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Virological failure among adult HIV positive patients three years after starting antiretroviral treatment at Mankweng Hospital, Limpopo Province, RSALekoloana, Matome Abel January 2014 (has links)
Thesis (MPH.) --Univesity of Limpopo, 2014 / Background: The main goal of HAART is to achieve maximal viral suppression. However, with poor adherence to therapy the chances of achieving and maintaining successful viral suppression are decreased, leading to virological failure. And virological failure has been recognized by WHO as one of the early warning signs of drug resistance. This operational research sought to explore virological failure as a treatment outcome to evaluate program performance at a facility level.
Methods: Purposive sampling as per inclusion and exclusion criteria was used to retrospectively review clinical records of the first 700 adult HIV positive patients (350 males and 350 females) who initiated antiretroviral treatment between April 2004 and December 2007 at this adult HIV clinic, were followed up for at least 3 years and treated according to the South African government’s National Department of Health 2004 HIV treatment guidelines for adults and adolescents.
Major Results: 268 clinical records, 97 (27.71%) male and 171 (58.86%) female records were eligible for inclusion in the study. The proportion of females was higher (63.8%) than males (32.8%) with an average age of 38.95 years. 24 (8.9%) patients in the study sample experienced virological failure during the study period; 11 (11.3%) males and 13 (7.6%) females. Two-thirds (66.6%) of patients who failed to suppress at their first viral load measurement proceeded to develop virological failure. Overall, there was no association of statistical significance between age, sex, baseline CD4 cell count and baseline regimen, and virological failure at various intervals, p> 0.05.
Conclusion: It was a challenge to keep patients in care but those that remained in care had good treatment outcomes with only 8.9% developing virological failure. Failure to suppress at first viral load preceded virological failure in the majority of patients.
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Factors affecting the adherence to atiretroviral therapy by HIV positive patients treated in a community based HIV/AIDS care programme in rural Uganda : a case in Tororo districtSendagala, Samuel 11 1900 (has links)
Health Studies / (M.P.H. (Health Studies))
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Investigating the effects of haart on early markers of cardiovascular disease among HIV-positive patients in the Mankweng District, Limpopo ProvinceHanser, Sidney January 2021 (has links)
Thesis (Ph.D. (Physiology and Environmental Health)) -- University of Limpopo, 2021 / Background: Human immunodeficiency virus (HIV)-infection remains a major public
health burden where approximately 38 million people are affected globally. Human
immunodeficiency virus infection is associated with chronic inflammation which can
lead to endothelial dysfunction and thrombosis, which are precursor events for cardiometabolic
abnormalities such as dysglycaemia and dyslipidaemia. The degree of
chronic inflammation, endothelial dysfunction, and hypercoagulation among HIVpositive
adults on highly active antiretroviral therapy are not well understood in Sub-
Saharan Africa. The objective of this study was to determine the effect of highly active
antiretroviral therapy (HAART) on chronic inflammation, endothelial dysfunction, and
hypercoagulation among HAART-exposed adult South African participants in a rural
setting.
Aim: The study aimed to determine the effects of HAART on early biomarkers of
cardiovascular disease in the HIV-positive subjects.
Methods: The study was cross-sectional, descriptive, and quantitative in design. The
research population consisted of 158 participants of males and females within the age
range of 18 – 81 years from Mankweng Hospital and surrounding clinics. The study
population comprised of three groups, HIV-negative (control group), HIV-positive
treatment naïve (HAART-naïve group), and HIV-positive participants on HAART
(HAART-exposed group). Weight and height were measured using Omron BF 400 and
a portable stadiometer respectively, to calculate the body mass index. Glucose and
lipid levels were determined on Cobas® Integra 400 plus auto-analyser. The CD4+ T
cell count was determined on the Cytomics FC500 Flow Cytometer Multi-Platform
loader. The concentration of fibrinogen, c-reactive protein (CRP), L-selectin, D-dimers,
P-selectin, von Willebrand factor (VWF), soluble intercellular adhesion molecule
(sICAM-1), and soluble vascular cell adhesion molecule (sVCAM-1) in serum samples
were determined on the Luminex 200TM. Data were analysed using SPSS version
25.0. Descriptive statistics were performed on all variables and analysis of covariance
was used to determine differences across all groups. Correlation coefficients and
multiple regression analyses were used to determine associations.
