Thesis (M.A.)--Kent State University, 2009. / Title from PDF t.p. (viewed April 16, 2010). Advisor: John Gunstad. Keywords: HIV; executive function; adherence. Includes bibliographical references (p. 41-54).

“Cartas al editor” / Revisión por pares

Magister Public Health - MPH / The government of Namibia established a comprehensive HIV/AIDS treatment and care programme in 2002. This programme provides anti-retroviral treatment to all eligible HIV patients in the public health sector. The antiretroviral treatment programme in Keetmanshoop started in October 2003. Adherence to treatment regimes in HIV care is a key factor in determining clinical outcomes and is associated with improved survival among HIV and AIDS patients. Sustained high levels of adherence (95% or more) are essential for the success of highly active antiretroviral therapy (HAART). Maintaining high adherence levels is therefore a major concern in HIV/AIDS treatment programmes. This study investigated adherence to HAART among patients in the Keetmanshoop antiretroviral therapy (ART)clinic and the factors that affect adherence.Aim of the research The aim of the research was to describe adherence to HAART and factors influencing adherence among patients in Keetmanshoop ART clinic, Namibia.Objectives: 1. To describe levels of adherence to HAART amongst clients at Keetmanshoop ART clinic. 2. To assess the changes in CD4 count and body weight of clients on HAART over a 12 month period.3. To assess factors associated with adherence to HAART.4. To analyse associations between CD4 count and adherence. 5. To analyse associations between changes in body weight and adherence. Methodology: A quantitative descriptive cross-sectional survey was used. The study population included all clients 18 years and above, who were on HAART for one year or more at the Keetmanshoop clinic. One hundred and six clients participated in the study. Data was collected through an interview with the participants and a review of clinical records. Results: Most respondents had good adherence levels; with 86.1% reporting optimal adherence levels.The respondents also showed an increase of median CD4 counts from 126 cells/μl at baseline to 304 cells/μl at 12 months and an increase in body weight from an average of 50kg at baseline to an average of 57kg at 12 months. Adherence levels were found to have an impact on CD4 cell counts and on body weight, with respondents who had sub-optimal adherence experiencing a drop in median CD4 cell counts and median body weight by 12 months.Living far from the clinic (>10km) was found to be the only factor significantly associated with sub-optimal adherence.Conclusion: The study showed a positive correlation between adherence levels and CD4 cell counts and body weight gain. In the absence of viral load, CD4 cell count testing can be used as a measure of adherence. Though most respondents appear to be adhering well to HAART, a sub-optimal adherence rate of >10% is a concern for the Keetmanshoop ART programme and will need to be addressed. There is a need for further research to determine the level of default or attrition from HAART in the programme

Magister Public Health - MPH / Background: First line regimens give patients the best chance of long-term treatment success. It is imperative that patients stay on their original first line regimens to ensure program viability. As the ART programme matures in Namibia the proportion of patients who have had their first line regimens modified continues to increase. It is estimated that 3.1% of adults in Namibia are on second line regimens. Second line or other modified regimens are generally reserved for clinical, immunological or virological failure and toxicity related complications. These modified regimens often involve a higher pill burden, more toxicities and are often more expensive. A more detailed understanding of the factors associated with first line regimen modification could allow healthcare providers in Namibia to target these factors for intervention to reduce regimen modification and improve treatment outcomes. Methodology: This quantitative descriptive retrospective cohort study sought to describe factors associated with first line HAART regimen modification in treatment naïve adult patients who started HAART at Gobabis State Hospital between 1st January 2007 and 31st December 2010. Utilizing data from an existing electronic patient management system, quantitative methods were used to assess the prevalence, reasons and factors associated with first line HAART regimen modification. Results: The prevalence of HAART regimen modification was 14.1%. Treatment toxicity was the major reason (35%) for HAART regimen modification and this was largely due to D4T containing regimens. This was followed by treatment modification due to concurrent TB disease (27.3%), new drug availability (19%), pregnancy (6.6%) and virological failure (2%). A death rate of 9% was recorded by the end of the study period in each of the two groups, of those who had their first line HAART regimen modified and those who remained on original regimens respectively. There were statistically significant associations between regimen modification and type of regimen, care entry point, duration from HIV diagnosis to entry into HIV care, sex and functional status. Regimen modifications resulted in more AZT and TDF based regimes while 88.7% of patients had D4T taken off their HAART regimens. Conclusions: HAART regimen modification at Gobabis State hospital is lower than in other settings was largely due to treatment toxicity. The death rate is high and warrants further exploration. Regimen modifications resulted in more AZT and TDF based regimes and more patients had D4T taken off their HAART regimens. Recommendations: Patients still on D4T need close monitoring for side effects associated with this drug and should be promptly changed if this is the case. This study raises the important programmatic issue of the need for good data collection practices. HIV positive patients who are pregnant and those with concurrent TB disease need close monitoring to ensure that HAART regimens are modified appropriately.

