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

Introduction: While the antiretroviral (ARV) coverage has been scaled- up in the last 3 years in South Africa, there is limited data on the operating costs and financial sustainabihty of an anti- retroviral programme. Study Aim: To conduct a cost analysis of the stepdown ARV programme at the Kwadukuza Municipality Clinic (KMC) in the Ilembe district from a healthcare providers' perspective for the period 1st April 2005 to 31st March2006. Study Objectives: To determine the total costs and cost per patient per visit for outpatients attending the ARV, Wellness and VCT clinics respectively at KMC. Study Methods: Study location: This study was conducted at the Kwadukuza Municipality Clinic located in the Ilembe district in Kwazulu- Natal, South Africa. Study population: The population that is included in this study for the purposes of costing comprised: all the patients who received ARVs for the period under study; all the patients who attended the Wellness and VCT clinics and all the staff attached to the ARV programme at the KMC clinic Study design: This is a retrospective and cross- sectional study with both a descriptive and analytical component. Results: Seventy- one percent of the patients on ARVs were female with 50% of the patients being between 31 and 40 years of age. The total operating costs of running the ARV programme was R2 439 940- 90. The total cost accrued to the ARV clinic was R 1 698 003- 60. The Wellness clinic had a total cost of R 460 279- 68 and the VCT clinic accounted for the least total operating cost of R 281 657-77. The cost per patient visit was R440- 13 for the ARV clinic; R133- 05 for the VCT clinic and an amount of R61- 71 for the Wellness clinic. Conclusion This study provides the basis for determining the three cardinal cost components of the ARV programme, namely human resources, the cost of ARVs and the costs of viral load testing for the purposes of future planning and sustainability. The cost- effectiveness of ARV drugs can be improved if the healthcare providers negotiate a lower price for these drugs. The high cost due to monitoring tests can be lowered by decreasing the frequency of these tests but this may allow ARV drug resistance to be undetected. / Thesis (M.Med.)-University of KwaZulu-Natal, Durban, 2008.

HIV/AIDS remains one of the most pressing challenges facing South African society. South Africa has the highest number of people living with HIV as well as the highest number of people on HIV treatment globally, yet only 37% of persons eligible for treatment have access to treatment. The advent of HAART ushered in a new era in the treatment of HIV infection. HIV infection was no longer a life threatening terminal illness, HIV/AIDS became a chronic manageable disease. The full clinical benefit of HAART can only be achieved with near perfect adherence i.e. > 95%. This means taking the medication exactly as prescribed; on time, no missed doses, every day, lifelong. No other chronic medication requires such stringent adherence rates for optimal therapeutic benefit, which may mean the choice between life and death. Achieving near perfect adherence poses a serious challenge to health service providers and persons on treatment as typical adherence rates for medication prescribed over long periods are in the 50 – 75 % range. Persons on HAART live with the additional burden of drug resistance and limited treatment options if near perfect adherence rates are not achieved. The purpose of this qualitative study was to explore the factors that influence adherence to HAART. These factors may be related to the person, the health care team and system, the treatment regimen, the social and economic environment or to the effects of HIV disease. Factors may either negatively or positively influence a person’s ability to adhere optimally to their prescribed treatment. A small sample of thirteen participants were purposefully selected for this study. Data was collected using in-depth interviews which were tape recorded and transcribed for thematic analysis. The value of this study is that it may assist health care providers, persons on treatment and the health care system to better comprehend the challenges of lifelong optimal adherence to HAART. / Thesis (M.A.)-University of KwaZulu-Natal, Durban, 2011.

In the last seven to eight years, Antiretroviral Treatment (ART) has received an increasing amount of attention internationally. It has come to be viewed as an important way of preventing new HIV infections and prolonging HIV-positive peoples' lives. In late 2003 the increased attention, amongst other factors, led the South African government to publish a comprehensive health care plan stating that all citizens in South Africa who need ART should receive it by year 2009. Patients' adherence and their sexual behavior are crucial to the success of ART. This thesis focuses on what factors influence patients' sexual behavior after commencing ART. It will especially look at ART patients' perception of their own infectiousness, as studies have suggested that lower viral loads caused by ART will increase their sexual risk behaviour. The research was conducted on patients attending Ithembalabantu Clinic in KwaZulu-Natal, South Africa. Qualitative and quantitative data were used in the study. The quantitative data involved 271 face-to-face interviews based on a survey. The qualitative data involved conducting 20 semistructured interviews. The results indicated that consistent condom use was high among the sample population (72%), and only two females and seven males having multiple partners (7%). However, due to ART just recently having been introduced in South Africa, the average time spent on ART was 14 months. The findings reveal that a partner's attitude to HIV/AIDS and the levels of communication and openness in a relationship influenced consistent use of condoms. The use of condoms was significantly related to knowledge of partners' status. A high level of sexual assertiveness amongst the females in the sample might have made it easier for them to negotiate condom use. The stage at which members of the sample population entered the relationship was also a predictor of condom use. People who were unemployed and over 35 years in age were less likely to use condoms consistently. The study also examined the respondents' perception of their own infectiousness. The results indicate that respondents and participants felt that it was just as, or even more dangerous, to have sexual intercourse without a condom when they are on ART. Few of the participants in the study understood the concept of viral load. They used the same explanation for both viral load and CD4 count. / Thesis (M.A.)-University of KwaZulu-Natal, 2006.

