Immunologic monitoring is part of the standard care for patients on antiretroviral treatment. Yet, little is known about the routine implementation of immunologic monitoring in Ethiopia. This study assessed the pattern of immunologic monitoring, immunologic response, level of immunologic treatment failure and factors related to it among patients on antiretroviral therapy in selected hospitals in southern Ethiopia. A retrospective longitudinal analytic study was conducted using documents of patients started on antiretroviral therapy. A total of 1,321 documents of patients reviewed revealed timely immunologic monitoring were inadequate. Despite overall adequate immunologic response, the prevalence of immunologic failure was 11.5% (n=147). Having WHO Stage III/IV of the disease and a higher CD4 (cluster differentiation 4) cell count at baseline were identified as risks for immunologic failure. These findings highlight the magnitude of the problem of immunologic failure. Prioritizing monitoring for high risk patients may help in effective utilisation of meager resources / Health Studies / M.A. (Public Health)

Purpose: The purpose of this study is to assess risk factors associated with TB co-infection in HIV/AIDS patients taking antiretroviral therapy (ART). Methodology: An observational, analytic, case-control and quantitative study was conducted on a randomly selected 367 HIV and AIDS patients of whom 92 of them were TB co-infected. Data collection was done by using self-structured questionnaire. Result: In this study, educational status, waste disposal system, monthly income, contact history with a patient of active tuberculosis or presence of a family member with active tuberculosis, drug adherence, knowledge on tuberculosis prevention and history of exposure to substance were factors independently associated with the occurrence of active tuberculosis among HIV and Aids patients taking ART. Conclusion: The findings highlight the need for on-going educational, informational and other interventions to address the risk factors of tuberculosis in HIV and Aids patients in order to decrease the rate of TB co-infection / Health Studies / M.A. Public Health

Immunologic monitoring is part of the standard care for patients on antiretroviral treatment. Yet, little is known about the routine implementation of immunologic monitoring in Ethiopia. This study assessed the pattern of immunologic monitoring, immunologic response, level of immunologic treatment failure and factors related to it among patients on antiretroviral therapy in selected hospitals in southern Ethiopia. A retrospective longitudinal analytic study was conducted using documents of patients started on antiretroviral therapy. A total of 1,321 documents of patients reviewed revealed timely immunologic monitoring were inadequate. Despite overall adequate immunologic response, the prevalence of immunologic failure was 11.5% (n=147). Having WHO Stage III/IV of the disease and a higher CD4 (cluster differentiation 4) cell count at baseline were identified as risks for immunologic failure. These findings highlight the magnitude of the problem of immunologic failure. Prioritizing monitoring for high risk patients may help in effective utilisation of meager resources / Health Studies / M. A. (Public Health)

Human Immunodeficiency Virus (HIV) and Acquired Immune Deficiency Syndrome (AIDS) is a global problem. Introduction of antiretroviral therapy (ART) came as a relief to people living with HIV and AIDS as it improved their quality of life. However, maintaining high adherence levels to antiretroviral treatment is still a challenge in some settings yet strict adherence to treatment instructions is critical for successful suppression of HIV. A qualitative, descriptive phenomenological research was conducted to explore factors that influence adherence to antiretroviral therapy at Beatrice Road Infectious Disease Hospital (BRIDH). Purposive homogenous sampling was done. Data was collected from twenty patients through in-depth interviews. Study findings identified five main themes that facilitate adherence and these entail knowledge on HIV and AIDS and ART, motivation to live, adherence support networks, good service delivery and factors related to medication / Health Studies / M.A. (Public Health)

