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The influence of traditional healing practices on anti-retroviral treatment adherence in Vhembe District, South AfricaMusvipwa, Faith Mary 20 September 2019 (has links)
PhD (Sociology) / Department of Sociology / The purpose of the study was to investigate the influence of traditional healing practices on anti-retroviral treatment adherence in Vhembe District. This qualitative study used an explorative design to envisage the aim. A cross-sectional snowball sample was used to draw a sample of 9 participants from the 4 municipalities of Vhembe District. The data collection methods were; in-depth interviews, focus group discussions and key informants’ interviews. The 3 data collection techniques ensured triangulation for more complete and well-validated outcomes of the study. The researcher used the Van Manen method to analyse data. Contrary to popular belief that THPs promote non-adherence among people living with HIV/AIDS (PLWHA), the study found out that the majority of Traditional Healing Practitioners (THPs) encourage and positively influence PLWHA to adhere to anti-retroviral treatment. Apart from a minority of participants who claimed to cure HIV/AIDS, the majority acknowledged and admitted that traditional healing practices do not cure HIV/AIDS but it only heals opportunistic infections. As a result, the majority of THPs influences PLWHA to adhere to anti-retroviral therapy (ART). However, the positive influence of THPs is challenged by individual and social-cultural factors that are beyond THPs’ control which influence treatment adherence such as; traditional and cultural beliefs, side effects of ARVs, nurses’ attitude, inconveniences, lack of transport, personal choices, lack of trust in ARVs and fear of loss of the Disability Grant. It is on this backdrop that study findings prompted devising of a model and a 5 phase support program for intervention. / NRF
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Linkages between PMTCT, ART and wellness services: an assessment of uptake of ART and wellness services by women attending PMTCT at selected ANC clinics in SowetoChing'andu, Annette Mulenga 18 February 2011 (has links)
MPH, Maternal and Child Health, Faculty of Health Sciences, University of the Witwatersrand / Due to the high prevalence of HIV in South Africa, all pregnant women are offered an
HIV test as part of the package of services offered during ante natal care (ANC). All
women who present to an ANC clinic for the first time for that given pregnancy are given
group talks about HIV and the availability of services to protect their children from HIV
through Prevention of Mother to Child Transmission (PMTCT) services. Following these
group discussions, all the women are then counselled on a one on one basis and are
offered an HIV test. Women who decide not to take the test can opt out of testing at this
stage, those who do go ahead and test are also offered post test counselling after which
their test result is given to them. All HIV tests are conducted using rapid HIV test kits
which make results known within 15 minutes, the results are given to the women on the
same day of testing.
Women whose CD4 count is below the antiretroviral treatment(ART) initiation
threshold† are fast tracked onto ART , those whose CD4 is above the threshold should
then be referred to other services which can help them maintain their health.1 These
services are part of the Comprehensive Care, Management and Treatment (CCMT)
approach. They include: CD4 count monitoring; treatment for opportunist infections;
social workers, and support groups for psychosocial support.2 For purposes of this study,
these services are collectively referred to as Wellness services. Thus PMTCT should
serve as a gateway to either ART or Wellness services.
This study therefore sought to describe the linkages between PMTCT, ART and Wellness
by reviewing service utilisation levels and referral systems at sampled health facilities in
Soweto.
Data for this study were collected via a cross sectional record review of PMTCT registers
and an ART initiation register at sampled health facilities. PMTCT registers were
reviewed for the period January to March 2008 to determine what service had been given
to pregnant women who accessed PMTCT services for the first time during that period
† In his speech on World AIDS Day (December 1st 2009) President Jacob Zuma announced that CD4 count
threshold for treatment initiation will be raised from 200 to 350 as of April 2010.
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and which follow on services they had been referred to. ART registers were reviewed for
the period January to August 2008 to determine which of the pregnant women who had
been referred to ART from the PMTCT service points at the sampled clinics accessed the
service. Key informant interviews were also conducted with staff at PMTCT, ANC, ART
and voluntary counselling and testing (VCT) service points at the sampled facilities.
