Nigeria, six (6) states, including Oyo State, account for 41% of people living with HIV [ 27 ]. The spatial distribution of HIV/AIDS according to research findings is highest in the Saki zone, with 22% of respondents, and lowest in the Oyo zone, with 18.5%. Ogbomoso reported a prevalence of 21.5%, Ibarapa reported 19.0%, and Ibadan reported 19.0% of respondents with the disease [ 28 ]. Study participants The study participants included community-based pharmacists who work in selected community pharmacies registered by the PCN in Oyo State, Nigeria [ 24 ], while all community pharmacies without current registration status as of December 31, 2018, in the state were excluded from the study. Sampling and Sample Size Determination The records of registered community pharmacies from the PCN register in Oyo State as of December 31, 2018, were used [ 24 ]. A multistage sampling method was employed. This depended on the town and local government area (LGAs) of the community pharmacies in the state. Each community pharmacy was chosen from each town/LGA on the basis of a defined population. The sample size for community pharmacies was determined before the sample size of the pharmacists was determined. One registered pharmacist per pharmacy was taken as a respondent for each pharmacy. The sample size was determined via Taro Yamane's formula. At the baseline assessment, 100 respondents participated in the survey, while 70 were invited for training. Among the 50 students who attended the training, 45 participated in the implementation of the HTS [ 21 – 23 ]. This comparative analysis was based on the respondents who participated at the baseline, attended the training, and implemented the HTS in their pharmacies. The data of the 45 participants at the baseline were extracted and compared with the service they provided after the implementation of the services. Research instrument With the use of a similar questionnaire used before the training, the HIV/AIDS services provided after training by the same respondent community pharmacists were assessed [ 21 ], while the questionnaire included the value-added services provided by the respondents in their pharmacies. This is to determine whether the training intervention delivered earlier to the respondents has any effect on the services being provided. Section A of the questionnaire explored the sociodemographic characteristics of the pharmacists, including sex, the number of years of practice as a pharmacist, qualifications, and position/status on the premises. In Section B, 8 items that measured HTS and 9 items that measured ARV/MTM were arranged with a 'Yes/No' response option to explore the nature and type of services offered by the community pharmacists. The level of involvement of the participants was also measured on a 5-point Likert scale ranging from "very much involved = 5, very involved = 4, moderately involved = 3, little involved = 2, not involved = 1". The challenges faced by community pharmacist respondents in integrating HIV/AIDS services into their pharmacy practice were explored in Section C. Several suggested barriers were presented to respondents with multiple choices. Open-ended questions on HIV/AIDS initiatives in pharmacies, positive impacts of training on community pharmacy practices, and factors that facilitate the delivery of HIV/AIDS services in community pharmacies were assessed in Section D. Data collection The questionnaire was administered to the respondents with the use of the Google form four months after implementation and monitoring of the services. Reminders were given to respondents within two weeks of sending the form through a WhatsApp group created for all the respondents and to individual sites. The respondents were also followed up periodically through text messages and phone calls to ascertain their responses. Data analysis Descriptive statistics used to analyse the sociodemographic characteristics of the respondents and other responses on the Yes/No responses were frequency and percentages, whereas the mean and standard deviation were used to calculate the level of involvement on a 5-point Likert scale from very involved (= 5) to not much involved (= 1). With the highest score for each indicator, neutral points were taken to be the midpoint between the minimum and maximum scores. By adding the sum of the lowest and highest scores and calculating the average, the midpoint was obtained. Responses on very much involved and very involved were taken as positive responses, whereas the midpoint scores of 3 and above were taken as positive for individual responses for each indicator. Total mean scores were also calculated for both the HTS and ARV/MTM services provided before and after the training intervention, and these scores were compared. Inferential statistics such as paired t tests were used to compare the mean degree of involvement in HIV/AIDS services before and after training and the barriers to integrating HIV/AIDS services in community pharmacies. An alpha value of ≤ 0.05 was used to test for statistical significance. Ethical clearance The Oyo State Research Ethical Review Committee, Ministry of Health, provided ethical clearance (Reference no. AD13/479/1240) for the study. Informed consent was obtained from the community pharmacists who filled out the questionnaire through writing by signing the consent form attached to the questionnaire. Results A total of forty-five respondents participated in the study. Table 1 shows the sociodemographic characteristics of the respondents. Approximately 64% of the respondents were male, whereas 36% were female. Most of them (75.6%) had a B. Pharm. degree within 1–10 years of postgraduate (44.4%) and were superintendent pharmacists (77.8%). Table 2 compares the nature and types of HIV/AIDS services provided by community pharmacists before and after the training program. Before the training, 17.8% of the respondents were providing rapid HIV tests, whereas 46.7% were referring patients for HIV counselling. Additionally, adherence counselling for HIV/AIDS patients was the highest service provided for HIV/AIDS patients (72.2%) after training, and the least common service provided was home delivery of ART by 2.8% of the respondents. In terms of the respondents’ provision of HIV test services, only 17.8% were involved in rapid HIV testing services before training, whereas all the respondents were involved after training. This also had multiple effects on the overall HTS provided after the training. Hence, there was a significant difference in all eight HTSs provided after the training program by the respondents compared with the services provided before the training (p ≤ 0.05). For ARV/MTM services, no significant difference was observed in the nine services provided before and after training (p > 0.05), except for adherence counselling for HIV/AIDS patients. Table 1 Sociodemographic characteristics of the respondents involved in HIV/AIDS services after training Variable Frequency n = 45 % Sex Male 29 64.4 Female 16 35.6 Qualification B.Pharm. 34 75.6 M.Sc./M.Pharm. 5 11.1 Pharm. D 3 6.7 FPCPharm. 3 6.7 Ph.D 0 0 Years of practice (postgraduation) 1–10 20 44.4 11–20 11 24.4 21–30 3 6.7 31–40 9 20.0 41 + 2 4.4 Position of respondent in the pharmacy Superintendent pharmacist (SP) 35 77.8 Locum 0 0.0 Full time (not SP) 10 22.2 Table 2 A comparison of nature and types of HIV/AIDS services provided before and after training HIV/AIDS services Before training n = 45 After training n = 45 f(%) p value HIV Testing Services (HTS) Rapid HIV testing 8(17.8) 45 (100.0) 0.000* Stocking of HIV test kits 6(13.3) 16(35.6) 0.003* HIV pre- testing counselling 10(22.2) 43(95.6) 0.000* HIV post- testing counselling 12(26.7) 40(88.9) 0.000* Provision of patient/client with confidential test result 6(13.3) 39(86.7) 0.000* Linkage to confirmatory HIV test services 20(44.4) 35(77.8) 0.001* Referral of known HIV patient to Physician/health centre for HIV clinical care and support services 25(25.6) 37(82.2) 0.002* Referral of patient for HIV counselling 21(46.7) 34(75.6) 0.003* Antiretroviral Therapy (ART) Medication Therapy Management (MTM) Refill of Antiretroviral Therapy (ART) 16(35.6) 17(47.2) 0.570 Stocking of ART 12(26.7) 12(33.3) 1.000 Medication treatment and monitoring of ART 10(22.2) 8(22.2) 0.486 Adherence counselling for HIV/AIDS patients 18(40.0) 26(72.2) 0.019* Social responsibility to HIV patients 10(22.2) 13(36.1) 0.323 Provision of Post Exposure Prophylaxis (PEP) test for patient 1(2.2) 6(16.7) 0.058 Referral of patient for PEP 19(42.2) 22(61.1) 0.445 Home delivery of ART 2(4.4) 1(2.8) 0.570 Pharmaceutical Care to HIV patients 15(33.3) 20(55.6) 0.133 Yes = 1, No = 2. S.D. = Standard deviation, *Significant at p ≤ 0.05 Table 3 also shows the mean scores of the level of involvement in the services before and after the training. Significant differences were detected in the level of involvement of HTSs after training compared with their involvement before training (p ≤ 0.05), except for the referral of known HIV patients to physicians/health centers for HIV clinical care and support services (p > 0.05). The total mean total score after the training was 31.80 ± 9.824, whereas it was 21.38 ± 16.542 before the training (range 8–40, midpoint = 24, p ≤ 0.05). However, there was no significant difference in the number of ARV/MTM services offered before (23.27 ± 18.896) and after (23.71 ± 13.441) the training programme (range 9–45, midpoint = 27, p > 0.05). Table 3 A comparison of involvement in HIV/AIDS services before and after training HIV/AIDS services Before n = 45 After n = 45 Mean (SD) Mean (SD) p value HIV Testing Services (HTS) Rapid HIV testing 2.29(2.074) 4.44(0.867) 0.000* Stocking of HIV test kits 2.04(1.953) 2.89(1.627) 0.013* HIV pre- testing counselling 2.53(2.007) 4.29(0.968) 0.000* HIV post- testing counselling 2.76(2.058) 4.18(1.154) 0.000* Provision of patient/client with confidential test result 2.44(2.149) 4.22(1.106) 0.000* Linkage to confirmatory HIV test services 2.76(2.024) 3.87(1.392) 0.001* Referral of known HIV patient to Physician/health centre for HIV clinical care and support services 3.40(2.199) 4.00(1.348) 0.077 Referral of patient for HIV counselling 3.16(2.078) 3.91(1.362) 0.036* Mean total 21.38 (16.542) 31.80(9.824) Antiretroviral Therapy (ART) Medication Therapy Management (MTM) Refill of Antiretroviral Therapy (ART) 2.69(2.151) 2.67(1.732) 0.930 Stocking of ART 2.44(2.149) 2.22(1.460) 0.494 Medication treatment and monitoring of ART 2.40(2.049) 2.44(1.470) 0.882 Adherence counselling for HIV/AIDS patients 3.16(2.088) 3.36(1.540) 0.530 Social responsibility to HIV patients 2.76(2.288) 2.80(1.561) 0.910 Provision of Post Exposure Prophylaxis (PEP) test for patient 2.00(2.174) 2.31(1.427) 0.457 Referral of patient for PEP 3.04(2.121) 3.24(1.540) 0.517 Home delivery of ART 1.67(1.796) 1.67(1.087) 1.000 Pharmaceutical Care to HIV patients 3.11(2.080) 3.00(1.624) 0.731 Mean total 23.27(18.896) 23.71(13.441) Very much involved = 5, Very Involved = 4, Moderately involved = 3, Little involvement = 2, Not involved = 1”, S.D. = Standard deviation. *Significant at p ≤ 0.05 Table 4 shows the barriers to integrating HIV/AIDS services into community pharmacy practices before and after the training program. There was a significant percentage reduction in the barriers after the training, where barriers such as lack of information or training on HIV/AIDS services (44.4%) and inadequate knowledge of HIV/AIDS services (26.7%) before the training no longer existed after the training (i.e., 0.0%). Barriers such as a lack of clinical tools noted by 57.8% of the respondents before the training also decreased to 8.9% after the training. There were significant differences in the barriers to integrating health promotion services into community pharmacy practices before