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A sociological study on the challenges to treatment adherence in antiretroviral therapy in the Mopani District of the Limpopo ProvinceMona, Tiny Petunia January 2014 (has links)
Thesis (Ph. D. (Sociology)) -- University of Limpopo, 2014. / This study investigated the challenges to antiretroviral therapy adherence. Qualitative and
quantitative research methodologies were applied in the study. Purposive sampling was used
to select clients on antiretroviral therapy, convenience sampling was applied to select clients
who participated in the focus group discussions and health care workers and lay counsellors
were selected through the simple random sampling method. In-depth interviews were
conducted with 31 clients on antiretroviral therapy at 8 health facilities, 2 focus group
discussions comprising of 7 members each were conducted at two health facilities, medical
records of all respondents on antiretroviral therapy were reviewed and a stigma scale was
administered. A questionnaire was distributed amongst 17 health care workers and lay
counsellors.
Most of the respondents who participated in this study were females. Data gathered in this
study confirmed that women are more vulnerable to HIV than men. The majority of the
respondents were poor African people. The predominant language amongst the respondents
was the Xitsonga language; hence the world-view of the Va-Tsonga people was assessed.
HIV and AIDS cause many social problems in communities.
Some of the major findings are that:
Literacy levels were found to be very low as most of the respondents pointed out that they
had only obtained grade 7 or below. However, this did not have an impact on treatment
adherence. Some respondents indicated that they were unemployed; the majority said they
were employed.
Even though the stigma and discrimination experienced by the respondents was very low, the
few who experienced it had very traumatic and cruel experiences perpetrated by their own
family members and people in the community. In terms of disclosure, data indicates that
most people prefer disclosing to their mothers as they feel that they will get support. The
majority of the respondents disclosed to female family members and they were supported by
the people they disclosed to.
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Social support is very crucial for people who are on antiretroviral therapy (ART), most of the
respondents indicated that they had treatment supporters. Institutional support was very
minimal in that most pointed out that they did not belong to any support groups. There were
some who did not even know about the existence of any support groups at the health facilities
where they were receiving their treatment.
Most of the respondents indicated that they disclosed to their colleagues and others had not
as they feared that they would lose their jobs. Those who had disclosed indicated that they
needed support from their colleagues and employers with regard to compliance with their
clinic appointments. Most of the respondents had sexual partners, and had also disclosed to
their sexual partners, and disclosure was almost immediately after being diagnosed HIVpositive.
There are those who had not disclosed to their sexual partners as they feared
rejection or violent reaction. There were sero-discordant couples amongst the respondents
who supported each other regarding adherence. Most of the respondents indicated that they
had taken care of a family member living with HIV.
HIV prevalence also varies amongst health facilities. Strategies employed by health facilities
to monitor and evaluate HIV and AIDS programmes differ. Health Care Workers and lay
counsellors provided contrasting information. Primary Health Care facilities have been
accredited to provide ART, however the down-referral system seems to be failing as some
clinics now have more clients on ART than hospitals. Health Care Workers and counsellors
also need to be familiarized with the World Health Organization (WHO) standards. The level
of adherence acceptable for an individual on ART is 95%; there is however health facilities
that indicated the adherence level far below the required level.
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Adherence to antiretroviral therapy among HIV and AIDS patients at the Kwa-Thema Clinic in the Gauteng ProvinceEyassu, Melaku Alazar January 2015 (has links)
Thesis (MPH.) -- University of Limpopo, 2015 / Background: The introduction of Antiretroviral Therapy (ART) has shown a tremendous reduction in HIV-related mortality and morbidity in people living with HIV / AIDS. Adherence to ART is the key to a successful treatment outcome. This study investigates the adherence of people living with HIV who are on ART. Since high levels of adherence of more than 95% are required to achieve effective suppression of the viral load, the researcher finds it very important to establish whether the people are pursuing what is expected of them. While the use of ART has brought much excitement and hope to both patients and medical practitioners in the world, it has also brought many new questions and challenges, including adherence issues. Adherence is, therefore, essential to achieve the success of ART.
Aim: The main objective was to determine which factors influence adherence to ART among HIV and AIDS patients.
