This research focuses on the psychosocial factors that affect adherence to highly active antiretroviral therapy (HAART) amongst HIV/AIDS patients at Kalafong Hospital. Even though the development of such regimens has helped turn HIV infection in the United States into a relatively manageable, though still serious chronic disease, compliance remains one of the major challenges in managing medication for those patients living with HIV/AIDS. This is particularly relevant given the high adherence rate (95%) required to obtain a successful long-lasting effect. In South Africa non-compliance to HAART is an under-explored phenomenon. Consequently, an understanding of factors influencing compliance is still incomplete. A qualitative study that investigates non-adherence to medication in HIV/AIDS patients was undertaken at Kalafong Hospital. This study aimed to understand patients’ psychosocial difficulties resulting in non-adherence. The study was approached in terms of the health belief model (HBM), which addresses individual characteristics pertaining to change, the transtheoretical change model (TTM) and the motivational interviewing model (MI), which address both individual and social contexts pertaining to change. The findings are designed for use by healthcare professionals as a proactive compliance enhancement tool. Participants were recruited through referrals by the medical staff to the researcher. The criteria included that participants had relapsed due to non-compliance with drug therapy. Participants that were currently experiencing difficulties with adherence were also included in the study. Males and females aged between 20 and 40 were included in the study. Fifteen participants between the ages of 20 and 40 participated in the study (13 females and two males). The data were collected by means of semi-structured interviews and follow-up unstructured questions. The interviews were audio recorded and field notes were taken. Data were analysed qualitatively. Sixteen themes emerged and were further classified into two categories: individual and social context. The themes were then compared and integrated with the literature. The study concludes that psychosocial factors such as support from family, friends and healthcare workers was found to be of utmost importance in encouraging adherence. Medication can only prolong a patient’s life if the psychosocial context in which the patient is embedded is considered in the treatment plan. / Dissertation (MA)--University of Pretoria, 2008. / Psychology / unrestricted

Orientador: Maria Luiza Moretti / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-18T15:05:39Z (GMT). No. of bitstreams: 1 Passos_AnaIsabelaMorsch_M.pdf: 2317515 bytes, checksum: 2a34cbc644c6ec0279e1f66cf58ccf4a (MD5) Previous issue date: 2011 / Resumo: A função pulmonar, em pacientes infectados pelo vírus da imunodeficiência humana (HIV), tem sido associada com a redução nos parâmetros de ventilação pulmonar. Métodos: Foi realizado estudo do tipo corte transversal para avaliar a função pulmonar de pacientes com aids atendidos em ambulatórios de doenças infecciosas. Foram avaliados dados de espirometria, pressão inspiratória máxima (PImáx) e pressão expiratória máxima (PEmáx). Também foram coletados, através de prontuários médicos, dados clínicos, demográficos e laboratoriais. Resultados: Os dados de PImáx e PEmáx foram avaliados em 73 pacientes, o exame de espirometria foi avaliado em 54 pacientes. O tempo médio de infecção pelo HIV (em anos) foi semelhante para os homens (8,5 ± 5,1) e mulheres (10,4 ± 4,2, p = 0,13) e o tempo médio de utilização da terapia antiretroviral foi de 8,5 ± 4,1 anos para as mulheres e 7,7 ± 4,1 anos para os homens (p = 0,46). Os valores de PImáx e PEmáx foram abaixo do previsto em 38 (52%) e 25 (34%) pacientes, respectivamente. O uso do tenofovir e a presença de tosse, no momento em que o teste foi realizado, foram independentemente associados com PEmáx abaixo do valor previsto. Valores elevados de creatinoquinase foram associados com o uso prolongado de terapia antiretroviral (9,6 ± 4,1 anos versus 7,4 ± 3,9 anos, p = 0,05). Os valores de capacidade vital forçada (CVF) se apresentaram reduzidos em 14 (26,4%) pacientes e foi independentemente associado com risco cardiovascular intermediário ou alto (p = 0,002) e com murmúrio vesicular reduzido à ausculta pulmonar (p = 0,047). Os valores de volume expiratório forçado no primeiro segundo (VEF1) foram significativamente menores nos pacientes com tempo prolongado de tabagismo (p = 0,019) e risco cardiovascular intermediário ou alto (p = 0,003). A redução da relação VEF1/CVF foi associada com o tabagismo (p = 0,041). Conclusão: Nas medidas de PImáx e PEmáx, 38 (52,1%) e 25 (34,2%) pacientes apresentaram resultados abaixo do previsto. O exame de Espirometria foi considerado normal em 45 pacientes. Houve diagnóstico de distúrbio obstrutivo e restritivo em um (1,9%) e 8 (14,8%) pacientes. O uso de Tenofovir e a presença de tosse foram independentemente associadas à PEmáx abaixo do previsto. Pacientes com menores valores de CVF foram os com maior risco cardiovascular e murmúrio vesicular diminuído à ausculta pulmonar. Pacientes com menores valores de VEF1 foram aqueles com maior tempo de tabagismo e maior risco cardiovascular. A variável independentemente associada a valores reduzidos