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1
Chivonivoni, Tamuka. "Antimycobacterial treatment among children at start of antiretroviral treatment and antimycobacterial treatment after starting antiretroviral treatment among those who started antiretroviral treatment without antimycobacterial treatment at a tertiary antiretroviral paediatric clinic in Johannesburg, South Africa." Thesis, University of the Western Cape, 2010. http://etd.uwc.ac.za/index.php?module=etd&action=viewtitle&id=gen8Srv25Nme4_3784_1360929496.
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Background: Although clinicians encounter antimycobacterial treatment in Human mmunodeficiency (HIV)-infected children as one of the most common treatments coadministered with antiretroviral treatment (ART), quantitative data on the extent of antimycobacterial treatment among HIV-infected children at the time of commencement of ART and at different times during ART is scarce. The baseline risk factors associated with being on both ART and antimycobacterial treatments are not known and it remains to be elucidated how the different exposure factors impact on the antimycobacterial treatment-free survival of children who begin ART without antimycobacterial treatment.Objectives: To describe the prevalence of antimycobacterial treatment among children at the time of starting ART and the antimycobacterial treatment-free survival after starting ART. Design: A retrospective cohort study based on record reviews at the Harriet Shezi children&lsquo
s clinic (HSCC).Population: HIV-infected children less than fifteen years of age presumed ART naï
ve started on ART at HSCC.Analysis: A descriptive analysis of the prevalence of antimycobacterial treatment at time of start of ART was done. Kaplan Meier (KM) survival curves were used to determine the antimycobacterial treatment-free survival and logistic regression was used to analyze the association between baseline factors and future antimycobacterial treatment among children who had no antimycobacterial treatment at time of start of ART. Results: The prevalence of antimycobacterial treatment at the time of starting ART was 518/1941 (26.7%, 95% confidence interval (CI): 24.7-28.7). Among children who started ART without antimycobacterial treatment, the KM cumulative probability of antiretroviral and antimycobacterial (ART/antimycobacterial) co-treatment in the first 3 months of starting ART was 4.6% (95% CI: 4.1- 5.2), in the first 12 months it was 18.1% (95% CI: 17.0-19.2) and in the first 24 months of starting ART it was 24% (95% CI: 21.9-25.1). Survival analysis suggested that children with high baseline viral load, advanced World Health Organization (WHO) stage of disease, very low normalized weight for age (waz) and very young age (less than one year) at start of ART had significantly reduced antimycobacterial treatment-free survival (log rank p <
0.05) in the first two years of starting ART. In the logistic regression model, age less than one year {Odds ratio (OR): 3.7 (95% CI: 2.2-6.0
p <
0.0001)} and very low weight for age Z-score (waz <
-3) {OR
2.2 (95% CI: 1.4-3.6
p = 0.0015)} were the two critical risk factors independently associated with future antimycobacterial treatment. Conclusions: Antimycobacterial treatment is extremely common among HIV-infected children at the time of starting ART and early after starting ART and the incremental risk of being on ART/antimycobacterial co-treatment decreases with time on ART. The results emphasize the need for a heightened and careful alertness for mycobacterial events especially among children starting ART with severe malnutrition and those who start ART at age less than one year. The results further suggest that it is probably optimal to start ART in children before their nutritional status has deteriorated severely in the course of the HIV disease so that they get protection against mycobacterial events by early ART.
2
Södergård, Björn. "Adherence and Readiness to Antiretroviral Treatment." Doctoral thesis, Uppsala University, Department of Pharmacy, 2006. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-7282.
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Antiretroviral therapy places extraordinarily high demands on adherence, since non-adherence affects both individuals and society due to the spread of resistant viral strains. The aims of the thesis were to investigate the prevalence of adherence in Swedish HIV-infected patients, changes in adherence over time, and factors associated with adherence, including patients’ readiness to adhere. Further, to investigate the collaboration between nurses, doctors and pharmacists after the introduction of a HIV-clinic satellite pharmacy. Data were collected via two cross-sectional patient surveys in 1998 and 2002, qualitative interviews with health care personnel at a major HIV clinic, and a nation-wide, cross-sectional patient survey in 2003-2004.
The level of adherence improved from 28% in 1998 to 57% in 2002, possibly due to simplified treatment and a new multi-professional treatment model at the clinic. The proportion of adherent patients was 63% in the nationwide survey. Factors associated with adherence were high age, high quality patient-provider relationships, no drug or alcohol problems and shorter time on treatment.
A hypothesized structural equational model, using readiness and adherence as separate latent concepts, was tested and found to support readiness as a distinct factor influencing adherence.
The health care personnel believed that conventional pharmacies had several disadvantages in serving the HIV infected population. They found the HIV-clinic satellite pharmacy valuable, since it contributed to increased communication and trust between the health care professions, and improved teamwork in medication management.
In conclusion, the level of adherence increased over time, and several factors associated with adherence were identified. Improved collaboration between health care professionals may enhance treatment support, and increased attention should be given to interventions that focus on the individual’s readiness for behavioural change in order to optimize treatment outcomes.
3
Södergård, Björn. "Adherence and readiness to antiretroviral treatment /." Uppsala : Acta Universitatis Upsaliensis, 2006. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-7282.
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Wasti, Sharada Prasad. "Adherence to antiretroviral treatment in Nepal." Thesis, University of Sheffield, 2012. http://etheses.whiterose.ac.uk/2750/.
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Terblanche, Lauren Muriel. "The knowledge about HIV/AIDS and antiretroviral treatment of patients receiving antiretroviral therapy." Thesis, Stellenbosch : Stellenbosch University, 2012. http://hdl.handle.net/10019.1/20131.
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Thesis (MCur)--Stellenbosch University, 2012.ENGLISH ABSTRACT: Many HIV positive patients are on antiretroviral therapy (ART) to assist in decreasing the replication of the HIV virus within the body. Adherence to this medication is important, as non- adherence can have serious repercussions. Therefore, the patients’ knowledge of ART and their disease is crucial in ensuring good adherence. A range of barriers to patient education were suspected by the researcher in this community of Delft. The high influx of patients into the clinic everyday minimized consultation time and thereby diminished the opportunity for effective patient education. Consequently, adherence to medication which is closely related to the knowledge and understanding of patients about the disease may be affected. The following research question was therefore explored: What is the knowledge of infected HIV/AIDS patients who are receiving antiretroviral treatment about HIV/AIDS and ART? The objectives set were to evaluate the patient’s knowledge of HIV/AIDS, evaluate the knowledge of ART and to determine whether there are statistical differences between the dependant and independent variables within the study. A quantitative descriptive correlational research design was applied and a convenience sample of n= 200 (8.5%) patients was selected from a population of N= 2349 at the Delft Community Health Centre. A multiple choice questionnaire comprising of mainly closed ended questions with multiple responses was used in individual interviews conducted by either the researcher or fieldworker. Reliability and validity was ensured through the consultation of experts in the fields of research methodology, statistics, HIV/AIDS and the Health Research Ethics Committee of Stellenbosch University. Permission to conduct this study was granted by the Health Research Ethics Committee of Stellenbosch University, the Provincial Regional Head for Primary Health Care Services, as well as the head of the Delft Community Health Centre. Data revealed that the participants were mainly female (n=145/72.5%), and the mean age was 37.5 years. Participants were mostly Xhosa speaking and literate, and the majority (n=112/56%), of the participants had a highest education level between grade 9 and grade 12. Many (n=73/36.5%) of the participants had been living with HIV for more than 5 years, but had been on ART for between 1 to 3 years. Knowledge was assessed by asking questions about various aspects of HIV and ART throughout the study. Scores for the 14 critical questions revealed that (n=0/0%) of the participants had good knowledge, (n=40/20%) of the participants had average knowledge and (n=160/80%) of the participants had poor knowledge. The average score for all participants for all 20 knowledge testing questions was (12.6/63%). The findings showed that the overall knowledge (n=160/80%) is poor. Basic terms and principles of HIV/AIDS and ART were not understood and serious misconceptions regarding the disease were revealed.
AFRIKAANSE OPSOMMING: Baie MIV positiewe pasiënte is op antiretrovirale terapie (ART) om te help met die vermindering van die replisering van die HIV virus in die liggaam. Gebruik van hierdie medikasie is belangrik omdat versuiming van inname ernstige gevolge kan hê. Dus, is die pasiënte se kennis van ART en hul siekte van deurslaggewende belang om volgehoue inname te verseker. ’n Reeks van hindernisse om pasiënte te onderrig, is deur die navorser in die Delftgemeenskap vermoed. Die hoë toestroming van pasiënte na die kliniek elke dag het die konsultasietyd tot die minimum beperk en daardeur die geleentheid vir effektiewe pasiëntonderrig laat verminder. Gevolglik, kan die nakoming om die medikasie te neem wat ’n noue verband toon met die kennis en begrip wat pasiënte het oor die siekte, geaffekteer word. Die volgende navorsingsvraag is gevolglik ondersoek: Wat is die kennis van geïnfekteerde HIV/VIGS pasiënte wat antiretrovirale behandeling ontvang oor HIV/VIGS en ART? Die doelwitte wat gestel is, is om die pasiënt se kennis van HIV/VIGS te evalueer, die kennis van ART te evalueer en te bepaal of daar ’n statistiese verwantskap tussen onafhanklike en afhanklike veranderlikes binne die studie is. ’n Kwantitatiewe beskrywende korrelerende navorsingsontwerp is toegepas en ’n gerieflikheidsmonster van n= 200 (8.5%) pasiënte is geselekteer uit ’n bevolking van N = 2349 by die Delftgemeenskap Gesondheidssentrum. ’n Veelkeusige vraelys wat hoofsaaklik uit geslote vrae met veelkeusige response bestaan het, is gebruik in individuele onderhoude wat deur of die navorser of veldwerker gevoer is. Betroubaarheid en geldigheid is verseker deur oorlegpleging met spesialiste op die gebied van navorsingsmetodologie, statistiek, HIV/VIGS en die Gesondheidsnavorsing se Etiese Komitee van die Universiteit van Stellenbosch. Toestemming om die navorsing te doen, is gegee deur die Gesondheidsnavorsing se Etiese Komitee van Stellenbosch Universiteit, die Provinsiale Streekshoof vir Primêre Gesondheidsdienste, asook die hoof van die Delftgemeenskap Gesondheidssentrum. Data het bewys dat die deelnemers hoofsaaklik vroulik is (n=145/72.5%) en die gemiddelde ouderdom 37.5 jaar. Deelnemers is meestal Xhosasprekend en geletterd en die meerderheid (n=112/56%) van die deelnemers se hoogste opleidingsvlak is tussen graad 9 en graad 12. Baie (n=73/36.5%) van die deelnemers het met HIV geleef vir 5 jaar, maar was op ART vir tussen 1 tot 3 jaar. Kennis is geassesseer deur vrae te stel oor verskeie aspekte van HIV en ART dwarsdeur die ondersoek. Puntetelling vir die 14 kritiese vrae het aan die lig gebring dat (n=0/0%) van die deelnemers goeie kennis het, (n=40/20%) van die deelnemers beskik oor gemiddelde kennis en (n=160/80%) van die deelnemers se kennis is gering. Die gemiddelde puntetelling vir al die deelnemers van al 20 kennisvrae wat getoets is, is (12.6/63%). Die bevindinge bewys dat die algehele kennis (n= 160/80%) gering is. Basiese terminologie en beginsels van HIV/VIGS en ART word nie begryp nie en ernstige wanopvattinge aangaande die siekte is geopenbaar.
6
Gerlach, Undine Ariane. "Interruption of antiretroviral treatment in HIV-infected children." Diss., lmu, 2004. http://nbn-resolving.de/urn:nbn:de:bvb:19-26945.
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Cantrell, Ronald Alexander. "Diagnosing antiretroviral treatment failure in resource-limited settings." Thesis, Birmingham, Ala. : University of Alabama at Birmingham, 2008. https://www.mhsl.uab.edu/dt/2008p/cantrell.pdf.
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Ogunsanwo, Damilola Akinkunle. "Determination of patient satisfaction at accredited antiretroviral treatment sites in the Gert Sibande District, Mpumalanga Province." Thesis, University of Limpopo (Medunsa Campus), 2012. http://hdl.handle.net/10386/778.