Methods: This study utilised a quantitative cross-sectional descriptive design that was conducted at the Kwa-Thema Clinic, Ekurhuleni District, Gauteng Province. Data was collected using a structured questionnaire with open- and closed-ended questions where a total of 290 respondents were interviewed. Data was analysed using SPSS software version 22 and the analysed data was presented by means of charts, graphs, and frequency tables.
Results: The findings indicated that the adherence to ART at the Kwa-Thema Clinic was 77%. Factors that were significantly associated with adherence were gender ((χ2 = 3.78, df = 1, p < 0.05).), level of education ((χ2 = 3.52, df = 3, p = 0.032), co-treatment of HIV and other infections (χ2 = 5.46, df = 4, p = 0.019).), ability to follow ART ((χ2 = 12.82, df = 1, p = 0.000 < 0.05), and types of ARV drugs.
Recommendation: To enhance ART adherence the study recommends intensification of health education campaign against stigma and gender discrimination. Providing feedback to the patients by the healthcare providers regarding the benefits of ART is important.
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Conclusion: It was concluded that the adherence to ART at the Kwa-Thema Clinic was sub-optimal (less than 95%) at 77% but comparable to the adherence levels in other developing countries.
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Barriers to adherence to antiretroviral therapy among adult patients in a rural hospital in the Eastern CapeAkusoba, Kenechukwu Okechukwu January 2013 (has links)
Magister Public Health - MPH / Antiretroviral therapy (ART) improves the quality of lives of people living with HIV/AIDS by suppressing HIV replication and improving the patient’s immunity. An improved immunity will help prevent patients from contracting opportunistic infections. Adherence to ART is vital to obtain good clinical outcome for patients. Defaulting ART leads to increase in viral load, decreased host immunity, development of HIV drug resistant strains, exposure to opportunistic infections and ultimately death. HIV positive patients who are on ART face many challenges in adhering to their medications, these challenges act as barriers to their adherence to treatment. This study explores the barriers that adult patients in a hospital in
Eastern Cape of South Africa face while on treatment. These barriers include individual factors, socio-economic factors, health service factors, medical regimen factors.
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Psychosocial factors that affect adherence to antiretroviral therapy amongst HIV/AIDS patients at Kalafong hospitalMoratioa, Gugulethu 05 August 2008 (has links)
This research focuses on the psychosocial factors that affect adherence to highly active antiretroviral therapy (HAART) amongst HIV/AIDS patients at Kalafong Hospital. Even though the development of such regimens has helped turn HIV infection in the United States into a relatively manageable, though still serious chronic disease, compliance remains one of the major challenges in managing medication for those patients living with HIV/AIDS. This is particularly relevant given the high adherence rate (95%) required to obtain a successful long-lasting effect. In South Africa non-compliance to HAART is an under-explored phenomenon. Consequently, an understanding of factors influencing compliance is still incomplete. A qualitative study that investigates non-adherence to medication in HIV/AIDS patients was undertaken at Kalafong Hospital. This study aimed to understand patients’ psychosocial difficulties resulting in non-adherence. The study was approached in terms of the health belief model (HBM), which addresses individual characteristics pertaining to change, the transtheoretical change model (TTM) and the motivational interviewing model (MI), which address both individual and social contexts pertaining to change. The findings are designed for use by healthcare professionals as a proactive compliance enhancement tool. Participants were recruited through referrals by the medical staff to the researcher. The criteria included that participants had relapsed due to non-compliance with drug therapy. Participants that were currently experiencing difficulties with adherence were also included in the study. Males and females aged between 20 and 40 were included in the study. Fifteen participants between the ages of 20 and 40 participated in the study (13 females and two males). The data were collected by means of semi-structured interviews and follow-up unstructured questions. The interviews were audio recorded and field notes were taken. Data were analysed qualitatively. Sixteen themes emerged and were further classified into two categories: individual and social context. The themes were then compared and integrated with the literature. The study concludes that psychosocial factors such as support from family, friends and healthcare workers was found to be of utmost importance in encouraging adherence. Medication can only prolong a patient’s life if the psychosocial context in which the patient is embedded is considered in the treatment plan. / Dissertation (MA)--University of Pretoria, 2008. / Psychology / unrestricted
