<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>

<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 / 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

Magister Public Health - MPH / Background: HIV and AIDS is one of the major public health problems facing South Africa today. In 2005, it was estimated that 5.54 million people were living with HIV in South Africa, which means that 18.8% of the population between the ages of 15 – 49 years are infected with HIV. This makes South Africa the developing country worst affected by the HIV pandemic. The severity of the HIV epidemic is closely linked to poverty and other socio-economic factors. The National Department of Health of South Africa launched the National Operational Plan for Comprehensive HIV and AIDS management, treatment, care, and support in 2007 to ensure that ART is freely available in the public health sector. It is estimated that by mid-2008 approximately 568, 000 HIV infected patients were receiving ART at South African hospitals. Suboptimal adherence to ART is pervasive despite specific protocols to prepare patients for long-term adherence prior to treatment initiation. Known barriers to ART adherence have been categorized as patient, socio-economic, service, therapy/regimen and communityrelated factors. Effective delivery of ART services requires an understanding of patients’ knowledge, attitudes, and beliefs about ART and how these influence their adherence. Aim: The aim of the study was to assess adherence to antiretroviral therapy and knowledge, attitudes and beliefs about ART among people on ART at Shongwe hospital in Nkomazi region in Mpumalanga province, South Africa. Methodology: A descriptive, cross-sectional survey was conducted among 184 patients receiving ART at Shongwe hospital in Mpumalanga. Data was collected through selfiv administration and face-to-face interviews. Quantitative data was analysed using the SPSS version 16.0 and for stratification Epi-Info version 3.4.1 was used. Results: All participants were on first line regimens: lamivudine/stavudine/stocrine or efivarenz (65.6%); and lamivudine/stavudine/nevirapine (34%). Self-reported adherence was high - 92.4% and 84.2% of participants reported optimal adherence over the previous two days and seven days, respectively. Disclosure of HIV status and being on ART was high among the respondents (97% and 97.3%) respectively. The most common barriers to missing doses were problems travelling to the clinic (22.3%), forgetting (19.6%), and sleeping away from home (18.5%). There was significant association between participants knowing that “missing doses of ART leads to disease progression”, and ART adherence on two day recall (p=0.00) and seven day recall (p=0.02). There was a significant association between disclosure of HIV status and ART adherence on two day recall (p=0.01). Significantly more participants who disclosed being on ART (98.2%) reported optimal adherence over the previous two days (p = 0.00) and seven days (p = 0.00) compared to those who did not disclose being on ART. Participants who reported forgetfulness were 76% less likely (95% CI: 0.09-0.65) and 92% less likely (95% CI: 0.04 – 0.17) to have optimal adherence over two and seven days, respectively, than participants who did not report forgetfulness to be a barrier. Conclusion: Adherence levels in Nkomazi region are to be comparable with those in other regions in South Africa, despite the fact that participants were facing financial constraints and high unemployment rates. These study findings emphasize the need for strengthening communication between patients and health care providers, and the need for overcoming access barriers related to the services, forgetfulness and sleeping away from home.