Descriptive statistics were run using SPSS version 17.0, comparisons were done using
OpenEpi and key informant interview data were thematically analysed using Atlas TI
version 5.2.0.
Records at the PMTCT clinics showed that of the 1350 women who attended ANC
clinics at the sampled facilities between January and March 2008, all but one agreed to
test for HIV. Twenty-nice percent (388) tested positive for HIV. Of these 388 HIV
positive women, 20% (77 women) had CD4 counts below 200 and were therefore eligible
for initiation of ART. Review of records at the ART clinic showed that only 23% (n =
18, N = 77) of all ART eligible women had accessed the service. Review of the PMTCT
register also showed that a significant proportion, 37% (n = 144, N =388), of women who
tested HIV positive did not return to the clinics for their CD4 count results. These
women therefore missed opportunities to access other follow on services to which they
could have been referred and possibly ART as 31% (24 women) of these women were
also eligible for ART.
Review of records at Wellness services was not possible as no indications were made in
the PMTCT registers of follow on services other than ART to which HIV positive women
were referred.
Thus the greater majority of women who were eligible for ART (77% of the 77 eligible
women) did not access ART which they required to help them maintain their physical
wellbeing. These women missed the opportunity to access holistic health care services, it
is not known if they accessed ART services at other health facilities. Without the
required antiretroviral therapy, it is highly likely that their women’s health status
deteriorated such that they faced higher chances of morbidity and ultimately mortality.
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The review of records at both PMTCT and ART service points showed poor data
management systems as referrals from PMTCT to ART were not always documented
against client names in the PMTCT registers. Communication systems between the
service points were also found to be poorly structured as there were no systematic
feedback mechanisms on clients referred and seen. Linkages to Wellness services were
even more poorly structured as no referrals to services which fall under Wellness were
documented in the PMTCT registers.
Key informants interviewed suggested several possible reasons why PMTCT and ART
services were not being fully utilised as was evidenced by the of 37% of women who
were not retained in care as they did not return for CD4 results and the low ART
utilisation rate of 23%. Possible reasons suggestions were: ignorance of the need to
access ANC services, preference for traditional medicine, fear of stigmatisation within
their communities and poor staff attitudes towards patients.
The key informants also suggested measures they thought could improve utilisation, these
include hire of more staff, improved staff wages, improved interdepartmental
communication and a bottom up approach to service improvement. A suggestion was
also made to include PMTCT messaging in general HIV/AIDS information education
communication material so as to raise awareness of the availability of PMTCT
interventions.
Although there were linkages between PMTCT, ART and Wellness services, these
linkages were poorly developed and drop out from services was high. Efforts to follow
up on patients or to retain them in care were not well developed as the data management
systems employed by the service points were not consistently used nor did they facilitate
patient monitoring and follow-up. Furthermore, the structural and managerial separation
of the ART service point from PMTCT as well as the lack of standard protocols for
referral to Wellness introduced barriers to service utilisation for women who required
these services.
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Acceptability of a home-based antiretroviral therapy delivery model among HIV patients in Lusaka districtBwalya, Chiti January 2018 (has links)
Master of Public Health - MPH / BACKGROUND: The Zambian anti-retroviral therapy (ART) program has successfully enrolled
over 770, 000 people living with HIV (PLWH), out of a population of 1.2 million PLWH.
This tremendous success has overburdened the clinic system resulting in many challenges for
both patients and healthcare staff. To promote ART initiation, adherence, and retention and at
the same time relieve pressure on the health system, a home-based ART delivery model
(HBM) was piloted in two urban communities of Lusaka. This study explored levels of
acceptability of the model and factors influencing this among PLWH living in the two
communities. Acceptability was defined as degree of fit between the patient’s expectations
and circumstances and the home-based delivery model of ART, taking into consideration all
the contextual elements surrounding the patient.