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Determinant factors affecting adherence to antiretroviral therapy among HIV infected patients in Addis AbabaAbelti Eshetu Abdissa 09 September 2014 (has links)
The purpose of this study was to explore and describe the determinant factors affecting adherence to antiretroviral therapy among HIV infected patients in Addis Ababa, Ethiopia. A cross-sectional study design was used and data were collected by interviewing 290 study participants from two health facilities using structured questionnaire. The research finding revealed 80.0% of the study participants had optimal combined adherence to dose, schedule and dietary instructions in the past three days. And, the non adherence rate was 20.0%. In multivariate analysis only WHO clinical stage, change of ARV medication, knowledge about HIV disease and ART, and use of reminders were found to be independently associated with adherence to antiretroviral therapy. The most common reasons for missing HIV medications in the past one month were forgetfulness (35.1%), being busy with other things (17.5%), and running out of pills (10.5%). Adherence improving interventions should be emphasized to address multi-faceted problems. This study recommends setting of convenient appointment schedule, disclosure of one's HIV status, maintaining confidentiality of patient-related information, enhancing patient-provider relationship, use of reminders including SMS text messages, and engagement of PLHIV in adherence improving interventions through peer support, and providing regular health education to the PLHIV to improve adherence of patients to ART / Health Studies / M.A. (Public Health)
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Evaluation of treatment progression amongst patients initiated on antiretroviral therapy at the university of Limpopo, South AfricaMaselela, Tshepho Jan January 2022 (has links)
Thesis (MPH.) -- University of Limpopo, 2022 / Human Immunodeficiency Virus (HIV) has affected all parts of the world, and as of
2019, more than 76 million people have been infected by HIV. South Africa has the
largest population of people living with human immunodeficiency virus (HIV) in the
world and the highest infected group were aged 24 to 49, and females had the highest
percentage in viral load suppression for all age groups. HIV infection leads to
advanced loss of CD4 T cells and the roll out of antiretroviral therapy (ART) has bring
about in significant cutbacks in HIV-associated complications by recovering the CD4+
T cell count. Some patients may not be successful in attaining this result, and some
may accomplish it only after a number years of treatment. The disease progression
and the health conditions amongst People Living with HIV-AIDS (PLWA) has improved
substantially in the past two decades. The purpose of this study was to evaluate the
disease progression of the patients initiated on ART from 2017 to 2019 at the
University of Limpopo Health Centre, in Limpopo province.
Methodology:
A descriptive retrospective investigation was carried out which followed a quantitative
approach in which secondary data from medical files of 259 patients initiated on ART
at University of Limpopo Health Centre was used. where outcomes of ART initiation
assessed and evaluated in association with characteristics of patients. Data analysis
was done using the STATA statistical software version 12 for Windows (STATA
Corporation, College Station, Texas). Frequency tables were used to make
comparisons between groups for continuous and categorical variables using student
t-test, and chi-square test. P-value less than 0.05 at 95% confidence level were
regarded as significant.
Results:
The research finding revealed 80.0% of the study participants were females and the
mean age group of participants diagnosed HIV positive was 28.28 years with standard
deviation of ±7.5. The mean of the CD4 count cells at baseline for females was 411.4
cells/μL while for males was 341.2 cells/μL (p=0.212). The mean CD4 count cells at
last ART visit for females was 613.7 cells/μL while for males was 452.9 cells/μL
(p<0.001). There has been significant increase of the CD4 cell count from the baseline
to the last ART visit as it is noted in the increase in proportion of patients with CD4 cell
count of more than 500 in all the years. The proportion of patients with baseline CD4
cell count of 200 to 350 (moderate immunodepression) were high in 2019 and 2017 at
40.6% and 40.3% respectively. Majority of the patients were transferred out to other
facilities at 79.4% as most patients are students and only 2.3% mortality rate has been
reported for the study period. Majority of the patients initiated on ART at University of
Limpopo were in WHO stage 2 at 45.5% followed by those in stage 3 and stage 1 at
22.2% and 21.8% respectively. Patients who were 24 years or older were 1.1 times
more likely to have improved CD4 cell count at the last date of ART visit as compared
to younger patients but not statistically significant while males were 3.5 times more
likely to have improved CD4 cell count at the last date of ART visit as compared to
females which was statistically significant. Patients who were initiated on ART at WHO
stage 4 were 6.67 more likely to have improved CD4 cell count at the last date of ART
visit as compared to those who were initiated on ART at WHO stage 1.