de VEF1/CVF foi tabagismo / Abstract: Background: Pulmonary function, in HIV infected patients, has been associated with reduction in pulmonary ventilation parameters Methods: We conducted a sectional study to evaluate the pulmonary function of AIDS patients cared for in the infectious diseases ambulatories. Maximal inspiratory (MIP) and expiratory (MEP) pressures and spirometry were assessed. Clinical, demographic and laboratorial data were also evaluated. Results: MIP and MEP were assessed in 73 and spirometry in 54 patients. The mean time of HIV infection (in years) was similar for men (8.5+5.1) and women (10.4±4.2; p= .13) and the mean time of use of antiretroviral therapy (ART) was 8.5±4.1 years for women and 7.7±4.1 years for men (p= .46). MIP and MEP values were not normal in 38 (52%) and 25 (34%) patients, respectively. The use of tenofovir (TVF) and presence of cough, by the time the test was performed, were independently associated MEP below the predictive value. Elevated CK values were associated with prolonged time ARV usage (9.6±4.1 years vs 7.4±3.9 years; p= .05). FVC was reduced in 14 (26.4%) patients and was independently associated with high and/or intermediate cardiovascular risk (p= .002), and those with reduced vesicular murmur in auscultation (p= .047). FEV1 was significantly lower in patients with prolonged time of smoking (p= .019) and high and/or intermediate cardiovascular risk (p= .003). Reduced FEV1/FVC ratio was associated with smoking (p= .041). Conclusions: In measurements of MIP and MEP, 38 (52.1%) and 25 (34.2%) patients had results below forecast. The spirometry test was considered normal in 45 patients. There was a diagnosis of obstructive and restrictive ventilation disorder in one (1.9%) and 8 (14.8%) patients. The use of tenofovir and cough were independently associated with lower than expected MEP. Patients with lower values of FVC had the highest cardiovascular risk and reduced breath sounds on pulmonary auscultation. Patients with lower values of FEV1 were those with longer duration of smoking and increased cardiovascular risk. The variable independently associated with lower values of FEV1/FVC was smoking / Mestrado / Ciencias Basicas / Mestre em Clinica Medica

Human immunodeficiency virus (HIV) infection has reached epidemic proportions in South Africa. The availability of highly active anti-retroviral therapy (HAART) prolongs life in HIV-infected persons, who may subsequently present with chronic manifestations of HIV-infection. The respiratory morbidity attendant to HIV-infection, even in the presence of HAART is high, the aftermath of which is lung tissue destruction and bronchiectasis. As a consequence of the political decision not to offer HAART to HIV-infected children, a number of children in South Africa have been left with severe consequences of uncontrolled HIV-infection. Bronchiectasis is one of those and because children with this devastating condition were numerous in the Pretoria region, the author and her colleagues began a Chronic Lung Disease Clinic in that region. This prompted the idea of investigating both the epidemiological profiles of these children and an attempt to intervene with both standard bronchiectasis guideline care and the use of a form of therapy commonly employed in other forms of bronchiectasis. This thesis explores those ideas. Important new and novel findings that were consequent were; that bronchiectasis is diagnosed late in HIV-infected children at a mean age of 6.9 years. The predominant organisms cultured from the airways are Haemophilus influenzae and parainfluenzae in 49% of samples. Pseudomonas aeruginosa (PA), common in cystic fibrosis (CF)-bronchiectasis is an uncommon pathogen in HIV-related bronchiectasis; isolated in only 2% of specimens. Tuberculosis (TB), at least as reported, is a significant antecedent of bronchiectasis, reported in 48.5%of children. A further 21.2% of the patients had received more than two courses of anti-TB treatment. However, proof of TB infection has been lacking. Respiratory morbidity is significant with the mean forced expiratory flow in one second (FEV1) of 53%, in this cohort at the time of presentation. Thirty-six percent of all children were exposed to environmental tobacco smoke, although this was not correlated with disease severity or HIVdisease progression. There is elevation of immunoglobulins in HIV-related bronchiectasis, with a mean IgE of 79 kU/l. This was not, though, associated with HIV disease progression as previously described in adult studies, nor with the presence of allergic bronchopulmonary aspergillosis (ABPA). The elevation in IgE was also not associated with an elevation of T helper-2 mediated cytokines, confirming the lack of association with atopy. The predominant cytokine, identified is interleukin (IL)-8, both systemically and locally (in airway secretions). There was elevation of other T helper-1 driven cytokines, reflecting an ability to mediate adequate inflammatory responses, which was independent of the level of immunosuppression. With the presence of HAART, there was a decline in the pro-inflammatory cytokines over time, which may be attributed to the ongoing effect of HAART that ties in to, or goes beyond the restoration of T cell numbers. Soluble triggering receptor expressed on myeloid cells (sTREM), an innate immune marker, is elevated in children with HIV-related bronchiectasis when compared to a control group of children with cystic fibrosis-related bronchiectasis. sTREM is not associated with the presence of exacerbations and the level of immunosuppression. The use of an anti-inflammatory drug erythromycin also did not impact the sTREM values. There was also no relationship between sTREM and pro and antiinflammatory cytokines and chemokines. Fluorine-18-fluorodeoxyglucose positron emission tomography (18F-FDG PET) could not reliably predict the presence of pulmonary exacerbations. Its diagnostic value was limited to identifying disease activity in acute pneumonia. 