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Thesis(MSc(Med)(Pharmacy))--University of Limpopo, 2012.CHAPTER 1 INTRODUCTION 1.1 INTRODUCTION This chapter presents the background and rationale for the study followed by the problem statement. The aim and objectives of the study as well as the significance of the study will also be explained. 1.2 BACKGROUND AND RATIONALE FOR THE STUDY In the past decade, patient satisfaction has become an important performance and outcome measure of health care (Moret, Nguyen, Pillet, Faissard, Lombrail & Gasquet, 2007). Although high levels of patient satisfaction are important for a successful strategy against Human Immuno-deficiency Virus/Acquired Immune Deficiency Syndrome (HIV/AIDS), research into patient satisfaction with health care services in general, and with antiretroviral treatment (ART) services in particular, has been limited in South Africa (Myburgh, Solanki, Smith & Lalloo, 2005). In a weakened healthcare system, it is even more crucial to ensure a high quality of care and patient satisfaction to maximise the benefits of scarce resources. In addition, patient views on the quality of public sector antiretroviral (ARV) care are relatively unexplored (Igumbor, 2003; Myburgh et aI., 2005). The assessment of satisfaction among hospitalised patients is increasingly recognised as a major component of quality management in patient care. Continuous quality improvement, comparison of hospital performances and demands for accountability are some of the reasons that lead hospitals to measure patient satisfaction (Ross, Steward & Sinacore, 1995). As has been observed in many industrialised countries, the provision of ART via public health systems, can transform AIDS from a fast, insidious killer into a more manageable, though still incurable, chronic illness (Abdool Karim, 2005). However, in resource-limited settings, there are many challenges in successfully scaling-up ART and reorienting service delivery towards chronic disease care. Shortages in human resources for healthcare are often cited as the most important obstacle to a specific for all ART sites in the province should be developed and monitored. A long term strategy to address the critical shortage of healthcare professionals should be developed by provincial policy makers which will in the long run reduce long waiting times experienced by our clients.
9
Zhu, Hao. "Outcomes of China Free Antiretroviral Treatment Program, 2003--2010." THE UNIVERSITY OF NORTH CAROLINA AT CHAPEL HILL, 2012. http://pqdtopen.proquest.com/#viewpdf?dispub=3495747.
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Larsson, Kiara. "Barriers to Access to Antiretroviral Treatment in Babati, Tanzania." Thesis, Södertörns högskola, Institutionen för naturvetenskap, miljö och teknik, 2016. http://urn.kb.se/resolve?urn=urn:nbn:se:sh:diva-30711.
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Sub-Saharan Africa is the region in the world most severely affected by HIV, and Tanzania is among the most severely affected countries in the region. The introduction of antiretroviral treatment has offered hope to people living with HIV/AIDS, improving their quality of life significantly. Still, there are individuals living with HIV who either lack access to ART, or choose not to make use of the available treatments. The purpose of this thesis is to identify underlying factors perceived as barriers for HIV- positive individuals to initiate and maintain Antiretroviral treatment in Babati District, Tanzania. Twenty semi-structured interviews were carried out between the 15th of February and 6th of March 2016. The interviews were conducted with ART-patients, health workers and members of the community. An analysis was made within a theoretical framework based upon Goffman's notion of stigma and the Initial Behavioral Model by Andersen. The following obstacles to access to ART were indicated by the findings: HIV/AIDS related stigma issues, discrimination, economic barriers, ignorance due to lack of education, counseling on HIV treatment, and beliefs that HIV can be cured by traditional healers.
11
Kotze, E., and T. McDonald. "A longitudinal patient record for patients receiving antiretroviral treatment." Journal for New Generation Sciences, Vol 10, Issue 1: Central University of Technology, Free State, Bloemfontein, 2012. http://hdl.handle.net/11462/598.
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Published ArticleIn response to the Human Immunodeficiency Virus (HIV) epidemic in the country, the South African Government started with the provisioning of Antiretroviral Therapy (ART) in the public health sector. Monitoring and evaluating the effectiveness of the ART programme is of the utmost importance. The current patient information system could not supply the required information to manage the rollout of the ART programme. A data warehouse, consisting of several data marts, was developed that integrated several disparate systems related to HIV/AIDS/ART into one system. It was, however, not possible to trace a patient across all the data marts in the data warehouse. No unique identifiers existed for the patient records in the different data marts and they also had different structures. Record linkage in conjunction with a mapping process was used to link all the data marts and in so doing identify the same patient in all the data marts. This resulted in a longitudinal patient record of an ART patient that displayed all the treatments received by the patient in all public health care facilities in the province.
12
Maseko, Batlile Paulos. "Antiretroviral treatment programme outcomes scenarios in South Africa in the next two decades." Thesis, University of Limpopo (Medunsa Campus), 2012. http://hdl.handle.net/10386/1094.
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Anderson, Kim. "Treatment outcomes in perinatally-infected HIV positive adolescents and young adults after 10+ years on antiretroviral therapy." Master's thesis, University of Cape Town, 2018. http://hdl.handle.net/11427/29183.
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There are currently more than 30 0 000 children under the age of 15 living with HIV in South Africa (SA). Due to a combination of recent success in preventing new vertical infections and success of paediatric antiretroviral treatment (ART) programmes in improving life-expectancy in perinatally HIV-infected (PHIV) children, the burden of paediatric HIV in SA has changed to older children. An increasing population of PHIV children on ART is reaching adolescence, yet information on long-term treatment outcomes in this group is lacking. There is very limited published data on treatment outcomes in PHIV children after ≥10 years on ART in high income countries (HIC), and none in low- and middle-income countries (LMIC). We conducted a retrospective cohort study of PHIV adolescents on ART for ≥ 10 years at a single ART facility. The main objective of the study was to describe long-term clinical, growth, immunologic and virologic outcomes in the cohort. Part A, the protocol, as submitted for departmental and ethical approval, details the purpose and methodology of the study. Part B, the literature review, discusses what is known about long-term treatment outcomes in PHIV children on ART to date. It compares findings between HIC and LMIC. Long-term growth, immunologic and virologic outcomes, as well as factors associated with viral failure are described. The paucity of long-term data is demonstrated, indicating the need for further research on the topic. Part C, the journal-ready manuscript, details the methodology, results and interpretation of the longitudinal analysis of long-term treatment outcomes among 127 PHIV-infected adolescents and young adults on ART for ≥10 years. After median follow-up of 12 years since ART initiation, 80% of the cohort were virally suppressed and 79% had optimal immunologic status (CD4 >500 cells/μl). These results are favourable overall, but >40% of adolescents were on 2nd-line ART with poorer immunologic outcomes than those on 1st-line ART, and approximately one in three children experienced viral failure during adolescence. This highlights the vulnerability of this group, which requires careful further management. Appendices include all supporting documentation necessary for the above parts of the mini-dissertation.
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Omenka, Charity Ochuole. "Factors influencing access to antiretroviral treatment in Benue State, Nigeria." Thesis, University of the Western Cape, 2010. http://etd.uwc.ac.za/index.php?module=etd&action=viewtitle&id=gen8Srv25Nme4_5804_1308546328.
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The study utilized a qualitative case study design to explore the problem of poor access to ART in Benue State. PLWHAs, policy makers, program managers and health workers were involved in an effort to describe the factors influencing access to ART in the State. Semi structured interviews, exit interviews and focus group discussions were used. To analyse the findings, categorization was done into facilitators and barriers to access, in addition to the ways respondents believe these barriers can be overcome. Other sub-themes were also identified and sorted. Themes were linked to direct quotes from the respondents. Additional literature review was done to review available information on the themes identified. Facilitators of access included free cost and increased number of sites
beneficial effects of ART
disclosure, membership in a support group and having a treatment partner. Barriers included stigma and discrimination
hunger, poverty, transportation and opportunity costs
hospital factors
non-disclosure
inaccurate knowledge and perceptions about HIV and ART
certain religious beliefs and advice
coverage, capping of services and fear of non-availability of ART. In addition to stigma, patients bypass closer ART access points to further away hospitals because of business opportunities
financial assistance
perceived better standard of care and hope that a cure, when found, will be more accessible to patients in bigger hospitals.
15
Nikisi, Joseph. "Access to antiretroviral treatment in the public sector, in Zambia /." Access to E-Thesis, 2005. http://upetd.up.ac.za/thesis/available/etd-04282009-163207/.
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Yilmaz, Aylin. "Antiretroviral treatment of HIV-1 in the central nervous system /." Göteborg : Department of Infectious Diseases, The Sahlgrenska Academy at Göteborg University, 2007. http://hdl.handle.net/2077/4438.
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Phalafala, Mathatho Samuel. "The effects of HIV status disclosure on antiretroviral treatment adherence." Thesis, Stellenbosch : Stellenbosch University, 2015. http://hdl.handle.net/10019.1/96973.
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Thesis (MSc)--Stellenbosch University, 2015.ENGLISH ABSTRACT: Successful antiretroviral therapy (ART) depends on appropriate use of antiretroviral agents; which ultimately prevents replication of Human Immunodeficiency Virus (HIV) thus delaying clinical progression of the disease. This study explored how HIV status disclosure affects adherence to antiretroviral therapy at Mamelodi Hospital, using a convenience sampling method with a sample size of 50 adults above 18 years who were on treatment for a minimum of two years prior to the study. An interview protocol was used to uncover patients’ demographics, sexual orientation, and HIV status disclosure, adherence to antiretroviral drugs, drug side effects, how often they missed their doses and how HIV status disclosure / non-disclosure affected their adherence to treatment. Patients’ medical records were assessed to validate and correlate the information obtained from the interviews. The scientific test results used were the CD4count and Viral loads which are used to monitor the HIV/AIDS disease progression. All partakers involved in the study made their HIV status known and reported taking their medicines regularly. The patients’ CD4 count and VL were verified, the CD4 count has shown an upward trend while the VL load showed a downward trend in keeping with patients who are adhering to ART. The majority of participants (54% or 27 patients) reported they had never skipped taking their medication. The participants also reported they had taken their medicine in front of other people and they constituted 74% (37) of the group. Of this 74%, 78.38% (29 patients) said it was because they had disclosed their status. This observation supports the fact that if you have disclosed your HIV status, you have better chances of adhering to prescribed medication. Findings from the study at Mamelodi Hospital revealed that for as long as one has disclosed their HIV status, the outcome of treatment adherence will be better. The only shortfall noted was lack of partakers who did not divulge their HIV status thus a comparison could not be done. It was acknowledged that some participants in the study might have reported disclosure of their HIV status to be in good favour of the researcher to create an impression that they are adhering to their medication. The study has confirmed the existence of a relationship between HIV status disclosure and adherence to ART.
AFRIKAANSE OPSOMMING: Suksessvolle antiretrovirale terapie (ART) hang af van die toepaslike gebruik van antiretrovirale middels, wat replikase van die MI-virus verhoed, en dus die kliniese vordering van die siekte vertraag. Hierdie studie het ondersoek hoe die bekendmaking van MIV-status die gehoorsaamheid tot ART beïnvloed het by die Mamelodi Hospitaal. ‘n Gerieflikheid-streekproef met ‘n groote van 50 volwassenes bo 18 jaar is gebruik en die deelnememers moes ten minste vir twee jaar voor die studie reeds op behandeling gewees het. Data is deur middel van onderhoude ingesamel, met die doel om pasiënte se demografiese inligting, seksuele orientasie, MIV-status, gehoorsaamheid tot ART en newe-effekte van ART in te samel. Pasiënte se mediese rekords is nagegaan om die inligting wat uit die onderhoude verkry is te bevestig. Die wetenskaplike toetse wat gebruik is, was die CD4-telling en virale lading wat gebruik word om MIV/Vigs te monitor. Al die deelnemers het hul MIV-status bekend gemaak en aangedui dat hul hul medikasie gereeld gebruik. Die pasiënte se CD4-tellings en virale lading is bevestig, die CD4-tellings het ‘n opwaartse neiging getoon terwyl die virale lading ‘n afwaartse neighing getoon het. Die meerderheid van die deelnemers (54%) het aangedui dat hul nog nooit hul medikasie oorgeslaan het nie. 74% van die deelnemers het aagedui dat hul hul medikasie voor ander mense neem - hul noem dat dit as gevolg van die feit is dat hul hul status bekend gemaak het. Dit ondersteun die feit dat mense wie hul status bekend maak beter kanse het om gehoorsaam hul medikasie te gebruik. Die studie by die Mamelodi Hospitaal toon dat solank mense hul MIV-status bekend maak, hul meer gehoorsaam is teenoor die gebruik van hul medikasie. Die studie bevestig dus die verband tussen bekendmaking van MIV-status en gehoorsaamheid tot ART.
