Thesis (M.A.(Community-Based Counselling Psychology))--University of the Witwatersrand, Faculty of Humanities, 2013. / The amount of research that examines adherence to antiretroviral treatment is now immeasurable. However, research on understanding the subjective experiences of men who have sex with men (MSM) and living with HIV while taking antiretroviral therapy remains limited. This research uses a qualitative methodology, using semi-structured interviews, carried out on nine participants who frequently use a Johannesburg support group aimed at MSM living with HIV. The time period of these men living with HIV and taking antiretroviral therapy varied from a number of months to many years. The interviews were audio-recorded and transcribed. In terms of analysis, thematic content analysis was used identified the enablers and barriers to treatment adherence. These were broken into biopsychosocial factors with the main outcomes of this research suggesting that adherence is complex and influences are far beyond just biological. The majority of the elements raised by the participants indicate the significance of psychological and social factors. This makes the development of adherence interventions aimed at MSMs more detailed than simply following medical provider directions. There appeared to be consensus that although some participants of this research would prefer to not take antiretroviral therapy because of the side-effects, the alternative for them was something that they wanted to consider, such as illness and death. The belief that the medication is keeping them healthy, improving quality of life and allowing them to focus on day-to-day living seemed to dominate over the psychological effects of the condition or the medication in terms of adherence. Because of the way that HIV is perceived within society, the threat of discrimination is real and for many of the participants shape the way they see themselves, the world and this in turn guides their thinking when it comes to issues, especially with disclosure. Above all, this research explores the antiretroviral adherence factors specifically associated to MSM.

Thesis (MPH)-- University of Limpopo, 2011 / Background The increased access to HAART and increased survival of perinatally HIV-infected children have given rise to challenges that parents and caregivers face of disclosure of HIV serostatus to their infected children. Given the increased number of children on ART in the country health care providers and caregivers are now faced with the challenge of a population of children who have not been disclosed. The issue of disclosure should be viewed as a great public health concern. Aim and objectives The aim of the study was to determine the socio-demographics of caregivers and children and determine caregivers’ reasons for disclosure and non-disclosure of HIV diagnosis to children on antiretroviral therapy. Methodology: A quantitative descriptive study using researcher administered questionnaires was conducted with a sample of 149 disclosed and non-disclosed caregivers of children aged 4-17 enrolled in an antiretroviral treatment programme of a district hospital. Data were cleaned, coded and captured on Microsoft Excel and analysed in STATA version 10. Results Of 149 caregivers, 97.99% were females, and 2.01% were males, age ranged from 19-81 years with a mean age of 42 years, 25% attained primary education, 51% the grade not completed, 21% completed grade 12, and 3% had a tertiary education, 55.7% were unemployed, 27.3% fully employed, 14% were pensioners, 3% were schooling. Of the 149 children, 58% were girls, 42% boys, aged range of 4-17 years, mean age of 8.3 years, mean diagnosis age was 6 years, mean time on ARVs was 3.1years, and mean disclose age was 9.3 years. Majority (52.3%) children were cared for by mothers, (28.2%) by grandparents, and of the rest (17.4%) by other relatives, only 2% by their fathers. About 38% single orphans having lost their biological mothers, 35% were double orphans. About 39.6% of children were disclosed to and 60.4% not disclosed to. For those children to whom disclosure had been made 52.5% were disclosed to between ages 6-10, 35.6% between ages 11-15, 10.2% between ages 1-5. Reasons for disclosure were varied, and most cited were adhere to medication (36.5%), consistent questioning about disease and medications (36.5%), fear of accidental disclosure (9.5%), prompted by health professionals (7.9%), and child reaching puberty (3.2%). Reasons for non disclosure were also varied, most cited were child was too young to understand the disease, child will tell others, fear of stigma and discrimination, and did not have the skills to disclose Conclusions Prevalence of disclosure was much higher (39.5%) than other findings and there was greater involvement of health care providers in disclosing HIV to children. The study found a low disclosure rate among biological