AIM: This study aimed to explore the factors influencing antiretroviral therapy patients` data quality at Princess Marina Hospital Pharmacy in Botswana. METHODS: A phenomenological approach was adopted in this study. Specifically, Interpretative Phenomenological Analysis qualitative design was used to explore the factors influencing antiretroviral therapy patients` data quality at Princess Marina Hospital Pharmacy in Botswana. Data were collected using a semi-structured interview format on 18 conveniently selected pharmacy staff. Data were analysed using Smith’s (2005) Interpretative Phenomenological Analysis framework. RESULT: Five thematic categories emerged from data analysis: data capturing: an extra task, knowledge and experience of IPMS, training and education, mentoring and supervision, and data quality: impact on patients’ care. The findings of this study have implications for practice, training and research. CONCLUSION: Pharmacy staff had limited knowledge of IPMS and its utilisation in data capturing. Such limitations have implications in the context of the quality of data captured / Health Studies / M.A. (Health Studies)

Purpose of the study - Identify predictors of mortality and develop a related care plan for patients who are on antiretroviral therapy (ART) in Gondar, Ethiopia. Design - A quantitative, retrospective cohort study was conducted analysing medical records of HIV patients who presented to Gondar University Hospital (GUH), Gondar, and started ART between 1 January 2007 and 30 June 2010. Results - In defining the predictors of mortality, the findings in bivariate analysis revealed: female sex, CD4 cell count ≤ 50/μl, CD4 cell count 51-199/μl, a haemoglobin concentration ≤8g/dl, a history of oral candidiasis, tuberculosis and Cryptococcus meningitis were all statistically significant. A female sex, CD4 cell count ≤ 50/μl and CD4 cell count 51-199/μl maintain their significance level in the multivariate analysis. Conclusions - The study therefore recommends that clinicians and case managers be vigilant of these predictors of mortality while managing HIV patients who are on ART / Health Studies / M.A. (Public Health)