Orientador: Helaine Maria Besteti Pires Mayer Milanez / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-26T14:20:51Z (GMT). No. of bitstreams: 1 PinhoNeto_OtavioSoares_D.pdf: 1689484 bytes, checksum: 9ac072f9702d3565268cb5bc1930d222 (MD5) Previous issue date: 2014 / Resumo: OBJETIVO: Analisar os protocolos de Antirretrovirais em uma coorte de gestantes HIV positivas e recém-natos expostos em seguimento no Serviço de Assistência Especializada (SAE) Familiar/Hospital Universitário Lauro Wanderley (HULW)/Universidade Federal da Paraíba (UFPB) no período de 2005 a 2012. SUJEITOS E MÉTODOS: Estudo descritivo, do tipo coorte, retrospectivo, numa abordagem quantitativa, a partir de um grupo de gestantes HIV+ e seus recém-nascidos (RN) expostos, atendidas no SAE Familiar do HULW/UFPB. Os dados foram codificados, digitados e armazenados em um banco de dados criado com esse propósito. Cada par mãe-RN foi identificado com um número. Foi realizada uma análise descritiva das características sociodemográficas da gestante, do acompanhamento pré-natal, do uso de terapia antirretroviral (TARV), do parto e do recém-nascido, através de distribuição percentual ou média. Posteriormente, foi realizada a análise das classes dos antirretrovirais e seus desfechos para a mãe e recém-nascidos expostos. As possíveis associações entre as variáveis categóricas foram testadas através do teste t (dados paramétricos). Não foi possível a realização de análise multivariada devido ao pequeno número de crianças infectadas. RESULTADOS: A taxa de transmissão vertical (TV) no SAE Familiar HULW/UFPB entre 2005 e 2012 foi de 3,9% em uma coorte de 153 gestações analisadas. A média de idade das gestantes foi de 25 anos e a de escolaridade de 7 anos. A maioria era de mulheres negras (78,7%), com união estável (59%), e a principal categoria de exposição foi a sexual (96,5%). Mais de cinquenta por cento já apresentavam diagnóstico do HIV anterior à gravidez estando 41% em uso de TARV. A média de CD4 inicial foi de 440 células/ml e, após uso de TARV de 516,07 células/ml. A média de carga viral (CV) pré uso de TARV foi de 24.022. Mais de 70% apresentaram carga viral indetectável com 34 semanas de gestação. Usaram TARV com IP 92% e 8% um esquema com nevirapina. Não foi utilizada monoterapia com AZT nessa coorte. A média de idade gestacional no parto foi de 36 semanas e em 95% dos casos a via de parto foi cesárea. A grande maioria dos casos (98%) recebeu AZT endovenoso no parto. O peso médio dos recém-nascidos foi de 2,89 gramas e apenas 17,64% tiveram baixo peso. A presença de prematuridade, patologias neonatais e o não uso do AZT intraparto foram fatores que se associaram a um maior risco de transmissão vertical. Não foi possível a realização de análise multivariada devido ao pequeno número de crianças infectadas. Houve poucos efeitos colaterais associados ao uso da TARV na gestação, sendo o mais frequente a presença de anemia materna (58,4%) e de anemia neonatal (21,6%). Não se observaram efeitos adversos graves, tanto na mãe quanto no recém-nascido. CONCLUSÃO: A taxa de TV no serviço universitário de João Pessoa foi de 3,9%, principalmente associada à prematuridade, patologia neonatal e não uso do AZT venoso intraparto. Houve baixa ocorrência de efeitos adversos, sendo mais frequente a anemia, tanto na mãe quanto no recém-nascido / Abstract: OBJECTIVE: To analyze antiretroviral therapy protocols in a cohort of HIV-positive pregnant women and exposed newborns followed at Serviço de Assistência Especializada (SAE) Familiar / Hospital Universitário Lauro Wanderley (HULW), Universidade Federal da Paraíba (UFPB), from 2005 to 2012. SUBJECTS AND METHODS: Descriptive, retrospective cohort study, using a quantitative approach, conducted on a group of HIV-positive pregnant women and their exposed newborns followed at SAE/HULW. Data were codified, entered and stored in a database created specifically for this purpose. Each mother-child pair was identified by a number. A descriptive analysis of the sociodemographic characteristics of pregnant women, prenatal care, use of antiretroviral therapy (ART), and delivery and neonate parameters was conducted using percentages or means. An analysis of the classes of antiretroviral drugs and their associated outcomes for mothers and exposed newborns was then conducted. Potential associations between categorical variables were assessed with the t-test (parametric data). Multivariate analysis could not be performed due to the small number of children infected. RESULTS: The mother-to-child transmission rate at SAE/HULW-UFPB between 2005 and 2012 was 3.9%, in a cohort of 153 pregnancies. The mean patient age was 25 years and the mean educational attainment was 7 years of schooling. Most subjects were black women (78.7%), in a stable relationship (59%), and the main risk factor was sexual contact (96.5%). More than 50% already had a diagnosis of HIV infection prior to pregnancy, and 41% were on ART. The mean CD4 count was 440 cells/ml at baseline and 516.07 cells/ml after ART. The median viral load before ART was 24.022. Over 70% had an undetectable viral load at 34 weeks of gestation. Overall, 92% were on PI-containing ART regimens and 8% were on nevirapine-containing regimens. AZT monotherapy was not used in this cohort. The mean gestational age at delivery was 36 weeks, and in 95% of cases, the mode of delivery was cesarean. The vast majority of cases (98%) received intrapartum intravenous AZT. The average birth weight of newborns was 2,890 g, and only 17.6% were underweight. Presence of prematurity, neonatal morbidity, and failure to administer intrapartum AZT were factors associated with higher risk of vertical transmission. Multivariate analysis could not be performed due to the small number of infected children. There was a low incidence of side effects associated with ART during pregnancy, the most common being maternal anemia (58.4%) and neonatal anemia (21.6%). No serious adverse effects were observed in either mothers or newborns. CONCLUSION: The rate of mother-to-child transmission at this university-based facility in João Pessoa was 3.9%, and was mainly associated with prematurity, neonatal morbidity, and failure to administer intrapartum intravenous AZT. There was a low rate of adverse effects, the most common being anemia, in both mothers and newborns / Doutorado / Saúde Materna e Perinatal / Doutor em Ciências da Saúde