mothers who were in majority in the sample. Adherence to medication and persistent questioning about the disease and medication were the most cited reasons for disclosing HIV to children. Majority of caregivers delayed disclosure fearing that children will tell others because they are still too young to understand the implications of the diagnosis. Fear of stigma and discrimination also influenced disclosure. Caregivers delayed disclosure because they did not have the skills to disclose and explain HIV to children. Recommendations We recommend that disclosure guidelines be developed and healthcare providers trained in disclosure counselling to better advice caregivers on how to disclose to, thus making HIV disclosure to children an integral part of the comprehensive care of children on ART. Strengthening of life skills education programs at school to take into account the situation of children living with HIV Key words: Disclosure, non-disclosure, caregiver, children, ART, South Africa

<p>Namibia is severely affected by the HIV/AIDS epidemic, with an estimated HIV prevalence of 17.8%. A comprehensive, public HIV/AIDS treatment and care programme was established in 2003 by the government of Namibia in association with its development partners. The introduction of antiretroviral therapy [ART] has dramatically decreased HIVrelated mortality and morbidity, improved quality of life, revitalized communities and transformed perceptions of HIV/AIDS from a plaque and death sentence to a manageable chronic condition. Intermediate Hospital Oshakati (IHO) in the Oshana region, is one of the six pilot hospitals where highly antiretroviral therapy (HAART) was initiated. Adherence to antiretroviral therapy (ART) is a key factor in ensuring optimal clinical outcomes and is associated with improved survival among HIV and AIDS patients. Sustained high levels of adherence (taking 95% or more of medication as prescribed) are essential for treatment success. Suboptimal adherence to treatment has been associated with virologic, immunologic and clinical failure, and may increase the risk of resistance to first-line ART drugs. Studies conducted in various parts of the country including the Oshakati district, report small proportions of patients defaulting on ART. Defaulting from treatment raises questions about adherence to ART as it can be assumed that poor adherence would precede defaulting from treatment. This study explored factors that influence poor adherence to ART among patients at Intermediate Hospital Oshakati.</p>

<p>The highly active antiretroviral therapy (HAART) drug agent, indinavir, and the endocrine disruptor compound, 2,4-dichlorophenol (2,4-DCP), are directly related to two of South Africa&rsquo / s, and in fact, two of the globe&rsquo / s most fundamentally important and comprehensively researched subjects areas, which includes, HIV/AIDS and water pollution. In fact&nbsp / these two compounds share multiple significant commonality factors. Firstly, they have a profound effect on the health aspects of humans, albeit from opposite sides of the&nbsp / &lsquo / equation&rsquo / . Secondly, in the context of metabolism, they both share the same rout of biotransformation, and as such, both have a profound effect on the main first pass&nbsp / metabolising hepatic enzyme, CYP450 3A4, as well as xenobiotics sharing the same metabolic athway. Thirdly and perhaps more importantly, in direct relation to the human mortality, their levels preferentially require constant or regular monitoring, a process, at this stage, is still only officially possible with complex specialized analytically-based techniques. Moreover, these techniques are only based on centralized detection and quantification, which essentially means expensive procedures, and long waiting periods for results. This thesis firstly reports on the development and characterization of reagent-less and cobalt(III) sepulchrate [Co(Sep)3+] mediated biosensor platforms (biosensor platform 1 and biosensor platform 2), with human recombinant heme thiolate, cytochrome P450 3A4 isoenzyme (CYP3A4), as biorecognition component. Secondly, each biosensor platform was evaluated by using an entirely different category of compound as model substrate, with the overall objective being the development of alternative analytical method for the detection and quantification of each of these substrates, by amperometric transduction method. In this regard biosensor platform 1 was evaluated for the detection of 2,4-dichlorophenol, whereas biosensor platform 2 was evaluated for the detection of protease inhibitor (PI) HAART drug, indinavir. Fourthly, this dissertation also reports on the use of genetic engineering as complimentary method during biosensor investigations, as source for continuous supply of catalytically active biological recognition component. With respect to the preparation of the biosensors in particular, biosensor platform 1 was constructed by entrapping the commercially sourced full-length, wild type CYP3A4 on a pre-formed electroactive carrier matrix, consisting of Co(Sep)3+&ndash / modified nafion membrane on a glassy carbon electrode. In this regard, the nafion-Co(Sep)3+ composite was prepared by integrating the Co(Sep)3+ species into a pre-formed nafion film through manual drop-coating and mixing methods.