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Nikisi, Joseph. "Access to antiretroviral treatment in the public sector, in Zambia." Diss., Pretoria : [s.n.], 2006. http://upetd.up.ac.za/thesis/available/etd-04282009-163207.
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Tsope, Lindiwe. "A narrative study of patients’ illness experiences on antiretroviral treatment." Thesis, Rhodes University, 2018. http://hdl.handle.net/10962/63032.
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Eight female respondents, who have publicly disclosed their HIV-positive status on social media, were involved in a semi-structured in-depth interview process. Using the theoretical frameworks of symbolic interactionism and social constructionism, the study explores the effects of antiretroviral treatment on patients’ illness experiences, looking at the personal and social symbolisms and meanings attached to taking antiretrovirals. The study revealed a positive and inspirational aspect of living with HIV/AIDS and especially consuming antiretroviral therapy. It became evident that the knowledge participants had of antiretrovirals before consuming them was misguided and based more on false ‘general knowledge’ among laypersons than actual medical fact. Moreover, the study revealed that there is a social reconstruction of narratives that has taken place in each participant’s life due to consuming antiretrovirals. Publicly disclosing their statuses has also proved to have both negative and positive consequences for the individuals and for society at large. While there is a consensus that participants’ illness experiences are directly affected by antiretroviral treatment, each participant’s narrative is different, yet positive.
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Kwanisai, Felistus. "Antiretroviral treatment : challenges experienced by HIV positive women in Zimbabwe." Diss., University of Pretoria, 2014. http://hdl.handle.net/2263/43137.
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HIV and AIDS which was discovered in the 1980s is causing havoc in many developing
countries and Sub-Saharan continent is the hardest hit. Pratt (2008:8) highlights that “the
number of people living with the disease is concentrated in the industrially developing world,
mostly in those resource deprived countries least able to afford the care of HIV-infected
people”. Zimbabwe is one of the SADC countries with the highest statistics of HIV and AIDS.
Women account for the largest number of people infected by the pandemic and this could be
as a result of the social and cultural norms which oppress women and their position in society.
Antiretrovirals (ARV’s) are the life-long drugs given to HIV-infected people to slow the
progression of the disease. There are different types of ARV regimens. Zimbabwe introduced
the ART roll-out in 2004, however the ART users face multiple obstacles in accessing ARVs.
The study targets women because they are a vulnerable group in society, specifically in
Zimbabwe. Women have been subjected to stigma, discrimination, violence, humiliation,
degradation and psychological torture when they are identified as being HIV positive. Some
are neglected and deserted by their partners and families after disclosure, as a result many are
too scared to disclose their status to families. The country’s political and economic situation
has a major impact on the HIV positive women’s access to ARV treatment. This is compounded
with the social and cultural norms and values of the people. The focus of this study is on the challenges experienced by HIV positive women with regard
to accessing ARV treatment in Zimbabwe. This study strived to understand the challenges HIV
positive women encounter in adhering and accessing to ARV treatment. The goal was to
explore the challenges experienced by HIV positive women with regard to accessing ARV
treatment in Zimbabwe. The research question of the study was: What are the challenges
experienced by HIV positive women with regard to accessing ARV treatment in Zimbabwe?
This study used a qualitative approach with a collective case study research design. The
population for this study was the African women from Zimbabwe who were infected with HIV
and AIDS. Non-probability purposive sampling was utilised in this study to select the sample
of 10 women who were living with HIV and AIDS in Masvingo District, Zimbabwe and who
were accessing ART. Specific criteria for sampling was used to select clients of two NGO’s in
Masvingo district of Zimbabwe: Batanai HIV and AIDS Service Organisation and the
Reformed Church in Zimbabwe Community Based AIDS Program.
Semi-structured one-to-one interviews were used to collect data. The researcher sought
permission of the participants to voice record their interviews and the researcher transcribed
them personally. The data gathered was analysed and theme and sub-themes were generated
from the data. The research findings were presented thereafter by providing a profile of
research participants followed by thematic analysis of the themes and sub-themes from the
transcriptions. Literature control and verbatim quotes were used to support these themes and
sub-themes. The following are the themes from this study: Theme One- Information regarding
HIV and AIDS, Theme Two- Information on ARV treatment, Theme Three- Societal and HIV
positive women’s views on HIV and AIDS, Theme Four- Experiences of being an HIV positive
woman and Theme Five- Needs identified by HIV positive women.
The conclusions of this study reflect that HIV positive women experience some challenges in
adhering and accessing ARV treatment. Disclosure, stigma and discrimination, traditional and
faith healer’s diagnosis of HIV and AIDS, access to medication for Opportunistic Infections,
food shortage, distance to ARV sites, the availability and change of ARV regimens were
amongst some of the factors which made access to ARV treatment a challenge. Recommendations from this study can be used by HIV and AIDS stakeholders to understand
the challenges and experiences by HIV positive women better. The social workers can also use
the recommendations to find ways to make their services known to the communities and also
improve their intervention and support to these women.Dissertation (MSW (Health Care))--University of Pretoria, 2014.
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Social Work and Criminology
MSW (Health Care)
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Moeketsi, Ntshebo Mirriam. "Treatment and regimen change in a cohort of HIV positive patients in anti-retroviral treatment at Tshepang Wellness Clinic, Dr George Mukhari Hospital." Thesis, University of Limpopo ( Medunsa Campus ), 2010. http://hdl.handle.net/10386/218.
Full textAbstract:
Thesis (MPH)--University of Limpopo, 2010.Background: Antiretroviral therapy led to a revolution in care of patients with HIV/AIDS in a developed world. Treatment is not a cure but it also presented with new challenges of side effects, drug resistance and it also dramatically reduces rate of mortality and morbidity and it also improves quality of life to people living with HIV/AIDS, and it also now considered as manageable chronic diseases. Aim: Aim of the study is to establish and describe reasons for treatment and regimen change in a cohort of HIV positive patients on ART enrolled in the pharmaco-epidemiological survey at Tshepang wellness clinic. Objectives: is to determine reasons for treatment and regimen change, types of treatment and regimen change among patients on ART who are enrolled in pharmacoepidemiological survey at Tshepang wellness clinic. Design and Methods: Study is a retrospective cohort study, and sample size of 301 medical records of a cohort of HIV positive patients on ARVs enrolled in a longitudinal pharmaco-epidemiological survey from November 2006-May 2007 reviewed. Data extraction tool used to collect data and software called SPSS 17.0 used to analyze data and relevant themes were extracted to determine distribution of variables. Results: Results of this study indicated that 91 (85%) were males and (87.8%) 191 were females. Age was grouped as teenagers (15-25yrs), young adults (26-49yrs) and adults (50- 70yrs). Results also shows reasons of treatment and regimen change of which majority of patients 134(44.8%) changed due toxicity followed by 16 (5.4%) who changed because of pregnancy, and the other 4(1.3%) changed because of resistance, and the last 2(0.7%) which are regarded as minorities change because of T.B. Conclusion and Recommendations: Results shows that majority of pharmacovigilance patients were initiated Regimen 1 compared to other regimens. Toxicity appear as the main reason of treatment and regimen change on this study as 140(46.4%) reported toxicities (peripheral neuropathy, lactic acidosis, lipodystrophy and lipoatrophy). Implementation of monitoring of adherence needed for prevention of resistance and virological failure.
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Aung, Kay Tu Jittima Dhitavat. "Pulmonary tuberculosis treatment outcomes in HIV infected patients on antiretroviral therapy /." Abstract, 2006. http://mulinet3.li.mahidol.ac.th/thesis/2549/cd388/4838793.pdf.
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Makobo, Leonard Lutegama. "Treatment outcomes of highly active antiretroviral therapy among HIV-infected patients in Mbeya, Tanzania : the Mbeya antiretroviral adherence (MARVAD) study." Thesis, London School of Hygiene and Tropical Medicine (University of London), 2010. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.550404.
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Eliphas, Hatutale John. "Barriers to adherence to antiretroviral treatment among adolescents in Onandjokwe district, Namibia." University of the Western Cape, 2017. http://hdl.handle.net/11394/5486.
Full textAbstract:
Master of Public Health - MPHPoor adherence to antiretroviral therapy (ART) among paediatric and adolescent patients remains a big concern to health workers at Onandjokwe CDC clinic in Oshikoto Region of Namibia. Despite successes in the scale up of ART in Oshikoto Region the clinic experienced high prevalence of poor adherence to ART among adolescent patients. Out of 631 adolescents alive and on ART in this clinic, 154 (24%) had records of poor drug adherence between Jan 2015 and August 2015; which compared poorly to only 4 % of 7289 adults currently on ART who have records of poor adherence during the same period. The aim of the current study was to explore barriers to adherence to antiretroviral therapy among these adolescents. Among the study population of 631 adolescents on ART in Onandjokwe, a sample population of 154 had records of poor adherence (scored below 85%) to ART between June 2015 and August of the same year were considered for the study but among them 16 adolescents were recruited as the study sample. Additionally, 5 caregivers of adolescents on ART, 6 Healthcare Providers were selected as key informants. A voice recorder and field notes were being used during data collection. Two 2 sessions of Focus Group Discussions (FGD) were held with adolescents while 2 FGD sessions held with 5 caregivers and 6 healthcare providers to elicit expert opinions. Lastly, 5 In-depth interviews were conducted with individual adolescents who missed ART medicine follow up for 1 month or more between January and August of 2015. Data Analysis was performed using hand manipulation by grouping responses into main study objectives/themes. Data cleaning, translation of voice transcription from Oshiwambo to English language and incorporating of non-verbal expressions was also done. The results indicate that factors contributing to poor ART adherence among adolescents are patient and family related, socio-economic, and related to substance abuse, stigma and discrimination, health care and health systems, as well as the environment and weather.
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Usman, Samuel. "Factors which affect optimal adherence to antiretroviral medications." Thesis, Stellenbosch : University of Stellenbosch, 2010. http://hdl.handle.net/10019.1/4181.
Full textAbstract:
Thesis (MPhil (Industrial Psychology. Africa Centre for HIV/AIDS Management))--University of Stellenbosch, 2010.ENGLISH ABSTRACT: The advent of anti-retroviral therapy (ART) has bought hope and reprieve in a previously hopeless situation where there was no available drug to combat the virus with the result that AIDS deaths from chronic, untreated HIV infection became the major cause of morbidity and mortality especially in sub-Saharan Africa where the disease burden is highest. Since March 19, 1987, when the FDA approved Zidovudine for the treatment of AIDS, there has been great improvement in the prognosis and quality of life of HIV infected persons especially in sub- Saharan countries like Nigeria where the burden of HIV disease is high. Even though the treatment of HIV looked promising to all HIV sufferers, there were strict requirements for taking the ARVs, that meant patients had to be able to take the medication more than 95% of the prescribed time. The requirements also involved strict dietary restrictions that further made adherence to these medications very difficult indeed. In addition, the potential for side effects of the medications and its requirement for life-style modifications like abstinence from excess alcohol made sticking to the required regimen very cumbersome and rather patient unfriendly. Therefore, as the use of ARVs became more popular and effective, so did the problem of nonadherence continue to fester and deteriorate even further. Therefore, the problem of lack of optimum adherence to ARVs is one that potentially threatens all the gains of the discovery and use of potent, life-saving ARVs. Hence, there is now a need to look at how best to improve adherence to ARVs in the most innovative, cost-effective and patient-friendly manner. This study argues for the use of simple, locally-driven adherence strategies that overcome the low literacy and excessive alcoholism that are major factors preventing optimal adherence to ARVs amongst patients.
AFRIKAANSE OPSOMMING: Die intrede van anti-retrovirale behandeling het hoop en genade gebring aan ‘n voorheen hopelose situasie waar daar geen behandeling beskikbaar was om die virus te beveg nie, wat daartoe gelei het dat VIGS, as gevolg van MIV-infeksie wat nie behandel is nie, die grootste oorsaak van sterftes in veral Sub-Sahara Afrika is. Sedert 19 Maart 1987, wanneer Zidovudine goedgekeur is vir die behandeling van VIGS, is daar ‘n groot verbetering in die prognose en kwaliteit van lewe van MIV-geinfekteerde mense, veral in Sub-Sahara lande soos Nigerië waar die voorkoms van MIV hoog is. Hoewel de behandeling van MIV vir alle MIV-lyers belowend gelyk het, was daar streng vereistes vir die neem van anti-retrovirale behandeling. Daar was ook streng dieetkundige beperkinge wat die getrouheid tot die behandeling bemoeilik het. Die moontlike newe-effekte van die behandeling en nodige leefstyl veranderinge, soos byvoorbeeld weerhouding van oormatige alkohol gebruik, maak die behandeling redelik pasiënt onvriendelik. Soos die anti-retrovirale behandeling meer gewild en effektief geraak het, het die probleem van ongetrouheid ook toegeneem. Die probleem rondom ongetrouheid tot behandeling bedreig alles wat deur die behandeling gebied kan word. Daar is nou ‘n behoefte daaraan om getrouheid tot anti-retrovirale behandeling te bevorder in die mees innoverende, koste-effektiewe en pasiënt vriendelike manier. Die studie beveel eenvoudige, plaaslik gedrewe getrouheid-strategieë aan wat optimale getrouheid aan behandeling sal verseker.
