>Magister Scientiae - MSc / Amperometric sensors for Tenofovir, a model nucleotide/ nucleoside reverse transcriptase inhibitor ARV drug, were studied based on the principle of ion-transfer electrochemistry at the membrane-stabilized oil/ water interface (O||W) in a four-electrode cell set-up. Solutions of the hydrophobic salts tetradodecylammonium tetrakis(4-chlorophenyl) borate (ETH500), ethyl violet tetraphenylborate (EthVTPB), tetrabutylammonium tetraphenylborate (TBATPB), tetraphenylphosphnium tetraphenylborate (TPphTPB) and three ionic liquids (Methyltrioctylammonium bis(trifluoromethyl sulfonyl)imide (IL1), 1-butyl-3- methylimdazolium bis(trifluoromethyl sulfonyl)imide (IL3) and 1-propyl-3- methylimdazolium bis(trifluoromethylsulfonyl)imide (IL4)) in nitrobenzene (NB), 1,2- dichloroethane (DCE), and 2-nitrophenyloctyl ether (NPOE) were each tested as O-phases. The cyclic voltammograms of the resulting O||W interfaces in aq. Li2SO4 or aq. MgSO4 were compared with respect to noise, potential window, and other parameters. The three ILs were also tested as self-sufficient salts without a solvent medium. In the end, the ETH500/ DCE salt/ solvent pair was found to yield the best behaved polarizable O||W interface in aq. MgSO4. The analytical characteristics of the resulting sensors to tenofovir without (Ag|ETH500/DCE||) and with the dibenzo-18-crown-6 (Ag|ETH5000/DB18C6/DCE|| in the O-phase were studied with respect to the two pairs of peaks in the CV, namely the WO ion transfer peak and the reverse OW peak. Both sensors exhibited operational stability of 90 min. After consideration of reasonable S/N ratio and sample throughput rates, the scan rate of 25 mV/ s was used in subsequent signal interrogation with CV. The final potential windows were 0.95 V wide for Ag|ETH500 (10 mM)/ DCE|| in aq. MgSO4 (50 mM) and 0.70 V wide for Ag|ETH500 (10 mM)/ DB18C6 (50 mM)/ DCE|| in aq. MgSO4 (50 mM). From plots of peak currents versus square of scan rate, tenofovir diffusion coefficients of about 2.48 × 10-11 cm2/ s were estimated, which indicated diffusion through the supporting membrane as the rate limiting process. Based on WO ion transfer peaks, the first one exhibited a detection limit of about 5 M, a linear range of 15 – 100 M, and sensitivity of 7.09 nA M-1 towards tenofovir, whereas for the second one these were respectively 3 M, 6.32 nA M-1, and 9 – 100 M. In this way, a four-electrode amperometric detection of ion transfer process at liquid | liquid interface, both under simple and ionophore-facilitated mode, has been demonstrated as promising for analysis of tenofovir as a representative of the nucleotide/ nucleoside reverse transcriptase inhibitor ARV drugs

A identificação de ateroma de carótida em radiografia panorâmica de pacientes com alterações sistêmicas que predispõem a aterosclerose é mais frequente do que em amostras da população em geral. O uso da terapia antirretroviral combinada (TARVc), que prolongou a sobrevida dos pacientes portadores do HIV (HIV+), também contribuiu para o aumento da incidência de alterações metabólicas e provavelmente de complicações cardiovasculares. Este estudo teve o objetivo de investigar a prevalência de imagens suspeitas de ateromas de carótida (ISAC) em radiografias panorâmicas de pacientes HIV+ em tratamento no Centro de Atendimento de Pacientes Especiais (CAPE) da Faculdade de Odontologia da Universidade de São Paulo, bem como tentar identificar variáveis associadas à ocorrência destas imagens. Foram avaliadas 300 radiografias de pacientes de ambos os gêneros e com média de idade de 40 anos (18-73 anos). A prevalência de radiografias com ISAC foi de 8,2% (25/300). Estes pacientes apresentaram a média de idade significativamente maior do que a dos pacientes sem ISAC (p= 0,008) e a mediana do nadir de CD4 significativamente menor (p=0,019). O uso do medicamento lopinavir/r (LPV/r) estava associado a chance 2,8 vezes maior para presença de ISAC (OD=2,79 1,12-6,95 IC=95%, p=0,045). Conclui-se que quanto maior a idade maior a probabilidade de ocorrência de ISAC e que as variáveis significativas encontradas (nadir de CD4 e LPV/r) são compatíveis com os fatores de risco cardiovascular observados em pacientes portadores do HIV, relacionados tanto à gravidade da infecção como ao uso de medicamentos. / The identification of calcified carotid artery atheroma (CCAA) in panoramic radiography of patients with systemic diseases that predispose the atherosclerosis is more frequent than in the general population samples. The use of high active antiretroviral therapy (HAART), which prolonged the life of patients with HIV (HIV+), also increase the incidence of cardiovascular complications, probably by the use of protease inhibitors (PI). This study aimed to investigate the prevalence of suspected images of CCAA in panoramic radiographs of HIV+ patients in treatment in the Special Care Dentistry Center of the University of São Paulo, São Paulo, Brazil, as well as trying to identify variables associated with these images. Three hundred radiographs of patients of both genders, with a mean age of 40 years (18-73 years) were evaluated. The prevalence of CCAA suspected images was 8.2% (25/300). This patients showed the mean age significantly higher than that of the patients without CCAA images (p = 0.008) and the CD4 nadir median significantly lower (p = 0.019). The use of HAART with lopinavir/r (LPV/r) was associated with a greater chance for CCAA images (OD 2.79, CI 95% 1.12-6.95; p = 0.045). In conclusion, patients with higher age are more susceptible to CCAA suspected image and the significant variables found (CD4 nadir and LPV/r) are compatible with the cardiovascular risk factors in patients HIV+, related both to the severity of the infection and the use of antiretroviral.