&nbsp / In addition to this, the so-formed biosensor was re-inforced by a thin nafion layer as outer-film. The complete biosensor may be denoted as GCE||naf|CMECo( Sep)3+|flCYP3A4|naf. Biosensor platform 2 on the&nbsp / other hand, was constructed by entrapment of the N-terminally modified human recombinant CYP3A4 (consisting only of the heme domain and the surrounding apoprotein), prepared locally through genetic engineering, as a histidine-tagged, catalytically active soluble construct, denoted nCYP3A4, in a biocompatible ionically crosslinked hydrogel-composite membrane. Enzyme immbilization in this case was also realized on a pre-formed nafion-Co(Sep)3+ carrier matrix film, however, in this case the electroactive carrier&nbsp / matrix was prepared by integrating the electroactive Co(Sep)3+ species deep within the nafion microstructure through potentiostatic electrodeposition method at a costant&nbsp / potential of +450 mV for 1200 sec. The so prepared biosensor, is denoted GCE||naf|El- Co(Sep)3+|nCYP3A4|Agrs-PEI-PVA. In this regard, biosensor for platform 2, different variables affecting the performance and stability of the biosensor were evaluated. Selected ex-situ characaterization methods, including scanning electrochemical microscopy (SEM), Fourier Transform Infrared (FTIR) and UVVis spectroscopy was used as complimentary characterization methods , morphological and structural charaterization, revealed&nbsp / the formation of a highly stable electroactive composite film for the carrier matrix in biosensor platform 2 , exhibiting a compact nature and a smooth consistancy in which the&nbsp / electroactive Co(Sep)3+ mediating species was embedded deep within the microstructure of the pre-formed nafion film. Moreover, the method of preparation was highly reproducible, while voltammetric studies also corroborated the stability of the carrier matrix film. Overall, the design path used for this method was shown to be an improvement&nbsp / as compared to the design path used for biosensor platform 1, particularly with regard to the carrier matrix. Nevertheless, the proposed substrates were successfully detected&nbsp / and quantified by the individual biosensor plaforms. In this regard, the dynamic linear range of the GCE||naf|CMECo( Sep)3+|flCYP3A4|naf biosensor, for 2,4-DCP exhibited an&nbsp / upper limit of 45&nbsp / A, with the sensitivity determined as 0.038 A M-1. In addition to this, the LOD was calculated as 0.043 g L-1, which was lesser than the USA Environmental Protection Agency&rsquo / s (EPA) drinking water equivalent level (DWEL) for 2.4-DCP. In the case of the GCE||naf|El-Co(Sep)3+|nCYP3A4|Agrs-PEI-PVA biosensor, the linear&nbsp / concentration range for indinavir was shown to be between 2.183 M 3.552 M, while the sensitivity was determined as 0.035 A M-1. Morover, the LOD value, determined as 59.72 mg L-1 was suggested to be of signifiance with regard to the maximum plasma concentration, CMax, with respect to the ritonavir-boosted regimen, which is the proposed method of administering indinavir. This can also be of value for HIV/AIDS patients who are poor metabolizers, as they will have significantly elevated concentration of the drug,&nbsp / when administered with ritonavir as booster. Above and beoynd these results, the overpotential for the reduction of dioxygen, which is a crucial step in the catalytic cycle of the&nbsp / CYP3A4 enzyme, was significantly reduced by the GCE||naf|El-Co(Sep)3+|nCYP3A4|Agrs-PEI-PVA biosesnor, as compared to the other biosensor.</p>

<p>The highly active antiretroviral therapy (HAART) drug agent, indinavir, and the endocrine disruptor compound, 2,4-dichlorophenol (2,4-DCP), are directly related to two of South Africa&rsquo / s, and in fact, two of the globe&rsquo / s most fundamentally important and comprehensively researched subjects areas, which includes, HIV/AIDS and water pollution. In fact&nbsp / these two compounds share multiple significant commonality factors. Firstly, they have a profound effect on the health aspects of humans, albeit from opposite sides of the&nbsp / &lsquo / equation&rsquo / . Secondly, in the context of metabolism, they both share the same rout of biotransformation, and as such, both have a profound effect on the main first pass&nbsp / metabolising hepatic enzyme, CYP450 3A4, as well as xenobiotics sharing the same metabolic athway. Thirdly and perhaps more importantly, in direct relation to the human mortality, their levels preferentially require constant or regular