A dissertation submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, in fulfilment of the requirements for the degree of MSc (Med) Johannesburg, 2011 / Peripheral sensory neuropathy is a common neurological complication of antiretroviral therapy, typically occurring within 6-months of starting Highly Active Antiretroviral Therapy (HAART) which includes stavudine. Therefore, the primary aim of the study was to determine the 6-month incidence of ATN in patients free of neuropathy and beginning stavudine-based HAART for the first time. Also, we examined whether initiating stavudine-based HAART altered the symptoms of patients who had a pre-existing, virus-mediated distal symmetrical polyneuropathy (HIV-DSP). Seventy-five HIV-positive patients were screened for neuropathy, at the Chris-Hani Baragwanath Hospital, using the AIDS Clinical Trials Group neuropathy screening tool. The bilateral presence of atleast one sign (decreased vibration sense in the great toe or absent ankle reflex) and one symptom (pain, paraesthesia or numbness) in the feet was indicative of neuropathy. On recruitment, 52 patients presented without neuropathy and 13 patients presented with HIV-DSP. After 3- months of follow-up (n=46), 23% (10/46) of patients had developed peripheral neuropathy, and by 6-months (n=44), 41% (18/44) of patients had developed neuropathy. Greater disease severity was the only risk factor significantly associated with the development of neuropathy. Eleven (61%) of the 18 patients that developed neuropathy, developed painful symptomatic neuropathy, and only 6 (55%) of these patients were receiving treatment for symptom relief. In patients with HIV-DSP, numbness was the most common symptom reported at baseline and was the only symptom to reduce in frequency across the 6-months. In conclusion, we found that the development of neuropathy is common in the first 6-months of patients initiating stavudine-based HAART.

The Human Immunodeficiency Virus (HIV) which causes Acquired Immunodeficiency Syndrome (AIDS) has caused a global scare with mainly poor African countries suffering the greatest burden. Treatment of HIV is more of palliation rather than cure such that there is no room for treatment interruption if treatment goals are to be met. Antiretroviral treatment is associated with short term and long term side effects which have the potential to negatively impact on the high levels of adherence to treatment that is required to maintain virological suppression and may eventually lead to development of drug resistance and treatment failure. This research aims to identify the extent to which these side effects, through possible poor adherence, impact on treatment successes by measuring the risk that side effects contribute towards treatment failure. Methods Secondary data analysis was conducted on a cohort of patients who initiated ART between 2004 and 2010 at a large tertiary facility in Johannesburg. Patients who were switched to second line ART due to treatment failure were identified. Assessment of side effects on adherence was done. The hazards of side effects among patients switching and not switching to second line were calculated using Cox proportional hazards regression adjusting for other socio-demographic and clinical predictors for treatment failure. Interaction between side effects, gender, age and that of side effects and adherence was investigated. Time dependent covariates were also investigated. Confounding was controlled using multivariate Cox regression analysis. Results There were 5285 patients in the baseline cohort with multiple entry points who contributed 16035 person-years of follow up. The cohort consisted of 63.2% females and 36.8% males. Of these 85.9% were initiated on stavudine (d4T)- based regimen, 7.1% on tenofovir (TDF), 6.3% on zidovudine (AZT)-based regimen and 0.7% on other regimens. The median and mean time at risk per subject was 2.2 and 2.3 years respectively. A total of 770 episodes of side effects due to first line ART were experienced with some patients recording multiple side effects at different time points. Adherence data were found to be missing and incoherent in some of the regimen dosages and could not be used to objectively compare patients. There were 430 patients who were switched to second line ART due to treatment failure. Relative to the group of no side effects, the adjusted hazard ratios for mild, moderate and severe side effects were 1.40 (95% CI=0.94-2.09) p=0.10; 1.72 (95% CI=1.35-2.20) p<0.01 and 1.24 (95% CI=0.65-2.35) p=0.52 respectively. Therefore, overally side effects did not seem to play a role in the time to switch to second line ART. Sex, baseline CD4 cell count, the period during which ART was initiated and the time between date of testing HIV positive and date of initiating were significantly associated with the time to switching to second line ART. Conclusion The study informs that side effects overally may not play a significant role in switching patients from first line to second line ART with the exception of moderate side effects. However, patients who experience side effects should be closely monitored and adequately counselled to help them cope with the side effects so that optimal adherence levels are maintained. Availability of adherence scores or additional information on pills that should have been taken on periods during which pills were reported to have been missed would have made the research more valuable by allowing objective comparison of adherence among patients.