Results: Body mass index (BMI) and glucose metabolism were not significantly
affected by HAART exposure. However, the HAART-exposed group had significantly
increased LDL-C (F (2, 154) = 7.501, p = 0.001) and TC (F (2, 154) = 9.174,
0.0002) levels. The prevalence of high LDL-C levels was significantly elevated in the
HAART-exposed group (29.6%) (p = 0.041). The prevalence of pre-diabetes (11.3%)
was the highest among the HAART-exposed group (non-significant), although, no
significant difference was observed. While P-selectin was significantly reduced in the
HAART-exposed group (F (2, 154 = 7.253, p = 0.001). On the other hand, the HAARTexposed
group also significantly increased VWF (F (2, 154 = 4.556, p = 0.011). The
HAART-exposed group showed no significant effect on L-selectin, sICAM-1, sVCAM-
1, CRP, fibrinogen and D-dimer levels. However, D-dimer was negatively associated
with HAART (r = -0.249, p = 0.011). There were significant independent association
between the combined HAART regimens and P-selectin (Std β = 0.219, p = 0.032),
first-line regimen with both P-selectin (Std β = 0.434, p = 0.004) and sVCAM-1 Std β
= 0.328, p = 0.031), second-line regimens with L-selectin (Std β = 1.032, p = 0.005)
and, a positive independent association between first-line regimen and D-dimer (β =
0.741, p = 0.0001). Although BMI and glucose metabolism were not significantly
affected in both the HAART-exposed and HAART-naïve groups, dyslipidaemia was
present across the three groups (HAART-exposed, HAART-naïve and control).
HAART-exposure showed a protective effect by reducing endothelial dysfunction (ED)
and hypercoagulation. Yet, ED was still present among this rural South African
HAART-exposed population. The HAART-exposed group may be at increased risk for
CVD. Therefore, CVD should be regularly monitored in the HAART-exposed
population. / National Research Fund, the Health and
Welfare Sector Education and Training Authority, and the University of Limpopo (UL)
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Adherence to isoniazide prevention therapy in HIV positive patients at Rethabile Community Health Centre Polokwane, Limpopo Province, South AfricaKhan, Mohammad Ishtiaq Hassan January 2017 (has links)
Thesis (M.Med. (Family Medicine)) -- University of Limpopo, 2017 / Objectives: To assess adherence to Isoniazide Prevention Therapy (IPT) among HIV positive patients in Rethabile Community Health Centre in the Capricorn District of the Limpopo Province.
Methods: A cross-sectional study with qualitative and quantitative data collection methods was conducted among HIV positive patients in Rethabile Community Health Centre from January 2013 to December 2013. Consecutive sampling was used to select 90 participants. Adherence was assessed using patient self-rated adherence to IPT, and confirmed by urine tests for isoniazid metabolites. Data was collected using an interviewer administered questionnaire. Information was also obtained from health care works regarding the perception about reason for non- adherence to IPT. Data was analysed using STATA software and thematic analysis.
Results: Self-rated adherence to IPT among the participant was 80% where as urine test was positive for Isoniazid metabolites in 73%. While 84% of participants reported that transportation was the main reason for non adherence, 70% also reported distance from the health care as their main reasons for non-adherence to IPT. However, health care providers reported that many patients do not adhere to treatment due to: Lack of money for transport, missed clinic appointment due to rain and fear of losing jobs, use of traditional medicine, wrong belief about IPT, medicine side effects and alcohol consumption.