monitoring, a process, at this stage, is still only officially possible with complex specialized analytically-based techniques. Moreover, these techniques are only based on centralized detection and quantification, which essentially means expensive procedures, and long waiting periods for results. This thesis firstly reports on the development and characterization of reagent-less and cobalt(III) sepulchrate [Co(Sep)3+] mediated biosensor platforms (biosensor platform 1 and biosensor platform 2), with human recombinant heme thiolate, cytochrome P450 3A4 isoenzyme (CYP3A4), as biorecognition component. Secondly, each biosensor platform was evaluated by using an entirely different category of compound as model substrate, with the overall objective being the development of alternative analytical method for the detection and quantification of each of these substrates, by amperometric transduction method. In this regard biosensor platform 1 was evaluated for the detection of 2,4-dichlorophenol, whereas biosensor platform 2 was evaluated for the detection of protease inhibitor (PI) HAART drug, indinavir. Fourthly, this dissertation also reports on the use of genetic engineering as complimentary method during biosensor investigations, as source for continuous supply of catalytically active biological recognition component. With respect to the preparation of the biosensors in particular, biosensor platform 1 was constructed by entrapping the commercially sourced full-length, wild type CYP3A4 on a pre-formed electroactive carrier matrix, consisting of Co(Sep)3+&ndash / modified nafion membrane on a glassy carbon electrode. In this regard, the nafion-Co(Sep)3+ composite was prepared by integrating the Co(Sep)3+ species into a pre-formed nafion film through manual drop-coating and mixing methods.&nbsp / In addition to this, the so-formed biosensor was re-inforced by a thin nafion layer as outer-film. The complete biosensor may be denoted as GCE||naf|CMECo( Sep)3+|flCYP3A4|naf. Biosensor platform 2 on the&nbsp / other hand, was constructed by entrapment of the N-terminally modified human recombinant CYP3A4 (consisting only of the heme domain and the surrounding apoprotein), prepared locally through genetic engineering, as a histidine-tagged, catalytically active soluble construct, denoted nCYP3A4, in a biocompatible ionically crosslinked hydrogel-composite membrane. Enzyme immbilization in this case was also realized on a pre-formed nafion-Co(Sep)3+ carrier matrix film, however, in this case the electroactive carrier&nbsp / matrix was prepared by integrating the electroactive Co(Sep)3+ species deep within the nafion microstructure through potentiostatic electrodeposition method at a costant&nbsp / potential of +450 mV for 1200 sec. The so prepared biosensor, is denoted GCE||naf|El- Co(Sep)3+|nCYP3A4|Agrs-PEI-PVA. In this regard, biosensor for platform 2, different variables affecting the performance and stability of the biosensor were evaluated. Selected ex-situ characaterization methods, including scanning electrochemical microscopy (SEM), Fourier Transform Infrared (FTIR) and UVVis spectroscopy was used as complimentary characterization methods , morphological and structural charaterization, revealed&nbsp / the formation of a highly stable electroactive composite film for the carrier matrix in biosensor platform 2 , exhibiting a compact nature and a smooth consistancy in which the&nbsp / electroactive Co(Sep)3+ mediating species was embedded deep within the microstructure of the pre-formed nafion film. Moreover, the method of preparation was highly reproducible, while voltammetric studies also corroborated the stability of the carrier matrix film. Overall, the design path used for this method was shown to be an improvement&nbsp / as compared to the design path used for biosensor platform 1, particularly with regard to the carrier matrix. Nevertheless, the proposed substrates were successfully detected&nbsp / and quantified by the individual biosensor plaforms. In this regard, the dynamic linear range of the GCE||naf|CMECo( Sep)3+|flCYP3A4|naf biosensor, for 2,4-DCP exhibited an&nbsp / upper limit of 45&nbsp / A, with the sensitivity determined as 0.038 A M-1. In addition to this, the LOD was calculated as 0.043 g L-1, which was lesser than the USA Environmental Protection Agency&rsquo / s (EPA) drinking water equivalent level (DWEL) for 2.4-DCP. In the case of the GCE||naf|El-Co(Sep)3+|nCYP3A4|Agrs-PEI-PVA biosensor, the linear&nbsp / concentration range for indinavir was shown to be between 2.183 M 3.552 M, while the sensitivity was determined as 0.035 A M-1. Morover, the LOD value, determined as 59.72 mg L-1 was suggested to be of signifiance with regard to the maximum plasma concentration, CMax, with respect to the ritonavir-boosted regimen, which is the proposed method of administering indinavir. This can also be of value for HIV/AIDS patients who are poor metabolizers, as they will have significantly elevated concentration of the drug,&nbsp / when administered with ritonavir as booster. Above and beoynd these results, the overpotential for the reduction of dioxygen, which is a crucial step in the catalytic cycle of the&nbsp / CYP3A4 enzyme, was significantly reduced by the GCE||naf|El-Co(Sep)3+|nCYP3A4|Agrs-PEI-PVA biosesnor, as compared to the other biosensor.</p>

