The purpose of this study was to explore and describe the determinant factors affecting adherence to antiretroviral therapy among HIV infected patients in Addis Ababa, Ethiopia. A cross-sectional study design was used and data were collected by interviewing 290 study participants from two health facilities using structured questionnaire. The research finding revealed 80.0% of the study participants had optimal combined adherence to dose, schedule and dietary instructions in the past three days. And, the non adherence rate was 20.0%. In multivariate analysis only WHO clinical stage, change of ARV medication, knowledge about HIV disease and ART, and use of reminders were found to be independently associated with adherence to antiretroviral therapy. The most common reasons for missing HIV medications in the past one month were forgetfulness (35.1%), being busy with other things (17.5%), and running out of pills (10.5%). Adherence improving interventions should be emphasized to address multi-faceted problems. This study recommends setting of convenient appointment schedule, disclosure of one's HIV status, maintaining confidentiality of patient-related information, enhancing patient-provider relationship, use of reminders including SMS text messages, and engagement of PLHIV in adherence improving interventions through peer support, and providing regular health education to the PLHIV to improve adherence of patients to ART / Health Studies / M.A. (Public Health)

Thesis (MTh)--Stellenbosch University, 2011. / ENGLISH ABSTRACT: This study is about the missional challenge of the HIV/AIDS pandemic to the leadership of the Kwazakhele congregation in Port Elizabeth, South Africa. This undertaking should be dealt with from the premise of a practical theological point of view. In this context, the HIV/AIDS pandemic aggravates the plight of those in the community with the least resources, i.e. orphans and the destitute. Very limited resources, for example financial, psychological and spiritual, are available to them. This has severely impacted on the lives of South Africans across the country. And, this impact of HIV/AIDS is being felt at all levels of the society with its ever-increasing cases of infections, deaths, rejections, stigmatization, number of orphans and households headed by children. This social reality poses a burden on ministerial health budgets, thus a dilemma for health resources. Through her leadership, the Church, as an instrument and field for the Triune God‟s missional praxis, is called to respond and act upon this plight. In that sense, a clear understanding of the missional Church is central in this theological and practical undertaking. The Kwazakhele leadership's empowerment will enable them to lead the congregation in a faithful response to the HIV/AIDS pandemic while taking cognizance of appropriate theological reflections that relate to the Triune God's salvific work. In essence, the researcher intends to investigate how the congregation of the Kwazakhele Uniting Reformed Church of South Africa (URCSA) can combat and deal with HIV/AIDS in a compassionate Christian manner while taking cognizance of biblical imperatives. In that respect, the researcher has been engaged with interviews of families in the Kwazakhele congregation, members of whom had died of AIDS. The objective was to shed light on