and after the training programme (p 0.05). Table 4 Barriers to integrating HIV/AIDS services into community pharmacy practices before and after the training programme Barriers Before n = 45 After n = 45 f (%) p value Inadequate knowledge on HIV/AIDS services 12(26.7) 0(0.0) 0.000* Lack of information or training on HIV/AIDS services 20(44.4) 0(0.0) 0.000* Lack of time 14(31.1) 3(6.7) 0.001* Lack of collaboration with other health care professionals 21(46.7) 1(2.2) 0.000* Lack of staff resources 12(26.7) 4(8.9) 0.019* Absence of financial compensation 9(20.0) 5(11.1) 0.160 Lack of clinical tools 26(57.8) 4(8.9) 0.000* Lack of space/inadequate physical design of the pharmacy 12(26.7) 2(4.4) 0.003* Patients are not interested in preventive services 8(17.8) 1(2.2) 0.018* Yes = 1, No = 2. S.D. = Standard deviation, *Significant at p ≤ 0.05 The respondents freely reported HIV/AIDS initiatives in their pharmacies after the training (Table 5 ). HIV/AIDS initiatives include counselling, screening, and conduct of HIV testing services (42.2%), community outreach/health promotion and health talks (22.2%), creation of awareness, sensitization, and publicizing community pharmacies as HTS centers (20%), and referral and follow-up of positive patients (6.7%). Table 5 HIV/AIDS initiatives in community pharmacies after training HIV/AIDS initiatives Frequency (n = 45) % Counselling, screening and conduct of HIV testing services 19 42.2 Community outreach/health promotion and health talks 10 22.2 Creating awareness, sensitization and publicizing community pharmacy as HTS centre 9 20.0 Referral and follow up of positive patients 3 6.7 Documentation of services 1 2.2 No initiative 3 6.7 The positive impact of HIV/AIDS services on the respondents’ practices, as shown in Table 6 , included improved awareness of HIV/AIDS services, which increased and encouraged patronage and patient inflow into the pharmacy (33.3%); more clients in the community tested and understood their status (11.1%); community pharmacists became more relevant in the community and improved their image (11.1%); and the activities increased the knowledge and skills of pharmacists of HIV services (8.9%), among others. Table 6 Positive impact of HIV/AIDS services on community pharmacy practices Positive impact on community pharmacy practice Frequency (n = 45) % More awareness on HIV/AIDS services which increase and encourage patronage and patient inflow into the pharmacy 15 33.3 More clients in the community were tested and know their status 5 11.1 Community pharmacists are more relevant in the community and improved good image 5 11.1 Boost knowledge and skill of pharmacists of HIV services 4 8.9 Community is more informed and aware on HIV testing, treatment and prevention through community pharmacy enlightenment 3 6.7 Community was pleased with the services brought closer to them 2 4.4 Community pharmacists fulfilled and relevant in health care services to the community 2 4.4 Stronger pharmacist-patient relationship, building trust and reliability 2 4.4 Enlarge scope of services rendered and make community pharmacy more clinical oriented 2 4.4 Increase social responsibilities of community pharmacists and their public health impact 2 4.4 Not much impact 2 4.4 Insight on how to care for PLWH 1 2.2 The respondents further noted factors that facilitate the delivery of HIV/AIDS services in community pharmacies in Table 7 . These include timely provision of material for testing kits, promotional materials, documentation forms and ARVs (31.1%), compensation and remuneration for healthcare providers (17.8%), increased community awareness (17.8%), and the availability of more health personnel to deliver services (11.1%), among others. Table 7 Factors that facilitate the delivery of HIV/AIDS services by community pharmacists Factors that will facilitate development of HIV/AIDS services Frequency (n = 45) % Timely provision of material for testing e.g. kits, promotion materials, documentation forms and drugs 14 31.1 More community awareness 8 17.8 Compensation and remuneration for healthcare providers 8 17.8 More personnel to deliver services 5 11.1 More promotional activities and medical outreaches 4 8.9 Better empowerment to deliver services including training 3 6.7 Adequate space in the pharmacy for privacy in conducting test 3 6.7 Discussion This study compared community pharmacists’ involvement in HIV/AIDS services before and after training interventions in Nigeria. This study also revealed the value added to community pharmacy services after community pharmacists were trained in HIV test services. The study revealed that some community pharmacists provided certain HIV/AIDS-related services in their pharmacies before training, even though their level of involvement was suboptimal. After the training, a significant difference was observed in the number of HIV testing services delivered by the community pharmacists. To be relevant as a community pharmacist in this century, the provision of health promotion, point-of-care, and primary healthcare services are important in a pharmacy outlet [ 29 – 30 ]. As seen in this study, some community pharmacists in Nigeria had been providing HIV/AIDS services in their pharmacies before training, in line with their extended clinical roles, even though their level of involvement had been low. These findings are in agreement with a similar study conducted in southeastern Nigeria [ 31 ], in which the mean score involvement in HIV services was below average. This also agreed with findings in a Lesotho-based study [ 32 ] on HIV testing services in community pharmacies, in which only 20% of the respondents offered HIV testing and counselling services. After the training, all the respondents were involved in rapid HIV testing. This is similar to a study conducted in the Caribbean Region by Hiner et al. [ 33 ], which showed that approximately two-thirds of trained voluntary counselling and testing (VCT) providers in clinical skills were confirmed as providing VCT services. In comparing the services provided, all the respondents were involved in the HTS after the training compared with before the training. The significant difference in the delivery of HTS before and after training was compared with the effect of the health care provider (HCP) training program in Swaziland [ 34 ]. Training increased the mean pre- and postessay scores in an educational strategy targeted toward healthcare workers in underserved communities in Central America [ 35 ] and demonstrated the ability to integrate HIV services into practice. However, there was no significant difference in the ARV/MTM services provided after the training. This could be because no HIV-stable patient was devolved to the trained community pharmacists after the training; hence, the number of trainees who were providing some of the MTM services indicated did not increase. Medication therapy management (MTM) services provided by pharmacists have been found to enhance adherence to medications among patients, reduce overall medical costs, and improve health outcomes [ 36 ]. Adherence is expected to improve patient and provider satisfaction, medication usage, therapeutic response, and patient quality of life. The present study revealed a significant difference in adherence to counselling for HIV/AIDS patients after training. This is similar to the study of Oqua et al. [ 37 ], where significant differences and improvements in pharmacy practices were observed after a training intervention vis-a-vis patient counselling, provision of individual counselling on medication use and monitoring and reporting of suspected adverse drug reactions, among others. There was a significant difference in the barriers to integrating HIV/AIDS services into community pharmacy practices before and after the training program, except for the absence of financial compensation. Hence, participants still cited reimbursement as a major barrier to the provision of services, as in other studies [ 9 , 36 , 38 ]. The positive impact of the delivery of HIV/AIDS services on community pharmacy practices includes improved knowledge and skills related to these services, increased and encouraged patronage, and patient inflow into the pharmacy. This aligned with the outcome of the SIDHAS Project at FHI 360 [ 39 ], where community pharmacists reported expanded clientele, business, and scope, and with Kamiru et al.’s study [ 40 ], where health care providers' knowledge about HIV/AIDS, antiretroviral therapy, and relevant clinical paediatric practices increased significantly. Stronger pharmacist–patient relationships, building trust, and reliability were also positive impacts on the services that the participants enjoyed, similar to the findings of Darin et al. [ 41 ]. Factors that facilitate the delivery of HIV/AIDS services in community pharmacies include the timely provision of materials for testing, and funding of the system to ensure the continuity and sustainability of the services is critical, as respondents wished to continue the service even after the end of the project and were already liaising with the local agency for control of AIDS (LACA) managers in their local government areas through the researcher, as in Weidle et al.’s study [ 42 ]. Community pharmacies have been identified as the first point of call for healthcare services in the community and have been suggested as an important addition to HIV testing locations [ 43 – 44 ]. Although routine HIV testing in healthcare settings has been recommended since 2006 in the USA, the necessary inclusion of community pharmacies in Nigeria as HIV testing service centres is evidenced by this study. Another outstanding factor that facilitates the delivery of HIV/AIDS services noted by the respondents is compensation and remuneration for healthcare providers. Compensation interventions, such as those in Hirsch et al. and Hirsch et al. [ 45 – 46 ], revealed that community pharmacists were more effective in providing MTM services for managing HIV/AIDS patients in pilot pharmacies than in other pharmacies where compensation was not considered. Limitations of the study This study included before- and postintervention training, and there was no control. Hence, it is challenging to attribute changes solely to the intervention. Additionally, findings from before-and-after studies are often specific to the context in which the study was conducted. This limits the ability to generalize the results of studies conducted in other settings or populations. Additionally, the clients were not surveyed after the training intervention to evaluate their attitudes toward the services offered. Conclusion The study revealed that the nature and types of HTS and ARV/MTM services offered by community pharmacists were low before training. The study further revealed that there was a significant difference in HTS delivery before and after training, whereas no significant difference was observed in ARV/MTM services. Hence, training interventions were shown to improve service delivery in HTSs. The study further revealed that there was a significant difference in the barriers to integrating HIV/AIDS services into community pharmacy practices before and after training. This finding indicates that training will reduce barriers to integrating HIV/AIDS services into community pharmacy practices. The reimbursement of community pharmacists has continued to reoccur as an important barrier to HIV/AIDS service delivery in community pharmacies; hence, the government needs to remunerate pharmacists to provide services and possibly incorporate them into the healthcare system and designate them as PHC centers. Finally, the study revealed that the delivery of HIV/AIDS services increases community pharmacist relevance and patronage to pharmacies. Suggestions for further studies can include