Human immune deficiency virus (HIV) and Acquire immune deficiency syndrome (AIDS) is a worldwide epidemic that impacts individuals physically, socially, and psychologically, and the rates of HIV/AIDS in youth are rising. Antiretroviral treatments have drastically prolonged life in individuals with HIV/AIDS; however, this type of treatment requires strict medication adherence. Many psychosocial factors impacting antiretroviral adherence have been explored, yet very little has been investigated regarding body image. This study investigated the potential impact of body dissatisfaction on antiretroviral medication adherence in adolescents with HIV. Seventy five male and female youth were administered questionnaires on the constructs of body dissatisfaction and medication adherence. Results support the hypothesis that body dissatisfaction negatively impacts medication adherence; yet, its effect in this sample was small (R2 = .06; F(1,61) =3.87, p =.05). Additionally, it was predicted that gender would moderate the nature of the relation between body dissatisfaction and medication adherence, given the disparate societal presentations of ideal body types among genders. However, within the current sample, gender did not have an effect on this relation. Furthermore, this study was interested in exploring if body dissatisfaction within a population of HIV-infected youth was best explained by specific body dissatisfaction with areas of the body associated with lipodystrophy or lipoatrophy syndromes. Due to a very small presentation of these syndromes in the final sample (n = 4), it was not surprising that body dissatisfaction was not best explained through specific dissatisfaction with these body parts. However, dissatisfaction with muscularity in general, was predictive of general body dissatisfaction regardless of gender. A discussion of these findings is included. This study is one of the first of its kind to explore the potential detrimental effects of body dissatisfaction in HIV infected youth.

Inflammatory bowel disease (IBD; Crohn’s disease & ulcerative colitis) is a chronic illness in which medication and dietary adherence may determine disease natural history and severity of symptoms. We hypothesized that age, prospective memory (PM) and body satisfaction would predict medication and dietary adherence in adolescents with IBD and that gender and age would modify the relation between body satisfaction and adherence, with older girls being less adherent than younger children. Fifty-seven participants aged 10-21 (M = 16.5, SD = 2.3) with IBD and their caregivers were recruited. Informed consent, demographics and body satisfaction questionnaires were completed. PM was assessed using a naturalistic task. Adherence was measured by the 1-week completion of a medication and dietary log. A questionnaire was administered to evaluate coping strategies used for overcoming obstacles to dietary adherence. Two hierarchical regressions were conducted for medication and diet adherence respectively. As hypothesized, age had a significant effect (â = -.42, p < .01) on dietary adherence, accounting for approximately 17% of the variance (R2change = .17; Fchange (1,41) = 8.57, p = .006), with younger children being more adherent. Body satisfaction had a greater and more significant effect on dietary adherence than age (â = -.33, p < .01); i.e. participants more satisfied with their body reported better dietary adherence (R2change = .28; Fchange (2,35) = 6.97, p < .05). Findings remained consistent across multiple measures of body satisfaction and dietary adherence. None of the predictors had a significant effect on medication adherence. Health care providers who treat adolescents with IBD and parents should be made aware of factors affecting adherence in order to improve disease outcomes and patients’ quality of life.

<p>In the era of AIDS, food and nutrition are becoming more of a priority for many households and communities. This is more so now that treatment is available for people infected with HIV and AIDS. Food and nutrition are fundamentally intertwined with HIV transmission and the impacts of AIDS. Evidence of the ways in which food insecurity and malnutrition may interfere with the effectiveness of antiretroviral therapy is well documented. Aim: The purpose of the study was to inform improvements in food security interventions for PLWHA through an investigation of existing food security interventions in the Khomas Region, Namibia.</p>