their experiences and to determine whether the Church is doing enough to support their members regarding this pandemic. Furthermore, this research also challenges the Kwazakhele congregation, in particular, whether she fulfills her calling, that is, crosses the boundaries to take care of the plight that the community faces regarding HIV/AIDS. In actual fact, the discernment of God's will is possible by a critical and sensitive leadership who should determine whether the congregation whom they serve is competent enough to deal with this HIV/AIDS pandemic, or not. This, indeed, challenges their Christian consciences. The researcher believes that the information and the resource material, as well as the institution to which he referred, will be of assistance to the Christian leadership of the Kwazakhele congregation and also the entire URCSA congregation at large. / AFRIKAANSE OPSOMMING: Die fokus van hierdie studie is die missionêre uitdaging van die MIV/VIGS pandemie aan die leierskap van die Kwazakhele gemeente in Port Elizabeth. Die studie word onderneem vanuit die gesigspunt van die Praktiese Teologie. Binne hierdie konteks, vererger die MIV/VIGS pandemie die lot van diegene in die gemeenskap met die minste bronne, naamlik die weeskinders en hulpbehoewendes. Baie min bronne (sielkundig, finansieel en spiritueel) is beskikbaar vir hulle. Die impak op die lewens van Suid-Afrikaners landswyd is drasties. Daar is toenemende sterftes, verwerping, stigmatisering en weeskinders, asook kinders aan die hoof van huishoudings. Hierdie maatskaplike werklikheid plaas groot druk op die nasionale gesondheidsbegroting. Die kerk, as instrument en lokus vir die missionêre praksis van die drieënige God, is geroepe om op te tree en hierdie haglike toedrag van sake aan te spreek deur haar leiers. 'n Duidelike verstaan van wat 'n missionêre kerk is, staan sentraal in hierdie teologiese en praktiese onderneming. Bemagtiging van die leierskap in die Kwazakhele gemeente sal hulle in staat stel om die gemeente te lei om getrou te wees aan hulle roeping om die MIV/VIGS pandemie aan te spreek. Terselfdertyd moet hulle ook bewus wees van toepaslike teologiese nadenke oor die drieënige God se ingrype om Sy reddened genade te laat realiseer. Die navorser poog dus om te ondersoek hoe die Kwazakhele Verenigende Gereformeerde Kerk (VGK) die MIV/VIGS pandemie kan teëwerk en daarmee op 'n barmhartige Christelike wyse kan handel, en voortdurend bewus wees van Bybelse imperatiewe in hierdie verband. Die navorser het ook onderhoude gevoer met familielede van persone wat as gevolg van VIGS gesterf het ten einde, aan die hand van hulle ondervindinge, vas te stel of die Kerk genoeg doen om lidmate te ondersteun ten tyde van hierdie pandemie. Hierdie navorsing is ook 'n uitdaging aan die Kwazakhele gemeente om te bepaal of sy haar roeping vervul, grense oorsteek, en omgee vir 'n gemeenskap in nood. Onderskeiding van God se wil is moontlik deur kritiese en sensitiewe leierskap wat moet bepaal of die gemeente, waarin hulle dien, in staat is om genoegsaam aandag aan die MIV/VIGS pandemie te skenk. Hierdie oefening daag hul Christelike gewete uit. Die navorser is van mening dat die inligting en navorsingsmateriaal, asook die instelling waarna verwys word, die Christelike leierskap van die Kwazakhele gemeente, sowel as hele VGKSA, van hulp kan wees.