the effect of compensation on community pharmacy services in Nigeria and the evaluation of pharmacy clients' attitudes toward HIV/AIDS services provided in community pharmacies. Abbreviations ARV - Antiretroviral ART - Antiretroviral therapy FHI - Family Health International HCP - Health Care Provider HTS - HIV testing services LGAs - Local Government Areas MTM - Medication Therapy Management OTC - Over-the-counter PCN - Pharmacists Council of Nigeria Now Pharmacy Council of Nigeria POCT - Point-of-Care Testing VCT - Voluntary Counselling and Testing SIDHAS - Strengthening Integrated Delivery of HIV/AIDS Services LACA - Local Agency for Control of AIDS USA - United States of America Declarations Ethical approval and consent to participate We followed the scientific requirements and research protocols for human subject recruitment of the Declaration of Helsinki. The Oyo State Research Ethical Review Committee, Ministry of Health, provided ethical clearance (Reference no. AD13/479/1240 of April 30, 2019) for the study. Informed consent was obtained from the community pharmacists who participated in the study and who filled out the questionnaire through writing by signing the consent form attached to the questionnaire. Clinical trial number Not applicable Consent for publication All the authors provided their consent in the publication of the article as declared in the cover letter. Availability of data and materials statement This manuscript has associated data Conflict of interest The authors declare no conflicts of interest. Funding No funding was received for the study. Author contributions Author contributions: Concept – Y.O.O.; Design – Y.O.O., W.O.E.; Supervision – Y.O.O., W.O.E.; Resource – Y.O.O.; Materials – Y.O.O.; Data collection &/or processing - Y.O.O.; Analysis &/or interpretation - Y.O.O., W.O.E.; Literature search – Y.O.O., W.O.E.; Writing original draft – Y.O.O.; Critical review and editing –Y.O.O., W.O.E. Acknowledgements The researchers appreciate all the community pharmacists who participated in the completion of the study questionnaires. Authors’ information Y. O. Oseniis a pharmacist with more than 34 years in practice and a senior lecturer (Pharmacy Administration) at Nigerian universities. She is an international conference presenter, consultant, and public health pharmacist, verses in health and pharmacy regulation and policy development, is an author of peer-reviewed publications, and is a reviewer of reputable international journals. W. O. Erhun is a Professor of Pharmacy Administration at Obafemi Awolowo University (OAU), Nigeria, and has been an Adjunct Professor of Pharmacy Administration to many Nigerian universities. References Mohiuddin AK. The Excellence of Pharmacy Practice. Innov Pharm. 2020 Jan 28;11(1):10.24926/iip.v11i1.1662. doi: 10.24926/iip.v11i1.1662. Retraction in: Innov Pharm. 2020;11(1). doi: 10.24926/iip.v11i2.3944. PMID: 34017646; PMCID: PMC8132542. 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Published 2023 Sep 27 https://www.pharmacytimes.com/view/pharmacies-and-labs-must-work-together-to-accelerate-test-and-treat-opportunities-enhance-patient-care-equity-improve-health-outcomes Plebani M, Nichols JH, Luppa PB, Greene D, Sciacovelli L, Shaw J, Khan AI, Carraro P, Freckmann G, Dimech W, Zaninotto M, Spannagl M, Huggett J, Kost GJ, Trenti T, Padoan A, Thomas A, Banfi G, Lippi G. Point-of-care testing: state-of-the art and perspectives. Clin Chem Lab Med. 2024;63(1):35-51. doi: 10.1515/cclm-2024-0675. PMID: 38880779. Aidoo M, Incardona S. Ten Years of Universal Testing: How the Rapid Diagnostic Test Became a Game Changer for Malaria Case Management and Improved Disease Reporting. Am J Trop Med Hyg. 2021;106(1):29-32. doi: 10.4269/ajtmh.21-0643. PMID: 34749303; PMCID: PMC8733544. Adjei A, Kukula V, Narh CT, Odopey S, Arthur E, Odonkor G, Mensah MM, Olliaro P, Horgan P, Dittrich S, Moore CE, Salami O, Awini E, Nkeramahame J, Williams J, Baiden R. 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J Am Pharm Assoc (2003). 2010;50(3):411-5. doi: 10.1331/JAPhA.2010.09039. PMID: 20452917. Zaller N, Jeronimo A, Bratberg J, Case P, Rich JD. Pharmacist and pharmacy staff experiences with nonprescription (NP) sale of syringes and attitudes toward providing HIV prevention services for injection drug users (IDUs) in Providence, RI. J Urban Health. 2010;87(6):942-53. doi: 10.1007/s11524-010-9503-z. PMID: 21116724; PMCID: PMC3005095. Amesty S, Blaney S, Crawford ND, Rivera AV, Fuller C. Pharmacy staff characteristics associated with support for pharmacy-based HIV testing. J Am Pharm Assoc (2003). 2012;52(4):472-9, 1-9. doi: 10.1331/JAPhA.2012.10194. PMID: 22825227; PMCID: PMC3703741. Crawford ND, Dean T, Rivera AV, Guffey T, Amesty S, Rudolph A, DeCuir J, Fuller CM. Pharmacy Intervention to Improve HIV Testing Uptake Using a Comprehensive Health Screening Approach. Public Health Rep. 2016;131 Suppl 1(Suppl 1):139-46. doi: 10.1177/00333549161310S116. PMID: 26862239; PMCID: PMC4720615. Tran A, Stewart AL, Covvey JR. Knowledge, attitudes and beliefs regarding human immunodeficiency virus and in-home testing among a regional sample of student pharmacists. Curr Pharm Teach Learn. 2017;9(6):980-988. doi: 10.1016/j.cptl.2017.07.013. Epub 2017 Sep 1. PMID: 29233395. Sianturi EI, Latifah E, Pane M, Perwitasari DA, Satibi, SA, Kristina EB, Hastuti JP, Taxis K. “Knowledge, Empathy, and Willingness to Counsel Patients with HIV among Indonesian Pharmacists: A National Survey of Stigma.” AIDS Care.2021; 34 (1): 21-28. doi:10.1080/09540121.2021.1883506. Oseni YO, Erhun WO. Assessing community pharmacists' involvement and clients' opinion on HIV/AIDS services in community pharmacies in Nigeria: a cross-sectional survey. Int J STD AIDS. 2021;32(6):538-550. doi: 10.1177/0956462420981527. Epub 2021 Feb 3. PMID: 33533299. Oseni YO, Erhun WO. Delivery of training in HIV/AIDS services among community pharmacists in Oyo State, Nigeria: an interventional study. Malays J Pharm Sci. 2023;21(2):13–28. https://doi.org/10.21315/mjps2023.21.2.2 Oseni YO, Erhun WO. Implementation strategies and outcomes in the delivery of HIV test services (HTS) in community pharmacies in Nigeria. BMC Prim. Care.2024; 25: 315. https://doi.org/10.1186/s12875-024-02568-1 Pharmacists Council of Nigeria (PCN). 2018 Register. List of registered pharmacists and pharmaceutical premises as at December. Abuja; 2018 National Bureau of Statistics (NBS, 2018). 2017 Demographic Statistics Bulletin. www.nigerianstat.gov.ng Source: National Population Commission Oyo State Pacesetter State. About Oyo State. https://old.oyostate.gov.ng/about-oyo-state/ National Agency for the Control of AIDS (NACA). ‘National Strategic Framework on HIV and AIDS: 2017–2021’ [pdf]. https://naca.gov.ng/2013-nationalhiv-validated-data-2-2/(accessed on November 15, 2018). Irene OF, Aikhole AE. HIV/AIDS in Oyo State, Nigeria: Analysis of Spatial Pattern of Prevalence and Policy Implication for Government. An International Multidisciplinary Journal, Ethiopia AFRREV @ Ten. African Research review 2016;10(5): Serial No.44: 30-51 ISSN 1994-9057 (Print) ISSN 2070-0083 (Online) DOI: http://dx.doi.org/10.4314/afrrev.v10i5.3 Pharmacists Council of Nigeria (2012). 4- Compendium of minimum standards for the assurance of pharmaceutical care in Nigeria Oseni YO, Afolabi MO. Development and evaluation of health promotion training programme for community pharmacists in Oyo State, Nigeria. Pedagogy in Health Promotion. 2020; 6(4): 296–304 sagepub.com/journals-permissions Ajagu N, Anetoh MU, Nduka SO. Expanding HIV/AIDS care service sites: a cross sectional survey of community pharmacists' views in South‒East, Nigeria. J Pharm Policy Pract. 2017 Nov 2;10:34. doi: 10.1186/s40545-017-0122-x. PMID: 29118990; PMCID: PMC5667033. Ryder PT, Meyerson BE, Coy KC, von Hippel CD. Pharmacists' perspectives on HIV testing in community pharmacies. J Am Pharm Assoc (2003). 2013 Nov-Dec;53(6):595-600. doi: 10.1331/JAPhA.2013.12240. PMID: 24091415. Hiner CA, Mandel BG, Weaver MR, Bruce D, McLaughlin R, Anderson J. Effectiveness of a training-of-trainers model in a HIV counselling and testing program in the Caribbean Region. Hum Resour Health. 2009 Feb 17;7:11. doi: 10.1186/1478-4491-7-11. PMID: 19222839; PMCID: PMC2653459. Kamiru HN, Ross MW, Bartholomew LK, McCurdy SA, Kline MW. Effectiveness of a training program to increase the capacity of health care providers to provide HIV/AIDS care and treatment in Swaziland. AIDS Care. 2009 Nov;21(11):1463-70. doi: 10.1080/09540120902883093. PMID: 20024725; PMCID: PMC2797129. Flys T, González R, Sued O, Suarez Conejero J, Kestler E, Sosa N, McKenzie-White J, Monzón II, Torres CR, Page K. A novel educational strategy targeting health care workers in underserved communities in Central America to integrate HIV into primary medical care. PLoS One. 2012;7(10):e46426. doi: 10.1371/journal.pone.0046426. Epub 2012 Oct 24. Erratum in: PLoS One. 2013;8(7). doi:10.1371/annotation/0e024b1f-cfcc-444d-836c-6fd97a6169c1. PMID: 23115628; PMCID: PMC3480350. Rosenquist A, Best BM, Miller TA, Gilmer TP, Hirsch JD. Medication therapy management services in community pharmacy: a pilot programme in HIV specialty pharmacies. J Eval Clin Pract. 2010;16(6):1142-6. doi: 10.1111/j.1365-2753.2009.01283.x. PMID: 21143346. Oqua D, Agu KA, Isah MA, Onoh OU, Iyaji PG, Wutoh AK, King RC. Improving pharmacy practice through public health programs: experience from Global HIV/AIDS initiative Nigeria project. Springerplus. 2013;2:525. doi: 10.1186/2193-1801-2-525. PMID: 24255831; PMCID: PMC3824707. Kauffman Y, Nair V, Herist K, Thomas V, Weidle PJ. HIV medication therapy management services in community pharmacies. J Am Pharm Assoc (2003). 2012;52(6):e287-91. doi: 10.1331/JAPhA.2012.12063. PMID: 23229993; PMCID: PMC4688897. Fhi360. Strengthening Integrated Delivery of HIV/AIDS Services (SIDHAS) Project at FHI 360: Getting community pharmacists on the differentiated care train in Nigeria: Strengthening integrated delivery of HIV services. Published 2021 Sep 21, https://www.fhi360.org/projects/strengthening-integrated-delivery-hivaids-services-sidhas/ Kamiru HN, Ross MW, Bartholomew LK, McCurdy SA, Kline MW. Effectiveness of a training program to increase the capacity of health care providers to provide HIV/AIDS care and treatment in Swaziland. AIDS Care. 2009;21(11):1463-70. doi: 10.1080/09540120902883093. PMID: 20024725; PMCID: PMC2797129. Darin KM, Klepser ME, Klepser DE, Klepser SA, Reeves A, Young M, Scarsi KK. Pharmacists provided rapid HIV testing in two community pharmacies. J Am Pharm Assoc (2003). 2015;55(1):81-8. doi: 10.1331/JAPhA.2015.14070. PMID: 25415222. Weidle PJ, Lecher S, Botts LW, Jones L, Spach DH, Alvarez J, Jones R, Thomas V. HIV testing in community pharmacies and retail clinics: a model to expand access to screening for HIV infection. J Am Pharm Assoc (2003). 2014;54(5):486-92. doi: 10.1331/JAPhA.2014.14045. PMID: 25216878; PMCID: PMC4698873. Centres for Disease Control and Prevention (CDC). Implementing HIV Testing in Nonclinical Settings: A Guide For HIV Testing Providers 2016. Available on: https://www.cdc.gov/hiv/pdf/testing/CDC_HIV_Implementing_HIV_Testing_in_Nonclinical_Settings.pdf CDC. HIV testing in retail pharmacies. 2020. Available on: https://www.cdc.gov/hiv/effectiveinterventions/diagnose/hiv-testing-in-retail pharmacies? Sort=Title%3A%3Aasc&Intervention%20Name=HIV%20Testing%20in%20Retail%20Pharmacies Hirsch JD, Rosenquist A, Best BM, Miller TA, Gilmer TP. Evaluation of the first year of a pilot program in community pharmacy: HIV/AIDS medication therapy management for Medi-Cal beneficiaries. J Manag Care Pharm. 2009 Jan-Feb;15(1):32-41. doi: 10.18553/jmcp.2009.15.1.32. PMID: 19125548; PMCID: PMC10438302. Hirsch JD, Gonzales M, Rosenquist A, Miller TA, Gilmer TP, Best BM. Antiretroviral therapy adherence, medication use, and health care costs during 3 years of a community pharmacy medication therapy management program for Medi-Cal beneficiaries with HIV/AIDS. J Manag Care Pharm. 