Conclusion: Self – rate adherence to IPT was suboptimal and appears over – estimated among study participants. Interventions to improve adherence to IPT must ensure easy access to healthcare facilities, address wrong perceptions and promote healthy social behaviours
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Physicians' transmission prevention assessment and counselling practices with their HIV-positive patientsNdlovu, Richard Vusi January 2002 (has links)
Thesis (M. A. (Clinical Psychology)) --University of the North, 2002 / Refer to the document
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A sociological study on the challenges to treatment adherence in antiretroviral therapy in the Mopani District of the Limpopo ProvinceMona, Tiny Petunia January 2014 (has links)
Thesis (Ph. D. (Sociology)) -- University of Limpopo, 2014. / This study investigated the challenges to antiretroviral therapy adherence. Qualitative and
quantitative research methodologies were applied in the study. Purposive sampling was used
to select clients on antiretroviral therapy, convenience sampling was applied to select clients
who participated in the focus group discussions and health care workers and lay counsellors
were selected through the simple random sampling method. In-depth interviews were
conducted with 31 clients on antiretroviral therapy at 8 health facilities, 2 focus group
discussions comprising of 7 members each were conducted at two health facilities, medical
records of all respondents on antiretroviral therapy were reviewed and a stigma scale was
administered. A questionnaire was distributed amongst 17 health care workers and lay
counsellors.
Most of the respondents who participated in this study were females. Data gathered in this
study confirmed that women are more vulnerable to HIV than men. The majority of the
respondents were poor African people. The predominant language amongst the respondents
was the Xitsonga language; hence the world-view of the Va-Tsonga people was assessed.
HIV and AIDS cause many social problems in communities.
Some of the major findings are that:
Literacy levels were found to be very low as most of the respondents pointed out that they
had only obtained grade 7 or below. However, this did not have an impact on treatment
adherence. Some respondents indicated that they were unemployed; the majority said they
were employed.
Even though the stigma and discrimination experienced by the respondents was very low, the
few who experienced it had very traumatic and cruel experiences perpetrated by their own
family members and people in the community. In terms of disclosure, data indicates that
most people prefer disclosing to their mothers as they feel that they will get support. The
majority of the respondents disclosed to female family members and they were supported by
the people they disclosed to.
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Social support is very crucial for people who are on antiretroviral therapy (ART), most of the
respondents indicated that they had treatment supporters. Institutional support was very
minimal in that most pointed out that they did not belong to any support groups. There were
some who did not even know about the existence of any support groups at the health facilities
where they were receiving their treatment.
Most of the respondents indicated that they disclosed to their colleagues and others had not
as they feared that they would lose their jobs. Those who had disclosed indicated that they
needed support from their colleagues and employers with regard to compliance with their
clinic appointments. Most of the respondents had sexual partners, and had also disclosed to
their sexual partners, and disclosure was almost immediately after being diagnosed HIVpositive.
There are those who had not disclosed to their sexual partners as they feared
rejection or violent reaction. There were sero-discordant couples amongst the respondents
who supported each other regarding adherence. Most of the respondents indicated that they
had taken care of a family member living with HIV.
HIV prevalence also varies amongst health facilities. Strategies employed by health facilities
to monitor and evaluate HIV and AIDS programmes differ. Health Care Workers and lay
counsellors provided contrasting information. Primary Health Care facilities have been
accredited to provide ART, however the down-referral system seems to be failing as some
clinics now have more clients on ART than hospitals. Health Care Workers and counsellors
also need to be familiarized with the World Health Organization (WHO) standards. The level
of adherence acceptable for an individual on ART is 95%; there is however health facilities
that indicated the adherence level far below the required level.