PhDH / Department of Public Health / Background: Since the introduction of three-tiered systems appointments, there are a large number of missed appointments among Human immunodeficiency virus-positive clients on Antiretroviral. However, no one knows why these clients missed their scheduled times. Missing of appointments predicts poor adherence and is associated with poor clinical outcomes. Objectives: The proposed study aimed at developing a strategy for reducing the missing of appointments among adults on Antiretroviral Therapy in the Limpopo Province, South Africa. The objectives of the study are to determine patients’ behaviour, the socio-environmental and economic factors that contribute to the missing of appointments and develop strategies to enhance compliance with appointments by Human immunodeficiency virus-positive clients on Antiretroviral therapy in the Limpopo Province. Method: A qualitative research design was used to address the study objectives. Non-probability purposive sampling was used to sample health care centres in Limpopo Province, patients, Professional Nurses and Community Health Workers. Individual interview and focus group discussions strengthened the triangulation of data obtained from the participants. Creswell’s model provided details for data analysis and interpretation. Trustworthiness and Ethics: Measures to ensure data quality, such as credibility, dependability, conformability and transferability, were observed. The researcher ensured compliance with ethical standards to protect the rights of the participants. Approval for this study was obtained from the University of Venda Research Ethics Committee and the Limpopo Department of Health Research Ethics. Results: The study revealed various factors that contribute to the missing of appointments by Human immunodeficiency virus positive-clients on Antiretroviral Therapy. Specific socioeconomic, behavioural, environmental and health service-related factors appear to prevent adherence to appointments. These factors include a lack of family support and client engagement, the absence of financial means, and cultural and religious beliefs. Lack of client involvement in planning their care and poor referral of clients to community health workers were ranked high as being the most contributing factors to clients missing their appointments. Strategy development: Phase 2 of this study dealt with the development of the strategy aimed at reducing the missing of appointment by adults on Antiretroviral Therapy based on the findings of the study. The strengths, weaknesses, opportunities and threats matrix was triangulated in Political, Environmental, Social, Technological and Legal analysis to develop this approach to reduce the missing of appointments among adults on Antiretroviral therapy. A transtheoretical framework illustrated how to implement the strategy. Validation of the developed strategy ensured that the system is free of errors and checked the applicability of the strategies utilising a quantitative design. A simple random sampling approach was used to select the population to participate in this study using the questionnaire developed by the researcher. Almost all respondents agreed that the strategy would facilitate reduced missing appointments by adults on Antiretroviral therapy. Recommendations: Clients involvement and engagement throughout the process of a treatment plan is essential to identify some of the barriers that might contribute to poor adherence to appointment by clients on Antiretroviral therapy. Community health workers and nurses should be capacitated with knowledge and skills to identify the clients at risk of defaulting treatment and appointments and provide counselling that will facilitate behaviour modifications. / HWSETA