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Mathebula, Tebogo Johanna. "Reasons for default follow - up of antiretroviral treatment at Thekganang ARV clinic." Diss., University of Pretoria, 2014. http://hdl.handle.net/2263/43174.
Full textAbstract:
HIV and AIDS pandemic have been declining in South Africa. HIV and AIDS affect individuals, families, organizations and the communities at large. While the roll out of the antiretroviral treatment (ART) has brought much excitement and hope to both patients and the health practitioners, it has also brought challenges (Maskew, Macphail, Menez & Rubel, 2007:853). In order for ART to be effective patients need to adhere to antiretroviral treatment, thus adherence is a critical component of ART. Patients who discontinue treatment are at high risk of illness and death because of AIDS related diseases or developing drug resistant virus. With a better understanding of the reasons for defaulting antiretroviral treatment interventions can be designed to improve adherence to antiretroviral treatment. Thus the purpose of this study was to explore the reasons why HIV and AIDS infected patients default antiretroviral treatment because adherence to ART is of utmost important.
Within the context of qualitative and applied research the researcher utilized the collective case study design. Semi structured interviewing was used as data collection method to elicit qualitative information on the reasons why patients default ART. The main research question that was put forward to all participants was: What are your reasons for defaulting ART?
The participants in this study were patients who have default their ART during 2012. By using systematic sampling fourteen participants from Thekganang ARV Clinic in Seshego District Hospital, Limpopo province, were selected to form a sample for this study. Some conclusions based on the findings were that:
The participants were knowledgeable about the basic facts of HIV and AIDS and they had a good understanding about the importance of adherence even though they defaulted their antiretroviral treatment. The use of ART may also be challenging to individuals. The findings of this study were that not all participants in the study experienced challenges with taking ART. Those who experienced challenges included fear of disclosing HIV status, fear of stigmatization and physical challenges due to ill health.
Regarding the reasons for defaulting ART, participants’ reasons for defaulting antiretroviral treatment were similar although some of the reasons applied to only one participant. Participants’ reasons for treatment default were classified into socio-economic factors, patient related, psychological related and medication related factors. Socio- economic factors included shortage of food in the household and lack of money for transport to attend clinic appointments. Patient related factors included substance abuse, lost appointment cards, participants were too busy with personal issues and relocation to another area of residence. Psychological factors that contributed to non-adherence to treatment were depression and denial. Medical related factor voiced was that participant was too confused about the drug regimen.
Most participants were satisfied with the services in Thekganang ARV clinic although some participants raised concerns about staff attitudes and long queue. The findings will assist the hospital management and the clinic staff to make informed decisions about the management of defaulters in the clinic.
The study was concluded with the relevant recommendations to the ART facilities. The recommendations included implementation of the multi-disciplinary centred approach, establishing patient education programmes and on-going support services to patients who fail to adhere to treatment.
Future research studies should determine the prevalence of drug resistant HIV patients in the ART facilities and the development of a systematic method of capturing ‘‘lost to follow up’’ patients who pass away within hospitals.Dissertation (MA)--University of Pretoria, 2014.
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Social Work and Criminology
MA
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Johnstone, Victoria. "Second-line antiretroviral therapy in a South African treatment programme : exploring determinants of switching and treatment outcomes." Thesis, London School of Hygiene and Tropical Medicine (University of London), 2013. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.590631.
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Wong, Mei-wan Farah, and 黃美雲. "Financial burden for HIV/AIDS patients to access antiretroviral therapy in Asian developing countries." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2013. http://hdl.handle.net/10722/193826.
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Background: Since the beginning of 21st century, several Asian countries started implementing their national free antiretroviral therapy (ART) programs to tackle one of the most striking public health issues in Asia – HIV/AIDS. Despite the efforts being made, the treatment coverage remains as low as 44% in 2010. Previous studies have identified financial constraint is a major barrier in accessing ART and an important reason of poor ART adherence in Asia. The purpose of this literature review is to explore the extent of financial burden experienced by people living with HIV (PLHIV) where free ART policy is implemented, and to provide valuable information for policy-making in reducing financial barriers and improve uptake of ART.
Methods: Literature search was performed by entering keywords in PubMed and Medline. Articles were screened and selected for in-depth review according to the inclusion and exclusion criteria. A process on data synthesis was performed on the final eligible papers.
Results: Five studies from four Asian countries describing the out-of-pocket health expenditure incurred by PLHIV during the delivery of ART were included in this review.
Findings: Out of all direct medical costs, the cost of drug was most important in contributing to the total costs for patients without health insurance, while the cost of transportation was more important for patients covered by health insurance. Direct medical costs increased with advancing stage of disease. Rural patients would have spent up to 1,173% of their monthly income per capita, or more than 100% of their total household expenditure even when ART was provided free-of-charge. Patients have also highlighted free ARV drugs were sometimes not available in the health facility and they had to turn to the private market. Hence, the extent of financial burden in this review might be underestimated.
Conclusion: Based on the data available, we concluded that increased accessibility of free ART should be accompanied with sustained ARV drugs supply and increased financial support for PLHIV.published_or_final_version
Community Medicine
Master
Master of Public Health
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Phiri, Elias. "Reasons for refusing antiretroviral therapy before completion of tuberculosis treatment at Pigg's Peak Hospital, Swaziland." Thesis, University of Limpopo (Medunsa Campus), 2013. http://hdl.handle.net/10386/1069.
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Thesis (MPH)--University of Limpopo, 2013.Statistics from Pigg’s Peak Hospital, in Swaziland, continue to show an improvement in the uptake of HIV testing among TB patients, as well as a very high rate of HIV co-infection among the TB patients. The unit’s reports also show a low uptake of antiretroviral therapy among the HIV co-infected TB patients, and high death rates. Most of these deaths occur among HIV co-infected TB patients who have not yet initiated ART despite being on TB treatment. Anecdotal evidence suggests that there is reluctance and refusal by a considerable proportion of TB/HIV co-infected patients to take TB treatment and ART concurrently, and that they prefer to commence ART after completing TB treatment. No study has ever been conducted in Swaziland to determine the reasons for refusal of ART initiation prior to the completion of TB treatment among HIV co-infected TB patients. Aim The aim of this study was to explore the reasons for refusing antiretroviral therapy among HIV co-infected tuberculosis patients, prior to the completion of tuberculosis treatment, at Pigg’s Peak Hospital, in Swaziland. Methods A qualitative descriptive study was conducted in order to generate information on the subjects’ experiences and views on the concurrent taking of tuberculosis and antiretroviral medicines. A sample of nineteen HIV co-infected TB patients was purposefully selected to answer the research question. Results The most common reasons given by the respondents for refusing ART initiation during TB therapy were their un-readiness for ART, especially because ART must be taken for life, the perception that one was still in good health, the fear of adverse outcomes being precipitated by combining ART with TB medicines, a preference of traditional medicines, and health systems-related problems. Other reasons were: a lack of food, substance abuse, a fear of the increased pill burden, a denial of the HIV-positive status, and problems related to treatment supporters. Conclusion In TB/HIV co-infection care settings, comprehensive Pre-ART counseling must be integrated with interventions that address the specific barriers to ART initiation faced by clients; to improve the acceptability of ART initiation during TB therapy to these HIV/TB co-infected patients.
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Nyasulu, Zinandi Ziyanda Zipho-zethu. "Mental health status of school going adolescents on antiretroviral treatment in Amajuba District, KwaZulu-Natal." Thesis, University of Zululand, 2017. http://hdl.handle.net/10530/1550.
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A dissertation submitted to the Faculty of Education in partial fulfillment of the requirements for the Degree of Masters in Educational Psychology in the Department of Educational Psychology & Special Needs Education at the University Of Zululand, 2017The aim of this study was to assess the mental health status of school going adolescents on ART. The objectives of the study being to establish the status of mental health before and after these adolescents are placed on ART. A literature study was done in order to determine the feasibility of the study and in order to strengthen the need for such information to be known. A qualitative approach was used so as to gain insight into the topic. Data was collected using face to face interviews and an interview guide was prepared to guide the discussions between the researcher and the participants. The data collected was thematically analysed and the results were presented using the research questions and the themes that emerged in answering those questions. Themes and sub-themes that emerged included compliance; fear of disclosing; normalisation of life with HIV; acceptance and support from family; fear of rejection, stigma and discrimination; institutional support; morally judged. Since participants were young when they tested mental health changes occurred once their status was disclosed to them. The adolescents have unresolved mental health issues and which become unknown to the healthcare workers due to ineffective communication. Participants were still preoccupied with the thought that they will be on ARVs for the rest of their lives. Key problems faced by the adolescents included preoccupation about the future, fear of stigma and discrimination and reject from society. There were no feelings of anger towards their caregivers once their status was disclosed to them. Only feelings of fear and confusion were raised which were quickly addressed by caregivers. Recommendations were included to address the concerns highlighted in the study and these included a need to address factors such as disclosure, stigma and discrimination as these directly and indirectly have an impact on the mental health of HIV positive adolescents and follow-up research needs to be done to document the lives of adolescents post admission in the ART programme.
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Langwenya, Nontokozo. "Adherence to antiretroviral treatment (ART) among HIV-infected pregnant women starting treatment immediately vs delayed: a cohort study." Master's thesis, University of Cape Town, 2016. http://hdl.handle.net/11427/22899.
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Introduction: Use of highly effective antiretroviral drugs to eliminate new paediatric HIV infections is the keystone of all prevention of mother-to-child transmission (PMTCT) programmes. Time on antiretroviral treatment (ART) before delivery reduces maternal viral load and decreases the risk of transmission in utero, during labour and whilst breastfeeding. Currently, many PMTCT programmes across Africa initiate HIV-infected pregnant women on lifelong antiretroviral therapy (ART) on the first day of antenatal care ("same-day" initiation). However concerns have been raised regarding patient readiness and whether same-day initiation in pregnancy may contribute to subsequent ART non-adherence. Methods: As part of a larger study of ART in pregnancy, consecutive ART-eligible pregnant women making their first antenatal care (ANC) visit at a primary care facility in Cape Town, South Africa were enrolled into a prospective cohort between March 2013 and June 2014. Before July 2013, eligibility was based on CD4 cell count ≤350 cells/μL ("Option A"), with a 1-2 week delay from the first ANC visit to ART initiation; thereafter all women were eligible regardless of CD4 cell count ("Option B+") and typically offered ART on the same day as first ANC visit. All women received standardized counselling before starting a fixed-dose regimen. Study interviews were conducted separately from the ART service through one week postpartum with self-reported adherence from 30- day recall. Results: Among 625 consecutive ART-eligible women (median age, 28 years; median gestation, 21 weeks; 55% newly diagnosed with HIV), 72% of women started ART same-day; this proportion was higher under "Option B+" versus "Option A" (p< 0.001). Of those with adherence assessments data available (n=618), 29% reported at least one missed ART dose during pregnancy. Missed doses were reported more frequently among women with previous use of PMTCT (p=0.014), of younger age (p=0.029) and starting ART under Option B+ (p=0.019). In women initiating ART same-day, 31% reported a missed dose compared to 23% among women who delayed ART start following first ANC visit (odds ratio, 1.07; 95% CI: 0.61 – 1.88). This finding did not vary after adjustment for demographic and clinical measures, and was consistent when restricted to women with CD4 cell counts ≤350 cells/μL. Conclusions: These results suggest same-day ART initiation in pregnant women is not associated with increased non-adherence during the antenatal period. While these results are reassuring for ART programmes implementing "Option B+", further research is required to examine adherence over time, particularly postpartum.
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Das, C. R. "Causes of non-adherence to antiretroviral therapy in Wellness Clinic, Tshepong Hospital, Klerksdorp." Thesis, Stellenbosch : University of Stellenbosch, 2009. http://hdl.handle.net/10019.1/97161.
