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.

Introduction: Improvements in early detection of human immunodeficiency virus (HIV), linkage to treatment, and availability of antiretroviral therapy (ART) have contributed to increasing life expectancy for people living with HIV (PLHIV) in South Africa. These improvements have resulted in the decline of HIV cause-specific mortalities. In addition to existing tuberculosis burden in PLHIV, cases of chronic non-communicable diseases (NCDs) are increasing in the general population. Considering the ageing population of PLHIV in South Africa, it is important to understand their health needs, as well as identify potential drivers of comorbidities that may provide avenues for future interventions. This study aimed at exploring HIV and comorbidity profiles in a virtual cohort of a population of healthcare clients accessing care in public facilities in Khayelitsha, Cape Town. Methods: Routinely collected data for healthcare clients accessing care in public facilities in 2016/17 were obtained from the Western Cape Provincial Health Data Centre, and analysed to describe ascertained comorbidities, comparing the profiles of PLHIV and HIV-negative individuals. The risks of comorbidity occurrence in PLHIV, in the context of other comorbidities and HIV metrics such as ART duration, viral load and CD4 cell counts, including the contribution of comorbidities to unsuppressed viral load levels in PLHIV were explored. Findings: The findings show that accessing HIV care may lead to earlier ascertainment of common chronic NCDs – hypertension, diabetes, chronic kidney disease (CKD), cervical cancer in PLHIV, compared to HIV-negative clients. Analysis of routine health data suggests that ascertainment of comorbidities differs for healthcare clients due to sub-population differences including age, sex, HIV status and reasons for accessing care. Routine laboratory testing results for renal function reflect distinct healthcare experiences by age for healthcare clients with and without HIV. Analysis of routine data shows that presence of an existing comorbidity may contribute to the incidence of other comorbidities and unsuppressed viral load levels in PLHIV. Conclusion: From real life routine health data, this study has explored comorbidities profiles of PLHIV and HIV-negative clients and observed that routine health data could provide a better understanding of disease profiles, healthcare access and requirements for both PLHIV and HIV-negative clients.

Magister Artium (Social Work) - MA(SW) / Botswana is experiencing high levels of HIV prevalence rate at 16.9% among the general population, 4.5% among adolescents aged 10-14 and 4.7% among adolescents aged 14-19. Adolescents are in a critically stage between childhood and adulthood and undergo a lot of developmental changes physically, sychologically and emotionally. The scourge of HIV/AIDS has also brought with it multiple challenges to adolescents as those who are HIV positive have to adhere to all the health requirements of being HIV positive and at the same time being pressurised by the societal expectations. Stigmatisation and discrimination are experienced as barriers against the fight towards HIV which is seen a major factor among adolescents. The aim of the study was to explore and describe adolescents’ perceptions and experiences of anti-retroviral therapy at a tertiary hospital in Francistown, Botswana. The study followed a qualitative research approach with an exploratory descriptive research design. Purposive sampling was used to recruit participants. Participants were school going adolescents aged between 13 and 19 years, who are on antiretroviral therapy and going for reviews at a tertiary hospital in Francistown, Botswana. Data were gathered though face to face semi structured interviews with each of the 24 participants. Data were analysed thematically. The following four themes emerged during the analysis: i. “ARVs control but don’t cure”; ii. “Why did it happen to me?-the reality of using ARVs”; iii. “I don’t want to take them for the rest of my life”; and iv. “No man is an island”, which addressed the research objectives. The findings led to the conclusion that, despite the fact that HIV has been around for over two decades and ARVs has been around for more than a decade, adolescents living with HIV still faces challenges such as stigmatisation due to social as well as clinical factors and adjusting to a lifelong treatment which made it difficult for them to adhere to their treatment. However, adolescents are happy as they are living a healthy and a fruitful life as a result of the ARVs. Ethical considerations were adhered too. Furthermore the findings of the study could assist the Ministries of Health, Education, Local Government and Rural Development to address these challenges experienced by the adolescents in the development of social programmes to improve the livelihood of the adolescents living with HIV/AIDS.