<p>Background: HIV/AIDS affects the health of millions of people world wide. According to the Joint United Nations Program on HIV/AIDS [UNAIDS], the number of people living with HIV globally has risen from 26 million in 2001 to 33.2 million in 2007. It is estimated that 2.5 million people were newly infected with HIV in 2007. The introduction of anti-retroviral therapy [ART] has brought hope to millions of people living with HIV and AIDS. More recently, the increased availability of treatment in many countries including Namibia has dramatically improved survival rates and lowered the incidence of opportunistic infections among HIV patients. Adherence to antiretroviral therapy (ART) is a fundamental attribute of excellent clinical HIV care and a key aspect in determining the effectiveness of treatment. Strict adherence to ART is vital to maintain low viral load and to prevent the development of drug resistant virus. Poor adherence is one of the key obstacles to successful ART for HIV positive patients. Literature has shown that there are various factors that hinder adherence to ART such as patient, service, community, family, socio-economic and work-related factors. Aim: This study aimed to describe the experiences of patients in the ART programme at Katutura State Hospital, Communicable Disease Clinic (CDC), in the Khomas region of Namibia and to explore factors that contribute to poor adherence.</p>

Magister Public Health - MPH / Background: HIV/AIDS affects the health of millions of people world wide. According to the Joint United Nations Program on HIV/AIDS [UNAIDS], the number of people living with HIV globally has risen from 26 million in 2001 to 33.2 million in 2007. It is estimated that 2.5 million people were newly infected with HIV in 2007. The introduction of anti-retroviral therapy [ART] has brought hope to millions of people living with HIV and AIDS. More recently, the increased availability of treatment in many countries including Namibia has dramatically improved survival rates and lowered the incidence of opportunistic infections among HIV patients. Adherence to antiretroviral therapy (ART) is a fundamental attribute of excellent clinical HIV care and a key aspect in determining the effectiveness of treatment. Strict adherence to ART is vital to maintain low viral load and to prevent the development of drug resistant virus. Poor adherence is one of the key obstacles to successful ART for HIV positive patients. Literature has shown that there are various factors that hinder adherence to ART such as patient, service, community, family, socio-economic and work-related factors. Aim: This study aimed to describe the experiences of patients in the ART programme at Katutura State Hospital, Communicable Disease Clinic (CDC), in the Khomas region of Namibia and to explore factors that contribute to poor adherence. / South Africa

Magister Public Health - MPH / In the era of AIDS, food and nutrition are becoming more of a priority for many households and communities. This is more so now that treatment is available for people infected with HIV and AIDS. Food and nutrition are fundamentally intertwined with HIV transmission and the impacts of AIDS. Evidence of the ways in which food insecurity and malnutrition may interfere with the effectiveness of antiretroviral therapy is well documented. Aim: The purpose of the study was to inform improvements in food security interventions for PLWHA through an investigation of existing food security interventions in the Khomas Region, Namibia. / South Africa

Magister Public Health - MPH / Namibia is severely affected by the HIV/AIDS epidemic, with an estimated HIV prevalence of 17.8%. A comprehensive, public HIV/AIDS treatment and care programme was established in 2003 by the government of Namibia in association with its development partners. The introduction of antiretroviral therapy [ART] has dramatically decreased HIVrelated mortality and morbidity, improved quality of life, revitalized communities and transformed perceptions of HIV/AIDS from a plaque and death sentence to a manageable chronic condition. Intermediate Hospital Oshakati (IHO) in the Oshana region, is one of the six pilot hospitals where highly antiretroviral therapy (HAART) was initiated. Adherence to antiretroviral therapy (ART) is a key factor in ensuring optimal clinical outcomes and is associated with improved survival among HIV and AIDS patients. Sustained high levels of adherence (taking 95% or more of medication as prescribed) are essential for treatment success. Suboptimal adherence to treatment has been associated with virologic, immunologic and clinical failure, and may increase the risk of resistance to first-line ART drugs. Studies conducted in various parts of the country including the Oshakati district, report small proportions of patients defaulting on ART. Defaulting from treatment raises questions about adherence to ART as it can be assumed that poor adherence would precede defaulting from treatment. This study explored factors that influence poor adherence to ART among patients at Intermediate Hospital Oshakati. / South Africa