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ENGLISH ABSTRACT: HIV/AIDS is the leading cause of death in Sub-Saharan Africa. According to 2001 estimates, there are 28.5 million people living with HIV in Africa, comprising more than 70% of the world’s HIV-infected population. HIV/AIDS remains one of the most important social and public health threats in Sub-Saharan Africa. UNAIDS 2006 estimates that 5.5 million people are living with HIV, and almost 1,000 AIDS deaths occur every day in South Africa. South Africa is currently one of the most severely affected countries in the world. Antiretroviral therapy (ART) is currently the only treatment available for HIV. It does not cure HIV infection, but reduces HIV related mortality and morbidity.AFRIKAANS ABSTRACT: No abstract available
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Pou, Gonzàlez Christian. "Clinical Value of Massive Parallel HIV-1 Sequencing in Antiretroviral Treatment-Experienced Subjects." Doctoral thesis, Universitat Autònoma de Barcelona, 2013. http://hdl.handle.net/10803/129499.
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Els test de resistència al antiretrovirals són utilitzats en la pràctica clínica per la
personalització del tractament antiretroviral (TARV) de les persones infectades pel
VIH-1. La seqüenciació poblacional (SP) és la tècnica més emprada pel genotipat del
VIH-1 obtenint una bona correlació amb la resposta clínica dels pacients. No obstant,
la baixa sensibilitat de la SP pel que fa a la detecció de mutacions de resistència als
antiretrovirals (DRM) o soques X4-tròpiques presents en baixes prevalences pot
comprometre l’eficàcia del TARV. L’aplicació de noves tècniques de seqüenciació
massiva pel genotipat del VIH-1 (genotipat ultrasensible) permetria una caracterització
de la població viral amb major resolució optimitzant el TARV.
L’objectiu d’aquesta tesi era avaluar el valor clínic del genotipat ultrasensible pel
maneig clínic de pacients infectats pel VIH-1 que han estat exposats a TARV.
Durant la utilització de 454 sequencing per la determinació del tropisme viral, 454
sequencing va obtenir una major concordança amb ESTA (Enhanced Sensitivity
TrofileTM Assay) en l’anàlisi de l’ARN viral. Tot i que la SP tenia una menor sensibilitat
respecte 454 sequencing, la seva elevada especificitat li va permetre obtenir una millor
precisió. Anàlisis filogenètics a partir de dades obtingudes per 454 sequencing van
revelar que, encara que les determinacions eren equivalents entre amdós
compartiments, en alguns pacients es va observar compartimentalització de
seqüències pel que fa als haplotips i a la seva prevalença. Aquesta
compartimentalització podria comprometre la determinació del tropisme viral en funció
del compartiment que s’analitzi.
Durant aquest treball també es va fer la validació de la SP per determinacions del
tropisme a partir d’ADN proviral en un assaig clínic prospectiu i aleatoritzat. Aquest
assaig va demostrar ser útil per guiar canvis de tractament antiretroviral que incloguin
antagonistes de CCR5. De tota manera, 454 sequencing va ser capaç de detectar
variants X4 tròpiques en dos pacients prèviament classificats com a R5 tròpics per SP.
Pel que fa a la detecció de DRM en el gen pol, 454 sequencing va demostrar ser
no-inferior a la SP durant l’avaluació de la susceptibilitat al tractament antiretroviral.
Cal destacar que 454 sequencing va aportar informació genotípica addicional en la
majoria dels pacients, encara que aquesta modifiqués poques prediccions de
susceptibilitat. A més, aquesta tecnologia va ser utilitzada per explorar l’origen de les
DRM en el gen de la integrasa del VIH-1, demostrant que virus mutants detectats durant el fracàs virològic poden ésser originats a partir de virus mutants minoritaris preexistents.
En resum, aquesta tesi ha mostrat la utilitat clínica del genotipat ultrasensible del
VIH-1 en pacients experimentats al TARV. 454 sequencing ha permès una profunda
caracterització de la diversitat viral dins l’hoste, facilitant l’estudi l’evolució viral i la seva
patogènesi del VIH-1. A més, l’estandarització i automatització dels protocols de 454
sequencing permetria la implementació d’aquesta tecnologia pel diagnòstic del VIH-1.Los ensayos de resistencia a los antiretrovirales son utilizados en la práctica clínica para la personalización del tratamiento antirretroviral (TARV) de las personas infectadas por el VIH-1. La secuenciación poblacional (SP) es la técnica más utilizada para el genotipado del VIH-1 obteniendo una buena correlación con la respuesta clínica de los pacientes. Asimismo, la baja sensibilidad de la SP para la detección de mutaciones de resistencia a los antiretrovirales o variantes X4-trópicas presentes en baja prevalencia puede comprometer la eficacia de la TARV. El objetivo de esta tesis era evaluar el valor clínico del genotipado ultrasensible para el manejo clínico de pacientes infectados por el VIH-1 que han estado expuestos a TARV. Durante la utilización de 454 sequencing para la determinación del tropismo viral, 454 sequencing obtuvo una mayor concordancia con ESTA (Enhanced Sensitivity TrofileTM Assay) en el análisis del ARN viral. Aunque la SP mostró una menor sensibilidad que 454 sequencing, su elevada especificidad le permitió obtener una mayor precisión. La información genotípica generada por 454 sequencing fue utilizada para evaluar la compartimentalización. Aunque las determinaciones del tropismo viral eran equivalentes entre los compartimentos, en algunos pacientes se observó compartimentalización de secuencias, lo que puede comprometer la determinación del tropismo viral en función del compartimento que analizado. Durante este trabajo también se hizo la validación de la SP para determinaciones del tropismo a partir de ADN proviral en un ensayo clínico prospectivo y aleatorizado. Este ensayo demostró ser útil para guiar cambios de tratamiento antirretroviral que incluyan antagonistas de CCR5. De todos modos, 454 sequencing fue capaz de detectar variantes X4 trópicas en dos pacientes previamente clasificados como R5 trópicos por SP. En cuanto a la detección de DRM en el gen pol, 454 sequencing demostró ser no inferior a la SP durante la evaluación de la susceptibilidad al tratamiento antirretroviral. Cabe mencionar que 454 sequencing aportó información genotípica adicional en la mayoría de los pacientes, aunque esta modificara pocas predicciones de susceptibilidad. Además, esta tecnología fue útil para explorar el origen de las DRM en el gen de la integrasa del VIH-1, mostrando que los mutantes detectados durante el fracaso virológico pueden ser originados a partir de mutantes pre-existentes. En resumen, esta tesis ha mostrado la utilidad clínica del genotipado ultrasensible del VIH-1 en pacientes experimentados al TARV. 454 sequencing ha permitido una profunda caracterización de la diversidad viral dentro del huésped, facilitando el estudio de la evolución viral i la patogénesis del VIH-1. Además, la estandarización i automatización de los protocolos de 454 sequencing permitiría la implementación de esta tecnología para el diagnóstico clínico del VIH-1.
Drug resistance testing is utilized in the clinical routine to personalize ART of HIV-1 infected people. Population sequencing is employed for HIV-1 genotyping obtaining good correlations with clinical outcomes. However, its lack of sensitivity to detect minority DRM mutations or minor CXCR4-using viruses can compromise the efficacy of antiretroviral therapy (ART). The use of next generation sequencing technologies for ultrasensitive HIV-1 genotyping might allow deep characterization of the viral population optimizing the ART. The objective of this work was to evaluate the clinical value of ultrasensitive HIV-1 genotyping obtained by 454 sequencing for the management of ART-experienced HIV- 1 subjects in different treatment situations. During the utilization of 454 sequencing for viral tropism determinations, this technology achieved the closest diagnostic accuracy to ESTATM in plasma ARN. Although population sequencing had lower sensitivity than 454 sequencing, its highest specificity led to obtain closest accuracy to ESTA. Even though tropism determinations were equivalent between plasma and cellular compartments, phylogenetic analyses from data generated by 454 sequencing revealed sequence compartmentalization in some subjects. We also validated triplicate population HIV-1 genotyping from PBMC-associated DNA for viral tropism determinations in a prospective and randomized clinical trial. Here, genotypic tropism testing in proviral DNA demonstrated to become a suitable tool to guide treatment switches to CCR5 antagonists in aviremic individuals. In this study, 454 sequencing was capable to detect non-R5 viral strains in two subjects previously classified as harboring R5 HIV-1 strains by population sequencing. This compartmentalization might compromise viral tropism determinations depending on the compartment analyzed. Furthermore, the absence of evolution observed during prolonged periods of aviremia suggested that testing of stored plasma sample would be generally safe and informative. Regarding the detection of minority DRM in pol gene, 454 sequencing for ultrasensitive HIV-1 genotyping was technically non-inferior than population HIV-1 genotyping during the assessment of antiretroviral drug susceptibility. However, although this technology provided additional genotypic information beyond population sequencing in most of heavily pre-treated individuals tested, only few antiretroviral susceptibility predictions were modified. This technology was also useful to explore the origin of DRM in integrase gene, revealing that mutants detected at the time of virological failure can be originated from pre-existing minority drug resistance variants. In summary, this thesis has shown the clinical utility of ultrasensitive HIV-1 genotyping in ART-experienced HIV-1 infected individuals. However, further studies should extend our findings. 454 sequencing allowed a deep characterization of the HIV-1 diversity within a host helping to understand viral evolution and HIV-1 pathogenesis. Moreover, the standardization and automation of 454 sequencing protocols for HIV-1 sequencing would allow the implementation of this technology for HIV-1 diagnosis.
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Spaar, Anne. "Prioritising prevention strategies for patients in antiretroviral treatment programmes in resource-limited settings /." Zürich, 2008. http://www.public-health-edu.ch/new/Abstracts/SA_25.03.09.pdf.
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Sengwana, Manyeke Jeanivive. "Analysis of the implementation of an antiretroviral treatment programme in KwaZulu- Natal province." University of the Western Cape, 2019. http://hdl.handle.net/11394/7058.
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Philosophiae Doctor - PhDThe rapid expansion of the ART programme in South Africa has placed an additional service demand on an already stretched public health infrastructure. The main aim of this study was therefore to analyse the implementation of the ART programme in KwaZulu- Natal province using the Donabedian Model of structure, process and outcome in order to develop an ART delivery model. Ethical approval to conduct this research was issued by the University’s Senate Research Committee. The first phase of the study used a descriptive quantitative approach to review existing data from government departments to analyse the ART programme. A checklist with the list of indicators for the three elements of the study; the structure, process and outcome were used to collect data. A pilot study was conducted and the Cronbach Alpha test was used to determine the rigour of the study. In the second phase, a systematic review of studies on implementation of the existing models of ART programme was conducted using quantitative descriptive approach. The Quality Appraisal Tool was used to determine the validity of the research findings from the literature. In phase 3, both qualitative and quantitative approaches were used to conduct the Delphi study which included a group of experts in the field of HIV and ART programme. Responses from the participants were modified to determine the reliability of the study. The study found that there were structural problems such as shortages of antiretroviral drugs and delays in the return of laboratory results. The systematic literature review found that there were only two community-based ART models in South Africa, namely; the adherence clubs and community-based adherence clubs. These two models of ART delivery were implemented only in Cape Town.
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Mgosha, Peter Charles. "Barriers to Switching Patients to Second-Line Antiretroviral Treatment Among Clinicians in Tanzania." ScholarWorks, 2017. https://scholarworks.waldenu.edu/dissertations/3535.
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Poor decision making among clinicians to transferring human immune deficiency virus (HIV) patients into second-line antiretroviral therapy (ART) has led to an increase in morbidity and mortality to people living with HIV (PLHIV). No clear barriers are known for clinicians not switching their patients. This is a descriptive qualitative research aimed to discover obstacles that influence clinicians' decision making to transferring patients into second-line ART despite higher level resistance to first-line ART. The researcher applied a participatory action research framework to solve the identified barriers with clinicians. Using the research questions the researcher explored reasons, perceived barriers and enabling factors for clinicians delay in making decision to transferring HIV patients into second-line ART. In-depth semistructured interviews were conducted with 30 participants. Six thematic areas (a) clinicians' capacity to diagnose treatment failure, (b) laboratory investigations, (c) availability, access, and tolerability to second-line ART, (d) clinicians' perceptions on ARV medicines, (e) clients' readiness for ARV medicines, and (f) adherence and retention to ARV medicines were analysed using STATA. Readiness, adherence and retention to ART, knowledge, competence and experience on ART , lack of viral load testing, and shortage of second-line ART were the common major barriers for clinicians in determining transferring patients into second-line ART. The government of Tanzania should acknowledge and create participation, responsibility, and commitment strategies to reduce the observed barriers. Findings of this study generates knowledge and provide actionable plans to help clinicians easily identify HIV patients who are in need of second-line ART.