Approximately 29.1% of South African women of childbearing age tested HIV positive during their first antenatal visit in 2006 (DoH, 2007). This rate of HIV amongst the women of childbearing age reinforces the importance of understanding the management of HIV during pregnancy. During antenatal visits the general health of the woman and her unborn baby is assessed and managed. Management includes antiretroviral therapy to the HIV infected women with a CD4 count below 200 cells/mm3, while women with a CD4 count above 200 cells/mm3 receive a single dose of nevirapine with the onset of labour provided to them by their local clinics. Currently, in Potchefstroom, women receive antenatal care at local primary health-care clinics and antiretroviral drugs at the antiretroviral clinic. There is little or no collaboration between the various clinics and the question arises if the needs of the women are being met. The aim of the research was to promote the health of HIV positive pregnant women by providing insight into the needs of these women and to formulate recommendations for antenatal care. The specific objective is to explore and describe the needs of HIV positive pregnant women regarding antenatal care. An explorative, descriptive, contextual design, following a qualitative approach was used during the research. Semi-structured interviews were used to collect data. Interview questions were compiled from the research problems. Before the commencement of data collection, permission was obtained from the district health manager and Potchefstroom Hospital. A total of sixteen (16) HIV positive women were interviewed after informed consent had been obtained. Data analysis was done after each session and themes were categorised according to the women's needs. From the interviews it was found that each woman has her own specific needs regarding antenatal care. The needs of the participants followed a similar pattern and for this reason it could be divided into various categories. These categories include a need for support, a need for education, a need for improved services and a need for a non-judgemental environment. Conclusions were drawn and recommendations were made for nursing practice, nursing education and nursing research. / Thesis (M.Cur.)--North-West University, Potchefstroom Campus, 2008.

No description available.

There is an increasing number of patients failing second line highly active antiretroviral therapy (AZT, DDI and LPV/r) in South Africa, where HIV-1 subtype C predominates. Mutations at gag cleavage sites (CS) have been found to correlate with resistance mutations in protease (PR). Therefore, it is important to collect data on subtype C protease and gag sequences from patients as these mutations may affect the efficacy of protease inhibitor (PI) containing drug regimens. In this study, 30 subtype-C infected second-line failures were genotyped using the ViroSeqTM resistance genotyping kit and the gag region from these isolates were then characterised. These sequences were then compared to 30 HIV-1 subtype C infected first-line failures (PI-naïve) and subtype B, C and group M naïve sequences that were downloaded from the Los Alamos Sequence Database. Amino acid diversity at the CS was measured using Mega version 4.0. To investigate the effect of CS mutations on replication capacity, a mutation was introduced by site-directed mutagenesis (Stratagene’s QuikChange Site-Directed Mutagenesis kit). Of the 30 second-line failures that we genotyped, only 16 had resistance mutations in PR and 23 in gag. The most frequent major PI mutations were: I54V/L, M46I, V82A, and I84V and in gag CS were V390L/I and A431V. Interestingly the A431V mutation significantly correlated with protease mutations M46I/L, I54V and V82A. The virus carrying the A431V mutation in vitro was found to have a lower replication capacity compared to the wild type. These findings emphasize the need for further investigation of gag mutations and their contribution to the evolution of HIV resistance to PIs. / Thesis (M.Med.Sc.)-University of KwaZulu-Natal, Durban, 2010.

<p>In the era of AIDS, food and nutrition are becoming more of a priority for many households and communities. This is more so now that treatment is available for people infected with HIV and AIDS. Food and nutrition are fundamentally intertwined with HIV transmission and the impacts of AIDS. Evidence of the ways in which food insecurity and malnutrition may interfere with the effectiveness of antiretroviral therapy is well documented. Aim: The purpose of the study was to inform improvements in food security interventions for PLWHA through an investigation of existing food security interventions in the Khomas Region, Namibia.</p>

<p>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.</p>

<p>Background: HIV/AIDS affects the health of millions of people world wide. According to the Joint United Nations Program on HIV/AIDS [UNAIDS], the number of people living with HIV globally has risen from 26 million in 2001 to 33.2 million in 2007. It is estimated that 2.5 million people were newly infected with HIV in 2007. The introduction of anti-retroviral therapy [ART] has brought hope to millions of people living with HIV and AIDS. More recently, the increased availability of treatment in many countries including Namibia has dramatically improved survival rates and lowered the incidence of opportunistic infections among HIV patients. Adherence to antiretroviral therapy (ART) is a fundamental attribute of excellent clinical HIV care and a key aspect in determining the effectiveness of treatment. Strict adherence to ART is vital to maintain low viral load and to prevent the development of drug resistant virus. Poor adherence is one of the key obstacles to successful ART for HIV positive patients. Literature has shown that there are various factors that hinder adherence to ART such as patient, service, community, family, socio-economic and work-related factors. Aim: This study aimed to describe the experiences of patients in the ART programme at Katutura State Hospital, Communicable Disease Clinic (CDC), in the Khomas region of Namibia and to explore factors that contribute to poor adherence.</p>