In this thesis, some issues about the human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS) have been addressed by concentrating on the stochastic modelling of the dynamics of the viruses. The aim of this thesis is to determine parameters such as the mean number of free HIV, infectious free HIV and non-infectious free HIV which are essential in determining incubation period of the virus, the disease progression of an infected individual and the efficacy of the treatment used. This thesis comprises of six chapters. The first two chapters are introductory to the viruses and reasons why HIV-1 is given priority over HIV-2 are given. The pathogenesis of the virus is addressed. This is because knowledge of the pathogenesis and strains of the virus has become essential in the study of HIV in vivo dynamics which is still paving ways into extensive research of the ways to contain the disease better. In chapter three the distribution functions of the HIV incubation period and seroconversion time are determined via stochastic models by building on previous work of Lui et al. (1988) and Medley et al. (1988). Also AIDS incidence projection was done using the Backcalculation method. Chapter four deals with the formulation of stochastic model of the dynamics of HIV in an infected individual. Two stochastic models are proposed and analysed for the dynamics of the viral load in a HIV infected person and the multiplication process of the virions inside an infected T4 cell. Also a numerical illustration of the stochastic models derived is given. In chapter five, the T4 cell count which is considered one of the markers of disease progression in HIV infected individual is examined. WHO has recently advocated that countries encourage HIV infected individuals to commence antiretroviral treatments once their T4 cell count is 350 cells per ml of blood. This is because when the T4 cell count is low, the T4 cells are unable to mount an effective immune response against antigens (and any such foreign matters in the body) and consequently, the individual becomes susceptible to opportunistic infections and lymphomas. We developed a stochastic catastrophe model to obtain the mean, variance and covariance of the uninfected, infected and lysed T4 cells; also the amount of toxin produced in a HIV infected person from the time of infection to the present time is derived. A numerical illustration of the correlation structure between uninfected and infected T4 cells, and infected and lysed T4 cells is portrayed. Antiretrioviral treatments were introduced while we await a cure. Treatment with single drug failed due to the fact that HIV evolved rapidly because of its high replication rate. Thus drug resistance to single therapeutic treatment in HIV infected individuals has promoted research into combined treatments. In chapter six a stochastic model under combined therapeutic treatment is derived. Mean numbers of free HIV, infectious free HIV and non-infectious free HIV are obtained. Variance and co-variance structures of our parameters were obtained unlike in previous work of Perelson et al. (1996), Tan and Xiang (1999). / Thesis (PhD)--University of Pretoria, 2009. / Statistics / unrestricted

Given the pathophysiology associated with the Human Immunodeficiency Virus (HIV) and the reported predilection for frontal circuitries and deep white matter, one might expect that executive dysfunction forms part of the neurocognitive profile of people living with HIV. However, such deficits have mainly been reported for adults living with HIV. Adolescence is a period where significant growth and refinement of executive functioning occurs and therefore specific research focused on HIV-positive adolescents is needed. Adolescence is also a developmental period where poor adherence to Antiretroviral Therapy (ART) persists despite marked increases in the national roll out of ART in South Africa, which has significantly decreased HIV-related morbidity and mortality rates. Poor adherence is not only a threat to the efficacy of ART but is also linked to the emergence of drug-resistant HIV strains and identified as a key contributor in the persistence of some cognitive impairments among people living with HIV. Studies show that executive dysfunction can undermine adherence to ART particularly in adolescents, whose frontal lobes are still developing. The first aim of this study was to compare the executive function profile of a group of HIV positive adolescents with that of a matched HIV negative control group. Using P. Anderson's (2002) model, executive functions were considered along the four subdomains: attentional control, processing speed, cognitive flexibility and goal setting. A second aim of the study was to investigate the relationship between executive function and levels of adherence to ART amongst the HIV positive adolescents in the sample. This cross sectional, between-groups study used a comprehensive neuropsychology test battery which was sorted into composite domains to investigate differences in executive functioning between the two study groups of adolescents aged between 14 to 16 (n = 22 in each group) using t-tests. Correlation coefficients were further computed to establish association between adherence and executive functioning. Apart from processing speed (p = 0.42, after the removal of outliers), there were no significant between-group differences in executive functioning outcomes that emerged between the HIV-positive and HIV-negative groups. The neuropsychological test scores for both groups were largely in the borderline range. Correlations between adherence and executive functioning outcomes did not yield any significant associations for each of the executive function domains. The lack of significant between-group differences may be explained by the mitigating effects of ART in the CNS in the HIV-positive group. However, consideration should be given to social factors as these may be important mediators of cognition and may therefore confound neuropsychological performance outcomes for both groups. Although the findings in the current study did not conclusively provide evidence for the role of executive functions in adherence, given the noted limitations, further studies with larger samples should confirm such outcomes.

