To examine the safety and acceptability of providing antiretroviral therapy (ART) in a resource poor setting. DESIGN: Two-stage observational and qualitative study. SETTING: Rural hospital in Southern Africa. METHODS: Structured observation using failure modes and effects analysis (FMEA) of the drug supply, dispensing, prescribing and administration processes. The findings from the FMEA were explored further in qualitative interviews with eight health professionals involved in the delivery of ART. To obtain a patient perspective, a stratified sample of 14 patients receiving ART was also interviewed. RESULTS: Key vulnerabilities in the process of ART provision include supply problems, poor packaging and labelling, inadequate knowledge among staff and lack of staff. Key barriers to successful patient adherence include transport inconsistency in supply and personal financial difficulties. There is, however, strong evidence of patient commitment and adherence. IMPLICATIONS AND CONCLUSION: Medication safety is relatively unexplored in the developing world. This study reveals an encouraging resilience in the health system and adherence among patients in the delivery of complex ART. The vulnerabilities identified, however, undermine patient safety and effectiveness of ART. There are implications for drug manufacturers; international aid agencies funding and supplying ART; and local practitioners. FMEA can help identify potential vulnerabilities and inform safety improvement interventions.

The study analysed and compared data from patients' medical and pharmacy refill records to identify correlations between CD4 cell counts and adherence to antiretroviral drugs at Katutura Intermediate Hospital (KIH) in Windhoek, Namibia. The study investigated whether the pharmacy refill adherence measurement methodology could predict immunological recovery through increased CD4 cell counts. There was a positive but weak relationship between adherence and CD4 cell counts. Although the pharmacy refill records could predict immunological response it was not sensitive enough and should be used in combination with other adherence measurement tools. / Public Health / M.A. (Public Health)

The impact of HIV and AIDS has threatened to destroy the education sector in South Africa. This qualitative study set out to investigate the psychosocial problems and needs of educators infected with HIV and/or affected by HIV and AIDS in Johannesburg Inner City schools. The study explores and describes the need to develop and implement a comprehensive and holistic treatment, care and support programme for educators infected with HIV and/or affected by HIV and AIDS. This study also reviews HIV/AIDS policies and programmes implemented by the Department of Education to indicate that these interventions are not effective in addressing the problems and needs of these educators. Therefore, the study contends that the Department of Education should revise and reformulate these HIV/AIDS policies and programmes to cater for the needs of educators infected with HIV and/or affected by HIV and AIDS. Ten educators infected with HIV and/or affected by HIV and AIDS from two selected Johannesburg Inner City schools participated in this study. Phenomenological strategies and in-depth interviews were used to capture day-to-day personal life experiences of these educators. The findings of the study reveal that there is a need for an urgent response by the Department of Education to develop and implement treatment, care and support programmes for educators infected with HIV and/or affected by HIV and AIDS. / Sociology / M.A. (Social Behaviour Studies in HIV/AIDS)

M.A. (Public Health) / Anti-Retroviral Therapy (ART) adherence is a crucial component of the patient management framework for people living with Human Immune Deficiency Virus (HIV). Trait emotional intelligence is “the constellation of behavioural-dispositions and self-perceived abilities to recognise, process, and utilise emotion-laden information”. The purpose of the study was to determine whether there was a correlation between ART adherence behaviour and behavioural-dispositions related to trait emotional intelligence among HIV/AIDS infected people receiving ART at the regional public hospitals in Addis Ababa. The study used observational, analytical, and cross-sectional research design. The participants were selected through a proportionally stratified systematic random sampling method. Data collection was through a structured self-report questionnaire format. The findings showed that 79.1% had optimal ART adherence behaviour; 84.4% had average trait emotional intelligence. The research finding showed a statistically significant positive correlation between ART adherence behaviour and behavioural-dispositions related to trait emotional intelligence at (r =0.417, n=392, P<0.001). / Health Studies

The purpose of this study was to determine factors affecting non-adherence to Anti-retroviral therapy among AIDS patients. A cross sectional quantitative survey, was used. Structured interviews were conducted with 300 ART patients. Data were analysed using SPSS version 13 and presented in charts, graphs and frequency tables. Motivators of good adherence were identified as disclosure of HIV positive status to more than one person, frequent adherence counselling, self-efficacy to adhere to ART, positive interactions between patients and healthcare providers; and using an adherence partner. Barriers to adherence were forgetfulness, transportation costs to and from the clinic, time away from work and side effects. There was a strong positive correlation between adherence, CD4 counts and viral load. Adherence was closely tied to immunologic and virologic improvements. Respondents with poor adherence were likely to have unsuppressed viral loads (OR 12.98, 95%, CI 4.9-34). / Health Studies / Masters of Public Health