Each year approximately 600 000 infants, most of them in Sub-Saharan Africa are born with HIV infection as a result of mother to child transmission of HIV. Whereas significant progress has been made in reduction of mother to child transmission of HIV in developed countries, the situation remains desperate in developing countries. Progress has been hampered by shortage of staff, facilities, limited access to voluntary counselling and testing and lack of support for women by their partners and communities. The challenge is to increase voluntary counselling and testing uptake during antenatal care. Onandjokwe district in Northern Namibia is currently introducing the Prevention of Mother to Child Transmission Program (PMTCT). It has been found the previous PMTCT programs have failed because they adopted a top down approach where there was no community consultation. This study was conducted to explore the community perceptions, knowledge and attitudes regarding mother to child transmission of HIV through focus group discussions and in-depth interviews of key community members.

Chaque année 330 000 (dont 300 000 en Afrique) nouvelles infections à VIH surviennent chez les moins de quinze ans – majoritairement par un mécanisme de transmission verticale d’une mère infectée à son enfant. Pourtant, des interventions efficaces pour réduire la transmission mère-enfant (TME) existent mais ne sont pas toujours disponibles en pratique de routine pour les femmes qui en ont besoin. L’agenda international en cours vise une élimination de l’infection pédiatrique de VIH – et le maintien des mères en vie – à l’horizon 2015. A la lumière de la crise économique mondiale, il apparait opportun de pouvoir juger du montant de ressources nécessaires à la réalisation de cet objectif. Ce travail de thèse dresse le panorama du mode de délivrance des interventions pour la prévention de la TME (PTME) et de la prise en charge des enfants infectés par le VIH dans cinq pays à ressources limitées que sont la Chine, la Côte d’Ivoire, la Namibie, le Rwanda et l’Ukraine. Il apporte une estimation de leur coût et renseigne sur leur efficacité et leur caractère abordable. En outre, une estimation du coût de l’implémentation de potentiels scénarios de passage à échelle des interventions est apportée ; la mesure du nombre de cas (et de décès) non évités sur la période de projection permet de se rendre compte du coût de l’inaction. Enfin, sont discutés deux obstacles majeurs à la diffusion des services de PTME que sont le contexte politique ambiant et l’organisation de l’offre de soins (contrainte en ressources humaines qualifiées notamment). / A decade into the implementation of prevention of mother-to-child HIV transmission (PMTCT) programs, countries are making impressive progress towards fulfilling global commitments and achieving global goals. However, achieving a generation free from HIV will entail sustained effort and commitment in the coming years and estimating the cost of this work is fundamental. In light of the global economic downturn, reliable and up-to-date information on the costs of the dedicated services is needed to estimate the amount of additional resources required to scale up those services within the context of the Millennium Development Goals, and to assist resource-limited countries, external funders and multilateral agencies in planning, identify cost drivers and areas of potential savings. This work pursued the aims (1) to produce a reliable estimation of the costs associated with PMTCT services in five low- and middle-income countries, and (2) to ascertain the range and median unit costs needed for scaling up these services across a prevention, treatment and care continuum. Countries were selected given three key criteria related to their economic level and health spending, the national HIV epidemic status and typology, and the coverage of their maternal, neonatal and child health (MNCH) and PMTCT programs. Data were collected in Cote d’Ivoire, China, Namibia, Rwanda, and Ukraine using a health-care provider perspective from October 2009 to April 2010. In-country samples were designed to reflect publicly funded MNCH facilities that were delivering a define range of PMTCT and pediatric HIV services. The package includes HIV testing and counseling, male partner testing, CD4 testing, antiretroviral prophylaxis provision, community-based activities, HIV-exposed infant prophylaxis, and 2-year post-partum family planning. Additional information on prices and volume of services was collected from national government bodies, international donor partners, and non-governmental organizations. Cost data were then analyzed using a bottom-up approach of "micro-costing" where costs are calculated by identifying the actual resources used for each patient. Primary outcomes are costs per specific end-users and nation-wide total program costs, subdivided by major cost categories. After that, we simulated the expected costs over time according to a scale-up analysis estimating the costs needed to increase service coverage under various scenarios of coverage and antiretroviral protocols. These scenarios are incremental in their content: each subsequent scenario adds components and costs to the previous one. Future costs are discounted at a 3% rate. The affordability of each scenario (compared to the previous one) was concomitantly examined through the generation of incremental cost effectiveness ratios. The cost of inaction, measured in both terms of cases non-averted and deaths non-avoided throughout the scaling-up period, was ultimately assessed.