2011 Apr;17(3):213-23. doi: 10.18553/jmcp.2011.17.3.213. PMID: 21434698; PMCID: PMC10437600. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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In addition to traditional laboratory settings, pharmacists perform several tests to enhance their clinical interventions [\u003cspan additionalcitationids=\"CR3 CR4\" citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e–\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Various point-of-care testing (POCT) kits with technological innovations are now available and have allowed for the assessment of laboratory tests at the point-of-care delivery in pharmacies [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Every day, the number of in-pharmacy rapid diagnostic tests continues to increase, thereby changing the face of patient care [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. This expanding scope of pharmacy practice comes with an increased capacity for informed clinical decisions by pharmacists [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn the United States, pharmacists have long been recognized as important members of the patient care team for HIV [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Improved outcomes have repeatedly been associated with their involvement in managing HIV-infected patients. Pharmacists select individualized HIV treatment regimens [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e–\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. They provide patient counselling, adverse drug event monitoring, evaluation of treatment regimens for potential drug‒drug interactions, and identification of opportunities to simplify the regimen. These interventions have been shown to reduce the viral load and improve CD4 + T lymphocyte responses and ART adherence while reducing medication errors [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe guidelines from the National Institute for Health and Care Excellence and Public Health England, 2015, also specified that pharmacies were allowed to make HIV testing available in England, where the condition was highly prevalent [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. In a study conducted to assess the attitudes of pharmacists towards over-the-counter (OTC) sales of HIV rapid tests in pharmacies at Midwest among licenced community pharmacists, participants agreed that rapid HIV tests when offered on an over-the-counter basis would significantly increase the level of awareness of their HIV status among people in the community [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Previous surveys suggested that the majority of pharmacists would also be willing to act as providers of HIV testing [\u003cspan additionalcitationids=\"CR16 CR17 CR18 CR19\" citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e–\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e] and that community pharmacists may be distinctively located to facilitate the critical link to HIV care.\u003c/p\u003e\n\u003ch3\u003ePurpose of the Study\u003c/h3\u003e\n\u003cp\u003eA baseline assessment of community pharmacists’ involvement in HIV/AIDS testing services (HTS) and ARV/MTM service delivery in Southwest China, Nigeria, by researchers revealed that few community-based pharmacists were previously involved in HTS and ARV/MTM [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. The baseline assessment was followed by training interventions for the same respondents [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e] and further implementation and monitoring of HIV test services (HTSs) in community pharmacies [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. The main goal of the service is to expand the uptake of HIV testing and reduce the viral load in HIV-positive clients through medication therapy management. To determine if there is an improvement in the services provided after training, implementation strategies, and monitoring, this study evaluated the HIV test services and ARV/MTM services provided by community pharmacist respondents before and after training intervention and implementation strategies. Hence, this study aimed to compare HIV/AIDS services provided by community pharmacists before and after training interventions. This is to ascertain if training has effects on the services offered and to determine if there is any value added to the community pharmacy practice in the State.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003cdiv id=\"Sec4\" class=\"Section3\"\u003e \u003c/div\u003e \u003c/div\u003e\n\n\n\n\n\n \n\n "},{"header":"Methods","content":"\u003ch2\u003eStudy Design\u003c/h2\u003e\u003cp\u003eThe study was a \"before and after\" intervention study and was conducted among 45 registered community pharmacists in Oyo State, Nigeria, from January to December 2019. The study is the last stage of a longitudinal study whereby community pharmacists in Oyo State at baseline assessment were surveyed on the HIV test and ART/MTM services they provided [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e] and were trained in HIV test services [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. The researchers also monitored the services during a four-month implementation stage [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e].\u003c/p\u003e\u003ch3\u003eStudy Area\u003c/h3\u003e\u003cp\u003eAll community pharmacists in Oyo State, Nigeria, who registered with the Pharmacists Council of Nigeria (PCN) were covered in the study [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. Oyo State is ranked 14th in size and 5th in population in Nigeria [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. The state is divided into five zones [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. Among the 36 states in Nigeria, six (6) states, including Oyo State, account for 41% of people living with HIV [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. The spatial distribution of HIV/AIDS according to research findings is highest in the Saki zone, with 22% of respondents, and lowest in the Oyo zone, with 18.5%. Ogbomoso reported a prevalence of 21.5%, Ibarapa reported 19.0%, and Ibadan reported 19.0% of respondents with the disease [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e].\u003c/p\u003e\u003ch3\u003eStudy participants\u003c/h3\u003e\u003cp\u003eThe study participants included community-based pharmacists who work in selected community pharmacies registered by the PCN in Oyo State, Nigeria [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e], while all community pharmacies without current registration status as of December 31, 2018, in the state were excluded from the study.\u003c/p\u003e\u003ch3\u003eSampling and Sample Size Determination\u003c/h3\u003e\u003cp\u003eThe records of registered community pharmacies from the PCN register in Oyo State as of December 31, 2018, were used [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. A multistage sampling method was employed. This depended on the town and local government area (LGAs) of the community pharmacies in the state. Each community pharmacy was chosen from each town/LGA on the basis of a defined population.\u003c/p\u003e\u003cp\u003eThe sample size for community pharmacies was determined before the sample size of the pharmacists was determined. One registered pharmacist per pharmacy was taken as a respondent for each pharmacy.\u003c/p\u003e\u003cp\u003eThe sample size was determined via Taro Yamane's formula. At the baseline assessment, 100 respondents participated in the survey, while 70 were invited for training. Among the 50 students who attended the training, 45 participated in the implementation of the HTS [\u003cspan additionalcitationids=\"CR22\" citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e–\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. This comparative analysis was based on the respondents who participated at the baseline, attended the training, and implemented the HTS in their pharmacies. The data of the 45 participants at the baseline were extracted and compared with the service they provided after the implementation of the services.\u003c/p\u003e\u003ch2\u003eResearch instrument\u003c/h2\u003e\u003cp\u003eWith the use of a similar questionnaire used before the training, the HIV/AIDS services provided after training by the same respondent community pharmacists were assessed [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e], while the questionnaire included the value-added services provided by the respondents in their pharmacies. This is to determine whether the training intervention delivered earlier to the respondents has any effect on the services being provided.\u003c/p\u003e\u003cp\u003eSection A of the questionnaire explored the sociodemographic characteristics of the pharmacists, including sex, the number of years of practice as a pharmacist, qualifications, and position/status on the premises. In Section B, 8 items that measured HTS and 9 items that measured ARV/MTM were arranged with a 'Yes/No' response option to explore the nature and type of services offered by the community pharmacists. The level of involvement of the participants was also measured on a 5-point Likert scale ranging from \"very much involved = 5, very involved = 4, moderately involved = 3, little involved = 2, not involved = 1\".\u003c/p\u003e\u003cp\u003eThe challenges faced by community pharmacist respondents in integrating HIV/AIDS services into their pharmacy practice were explored in Section C. Several suggested barriers were presented to respondents with multiple choices. Open-ended questions on HIV/AIDS initiatives in pharmacies, positive impacts of training on community pharmacy practices, and factors that facilitate the delivery of HIV/AIDS services in community pharmacies were assessed in Section D.\u003c/p\u003e\u003ch3\u003eData collection\u003c/h3\u003e\u003cp\u003eThe questionnaire was administered to the respondents with the use of the Google form four months after implementation and monitoring of the services. Reminders were given to respondents within two weeks of sending the form through a WhatsApp group created for all the respondents and to individual sites. The respondents were also followed up periodically through text messages and phone calls to ascertain their responses.\u003c/p\u003e\u003ch2\u003eData analysis\u003c/h2\u003e\u003cp\u003eDescriptive statistics used to analyse the sociodemographic characteristics of the respondents and other responses on the Yes/No responses were frequency and percentages, whereas the mean and standard deviation were used to calculate the level of involvement on a 5-point Likert scale from very involved (= 5) to not much involved (= 1). With the highest score for each indicator, neutral points were taken to be the midpoint between the minimum and maximum scores. By adding the sum of the lowest and highest scores and calculating the average, the midpoint was obtained. Responses on very much involved and very involved were taken as positive responses, whereas the midpoint scores of 3 and above were taken as positive for individual responses for each indicator. Total mean scores were also calculated for both the HTS and ARV/MTM services provided before and after the training intervention, and these scores were compared.\u003c/p\u003e\u003cp\u003eInferential statistics such as paired t tests were used to compare the mean degree of involvement in HIV/AIDS services before and after training and the barriers to integrating HIV/AIDS services in community pharmacies. An alpha value of \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e≤\u003c/span\u003e 0.05 was used to test for statistical significance.