Submitted by Fabio Sobreira Campos da Costa (fabio.sobreira@ufpe.br) on 2017-07-14T15:57:43Z No. of bitstreams: 2 license_rdf: 811 bytes, checksum: e39d27027a6cc9cb039ad269a5db8e34 (MD5) disertaçãomestradoalexbernardoposneuro2016.pdf: 1482621 bytes, checksum: 6077c9780a49008fbef291d8e14c99fb (MD5) / Made available in DSpace on 2017-07-14T15:57:43Z (GMT). No. of bitstreams: 2 license_rdf: 811 bytes, checksum: e39d27027a6cc9cb039ad269a5db8e34 (MD5) disertaçãomestradoalexbernardoposneuro2016.pdf: 1482621 bytes, checksum: 6077c9780a49008fbef291d8e14c99fb (MD5) Previous issue date: 2016-05-30 / Um aspecto crucial na gestão do cuidado para pacientes com Esclerose Múltipla está na identificação, manutenção e inclusão dos pacientes quanto a aderência ao tratamento. Objetivo: O objetivo desta dissertação foi investigar quais fatores sociodemográficos, clínicos e relacionados à terapêutica medicamentosa influenciam na adoção da prática da autoadministração de imunomoduladores em pacientes de EM e se tal prática resulta em maior adesão ao tratamento. Métodos: trata-se de estudo prospectivo, descritivo e exploratório com abordagem quantitativa. A amostra foi composta por 82 pacientes de EM atendidos em um Centro de Referência do Estado de Pernambuco. Os dados foram coletados através de entrevistas realizadas nos meses de março e abril de 2016. Os dados foram armazenados e analisados no SPSS -21. Para a análise de associação foram utilizados testes estatísticos que considerou significância estatística quando o valor de p< 0,05. Resultados: Apresentaram significância estatística positiva para adoção da prática da autoadministração foram: menor idade (p=0,021), maior escolaridade (p=0,006), permanecia na atividades acadêmicas e/ou profissionais (0,001), realizavam todas as doses prescritas do medicamento (p=0,001). Quanto a adesão ao tratamento as variáveis que apresentaram significância estatística positiva foram: permanecia na atividades acadêmicas e/ou profissionais (p=0,001), menor impacto da doença na qualidade de vida (p=0,042). Os paciente aderentes ao tratamento mudaram menos de imunomodulador (p=0,001). Conclusão: idade, escolaridade e ocupação podem torna-se barreiras para adoção da prática da autoadministração de imunomoduladores em pacientes de Esclerose Múltipla. A prática da autoadministração melhora a aderência ao tratamento, resultado em menor taxa de migração do immunomoduador e menor índice de falha terapêutica. / A crucial aspect of care management for patients with Multiple Sclerosis is the identification, maintenance and inclusion of patients and adherence to treatment. Objective: The aim of this work was to investigate which sociodemographic, clinical factors and related to drug therapy influence the adoption of the practice of selfadministration of immunomodulators in MS patients and the practice results in better treatment adherence.Methods: It is a prospective, descriptive study with a quantitative approach. The sample consisted of 82 patients with MS treated at a State of Pernambuco Reference Cente. Data were collected through interviews conducted in March and April 2016. Data were stored and analyzed using the SPSS -21. For association analysis statistical tests were used which considered statistically significant when the p value <0.05.Results: Showed positive statistical significance for adoption of the practice of self-administration were younger age (p = 0.021), higher education (p = 0.006) remained in academic activities and / or professionals (0,001), performed all prescribed doses of the drug (p = 0.001). The adherence to treatment variables that showed positive statistical significance were remained in academic and / or professional activities (p = 0.001), lower impact of disease on quality of life (p = 0.042). The adherent to treatment immunomodulator changed less (p = 0.001). Conclusion: age, education and occupation can become barriers to adoption of the practice of selfadministration of immunomodulators in multiple sclerosis patients. The practice of self management improves adherence to treatment, results in lower immunomoduador migration rate and lower treatment failure rate.