Despite widespread availability of effective antiretroviral therapy (ART), people living with HIV (PWH) remain at risk of developing comorbidities including HIV-associated neurocognitive impairment (H-NCI). These individuals may then be at an increased risk for treatment non-adherence, which leads to poor quality of life and early mortality. Despite this risk, there is a paucity in trained professionals in low- and middle-income countries with appropriate knowledge and skills to identify H-NCI and make appropriate referrals for additional confirmatory testing or intervention, depending on the severity and context of the screening. General medical doctors, nurses and adherence counsellors provide most HIV related healthcare services at a primary healthcare level in South Africa. However, awareness of the clinical presentation of H-NCI, and their current screening practices among these cadres, is unclear. To address these knowledge gaps this thesis set out to explore the following aims (1) examine existing H-NCI knowledge and practices among healthcare workers delivering HIV services in South Africa, (2) develop an appropriate H-NCI training programme for primary healthcare workers, and (3) lastly, pilot the H-NCI training to determine whether H-NCI screening would be feasible at a primary healthcare level in South Africa. Methods To achieve these objectives, the study was divided into two phases. In phase one, a scoping review identified and summarised published studies addressing brain and/or behaviour training approaches, including H-NCI, targeting frontline HIV healthcare workers in Africa. An online survey was developed and administered to examine existing H-NCI knowledge and current practices among healthcare workers providing HIV services in South Africa. Focus group discussions and in-depth interviews were then conducted to explore knowledge gaps, previous H-NCI training and healthcare workers' perspectives of screening at a primary healthcare level. In phase two, an H-NCI training curriculum was developed and a work-integrated H-NCI training programme targeting primary healthcare workers was piloted. The pilot training assessed knowledge of H-NCI signs and symptoms, healthcare workers' attitude toward and comfort with H-NCI screening tools and healthcare workers ability to accurately administer an H-NCI screening tool. The assessments were repeated two months post-training to evaluate retention of knowledge and skills. Results The scoping review of the existing literature suggested that there were few brain and/ or behaviour training programs targeting healthcare workers providing HIV services in Africa. Of the ten studies identified in the scoping review, one study included H-NCI in the training curriculum. The online survey found that H-NCI knowledge was limited and screening practices virtually non-existent among healthcare workers providing HIV care in South Africa. Qualitative data gathered during the focus group discussions and the in-depth interviews provided greater insight on the existing knowledge and practices gaps as well as highlighting that healthcare workers had not received training on H-NCI. The results from the qualitative investigations showed that primary healthcare workers were in favour of receiving such training. Overall, knowledge of H-NCI improved among primary healthcare workers following the work-integrated H-NCI training programme. The training demonstrated that primary healthcare workers providing clinical services, such as medical doctors or professional nurses were able to administer an H-NCI screening tool. Although knowledge of the clinical presentation of H-NCI improved among adherence counsellors, these healthcare workers experienced challenges in administering the H-NCI screening tool. Conclusion As a body of work, the findings from this thesis suggest that healthcare professionals providing HIV services in South Africa have limited knowledge to identify H-NCI, and screening practices are uncommon. Although training revealed differences between cadres in administering screening tools, healthcare workers providing clinical care, including general medical