<p>Background: Tuberculosis (TB) is a resurgent disease in many parts of the world, fuelled by HIV/AIDS and poverty. According to WHO, over two billion people were estimated to be infected by TB globally, 9.4 million new cases of TB were reported, while about 1.7 million people were estimated to have lost their lives to TB in 2009 (WHO, 2010). The&nbsp / global defaulter rate for TB was estimated at about 9% in 2007 (WHO, 2007). With Africa remaining the global epicentre of the TB epidemic, the epidemic in Sub-Saharan Africa,&nbsp / one of the worst affected areas in the world, shows no evidence of decline (WHO, 2008). According to the 2009 MOHSS annual report, 1300 people lost their lives to TB in&nbsp / Namibia (MOHSS, 2010). The introduction of TB treatment saves many lives globally. However, despite this effort, TB patients have been reported to default treatment in many&nbsp / parts of the world including Namibia. Namibia reported a defaulter rate of 10% above the national target of less than 5% (Maletsky, 2008). Aim: This study aimed to investigate&nbsp / the factors that contribute to treatment defaulting amongst TB patients at a major health centre in Windhoek district, Namibia. Methodology: A descriptive qualitative study using&nbsp / in-depth interviews was conducted among ten TB defaulters. Key informant interviews were also conducted with the two TB nurses based at the health centre. Eligible&nbsp / participants were purposively selected. A thematic content analysis of transcribed data was conducted where themes related to patient&rsquo / s experiences of the illness / socio- economic / community, family, cultural and religious as well as health system factors were drawn out. Results: The study results indicate that defaulting TB treatment is a big challenge to TB management. The reasons for defaulting given by respondents were complex and included patient factors such as medication related factors, lack of knowledge and information as well as alcohol abuse. The findings also revealed unemployment as a major socio-economic factor that contributes to defaulting. In addition, the study shows that community, family, religious and cultural factors such as poor family support, work-related factors and religious and cultural beliefs have an influence on defaulting. Accessibility to health care services, sharing of the TB department with ART patients and attitudes of health workers were identified as health service&nbsp / factors that influence treatment defaulting. This study also highlights the relationship between some of these factors. Conclusion: The study concludes that no single factor contributed to treatment defaulting amongst TB patients in the selected health centre in&nbsp / Windhoek district and this concurred with the literature. There are many different factors at different levels that have an influence on TB treatment defaulting. An interrelationship between personal, socio- economic, community, family, religious and cultural as well as health services- related factors was evident What makes it more complex is that these&nbsp / factors also impact on each other and therefore a holistic approach in the management of TB is required to address these factors. Recommendations based on the findings of the&nbsp / study are made. </p>

<p>Background: Tuberculosis (TB) is a resurgent disease in many parts of the world, fuelled by HIV/AIDS and poverty. According to WHO, over two billion people were estimated to be infected by TB globally, 9.4 million new cases of TB were reported, while about 1.7 million people were estimated to have lost their lives to TB in 2009 (WHO, 2010). The&nbsp / global defaulter rate for TB was estimated at about 9% in 2007 (WHO, 2007). With Africa remaining the global epicentre of the TB epidemic, the epidemic in Sub-Saharan Africa,&nbsp / one of the worst affected areas in the world, shows no evidence of decline (WHO, 2008). According to the 2009 MOHSS annual report, 1300 people lost their lives to TB in&nbsp / Namibia (MOHSS, 2010). The introduction of TB treatment saves many lives globally. However, despite this effort, TB patients have been reported to default treatment in many&nbsp / parts of the world including Namibia. Namibia reported a defaulter rate of 10% above the national target of less than 5% (Maletsky, 2008). Aim: This study aimed to investigate&nbsp / the factors that contribute to treatment defaulting amongst TB patients at a major health centre in Windhoek district, Namibia. Methodology: A descriptive qualitative study using&nbsp / in-depth interviews was conducted among ten TB defaulters. Key informant interviews were also conducted with the two TB nurses based at the health centre. Eligible&nbsp / participants were purposively selected. A thematic content analysis of transcribed data was conducted where themes related to patient&rsquo / s experiences of the illness / socio- economic / community, family, cultural and religious as well as health system factors were drawn out. Results: The study results indicate that defaulting TB treatment is a big challenge to TB management. The reasons for defaulting given by respondents were complex and included patient factors such as medication related factors, lack of knowledge and information as well as alcohol abuse. The findings also revealed unemployment as a major socio-economic factor that contributes to defaulting. In addition, the study shows that community, family, religious and cultural factors such as poor family support, work-related factors and religious and cultural beliefs have an influence on defaulting. Accessibility to health care services, sharing of the TB department with ART patients and attitudes of health workers were identified as health service&nbsp / factors that influence treatment defaulting. This study also highlights the relationship between some of these factors. Conclusion: The study concludes that no single factor contributed to treatment defaulting amongst TB patients in the selected health centre in&nbsp / Windhoek district and this concurred with the literature. There are many different factors at different levels that have an influence on TB treatment defaulting. An interrelationship between personal, socio- economic, community, family, religious and cultural as well as health services- related factors was evident What makes it more complex is that these&nbsp / factors also impact on each other and therefore a holistic approach in the management of TB is required to address these factors. Recommendations based on the findings of the&nbsp / study are made. </p>

