INTRODUÇÃO: Com a melhora do prognóstico nos pacientes com lúpus eritematoso sistêmico juvenil novas recomendações são necessárias na reumatologia pediátrica, como avaliação da saúde bucal e do sistema mastigatório. O objetivo deste estudo é avaliar o comprometimento orofacial nos pacientes com lúpus eritematoso sistêmico juvenil e grupo controle, e avaliar possíveis associações entre o comprometimento orofacial e manifestações clínicas, exames laboratoriais e terapias da doença. MÉTODOS: Entre março de 2004 e julho de 2005 foram avaliados 48 pacientes com diagnóstico de lúpus eritematoso sistêmico juvenil, atendidos na Unidade de Reumatologia Pediátrica do ICr-HC-FMUSP. O grupo controle incluiu 48 crianças e adolescentes saudáveis atendidos na Divisão de Odontologia do HC-FMUSP. A pesquisa incluiu avaliação de dados sócio-demográficos, manifestações clínicas, exames laboratoriais, atividade da doença (SLEDAI), dano cumulativo (SLICC/ACR-DI) e terapias da doença. A avaliação orofacial incluiu questionário de anamnese, índice CPO-D, índice de placa, índice de sangramento gengival, relação dentária, perfil facial, índice de Helkimo e avaliação da articulação temporomandibular através da radiografia panorâmica de face em todos os pacientes e tomografia computadorizada apenas nos casos com achatamento e/ou destruição dos côndilos mandibulares. RESULTADOS: Os dois grupos foram homogêneos com relação à faixa etária, distribuição por gênero e classe sócio-econômica. A idade dos pacientes com lúpus eritematoso sistêmico juvenil variou de 87 a 218 meses (média de 161,9±38,4) e do grupo controle de 78 a 254 meses (média de 154,4±45,8; p=0,384). As medianas dos índices de placa e de sangramento gengival nos pacientes com lúpus eritematoso sistêmico juvenil foram superiores em relação aos controles (61,5X38,1; p=0,003 e 26,0X15,95; p=0,014). O índice de disfunção clínica e o índice de mobilidade mandibular mostraram-se mais alterados nos pacientes com LESJ versus controles (p=0,002, p=0,025). Correlação linear estatística foi evidenciada entre: tempo de doença e índice de sangramento gengival (p=0,017; r=0,11), dose cumulativa de prednisona e índice de placa (p=0,010, r=0,385) e dose cumulativa de prednisona e índice de sangramento gengival (p=0,001, r=0,02). A mediana do índice de mobilidade mandibular foi superior nos pacientes com lúpus eritematoso sistêmico juvenil em uso de um ou mais imunossupressores em relação aos que não utilizaram estas drogas (p=0). Apenas dois pacientes apresentaram radiografia panorâmica com achatamento e/ou destruição dos côndilos mandibulares e na tomografia computadorizada de ATM os achados foram: redução do espaço articular bilateralmente, erosões dos platôs articulares com aplainamento dos côndilos sugestivo de necrose avascular da articulação temporomandibular. CONCLUSÕES: Os pacientes com lúpus eritematoso sistêmico juvenil apresentaram uma precária higiene oral, maior freqüência de gengivite e disfunção da articulação temporomandibular em relação ao grupo controle. Os pacientes com maior tempo de doença e maior dose cumulativa de prednisona tiveram maior freqüência de gengivite e os que utilizaram imunossupressores apresentaram disfunção da articulação temporomandibular / INTRODUCTION: Given the enhanced prognosis of patients with juvenile systemic lupus erythematosus, new recommendations are necessary in pediatric rheumatology, such as the analysis of oral health and the masticatory system. The aim of this study was to compare dental and facial conditions of patients with juvenile systemic lupus erythematosus and a control group, and to evaluate a potential relationship between dental and facial endangering and clinical manifestations, laboratory tests and therapies for the disease. PATIENTS AND METHODS: A total of 48 children and adolescents with juvenile systemic lupus erythematosus attending the Pediatric Rheumatology Unit of the Children\'s Institute of our University Hospital were studied between January 2004 and July 2005. The control group included 48 healthy children and adolescents that were selected from the Odontology Division of our University Hospital. The search included the analysis of social and demographic data, clinical manifestations, laboratory tests, juvenile systemic lupus erythematosus disease activity and cumulative damage (using the SLEDAI and the SLICC/ACR-DI), and therapies. The dental and facial examination included the anamnesis questionnaire, DMFT index, plaque and gengival bleeding index, dental relationship, facial profile, Helkimo\'s index and evaluation of the temporomandibular joint through a radiographic panoramic examination of all patients and a computer tomography on those with flattening and/or destruction of the mandibular condyles. RESULTS: The two groups were homogeneous regarding age, gender and social-economic class. The age of the juvenile systemic lupus erythematosus patients ranged from 87 to 218 months (mean of 161.9±38.4) and of the control group from 78 a 254 months (mean of 154.4±45.8; p=0.384). The medians of the plaque and gingival bleeding indexes were higher in juvenile systemic lupus erythematosus patients than in the control group (61.5X38.10; p=0.003 and 26.0X15.95; p=0.014). The indexes of clinical dysfunction and mandibular