METHODOLOGY: A qualitative study of HBM acceptability was nested within a clusterrandomized
trial comparing outcomes in patients receiving HBM intervention compared to the
standard of care in two communities in Lusaka, Zambia. Using an exploratory qualitative
study design and a purposive sampling technique, qualitative data were collected using
observations of HBM delivery (n=12), in-depth interviews with PLWH (n=15) and Focus
Group Discussions with a cadre of community health workers called community HIV care
providers (CHiPs) administering the HBM (n=2). Data were managed and coded using Atlas.ti
7 and analysed thematically.
RESULTS: Overall, the HBM was found to be a good fit with the lives and expectations of
PLWH and therefore highly acceptable to them. This acceptability was influenced by a
combination of cross cutting clinic based, program design and socio-economic factors that
have been categorized into push and pull factors. Push factors were those related to the
challenges that PLWH faced when accessing ART from the clinic and included congestion,
long waiting times, confidentiality breaches and stigma arising from attending a dedicated
clinic. These factors resulted in considerable direct and indirect livelihood opportunity costs.
The HBM as an alternative had a number of ‘pull factors’. PLHW described services offered
through the model as convenient, confidential, trusted, personalized, less stigmatizing,
comprehensive, client centred, responsive, and respectful. Disclosure of client’s HIV status to
people they lived with was found to be critical for the acceptability of the model.
CONCLUSIONS AND RECOMMENDATIONS: The HBM is highly acceptable and this acceptability is
influenced by a combination of crosscutting push and pull factors. Key to the HBM’s
acceptability was its delivery design that was responsive to individual patient needs and the
steps CHiPs took to minimize the ever-present threat of disclosure and stigma. Future
adoption and scaling up of HBM should recognize the importance of these design features.
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Pulmonary tuberculosis treatment outcomes in HIV infected patients on antiretroviral therapy /Aung, Kay Tu, Jittima Dhitavat, January 2006 (has links) (PDF)
Thesis (M.C.T.M. (Clinical Tropial Medicine))--Mahidol University, 2006. / LICL has E-Thesis 0012 ; please contact computer services. LIRV has E-Thesis 0012 ; please contact circulation services.
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Desenvolvimento e validacao da metodologia de analise do teor de lamivudina e do ensaio limite do enantiomero(+)BCH-189 em comprimidos de lamivudinaLowen, Teresa Cristina Raposo. January 2003 (has links)
Mestre -- Instituto Nacional de Controle de Qualidade em Saude, Rio de Janeiro, 2003.
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Associated factors of efavirenz plasma levels in hiv-positive individuals with viral supressionWeyh, Julia Poeta January 2010 (has links)
A mortalidade de pacientes portadores do HIV tem diminuído drasticamente desde a introdução da terapia antirretroviral altamente ativa (HAART). Segundo estimativas da Organização Mundial da Saúde (OMS) são 33,4 milhões de pessoas infectadas e, no Brasil, estima-se que cerca de 630 mil pessoas vivem com HIV ou SIDA. A terapia antirretroviral atual utiliza a combinação de três antirretrovirais (ARVs) que podem pertencer a duas ou três das seguintes classes: inibidores da transcriptase reversa análogos de nucleosídeos / nucleotídeos (ITRNs), inibidores da transcriptase reversa não-análogos de nucleosídeos (ITRNNs) e inibidores da protease do HIV (IPs). Embora a atual terapia antirretroviral tenha modificado significantemente a história natural do HIV, uma alta evidência de falhas terapêuticas ainda é observada em esquemas atualmente utilizados. Recentemente, a atenção tem se focado na importância da concentração plasmática de ARVs e, também, no fato de que as concentrações inadequadas do fármaco podem colaborar significativamente para a ineficácia do tratamento. Concentrações abaixo do intervalo terapêutico estão sendo associadas com a diminuição da resposta virológica e com o aumento de resistências isoladas e, concentrações acima desse intervalo estão sendo associadas ao surgimento de efeitos adversos. Com o objetivo de impedir a falha na utilização da terapia, tem sido indicado o monitoramento terapêutico de fármacos (MTF), na medida em que determina as concentrações plasmáticas fora da faixa terapêutica, detecta a dosagem incorreta e/ou a falta de adesão e, também, pode