Thesis (PhD)--Stellenbosch University, 2012. / ENGLISH ABSTRACT: Introduction: Since the South African public sector antiretroviral roll-out programme started in 2004, the success of antiretroviral combination therapy (cART) has been experienced in terms of survival, prevention of mother-to-child transmission (PMTCT) and quality of life. However, as the programme matures, viral resistance to the constituent drugs will increase. Monitoring antiretroviral drug resistance (ARVDR) should therefore be a priority in the public health approach to HIV treatment. Methods: A cross-sectional investigation of genotypic antiretroviral drug resistance in: a) HIV-infected mothers who were exposed to a PMTCT regimen of short course azidothymidine (AZT) with single dose nevirapine (NVP) during labour. b) HIV-infected adults and children who were cART-naïve (transmitted or initial resistance). c) HIV-infected adults and children who were failing cART (drug-induced or acquired resistance). In case of adults, this includes patients on a first-line, non-nucleoside reverse transcriptase (NNRTI)-based regimen, or on a second-line, protease inhibitor (PI)-based regimen, and in case of children, this includes patients on a first-line PI-based regimen. Results: In mothers who received a PMTCT-regimen that combined AZT and NVP the prevalence of NNRTI resistance mutations was 17.1% (95% CI: 8.7-25.6%). The prevalence of transmitted ARVDR in adults was low, as was initial ARVDR in young children (mostly PMTCT-exposed), except for NNRTI resistance in children who had received NVP as part of PMTCT. Drug-induced resistance was found in adults failing first-line NNRTI-based cART, with 83% having resistance to ≥1 drug. In contrast, adult patients failing second-line PI-based cART had a low prevalence of PI resistance; the predominant reason for failure was poor drug exposure, as detected by measuring lopinavir concentrations in blood plasma and hair samples. In contrast, PI resistance in children was not rare, largely due to historic exposure to un-boosted PIs. This resulted in extensive resistance to PIs and reverse transcriptase inhibitors (RTI) in some children. Conclusions: A combined regimen of short course AZT with intrapartum NVP for PMTCT may, in addition to reducing the risk of neonatal infection, also reduce the risk of NVP resistance in the mothers compared to a regimen of NVP only. In South Africa, the prevalence of transmitted ARVDR remains low relative to industrialised countries, probably as comparatively little time has elapsed since the scale-up of cART. Adults failing first-line cART are likely to respond to second-line cART, without failure due to resistance. However some children with PI and RTI resistance cannot be adequately treated with drugs currently available through the roll-out programme. This emphasizes the urgent need for a rational and science-based approach to managing cART-experienced children, including access to additional drugs to form a third-line paediatric cART regimen. / AFRIKAANSE OPSOMMING: Inleiding: Sedert die begin van die Suid Afrikaanse publieke sektor antiretrovirale uitrol program in 2004 is die sukses van antiretrovirale kombinasie-behandeling (k-ARB) ervaar in terme van oorlewing, voorkoming van moeder na kind oordrag (VMKO) en lewenskwaliteit. Nietemin, sal weerstandigheid teen die middels wat in die antiretrovirale program gebruik word toeneem soos wat die program gevestig raak. Die monitoring van antiretrovirale middel-weerstandigheid is derhalwe ‘n prioriteit in gemeenskap-gesondheid benadering tot MIV behandeling. Metodes: ‘n Deursnit ondersoek van genotipiese antiretrovirale middel-weerstandigheid in: a) MIV-geïnfekteerde moeders wat blootgestel is aan VMKO regimen bestaande uit ‘n kort kursus AZT met ‘n enkeldosis nevirapien (NVP) tydens kraam. b) MIV-geïnfekteerde volwassenes en kinders wat komibinasieterapie-naïef (oorgedraagde of inisiële weerstandigheid) is. c) MIV-geïnfekteerde volwassenes en kinders wat k-ARB faal (middel-geïnduseerde weerstandigheid). In geval van volwassenes, sluit dit pasiënte op ‘n eerste-linie, non-nucleosied tru-transkriptase inhibitor (NNRTI)-regimen, en tweede-linie protease inhibitor (PI)-gebaseerde regimen, en in geval van kinders, sluit dit pasiënte in op ‘n eerste-linie PI-gebaseerde regimen. Resultate: In moeders wat ‘n gekombineerde AZT en NVP VMKO-regimen ontvang het, was die voorkoms van NNRTI weerstandigheid 17.1% (95%-vertrouensinterval: 8.7-25.6%). Die voorkoms van oorgedraagde ARVMW in MIV-geïnfekteerde volwassenes en kinders wat kombinasieterapie-naïef is, was laag, so ook ARVMW in jong kinders (meestal VMKO-blootgestel), behalwe vir non-nukleosied tru-transkriptase inhibitor (NNRT) weerstandigheid in kinders wat NVP ontvang het deur VMKO. Middel-geïnduseerde weerstandigheid was gevind in volwassenes wat die eerste-linie NNRTI-gebaseerde k-ARB gefaal het, met 83% wat weerstandigheid teen ≥1 middel het. Volwassenes wat ‘n tweede-linie protease inhibitor (PI) –gebaseerde k-ARB gefaal het , het ‘n lae voorkoms van PI weerstandigheid, met die oorwegenede oorsaak, swak middel-bloostelling, soos bepaal deur van lopinavir-konsentrasies in bloed plasma en hare. In teenstelling hiermee was PI weerstandigheid nie skaars in kinders nie, hoofsaaklik weens historiese blootstelling an ongeskraagde PI-behandeling. Dit het tot uitgebreide weerstandigheid tot PIs en tru-transkritptase inhibitors (RTI) in sommige kinders gelei. Gevolgtrekkings: ‘n Gekombineerde regimen van ‘n kort kursus AZT met NVP tydens kraam vir VKMO, mag bykomend tot die vermindering die risiko van pasgebore infeksie, ook die kans vir weerstandigheid teen NVP in die moeders verlaag in vergelyking met ‘n regimen van NVP-alleen. Die voorkoms van oorgedraagde ARVMW is tans laag in vergelyking met geïndustrialiseerde lande, waarskynlik aangesien daar nog betreklik min tyd verloop het sedert k-ART wyd beskikbaar gemaak is. Volwassenes wat eerstelyn kombinasie terapie faal sal waarskynlik goed reageer op tweede-linie terapie, sonder terapie faling weens middelweerstandigheid. Daarenteen kan sommige kinders met protease inhibitor en tru-transkriptase weerstandigheid nie voldoende behandel word met die huidig-beskikbare middels in die uitrol program nie. Dit beklemtoon die dringende noodsaaklikheid van ‘n rasionele en wetenskaplike benadering tot k-ART in kinders, met ‘n lang terapie geskiedenis, wat toegang tot bykomende medikasie behels om `n derde-linie regimen saam te stel.