A identificação de ateroma de carótida em radiografia panorâmica de pacientes com alterações sistêmicas que predispõem a aterosclerose é mais frequente do que em amostras da população em geral. O uso da terapia antirretroviral combinada (TARVc), que prolongou a sobrevida dos pacientes portadores do HIV (HIV+), também contribuiu para o aumento da incidência de alterações metabólicas e provavelmente de complicações cardiovasculares. Este estudo teve o objetivo de investigar a prevalência de imagens suspeitas de ateromas de carótida (ISAC) em radiografias panorâmicas de pacientes HIV+ em tratamento no Centro de Atendimento de Pacientes Especiais (CAPE) da Faculdade de Odontologia da Universidade de São Paulo, bem como tentar identificar variáveis associadas à ocorrência destas imagens. Foram avaliadas 300 radiografias de pacientes de ambos os gêneros e com média de idade de 40 anos (18-73 anos). A prevalência de radiografias com ISAC foi de 8,2% (25/300). Estes pacientes apresentaram a média de idade significativamente maior do que a dos pacientes sem ISAC (p= 0,008) e a mediana do nadir de CD4 significativamente menor (p=0,019). O uso do medicamento lopinavir/r (LPV/r) estava associado a chance 2,8 vezes maior para presença de ISAC (OD=2,79 1,12-6,95 IC=95%, p=0,045). Conclui-se que quanto maior a idade maior a probabilidade de ocorrência de ISAC e que as variáveis significativas encontradas (nadir de CD4 e LPV/r) são compatíveis com os fatores de risco cardiovascular observados em pacientes portadores do HIV, relacionados tanto à gravidade da infecção como ao uso de medicamentos. / The identification of calcified carotid artery atheroma (CCAA) in panoramic radiography of patients with systemic diseases that predispose the atherosclerosis is more frequent than in the general population samples. The use of high active antiretroviral therapy (HAART), which prolonged the life of patients with HIV (HIV+), also increase the incidence of cardiovascular complications, probably by the use of protease inhibitors (PI). This study aimed to investigate the prevalence of suspected images of CCAA in panoramic radiographs of HIV+ patients in treatment in the Special Care Dentistry Center of the University of São Paulo, São Paulo, Brazil, as well as trying to identify variables associated with these images. Three hundred radiographs of patients of both genders, with a mean age of 40 years (18-73 years) were evaluated. The prevalence of CCAA suspected images was 8.2% (25/300). This patients showed the mean age significantly higher than that of the patients without CCAA images (p = 0.008) and the CD4 nadir median significantly lower (p = 0.019). The use of HAART with lopinavir/r (LPV/r) was associated with a greater chance for CCAA images (OD 2.79, CI 95% 1.12-6.95; p = 0.045). In conclusion, patients with higher age are more susceptible to CCAA suspected image and the significant variables found (CD4 nadir and LPV/r) are compatible with the cardiovascular risk factors in patients HIV+, related both to the severity of the infection and the use of antiretroviral.