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Mall, Sumaya. "The impact of African traditional healers on Antiretroviral (ARV) treatment in South Africa." Master's thesis, University of Cape Town, 2007. http://hdl.handle.net/11427/9330.
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Includes bibliographical references (leaves 90-93).There are few studies on the impact of African traditional healing on HIV/AIDS care and treatment in South Africa. There is a need for concrete data on the subject as many people across the African continent are thought to be accessing these kinds of healing services. This study which consists of three inter-related sub studies, investigated the impact of African traditional healers on Antiretroviral (ARV) treatment in South Africa. Each of the sub studies focused on the insights and opinions of three different populations, i.e. health care workers, traditional healers (who were affiliated with HIV/AIDS care services) and HIV positive patients. The first of the sub studies used in- depth interviews to explore the attitudes and approaches often health care professionals (nurses, doctors, ARV counsellors and a pharmacy assistant) working in ARV roll out sites in South Africa to their patients taking traditional medicine and accessing traditional healing paradigms. The sub study also probed their opinions of collaborating with traditional healers to strengthen ARV care. Furthermore, this sub study included two focus group discussions with lay health workers at two ARV sites (i.e. ARV counsellors and patient advocates). On the whole the study showed that health care professionals are concerned about the possibility of traditional healers undermining an ARV roll out programme. These perceptions are based on concerns that traditional healers may provide untested substances to HIV positive patients that could interact adversely with ARV drugs. They also believed that traditional healers could discourage patients from adhering to their ARV regimen. However, despite these concerns, most of the health care professionals were willing to collaborate with traditional healers but the partnership would have to be formed on the basis of the principles of the biomedical paradigm of healing. Health care professionals preferred to be solely in charge of the ARV drug regimen with (biomedically) trained traditional healers supporting them. They preferred traditional healers to concentrate solely on symbolic rituals. The focus groups with the ARV counsellors and patient advocates show that these lay health workers support an ARV roll out process that effectively underplays the role of traditional healers and therefore actively discourage their patients from using traditional healing services while taking ARV treatment. The second sub study complements the first and used in-depth interviews to explore the attitudes and approaches of five female traditional healers (working in HIV/AIDS organizations in the Western Cape) towards the use of ARV treatment by their clients. This study also explored their attitudes towards a partnership with the formal public health sector with regard to HIV/ AIDS care. The sub study showed that traditional healers are concerned about the wellbeing of HIV positive people. All of the traditional healers who were recruited into this study were in favour of a partnership with health care workers as long as such a partnership is based on mutual collaboration and respect. The third sub study was a study of HIV positive patients attending health facilities that provide ARV care. A semi structured questionnaire was adapted from instruments used in previous studies and was complemented by in depth interviews with patients who reported use of traditional healing systems in the past year. This sub study explored the attitudes of the respondents towards African traditional healers and their practices. The responses of the patients show that the majority of respondents have never accessed a traditional healing service. Some of the patients recruited in the study said they had accessed a traditional healing service before they had begun ARV treatment or before they were recruited into this study. They expressed the reasons for their choice. Only two patients were found to be actively crossing between ARV treatment facilities and traditional healing services at the time of their interview. A public health and human rights analysis suggests means of incorporating a traditional healer in ARV care, whereby an ARV treatment policy can respect cultural rights of patients and traditional healers while simultaneously improving ARV treatment infrastructure. Limitations encountered in the study such as location of the research sites, nature of the respondents and the ways in which the questions were worded to the respondents were addressed through efforts by the researcher. The study concludes that a partnership between traditional healers and the formal public health sector is feasible but must incorporate respect for cultural rights.
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Mukhtar, Abdulaziz Y. A. "Mathematical modeling of population dynamics of HIV with antiretroviral treatment and herbal medicine." Thesis, University of Western Cape, 2014. http://hdl.handle.net/11394/3351.
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>Magister Scientiae - MScHerbal medicines have been an important part of health and wellness for hundreds of years. Recently the World Health Organization estimated that 80% of people worldwide rely on herbal medicines. Herbs contain many substances that are good for protecting the body and are therefore used in the treatment of various illnesses. Along with traditional medicines, herbs are often used in the treatment of chronic diseases such as rheumatism, migraine, chronic fatigue, asthma, eczema, and irritable bowel syndrome, among others. Herbal medicines are also applied in certain traditional communities as treatment against infectious diseases such as flu, malaria, measles, and even human immunodeficiency virus HIV-infection. Approximately 34 million people are currently infected with the human immunodeficiency virus (HIV) and 2.5 million newly infected. Therefore, HIV has become one of the major public health problems worldwide. It is important to understand the impact of herbal medicines used on HIV/AIDS. Mathematical models enable us to make predictions about the qualitative behaviour of disease outbreaks and evaluation of the impact of prevention or intervention strategies. In this dissertation we explore mathematical models for studying the effect of usage of herbal medicines on HIV. In particular we analyze a mathematical model for population dynamics of HIV/AIDS. The latter will include the impact of herbal medicines and traditional healing methods. The HIV model exhibits two steady states; a trivial steady state (HIV-infection free population) and a non-trivial steady state (persistence of HIV infection). We investigate the local asymptotic stability of the deterministic epidemic model and similar properties in terms of the basic reproduction number. Furthermore, we investigate for optimal control strategies. We study a stochastic version of the deterministic model by introducing white noise and show that this model has a unique global positive solution. We also study computationally the stochastic stability of the white noise perturbation model. Finally, qualitative results are illustrated by means of numerical simulations. Some articles from the literature that feature prominently in this dissertation are [14] of Cai et al, [10] of Bhunu et al., [86] of Van den Driessche and Watmough, [64] of Naresh et al., Through the study in this dissertation, we have prepared a research paper [1], jointly with the supervisors to be submitted for publication in an accredited journal. The author of this dissertation also contributed to the research paper [2], which close to completion. 1. Abdulaziz Y.A. Mukhtar, Peter J. Witbooi and Gail D. Hughes. A mathematical model for population dynamics of HIV with ARV and herbal medicine. 2. P.J. Witbooi, T. Seatlhodi, A.Y.A. Mukhtar, E. Mwambene. Mathematical modeling of HIV/AIDS with recruitment of infecteds.
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Masokoane, Kgomotso Quentinne. "Adherence and non-adherence to antiretroviral treatment in HIV people in Port Elizabeth." Thesis, Nelson Mandela Metropolitan University, 2009. http://hdl.handle.net/10948/1185.
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The introduction of antiretroviral drugs (ARVs) in 1996 transformed the treatment of HIV and AIDS, improving the quality and greatly prolonging the lives of many infected people. HIV (Human Immunodeficiency Virus) is the virus that is believed to cause AIDS. AIDS (Acquired Immune Deficiency Syndrome) is the collection of illnesses or symptoms that ultimately results in death. Antiretroviral (ARVs) drugs or Highly Active Antiretroviral Therapy (HAART) is the treatment that has been applied to combat the HI virus in a bid to slow down the progression of AIDS and ultimately prolong the life of the infected individual. The study aimed to explore and describe the factors contributing to adherence and non-adherence to ARVs in individuals on treatment. A sample of 81 individuals who have been on ARV and HAART treatment for six months or more was used. The methodology used was exploratory-descriptive and the data obtained was quantitative in nature. A biographical questionnaire and questionnaire with questions aimed at ascertaining the possible factors that contribute to individuals either adhering to or defaulting on their treatment, such as side effects and cost of treatment, was administered. The data obtained was analysed by means of descriptive statistics and frequency counts. The results of the study showed that the sample had a fairly high level of adherence. The factors that could undermine adherence were identified as lack of support, as familial and health provider support acts as a motivator to adhere; substance abuse as it can lead to forgetting to take treatment; unemployment and poverty, as these can lead to an inability to return for follow up clinic visits or failure to have food to take with the pills; and the type of treatment regimen whereby the more complex the treatment is the more likely it is that adherence will be difficult to maintain. Suggestions were made as to future research involving antiretroviral therapy (ART). Finally the limitations as well as the value of the research were outlined.
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Mwale, Joyce Chali. "Factors affecting retention in care of patients on antiretroviral treatment in the Kabwe district, Zambia." University of the Western Cape, 2016. http://hdl.handle.net/11394/5251.
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Masters of Public Health - see Magister Public HealthIntroduction: HIV and AIDS continues to be a major public health challenge for Zambia, which has the highest HIV prevalence rate of 13.1% in sub-Saharan Africa. Although individuals living with HIV/AIDS in Zambia have increased access to antiretroviral treatment (ART), not all patients who are initiated on antiretroviral treatment remain in care; with some patients being lost at different points in the continuum of care. The current study aimed to explore the factors affecting retention in care among patients receiving antiretroviral treatment at three primary health facilities in the Kabwe district in Zambia. Methodology: An exploratory qualitative study design was used to explore the patient, health systems and socio-economic factors that underlie retention on ART in three purposefully selected primary health care facilities in Kabwe district. Data was collected through in-depth interviews with 45 ART patients and three focus group discussions with 20 health care providers. The content of the transcribed interviews was analyzed thematically. Findings: The overall retention rate of the ART sites was found to be 65%. The main patient factors that influenced retention in care were side effects of antiretroviral drugs and weight increase as a sign of good health. The social related factors that influenced patient retention in care were stigma and non-disclosure of HIV status, faith healing, use of herbal remedies and alcohol use. The health system factors that contributed to poor retention of patients in care were long waiting times due to staff shortage, high patient load, travel distance to ART centers and transportation cost. Other health system factors reported by participants included shortage of third line ARV drugs and inadequate space in ART clinic. Finally, food shortage and mobility of patients due to employment were some of the identified economic factors that influenced patient retention in care. Conclusions: A large proportion of adult patients initiating ART in Zambia are poorly retained in care because of patient, health system, social and economic factors. In order to improve retention, more nurses and clinical officers should be trained in ART management to improve skills and address staff shortages. It would also be useful for Zambia to introduce community drug distribution points for delivering ARV refills to reduce the workload on the existing ART sites and reduce on the distances that patients have to travel to ART centers. Additionally, efforts should also be made to improve ART care by extending ART clinic days to include all the days of the week except Sundays.
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Engel, Tania. "Measuring adherence levels to antiretroviral treatment (ART) and assessing certain factors affecting adherence in a state primary health care clinic, Mitchells Plain Community Health Centre, South Africa." Thesis, Stellenbosch : University of Stellenbosch, 2015. http://hdl.handle.net/10019.1/97236.
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Objective. Measuring adherence levels and assessing the impact on adherence to ART (antiretroviral treatment) of the factors: disclosure to partner, partner support, other support and length of time between diagnosis and ART commencement, in a state-run ART clinic at Mitchells Plain Community Health centre.
Design. A retrospective case control study was conducted and the information was obtained by means of a file audit.
Methods. Every 5th file was selected for the study and 199 participants were chosen based on the inclusion and exclusion criteria. Adherence for each patient was measured using a formula documented in a published study. For the comparison group 82 cases (non-adherent patients) were matched for age and gender with 82 adherent controls.
Results. The mean adherence for the initial group of 199 participants was 80.1%. Disclosure to a partner and partner support were not found to significantly affect adherence. The time between HIV diagnosis and ART commencement was also not found to make a statistically significant difference to adherence. There appeared to be an association, though not statistically significant, between other support (not from the partner) and >95% adherence (p= 0.0579).
Conclusion. It can be concluded that adherence is probably influenced by a wide variety of factors. More qualitative studies or larger samples are recommended to better assess the impact of partner support and acceptance of HIV on adherence. Approaches to partner disclosure prior to commencing ART should be reviewed. The mean adherence level of 80.1% is an indication that more work is urgently needed to improve adherence levels in state-run clinics in South Africa.
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Ren, Yuan. "The Plasma, Whole Blood and Intracellular Concentrations of Antiretroviral Agents in South African Children Receiving Combination Antiretroviral Therapy with and without Concomitant Antitubercular Treatment." Doctoral thesis, University of Cape Town, 2009. http://hdl.handle.net/11427/3297.