AIM: This study aimed to explore the factors influencing antiretroviral therapy patients` data quality at Princess Marina Hospital Pharmacy in Botswana. METHODS: A phenomenological approach was adopted in this study. Specifically, Interpretative Phenomenological Analysis qualitative design was used to explore the factors influencing antiretroviral therapy patients` data quality at Princess Marina Hospital Pharmacy in Botswana. Data were collected using a semi-structured interview format on 18 conveniently selected pharmacy staff. Data were analysed using Smith’s (2005) Interpretative Phenomenological Analysis framework. RESULT: Five thematic categories emerged from data analysis: data capturing: an extra task, knowledge and experience of IPMS, training and education, mentoring and supervision, and data quality: impact on patients’ care. The findings of this study have implications for practice, training and research. CONCLUSION: Pharmacy staff had limited knowledge of IPMS and its utilisation in data capturing. Such limitations have implications in the context of the quality of data captured / Health Studies / M. A. (Health Studies)

NTRODUÇÃO: Embora haja cada vez mais provas de que a co-infecção pelo HCV piora a evolução da hepatotoxicidade relacionada ao HIV, as influências dos diferentes fatores associados a este permanecem mal compreendidas. Este estudo está destinado a avaliar os dados epidemiológicos, laboratoriais e HAART e sua associação com a evolução da taxa de progressão da fibrose (FPR), em doentes co-infectados acompanhados em centros de referência para o tratamento de HIV/VHC na cidade de São Paulo, Brasil. MÉTODOS: 938 prontuários de patientes coinfectados foram revisados para este estudo e 102 preencheram os critérios de inclusão. Um estudo transversal, avaliando os aspectos sócioepidemiológicos, laboratoriais e biópsia hepática foi realizado e correlacionado o grau de fibrose hepática e a FPR encontrada. RESULTADOS: A população foi caracterizada por indivíduos homens (83,3%), de meia-idade (42,9 anos), brancos (53,9%), com o principal fator de risco de aquisição de ambas as infecções foi através da utilização de drogas ilícitas (72,5%), principalmente intravenosa e presença de consumo de álcool (75,5%), com predominância do genótipo 1 de HCV (56,9%) e tempo médio de uso de antirretrovirals de 7,9 anos (DP = 3,6 a). A avaliação histológica não mostrou qualquer relação entre maior grau de fibrose na biópsia hepática relacionados com a exposição da antirretrovirals ou mesmo na FPR. Abuso de drogas ilícitas, incluindo cocaína inalada e intravenosa relacionam-se com taxas mais elevadas fibrose hepática e FPR. CONCLUSÃO: Os resultados enfatizam a necessidade de incentivar a retirada do consumo de drogas ilícitas da população de pacientes coinfectados HIV/VHC em uso de qualquer regime antirretroviral. O nosso estudo não encontrou nenhuma relação entre a utilização de regimes baseados em IP ou NNRTI e um pior prognóstico da fibrose hepática ou FPR na população avaliada. / BACKGROUND: Although there\'s growing evidence that the co-infection with HCV worsens the evolution of the HIV-related hepatotoxicity, the influence of the different factors associated to this remains poorly understood.This study intended to evaluate the epidemiological, laboratorial and HAART associated to the evolution of the fibrose progression rate (FPR) in co-infected patients followed in reference centers for the treatment of HIV/HCV in the city of São Paulo, Brazil. METHODS: 938 medical charts of co-infected patientes were reviewed for this study.and 102 fullfilled the inclusion and exclusion criteria to participate. A cross-sectional study evaluating socio-epidemiological aspects, laboratorial assesment and liver biopsy was performed and correlated with the fibrosis rate and the fibrosis progression rate (FPR). RESULTS: The population was characterized by male (83,3%), middle-age (42,9 years), white (53,9%) individuals, with a main risk factor of adquisition of both the infections trough illicit drugs-use (72,5%), mainly intravenous and alcohol consumption (75,5%), with predominance of HCV genotype 1 (56,9%) with a medium time of use of antiretrovirals of 7,9 years (SD=3,6 y). Histologic evaluation showed no relation between higher fibrosis degree in the liver biopsy related to the exposure of the antiretrovirals or even in the fibrosis progression rate (FPR). Illicit drugs abuse, including inaled and intravenous cocaine , were related to higher liver fibrosis rates and FPR. CONCLUSION: Our results emphasize the necessity of encourage the withdraw of ilicit drugs consumption in the HIV/HCV co-infected population in use of any antiretroviral regimen. Our study does no find any relation between the use of IP or NNRTI-based regimens and the poor prognosis of the liver fibrosis in this population.

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. viii 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.