ser uma ferramenta útil na administração da toxicidade do fármaco. O Efavirenz (EFV), um ITRNN, está entre os ARVs mais amplamente utilizados. Em geral, é bem tolerado e possui uma meia-vida plasmática prolongada, uma baixa barreira genética e uma alta variabilidade interpaciente nos níveis plasmáticos. Entre os principais efeitos adversos relacionados à utilização do EFV estão as alterações neurológicas, a dislipidemia e o desenvolvimento de resistência após a descontinuação do tratamento. No entanto, a baixa barreira genética e a alta variabilidade plasmática entre indivíduos favorecem uma alta ocorrência de resistências fenotípicas, o que justifica a análise das concentrações plasmáticas deste fármaco através da utilização do monitoramento terapêutico. O objetivo deste estudo foi desenvolver e validar um método analítico sensível de detecção e quantificação, por cromatografia líquida de ultraeficiência (UPLC), capaz de medir as concentrações plasmáticas do EFV e, assim, associá-las com características demográficas e com o desenvolvimento de dislipidemia numa coorte de pacientes em terapia antirretroviral. Os resultados não apresentaram diferenças significativas entre as principais característcas demográficas e as concentrações plasmáticas de EFV. No entanto, houve uma relação inversa e significativa entre as concentrações de EFV e o peso e o índice de massa corporal (IMC). Encontramos uma alta variabilidade nas concentrações plasmáticas de EFV, embora a maioria das concentrações plasmáticas de EFV estar dentro do intervalo terapêutico. Contudo, ensaios clínicos maiores ainda são necessários para investigar melhor a concentração plasmática de EFV e os desfechos clínicos.
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Pneumocystis jirovecii : estudo da infecção antes e após a implantação da terapia antiretroviral de alta potência (HAART)Machado, Cristiane Pimentel Hernandes January 2009 (has links)
Estudo retrospectivo de 80 casos de pneumonia por Pneumocystis jirovecii (PCP), diagnosticados no Laboratório de Micologia, Santa Casa-Complexo Hospitalar – Porto Alegre (RS), de agosto de 1984 à janeiro de 2006. Dos 80 pacientes, 23 (36,3%) já tinham diagnóstico de Aids; 40 (50%) tiveram diagnóstico de infecção pelo vírus da imunodeficiência humana (HIV) concomitantemente com o diagnóstico de PCP. O fator predisponente mais encontrado foi a linfopenia associada à síndrome da imunodeficiência adquirida (Aids), com mediana da dosagem de CD4+ 36,5 células/mm3. Os achados clínicos mais frequentes foram tosse (81,3%), febre e dispnéia (76,3%). Na radiologia de tórax 92,5% apresentavam infiltrado pulmonar intersticial. Os diagnósticos foram feitos por fibrobroncoscopia com lavado broncoalveolar em 67,5%. Apenas 11,6% dos pacientes com Aids faziam uso de terapia antiretroviral; e apenas 6,3% de todos os pacientes do estudo faziam profilaxia para pneumocistose. O tratamento da PCP constituiu de sulfametoxazol-trimetoprim (SMX+TMP) em 92,3%. A maior incidência de PCP foi entre pacientes infectados pelo HIV (86,3%). Os pacientes apresentaram uma mortalidade de 34,3%, e 74,1% naqueles que necessitaram de ventilação mecânica. Complicações ocorreram em 40% dos casos, aumentando os dias de internação e de outras medicações com aumento de custo do tratamento. / The present study is based on a retrospective research of 80 cases with Pneumocystis jirovecii pneumonia (PCP), diagnosed at the Mycology Laboratory - Santa Casa Complexo Hospitalar Porto Alegre (RS), from August 1984 to January 2006. Out of those 80 patients, 23 (36.3%) had diagnosis of AIDS, 40 (50%) were diagnosed with infection by human immunodeficiency virus (HIV) concomitantly with PCP diagnosis. The most common predisposing factor was lymphopenia associated with AIDS, with a median dose of CD4 + 36.5 cells/mm3. The clinical manifestations most frequent were cough (81.3%), fever and dyspnea (76.3%). Chest x-ray findings had interstitial pulmonary infiltrates in 92.5%. The diagnoses were made by bronchoscopy with bronchoalveolar lavage in 67.5% samples. Only 11.6% of patients with AIDS received antiretroviral therapy, and only 6.3% of all patients received prophylaxis for PCP. The treatment for PCP was trimethoprim-sulfamethoxazole (TMP + SMX) in 92.3% of patients. The highest incidence of PCP was among HIVinfected patients (86.3%). The mortality rate were 34.3% and 74.1% in those who required mechanical ventilation. Complications occurred in 40% of cases, increasing days of hospitalization and other medications, which increased the cost of treatment.