Thesis (MPhil (Industrial Psychology. Africa Centre for HIV/AIDS Management))--University of Stellenbosch, 2010. / ENGLISH ABSTRACT: Purpose of the study. The primary purpose of the study was to evaluate the referral system between CMH ART unit and its feeder sites, and assess the staff perception and patient.s satisfaction about the latter with the intention of improving and shaping it. Research design A non-experimental descriptive type of quantitative research was used in conducting a cross sectional survey to evaluate the referral system between CMH ART unit and its feeder sites. Data was collected through open and closed ended questionnaires handed to the respondents to fill and return back to the researcher. Findings The results revealed lack of management support and supervision of the system; absence of standard operative procedure to follow when down referring patients; insufficient staffing; congested waiting rooms and long waiting hours. Conclusion The down referral process began without the completion of planning with all involved stakeholders because of the pressure to implement the decision to down refer, staff at the feeder clinics although trained on ART care, but not experienced enough to manage the large influx of patients on ART were left alone to manage patients on HAART. Simple measures like communication between facility staff and patient education should be adopted to improve the system. / AFRIKAANSE OPSOMMING: Doel van die studie Die primêre doel van die studie was om die verwysing stelsel tussen die CMH ART eenheid en sy voeder werwe te evalueer, asook om die personeel se persepsie en pasiënte se tevredenheid oor die laasgenoemde te evalueer met die voorneme om dit te verbeter en verwerk. Navorsingsontwerp 'n Nie-eksperimentele beskrywende aard van kwantitatiewe navorsing is gebruik in die uitvoering van' n kruis deursnee-opname om die verwysing stelsel tussen CMH ART eenheid en sy voeder werwe te evalueer Data is ingesamel deur middel van oop en geslote geëindig vraelyste uitgedeel aan die respondente om in te vul en terug te keer na die navorser. Bevindings Die resultate blyk 'n gebrek aan ondersteuning van die bestuur en beheer van die stelsel; die afwesigheid van standaard operatiewe prosedure om te volg wanneer pasiënte af verwys word; „n tekort aan personeel; oorgelaaide wagkamers en lang wag ure. Gevolgtrekking Die af verwysing proses het sonder die voltooiing van die beplanning met alle betrokke belanghebbendes begin as gevolg van die druk om die uitvoering van die besluit om af te verwys te implementeer. Personeel by die voeder klinieke, alhoewel opgelei in ART sorg, maar sonder die nodige onderving om die groot instroming van ART pasiënte te behandel, was alleen gelos om die pasiënte op HAART te behandel. Eenvoudige maatreëls soos die kommunikasie tussen die fasiliteit personeel en die opvoeding van pasiente sal moet goedgekeur word om die stelsel te verbeter.