mobility were higher in juvenile systemic lupus erythematosus patients versus the control group (p=0,002, p=0,025). A linear statistical correlation was evidenced between: juvenile systemic lupus erythematosus duration and the gingival bleeding index (p=0.017; r=0.11), cumulative dose of prednisone and the plaque index (p=0,010; r=0.385) and cumulative dose of prednisone and the gingival bleeding index (p=0.001, r=0.02). The median of the mandibular mobility index was higher in juvenile systemic lupus erythematosus patients that used at least one imunossupressive drugs compared with those that didn\'t use this medication (p=0). Only two patients showed a panoramic radiography with flattening and/or destruction of the mandibular condyles. The computer tomography revealed: narrowing of joint spaces bilaterally and erosions of joints plateaus with flattening of condyles that suggested avascular necrosis of temporomandibular joint. CONCLUSIONS: Juvenile systemic lupus erythematosus patients presented poor oral hygiene, higher incidence of gingivitis and temporomandibular joint dysfunction compared to the control group. Patients with longer disease duration and higher cumulative dose of prednisone had a greater incidence of gingivitis, and those who used imunossupressives drugs showed temporomandibular joint dysfunction

The fragmented approaches to delivering health care services in the United States, along with the associated structural inefficiencies and unsustainable increases in health care costs affecting all payers, compel the need for reform. Various federal and state-level delivery system reform models have emerged in response. The Medical Home (MH) is one of such reform models. In 2004 a national initiative entitled "The Future for Family Medicine Project" identified the lack of emphasis on comprehensive primary care, especially for chronic care patients, and proposed the introduction of MHs to improve comprehensive primary care delivery for every patient. Oregon's MH variant, the Patient-Centered Primary Care Home (PCPCH), was introduced in 2009 as part of a state-wide health reform initiative ushered in by the passage of House Bill 2009 to promote the Triple Aim. Since 2011, over 600 primary care clinics have been recognized as PCPCHs. Proponents of the model argued that it will help improve comprehensive primary care services upstream and reduce inappropriate utilization of Emergency Department (ED) and Inpatient (IP) care and expenditures downstream. Evidence on the model's application to reduce ED and IP utilization and expenditures have so far been mixed. Based on growing interests in the effects of the model's application to provide care for different types of patients, this research was designed to evaluate the policy effects of the application of PCPCHs, with a focus on PCPCHs that treat greater proportions of chronic care patients, to answer the following questions: (1) What is the average chronic disease burden of PCPCHs, and how does their average chronic disease burden compare to the communities PCPCHs are in pre-post PCPCH recognition? (2) How do primary care expenditures change based on the chronic disease burden of PCPCHs? (3) Do PCPCHs that engage more high chronic disease burden patients have more reductions in ED and IP expenditures? For this research, a chronic disease burden measure was developed from 10 markers of chronic conditions. This measure was then used to stratify PCPCH clinics and their comparators into high and low chronic disease burden clinics. The research was designed as a natural experiment, utilizing difference-in-difference methods to measure outcome differences pre-post PCPCH policy implementation and comparing outcome differences between PCPCHs and their control groups. The unit of analysis was PCPCH clinics. The theoretical perspectives that informed this research were Risk Selection and Complex Adaptive Systems (CAS). Data from Oregon's All Payer All Claims (APAC) data system, which included 16 quarters of claims and eligibility data from fourth quarter 2010 to third quarter 2014, as well as PCPCH attestation data on 525 clinics were utilized for this research. The results suggest that the chronic disease burden for PCPCHs was significantly lower than their comparator groups before clinics recognition as PCPCHs, but the chronic disease burden did not change after clinics recognition as PCPCHs. Average primary care expenditures did not change after PCPCH recognition. Average ED and average IP expenditures for high chronic disease burden PCPCHs did not change but rather decreased significantly for low chronic disease burden PCPCHs. The results imply that the distribution of chronic disease burden in PCPCHs is important and related to ED and IP expenditures, but in a different direction than expected. The results also suggest that focusing on low chronic disease burden patients in PCPCHs could help reduce ED and IP expenditures in the short and medium terms. Policies to engage a broader mix of chronic disease burden patients in PCPCHs could help increase savings from ED and IP utilization. The results also suggest the need for more research to improve current understanding of how PCPCHs are impacting health care trajectories in the current delivery system environment.