Thesis (MPH.) -- University of Limpopo, 2015 / Background: The introduction of Antiretroviral Therapy (ART) has shown a tremendous reduction in HIV-related mortality and morbidity in people living with HIV / AIDS. Adherence to ART is the key to a successful treatment outcome. This study investigates the adherence of people living with HIV who are on ART. Since high levels of adherence of more than 95% are required to achieve effective suppression of the viral load, the researcher finds it very important to establish whether the people are pursuing what is expected of them. While the use of ART has brought much excitement and hope to both patients and medical practitioners in the world, it has also brought many new questions and challenges, including adherence issues. Adherence is, therefore, essential to achieve the success of ART. Aim: The main objective was to determine which factors influence adherence to ART among HIV and AIDS patients. Methods: This study utilised a quantitative cross-sectional descriptive design that was conducted at the Kwa-Thema Clinic, Ekurhuleni District, Gauteng Province. Data was collected using a structured questionnaire with open- and closed-ended questions where a total of 290 respondents were interviewed. Data was analysed using SPSS software version 22 and the analysed data was presented by means of charts, graphs, and frequency tables. Results: The findings indicated that the adherence to ART at the Kwa-Thema Clinic was 77%. Factors that were significantly associated with adherence were gender ((χ2 = 3.78, df = 1, p < 0.05).), level of education ((χ2 = 3.52, df = 3, p = 0.032), co-treatment of HIV and other infections (χ2 = 5.46, df = 4, p = 0.019).), ability to follow ART ((χ2 = 12.82, df = 1, p = 0.000 < 0.05), and types of ARV drugs. Recommendation: To enhance ART adherence the study recommends intensification of health education campaign against stigma and gender discrimination. Providing feedback to the patients by the healthcare providers regarding the benefits of ART is important. ix Conclusion: It was concluded that the adherence to ART at the Kwa-Thema Clinic was sub-optimal (less than 95%) at 77% but comparable to the adherence levels in other developing countries.

<p>Antiretroviral regimens have side effects that can threaten adherence by patients resulting in evolution of viral resistance due to suboptimal drug levels. Studies have shown that drug adherence of at least 80% can result in viral load suppression. There is no literature on the association between the level of adherence to antiretroviral therapy and the degree of virological suppression in Namibia. The aim of the present study was to determine the therapeutic and virological outcomes in HIV/AIDS patients at 6 and 12 months after initiation of highly-active antiretroviral therapy (HAART) in an urban population in Namibia. The distribution of viral load results showed a low uptake (35%) of virological monitoring at 6 month time point and even lower (12%) at 12 months. A conservative viral load threshold for virological response is required in the Namibian setting. The current adherence level of &gt / 80% encourage increased ARV therapy rollout. Poor virological outcome was associated with self-reported adherence.</p>

<p>Antiretroviral regimens have side effects that can threaten adherence by patients resulting in evolution of viral resistance due to suboptimal drug levels. Studies have shown that drug adherence of at least 80% can result in viral load suppression. There is no literature on the association between the level of adherence to antiretroviral therapy and the degree of virological suppression in Namibia. The aim of the present study was to determine the therapeutic and virological outcomes in HIV/AIDS patients at 6 and 12 months after initiation of highly-active antiretroviral therapy (HAART) in an urban population in Namibia. The distribution of viral load results showed a low uptake (35%) of virological monitoring at 6 month time point and even lower (12%) at 12 months. A conservative viral load threshold for virological response is required in the Namibian setting. The current adherence level of &gt / 80% encourage increased ARV therapy rollout. Poor virological outcome was associated with self-reported adherence.</p>

HIV drug resistance (HIVDR) has emerged as a major clinical and public health challenge in many resource poor countries especially in Africa. HIVDR testing has become increasingly important and is of significant value in the management of HIV. The use of low cost technologies and procedures in testing HIVDR is being recommended. HIVDR computer interpretation algorithms make use of artificial intelligence and other computer technologies to predict HIVDR, and are recommended for use in resource poor countries. However, there is little known about the knowledge, attitude and perception of HIVDR computer algorithms by doctors in developing countries who are supposed to use computer algorithms. This study aimed to determine the knowledge, attitude and perception regarding computer interpretation algorithms of the 4th and 5th year medical students at Nelson R. Mandela School of Medicine, University of KwaZulu Natal in South Africa. Primary data collection was done using a questionnaire administered to a convenience sample of 216 4th and 5th year medical students. The study revealed that 90% of the respondents were aware of HIV drug resistance testing in South Africa but only 4% had knowledge of the computer interpretation algorithms. The study revealed that although the UKZN medical students are not aware of computer interpretation algorithms, majority are willing to use them in the future. / Thesis (M.Med.Sc.)-University of KwaZulu-Natal, Durban, 2013.