\u003c/p\u003e\u003ch2\u003eEthical clearance\u003c/h2\u003e\u003cp\u003e The Oyo State Research Ethical Review Committee, Ministry of Health, provided ethical clearance (Reference no. AD13/479/1240) for the study. Informed consent was obtained from the community pharmacists who filled out the questionnaire through writing by signing the consent form attached to the questionnaire.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eA total of forty-five respondents participated in the study. Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e shows the sociodemographic characteristics of the respondents. Approximately 64% of the respondents were male, whereas 36% were female. Most of them (75.6%) had a B. Pharm. degree within 1\u0026ndash;10 years of postgraduate (44.4%) and were superintendent pharmacists (77.8%). Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e compares the nature and types of HIV/AIDS services provided by community pharmacists before and after the training program. Before the training, 17.8% of the respondents were providing rapid HIV tests, whereas 46.7% were referring patients for HIV counselling. Additionally, adherence counselling for HIV/AIDS patients was the highest service provided for HIV/AIDS patients (72.2%) after training, and the least common service provided was home delivery of ART by 2.8% of the respondents. In terms of the respondents\u0026rsquo; provision of HIV test services, only 17.8% were involved in rapid HIV testing services before training, whereas all the respondents were involved after training. This also had multiple effects on the overall HTS provided after the training. Hence, there was a significant difference in all eight HTSs provided after the training program by the respondents compared with the services provided before the training (p\u0026thinsp;\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026le;\u003c/span\u003e\u0026thinsp;0.05). For ARV/MTM services, no significant difference was observed in the nine services provided before and after training (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05), except for adherence counselling for HIV/AIDS patients.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSociodemographic characteristics of the respondents involved in HIV/AIDS services after training\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFrequency\u003c/p\u003e \u003cp\u003en\u0026thinsp;=\u0026thinsp;45\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSex\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e64.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e35.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eQualification\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eB.Pharm.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e75.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eM.Sc./M.Pharm.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePharm. D\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFPCPharm.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePh.D\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eYears of practice (postgraduation)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1\u0026ndash;10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e44.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e11\u0026ndash;20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e24.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e21\u0026ndash;30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e31\u0026ndash;40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e41\u003csup\u003e+\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePosition of respondent in the pharmacy\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSuperintendent pharmacist (SP)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e77.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLocum\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFull time (not SP)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e22.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eA comparison of nature and types of HIV/AIDS services provided before and after training\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHIV/AIDS services\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBefore training\u003c/p\u003e \u003cp\u003en\u0026thinsp;=\u0026thinsp;45\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAfter\u003c/p\u003e \u003cp\u003etraining\u003c/p\u003e \u003cp\u003en\u0026thinsp;=\u0026thinsp;45\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003ef(%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ep value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHIV Testing Services (HTS)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRapid HIV testing\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e8(17.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e45 (100.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.000*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStocking of HIV test kits\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e6(13.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e16(35.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.003*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHIV pre- testing counselling\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e10(22.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e43(95.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.000*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHIV post- testing counselling\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e12(26.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e40(88.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.000*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProvision of patient/client with confidential test result\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e6(13.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e39(86.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.000*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLinkage to confirmatory HIV test services\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e20(44.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e35(77.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.001*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eReferral of known HIV patient to Physician/health centre for HIV clinical care and support services\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e25(25.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e37(82.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.002*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eReferral of patient for HIV counselling\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e21(46.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e34(75.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.003*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAntiretroviral Therapy (ART) Medication Therapy Management (MTM)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRefill of Antiretroviral Therapy (ART)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e16(35.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e17(47.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.570\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStocking of ART\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e12(26.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e12(33.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMedication treatment and monitoring of ART\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e10(22.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e8(22.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.486\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAdherence counselling for HIV/AIDS patients\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e18(40.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e26(72.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.019*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSocial responsibility to HIV patients\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e10(22.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e13(36.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.323\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProvision of Post Exposure Prophylaxis (PEP) test for patient\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1(2.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6(16.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.058\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eReferral of patient for PEP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e19(42.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e22(61.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.445\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHome delivery of ART\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2(4.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1(2.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.570\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePharmaceutical Care to HIV patients\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e15(33.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e20(55.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.133\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003eYes\u0026thinsp;=\u0026thinsp;1, No\u0026thinsp;=\u0026thinsp;2. S.D. = Standard deviation, *Significant at p\u0026thinsp;\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026le;\u003c/span\u003e\u0026thinsp;0.05\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e also shows the mean scores of the level of involvement in the services before and after the training. Significant differences were detected in the level of involvement of HTSs after training compared with their involvement before training (p\u0026thinsp;\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026le;\u003c/span\u003e\u0026thinsp;0.05), except for the referral of known HIV patients to physicians/health centers for HIV clinical care and support services (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05). The total mean total score after the training was 31.80\u0026thinsp;\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026plusmn;\u003c/span\u003e\u0026thinsp;9.824, whereas it was 21.38\u0026thinsp;\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026plusmn;\u003c/span\u003e\u0026thinsp;16.542 before the training (range 8\u0026ndash;40, midpoint\u0026thinsp;=\u0026thinsp;24, p\u0026thinsp;\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026le;\u003c/span\u003e\u0026thinsp;0.05). However, there was no significant difference in the number of ARV/MTM services offered before (23.27\u0026thinsp;\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026plusmn;\u003c/span\u003e\u0026thinsp;18.896) and after (23.71\u0026thinsp;\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026plusmn;\u003c/span\u003e\u0026thinsp;13.441) the training programme (range 9\u0026ndash;45, midpoint\u0026thinsp;=\u0026thinsp;27, p\u0026thinsp;\u0026gt;\u0026thinsp;0.05).