The roll-out of antiretroviral drugs in South Africa started in March 2004. In Mopani district, a rural district of Limpopo Province, the roll-out programme commenced in October 2004. While many resources were invested in this program, no study has assessed the clinical outcomes in this rural district. In addition, most studies conducted in South Africa were conducted in urban and tertiary settings. Assessing clinical outcomes is important in determining whether the program is making the desired clinical difference in the lives of the patients and may serve as feedback into the program for quality improvement purposes. Methodology The study was a retrospective record review of patients who were initiated on antiretroviral (ARV) treatment between December 2007 and November 2008. A structured questionnaire was used to collect data from 124 patient’s files and data was collected up to November 2011. The data collected included patients’ socio-demographic characteristics, clinical outcomes (CD4 count, viral load, presence of opportunistic infections, adverse effects and hospital admissions recorded at 6, 12, 24 and 36 months), the number of patients who were still attending the ARV clinic at 36 months and the reasons why patients are no longer attending the clinic. Data was analysed with Epi-Info and STATA. Results Of the 124 patients, 69% were females, 28% males and 3% did not have their sex specified. The majority of the patients were between 30 and 49 years. There was a significant improvement in CD4 count and viral load between baseline and all timeperiods after the initiation of ARV treatment. The mean CD4 count at baseline was 128The roll-out of antiretroviral drugs in South Africa started in March 2004. In Mopani district, a rural district of Limpopo Province, the roll-out programme commenced in October 2004. While many resources were invested in this program, no study has assessed the clinical outcomes in this rural district. In addition, most studies conducted in South Africa were conducted in urban and tertiary settings. Assessing clinical outcomes is important in determining whether the program is making the desired clinical difference in the lives of the patients and may serve as feedback into the program for quality improvement purposes. Methodology The study was a retrospective record review of patients who were initiated on antiretroviral (ARV) treatment between December 2007 and November 2008. A structured questionnaire was used to collect data from 124 patient’s files and data was collected up to November 2011. The data collected included patients’ socio-demographic characteristics, clinical outcomes (CD4 count, viral load, presence of opportunistic infections, adverse effects and hospital admissions recorded at 6, 12, 24 and 36 months), the number of patients who were still attending the ARV clinic at 36 months and the reasons why patients are no longer attending the clinic. Data was analysed with Epi-Info and STATA. Results Of the 124 patients, 69% were females, 28% males and 3% did not have their sex specified. The majority of the patients were between 30 and 49 years. There was a significant improvement in CD4 count and viral load between baseline and all timeperiods after the initiation of ARV treatment. The mean CD4 count at baseline was 128 The roll-out of antiretroviral drugs in South Africa started in March 2004. In Mopani district, a rural district of Limpopo Province, the roll-out programme commenced in October 2004. While many resources were invested in this program, no study has assessed the clinical outcomes in this rural district. In addition, most studies conducted in South Africa were conducted in urban and tertiary settings. Assessing clinical outcomes is important in determining whether the program is making the desired clinical difference in the lives of the patients and may serve as feedback into the program for quality improvement purposes. Methodology The study was a retrospective record review of patients who were initiated on antiretroviral (ARV) treatment between December 2007 and November 2008. A structured questionnaire was used to collect data from 124 patient’s files and data was collected up to November 2011. The data collected included patients’ socio-demographic characteristics, clinical outcomes (CD4 count, viral load, presence of opportunistic infections, adverse effects and hospital admissions recorded at 6, 12, 24 and 36 months), the number of patients who were still attending the ARV clinic at 36 months and the reasons why patients are no longer attending the clinic. Data was analysed with Epi-Info and STATA. Results Of the 124 patients, 69% were females, 28% males and 3% did not have their sex specified. The majority of the patients were between 30 and 49 years. There was a significant improvement in CD4 count and viral load between baseline and all timeperiods after the initiation of ARV treatment. The mean CD4 count at baseline was 128 cells/mm3; it increased to 310 cells/mm3 at 6 months, 380 cells/mm3 at 12 months and 470 cells/mm3 at 24 months. By 6 months, 67% of the patients had achieved viral suppression, but at 24 months, patients started having viral rebound. During the study, 20 patients fell pregnant and four patients fell pregnant twice. Overall, pregnant patients had a significantly higher viral load compared to non-pregnant patients (p-values = 0.015 at 6 months, 0.002 at 12 months and 0.027 at 24 months). Seventy two percent of patients were retained in the program at 36 months. Of the 28% that were no longer attending the clinic, 11.3% were transferred to other institutions, 6.5% were down referred to clinics, 3.2% died, 3.2% defaulted and 3.2% were lost to follow-up. Conclusion This study shows that good clinical outcomes can be achieved within an antiretroviral rollout program in a rural hospital. The biggest magnitude of clinical benefits was observed in the first six months after the initiation of ARV treatment with threats of viral rebound thereafter. There was good patient retention at 36 months after initiation of ARV treatment and a significant difference in viral load between pregnant and non-pregnant patients. The high rate of unplanned pregnancy signifies the need to place closer attention to family planning among female patients on antiretroviral treatment.