Conclusion:
The treatment progression in the study setting was found to be convincing and
acceptable which is similar to the findings reported in other studies in many other
countries. The significance of CD4 cell counts monitoring for HIV patients cannot be
overemphasised. This study recommends a strengthened testing and treatment
programme targeted males amongst the university community, enhance provider provider relationship when patients are transferred out to other health facilities,
enhance the collection of baseline and progressive data on both the CD4 cell count
and viral load.
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Evaluation of antiretroviral use in children managed in public clinics of Mopani District, Limpopo Province : towards a dosing and dispensing training programme for nursesMabila, Linneth Nkateko January 2022 (has links)
Thesis (Ph.D. (Pharmacy)) -- University of Limpopo, 2022 / Antiretroviral (ARV) management in children is considered a challenging process, and
patients receiving ARVs remain at risk of medication errors. Recently, there has also
been a noticeable increase in Treatment Failure (TF) and the development of drug
resistance amongst children on ART. However, ART failure amongst children seems
to be an under-recognised issue, and adherence to treatment guidelines is reported
to be a challenge among nurses caring for People Living with HIV (PLWHIV). Hence,
the aim of this study was to explore the prescribing practices, and to determine the
knowledge, understanding, and competence levels of NIMART-trained nurses’ in the
management of children on Antiretroviral Therapy (ART) in Public Health Care (PHC)
facilities located in a rural district of Limpopo Province. To attain the purpose of the
study, the researcher in this study adopted a mixed-method, in an explanatory
sequential manner. The quantitative phase adopted a descriptive cross-sectional and
retrospective census of medical records to determine whether or not the children on
ART were prescribed the correct ARV regimen, dose, strength, dosing frequency and
received the correct quantities to last until the next appointment date. Whereas the
qualitative phase embraced a total purposive sampling of the NIMART-trained
professional nurses to explore their knowledge, understanding and views of ART
management in children. The results highlighted that these children under study even
though they were prescribed a correct ARV regimen in (n=7045; 96%) of the
cases;they were only correctly dosed in (n=7797; 53%); and prescribed the correct
strength (n=9539; 77%), with only (n=2748; 36.9%) having received the correct
quantity of treatment to last them until the next appointment date. Most nurses even
though they rated themselves very knowledgeable and competent in paediatric
HIV/AIDS management. This finding was contradicting the results obtained from the
medical records, as well as their responses to the given case scenario depicted some
level of non-adherence to treatment guidelines as well as a lack of understanding of
ARV management. From the findings of this ARV utilisation review and the
implementation of the developed ART dosing and dispensing training programme. The
study concludes that the nurse's prescribing practice was irrational in this cohort of
children, and most prescriptions did not entirely comply with the 2014/15 HIV/AIDs treatment recommendations. Since, this cohort of children was found to be susceptible
to medication related errors such as; Drug omissions in ARV regimens; Incorrect
dosing & dosing frequencies; as well as incorrectly supplied quantities. From the study
findings it is recommended that ARV stewardship programs should be considered in
order to develop and establish a core strategy for enhancing quality improvement in
the management of HIV-infected children on ART in resource-limited settings, not only
to inundate viral suppression and maintain it, but also to help achieve the UNAIDS 95-
95-95 target in children under 15 year / National Research Foundation (NRF)
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A longitudinal patient record for patients receiving antiretroviral treatmentKotze, E., McDonald, T. January 2012 (has links)
Published Article / In response to the Human Immunodeficiency Virus (HIV) epidemic in the country, the South African Government started with the provisioning of Antiretroviral Therapy (ART) in the public health sector. Monitoring and evaluating the effectiveness of the ART programme is of the utmost importance. The current patient information system could not supply the required information to manage the rollout of the ART programme. A data warehouse, consisting of several data marts, was developed that integrated several disparate systems related to HIV/AIDS/ART into one system. It was, however, not possible to trace a patient across all the data marts in the data warehouse. No unique identifiers existed for the patient records in the different data marts and they also had different structures. Record linkage in conjunction with a mapping process was used to link all the data marts and in so doing identify the same patient in all the data marts. This resulted in a longitudinal patient record of an ART patient that displayed all the treatments received by the patient in all public health care facilities in the province.