doctors and professional nurses, may be able to provide H-NCI screening at routine annual visits. Although adherence counsellors are ideally situated in the clinic flow to provide targeted screening by flagging clinical presentation of H-NCI among PWH accessing care, this cadre will require additional training, mentorship and support to successfully administer H-NCI screening tools. However, the feasibility of H-NCI screening at a primary healthcare, timing and nature of any screening remains to be explored. This body of work is a step toward increasing the availability of skilled healthcare workers with appropriate knowledge and skills to screen and identify H-NCI in low- and middle-income countries. The work presented in this thesis provides a foundation for further development of the H-NCI training module and future investigations examining targeted screening strategies at a primary healthcare level, feasibility and access to existing interventions post-screening

Thesis (MSc)--Stellenbosch University, 2012. / Background: While Selection of reverse transcriptase (RT) mutation has been reported frequently, protease (PR) mutations on antiretroviral therapy (ART) including boosted Protease inhibitor (PI) have not been reported as much in Zambia. Affordable in-house genotyping assays can been used to expand the number of patients receiving drug resistance geno-typing, which can aid in determining prevalence of RT/PI emerging mutations. Methods: A previously published drug resistance genotyping assay was modified and used to genotype RT and PR genes. 19 patients virologically failing first-line regimen and 24 failing second-line regimen were studied to determine resistance patterns. Virological failure was defined as failing to maintain <1000 copies/mL during ART. Only major and minor RT and PR mutations (IAS-USA 2010) were considered for analysis. The in-house assay was validated by comparing sequence data of 7 previously ViroSeq tested samples and 5 randomly selected samples to determine reproducibility. Results: The in-house assay efficiently amplified all 12 validation samples with the lowest sample scoring 99.4% sequence homology. The most common RT mutation was M184V (79% n=19) and (71% n=24) first and second-line respectively. No significant differences were reported in all the other RT mutations between first-line and secondline regimens. Drug resistant PI mutations (I54V, M46I and V82A all present 20.8%) were only found in the second-line regimen and were insignificant, p= 0.0562. Conclusion: The in-house assays can be used as alternatives for commercial kits to genotype HIV-1C in Zambia without compromising test quality. The insignificant PI drug resistant mutations which were found, despite virological failure in patients, could indicate a possibility of other mutations within the HIV-1 genome that could reduce PI susceptibility.

Considerando a infecção pelo HIV uma condição crônica e de alta prevalência no ambiente carcerário, este estudo objetivou analisar os desafios relacionados à regularidade no uso da terapia antirretroviral (TARV) pelas pessoas vivendo com HIV em unidades prisionais (UP) da região de Ribeirão Preto (RP), São Paulo. Tratase de um estudo descritivo, do tipo inquérito. Foram incluídos indivíduos reclusos há mais de seis meses, com diagnóstico de HIV e em uso de TARV. Utilizou-se um banco de dados contendo variáveis sociodemográficas, clínicas e de acompanhamento dos casos; adesão à TARV e ações desenvolvidas pelas equipes de saúde das UP para o monitoramento da ingestão medicamentosa. Os dados foram analisados por meio de técnicas descritivas e testes de associação (Quiquadrado e Exato de Fisher). Identificou-se 67 indivíduos em uso de TARV, dos quais, 80,6% cumpriam pena em regime fechado e 38,8% possuíam de dois a cinco anos de clausura. Houve o predomínio de homens (79,1%); 25 a 39 anos (52,2%); não brancos (64,2%); solteiros (47,8%); ensino fundamental I e II (67,1%); possuíam profissão (88,1%) e ganhavam de um a três salários mínimos (50,7%) antes da reclusão. Quanto ao perfil clínico e de acompanhamento: 44,8% diagnosticaram HIV na prisão; 86,6% faziam acompanhamento