Title: An assessment of the effectiveness of Andolex-C ® mouth rinse on oral palliation in HIV-infected patients. Background: The majority of HIV-infected patients present with oral lesions associated with the disease. HIV-infected patients experience profound disorders like oral infections and ulcerations, discomfort and greater levels of social impact than non-HIV patients as a result of oral lesions. Studies have indicated that mouth pain is a significant symptom reported by HIV-infected patients. In order to relieve pain and discomfort and improve quality of life, management of HIV-infected patients should include relief of mouth pain, discomfort as well as the social and psychological distress caused by the oral lesions. Objectives: To determine the prevalence of oral lesions associated with HIV among a cohort of HIV-infected patients. To assess the effectiveness of Andolex-C® mouth rinse on oral palliation in HIV-infected patients. Methods: The intervention of Andolex C® mouth rinse plus a proven preventive oral hygiene regimen was compared to an established oral hygiene intervention. Two hundred and ninety nine patients were randomly assigned into Groups 1 and 2. Patients in Group 1 were given toothbrushes and toothpaste and oral hygiene instruction ‘routine oral hygiene package’. Those in Group 2 received Andolex-C® mouth rinse in addition to the ‘routine oral hygiene package’ given to the first group. A baseline assessment of mouth pain and/or discomfort was done via a clinical examination and an assessment of quality of life was done using the Oral Health Impact Profile (OHIP) questionnaire. The intervention was carried out over a four week period after which a follow-up assessment was done using the same tools. Comparison of baseline versus post-treatment scores was performed to determine impact of intervention in both groups. Results: The prevalence of combined candidal lesions was 71.6% of which Pseudomembranous candidiasis was 43.2%. Erythematous candidiasis and angular cheilitis were the next commonly seen, each with an equal prevalence of 14.2 %. Group 2 (Andolex-C® mouth rinse) showed a statistically significant improvement in quality of life on all subscales related to functioning, pain, psychological and social aspects when using the OHIP index. The patients demonstrated substantial reduction of [64%] of mouth pain and/or discomfort and a 73% reduction of oral lesions compared to Group 1 where there was a much smaller [22%] reduction of mouth pain and/or discomfort and a 40% reduction of the oral lesions. Conclusion: Andolex-C® mouth rinse improved the quality of life of HIV-infected patients who presented with mouth pain and/or discomfort and demonstrated that in combination with proper oral care and good hygiene habits, this regimen could be recommended for oral palliation in HIV positive patients.

M.P.H., Faculty of Health Sciences, University of the Witwatersrand, 2011 / Although the nursing sector has not been spared the effects of human resource shortages and Human Immune-deficiency Virus/Acquired Immune Deficiency Syndrome (HIV/AIDS) crisis in Lesotho, it still remains the backbone of the primary health care delivery. There is a well-established linkage between oral health and HIV/AIDS with many of the early symptoms of HIV manifesting in the oro-facial region. However, the lack of oral health personnel at primary health care levels in Lesotho makes Primary Health Care Nurse Practitioners (PHCNPs) often the first health care providers to consult, manage and refer patients with such oral lesions. Aim: To assess the “knowledge, attitude and practice” (KAP) of the PHCNPs regarding oral health and oral HIV lesions in Queen Elizabeth II (QE II) and Roma health service areas (HSA) of Maseru district in Lesotho. Objectives: To assess the demographic profile of PHCNPs in the target health facilities, their knowledge, attitude and practice regarding oral health and oral HIV lesions. Methods and Materials: The research was a descriptive cross-sectional survey. A convenience sample of 57 primary health care nurse practitioners (PHCNPs) from QE II and Roma health service areas were identified. During their monthly PHC meeting, a questionnaire was administered to assess the knowledge, attitude and practice regarding oral health and oral HIV lesions. The information gathered was both quantitative and qualitative. Data was entered and analysed using the SPSS statistical package. Results: The response rate was 87.7%. There was 100% consensus regarding the importance of oral health to the total well being of individuals. The majority of the PHCNPs recognised oral candidiasis (OC) (94.7%), bleeding gums (87.7%), herpes lesions (71.9%) and dental caries (75.4%). Lesions such as acute necrotizing ulcerative gingivitis (ANUG) (40.3%), angular cheilitis (AC) (56.1%) and apthous ulcerations (24.6%) were also recognised but to a lesser extent. The respondents associated OC (84%), herpes (61%), AC (54%), Oral Hairy Leukoplakia (OHL) (49%), Kaposi‟s‟ sarcoma (KS) (49%) with HIV/AIDS. OC was the most common lesion associated with HIV. Some lesions commonly seen in the clinics such as apthous ulceration and ANUG were not significantly associated with HIV (18% and 