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eA comparison of involvement in HIV/AIDS services before and after training\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHIV/AIDS services\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBefore\u003c/p\u003e \u003cp\u003en\u0026thinsp;=\u0026thinsp;45\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAfter\u003c/p\u003e \u003cp\u003en\u0026thinsp;=\u0026thinsp;45\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMean (SD)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMean (SD)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ep value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHIV Testing Services (HTS)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRapid HIV testing\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2.29(2.074)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4.44(0.867)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.000*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStocking of HIV test kits\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2.04(1.953)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.89(1.627)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.013*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHIV pre- testing counselling\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2.53(2.007)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4.29(0.968)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.000*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHIV post- testing counselling\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2.76(2.058)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4.18(1.154)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.000*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProvision of patient/client with confidential test result\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2.44(2.149)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4.22(1.106)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.000*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLinkage to confirmatory HIV test services\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2.76(2.024)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3.87(1.392)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.001*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eReferral of known HIV patient to Physician/health centre for HIV clinical care and support services\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3.40(2.199)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4.00(1.348)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.077\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eReferral of patient for HIV counselling\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3.16(2.078)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3.91(1.362)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.036*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMean total\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e21.38 (16.542)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e31.80(9.824)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAntiretroviral Therapy (ART) Medication Therapy Management (MTM)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRefill of Antiretroviral Therapy (ART)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2.69(2.151)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.67(1.732)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.930\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStocking of ART\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2.44(2.149)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.22(1.460)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.494\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMedication treatment and monitoring of ART\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2.40(2.049)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.44(1.470)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.882\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAdherence counselling for HIV/AIDS patients\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3.16(2.088)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3.36(1.540)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.530\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSocial responsibility to HIV patients\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2.76(2.288)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.80(1.561)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.910\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProvision of Post Exposure Prophylaxis (PEP) test for patient\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2.00(2.174)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.31(1.427)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.457\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eReferral of patient for PEP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3.04(2.121)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3.24(1.540)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.517\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHome delivery of ART\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.67(1.796)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.67(1.087)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePharmaceutical Care to HIV patients\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3.11(2.080)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3.00(1.624)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.731\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMean total\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e23.27(18.896)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e23.71(13.441)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003eVery much involved\u0026thinsp;=\u0026thinsp;5, Very Involved\u0026thinsp;=\u0026thinsp;4, Moderately involved\u0026thinsp;=\u0026thinsp;3, Little involvement\u0026thinsp;=\u0026thinsp;2, Not involved\u0026thinsp;=\u0026thinsp;1\u0026rdquo;, S.D. = Standard deviation. *Significant at p\u0026thinsp;\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026le;\u003c/span\u003e\u0026thinsp;0.05\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e shows the barriers to integrating HIV/AIDS services into community pharmacy practices before and after the training program. There was a significant percentage reduction in the barriers after the training, where barriers such as lack of information or training on HIV/AIDS services (44.4%) and inadequate knowledge of HIV/AIDS services (26.7%) before the training no longer existed after the training (i.e., 0.0%). Barriers such as a lack of clinical tools noted by 57.8% of the respondents before the training also decreased to 8.9% after the training. There were significant differences in the barriers to integrating health promotion services into community pharmacy practices before and after the training programme (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05), except for the absence of financial compensation (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eBarriers to integrating HIV/AIDS services into community pharmacy practices before and after the training programme\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBarriers\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBefore\u003c/p\u003e \u003cp\u003en\u0026thinsp;=\u0026thinsp;45\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAfter\u003c/p\u003e \u003cp\u003en\u0026thinsp;=\u0026thinsp;45\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003ef (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ep value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInadequate knowledge on HIV/AIDS services\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e12(26.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0(0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.000*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLack of information or training on HIV/AIDS services\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e20(44.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0(0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.000*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLack of time\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e14(31.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3(6.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.001*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLack of collaboration with other health care professionals\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e21(46.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1(2.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.000*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLack of staff resources\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e12(26.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4(8.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.019*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAbsence of financial compensation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e9(20.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5(11.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.160\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLack of clinical tools\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e26(57.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4(8.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.000*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLack of space/inadequate physical design of the pharmacy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e12(26.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2(4.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.003*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePatients are not interested in preventive services\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e8(17.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1(2.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.018*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003eYes\u0026thinsp;=\u0026thinsp;1, No\u0026thinsp;=\u0026thinsp;2. S.D. = Standard deviation, *Significant at p\u0026thinsp;\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026le;\u003c/span\u003e\u0026thinsp;0.05\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe respondents freely reported HIV/AIDS initiatives in their pharmacies after\u003c/p\u003e \u003cp\u003ethe training (Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e). HIV/AIDS initiatives include counselling, screening, and conduct of HIV testing services (42.2%), community outreach/health promotion and health talks (22.2%), creation of awareness, sensitization, and publicizing community pharmacies as HTS centers (20%), and referral and follow-up of positive patients (6.7%).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eHIV/AIDS initiatives in community pharmacies after training\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHIV/AIDS initiatives\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFrequency\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;45)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCounselling, screening and conduct of HIV testing services\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e42.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCommunity outreach/health promotion and health talks\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e22.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCreating awareness, sensitization and publicizing community pharmacy as HTS centre\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e20.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eReferral and follow up of positive patients\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDocumentation of services\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo initiative\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe positive impact of HIV/AIDS services on the respondents\u0026rsquo; practices, as shown in Table\u0026nbsp;\u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e6\u003c/span\u003e, included improved awareness of HIV/AIDS services, which increased and encouraged patronage and patient inflow into the pharmacy (33.3%); more clients in the community tested and understood their status (11.1%); community pharmacists became more relevant in the community and improved their image (11.1%); and the activities increased the knowledge and skills of pharmacists of HIV services (8.9%), among others.