em serviço de assistência especializada em HIV (SAE); 41,7% interromperam o tratamento em algum momento; 31,3% possuíam TCD4+ acima de 500 cópias e em 62,7% a carga viral era indetectável. Identificou-se o uso de drogas ilícitas (71,6%) e lícitas (80%) prévias ao encarceramento. Em relação ao atraso na entrega da TARV, 70,3% referiram nunca ou quase nunca ocorrer tal situação; 42,2% referiram nunca ou quase nunca perderem consultas nos SAE; 79,1% informaram que nunca ou quase nunca recebem os resultados dos exames laboratoriais processados fora das UP. Sobre o questionamento acerca do uso da TARV nos últimos sete dias: 76,1% tomaram medicamentos fora do horário; 80,6% deixaram de tomar medicamentos; 91% tomaram menos ou mais compridos. Em 58,2% dos casos houve retirada regular da TARV junto às unidades dispensadoras de medicamentos situadas na rede pública de saúde de Ribeirão Preto. Quanto às ações desenvolvidas dentro das UP voltadas ao monitoramento da TARV, considerou-se regular apenas o questionamento sobre o uso contínuo dos medicamentos, sendo que as demais foram insatisfatórias. A adesão à TARV apresentou associação estatisticamente significante com o sexo feminino (p=0,028); o uso de drogas lícitas (p=0,006) e a interrupção do acompanhamento médico (p=0,014) estiveram associadas à não adesão. Os achados deste estudo permitem refletir sobre a complexidade da assistência prestada às pessoas que vivem com HIV/aids no ambiente prisional, principalmente no que tange o monitoramento do uso da TARV, sinalizando a necessidade de desenvolvimento e incorporação de estratégias de intervenção que qualifiquem a produção do cuidado em saúde na perspectiva integral e resolutiva, capaz de produzir impactos condizentes com os desafios que perpassam a prevenção e o manejo do HIV / Considering that the HIV/aids infection constitutes a chronic condition with high prevalence in prisons, this study aimed to analyze the challenges related to regularity in the use of antiretroviral therapy (ART) by people living with HIV in prisons (UP) in the region of Ribeirão Preto (PR), São Paulo. This is a descriptive, inquiry-type study. We included individuals who had been incarcerated for more than six months, diagnosed with HIV/aids and using ART. We used a database containing sociodemographic and clinical information and variables on the case follow-up, ART adherence and actions developed by PU health teams to monitor drug intake. Data were analyzed using descriptive techniques and association tests (Chi-square and Fisher\'s Exact). A total of 67 individuals using ART were identified, of whom 80.6% were in closed regime and 38.8% had two to five years of incarceration. There was a predominance of men (79.1%); 25 to 39 years old (52.2%); non-white (64.2%); single (47.8%); elementary education I and II (67.1%); having a profession (88.1%) and earning one to three minimum wages (50.7%) before incarceration. In regard of the clinical and follow-up profile: 44.8% had HIV diagnosed in prison; 86.6% were attending a specialized HIV care service (SAE); 41.7% discontinued treatment at some point of time; 31.3% had TCD4+ over 500 copies and in 62.7% of participants the viral load was undetectable. The use of illicit drugs (71.6%) and licit drugs (80%) prior to incarceration was also identified. Regarding delays in ART delivery, 70.3% reported that a delayed delivery never or almost never occurred; 42.2% reported that they never or almost never miss appointments in SAE; 79.1% reported that they never or almost never receive the results of laboratory tests processed outside the PU. Regarding the use of ART in the last seven days: 76.1% took medicines outside medication time; 80.6% stopped taking medicines; 91% took a higher or a lower dosage. In 58.2% of the cases, the withdrawal of ART from the drug dispensing units located in the public health network of RP was regular. Regarding the actions developed within the PUs aimed at ART monitoring, the questioning about the continuous use of the drugs was assessed as regular and the others were unsatisfactory. Adherence to ART had a statistically significant association with woman (p = 0.028). The use of licit drugs (p = 0.006) and interruption of medical follow-up (p = 0.014) were associated with non-adherence. The findings of this study allow us to reflect on the complexity of care provided to people living with HIV/aids in prisons, especially regarding the monitoring of ART, suggesting the need for development and incorporation of strategies that qualify the health care delivery towards an integral and resolutive perspective, capable of producing impacts that are consistent with the challenges of HIV prevention and management

