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Client factors determining ARV adherence in Natalspruit hospital and Impilisweni CHC in Gauteng Province in 2006Kigozi, Lubwama John 14 October 2008 (has links)
Introduction: South Africa has embarked on a massive roll out of ARVs to more than 1.4
million people living with HIV/AIDS. Provision of ARVs to people living with HIV/AIDS
encounters many challenges associated with adherence. Properly taken ARVs have been shown
to reduce viral loads to undetectable levels and increase the CD4 count. This in turn leads to a
drop in opportunistic infections and better health outcomes but the requirements for adherence
are high. Several patient-related factors have been reported to affect adherence rates. Nonadherence
on the other hand has been reported to lead to the development of drug resistant
strains of HIV. It recognised that the resistance to ARVs can quickly lead to build up of highly
resistant strains in the blood due to one week of missed medication.
Aims and objectives: This study set out to identify factors which affect adherence to HAART
among adults on HAART in two health facilities in Gauteng province in 2006.The main
objectives were to assess the patient adherence using viral load response and self-report data.
Secondly, the study was to determine factors that facilitate adherence and finally barriers to
adherence at the two sites.
Materials and methods: A cross sectional study was done at the two ARV facilities in Gauteng
from July to November 2006. Two physiological methods -CD4 counts and plasma viral load,
and one subjective-3 day recall self- report methods were used to asses adherence. Exit
interviews and record reviews were done to collect data. Virologic outcome was the preferred
surrogate marker for adherence. Univariate and bivariate analyses were done to determine
measures of association. Measures of association (Chi square) at a 95% significance level for
factors affecting adherence were then determined and results obtained.
Results: The mean age was 36.9 years (range 18-70 years) and 73.5% were women. Self-report
data (n=343) indicated 98.4% in the higher adherence category (taken 100% of their doses). Viral
load data (n=343) showed that 88.8% were in the adherence lower category (<400 RNA copies).
Viral load outcome (“adherence”) was significantly associated with the length on treatment
(p<0.05) and patients who had been on treatment for 12-24 months had lower viral load than
those who had been treatment for a shorter time (<12 months) or longer (>24months).
However, gender (p=1.000), age (p=0.223), level of education (p=0.697) and access to social
grants (p=0.057) were not associated with “adherence”. Socio-economic status was significantly
associated with viral load outcome (p<0.01) as well as cost (n=185; p<0.05). Individuals who
incurred the highest costs (>R25) were the least likely to adhere followed by those facing average
costs (R15-25) compared to the reference group (< R15).
Conclusion: Adherence rates of 88.8% suggest that respondents from both facilities can
optimally adhere to their medication when they have been on ARVs for longer than a year.
These are minimum adherence rates. There were factors that still hinder adherence at both the
individual patient level. There is still a need for more targeted interventions especially towards
men who were noted to have a relatively low uptake of HAART within the two sites.
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Anthropocentric impacts on the ecology and biodiversity of the Natalspruit watercourse and its associated wetlandsKruger-Franck, Elmarie 07 1900 (has links)
Information regarding the ecological wellbeing of the Natalspruit and its adjoining wetlands is
essential if the river is being managed using sound ecological management principles. Despite
this, little is known about this river, with little documentation at the regional or municipal level.
This study partially addresses this knowledge gap by evaluating the impacts of human activity
on a section of the Natalspruit and its adjoining wetlands. It reports on pollution concentrations
found at selected sample sites and compares the results to Rand Water data and the National
Standards and Guidelines of South Africa for physicochemical parameters and contaminated
soils. Water samples were collected at five chosen sample sites during May and July 2018. Soil
samples were taken during July 2018. The study found that water at all five sample sites is not
suitable for drinking, the health of livestock and recreational use due to the present and high
Total Coliform levels (ranging from 450 CFU/100ml to 100 000 CFU/100ml), as well as
Turbidity, Total Hardness, TDS, Mg, NO2, SO4, and BOD which also exceeded the guidelines.
Only site SS1 (May) exceeded the CaCO3 concentrations regarding livestock health. No
guidelines were available for DO levels on the health of livestock. Cl levels in the Natalspruit
was suitable for drinking. PO4 concentration at all the sites were all within the guidelines of
acceptable levels for aquatic ecosystems. In terms of heavy metals, Cr levels significantly
exceeded the guidelines at all five sample sites with the exception of ecosystem health. This is
of great concern due to the toxicity of Cr. Cu concentrations exceeded the guidelines for both
all land-uses protective of water resources and ecosystem health, at SS1, SS2, SS3 and SS5. Ni
concentrations exceeded the guidelines for all land-uses protective of the water resources at
SS5. Pb and Zn concentrations exceeded the guidelines for the land-uses protective of the water
resources at all the sites with the exception of SS4 for Pb and SS2 and SS4. SS1 and SS5
reported Zn concentrations higher than the guideline for the protection of ecosystem health.
SASS 5, PES and EIS assessments indicated moderate to severe modifications of the river.
Thus, mining, industrial activities, surface runoff from densely populated informal settlements and wastewater treatment plants have negatively impacted upon the river. Decades of
environmental neglect and effluent discharge have degraded the ecosystem, thus necessitating
rehabilitation. However, as the study was limited in both time and scope, so additional research
should be undertaken. / Environmental Sciences / M. Sc. (Environmental Management)
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'n Ondersoek na die versteuring van die fauna in die Elsburg-Natalspruitsisteem deur die industriële en mynaflope in die Johannesburg-Oos-Randse gebiedePotgieter, Frederick Theodore 18 August 2014 (has links)
M.Sc. (Zoology) / Please refer to full text to view abstract
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