Adherence to Treatment in Patients after Kidney Transplantation Author: Barbora Vaňková Tutor: PharmDr. Josef Malý, Ph.D. Consultant: PharmDr. Kateřina Ládová, Ph.D. Department of Social and Clinical Pharmacy, Faculty of Pharmacy in Hradec Králové, Charles University Introduction and aims: Kidney transplantation (KT) is the best treatment option for patients with end- stage renal disease. However, despite its numerous benefits it requires a lifelong medical regimen of immunosuppressive treatment (IS) with a special emphasis on a strict medication adherence (MA). The objective of our study was to analyse MA in KT outpatients. We also intended to analyse non- adherence as one of the drug-related problems. Furthemore, we focused on analysis of the main self- management tasks. Methods: The prospective cross-sectional study was undertaken in one year period from March 2016 to March 2017 at the Haemodialysis Centre in the Teaching Hospital Hradec Králové. Patients ≥ 18 years old and at least 3 weeks after KT were addressed within their regularly scheduled visit to the nephrologist. Structured interview was performed by pharmacist to determine patients' self-reported MA to IS using validated Czech version of Medication Adherence Report Scale (MARS-CZ). In addition, patients were interviewed about other...

To sustain the health and viability of renal transplants, adherence to immunosuppressant therapy (IST) medications is critical. Studies continue to identify decreased adherence rates as time from transplant increases (Chisholm-Burns, Kwong, Mulloy & Spivey, 2008; Chisholm, Lance, Mulloy, 2005; Chisholm, Mulloy, & DiPiro, 2005; Nivens & Thomas, 2009). While previous research has explored the effect of variables known to influence IST adherence in adult renal transplant recipients, limited studies have explored these variables in a population of renal transplant recipients with longer time posttransplant intervals. The purpose of this study was to examine demographic variables, time posttransplant, immunosuppressive agents, health beliefs, social support, and symptom experience and test their relationship to adherence in a population of long-term renal transplant recipients. A cross-sectional correlational design was used to collect data from a convenience sample of 98 adult renal transplant recipients who were three or more years from transplant. Participants completed five instruments: 1) demographic survey, 2) the Beliefs About Medicines Questionnaire (BMQ), 3) the Medical Outcomes Study (MOS) Modified Social Support Survey (MSSS), 4) the Basel Assessment of Adherence with Immunosuppressive Medication Scales (BAASIS), and 5) the Modified Transplant Symptom Occurrence and Symptom Distress Scale- 59R (MTSOSD-59R). A composite adherence score (CAS) consisting of a self-report measure of adherence (BAASIS), nontherapeutic serum drug assay, and collateral report of adherence as provided by two transplant clinic professionals was used to determine final adherence group classification (adherent/nonadherent). Analysis of the relationship between all independent variables and adherence was conducted using Spearman’s rho correlation coefficient. Mean scores for medication complexity, health beliefs, social support, and symptom experience were 4 compared between age, gender, and time posttransplant groups using independent-samples t tests. A logistic regression prediction of probability was conducted to determine which of the variables that demonstrated a significant relationship to adherence were most predictive of adherence. Of the total sample population (N = 98), 39.8% (n = 39) were classified as adherent and 60.2% (n = 59) were nonadherent. Results demonstrated no significant relationship between age (continuous variable), time posttransplant, immunosuppressant medications (measured by a medication complexity index), health beliefs, symptom experience, and adherence. Weak, but significant relationships between age groups (r = -.213, p=.035), tangible social support (r = .215, p =.017), emotional informational social support (r = .274, p = .003), positive social interaction support (r = .199, p = .025), total overall social support (r = .274, p =.003) and composite adherence group classification were found. Older participants ( > 55 yrs) were significantly less adherent than younger ( < 54 yrs) participants. Mean scores for emotional / informational (EMI), positive social interaction (POS), and total social support (MSSS) were significantly lower in nonadherent participants. Regression results indicated the overall model of two predictors (age grouped [ < 54 yrs; > 55 yrs] and EMI social support subscale) was statistically reliable in distinguishing between adherent and nonadherent participants (-2 Log Likelihood 116.244; Goodness-of-Fit x 2 (2) = 13.664, p = .001), correctly classifying 69.1% of the cases. Findings from this study contribute to the body of research exploring predictors of immunosuppressant adherence in long-term renal transplant recipients. Data suggest both younger age (< 55) and categories of social support predict adherence in long-term renal transplant recipients. Healthcare providers caring for renal transplant recipients long-term 5 should consider annually assessing older participants for adherence as well as for changes in social networks.