Nos últimos anos o tratamento da infecção crônica pelo HCV passou por importantes mudanças. Recentes avanços em biologia molecular proporcionaram o melhor conhecimento sobre a estrutura molecular do HCV e permitiram o desenvolvimento de moléculas que tem como alvo proteínas específicas integrantes do ciclo replicativo do vírus, denominados agentes antivirais de ação direta (DAAs). No Brasil, atualmente, os DAAs aprovados para o tratamento da Hepatite C são: Simeprevir (2ª geração de inibidor de protease), Daclatasvir (inibidor de NS5A) e o Sofosbuvir (inibidor análogo nucleotídeo de polimerase). A combinação dessas diferentes classes de DAAs permite maior eficácia no tratamento do HCV, reduz a duração do tratamento e o risco da emergência de resistência. Ao mesmo tempo em que o desenvolvimento de DAAs promete melhorar a chance de sucesso do tratamento dos pacientes crônicos infectados pelo HCV, a emergência de variantes associadas à resistência representa um grande desafio ao sucesso da terapia antiviral atualmente proposta e informações sobre a presença dessas mutações ainda são escassas. Este estudo tem como objetivo o mapeamento de variantes associadas à resistência (RAVs) primárias aos inibidores da polimerase (NS5B) do HCV em pacientes monoinfectados (HCV) e em pacientes coinfectados (HCV/HIV). Para tal, o rastreamento de substituições de aminoácidos foi realizado entre as posições 159 e 495 da proteína NS5B do HCV nas sequências de 244 pacientes infectados pelo HCV-1: 133 monoinfectados [1b (n=93); 1a (n=40)] e 111 coinfectados [1a (n=93); 1b (n=18)]. A ocorrência natural de RAVs nos resíduos S282, L320 e P495 não foi observada nas sequências analisadas neste estudo. As RAVs encontradas no grupo de monoinfectados foram: L159F (16,1% - 1b), C316N (16,3% - 1b) e A421V (21,4% - 1a; 3,2 - 1b) ; e no grupo de coinfectados foram: C316N (7,1% - 1b), V321A (1,6% - 1a), M414V (1,3% - 1a); A421V (23,7% - 1a; 6,3% - 1b), A421G (1,3% - 1a); Y448H (1,3% - 1a). Entre os pacientes monoinfectados, a região NS5B do HCV-1a apresentou menor número de variantes associadas à resistência (RAVs) quando comparada ao subtipo 1b, ao contrário do observado nos coinfectados. A variante C316N foi a única que ocorreu em combinação com outras variantes. Houve a ocorrência concomitante das variantes L159F e C316N em 8 pacientes monoinfectados pelo HCV-1b (8/56; 14,3%). Entre os coinfectados, foi observada a ocorrência concomitante das variantes C316N e A421V em apenas 1 paciente infectado pelo HCV-1b (1/14; 7,1%). A presença de RAVs foi detectada nas duas populações estudadas neste estudo. Contudo, outros estudos são necessários para que se possa avaliar o real impacto dessas mutacões na resposta ao tratamento / The treatment of chronic HCV infection has undergone important changes recently. Advances in molecular biology provided a better knowledge of the HCV molecular structure and allowed the development of molecules which target specific proteins that have important roles in the viral replicative cycle, known as direct action antiviral agents (DAAs). In Brazil, DAAs approved for treating hepatitis C are Simeprevir (2nd generation protease inhibitor), Daclatasvir (NS5A inhibitor) and sofosbuvir (nucleotide analogue NS5B polymerase inhibitor). The combination of these different DAAs classes leads to a greater efficacy in the treatment of HCV, reducing its duration and the risk of resistance associated variants (RAVs) emergence. DAAs increase the chance of successful treatment of HCV chronic infected patients. RAVs emergence represents a major challenge to the success of antiviral therapy. Nevertheless, data about the presence of these mutations are still scarce. The aim of this study was to verify the presence of primary RAVs associated to HCV polymerase inhibitors primary resistance in monoinfected (HCV) and coinfected (HCV / HIV) patients. For this purpose, amino acid substitutions identification was conducted between positions 159 and 495 of the HCV NS5B protein in the sequences of 244 patients with HCV-1: 133 monoinfected [1a (n=40); 1b (n=93)] and 111 coinfected [1a (n=93); 1b (n=18)]. Naturally occurring RAV in S282, L320 and P495 residues were not observed among the sequences analyzed in this study. RAVs found in monoinfected patients were L159F (16.1% - 1b), C316N (16.3% - 1b) and A421V (21.4% - 1a; 3.2% - 1b); while in co-infected group, the following RAVs were identified: C316N (7.1% - 1b), V321A (1.6% - 1a), M414V (1.3% - 1a); A421V (23.7% - 1a; 6.3% - 1b), A421G (1.3% - 1a); Y448H (1.3% - 1a). Among monoinfected patients, HCV-1a NS5B region showed fewer RAVs when compared to HCV-1b, conversely to what was observed in HIV coinfected patients. Variant C316N occurred in combination with other ones: there was the simultaneous occurrence of L159F and C316N variants 8/56 (14.3%) 8 HCV-1b monoinfected patients Among the coinfected patients, it was observed concomitant occurrence of C316N and A421V variant in only 1/14 (7.1%) HCV-1b infected patient. RAVs were detected in both HCV and HCV/HIV infected populations in this study. Further studies are required to assess the real impact of these changes in response to treatment