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Marcadores genéticos associados à dislipidemia e redistribuição de gordura corporal em indivíduos infectados pelo HIV em terapia antirretroviralLazzaretti, Rosmeri Kuhmmer January 2012 (has links)
Resumo não disponível
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Pneumocystis jirovecii : estudo da infecção antes e após a implantação da terapia antiretroviral de alta potência (HAART)Machado, Cristiane Pimentel Hernandes January 2009 (has links)
Estudo retrospectivo de 80 casos de pneumonia por Pneumocystis jirovecii (PCP), diagnosticados no Laboratório de Micologia, Santa Casa-Complexo Hospitalar – Porto Alegre (RS), de agosto de 1984 à janeiro de 2006. Dos 80 pacientes, 23 (36,3%) já tinham diagnóstico de Aids; 40 (50%) tiveram diagnóstico de infecção pelo vírus da imunodeficiência humana (HIV) concomitantemente com o diagnóstico de PCP. O fator predisponente mais encontrado foi a linfopenia associada à síndrome da imunodeficiência adquirida (Aids), com mediana da dosagem de CD4+ 36,5 células/mm3. Os achados clínicos mais frequentes foram tosse (81,3%), febre e dispnéia (76,3%). Na radiologia de tórax 92,5% apresentavam infiltrado pulmonar intersticial. Os diagnósticos foram feitos por fibrobroncoscopia com lavado broncoalveolar em 67,5%. Apenas 11,6% dos pacientes com Aids faziam uso de terapia antiretroviral; e apenas 6,3% de todos os pacientes do estudo faziam profilaxia para pneumocistose. O tratamento da PCP constituiu de sulfametoxazol-trimetoprim (SMX+TMP) em 92,3%. A maior incidência de PCP foi entre pacientes infectados pelo HIV (86,3%). Os pacientes apresentaram uma mortalidade de 34,3%, e 74,1% naqueles que necessitaram de ventilação mecânica. Complicações ocorreram em 40% dos casos, aumentando os dias de internação e de outras medicações com aumento de custo do tratamento. / The present study is based on a retrospective research of 80 cases with Pneumocystis jirovecii pneumonia (PCP), diagnosed at the Mycology Laboratory - Santa Casa Complexo Hospitalar Porto Alegre (RS), from August 1984 to January 2006. Out of those 80 patients, 23 (36.3%) had diagnosis of AIDS, 40 (50%) were diagnosed with infection by human immunodeficiency virus (HIV) concomitantly with PCP diagnosis. The most common predisposing factor was lymphopenia associated with AIDS, with a median dose of CD4 + 36.5 cells/mm3. The clinical manifestations most frequent were cough (81.3%), fever and dyspnea (76.3%). Chest x-ray findings had interstitial pulmonary infiltrates in 92.5%. The diagnoses were made by bronchoscopy with bronchoalveolar lavage in 67.5% samples. Only 11.6% of patients with AIDS received antiretroviral therapy, and only 6.3% of all patients received prophylaxis for PCP. The treatment for PCP was trimethoprim-sulfamethoxazole (TMP + SMX) in 92.3% of patients. The highest incidence of PCP was among HIVinfected patients (86.3%). The mortality rate were 34.3% and 74.1% in those who required mechanical ventilation. Complications occurred in 40% of cases, increasing days of hospitalization and other medications, which increased the cost of treatment.