18F-FDG PET also had no significant correlation with CRP, inflammatory cytokines or markers of HIV disease activity. In a randomised controlled trial of erythromycin, a cost-effective immunomodulatory drug, compared to placebo, erythromycin was ineffective in reducing the number of pulmonary exacerbations. Erythromycin also failed to demonstrate any effect on systemic and local pro- and anti-inflammatory cytokines/chemokines. With access to anti-retroviral therapy, airway clearance, nutritional rehabilitation and vigilant follow up there was an improvement in pulmonary function parameters and stability of the degree of bronchiectasis that we propose is probably in keeping with an organ system disease modifying effect that may be, an as yet, undefined and undescribed byproduct of HAART. / Thesis (PhD)--University of Pretoria, 2012. / Paediatrics and Child Health / unrestricted

AIM The objective of this study is to determine factors that may contribute to hospital admissions in a cohort of medically insured South African patients in the era of HAART. METHODS This was a retrospective cohort of all HIV-positive adult and paediatric patients enrolled on a medical aid disease management programme in South Africa over a period of three years. Patient-specific demographic and clinical information were obtained from the medical aid records. Survival analysis was used to analyse time to first admission looking at admissions occurring after enrolment to the programme, during the study period of between 01 January 2006 and 31 December 2008. Only the right censored cases were included in the analyses. Descriptive analyses were conducted on the key prognostic factors. Variables that were significant in the univariate were considered in the multivariate Cox proportional hazards model. RESULTS A total of 8440 patients were included in the analysis. Half of these patients had at least one admission during the observation periods with 43.28% having had 2 or more admissions. The average admission rate was 2 admissions per patient over the 36 month observation period. Young children, adolescents and the very old (> 60 years) were significantly more likely to be admitted than the middle age groups, HR = 1.30 [95%CI 1.21 -1.40] p<0.01, 1.24 [95%CI 1.10 – 1.41] and 1.13 [95% CI 1.10 – 1.27] p<0.01 respectively. Low CD4 cell counts of < 200 cells/ µL were significantly associated with a higher likelihood of hospitalizations with hazard ratios even greater for CD4 cell counts of less than 100 cells/ µL, HR= 1.34 [95%CI 1.29 – 1.39], p<0.01. Cases were more likely to be admitted by a clinical haematologist or gynaecologist than by other specialist categories.HR =1.58 [95%CI 1.29 –1.94] and 1.17[95%CI 1.08 – 1.27] respectively with p<0.01. CONCLUSION Factors that are associated with hospital admissions in this private sector, medically insured population are a younger and older age, low CD4 cell counts and admission by a clinical haematologist and gynaecologist. These results suggest that disease management strategies should be intensified for the younger and older age groups. All HIV-positive patients should be closely monitored for CD4 deterioration so that treatment is initiated timeously. Routine haematological investigations should be recommended for all HIV-positive patients in order to pick up and treat haematological conditions before they result in a hospital admission. Evidence based guidelines, outlining the place of caesarian section deliveries in the HIV population, should be developed for use by gynaecologists specifically in the private sector. Copyright / Dissertation (MSc)--University of Pretoria, 2011. / Clinical Epidemiology / unrestricted

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 (M.Sc. (Physiology)) -- University of Limpopo, 2021 / The purpose of this study was to investigate the effect of cART on renal function and assess the association between renal function and cardiovascular risk factors in a black rural HIV-positive population in Limpopo Province, Mankweng district. We have conducted a cross-sectional study which included both male and female cART-treated patients (n=84), cART-naïve patients (n=27) and HIV-negative controls (n=44). We have measured biomarkers of renal function (plasma cystatin C, clusterin, retinol binding protein 4 [RBP4]) and determined the estimated glomerular filtration rate (eGFR) using the chronic kidney disease-epidemiology collaboration formula (CKD-EPI). We have also measured blood pressure (BP), body mass index (BMI) and fasting blood glucose (FBG). The prevalence of renal dysfunction was similar among the study groups. A significant difference in RBP4 was found