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The development of a scale to assess structural barriers to adherence to antiretroviral therapyCoetzee, Bronwyne Jo'sean 12 1900 (has links)
Thesis (MSc)--Stellenbosch University, 2011. / ENGLISH ABSTRACT: As the only effective treatment for HIV/AIDS, adherence to antiretroviral therapy (ART) is critical for successful treatment outcomes. Despite its open availability since the national rollout in 2004, adherence to ART has remained sub-optimal and the number of individuals shifted to the more expensive second-line therapy on steady increase. The literature reports more commonly on individual, psychological, and behavioural barriers to treatment. However, there has been a vast interest in the structural barriers that prohibit adherence to ART. In previous research, my colleagues and I identified the following structural barriers to treatment adherence: stigma-related barriers, the disincentives associated with disability grants, poor relationships with clinic staff, lack of privacy at clinics for counselling and treatment, transport difficulties in travelling to the clinic, long patient waiting times, food insecurity, substance abuse and the absence of substance abuse programmes, and migration. The data were arrived at by means of triangulated qualitative interviews obtained from patients, patient advocates, doctors, and nurses. Together, these qualitative data formed phase 1 of this study. The next step or phase 2, in this research was to develop a valid and reliable quantitative instrument based on these qualitative data.
Therefore the primary aim of the study presented in this thesis was to identify the underlying factor structure of four scales aimed at measuring adherence at two levels namely, adherence to clinic attendance, and adherence to pill-taking. After sampling a group of almost 300 persons living with HIV (PLWH) four valid and reliable scales assessing structural barriers to adherence to ART were derived at with Cronbach alpha coefficients ranging from 0.87 to 0.91. For each scale, a general or higher order factor was determined by means of hierarchical transformation suggesting that the items on each of the scales were dominated by a single underlying factor.
The findings of this research suggest that it is possible to assess the structural barriers to adherence that PLWH face on a daily basis. With a proper means, such as these scales, to assess structural barriers to adherence to ART clinicians may be able to identify patients who are likely to default and provide adequate attention to the most distressing barriers. / AFRIKAANSE OPSOMMING: Antiretrovirale terapie (ART) is die enigste effektiewe behandeling teen MIV/Vigs. Behandeling met hierdie terapie kan slegs suksesvol voltooi word indien die medikasie ononderbroke en gereeld geneem word. Alhoewel medikasie vrylik beskikbaar was sedertdien die nasionale bekendstelling in 2004, het die aantal individue wat na duurder tweede lyn terapie oorgegaan het toegeneem. Die volhoubaarheid van ART was dus nie optimaal nie. Dit kan toegeskryf word aan individuele -, sielkundige - en gedragstruikelblokke tydens behandeling wat tans baie aandag geniet in die literatuur. Om by te voeg, strukturele hindernisse tot ART geniet ook tans baie aandag. Met hierdie as agtergrond, was die primêre doel van die studie om die onderliggende faktor struktuur van vier skale wat strukturele hindernisse tot ART op twee vlakke meet, naamlik getroue kliniek bywoning en neem van medikasie, te indentifiseer. Ons het met vorige navorsing die volgende strukturele hindernisse tot ART geidentifiseer: stigma-verwante hindernisse, hindernisse wat verband hou met ongeskiktheidstoelaes, swak verhoudings met kliniek personeel, die gebrek aan privaatheid by klinieke in terme van berading en behandeling, vervoerprobleme, lang wagtye vir pasiënte, voedselonsekerheid, dwelmmisbruik en die afwesigheid van middelmisbruik-programme, asook migrasie. Data aangaande bogenoemde strukturele hindernisse is ingesamel deur middel van kwalitatiewe onderhoude met pasiënte, pasiënt-advokate, dokters en verpleegsters (fase 1). Gedurende fase 2 van hierdie studie is 'n geldige en betroubare kwantitatiewe instrument op grond van hierdie kwalitatiewe data ontwikkel. 