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Background: Tuberculosis (TB) is the most common opportunistic infection in children with human immunodeficiency virus (HIV) infection in developing countries, and co-treatment for HIV infection and TB is frequently indicated. Efavirenz and lopinavir/ritonavir (ratio 1:1) as part of antiretroviral therapy are used in combination with rifampicin-based antitubercular treatment in South African TB/HIV co-infected children. Adult studies show that concomitant rifampicin significantly reduces efavirenz and lopinavir plasma concentrations. However, the pharmacokinetics (PK) of efavirenz and lopinavir/ritonavir are poorly characterized in children, especially African children and no study has evaluated the effect of rifampicin-based antitubercular treatment on efavirenz and lopinavir/ritonavir plasma concentrations in children. Although therapeutic drug monitoring (TDM) is recommended in selected patients (including young children and patients receiving concomitant antitubercular treatment), TDM is seldom available in resource-constrained countries. There is an urgent need to develop a field friendly method which requires small volumes of blood, and inexpensive processing and storage conditions. Furthermore, because HIV replicates in the cells, efavirenz and lopinavir need to penetrate into these infected cells to inhibit viral replication. Therefore, directly measurement of intracellular concentrations of these drugs in HIV-infected children could provide better understanding of drug exposure at the action site. It is also important to evaluate the effects of frequently co-administered drugs on intracellular accumulation of efavirenz and lopinavir. Objectives: 1) To evaluate efavirenz and lopinavir/ritonavir plasma concentrations and determine the effects of rifampicin on efavirenz and lopinavir/ritonavir PK in HIV-infected African children with and without rifampicin-based antitubercular treatment. 2) To develop and validate the dried blood spot (DBS) method as an alternative to conventional plasma methods of drug concentration measurement in TDM. 3) To evaluate in vivo intracellular concentrations of efavirenz and lopinavir/ritonavir in HIV-infected children with and without concomitant antitubercular treatment. 4) To determine the in vitro modulation effects on the intracellular accumulation of efavirenz IV and lopinavir in human peripheral blood mononuclear cells (PBMCs) by drug efflux protein inhibitors, as well as frequently co-administered rifampicin and ritonavir (at low dose; as pharmacoenhancer). Methods: 1) Plasma efavirenz and lopinavir/ritonavir concentrations were measured by validated liquid chromatography/tandem mass spectrometry (LC/MS/MS) method in TB/HIV co-infected children during and after rifampicin-based antitubercular treatment as well as in a group of controls (HIV-infected children without TB). Children in the efavirenz study (n= 30) were receiving standard doses of efavirenz as part of antiretroviral treatment. Trough concentrations (Cmin) of efavirenz were estimated by extrapolation of the log-linear concentration-time line to 24 hours after the previous dose. Children in the lopinavir/ritonavir study were receiving additional ritonavir (lopinavir: ritonavir ratio 1:1) during antitubercular treatment (n= 15), and standard doses of lopinavir/ritonavir (LPV/r; ratio 4:1) after antitubercular treatment, and in controls (n= 15). The PK of lopinavir and ritonavir were characterized from concentration-time curves using WinNonlin version 4.1 by non-compartmental analysis. 2) Aliquots of 50 μ L of whole blood from the efavirenz and lopinavir/ritonavir studies were dried onto filter paper. The drug concentrations were analyzed using validated LC/MS/MS method. The effects of high temperature and direct sunlight on the stabilities of these antiretroviral drugs in DBS samples were tested. 3) Intracellular concentrations of efavirenz, lopinavir and ritonavir were measured in trough concentrations of 11 TB/HIV co-infected children using a validated LC/MS/MS method. Six children were receiving double dose of LPV/r (4:1) with concomitant rifampicin; 5 children were receiving standard doses of efavirenz with rifampicin-based antitubercular treatment, 3 of them had intracellular concentrations measured again after completing rifampicin-based antitubercular treatment. 4) in vitro intracellular accumulation of efavirenz and lopinavir were measured in human PBMCs in the absence and presence of P-glycoprotein inhibitors (verapamil at 50 μ M, V furosemide at 50 μ M and cyclosporine A at 20 μ M) and frequently co-administered drugs at levels representing the average concentrations found in patients (ritonavir at 5 mg/L and rifampicin at 4 mg/L). The concentrations of efavirenz and lopinavir in PBMCs were determined by LC/MS/MS. Results and Conclusions: 1) The co-administration of rifampicin did not significantly reduce efavirenz estimated Cmin concentrations. A high proportion of children with and without concomitant antitubercular treatment had sub-therapeutic efavirenz concentrations despite being correctly dosed according to the manufacturer's instructions, raising concerns about the adequacy of current efavirenz dosing recommendations in children. The lopinavir key PK parameter, Cmin, was not significantly different in same group of children during and after rifampicin-based antitubercular treatment or compared to HIV-infected children without tuberculosis. The recommended minimum therapeutic concentration was achieved in 87% of children during antitubercular treatment and in 92% without concomitant antitubercular treatment. Therefore, in the context of limited options, LPV/r with additional ritonavir (ratio 1:1) is an acceptable approach to treat young children receiving concomitant rifampicin-based antitubercular treatment, although safety remains a concern and hepatic alanine transaminase levels should be monitored regularly. 2) Plasma and DBS concentrations of efavirenz, lopinavir and ritonavir were strongly correlated. The median (interquartile range, IQR) DBS/plasma concentration ratios for efavirenz, lopinavir and ritonavir were 0.93 (IQR 0.83, 1.08), 0.73 (IQR 0.61, 0.90) and 1.05 (IQR 0.74, 1.21), respectively. PK parameters of efavirenz and ritonavir were closely similar between DBS and plasma; whereas lopinavir pre-dose and Cmin (at 12 hours after lopinavir intake) concentrations were 16% lower in DBS samples. The 3 antiretroviral drugs in DBS samples were stable at 37 deg C for 7 days and with exposure to direct sunlight for 2 hours. DBS can be used as an alternative field-friendly method for efavirenz, lopinavir and ritonavir concentration monitoring. However, pre-dose and Cmin concentrations of lopinavir in DBS samples need to be increased by 16% when used to predict plasma concentrations. VI 3) In vivo median intracellular/plasma concentration ratios for efavirenz, lopinavir and ritonavir amongst 11 TB/HIV co-infected children during antitubercular treatment were 0.91 (IQR 0.54, 1.19), 0.22 (IQR 0.09, 0.31) and 4.17 (IQR 1.30, 7.33), respectively. Two children had efavirenz intracellular/plasma concentration ratios during vs. after antitubercular treatment: 1.00 vs. 0.61 and 0.27 vs. 0.79. 4) Furosemide significantly increased efavirenz and lopinavir accumulation in healthy human PBMC samples by 1.2- 1.5 fold. Whereas, neither verapamil nor cyclosporin A had significant effects on efavirenz or lopinavir intracellular accumulation. Despite being an inducer of P-glycoprotein, rifampicin increased the accumulation of both efavirenz and lopinavir to different extents in all 3 PBMC samples. The low-dose ritonavir (at the concentration found in HIV-infected patients) had no effect on intracellular accumulation of efavirenz and lopinavir at therapeutic concentrations.
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Mallon, Patrick William Gerard School of Medicine UNSW. "Clinical and molecular aspects of HIV-associated lipodystrophy." Awarded by:University of New South Wales. School of Medicine, 2006. http://handle.unsw.edu.au/1959.4/33048.
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HIV-associated lipodystrophy (HIVLD) syndrome is a condition comprising abnormalities in distribution of body fat and metabolism of lipids and glucose that arises in HIV-infected patients on long-term antiretroviral therapy. This thesis describes clinical research into aspects of the natural history and treatment of HIVLD, as well as molecular research into its pathogenesis centred on subcutaneous adipose tissue. Results demonstrate HIVLD to be a treatment-induced syndrome characterised by initial gains in body fat followed by selective, progressive loss of limb fat. Exposure to thymidineanalogue nucleoside reverse transcriptase inhibitors (tNRTI) induces lipoatrophy through mitochondrial dysfunction of which inhibition of mitochondrial RNA expression, rather than mitochondrial DNA depletion, is an early feature. Mitochondrial dysfunction is associated with decreases in expression of peroxisome proliferatoractivated receptor gamma (PPAR??), an adipocyte transcription factor, which helps explain how tNRTI exposure leads to the loss of adipocyte function. Once established, lipoatrophy is characterised by mitochondrial DNA depletion, although this depletion occurs throughout the mitochondrial genome, suggesting an underlying cause other than inhibition of DNA polymerase gamma. HIVLD is a difficult syndrome to treat. Lipoatrophy is resistant to treatment with rosiglitazone, an agonist of PPAR??, which is ineffective in the setting of ongoing tNRTI therapy and mitochondrial dysfunction. Dyslipidaemia is also difficult to treat as use of pravastatin in the setting of ongoing exposure to protease inhibitors results in only modest declines in fasting cholesterol concentrations. Gains in central fat, such as that seen in patients with buffalo hump, are associated with insulin resistance and diabetes, but only occur in a relatively small percentage of treated patients, suggesting a role for genetic factors in its development. Use of strategies such as avoidance of tNRTI in firstline ART, genetic screening to identify those at risk of toxicities and targeted selection of interventions in subgroups of affected patients, may help prevent this syndrome occurring and better treat those patients in which it has already occurred.
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Sutinen, Jussi. "Pathogenesis and treatment of lipodystrophy in HIV-infected patients receiving highly active antiretroviral therapy." Helsinki : University of Helsinki, 2003. http://ethesis.helsinki.fi/julkaisut/laa/kliin/vk/sutinen/.
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Ikoona, Eric. "Factors influencing the development and implementation of nurse-led antiretroviral treatment clinics in Uganda." Thesis, London School of Hygiene and Tropical Medicine (University of London), 2017. http://researchonline.lshtm.ac.uk/4189857/.
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A major barrier to universal access to antiretroviral treatment (ART) in Uganda is the critical shortage of trained healthcare workers, particularly doctors. Although there are plans to legalise nurses to provide ART, little is known about the potential barriers and facilitators to the development and implementation of effective nurse-led ART clinics in Uganda. Thus, this study sought to understand the factors influencing the introduction of nurse-led ART clinics in Uganda as well as to determine nurses’ and doctors’ competencies in delivering HIV care to inform the design of strategies that would enhance their success. To this end, descriptive cross-sectional studies through a questionnaire survey, semi-structured interviews, and focus group discussions (FGDs) were conducted with numerous stakeholders including patients. HIV clinical vignette tests were used to assess doctors’ and nurses’ competencies in delivering ART. The results revealed that nurse-led ART clinics were already widespread in Uganda, albeit the lack of a policy allowing them to operate. Moreover, their successful development and implementation is critically dependent on nurses’ competence, self-confidence, motivation, authority, and autonomy, as well as on the availability of systems and human resource support and on the acceptability of nurses as providers of ART by patients and other stakeholders. Major challenges identified include the lack of patients’ and cmmunity support, the absence of legal and regulatory frameworks, and a weak general health system including inadequate equipment, supervision support and mentoring, among others. In conclusion, this study found that nurse-led ART clinics are already operating on a wide scale in Uganda, although on an ad hoc basis, and are viewed by stakeholders as a key strategy for scaling up human immune deficiency virus HIV services including ART. Now may be the appropriate time to plan adequately for the legalised and regulated development and implementation of these clinics while addressing the numerous factors that influence nurses’ ability and capacity to deliver HIV services efficiently and effectively.
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Otura, Kingsley. "Stigma in access to antiretroviral treatment in Abuja, Nigeria : the importance of social connections." Thesis, Queen Margaret University, 2013. https://eresearch.qmu.ac.uk/handle/20.500.12289/7455.
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Access to anti-retroviral drug (ARV) therapy in Nigeria has been a big challenge. Despite the fact that ARVs have been demonstrated to improve quality of life, reduce AIDS prevalence and AIDS deaths, many people in Nigeria still do not have access to ARV therapy. At the time this study was started, the ARV access rate was 16.6%. This Grounded Theory study examines the experiences of HIV positive people accessing ARVs in Abuja, Nigeria. 30 Patients living with HIV/AIDS were interviewed in an iterative manner. The results of the Grounded Theory analysis were triangulated with the documentary analysis of preliminary and secondary literature. As reported by the participants of the study, patients initially found it very difficult to access treatment. Stigma emerged as the main concern of the research participants. Although access to anti retroviral treatment has improved over the years, different forms of stigma still pose important barriers to access in this group of participants. The results of this research suggest that stigma occurs at individual, familial, community, organisational and national levels. The main concern of research participants was resolved mainly through the use of social connections. The contribution to knowledge is the development of the Social Connection Theory. 5 main stages that patients pass through when they attempt to access ARVs were identified in this study. During each of these stages, the patient may experience barriers through stigma or other forms of structural issues such as poverty. They may also move from one stage to another through social connectors who assist them to access ARVs. In the Social Connection Theory, it is argued that in African settings, social connectors play a vital role in influencing the way that patients access antiretroviral treatment. Social connectors are social acquaintances of the patient who help shape their health care seeking decisions. They play a vital role in supporting and linking HIV positive persons to where they can access ARVS. Social connection serves as a useful tool for empowering HIV patients to overcome different obstacles and access treatment. However, these processes do not occur in a structural vacuum. Structural factors such as religion, gender, politics and the economy were also found to shape the way stigma is experienced in Nigeria and how people access HIV treatment. To improve access to ARVs, it is suggested that while taking cognisance of structural forces, multidisciplinary strategies should be developed that integrate social connectors at different critical points in the access continuum.