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Associated factors of efavirenz plasma levels in hiv-positive individuals with viral supressionWeyh, Julia Poeta January 2010 (has links)
A mortalidade de pacientes portadores do HIV tem diminuído drasticamente desde a introdução da terapia antirretroviral altamente ativa (HAART). Segundo estimativas da Organização Mundial da Saúde (OMS) são 33,4 milhões de pessoas infectadas e, no Brasil, estima-se que cerca de 630 mil pessoas vivem com HIV ou SIDA. A terapia antirretroviral atual utiliza a combinação de três antirretrovirais (ARVs) que podem pertencer a duas ou três das seguintes classes: inibidores da transcriptase reversa análogos de nucleosídeos / nucleotídeos (ITRNs), inibidores da transcriptase reversa não-análogos de nucleosídeos (ITRNNs) e inibidores da protease do HIV (IPs). Embora a atual terapia antirretroviral tenha modificado significantemente a história natural do HIV, uma alta evidência de falhas terapêuticas ainda é observada em esquemas atualmente utilizados. Recentemente, a atenção tem se focado na importância da concentração plasmática de ARVs e, também, no fato de que as concentrações inadequadas do fármaco podem colaborar significativamente para a ineficácia do tratamento. Concentrações abaixo do intervalo terapêutico estão sendo associadas com a diminuição da resposta virológica e com o aumento de resistências isoladas e, concentrações acima desse intervalo estão sendo associadas ao surgimento de efeitos adversos. Com o objetivo de impedir a falha na utilização da terapia, tem sido indicado o monitoramento terapêutico de fármacos (MTF), na medida em que determina as concentrações plasmáticas fora da faixa terapêutica, detecta a dosagem incorreta e/ou a falta de adesão e, também, pode ser uma ferramenta útil na administração da toxicidade do fármaco. O Efavirenz (EFV), um ITRNN, está entre os ARVs mais amplamente utilizados. Em geral, é bem tolerado e possui uma meia-vida plasmática prolongada, uma baixa barreira genética e uma alta variabilidade interpaciente nos níveis plasmáticos. Entre os principais efeitos adversos relacionados à utilização do EFV estão as alterações neurológicas, a dislipidemia e o desenvolvimento de resistência após a descontinuação do tratamento. No entanto, a baixa barreira genética e a alta variabilidade plasmática entre indivíduos favorecem uma alta ocorrência de resistências fenotípicas, o que justifica a análise das concentrações plasmáticas deste fármaco através da utilização do monitoramento terapêutico. O objetivo deste estudo foi desenvolver e validar um método analítico sensível de detecção e quantificação, por cromatografia líquida de ultraeficiência (UPLC), capaz de medir as concentrações plasmáticas do EFV e, assim, associá-las com características demográficas e com o desenvolvimento de dislipidemia numa coorte de pacientes em terapia antirretroviral. Os resultados não apresentaram diferenças significativas entre as principais característcas demográficas e as concentrações plasmáticas de EFV. No entanto, houve uma relação inversa e significativa entre as concentrações de EFV e o peso e o índice de massa corporal (IMC). Encontramos uma alta variabilidade nas concentrações plasmáticas de EFV, embora a maioria das concentrações plasmáticas de EFV estar dentro do intervalo terapêutico. Contudo, ensaios clínicos maiores ainda são necessários para investigar melhor a concentração plasmática de EFV e os desfechos clínicos.
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