Liver transplantation is the gold standard treatment for patients with cirrhosis and hepatocellular carcinoma. The Brazilian Registry of Transplantation revealed that liver transplantation was the second solid organ most transplanted in 2010. With the purpose to eliminate foci of infection and reduce the risk of infection on the postransplant stage, these patients should undergo dental treatment to the removal of dental foci, with special care regarding the hemostasis impairment, mainly related to a reduced hepatic synthesis of procoagulants factors and thrombocytopenia. The aim of this prospective study was to evaluate the incidence of postoperative bleeding after dental extraction in candidates for liver transplantation. In this study, 23 patients were included with a mean age of 43.17  14.62 years, with a higher prevalence of whites (82.6%) and men (60.9%). In 23 patients, 84 simple extractions were performed in 35 dental surgical procedures. Patients were divided in two groups to compare two local hemostatic measures after tooth extraction: in group 1, local pressure after sutures was applied with gauze soaked with tranexamic acid, and in group 2, the same procedure without the tranexamic acid was performed. In all subjects, absorbable hemostatic sponges and cross sutures were used as a standard hemostatic measure. The main preoperative blood tests found were: mean hematocrit of 34.54% (SD  5.84%, range 21.7% â 44.4%), platelets ranged from 31,000/mm3 to 160,000/mm3, mean international normalized ratio (INR) was 1.50 (SD  0.39; range 0.98 - 2.59). Postoperative bleeding occurred in only one procedure (2.9%) and local pressure with gauze was effective to achieve hemostasis. Thus, this paper demonstrates the possibility of performing tooth extractions in patients with liver cirrhosis, with INR ≤ 2.50 and platelets ≥ 30,000/mm3, without the need of blood transfusion, and in case of bleeding events, the use of local hemostatic measures can be satisfactory. / O transplante hepÃtico à o tratamento padrÃo para pacientes com cirrose hepÃtica e carcinoma hepatocelular. Dados do Registro Brasileiro de Transplantes (RBT) demonstraram que o transplante hepÃtico foi o segundo ÃrgÃo sÃlido mais transplantado em 2010. Para eliminar focos de infecÃÃo e reduzir o risco infeccioso na fase pÃs-transplante, esses pacientes devem passar por uma avaliaÃÃo odontolÃgica minuciosa para remoÃÃo dos focos de origem dental. No caso de procedimentos odontolÃgicos que gerem sangramento, o cirurgiÃo-dentista deve dar atenÃÃo especial para a hemostasia, devido, principalmente, à reduÃÃo da sÃntese hepÃtica de fatores da coagulaÃÃo e trombocitopenia. O objetivo deste estudo prospectivo foi avaliar a incidÃncia de hemorragia pÃs-operatÃria de exodontias em pacientes na fila de espera por um transplante de fÃgado. Nesse estudo foram incluÃdos 23 pacientes com idade mÃdia de 43,17  14,62 anos com predominÃncia da raÃa branca (82,6%) e do sexo masculino (60,9%). Nos 23 pacientes, 84 exodontias simples foram realizadas em 35 procedimentos cirÃrgicos. Os pacientes foram divididos em dois grupos para comparaÃÃo de duas medidas hemostÃticas locais apÃs as exodontias: no grupo 1, aplicou-se pressÃo local com gaze embebida em Ãcido tranexÃmico, e no grupo 2, realizou-se a mesma conduta sem o uso do referido Ãcido. Em todos os pacientes foram utilizadas a esponja de colÃgeno reabsorvÃvel e sutura em X como medida hemostÃtica padrÃo. Os valores encontrados para os exames hematolÃgicos foram: hematÃcrito mÃdio de 34,54  5,84% (intervalo de 21,7% â 44,4%), plaquetometria variou de 31.000/mm3 a 160.000/mm3 e o Ãndice mÃdio encontrado para a razÃo internacional normatizada (INR) foi 1,50  0,39 (intervalo de 0,98 â 2,59). Sangramento pÃs-operatÃrio ocorreu apenas em um procedimento (2,9%) e a pressÃo local com gaze foi eficaz em parar o episÃdio de hemorragia. Dessa forma, esse trabalho demonstra a possibilidade da realizaÃÃo de exodontias em pacientes com cirrose hepÃtica com valores de INR ≤ 2,50 e plaquetometria ≥ 30.000/mm3 sem a necessidade de transfusÃo sanguÃnea e que diante da ocorrÃncia de intercorrÃncias hemorrÃgicas, o uso de medidas hemostÃticas locais pode ser satisfatÃrio.

