Thesis (M. Tech. (Biomedical technology)) - Central University of technology, Free State, 2013 / INTRODUCTION: The renal effects of Tenofovir Disoproxil Fumarate (TDF) and antiretroviral treatment (ART) outcomes remain under-reported in African settings. The study sought to assess immunological outcomes and to compare renal function outcomes between patients exposed to TDF and unexposed patient group. METHODS: Phase 1 of the study was a retrospective case control analysis of serum creatinine data for 312 ART naïve adult patients exposed to TDF and 173 unexposed patients enrolled on ART between Dec 2006 and Jan 2011 at Roma Health Service Area in Lesotho. Sub-optimal renal function outcomes were serum creatinine clearance values <50 ml/min calculated using the Cockcroft-Gault equation. Phase 2 was based on re-sampling of the study population and analysis of CD4 counts of 516 adult naïve HIV-positive patients. Univariate logistic regression (p<0.1) and multivariate analyses (p<0.05) were performed using STATA® version 11 software. RESULTS: Overall, 153 (31.5%) patients had moderate baseline (30-60 ml/min) renal insufficiency. Renal function improved by +2 ml/min at 24 months. Almost 18% (n=312) of the patients on TDF were erroneously put on TDF. The use of TDF was a marginally significant factor (p=0.054) associated with CrCl<50 ml/min outcomes in univariate analysis but was insignificant (p=0.122) in multivariate analysis. Female gender (p=0.016), high blood pressure (p=0.009), ages over 60 (p=0.004), and underweight (p<0.001) were significantly associated with CrCl<50 ml/min outcomes. The proportion of patients who developed immunological failure in this study was low (6.8%, n=516). The mean CD4 count increased significantly after treatment (p<0.001). Baseline CD4 count below 50 cells/mm3 (p=0.049) and male gender (p=0.005) were significantly associated with sub-optimal immunological outcomes. CONCLUSIONS: TDF is a weak contributing factor associated with renal impairment outcomes compared to other variables such as hypertension, older age, underweight and female gender. More research on long term effects of TDF is recommended. Baseline renal function screening should be improved to minimise leakages of patients contraindicated of TDF. Although the patients’ immunological status generally improved, males and patients with low baseline CD4 counts should be monitored closely while on ART.

The purpose of this study was to evaluate the antiretroviral therapy program in primary health care settings in Lesotho. Mixed methods research using a convergent parallel mixed methods design was used to collect both quantitative and qualitative data which were analysed during the same phase of the research process. Two groups of participants participated in the study, the registered nurse group was composed of registered nurses/midwives/nurse clinicians involved in ART service provision and the second group was composed of adults aged 18 years and older who were HIV/AIDS positive. Quantitative data had a compliance rate of 92% and it were analysed using SPSS (23). Qualitative data were analysed using constant comparison analysis and seven themes, fourteen categories and twenty two sub-categories emerged from the data analysis. Findings of the study revealed that the majority of PHC facilities were staffed by registered nurse midwives and nurse clinicians who were qualified, confident, knowledgeable and competent in the execution of duties. Generally there were a large number of patients that sought ART services which were offered on a weekly basis although there was variation in the actual number of days the services were provided. The time patients spent seeking ART services varied across the facilities and ARVs and other drugs were usually available. Challenges in the delivery of ART services included unsatisfactory staffing resulting in the provision of inadequate services and work overload, lack of knowledge of some patients, use of incentives by some partners and too many partners being involved in ART, inadequate documentary evidence and stigma pertaining to the HIV status of individuals. Furthermore, ARVs were reported to make patients feel hungry hence resulting in lack of satisfaction in ART services, ART services were inadequate due to dysfunctional equipment and some patients had been lost due to inability to screen for cancer and there was incomplete monitoring and evaluation of the ART program. However, participants in this study generally showed their acknowledgement of the ART services as they generally improved their health status despite the many challenges that were being faced. / Health Studies / D.Litt.et Phil. (Health Studies)

As the Human Immunodeficiency Virus (HIV) prevalence rises, uninfected Basotho face an increased risk of exposure. This necessitates strengthening of strategies that prevent exposure, and where exposure has occurred, measures that prevent infection. One such measure is Human Immunodeficiency Virus (HIV) Post-Exposure Prophylaxis (PEP). Awareness and knowledge of HIV PEP is therefore of paramount importance. The purpose of this study was to assess knowledge, attitudes and utilisation of HIV PEP among adults in Roma, Lesotho. A quantitative cross-sectional study was conducted among 96 adult outpatients at St Joseph’s Hospital. Data were collected by means of structured questionnaire and analysed using SPSS version 23.0. Results were presented using charts and tables. Awareness of HIV PEP among the respondents was found to be very low and for most respondents’ knowledge of HIV PEP was either non-existent or very poor. Utilisation was also found to be very low. Attitudes towards HIV PEP were, however, found to be favourable. More studies should be conducted throughout the country to further explore Basotho’s knowledge, attitude and use of HIV PEP. / Health Studies / M.A. (Nursing Science)