'n Steekproef van ongeveer 300 MIV-geinfekteerde individue het deelgeneem. Vier geldige en betroubare skale is ontwikkel ten opsigte van die assessering van strukturele hindernisse in terme van gereelde gebruik van antiretrivale middels, met Cronbach alpha koëffisiënte tussen 0.87 en 0.91. Vir elke skaal is 'n algemene of hoër-orde faktor bepaal deur middel van hiërargiese transformasie wat daarop dui dat die items op elk van die skale gekenmerk is deur 'n enkele onderliggende faktor. Ons bevindinge dui daarop dat dit moontlik is om die strukturele hindernisse wat MIV individue daagliks tot ART ondervind te meet. Met die gebruik van hierdie skale sal klinici dus in staat wees om pasiënte te identifiseer wat moontlik van ART sal afwyk of die terapie sal staak met die klem op mees onstellende hindernisse.
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A retrospective study of the clinical management and treatment outcomes of patients established on antiretroviral therapy who are newly diagnosed with tuberculosis in the public sector, KwaZulu-NatalVeerasami, Sowbagium 03 1900 (has links)
Thesis (MCurr)--Stellenbosch University, 2013. / ENGLISH ABSTRACT: Taking into consideration the long duration of standard treatment for Mycobacterium
tuberculosis (TB), the high prevalence of HIV co-infection and the growing prevalence of
drug-resistant TB, there is an urgent need for improved treatment approaches for TB and
HIV. However, there is inadequate information regarding the burden being placed on the
Department of Health (DOH) systems by the current treatment of patients established on
Antiretroviral Therapy (ART) who are newly diagnosed with TB, and by their clinical
management.
The aim of the study was to determine what proportion of patients established on ART
were newly diagnosed with TB, and what their clinical and treatment outcomes were in
different public sector settings in the eThekwini Region, KwaZulu-Natal (KZN). Approval
for the study was obtained from the Human Research Committee of Stellenbosch
University and from the Biomedical Research Committee, KZN.
The study used a retrospective, quantitative, cohort technique at both TB and ART clinics
at three sites in the eThekwini region, KZN. These sites were DOH clinics and were
selected as they all had a TB clinic and a DOH-registered ART clinic. The study focused
on a period of one year prior to a patient established on ART developed TB. The study
population comprised all TB patients who attended the selected DOH clinics.
A data collection tool was developed and pilot-tested. A small sample of patient files
(n=15, representing 2% of the study population) was randomly selected; five from each
site. The files and data were excluded from the main study.
A total of 1824 files (579 from the TB clinics and 1245 from the ART clinics) were
reviewed. The data were captured into an electronic database (EpiData Version 3.3) and
analyzed using STATA (Version 11.0) with the assistance of a statistician. The findings show that of the study sample from the TB clinics (N=579), 78% (454/579)
were newly diagnosed with TB. Of the new TB cases, 90% (409/454) had pulmonary TB
and 71% (413/579) were HIV-positive. Nearly 50% (68/137) of the patients had
commenced ART prior to TB diagnosis and treatment, and 14% (19/137) had commenced
ART after TB. Of those who commenced ART prior to TB diagnosis and treatment, 29%
(20/68) had commenced ART more than three months prior to acquiring TB. The findings from the ART clinics show that of the files (N=1245) reviewed, 40%
(501/1245) had TB, and of these 8% (42/501) developed TB after three months or more of
ART.
Missing data in the patient medical files was a major challenge. The lack of recorded data
about ART in the TB clinics and about TB in the ART clinics suggests suboptimal clinical
management and poor integration of HIV and TB services. It was therefore not possible to
derive a combined HIV-TB outcome measure.