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab6\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 6\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePositive impact of HIV/AIDS services on community pharmacy practices\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePositive impact on community pharmacy practice\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFrequency (n\u0026thinsp;=\u0026thinsp;45)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMore awareness on HIV/AIDS services which increase and encourage patronage and patient inflow into the pharmacy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e33.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMore clients in the community were tested and know their status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e11.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCommunity pharmacists are more relevant in the community and improved good image\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e11.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBoost knowledge and skill of pharmacists of HIV services\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e8.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCommunity is more informed and aware on HIV testing, treatment and prevention through community pharmacy enlightenment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCommunity was pleased with the services brought closer to them\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCommunity pharmacists fulfilled and relevant in health care services to the community\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStronger pharmacist-patient relationship, building trust and reliability\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEnlarge scope of services rendered and make community pharmacy more clinical oriented\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIncrease social responsibilities of community pharmacists and their public health impact\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNot much impact\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInsight on how to care for PLWH\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe respondents further noted factors that facilitate the delivery of HIV/AIDS services in community pharmacies in Table\u0026nbsp;\u003cspan refid=\"Tab7\" class=\"InternalRef\"\u003e7\u003c/span\u003e. These include timely provision of material for testing kits, promotional materials, documentation forms and ARVs (31.1%), compensation and remuneration for healthcare providers (17.8%), increased community awareness (17.8%), and the availability of more health personnel to deliver services (11.1%), among others.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab7\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 7\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eFactors that facilitate the delivery of HIV/AIDS services by community pharmacists\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFactors that will facilitate development of HIV/AIDS services\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFrequency (n\u0026thinsp;=\u0026thinsp;45)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTimely provision of material for testing e.g. kits, promotion materials, documentation forms and drugs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e31.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMore community awareness\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e17.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCompensation and remuneration for healthcare providers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e17.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMore personnel to deliver services\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e11.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMore promotional activities and medical outreaches\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e8.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBetter empowerment to deliver services including training\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAdequate space in the pharmacy for privacy in conducting test\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study compared community pharmacists\u0026rsquo; involvement in HIV/AIDS services before and after training interventions in Nigeria. This study also revealed the value added to community pharmacy services after community pharmacists were trained in HIV test services. The study revealed that some community pharmacists provided certain HIV/AIDS-related services in their pharmacies before training, even though their level of involvement was suboptimal. After the training, a significant difference was observed in the number of HIV testing services delivered by the community pharmacists.\u003c/p\u003e \u003cp\u003eTo be relevant as a community pharmacist in this century, the provision of health promotion, point-of-care, and primary healthcare services are important in a pharmacy outlet [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. As seen in this study, some community pharmacists in Nigeria had been providing HIV/AIDS services in their pharmacies before training, in line with their extended clinical roles, even though their level of involvement had been low. These findings are in agreement with a similar study conducted in southeastern Nigeria [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e], in which the mean score involvement in HIV services was below average. This also agreed with findings in a Lesotho-based study [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e] on HIV testing services in community pharmacies, in which only 20% of the respondents offered HIV testing and counselling services.\u003c/p\u003e \u003cp\u003eAfter the training, all the respondents were involved in rapid HIV testing. This is similar to a study conducted in the Caribbean Region by Hiner et al. [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e], which showed that approximately two-thirds of trained voluntary counselling and testing (VCT) providers in clinical skills were confirmed as providing VCT services.\u003c/p\u003e \u003cp\u003eIn comparing the services provided, all the respondents were involved in the HTS after the training compared with before the training. The significant difference in the delivery of HTS before and after training was compared with the effect of the health care provider (HCP) training program in Swaziland [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. Training increased the mean pre- and postessay scores in an educational strategy targeted toward healthcare workers in underserved communities in Central America [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e] and demonstrated the ability to integrate HIV services into practice. However, there was no significant difference in the ARV/MTM services provided after the training. This could be because no HIV-stable patient was devolved to the trained community pharmacists after the training; hence, the number of trainees who were providing some of the MTM services indicated did not increase.\u003c/p\u003e \u003cp\u003eMedication therapy management (MTM) services provided by pharmacists have been found to enhance adherence to medications among patients, reduce overall medical costs, and improve health outcomes [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]. Adherence is expected to improve patient and provider satisfaction, medication usage, therapeutic response, and patient quality of life. The present study revealed a significant difference in adherence to counselling for HIV/AIDS patients after training. This is similar to the study of Oqua et al. [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e], where significant differences and improvements in pharmacy practices were observed after a training intervention vis-a-vis patient counselling, provision of individual counselling on medication use and monitoring and reporting of suspected adverse drug reactions, among others.\u003c/p\u003e \u003cp\u003eThere was a significant difference in the barriers to integrating HIV/AIDS services into community pharmacy practices before and after the training program, except for the absence of financial compensation. Hence, participants still cited reimbursement as a major barrier to the provision of services, as in other studies [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe positive impact of the delivery of HIV/AIDS services on community pharmacy practices includes improved knowledge and skills related to these services, increased and encouraged patronage, and patient inflow into the pharmacy. This aligned with the outcome of the SIDHAS Project at FHI 360 [\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e], where community pharmacists reported expanded clientele, business, and scope, and with Kamiru et al.\u0026rsquo;s study [\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e], where health care providers' knowledge about HIV/AIDS, antiretroviral therapy, and relevant clinical paediatric practices increased significantly. Stronger pharmacist\u0026ndash;patient relationships, building trust, and reliability were also positive impacts on the services that the participants enjoyed, similar to the findings of Darin et al. [\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eFactors that facilitate the delivery of HIV/AIDS services in community pharmacies include the timely provision of materials for testing, and funding of the system to ensure the continuity and sustainability of the services is critical, as respondents wished to continue the service even after the end of the project and were already liaising with the local agency for control of AIDS (LACA) managers in their local government areas through the researcher, as in Weidle et al.\u0026rsquo;s study [\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eCommunity pharmacies have been identified as the first point of call for healthcare services in the community and have been suggested as an important addition to HIV testing locations [\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e]. Although routine HIV testing in healthcare settings has been recommended since 2006 in the USA, the necessary inclusion of community pharmacies in Nigeria as HIV testing service centres is evidenced by this study.\u003c/p\u003e \u003cp\u003eAnother outstanding factor that facilitates the delivery of HIV/AIDS services noted by the respondents is compensation and remuneration for healthcare providers. Compensation interventions, such as those in Hirsch et al. and Hirsch et al. [\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e], revealed that community pharmacists were more effective in providing MTM services for managing HIV/AIDS patients in pilot pharmacies than in other pharmacies where compensation was not considered.\u003c/p\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eLimitations of the study\u003c/h2\u003e \u003cp\u003eThis study included before- and postintervention training, and there was no control. Hence, it is challenging to attribute changes solely to the intervention. Additionally, findings from before-and-after studies are often specific to the context in which the study was conducted. This limits the ability to generalize the results of studies conducted in other settings or populations. Additionally, the clients were not surveyed after the training intervention to evaluate their attitudes toward the services offered.