Magister Public Health - MPH / Background Nigeria accounted for 2.95 million of the 22 million people globally living with HIV in 2008. In 2010, the HIV prevalence increased to 3.1 million, with 1.5 million people requiring anti-retroviral treatment (ART). ART is effective if patients adhere to treatment (taking 95% or more of drugs as prescribed) over a sustained period. Taking less than 95% of the medication can lead to drug resistance and treatment failure, which have dire individual and public health consequences. This study described adherence to ART and the factors that constrain and motivate adherence among patients on ART at the University of Abuja Teaching Hospital in the Federal Capital Territory (FCT), Nigeria. Methodology An observational, descriptive and analytical, cross-sectional survey of adherence among 502 adult ART patients (254 women and 248 men) from the University of Abuja Teaching Hospital was conducted. I collected sociodemographic and clinical characteristics of participants, and barriers and facilitators to adherence. For the prescription refill data, I utilized the updated pharmacy refill records from the ART dispensary. Bivariate and multivariate analysis was performed to analyse the factors that influence adherence to ART. Results Participants in this study had been on therapy for a mean of 43±27 months. Total optimal self-reported adherence over the previous three days (not missing a dose, taking correct doses in the correct frequency and correct schedule) was 53.6%, compared with 62.5% adherence calculated by prescription refill. However, most (80.3%) participants achieved virologic suppression at a level of <400 copies/μl3. Reported barriers to adherence were: forgot (43%); travelled away from home (21%); ran out of medication (16%); busy at work (13%); lack of food (5%) and medication snatched by armed robbers (2%). Self-reported adherence over the previous three days was positively associated with age and viral load. Younger respondents (under 30 years) were 3 times more likely to adhere to their regimen compared with those older than 30 years (OR = 2.5; 95% CI = 1.26-4.61; p =

"Although the number of new infections has dramatically decreased during the last ten years, portraying this country [Uganda] as the 'AIDS miracle', the number of people already infected and progressing to AIDS is increasing. Acces to anti-retroviral (ARV) drugs, as well as to medicines for treatment of opportunistic infections (TOI), is essential for people living with HIV/AIDS (PLWHA) to enjoy their right to life and health. Although access to these essentail medicines forms part of the core content of the right to health, which states should be able to provide irrespective of their available resources, slightly more than half of the people in need in Uganda were accessing them in June 2005. Of 63,896 PLWHA accessing ARVs, still 83.5 percent are paying the medicines out of their pockets. This is despite the fact that Uganda receives funds from various sources, among which Global Fund to Fight AIDS, Tuberculosis and Malaria (GF) and the US President's Emergency Plan for AIDS Relief (PEPFAR). Although the cost of ARV treatment in Uganda has dramatically decreased since 1997, the price of treatment remains still unaffordable for most Ugandans. ... This study comprises five chapters. The present chapter exposes the problem, the objectives of the study and the research questions, reviews the literature available on the subject, outlines the study's structure, proposes a methodology and points out the study's limitations and relevance. Chapter two sets out the international legal framework of the study. It oulines the scope of the right of PLWHA to access to essential treatment under different international instruments of relevance for Uganda and its connection with other human rights. The chapter also assesses the implications of this right for state and non-state actors. Chapter three sets out the national legal, policy and judicial framework. It explores the action taken by the various branches of the government in addressing the international obligations with regard to access essential treatment. This chapter will also look at the role played by other relevant stakeholders in the realisation of this right in Uganda. Chapter four analyses the various obstacles that impede the realisation of this right at national level, taking into account the globalisation process, the political situation of Uganda, as well as other socio-economic factors. Chapter five provides the final conclusions and recommends legal, judicial and administrative channels towards the realisation of the right to access essential treatment for OLWHA in Uganda." -- Introduction. / Thesis (LLM (Human Rights and Democratisation in Africa)) -- University of Pretoria, 2005. / [Prepared under the supervision of] Dr. Ben Kiromba Twinomugisha, Makerere University / http://www.chr.up.ac.za/academic_pro/llm1/dissertations.html / Centre for Human Rights / LLM

Few studies have assessed the optimum second line highly active anti-retroviral therapy (HAART) regimen in patients who had failed on the first-line HAART in resource-limited settings. This study aimed to compare the Protease inhibitor (PI)-based second line HAART regimens used in one clinic in Trinidad by comparing immunological, virological and clinical outcomes of patients on the different second line HAART regimens. The records of 35 treatment-experienced patients, over 21years of age and on PI-based regimens for at least six months, were analysed using SPSS version 20. The regimen containing TDF/FTC/AZT/LPV/r proved to produce superior outcomes compared to the other second line regimens. Due the small number of usable patients’ records, the findings cannot be generalised but indicate directions for future studies attempting to compare the treatment outcomes of different second line HAART regimens / Health Studies / M. A. (Public Health)