Recommendations to promote and implement the integration of TB and HIV services
included policy changes and implementation, management and practice suggestions,
education and training to integrate TB/HIV services and increase research to identify gaps
in clinical management and to improve integration of services. / AFRIKAANSE OPSOMMING: Met inagneming van die lang duur van die standaard behandeling vir Mycobacterium
tuberkulose (TB), hoë voorkoms van MIV-infeksie en die groeiende voorkoms van
dwelmweerstandige TB, is daar ’n dringende behoefte aan verbeterde
behandelingbenaderings vir TB en MIV. Daar is egter ’n gebrek aan inligting oor die las
geplaas op die Departement van Gesondheid (DvG) se stelsels deur die huidige
behandeling van pasiënte op antiretrovirale terapie (ART) wat gediagnoseer is met TB en
deur hul kliniese bestuur.
Die doel van die studie was om vas te stel watter persentasie van pasiënte wat op ART
gevestig is, wel met TB gediagnoseer is, en wat hul kliniese en behandeling-uitkomste was
in verskillende openbare-sektorinstellings in die eThekwini-streek, KwaZulu-Natal (KZN).
Goedkeuring vir die studie is verkry van die Menslike Navorsingskomitee van die
Universiteit van Stellenbosch en van die Biomediese Navorsingskomitee, KZN.
Die studie het gebruik gemaak van ’n retrospektiewe, kwantitatiewe ‘cohort’-tegniek by
beide TB en ARB-klinieke op drie plekke in die eThekwini-streek, KZN. Hierdie terreine
was DvG-klinieke en is gekies omdat hulle almal oor ’n TB-kliniek en 'n DvGgeregistreerde
ART-kliniek beskik. Die studie het gefokus op ’n tydperk van een jaar voor
’n pasiënt wat op ART is, TB ontwikkel het. Die studiepopulasie bestaan uit alle TBpasiënte
wat die geselekteerde DvG-klinieke bygewoon het. ’n Data-insamelinginstrument is ontwikkel en getoets. ’n Klein voorbeeld van die
pasiëntlêers (n = 15, 2% van die studie bevolking verteenwoordig) is ewekansig gekies:
vyf uit elke plek, en die data is vervat in ’n elektroniese databasis (EpiData Version 3,3).
’n Totaal van 1824 lêers (579 in die TB-klinieke en 1245 lêers in die ART-klinieke) is
ondersoek. Die data is ontleed deur gebruik te maak van Stata (weergawe 11,0) met die
hulp van ’n statistikus. Die bevindinge toon dat van die studiemonster in die TB-klinieke (N = 579), 78% (454/579)
met TB gediagnoseer is. Van die nuwe TB-gevalle, het 90% (409/454) pulmonêre TB
gehad en was 71% (413/579) MIV-positief. Byna 50% (68/137) van die pasiënte het ART
begin vóór hulle TB-diagnose en -behandeling, en 14% (19/137) ART ná TB. Van dié wat
ART voor TB-diagnose en -behandeling begin het, het 29% (20/68) meer as drie maande
voor die opdoen van TB met ART begin. Die bevindinge van die ART-klinieke toon dat van
die lêers (N = 1245) wat bestudeer is, 40% (501/1245) TB het, en hiervan het 8% (42/501)
TB na drie of meer maande van ART ontwikkel.
Ontbrekende data in die pasiënt se mediese lêers was ’n groot uitdaging. Die gebrek aan
aangetekende data oor ART in die TB-klinieke en oor TB in die ART-klinieke dui op
suboptimale kliniese bestuur en swak integrasie van MIV- en TB-dienste. Dit was dus nie
moontlik om ’n gesamentlike MIV-TB uitkomsmaatreël af te lei nie.
Aanbevelings om die integrasie van TB- en MIV-dienste te bevorder en te implementer,
het beleidveranderinge en -implementering ingesluit, asook bestuur- en praktykvoorstelle,
onderwys en opleiding om TB-/MIV-dienste by DvG-vlak te integreer en meer navorsing
om gapings in die kliniese bestuur te identifiseer en die integrasie van dienste te verbeter.
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