<p>Namibia is severely affected by the HIV/AIDS epidemic, with an estimated HIV prevalence of 17.8%. A comprehensive, public HIV/AIDS treatment and care programme was established in 2003 by the government of Namibia in association with its development partners. The introduction of antiretroviral therapy [ART] has dramatically decreased HIVrelated mortality and morbidity, improved quality of life, revitalized communities and transformed perceptions of HIV/AIDS from a plaque and death sentence to a manageable chronic condition. Intermediate Hospital Oshakati (IHO) in the Oshana region, is one of the six pilot hospitals where highly antiretroviral therapy (HAART) was initiated. Adherence to antiretroviral therapy (ART) is a key factor in ensuring optimal clinical outcomes and is associated with improved survival among HIV and AIDS patients. Sustained high levels of adherence (taking 95% or more of medication as prescribed) are essential for treatment success. Suboptimal adherence to treatment has been associated with virologic, immunologic and clinical failure, and may increase the risk of resistance to first-line ART drugs. Studies conducted in various parts of the country including the Oshakati district, report small proportions of patients defaulting on ART. Defaulting from treatment raises questions about adherence to ART as it can be assumed that poor adherence would precede defaulting from treatment. This study explored factors that influence poor adherence to ART among patients at Intermediate Hospital Oshakati.</p>

No description available.

Background: The HIV/AIDS epidemic is continuing to impact negatively on the health of populations globally. The region most affected by this epidemic is sub-Saharan Africa, with two-thirds of people living with HIV/AIDS located in this region. In order to combat this epidemic, countries are putting up efforts to scale-up the provision of antiretrovirals to affected individuals. South Africa faces challenges similar to other sub-Saharan countries in the scaling-up of antiretrovirals, such as cost of drugs, inadequate laboratory infrastructure and the low and declining number of health professionals. Therefore, the contribution of private general practitioners as part of the overall strategy to combat the HIV/AIDS epidemic needs to be considered. However, the performance of antiretroviral programmes in the private sector are unknown and there is therefore a need to explore patient outcomes in antiretroviral programmes being run by general practitioners in the private sector. The findings of this study will add to understanding what the outcomes of ARV programmes by GPs in private practice could be in a public-private partnership. Aims: The main aim of the study was to evaluate patient outcomes in an antiretroviral programme in the setting of a solo private general practitioner. Methods: This was a cross-sectional study using retrospective data from March 2005 to February 2008. A total of 170 patient records from a private general practitioner’s rooms were examined. The data were analysed using the using the median, interquartile and proportions. The Chi square was used to test for association between baseline characteristics and patient outcomes in the univariate analysis. Results: The increase in median CD4 count was 242 cells/μl and 265 cells/μl at 6 months and 12 months respectively. The proportion of patients who achieved viral suppression at 6 months and 12 months was 75% and 73% respectively. Rate of loss to follow-up was 29% and 38% at 6 months and 12 months respectively, which was much higher than in other settings. Although there were no statistically significant associations established by the study, the patterns emerging from the study showed that the baseline characteristics that were a risk for poor virological outcomes during the period of the study were female gender, younger age group, higher WHO clinical staging, lower CD4 count and higher viral load. Baseline characteristics that were a risk for loss to follow-up during the period of the study were male gender, younger age group, higher WHO clinical staging, lower CD4 count and higher viral load. Conclusion: Patient outcomes in an antiretroviral programme in the setting of a solo private general practitioner are comparable with patient outcomes in antiretroviral programmes in public sector settings in terms of immunological and virological outcomes. However, the lost to follow-up rate was much higher than in public sector settings.