"Zimbabwe and South Africa are facing an HIV/AIDS epidemic of such proportions that the populations of these countries will markedly decline in the next ten years despite the existence of effective drugs to treat the symptoms of AIDS and dramatically lower the communicability of the virus. These drugs are under patent protection by companies in the developed world and the patents raise the prices above the level of affordability for HIV infected persons in South Africa and Zimbabwe. Zimbabwe has declared a national emergency on HIV/AIDS, apparently in conformance with TRIPS and has issued compulsory licenses to a local company that has started to manufacture and sell cheap anti-retroviral drugs. South Africa has not declared a national emergency and has not invoked the TRIPS flexibilities or utilized flexibilities inherent in its own legislation. However, while thousands of people die every week in the two countries, neither government has yet provided an effective HIV/AIDS policy. Extensive litigation and public pressure in South Africa has led the government to announce a policy of supplying free HIV drugs in public hospitals while the Zimbabwean government has announced the provision of the same drugs, also in public hospitals, apparently utilising the state of emergency. The TRIPS agreement under which the two governments undertook to protect international patents allows compulsory licensing under certain circumstances (not limited to a national emergency) and the Doha Declaration on TRIPS and Public Health, and subsequent agreements by the Ministerial Council of the WTO allow the manufacture and, in limited circumstances, the parallel importation of generic drugs. These provisions provide a theoretical mechanism for poor countries to ensure their citizens' rights of access to health (care). The research is aimed at identifying the extent of the effectiveness of the legal norms created by Articles 20 and 31 of TRIPS, the Doha Declaration and subsequent Council of Ministers' decisions, which together ostensibly provide a framework to allow provision of generic drugs. It is further aimed at investigating how the state of emergency in Zimbabwe has been utilised to provide cheap generic drugs to Zimbabweans and whether this would be an option for South Africa. A comparison of the legal provisions governing the provision of drugs in the two countries will also be undertaken to examine the extent to which international and national constitutional and legal provisions may be utilised to give effect to the right to health." -- Introduction. / Thesis (LLM (Human Rights and Democratisation in Africa)) -- University of Pretoria, 2004. / Prepared under the supervision of Dr. Enid Hill at the American University in Cairo. / http://www.chr.up.ac.za/academic_pro/llm1/dissertations.html / Centre for Human Rights / LLM

Few studies have assessed the optimum second line highly active anti-retroviral therapy (HAART) regimen in patients who had failed on the first-line HAART in resource-limited settings. This study aimed to compare the Protease inhibitor (PI)-based second line HAART regimens used in one clinic in Trinidad by comparing immunological, virological and clinical outcomes of patients on the different second line HAART regimens. The records of 35 treatment-experienced patients, over 21years of age and on PI-based regimens for at least six months, were analysed using SPSS version 20. The regimen containing TDF/FTC/AZT/LPV/r proved to produce superior outcomes compared to the other second line regimens. Due the small number of usable patients’ records, the findings cannot be generalised but indicate directions for future studies attempting to compare the treatment outcomes of different second line HAART regimens / Health Studies / M. A. (Public Health)

This study attempted to identify personal (patient-related) factors influencing anti-retroviral therapy (ART) adherence in Addis Ababa, Ethiopia. A quantitative, descriptive, cross-sectional and analytical design was used. Structured interviews were conducted with 355 ART patients. The findings revealed that stigma, discrimination, depression and alcohol use negatively affected patients’ ART adherence levels. However, patients’ knowledge levels had no influence on their ART adherence levels, contrary to other researchers’ reports. Addressing stigma and discrimination at community levels might enhance patients’ abilities to take their medications in the presence of others. Healthcare professionals should be enabled to diagnose and treat depression among ART patients during the early stages. Non-adherent ART patients should be counseled about possible alcohol abuse. / Health Studies / M.A. (Public Health with specialisation in Medical Informatics)

This study attempted to identify personal (patient-related) factors influencing anti-retroviral therapy (ART) adherence in Addis Ababa, Ethiopia. A quantitative, descriptive, cross-sectional and analytical design was used. Structured interviews were conducted with 355 ART patients. The findings revealed that stigma, discrimination, depression and alcohol use negatively affected patients’ ART adherence levels. However, patients’ knowledge levels had no influence on their ART adherence levels, contrary to other researchers’ reports. Addressing stigma and discrimination at community levels might enhance patients’ abilities to take their medications in the presence of others. Healthcare professionals should be enabled to diagnose and treat depression among ART patients during the early stages. Non-adherent ART patients should be counseled about possible alcohol abuse. / Health Studies / M.A. (Public Health with specialisation in Medical Informatics)