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Michaels, Desireé. "Paediatric antiretroviral HIV treatment : measurement and correlates of adherence in a resource-poor setting." Doctoral thesis, University of Cape Town, 2008. http://hdl.handle.net/11427/9425.
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Includes bibliographical references (p. 212-244).[Objectives] There is a paucity of data regarding paediatric adherence in resource-limited settings (RLS) especially among the very young age groups (<7yrs). The study investigated the rates of adherence, the identification of the adherence measurement, amongst four, which best correlates with viral load suppression; as well as correlates of adherence amongst a cohort of children younger than 7 years on antiretroviral HIV treatment. Design: A Prospective cohort study with 6 months follow-up [ Methods ] Measures of adherence used: caregiver self-report (CSR), medicine measure/pill count, pharmacy refill and clinic attendance. Child, caregiver, socio-economic and health service characteristics were assessed for impact on adherence. Bivariate and multivariate analyses were used to determine agreement between measures and viral load outcome and to determine correlates of adherence. [ Results ] Mean age of children enrolled into the study was 27.08 months with a cohort mean adherence rate of 85% and mean viral load suppression of 74% at 6 months. Biological mothers were the majority primary caregivers (85%) and the majority (76%) of caregivers were unemployed with 60% receiving some form of social welfare grant. Results showed that caregiver selfreported adherence (CSR) was significantly correlated with viral load at 6 months (p=0.004). Correlations were found between clinic visits and pharmacy refill (highest values 0.35; p=0.000) and between medicine measure and clinic visits (highest value -0.21; p=0.04) but none of these measures were significantly correlated with viral load. Sensitivity and specificity analysis for CGSR showed that >95% adherence ensured a good viral load outcome. Four factors were significantly associated with adherence in bivariate analyses. These were: access to social welfare grants (OR=2.7; p=0.05); being counselled for initiation of ARV treatment by a counsellor vs. a doctor or nurse (OR 3.2, p=0.03); having another person in the household other than the index child infected with HIV (OR = 0.34, p=0.05) and caregiver depression (OR=0.07, p=0.01). However, in multivariate analyses certain other child, caregiver, socio-economic and health system characteristics as well as the abovementioned variables emerged as significant. [ Conclusion ] Key findings indicate that adherence rates are relatively high in this cohort and CGSR is valid in a resource-poor setting but medicine measure was problematic as a paediatric HAART adherence measure. Certain child, caregiver, socio-economic and health system characteristics have a significant impact on adherence.
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Nchendia, Azia Ivo. "Barriers to adherence to antiretroviral treatment in a regional hospital in Vredenburg, Western Cape." Thesis, University of the Western Cape, 2012. http://hdl.handle.net/11394/4483.
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Magister Public Health - MPHBackground: South Africa has one of the most severe HIV epidemics globally, with an estimated 737,000 AIDS related deaths annually and over a million children rendered orphans due to AIDS in 2006. However in 2007, the South African government made a giant commitment to dealing effectively with the AIDS epidemic by implementing a National Strategic Plan (NSP), which had as one of its principal objectives the provision of antiretroviral medications to 80% of all people in need of the treatment by 2011. By the end of June 2011, the rollout of antiretroviral therapy continued to be successful with 1.4 million persons started on antiretroviral therapy and treatment initiation rates reaching 30, 000 per month. Patients have to subject to an uncompromising adherence of taking at least 95% of antiretroviral medication as prescribed, because poor adherence to ART leads to treatment failure, viral mutations and the development of drug resistance. Of major concern to ART programmes are the current obstacles that patients’ face in lieu of treatment. Aim: The aim of this study was to explore the barriers to adherence to antiretroviral treatment among patients in a public ART programme in Vredenburg, Western Cape. Methodology: An explorative qualitative study was conducted where data was collected through interviews with 18 patients receiving treatment from the Vredenburg hospital. Data was audio-tape recorded, transcribed in full and thematic content analysis done. Results: The study identified awareness of HIV status, disclosure, unemployment, lack of transport,insufficient feeding, disability grants, alcohol and alternative forms of therapy as well as stigma as major barriers to adherence. Whereas inadequate follow ups, recklessness in the way patients’ HIV results were handled, long waiting times and the fear of picking up other types of infections from other patients in the OPD also came under major criticisms from patients. Finally, the sharing of experiences at clinic visits, good healthcare provider’s patient relationships, believing in the treatment, good treatment literacy, being a parent and having children to take care of, the use of pill boxes, social and spiritual support from family members and friends were identified as factors that positively influenced adherence. Conclusion: HIV/AIDS has been a stigmatized illness since its onset in the early 1980s and, these results highlight that such stigma has yet to dissipate in Vredenburg. Therefore, stigma and disclosure must remain at the forefront of the ART programme implementation in Vredenburg; while long term projects that can support ART users economically should be created through partnerships with non-governmental organizations and the government of South Africa to optimize adherence in the community.
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Kabeja, Adeline. "Effectiveness of task shifting in antiretroviral treatment services in health centres, Gasabo district, Rwanda." Thesis, University of the Western Cape, 2012. http://hdl.handle.net/11394/4049.
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Magister Public Health - MPHIn the context of human resource crisis in African countries, the World Health Organization has proposed task-shifting as an approach to meet the ever-increasing need for HIV/AIDS care and treatment services. Rwanda started the process of task shifting towards nurse-based care in ART services in June 2010. After one year of implementation, a need to determine whether task shifting program has been implemented as intended and if it achieved its primary goal of increasing accessibility of people living with HIV to ARV therapy and improving nurse capacity in HIV patient care was imperative.A multi-method program evaluation study design, combining cross sectional, retrospective review and retrospective cohort sub-studies were used to evaluate the implementation,maintenance processes and outcomes of task shifting in 13 Health Centres (HCs) located in the catchment area of Kibagabaga District Hospital, in Rwanda. The study population consisted of HCs providing task shifted care (n=13), nurses working in the ART services of the 13 HCs(n=36), and more than 9,000 patients enrolled in ART care in the 13 HCs since 2006. All 13 HCs and 36 nurses were included in the evaluation. Routine data on patients enrolled in the pre-task shifting period (n=6 876) were compared with the post task shifting period (n=2 159), with a specific focus on data in the 20-months periods prior to and after task shifting. A cohort of patients 15 years and older, initiated onto ART specifically by nurses from June to December 2010 was sampled (n=170) and data extracted from patients medical files.Data collection was guided by a set of selected indicators. Three different data collection tools were used to extract data related to planning, overall programmatic data and individual data from respectively, the program action plans/reports, HIV central databases and patients medical files. Descriptive analysis was performed using frequencies, means and standard deviations (SD). The paired and un-paired t-tests were used to compare means, and chi-square test was used to compare categorical variables. To compare and to test statistical difference between two repeated measurements on a single sample but with non-normally distributed data, Wilcoxon signed rank test was used. To judge if current task shifted care is better, similar or worse than non-task shifted care, comparisons were made of program outputs and outcomes from the central database prior to and after the period of task shifting, and also with the cohort of nurse initiated patients.Results showed that 61% of nurses working in the ART program were fully trained and certificated to provide ART. Seven out of 13 HCs met the target of a minimum of 2 nurses trained in ART service delivery. Supervision and mentorship systems for the 13 HCs were well organized on paper, although no evidence documenting visits by mentors from the local district hospital to clinics was found. In term of accessibility, the mean number of patients newly initiated on ART per month in the HCs increased significantly, from 77.8/month (SD=22.7) to 93.9/month (SD=20.9) (t test (df=38), p=0.025). A small minority of patients was enrolled in late stages of HIV, with only 15% of the patient cohort having CD4 counts of less than 100 cell /μL at initiation on ART. The baseline median CD4 cell count was 267.5 cells /μL in the cohort as a whole. With respect to quality of care, only 8.8% of patients in the cohort had respected all appointments over a mean follow up period of 17.2 months; and although follow up CD4 counts had been performed on the majority of patients (80%), it was done after a mean of 8.5 months(SD=2.7) on ART, and only a quarter (24.7%) had been tested by 6 months (as stipulated by guidelines). From central ART program data, a small but significant increase of patients on 2nd line drugs was observed after implementation of task shifting (from 1.98% to 3.00%, 2=13.26,p<0.001), although the meaning of this shift is not entirely clear.The median weight gain was 1 kg and median CD4 increase was 89.5 cells /μL in the cohort after 6 months of receiving task shifted care and treatment. These increases were statistically significant for both male and female patients (Wilcoxon signed rank test, p<0.001). With regard to loss to follow up, only three of the 170 patients in the cohort followed up by nurses had been lost to follow-up after a mean of 17.2 months on treatment. The routine data showed a decrease of patients lost to follow up, from 7.0% in the pre-task shifting period to 2.5% in the post-task shifting period. In general, the mortality rate was slightly lower in the post-task shifting period than in the pre-task shifting (5.5% vs 6.9% respectively), although this was not statistically significant (2=2.4, df=1, p=0.1209).This study indicates that, after over one year of implementation of task shifting, task shifting enabled the transfer of required capacity to a relatively high number of nurses. In an already well established programme, task shifting achieved moderate improvements in uptake (access) to ART, significant reductions in loss to follow up, and good clinical outcomes. However,evaluation of process quality highlighted some concerns with respect to adherence to testing guidelines on the part of providers and follow up visits on the part of patients. Improvements in processes of monitoring and follow up are imperative for optimal mid-term and long-term task shifting in the ART program.
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Magadla, Nobuhle. "Factors influencing adherence to antiretroviral treatment in the Queenstown region Eastern Cape (South Africa)." University of the Western Cape, 2014. http://hdl.handle.net/11394/5840.
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Magister Curationis - MCurBACKGROUND: Failure to adhere to antiretroviral therapy (ART) has negative consequences not only for patients themselves, but for health systems. Strict adherence to ART therapy together with modified life style will result in a positive outcome (WHO, 2003a). AIM: The aim of the study was to describe factors that may influence adherence to ART treatment. METHOD: A quantitative research approach was used to conduct a survey using an interviewer administered questionnaire in the Queenstown region in three clinics with patients on ART. A random sample of 118 was selected out of a possible 594 patients. The response rate was n=97 (80.5%). The majority were females, n=77 (79%) with most of the respondents being 35-44 years, n=46 (47.4%) and single, n=76 (78%). Social and economic results: Respondents were economically inactive (unemployed), n= 49 (50, 5%) and n=40 (41.2%) on disability grant with no significant association between the employment status and acceptance of antiretroviral treatment. Males had higher rates for acceptance of ART and with more males n= 8/20 (40%) as compared to women n= 13/77 (16.8%) stating that they accepted their outcome (X2=5, p=.035). High levels of emotional support were reported n= 79 (81.4%). HEALTH CARE SERVICE RESULTS: Only n=3 (3.1%) of the respondents reported to have their own transport, resulting in 72 respondents (74.2%) reporting that it was difficult to comply with treatment if they lived far from the clinic. CONDITION RELATED RESULTS: Only n= 17 (17.5%) respondents reported that they suffered from OIs in the last six months with Diarrhoea being the most common n= 93 (94.9%). Patient related results: Only 7 respondents reported to take alcohol at an average of 1.4 bottles a week. About n=81 (83.5%) of respondents reported difficulty in taking treatment at work. TREATMENT RELATED RESULTS: The majority of respondents n= 43 (44.3%) reported to be on their current regiment for less than a year. Almost 100% of the respondents had correct knowledge of their treatment regimen and prescriptions for OIs and ART therapy. Most of the respondents (90.7%) agreed with the statement, that HIV patient's family should facilitates their intake of medication and this was significantly higher in respondents who have not accepted their diagnosis and the need to be on medication for the rest of their lives. CONCLUSION: Treatment adherence management should take into consideration the factors that may influence adherence