This study originates from experiences which led me to question the way pharmacists are equipped to advise and support the medicine-taking practice of patients using chronic medication. The study offers a critical theoretical consideration of underlying perspectives informing pharmacy education. I propose following a critical realist ontological perspective, a social realist understanding of social structure and human agency, and a sociocultural epistemology. Based on these perspectives, I consider a sociological critique of ‘health’, ‘disease’, ‘illness’ and ‘sickness’ perspectives on medicine-taking, and of pharmacy as a profession. I then propose an experiential learning approach, with an emphasis on developing reflexivity through affective learning. I follow this with an illustrative case study. Following a critical discourse analysis of student texts from the case study, I conclude that there is evidence that experiential learning may prove useful in developing pharmacy students’ reflexive competency to support the provision of pharmaceutical care to patients using chronic medications.

Kroniskt sjuka tar idag flera beslut om hur de på egen hand ska behandla sin sjukdom, genommediciner, kost och träning. Tidigare forskning visar att det finns ett samband mellan kronisktsjuka och låg hälsolitteracitet. Definitionen av hälsolitteracitet är förmågan att tolka text,dokument och nummer som står i samband med varandra, samt förmågan att fungera isjukvården (Baker, 2006). Personer med kroniska sjukdomar har sämre kunskap om sittsjukdomstillstånd och tillgängliga behandlingar, vilket leder till sämre hälsoutkomster.Kroniskt sjuka har god tillgänglighet att utföra medicinska mätningar i hemmet, vilket ledertill en mer förståelse för sin egna sjukdom och bättre hälsoutkomst. Omfattande mängderlångtidsdata sparas idag inom vården, vilket har gjort data mer komplex. För att kunna tolkaoch förstå datan behövs det ett sätt att visualisera hälsodata på, så att det kan omvandlas tillinsikter och ny kunskap. Ett område som skulle kunna möta utmaningarna inom visualiseringav hälsodata är spelvisualisering. Syftet med studien var att undersöka om kunskap omvisualisering som tidigare enbart används i speldesign kan placeras på hälsodata och såledesstötta hälsolitteraciteten hos kroniskt sjuka. Studien har tillämpat en designforskingsansats,där designriktlinjer för visualisering inom spel implementerades i en prototyp, för att kunnaidentifiera hur hälsodata lämpligast kan visualiseras. Studien resulterade i fem designförslagför hur hälsodata kan visualiseras för att stötta hälsolitteracitet. / Today, chronically ill make several decisions about how to treat their medical condition through medication, diet and exercise. Previous research shows that there is a connection between chronical illness and low health literacy. The definition of health literacy is the ability to interpret text, document and numeracy that are interrelated, as well as the ability to function in the health care system (Baker, 2006). People with a chronical illness have inferior knowledge about their health and available treatments, leading to poor health outcomes. Chronically ill people have good accessibility to perform medical measurements at home, which leads to a greater understanding of their own illness, and better health outcomes. Large amounts of long-term healthdata is today stored in the health care system, which has made the data more complex. To be able to interpret and understand this data there is a need to visualize health data in a way that it can be transformed into insights and new knowledge. One area that could possibly meet the challenges of visualizing health data is game visualization. The purpose of the study was to investigate if common game visualization patterns can be effectively applied to health dataand thus support the health literacy of people with a chronicall illness. This was accomplished through a design research approach, where design guidelines for visualization in games were implemented in a prototype. It was done to identify how health datacan best be visualized. The study resulted in five design suggestions for how health data can be visualized to support health literacy.