A research report submitted in submissible format to the Faculty of Health Sciences, University of Witwatersrand, Johannesburg, in partial fulfillment of the requirements for the degree of MSc in Child Health (Community Paediatrics) 20 June 2017 / Background: HIV antiretroviral therapy (ART) is associated with breast abnormalities in adults, especially efavirenz (EFV). Little is known about the prevalence of these adverse effects among adolescents receiving ART. Methods: A retrospective record review describing breast conditions in adolescents receiving ART at three facilities in Johannesburg, South Africa was conducted. Patients aged 10-19 years who presented from 1 January to 31 December 2014 were included. Analyses were conducted to determine whether EFV use was associated with an increase in breast conditions. Results: A total of 631 patient records were reviewed, 37 (6%) had an abnormal breast event documented of whom 24/37 (65%) were male. Patients with abnormal breast conditions developed them 1.5 years later than patients with normal breast development (p<0.0005). Forty-one abnormal breast events were observed in thirty-seven patients with twenty being described as gynaecomastia or lipomastia (49%). 44% had concurrent generalised lipodystrophy (n=19). Of those with an abnormal breast event, 71% of patients had CD4 counts >500 cells/μl and were virologically suppressed (n=29). Those on EFV had a significantly higher prevalence of breast abnormalities compared to other regimens (p=0.016) and all had been exposed to EFV before. No other ART drug was associated with breast abnormalities in this cohort. Sixteen patients had substitution of EFV and three breast events resolved once substituted from EFV. Breast abnormalities in adolescents on ART Conclusion: Six percent of patients had an abnormal breast condition in this study. Use of EFV and increasing age were associated with breast abnormalities in this population. Further research is needed to better understand this phenomenon. / MT2017

MA, School of Human and Community Development, Faculty of Humanities, University of the Witwatersrand / HIV/AIDS remains a global pandemic that is affecting millions of people. The advent of antiretroviral medication in the late 1980s has led to major advances in clinical treatment that has turned the deadly disease into a chronic condition for those who are infected. However, adherence to antiretroviral medication remains problematic. Whilst extensive international research has been done to identify various variables that contribute to rates of non-adherence, there is not much research being done in South Africa that provides a reliable prediction of non-adherence or generates a theoretical understanding of the issue. The main aim of this study was to ascertain the barriers and facilitators that contribute to the level of adherence to antiretroviral treatment. This was done from a biopsychosocial perspective that takes into account not only the biomedical factors that may have an impact on antiretroviral treatment levels but also includes the various psychological and socio-political factors that contribute to non-adherence. The qualitative research methodology was used. Data was collected from 14 participants using semi-structured interviews. The participants included 3 medical practitioners, 1 nutritionist, 2 counsellors, 2 treatment activist, 2 caregivers to PLWHA and 4 people on treatment. Interviews were audio-recorded and transcribed. Thematic content analysis was used to generate themes. Themes were categorised under individual, interpersonal level and systemic level barriers and facilitators to ARV treatment which included biomedical, psychological as well as social-political factors that facilitate non-adherence. The main findings in this study suggest that there is a complex web of interaction between the various biomedical, psychological and socio-political factors that impact on adherence levels. Additionally, the response by PLWHA to their illness and subsequently to ARV treatment is more complex than a mere conforming to a set of medical standards and instructions. As such intervention that looks to increase adherence levels cannot be a one-dimensional or onesided endeavour and requires a multifaceted approach.