Background: HIV drug resistance is presumed to be inevitable due to the error-prone nature of the virus. However, poor adherence to the antiretroviral drugs is proven to be an impending factor for HIV drug resistance development. Of these two explanations, which is the most common reason for HIV drug resistance?Method: A total of 40 published studies about HIV drug resistance, were retrospectively collected in Pubmed (May 2017), from 36 different countries for this paper. From each study was participants, percentage of HIV drug resistance and HIV-1 subtype extracted for analysis. All studies were than classified by either high-income, middle-income or low-income, based on a country income status, defined by the World Bank. HIV drug resistance was tested against: continents, HIV-1 subtypes, number of study participants, income levels, GDP per capita and EWI’s. All statistical analysis was performed in R: The R project for statistical computing.Result: This paper show, that HIV drug resistance primarily is caused by poor adherence which is closely associated with drug stock out. Highest HIV drug resistance levels was found in middle-income countries. However, number of participants enrolled per study was important for the outcome and this indicates that HIV drug resistance would be higher in low-income countries if larger studied had been carried out in these settings. This means that there is a large unrecorded prevalence of HIV drug resistance in low-income countries.

Magister Public Health - MPH / Background: Tuberculosis (TB) is a resurgent disease in many parts of the world, fuelled by HIV/AIDS and poverty. According to WHO, over two billion people were estimated to be infected by TB globally, 9.4 million new cases of TB were reported, while about 1.7 million people were estimated to have lost their lives to TB in 2009 (WHO, 2010). The global defaulter rate for TB was estimated at about 9% in 2007 (WHO, 2007). With Africa remaining the global epicentre of the TB epidemic, the epidemic in Sub-Saharan Africa, one of the worst affected areas in the world, shows no evidence of decline (WHO, 2008). According to the 2009 MOHSS annual report, 1300 people lost their lives to TB in Namibia (MOHSS, 2010). The introduction of TB treatment saves many lives globally. However, despite this effort, TB patients have been reported to default treatment in many parts of the world including Namibia. Namibia reported a defaulter rate of 10% above the national target of less than 5% (Maletsky, 2008). Aim: This study aimed to investigate the factors that contribute to treatment defaulting amongst TB patients at a major health centre in Windhoek district, Namibia. Methodology: A descriptive qualitative study using in-depth interviews was conducted among ten TB defaulters. Key informant interviews were also conducted with the two TB nurses based at the health centre. Eligible participants were purposively selected. A thematic content analysis of transcribed data was conducted where themes related to patient’s experiences of the illness; socio- economic; community, family, cultural and religious as well as health system factors were drawn out. Results: The study results indicate that defaulting TB treatment is a big challenge to TB management. The reasons for defaulting given by respondents were complex and included patient factors such as medication related factors, lack of knowledge and information as well as alcohol abuse. The findings also revealed unemployment as a major socio-economic factor that contributes to defaulting. In addition, the study shows that community, family, religious and cultural factors such as poor family support, work-related factors and religious and cultural beliefs have an influence on defaulting. Accessibility to health care services, sharing of the TB department with ART patients and attitudes of health workers were identified as health service factors that influence treatment defaulting. This study also highlights the relationship between some of these factors. Conclusion: The study concludes that no single factor contributed to treatment defaulting amongst TB patients in the selected health centre in Windhoek district and this concurred with the literature. There are many different factors at different levels that have an influence on TB treatment defaulting. An interrelationship between personal, socio- economic, community, family, religious and cultural as well as health services- related factors was evident What makes it more complex is that these factors also impact on each other and therefore a holistic approach in the management of TB is required to address these factors. Recommendations based on the findings of the study are made. / South Africa