Purpose: The purpose of this study is to assess risk factors associated with TB co-infection in HIV/AIDS patients taking antiretroviral therapy (ART). Methodology: An observational, analytic, case-control and quantitative study was conducted on a randomly selected 367 HIV and AIDS patients of whom 92 of them were TB co-infected. Data collection was done by using self-structured questionnaire. Result: In this study, educational status, waste disposal system, monthly income, contact history with a patient of active tuberculosis or presence of a family member with active tuberculosis, drug adherence, knowledge on tuberculosis prevention and history of exposure to substance were factors independently associated with the occurrence of active tuberculosis among HIV and Aids patients taking ART. Conclusion: The findings highlight the need for on-going educational, informational and other interventions to address the risk factors of tuberculosis in HIV and Aids patients in order to decrease the rate of TB co-infection / Health Studies / M.A. Public Health

Health Studies / (M.P.H. (Health Studies))

The health care industry in Nigeria is increasingly grappling with challenges of meeting end users’ requirements and expectations for quality antiretroviral therapy (ART) service provision. This study sought to explore and describe the quality of antiretroviral therapy in public health facilities in Nigeria and the perceptions of the end users. A descriptive qualitative research design was used in the study in order to generate ideas from end users for improving quality of ART service provision, and prompt additional research activities. Unstructured focus group discussions were conducted with end users (n=64) in 6 locations across the 6 geopolitical zones of Nigeria. Data was analysed using the framework approach because it reflects the original accounts and observations of the end users and the Weft QDA version 1.0.1 software to validate the results. Findings revealed that end users were satisfied with uninterrupted antiretroviral drug supplies, courtesy treatment, volunteerism of support group members and quality counselling services. End users expect public health facilities to accept diagnostic results from collaborating facilities, implement continuous quality improvement (CQI), maintain clean and adequate health infrastructure, reduce end user waiting time, reduce stigma, comprehensively assess end users during each clinic visit and ensure uninterrupted ART services. They also expect effective collaboration between healthcare providers and support group members, to enhance the quality of life of people living with HIV (PLHIV). End users identified the following as quality gaps in ART service provision: weak health facility leadership, non-attractive ART service infrastructure, frequently interrupted laboratory services, demotivated and inadequate health care workers, long waiting time, interrupted medicine supplies and inadequate procedure for complaints management. In conclusion, the following recommendations were proffered: deploy and train additional health care workers, integrate ART into regular health services, improve supply chain management of health commodities, and reduce end user overload in clinics. Finally, a best practice guideline for the provision of end user focused ART service provision was developed. / Health Studies / D.Litt. et Phil. (Health Studies)

Submitted in fulfillment of the requirements for the Degree of Master of Technology: Biomedical Technology, Durban University of Technology, 2012. / Antiretroviral therapy (ART) was introduced because it has shown to reverse the Acquired Immunodeficiency syndrome (AIDS), by reducing the HIV replication, allowing the regeneration of the patient’s immune system. ART is given to patients for the rest of their lives as part of HIV clinical care, but the use of ART has shown evidence of metabolic side effects which range from manageable to life threatening complications. Aims and objectives of the study The aim of the study was to investigate whether patients on ART developed metabolic side effects such as pancreatitis, dyslipidaemia and hepatotoxicity. These metabolic side effects were determined by laboratory testing of blood levels of specific biomarkers at stipulated intervals. Any significant change in the blood levels of these specific biomarkers was identified. Methodology : The study included 92 patients who were already selected for the ART programme which is in accordance to the South African National Antiretroviral Therapy Guidelines of 2003 Laboratory blood analysis was conducted. The repeated measures analysis of variance (ANOVA) was used to compare changes in biomarkers over time. The severity of each side effect was assessed by grading each biomarker laboratory result through the use of an established toxicity grading table. Results : It was found that the biomarker blood levels were not significantly altered within 12 months of ART, however, there was a gradual increase of most biomarker values, indicating that abnormalities may be detected after a longer period of treatment. Conclusion : Within 12 months of treatment, life-threatening toxicities were not detected. It may be speculated that if ART is monitored correctly, life-threatening toxicities may be avoided in many patients.