among the groups after controlling for covariates (age, gender, alcohol consumption, BMI, systolic blood pressure and FBG) (F (2, 146) = [4.479], p=0.010). The significant difference in RBP4 was specifically observed between the cART-treated and cART-naïve groups (p=0.008). Cystatin C, clusterin and eGFR were not significantly different among the study groups after controlling for the covariates. The cardiovascular risk factors age (β=0.207; p=0.039), CD4+ T-cell count (β=-0.236; p=0.040), and duration of cART (β=0.232; p=0.043) were independently associated with cystatin C. The use of cART independently associated with RBP4 (β=0.282; p=0.004). Age (β=-0.363; p=0.001), CD4+ T-cell count (β=0.222; p=0.034) and duration of cART (β=-0.230; p=0.034) independently associated eGFR. Renal dysfunction is common in this HIV-positive population, with similar rates as the HIV-negative population. Plasma cystatin C as a promising alternative renal biomarker need to be re-evaluated in this HIV-positive population. RBP4 may be a more promising renal function biomarker in the HIV-positive population. Cardiovascular risk factors are associated with renal dysfunction in this rural HIV-positive population and CD4+ T-cell count may be an independent predictor for renal function.

Thesis (MPH.) -- University of Limpopo, 2022 / Human Immunodeficiency Virus (HIV) has affected all parts of the world, and as of 2019, more than 76 million people have been infected by HIV. South Africa has the largest population of people living with human immunodeficiency virus (HIV) in the world and the highest infected group were aged 24 to 49, and females had the highest percentage in viral load suppression for all age groups. HIV infection leads to advanced loss of CD4 T cells and the roll out of antiretroviral therapy (ART) has bring about in significant cutbacks in HIV-associated complications by recovering the CD4+ T cell count. Some patients may not be successful in attaining this result, and some may accomplish it only after a number years of treatment. The disease progression and the health conditions amongst People Living with HIV-AIDS (PLWA) has improved substantially in the past two decades. The purpose of this study was to evaluate the disease progression of the patients initiated on ART from 2017 to 2019 at the University of Limpopo Health Centre, in Limpopo province. Methodology: A descriptive retrospective investigation was carried out which followed a quantitative approach in which secondary data from medical files of 259 patients initiated on ART at University of Limpopo Health Centre was used. where outcomes of ART initiation assessed and evaluated in association with characteristics of patients. Data analysis was done using the STATA statistical software version 12 for Windows (STATA Corporation, College Station, Texas). Frequency tables were used to make comparisons between groups for continuous and categorical variables using student t-test, and chi-square test. P-value less than 0.05 at 95% confidence level were regarded as significant. Results: The research finding revealed 80.0% of the study participants were females and the mean age group of participants diagnosed HIV positive was 28.28 years with standard deviation of ±7.5. The mean of the CD4 count cells at baseline for females was 411.4 cells/μL while for males was 341.2 cells/μL (p=0.212). The mean CD4 count cells at last ART visit for females was 613.7 cells/μL while for males was 452.9 cells/μL (p<0.001). There has been significant increase of the CD4 cell count from the baseline to the last ART visit as it is noted in the increase in proportion of patients with CD4 cell count of more than 500 in all the years. The proportion of patients with baseline CD4 cell count of 200 to 350 (moderate immunodepression) were high in 2019 and 2017 at 40.6% and 40.3% respectively. Majority of the patients were transferred out to other facilities at 79.4% as most patients are students and only 2.3% mortality rate has been reported for the study period. Majority of the patients initiated on ART at University of Limpopo were in WHO stage 2 at 45.5% followed by those in stage 3 and stage 1 at 22.2% and 21.8% respectively. Patients who were 24 years or older were 1.1 times more likely to have improved CD4 cell count at the last date of ART visit as compared to younger patients but not statistically significant while males were 3.5 times more likely to have improved CD4 cell count at the last date of ART visit as compared to females which was statistically significant. Patients who were initiated on ART at WHO stage 4 were 6.67 more likely to have improved CD4 cell count at the last date of ART visit as compared to those who were initiated on ART at WHO stage 1. Conclusion: The treatment progression in the study setting was found to be convincing and acceptable which is similar to the findings reported in other studies in many other countries. The significance of CD4 cell counts monitoring for HIV patients cannot be overemphasised. This study recommends a strengthened testing and treatment programme targeted males amongst the university community, enhance provider provider relationship when patients are transferred out to other health facilities, enhance the collection of baseline and progressive data on both the CD4 cell count and viral load.