Considerando a infecção pelo HIV uma condição crônica e de alta prevalência no ambiente carcerário, este estudo objetivou analisar os desafios relacionados à regularidade no uso da terapia antirretroviral (TARV) pelas pessoas vivendo com HIV em unidades prisionais (UP) da região de Ribeirão Preto (RP), São Paulo. Tratase de um estudo descritivo, do tipo inquérito. Foram incluídos indivíduos reclusos há mais de seis meses, com diagnóstico de HIV e em uso de TARV. Utilizou-se um banco de dados contendo variáveis sociodemográficas, clínicas e de acompanhamento dos casos; adesão à TARV e ações desenvolvidas pelas equipes de saúde das UP para o monitoramento da ingestão medicamentosa. Os dados foram analisados por meio de técnicas descritivas e testes de associação (Quiquadrado e Exato de Fisher). Identificou-se 67 indivíduos em uso de TARV, dos quais, 80,6% cumpriam pena em regime fechado e 38,8% possuíam de dois a cinco anos de clausura. Houve o predomínio de homens (79,1%); 25 a 39 anos (52,2%); não brancos (64,2%); solteiros (47,8%); ensino fundamental I e II (67,1%); possuíam profissão (88,1%) e ganhavam de um a três salários mínimos (50,7%) antes da reclusão. Quanto ao perfil clínico e de acompanhamento: 44,8% diagnosticaram HIV na prisão; 86,6% faziam acompanhamento em serviço de assistência especializada em HIV (SAE); 41,7% interromperam o tratamento em algum momento; 31,3% possuíam TCD4+ acima de 500 cópias e em 62,7% a carga viral era indetectável. Identificou-se o uso de drogas ilícitas (71,6%) e lícitas (80%) prévias ao encarceramento. Em relação ao atraso na entrega da TARV, 70,3% referiram nunca ou quase nunca ocorrer tal situação; 42,2% referiram nunca ou quase nunca perderem consultas nos SAE; 79,1% informaram que nunca ou quase nunca recebem os resultados dos exames laboratoriais processados fora das UP. Sobre o questionamento acerca do uso da TARV nos últimos sete dias: 76,1% tomaram medicamentos fora do horário; 80,6% deixaram de tomar medicamentos; 91% tomaram menos ou mais compridos. Em 58,2% dos casos houve retirada regular da TARV junto às unidades dispensadoras de medicamentos situadas na rede pública de saúde de Ribeirão Preto. Quanto às ações desenvolvidas dentro das UP voltadas ao monitoramento da TARV, considerou-se regular apenas o questionamento sobre o uso contínuo dos medicamentos, sendo que as demais foram insatisfatórias. A adesão à TARV apresentou associação estatisticamente significante com o sexo feminino (p=0,028); o uso de drogas lícitas (p=0,006) e a interrupção do acompanhamento médico (p=0,014) estiveram associadas à não adesão. Os achados deste estudo permitem refletir sobre a complexidade da assistência prestada às pessoas que vivem com HIV/aids no ambiente prisional, principalmente no que tange o monitoramento do uso da TARV, sinalizando a necessidade de desenvolvimento e incorporação de estratégias de intervenção que qualifiquem a produção do cuidado em saúde na perspectiva integral e resolutiva, capaz de produzir impactos condizentes com os desafios que perpassam a prevenção e o manejo do HIV / Considering that the HIV/aids infection constitutes a chronic condition with high prevalence in prisons, this study aimed to analyze the challenges related to regularity in the use of antiretroviral therapy (ART) by people living with HIV in prisons (UP) in the region of Ribeirão Preto (PR), São Paulo. This is a descriptive, inquiry-type study. We included individuals who had been incarcerated for more than six months, diagnosed with HIV/aids and using ART. We used a database containing sociodemographic and clinical information