Avanços recentes nos conhecimentos sobre a infecção viral e AIDS tem levado pacientes soropositivos a uma melhor qualidade de vida. A determinação de quais populações celulares ou qual mecanismo imunológico seja mais relevante para instalação da epidemia conduz a novos patamares de possibilidades de novas drogas antiretrovirais e tratamento mais eficientes. O uso de modelagem matemática, para a epidemiologia, correlaciona indivíduos (neste caso células) e doença (o vírus) através de equações diferenciais, onde se quer observar as condições necessárias para a instalação ou não da doença. Neste trabalho, observou-se através das simulações, que o componente mais importante, depois do linfócito TCD4+, é a célula macrófago (por ser um reservatório de proliferação viral), que a infecção ocorre várias vezes ao longo do tempo (devido o processo de apresentação de antígenos) e que os linfócitos CTL são ineficientes em erradicar a infecção pelo vírus HIV-1, que pode ser um simples fenômeno de co-adaptação. / Recent advances in knowledge about the viral infection and AIDS seropositive patients has led to a better life quality. The determination of what people or cellular immune mechanism which is more relevant for the epidemic installation leads to new levels of possibilities to new antiretroviral drugs discovers and more efficient treatment. Mathematical modeling use on epidemiology, correlates individuals (this case cells) and illness (the virus) through differential equations, where want to observe the conditions necessary to the installation or not the disease. In this study, it was observed through simulations, that the most important component, after lymphocyte CD4 T cells, macrophages is the cell (as a reservoir of viral proliferation) that the infection occurs repeatedly over time (because of the antigen presenting process) and CTL lymphocytes are inefficient in eradicating the infection by HIV-1, which may be a simple phenomenon of co-adaptation.

<p>Aim: To establish whether a family centered approach to HIV care in which HIV positive adults are counseled on the importance of having their children tested results in the adults bringing their children under the age of five years for testing and or accessing HIV care, and to explore challenges faced by caregivers in bringing children for testing and care.</p>

<p>Aim: To establish whether a family centered approach to HIV care in which HIV positive adults are counseled on the importance of having their children tested results in the adults bringing their children under the age of five years for testing and or accessing HIV care, and to explore challenges faced by caregivers in bringing children for testing and care.</p>

Each year approximately 600 000 infants, most of them in Sub-Saharan Africa are born with HIV infection as a result of mother to child transmission of HIV. Whereas significant progress has been made in reduction of mother to child transmission of HIV in developed countries, the situation remains desperate in developing countries. Progress has been hampered by shortage of staff, facilities, limited access to voluntary counselling and testing and lack of support for women by their partners and communities. The challenge is to increase voluntary counselling and testing uptake during antenatal care. Onandjokwe district in Northern Namibia is currently introducing the Prevention of Mother to Child Transmission Program (PMTCT). It has been found the previous PMTCT programs have failed because they adopted a top down approach where there was no community consultation. This study was conducted to explore the community perceptions, knowledge and attitudes regarding mother to child transmission of HIV through focus group discussions and in-depth interviews of key community members.

Avanços recentes nos conhecimentos sobre a infecção viral e AIDS tem levado pacientes soropositivos a uma melhor qualidade de vida. A determinação de quais populações celulares ou qual mecanismo imunológico seja mais relevante para instalação da epidemia conduz a novos patamares de possibilidades de novas drogas antiretrovirais e tratamento mais eficientes. O uso de modelagem matemática, para a epidemiologia, correlaciona indivíduos (neste caso células) e doença (o vírus) através de equações diferenciais, onde se quer observar as condições necessárias para a instalação ou não da doença. Neste trabalho, observou-se através das simulações, que o componente mais importante, depois do linfócito TCD4+, é a célula macrófago (por ser um reservatório de proliferação viral), que a infecção ocorre várias vezes ao longo do tempo (devido o processo de apresentação de antígenos) e que os linfócitos CTL são ineficientes em erradicar a infecção pelo vírus HIV-1, que pode ser um simples fenômeno de co-adaptação. / Recent advances in knowledge about the viral infection and AIDS seropositive patients has led to a better life quality. The determination of what people or cellular immune mechanism which is more relevant for the epidemic installation leads to new levels of possibilities to new antiretroviral drugs discovers and more efficient treatment. Mathematical modeling use on epidemiology, correlates individuals (this case cells) and illness (the virus) through differential equations, where want to observe the conditions necessary to the installation or not the disease. In this study, it was observed through simulations, that the most important component, after lymphocyte CD4 T cells, macrophages is the cell (as a reservoir of viral proliferation) that the infection occurs repeatedly over time (because of the antigen presenting process) and CTL lymphocytes are inefficient in eradicating the infection by HIV-1, which may be a simple phenomenon of co-adaptation.