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Experiences of HIV postitive patients on antiretroviral treatement at Thulamela Municipality in the Vhembe District of Limpopo Province, South AfricaNdou, Tshifhiwa Violet 06 February 2015 (has links)
Department of Public Health / MCur
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Antiretroviral adherence and HIV virological outcomes in HIV-positive patients in Ugu District, KwaZulu-Natal ProvinceKapiamba, Muteba Germain 24 July 2015 (has links)
Adherence to antiretroviral therapy is crucial to ensure viral suppression. In the scientific community it is widely accepted that an adherence level of at least 90% is necessary to achieve viral suppression. This study uses pharmacy refill records to describe antiretroviral adherence in HIV-positive patients in Ugu District and to describe pharmacy refill records as reliable monitoring method of antiretroviral therapy. In total, 61 patients’ records were reviewed. Overall, 82% of participants (n=50) achieved an optimum adherence level of at least 90%. Although 38% (n=19) of these participants did not show any related viral suppression. A statistically significant relationship between adherence and viral suppression was not demonstrated. Therefore, pharmacy refill records cannot be recommended as an alternative method of monitoring response to antiretroviral therapy, but laboratory tests including CD4 cell count and or viral load must be combined to pharmacy refill method for monitoring of antiretroviral therapy in HIV-positive patients / Health Studies / M.A. (Public Health)
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Antiretroviral adherence and HIV virological outcomes in HIV-positive patients in Ugu District, KwaZulu-Natal ProvinceKapiamba, Muteba Germain 24 July 2015 (has links)
Adherence to antiretroviral therapy is crucial to ensure viral suppression. In the scientific community it is widely accepted that an adherence level of at least 90% is necessary to achieve viral suppression. This study uses pharmacy refill records to describe antiretroviral adherence in HIV-positive patients in Ugu District and to describe pharmacy refill records as reliable monitoring method of antiretroviral therapy. In total, 61 patients’ records were reviewed. Overall, 82% of participants (n=50) achieved an optimum adherence level of at least 90%. Although 38% (n=19) of these participants did not show any related viral suppression. A statistically significant relationship between adherence and viral suppression was not demonstrated. Therefore, pharmacy refill records cannot be recommended as an alternative method of monitoring response to antiretroviral therapy, but laboratory tests including CD4 cell count and or viral load must be combined to pharmacy refill method for monitoring of antiretroviral therapy in HIV-positive patients / Health Studies / M.A. (Public Health)
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HIV and AIDS-related stigma and discrimination reduction-intervention strategy in health care settings of Amahara Region, EthiopiaWodajo, Befekadu Sedeta 06 1900 (has links)
Stigma and discrimination (SAD) attached to Human Immunodeficiency Virus (HIV) and Acquired Immune Deficiency Syndrome (AIDS) has been recognised as a major obstacle to HIV prevention, treatment, care and support throughout the world. SAD is more devastating when it occurs in health care settings where it is least expected. Health care providers (HCPs) are supposed to provide physical, social and psychological support to people living with HIV (PLWHA) but HIV and AIDS-related SAD has been extensively documented among the HCPs. Different studies have pointed out that there are three major actionable causes of HIV-related SAD in health care settings. These are lack of awareness among HCPs, fear of casual contacts and associating the SAD to immoral behaviour. The main objective of the current study is to determine the magnitude of HIV and AIDS-related SAD and its associated factors in hospitals and then to propose appropriate SAD reduction-intervention strategy in the health care settings. The study employed pre-test-post-test design with non-equivalent control group. Two paradigms were used in this study including quantitative and qualitative approaches. The sampling method for the quantitative part of the study was probability sampling in which the respondents were randomly selected using stratified sampling technique. The study was able to determine the magnitude of HIV and AIDS-related SAD among the HCPs. Moreover, the study has identified the factors that are attributed to the prevalence of SAD in the hospitals. The major factors identified for causing the SAD in the hospitals were sex, age, work experience, low level of knowledge, negative attitudes and percieved risk of HIV infection of some HCPs toward the PLWHA. The intervention made on the respondents in the treatment group was able to reduce the overall prevalence of the SAD among the HCPs. The study suggests that to reduce the SAD, HIV and AIDS-related trainings before and after graduation is critical to improve the knowledge, attitudes and practices of the HCPs. Besides, ensuring the availability of the protective supplies in hospitals is crucial in reducing the fear of HIV infection among the HCPs while providing care for HIV positive patients. Effective implementation of the hospital policies, strategies, guidelines and protocols along with good institutional support is also vital in creating safe and user-friendly hospitals for PLWHA / Health Studies / D.Litt. et Phil. (Health Studies)
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