Submitted by Paulo Junior (paulo.jr@fgv.br) on 2010-05-13T21:02:37Z No. of bitstreams: 1 Cláudia Hoirisch.pdf: 1193444 bytes, checksum: 18921b0201a6008cb606c1dcc39797a0 (MD5) / Approved for entry into archive by Paulo Junior(paulo.jr@fgv.br) on 2010-05-13T21:03:02Z (GMT) No. of bitstreams: 1 Cláudia Hoirisch.pdf: 1193444 bytes, checksum: 18921b0201a6008cb606c1dcc39797a0 (MD5) / Made available in DSpace on 2010-05-14T12:29:32Z (GMT). No. of bitstreams: 1 Cláudia Hoirisch.pdf: 1193444 bytes, checksum: 18921b0201a6008cb606c1dcc39797a0 (MD5) Previous issue date: 2010-03-24 / The scope of this study is to evaluate the implementation process of the Compulsory License in the case of the antiretroviral efavirenz. This research is descriptive in nature and the medium of investigation was the case study. It was conducted during the months of October through December 2009 with semi-structured interviews containing open-ended questions with a group of Public Health policy makers and managers residing in the states of Rio de Janeiro, Sao Paulo and the Federal District who participated in the compulsory license process. These individuals were allowed to express themselves without any constraints in such a way that they could produce discourses. The Collective Subject Discourse (CSD) technique was then used for analysis of the discourses. The results revealed that Brazil has the technological capability to develop and produce antiretrovirals within a reasonably short period of time. The results further showed that the Compulsory License helped to curb spending on antiretrovirals and that the measure can be used to ensure access by the public to high-cost and strategic antiretroviral drugs for the Brazilian public health service (Unified Health System – SUS) in an environment with limited funds, whenever an impasse is reached in negotiations for price reductions with transnational pharmaceutical laboratories. / O objetivo deste estudo é avaliar o processo de implementação da Licença Compulsória no caso do anti-retroviral efavirenz. Esta pesquisa é de caráter descritivo, o meio de investigação foi o estudo de caso e foi conduzido com entrevistas semi-estruturadas contendo questões abertas para um conjunto de atores representativos da área da Saúde Pública que participaram do processo da licença compulsória residentes nos estados do Rio de Janeiro e São Paulo e no Distrito Federal durante os meses de outubro a dezembro de 2009. Permitiu-se que esses indivíduos se expressassem mais ou menos livremente de forma que eles produzissem discursos. Para a análise dos discursos, utilizou-se a técnica do Discurso do Sujeito Coletivo (DSC). Os resultados demonstraram que o Brasil possui capacitação tecnológica para desenvolver e produzir anti-retrovirais em um prazo relativamente curto. Os resultados mostram ainda que a Licença Compulsória ajudou a refrear os gastos com anti-retrovirais e que o instrumento pode ser utilizado para garantir o acesso da população a medicamentos anti-retrovirais de alto custo e estratégicos para o Sistema Único de Saúde em um ambiente de recursos limitados sempre que se chegar a um impasse na negociação para redução de preços com os laboratórios farmacêuticos transnacionais.

The study analysed and compared data from patients' medical and pharmacy refill records to identify correlations between CD4 cell counts and adherence to antiretroviral drugs at Katutura Intermediate Hospital (KIH) in Windhoek, Namibia. The study investigated whether the pharmacy refill adherence measurement methodology could predict immunological recovery through increased CD4 cell counts. There was a positive but weak relationship between adherence and CD4 cell counts. Although the pharmacy refill records could predict immunological response it was not sensitive enough and should be used in combination with other adherence measurement tools. / Public Health / M.A. (Public Health)

The impact of HIV and AIDS has threatened to destroy the education sector in South Africa. This qualitative study set out to investigate the psychosocial problems and needs of educators infected with HIV and/or affected by HIV and AIDS in Johannesburg Inner City schools. The study explores and describes the need to develop and implement a comprehensive and holistic treatment, care and support programme for educators infected with HIV and/or affected by HIV and AIDS. This study also reviews HIV/AIDS policies and programmes implemented by the Department of Education to indicate that these interventions are not effective in addressing the problems and needs of these educators. Therefore, the study contends that the Department of Education should revise and reformulate these HIV/AIDS policies and programmes to cater for the needs of educators infected with HIV and/or affected by HIV and AIDS. Ten educators infected with HIV and/or affected by HIV and AIDS from two selected Johannesburg Inner City schools participated in this study. Phenomenological strategies and in-depth interviews were used to capture day-to-day personal life experiences of these educators. The findings of the study reveal that there is a need for an urgent response by the Department of Education to develop and implement treatment, care and support programmes for educators infected with HIV and/or affected by HIV and AIDS. / Sociology / M.A. (Social Behaviour Studies in HIV/AIDS)

Anti-Retroviral Therapy (ART) adherence is a crucial component of the patient management framework for people living with Human Immune Deficiency Virus (HIV). Trait emotional intelligence is “the constellation of behavioural-dispositions and self-perceived abilities to recognise, process, and utilise emotion-laden information”. The purpose of the study was to determine whether there was a correlation between ART adherence behaviour and behavioural-dispositions related to trait emotional intelligence among HIV/AIDS infected people receiving ART at the regional public hospitals in Addis Ababa. The study used observational, analytical, and cross-sectional research design. The participants were selected through a proportionally stratified systematic random sampling method. Data collection was through a structured self-report questionnaire format. The findings showed that 79.1% had optimal ART adherence behaviour; 84.4% had average trait emotional intelligence. The research finding showed a statistically significant positive correlation between ART adherence behaviour and behavioural-dispositions related to trait emotional intelligence at (r =0.417, n=392, P<0.001). / Health Studies / M. A. (Public Health)