Innovative primary care models that deliver comprehensive primary care to address medical and social needs are an established means of improving health outcomes and reducing healthcare costs among persons living with chronic disease. Care management is one such approach that requires providers to monitor their respective patient panels and intervene on patients requiring care. Health information technology (IT) has been established as a critical component of care management and similar care models. While there exist a plethora of health IT systems for facilitating primary care, there is limited research on their ability to support care management and its emphasis on monitoring panels of patients with complex needs. In this dissertation, I advance the understanding of how computational methods can better support clinicians delivering care management, and use the management of human immunodeficiency virus (HIV) as an example scenario of use. The research described herein is segmented into 3 aims; the first was to understand the processes and barriers associated with care management and assess whether existing IT can support clinicians in this domain. The second and third aim focused on informing potential solutions to the technological shortcomings identified in the first aim. In the studies of the first aim, I conducted interviews and observations in two HIV primary care programs and analyzed the data generated to create a conceptual framework of population monitoring and identify challenges faced by clinicians in delivering care management. In the studies of the second aim, I used computational methods to advance the science of extracting from the patient record social and behavioral determinants of health (SBDH), which are not easily accessible to clinicians and represent an important barrier to care management. In the third aim, I conducted a controlled experimental evaluation to assess whether data visualization can improve clinician’s ability to maintain awareness of their patient panels.

No description available.

Multiple chronic conditions (MCCs) are defined as two or more health conditions, each requiring treatment and limiting activities for a year or more. In the United States (US), MCCs are more common and costly than any individual chronic condition. The number of adults aged 65 years and older with MCCs is projected to nearly double between 2020 and 2050. Patients with MCCs often experience poor self-reported health and negative symptoms. In addition, they frequently visit emergency departments (EDs) and are hospitalized. Patients with MCCs need ongoing primary care services to manage their symptoms and prevent health deterioration. However, over 20% of the US population (many of whom have MCCs) resides in a primary care Health Professional Shortage Area (HPSA) and experiences poor access to primary care. The growing nurse practitioner (NP) workforce, which is projected to almost double in size between 2018 and 2030, can help meet the demand. Most NPs are trained to diagnose, treat, and manage chronic conditions and can provide a scope and quality of primary care comparable to physicians in many populations. Therefore, if distributed and supported strategically, the NP workforce can meet the complex care needs of patients with MCCs, especially in HPSAs. Maximizing the potential of the NP workforce to deliver MCC care will require enhanced care environments in the practices where NPs work, characterized by administrative support for NP care delivery and autonomous practice, collegial relationships between NPs and physicians, and NP professional visibility. On the other hand, poor NP care environments can negatively affect the quality of chronic disease care. Thus, improving the NP care environments within practices may increase the capacity of the NP workforce to care for MCC patients. Despite the potential of the NP workforce to meet the need for primary care among patients with MCCs, little is known about the impact of NP-delivered primary care models on outcomes in this population. Furthermore, the impact of HPSA status and NP care environments on NPs’ ability to care for patients with MCCs remains poorly understood. Thus, the overall purpose of this dissertation is to produce evidence on NP-delivered primary care models for patients with MCCs and examine the interplay between practice and community factors in shaping outcomes for these patients. In chapter 1, we introduce the unique healthcare needs of patients with MCCs, and the role of NPs in delivering and expanding access to care. In chapter 2, we synthesize the existing evidence on the effect of NP primary care models, compared to models without NP involvement, on cost, quality, and service utilization by patients with MCCs. Our synthesis suggests that NP-delivered primary care has similar or better impacts on outcomes among patients with MCCs compared to care delivered without NP involvement. In chapter 3, we perform secondary data analysis using multiple linked data sources including 1) patient data from the Medicare claims of 394,424 older adults with MCCs, 2) NP survey data on practice characteristics from 880 NPs at 779 primary care practices across five US states, and 3) data on HPSA status of the practice locations from the Health Resources and Services Administration. We examine differences in hospitalization and ED use among patients who receive care from NP practices in HPSAs compared to those in non-HPSAs. We find a higher likelihood of ED use among patients receiving care in NP practices located in HPSAs compared to practices in non-HPSAs, and no difference in the likelihood of being hospitalized. Our results suggest that relieving provider shortages may reduce ED use by MCC patients in HPSA practices that employ NPs, but may be insufficient to lower hospitalization rates unless combined with other interventions. Finally, in chapter 4, we analyze the same linked secondary data source as in chapter 3 to examine the effect of the NP care environment (measured by the NP survey) on the relationship between the HPSA status of the practice location and ED or hospital use among patients with MCCs. We find that the NP care environment moderates the association between primary care provider shortage areas and hospitalization but not ED use. Further analysis reveals that improved NP care environments have a more pronounced association with lowered odds of hospitalization among patients receiving care from practices located in areas with no shortage of primary care providers (i.e., non-HPSAs) compared to those receiving care in practices with provider shortages (i.e., HPSAs). Our findings suggest that improving the care environment may not have the effect of reducing MCC patients’ need for hospitalization unless sufficient providers are also available to care for patients. We suggest that cohesive solution sets addressing practice- and community-level interventions simultaneously may be needed to improve hospitalization outcomes for patients with MCCs. In the concluding chapter of this dissertation, chapter 5, we present a summary of findings, discuss the dissertation’s strengths, limitations, and its contributions to science. In this chapter, we also discuss implications for policy, practice, and directions for future research.