33%, respectively). The majority of PHCNPs (81%) indicated that they had knowledge about oral HIV lesions. Twenty nine 6 respondents (50.8 %) reported having received this knowledge through training institutions. Mass media (Radio (53%), TV (40%), and newspapers/magazines (49%)) was one of the major sources of information. Forty-four PHCNPs (77.2%) saw only Zero or one (0-1) HIV patients with oral lesions. Similarly, 15.8 % and 7% of the PHCNPs saw 11 to 20 and more than 20 (21+) HIV patients with oral lesions, respectively. The two thirds of the PHCNPs (67%) said they would not advise patients to seek care from Traditional Health Practitioners (THP) due to their lack of trust and confidence in the practices, knowledge and the patient management of the THPs. However, 16% of them reported that they would refer because they thought traditional medicine boosts the immune system. Only seven respondents (12.3%) routinely washed their hands with antiseptics. However, 44 of respondents (77.2 %) cleaned their instruments with bleach and disinfectants. The majority (89.5%) washed their hands with water and soap. Forty three respondents (75.4%) wore gloves during examination. Routine use of facemasks was limited to only 12 respondents (21.1 %). Ninety eight percent of the PHCNPs stated that they would like to learn to manage oral lesions at health centres. The majority (79%) of the respondents said that they would like to receive more training on the management of oral lesions through workshops. Conclusions: There was an observable correlation between PHCNPs self-assessment of oral health knowledge and the objective knowledge as assessed by ability to identify the oral lesions on a chart ( 2 –sided Fischer‟s test-0.000-0.261).This needs to be confirmed by undertaking a study with a larger sample size. OC was the most common lesion associated with HIV as reported by the PHCNPs. The majority of the participants (94.7%) identified OC and associated it (84%) with HIV infection. The finding indicated that with training and/or mentoring, PHCNPs are likely to confidently diagnose oral HIV lesions. PHCNPs showed a positive attitude towards learning more about the oral manifestations of HIV/AIDS. PHCNPs should be utilised more effectively in the diagnosis and management of HIV/AIDS.

Magister Scientiae Dentium - MSc(Dent) / Aim The aim of the study was to determine the oral health knowledge,management and referral patterns of patients with oral manifestations of HIV by Primary Health Care Nurses.Background Nurses working in Primary Health Care (PHC) facilities, and nursing educators, play a pivotal role in the early identification, referral and diagnosis of patients who present for treatment of health problems. They are in an ideal position to identify HIVinfected persons through a simple visual assessment of the mouth, in order to diagnose oral lesions that may be prognostic of HIV, and to then refer these persons for voluntary counselling and testing (VCT). Timely referral will lead to early medical intervention, with lower treatment costs and improved patient quality of life.Methods The study design comprised of a pre- and post-education test, training and provision of educational material, together with a quantitative and qualitative selfadministered questionnaire. The questionnaire gathered information on nurses demographics,experience, knowledge, training and treatment practices.The study design was a cross-sectional survey which was conducted during the period July to October 2010. The study population consisted of 121 nurses based at Primary Health Care and nursing education facilities within the uMgungundlovu Health District in KwaZulu-Natal. The chi-squared test was utilised to determine the statistical significance of the preeducation and post-education test results and Pearsons Correlation Coefficient was used to determine the significance of correlations between variables. A p-value of <0.05 was regarded as being statistically significant.Results A large number of the respondents did not receive substantial oral health education during both their pre-qualification and post-qualification education stages. Nurses had an inadequate knowledge of oral health assessment and of oral conditions, especially with regard to the common prognostic oral manifestations of HIV. The post-test results were statistically significant (p< .0001), indicating that the provision of education and training to the nurses had a significant impact on nurses knowledge of oral conditions. More than twothirds of the nurses (67,8%) reported that they do not examine the mouth as part of routine overall assessment of the patient, and only 13% referred patients for VCT.Conclusions There is a need to include oral health assessment and oral health promotion into both undergraduate and post-graduate nursing curricula. Further research is needed to identify the specific oral health training needs of all categories of nurses in order to overcome the barriers that prevent nurses from assessing the mouth. Oral health assessment and oral health promotion should become a key part of the curricula of nurses training. The use of oral health promotion workers at a primary health care level should also be considered.