and variables on the case follow-up, ART adherence and actions developed by PU health teams to monitor drug intake. Data were analyzed using descriptive techniques and association tests (Chi-square and Fisher\'s Exact). A total of 67 individuals using ART were identified, of whom 80.6% were in closed regime and 38.8% had two to five years of incarceration. There was a predominance of men (79.1%); 25 to 39 years old (52.2%); non-white (64.2%); single (47.8%); elementary education I and II (67.1%); having a profession (88.1%) and earning one to three minimum wages (50.7%) before incarceration. In regard of the clinical and follow-up profile: 44.8% had HIV diagnosed in prison; 86.6% were attending a specialized HIV care service (SAE); 41.7% discontinued treatment at some point of time; 31.3% had TCD4+ over 500 copies and in 62.7% of participants the viral load was undetectable. The use of illicit drugs (71.6%) and licit drugs (80%) prior to incarceration was also identified. Regarding delays in ART delivery, 70.3% reported that a delayed delivery never or almost never occurred; 42.2% reported that they never or almost never miss appointments in SAE; 79.1% reported that they never or almost never receive the results of laboratory tests processed outside the PU. Regarding the use of ART in the last seven days: 76.1% took medicines outside medication time; 80.6% stopped taking medicines; 91% took a higher or a lower dosage. In 58.2% of the cases, the withdrawal of ART from the drug dispensing units located in the public health network of RP was regular. Regarding the actions developed within the PUs aimed at ART monitoring, the questioning about the continuous use of the drugs was assessed as regular and the others were unsatisfactory. Adherence to ART had a statistically significant association with woman (p = 0.028). The use of licit drugs (p = 0.006) and interruption of medical follow-up (p = 0.014) were associated with non-adherence. The findings of this study allow us to reflect on the complexity of care provided to people living with HIV/aids in prisons, especially regarding the monitoring of ART, suggesting the need for development and incorporation of strategies that qualify the health care delivery towards an integral and resolutive perspective, capable of producing impacts that are consistent with the challenges of HIV prevention and management

Introduction: Decentralization of antiretroviral therapy (ART) services faces decreasing quality when increasing ART coverage. This study compares nurse initiated and managed patients to doctor managed patients under these circumstances, using retention in care as a crude measure of quality of care. Methods: This was an observational retrospective cohort study. A simple data abstraction tool was used to collect baseline patient data from medical records of HIV positive patients (N=871) initiating ART at Mbabane Government Hospital and four of its outreach clinics, between 1st January and 30th June 2011. Descriptive summary statistics and comparison of the two cohorts using multivariate analysis was done. Results There was no statistically significant difference in retention rates between the doctors and nurses cohorts at 69.1% and 70.9%, respectively (P was 0.56). After adjusting for sex, haemoglobin, CD4 cell count, weight and WHO stage, the odds of being retained in care were similar between the two groups, adjusted OR: 1.11(95% CI: 0.72, 1.69), with a p value of 0.64. Haemoglobin and weight were positively associated with retention in care, while male sex was negatively associated with retention in care. Discussion: The similar retention rates between the two cohorts suggest that in terms of retention in care the service provided by the nurses was comparable to that provided by doctors. This is important to ART program managers as they scale-up ART decentralization. Conclusion: Task-shifting of ART initiation from doctors to nurses is feasible as nurse initiated and managed antiretroviral therapy is comparable to doctor initiated and managed treatment. / Dissertation (MSc)--University of Pretoria, 2014. / gm2014 / Clinical Epidemiology / unrestricted