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe study revealed that the nature and types of HTS and ARV/MTM services offered by community pharmacists were low before training. The study further revealed that there was a significant difference in HTS delivery before and after training, whereas no significant difference was observed in ARV/MTM services. Hence, training interventions were shown to improve service delivery in HTSs. The study further revealed that there was a significant difference in the barriers to integrating HIV/AIDS services into community pharmacy practices before and after training. This finding indicates that training will reduce barriers to integrating HIV/AIDS services into community pharmacy practices.\u003c/p\u003e \u003cp\u003eThe reimbursement of community pharmacists has continued to reoccur as an important barrier to HIV/AIDS service delivery in community pharmacies; hence, the government needs to remunerate pharmacists to provide services and possibly incorporate them into the healthcare system and designate them as PHC centers.\u003c/p\u003e \u003cp\u003eFinally, the study revealed that the delivery of HIV/AIDS services increases community pharmacist relevance and patronage to pharmacies.\u003c/p\u003e \u003cp\u003eSuggestions for further studies can include the effect of compensation on community pharmacy services in Nigeria and the evaluation of pharmacy clients' attitudes toward HIV/AIDS services provided in community pharmacies.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eARV -\u0026nbsp;\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Antiretroviral\u003c/p\u003e\n\u003cp\u003eART - Antiretroviral therapy\u003c/p\u003e\n\u003cp\u003eFHI - \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Family Health International\u003c/p\u003e\n\u003cp\u003eHCP - \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Health Care Provider\u003c/p\u003e\n\u003cp\u003eHTS - \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;HIV\u0026nbsp;testing\u0026nbsp;services\u003c/p\u003e\n\u003cp\u003eLGAs - \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Local Government Areas\u003c/p\u003e\n\u003cp\u003eMTM -\u0026nbsp;\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Medication Therapy Management\u003c/p\u003e\n\u003cp\u003eOTC -\u0026nbsp;\u0026nbsp;\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Over-the-counter\u003c/p\u003e\n\u003cp\u003ePCN -\u0026nbsp;\u0026nbsp;\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Pharmacists Council of Nigeria Now Pharmacy Council of Nigeria\u003c/p\u003e\n\u003cp\u003ePOCT - \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Point-of-Care Testing\u003c/p\u003e\n\u003cp\u003eVCT - Voluntary Counselling\u0026nbsp;and Testing\u003c/p\u003e\n\u003cp\u003eSIDHAS - \u0026nbsp; \u0026nbsp; Strengthening Integrated Delivery of HIV/AIDS Services\u003c/p\u003e\n\u003cp\u003eLACA - \u0026nbsp; \u0026nbsp; \u0026nbsp; Local Agency for Control of AIDS\u003c/p\u003e\n\u003cp\u003eUSA - \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; United States of America\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthical approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe followed the scientific requirements and research protocols for human subject recruitment of\u0026nbsp;the Declaration of Helsinki. The Oyo State Research Ethical Review Committee, Ministry of Health,\u0026nbsp;provided\u0026nbsp;ethical clearance (Reference no. AD13/479/1240 of April 30, 2019) for the study. Informed consent was\u0026nbsp;obtained\u0026nbsp;from the community pharmacists who participated in the study and who filled out the questionnaire through writing by signing the consent form attached to the questionnaire.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical trial number\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll the authors provided their consent in the publication of the article as declared in the cover letter.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis manuscript has associated data\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no conflicts of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo funding was received for the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAuthor contributions: Concept \u0026ndash; Y.O.O.; Design \u0026ndash; Y.O.O., W.O.E.; Supervision \u0026ndash; Y.O.O., W.O.E.; Resource\u0026nbsp;\u0026ndash;\u0026nbsp;Y.O.O.; Materials \u0026ndash; Y.O.O.; Data\u0026nbsp;collection\u0026nbsp;\u0026amp;/or\u0026nbsp;processing\u0026nbsp;- Y.O.O.; Analysis \u0026amp;/or\u0026nbsp;interpretation\u0026nbsp;- Y.O.O., W.O.E.; Literature\u0026nbsp;search\u0026nbsp;\u0026ndash; Y.O.O., W.O.E.; Writing original draft \u0026ndash; Y.O.O.; Critical\u0026nbsp;review\u0026nbsp;and editing \u0026ndash;Y.O.O., W.O.E.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe researchers appreciate all the community pharmacists who participated in the completion of the study questionnaires.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; information\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eY. O. Oseniis a pharmacist with more than 34 years in practice and a senior lecturer (Pharmacy Administration) at\u0026nbsp;Nigerian universities.\u0026nbsp;She is an international conference presenter, consultant, and public health pharmacist, verses in health and pharmacy regulation and policy development, is an author of peer-reviewed publications, and is a reviewer of reputable international journals.\u003c/p\u003e\n\u003cp\u003eW. O. Erhun is a Professor of Pharmacy Administration at Obafemi Awolowo University (OAU), Nigeria, and has been an Adjunct Professor of Pharmacy Administration to many Nigerian universities.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eMohiuddin AK. The Excellence of Pharmacy Practice. Innov Pharm. 2020 Jan 28;11(1):10.24926/iip.v11i1.1662. doi: 10.24926/iip.v11i1.1662. Retraction in: Innov Pharm. 2020;11(1). doi: 10.24926/iip.v11i2.3944. PMID: 34017646; PMCID: PMC8132542.\u003c/li\u003e\n\u003cli\u003eKehrer JP, James DE. 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Implementing HIV Testing in Nonclinical Settings: A Guide For HIV Testing Providers 2016. Available on: https://www.cdc.gov/hiv/pdf/testing/CDC_HIV_Implementing_HIV_Testing_in_Nonclinical_Settings.pdf\u003c/li\u003e\n\u003cli\u003eCDC. HIV testing in retail pharmacies. 2020. Available on: https://www.cdc.gov/hiv/effectiveinterventions/diagnose/hiv-testing-in-retail pharmacies? Sort=Title%3A%3Aasc\u0026amp;Intervention%20Name=HIV%20Testing%20in%20Retail%20Pharmacies\u003c/li\u003e\n\u003cli\u003eHirsch JD, Rosenquist A, Best BM, Miller TA, Gilmer TP. Evaluation of the first year of a pilot program in community pharmacy: HIV/AIDS medication therapy management for Medi-Cal beneficiaries. J Manag Care Pharm. 2009 Jan-Feb;15(1):32-41. doi: 10.18553/jmcp.2009.15.1.32. PMID: 19125548; PMCID: PMC10438302.\u003c/li\u003e\n\u003cli\u003eHirsch JD, Gonzales M, Rosenquist A, Miller TA, Gilmer TP, Best BM. Antiretroviral therapy adherence, medication use, and health care costs during 3 years of a community pharmacy medication therapy management program for Medi-Cal beneficiaries with HIV/AIDS. J Manag Care Pharm. 2011 Apr;17(3):213-23. doi: 10.18553/jmcp.2011.17.3.213. PMID: 21434698; PMCID: PMC10437600.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Antiretroviral therapy, community pharmacists, HIV/AIDS services, HIV test services, medication therapy management, training intervention","lastPublishedDoi":"10.21203/rs.3.rs-5895000/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5895000/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eCommunity pharmacists' expanded roles in the delivery of HIV testing services (HTSs) and antiretroviral (ARV) medication therapy management (MTM) have been shown to improve with training interventions, but this has not been evaluated in Nigeria. This study evaluated community pharmacists' involvement in the delivery of HIV/AIDS services in community pharmacies in Nigeria before and after a training intervention and the value of the services added to community pharmacy practices.\u003c/p\u003e\u003ch2\u003eMethods:\u003c/h2\u003e \u003cp\u003eA before-and-after intervention study was conducted in 2019 among 45 selected community pharmacists in Oyo State, Nigeria. A semistructured questionnaire on a 5-point Likert scale was administered to assess their involvement, with 8 items for HTS and 9 items for ARV/MTM services before and after a training intervention. The data were analysed via descriptive and inferential statistics, and the p value was set at \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026le;\u003c/span\u003e\u0026thinsp;0.05.\u003c/p\u003e\u003ch2\u003eResults:\u003c/h2\u003e \u003cp\u003eAt the baseline survey, 17.8% of the respondents were involved in rapid HIV test services, while all the respondents were involved after training. The total mean total score for HTS after training was 31.80\u0026thinsp;\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026plusmn;\u003c/span\u003e\u0026thinsp;9.824, whereas it was 21.38\u0026thinsp;\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026plusmn;\u003c/span\u003e\u0026thinsp;16.542 before training (range 8\u0026ndash;40, midpoint\u0026thinsp;=\u0026thinsp;24, p\u0026thinsp;\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026le;\u003c/span\u003e\u0026thinsp;0.05). However, there was no significant difference in the number of ARV/MTM services offered before (23.27\u0026thinsp;\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026plusmn;\u003c/span\u003e\u0026thinsp;18.896) and after (23.71\u0026thinsp;\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026plusmn;\u003c/span\u003e\u0026thinsp;13.441) the training programme (range 9\u0026ndash;45, midpoint\u0026thinsp;=\u0026thinsp;27, p\u0026thinsp;\u0026gt;\u0026thinsp;0.05). The barriers to integrating HIV/AIDS services into community pharmacy practices before and after the training program were significantly lower after training (p\u0026thinsp;\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026le;\u003c/span\u003e\u0026thinsp;0.05), with the exception of the absence of financial compensation (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05). The services increased and encouraged patronage and patient inflow into the pharmacy (33.3%), where more clients in the community were tested and aware of their status (11.1%). Community pharmacists became more relevant in the community and had an improved positive image (11.1%), whereas the activities increased the knowledge and skills of pharmacists of HIV services (8.9%), among others.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eCommunity pharmacists\u0026rsquo; involvement in HIV/AIDS services was low before training. However, training interventions have been shown to improve HIV test services. For improved service delivery, the government should consider the remuneration of community pharmacists and possibly incorporate them into the healthcare system and designate them as PHC centers.\u003c/p\u003e","manuscriptTitle":"A comparative analysis of community pharmacists’ involvement in HIV/AIDS services before and after training interventions in Nigeria","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-01-31 09:27:48","doi":"10.21203/rs.3.rs-5895000/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"9ebba15d-1018-433c-b111-80c51e3bd3bc","owner":[],"postedDate":"January 31st, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-03-05T11:08:24+00:00","versionOfRecord":[],"versionCreatedAt":"2025-01-31 09:27:48","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-5895000","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5895000","identity":"rs-5895000","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}