Carcinoma of the cervix is frequently diagnosed in the department of Radiation Oncology in Charlotte Maxeke Johannesburg Academic Hospital(CMJAH). It is therefore is a condition of priority and there is scarce literature in the management of HIV positive patients. OBJECTIVES: The primary objective of the research is to determine the overall survival of 2yrs and more, as well as to determine acute and late toxicity for patients completing prescribed radiation treatment. The secondary objective was to determine the impact of highly active antiretroviral therapy on survival and toxicity. The study is limited to HIV positive women presenting with cervical cancer. DESIGN & METHOD: The study is a retrospective study of patients treated at Charlotte Maxeke Johannesburg Academic Hospital between 2008-2009. Inclusion criteria: Females between the ages of 18 and 70, Stages IB2 – Stage IIIB carcinoma of the cervix who have completed planned radiation therapy with or without chemotherapy. The sample size was 151 patients. RESULTS: The mean age was 42.7yrs. The median CD4 count was 309 and 26.2% had CD4 counts below 200.The majority of patients had either Stage IIB (55.0%) or IIIB (31.8%). The total dose to Point A was a median dose of 74Gy. The majority of patients had either Grade II (38.4%) or III (31.1%) toxicity. Significant association between these adverse events and HAART status was rated as p=0.0008. The most common late complication was cystitis (15.9%). Overall survival at 2 years was 100% for Stage I, 92.8% for Stage II and 96% for Stage III. CONCLUSION: The median age was lower than in the HIV negative patients. The acute complications for those not on HAART, were higher in comparison to patients on HAART. The overall survival at 2 yrs. was above 90% for all stages in this study / GR2018

No description available.

This study compare immunological and virological outcomes in antiretroviral therapy naïve patients exposed to Isoniazid prevention treatment.Medical records of antiretroviral naïve patients managed in the public sector from 1st January 2006 to 31st December 2006 were analysed.Multivariate analysis of variance showed that each treatment group achieved statistically significant increases in CD4+ cell count and viral load decay at each follow-up time point. Pairwise post hoc contrast tests showed patients in NVPipt-past group and EFVipt-past group to have superior immunological and virological outcomes respectively. / Health Studies / M.A. (Public health)