According to the Ministry of Health (1996:26), the most common chronic/terminal illnesses were cardiovascular disorders, diabetes, cancer, mental disorders, HIV/AIDS, tuberculosis and asthma. Long term treatment and care and the growing incidence of these conditions necessitated the introduction of home-based care (HBC). Consequently, family care givers play a major role in the provision of care to chronically/terminally ill patients and professional health care providers adopt a supervisory role. This study examined the quality of home care services provided in Botswana. The availability and accessibility of home-based care services and resources have a direct bearing on the quality of home-based care delivery system. The researcher used systems theory was used as the conceptual framework for this study. The study aimed to • determine the accessibility and availability of home-based care services in Molepolole East • investigate what the perspectives and experiences of family care givers, patients and professional health care providers of Botswana home-based care are • determine the roles of professionals health care providers, patients, and family care givers and their relationships in the context of home- based care • identify the needs of chronically/terminally ill patents and family care givers • determine the type of support given to family care givers and patients by professional health care providers and make recommendations for the improvement of home-based care • develop a model to prepare family care givers The research design combined quantitative and qualitative research methods. A sample of convenience was used to obtain information from patients' family care givers and professional health care providers. Interviews and questionnaires were used. A proposed care giving preparedness model is presented to meet needs of the family care givers. The study found that family care givers needs are neither known nor catered for by the professional health care provider. The family care givers were not adequately prepared before adopting the care-giving role. It is recommended that • The proposed preparedness care giving training model is considered for training of patients and family care givers before discharge and during HBC. • Increase patients and family care givers decision-making / Health Studies / D.Litt. et Phil. (Health Studies)

Wild foods are an integral component of the household food basket, yet their quantified contribution to food security relative to other sources in the context of HIV/AIDS, climate change and variability remains underexplored. This study was carried out in Willowvale and Lesseyton which are rural communities in the Eastern Cape province of South Africa. Willowvale is a relatively remote, medium-rainfall coastal community, while Lesseyton is a peri-urban low rainfall inland community. Qualitative and quantitative methods were used to collect data from 78 HIV/AIDS afflicted households with 329 individuals and 87 non-afflicted households with 365 individuals in the two study sites. Households were visited quarterly over 12 months to assess food acquisition methods, dietary intake and quality, and levels of food security, and to determine strategies employed by households to cope with droughts. The wild foods investigated were wild meat, wild birds, wild fish, wild mushrooms, wild leafy vegetables and wild fruits. Diets were moderately well-balanced and limited in variety, with cereal items contributing 52 % to total calorie intake. Mid-upper arm circumference measurements showed that all respondents were adequately nourished. The bulk of the food consumed by households was purchased, with supplementation from own production, wild vegetables and wild fruits. In Willowvale, wild vegetables comprised 46 % of overall vegetable consumption for afflicted households and 32 % for non-afflicted households, while own fruit production comprised 100 % of fruit consumption. In Lesseyton, wild vegetables comprised only 6 % and 4 % of vegetable consumption for afflicted and non-afflicted households, while wild fruit comprised 63 % and 41 % for afflicted and non-afflicted households. More than 80 % of respondents from both afflicted and non-afflicted households had sufficient daily kilocalories, although the majority of afflicted households felt they were food insecure and sometimes collected wild foods as one of their multiple coping strategies. Hunting and gathering of wild foods was associated with site, household affliction status, gender, age and season. More than 80 % of respondents ate wild vegetables and said they were more drought tolerant than conventional vegetables, making them the most consumed wild food and approximately 16 % of respondents ate wild birds, making them the least consumed wild food. Approximately 14 % of respondents from afflicted households in Willowvale sold wild fish, whilst 34 % of respondents from afflicted households and 7 % from non-afflicted households sold wild fruits in Lesseyton. Strategies adopted by households to cope with droughts were different between the two study sites, and households in Willowvale used a wider range of strategies. Given the devastating effects of HIV/AIDS coupled with the drawbacks of climate change and variability on food security, wild foods represent a free and easy way for vulnerable households to obtain food.