Thesis (Ph.D. (Pharmacy)) -- University of Limpopo, 2022 / Antiretroviral (ARV) management in children is considered a challenging process, and patients receiving ARVs remain at risk of medication errors. Recently, there has also been a noticeable increase in Treatment Failure (TF) and the development of drug resistance amongst children on ART. However, ART failure amongst children seems to be an under-recognised issue, and adherence to treatment guidelines is reported to be a challenge among nurses caring for People Living with HIV (PLWHIV). Hence, the aim of this study was to explore the prescribing practices, and to determine the knowledge, understanding, and competence levels of NIMART-trained nurses’ in the management of children on Antiretroviral Therapy (ART) in Public Health Care (PHC) facilities located in a rural district of Limpopo Province. To attain the purpose of the study, the researcher in this study adopted a mixed-method, in an explanatory sequential manner. The quantitative phase adopted a descriptive cross-sectional and retrospective census of medical records to determine whether or not the children on ART were prescribed the correct ARV regimen, dose, strength, dosing frequency and received the correct quantities to last until the next appointment date. Whereas the qualitative phase embraced a total purposive sampling of the NIMART-trained professional nurses to explore their knowledge, understanding and views of ART management in children. The results highlighted that these children under study even though they were prescribed a correct ARV regimen in (n=7045; 96%) of the cases;they were only correctly dosed in (n=7797; 53%); and prescribed the correct strength (n=9539; 77%), with only (n=2748; 36.9%) having received the correct quantity of treatment to last them until the next appointment date. Most nurses even though they rated themselves very knowledgeable and competent in paediatric HIV/AIDS management. This finding was contradicting the results obtained from the medical records, as well as their responses to the given case scenario depicted some level of non-adherence to treatment guidelines as well as a lack of understanding of ARV management. From the findings of this ARV utilisation review and the implementation of the developed ART dosing and dispensing training programme. The study concludes that the nurse's prescribing practice was irrational in this cohort of children, and most prescriptions did not entirely comply with the 2014/15 HIV/AIDs treatment recommendations. Since, this cohort of children was found to be susceptible to medication related errors such as; Drug omissions in ARV regimens; Incorrect dosing & dosing frequencies; as well as incorrectly supplied quantities. From the study findings it is recommended that ARV stewardship programs should be considered in order to develop and establish a core strategy for enhancing quality improvement in the management of HIV-infected children on ART in resource-limited settings, not only to inundate viral suppression and maintain it, but also to help achieve the UNAIDS 95- 95-95 target in children under 15 year / National Research Foundation (NRF)

This study analysed data obtained from respondents and their medical records to determine the barriers and motivators for good adherence to ART. Respondents' records were also reviewed together with their pharmacy refill records to identify any correlation between .CD4 cell counts, viral load, VL and adherence to antiretroviral drugs at extension 15 ARV clinic in Gaborone, Botswana. The study investigated whether the combination of pharmacy refills and pill counts adherence measurement methodologies could predict immunological recovery and virologic response through increased CD4 cell counts and suppressed VL. . There was a positive relationship between adherence, CD4 cell counts and VL. Pharmacy refills and pill counts adherence measurement methodologies scored high on sensitivity, specificity, and positive predictive values but low on negative predictive values. / Health Studies / M.A. (Public Health)

The study analysed and compared data from patients' medical and pharmacy refill records to identify correlations between CD4 cell counts and adherence to antiretroviral drugs at Katutura Intermediate Hospital (KIH) in Windhoek, Namibia. The study investigated whether the pharmacy refill adherence measurement methodology could predict immunological recovery through increased CD4 cell counts. There was a positive but weak relationship between adherence and CD4 cell counts. Although the pharmacy refill records could predict immunological response it was not sensitive enough and should be used in combination with other adherence measurement tools. / Public Health / M.A. (Public Health)