The aim of this study was to assess the extent on how effective was the prevention of mother-to-child transmission of Human Immunodeficiency Virus (HIV) infection at Oshakati District Health Centre. Explanatory survey was used to conduct the research. A total of 160 nurses experienced in prevention of mother-to-child transmission and women who attended antenatal care and post natal care services participated in the study. Respondents expressed unsatisfactory with the promoting involvement of male partners, high quality voluntary counselling and testing services, couple counselling and testing, integration of Highly Active Antiretroviral Therapy services, administration of short course of Zidovudine to pregnant mothers and the provision of antiretroviral drugs to infants. Therefore, promoting involvement of male partners, couple counselling and testing, administration of short course of Zidovudine to pregnant mothers and educating women about exclusive breastfeeding prior to delivery are some of recommendations for effective prevention of mother-to-child transmission of HIV infections. / Health Studies / (M.A. (Public Health))

This non-experimental, retrospective, descriptive and correlational study investigated adherence to antiretroviral drugs among HIV positive patients at Mpilo Central Hospital in Bulawayo Zimbabwe. Data among 118 patients was extracted from clinic registers and patient facility held medical records to determine level of adherence to ART using pharmacy refills (a non-immunological adherence parameter) and compared to CD4 cell count ( an immunological adherence parameter). Adherence levels obtained in this study using pharmacy refills was low (62.7%) and a relatively high non-adherence level of 37.3%. The pharmacy refill adherence level obtained was comparable to CD4 cell count adherence level of 64.6% (as indicated by a 50% CD4 cell count gain). These findings would seem to indicate the need for more education on the importance of adherence and further the need for better adherence monitoring systems / Health Studies / M.A. (Public Health)

The objectives of the study were (1) to quantify adherence rate among the study participants in the ART unit and (2) to identify factors that contribute to non-adherence. This cross sectional study was carried out at Nekemete referral clinic. Data was collected using a self-developed structured questionnaire where a total of 338 participants grouped into adherent and non-adherent based on a score derived from an adherence assessment were interviewed. Data was analysed using the Statistical Package for Social Sciences (SPSS) version 17.0. By using multivariate analysis of variables identified as correlates of adherence, non-adherence was common among those; with age between 18-30 yrs, with no education, who were not married, who had no pipe water supply, those with no electricity in the house, who perceived had no access to assistance from providers, who perceived the health care providers (HCPs) did not keep information confidentially, who had a language barrier with providers, and who were treated with a psychiatric illness. The study concludes that adherence is multi-factorial and varies significantly by individual and care setting. Psychosocial factors were found to impact adherence and should be analysed in more detail by further studies. Three psychosocial factors were independently associated with poor adherence: the study found that patients perceiving poor access; those perceiving problems in information confidentiality (and possibly experiencing stigmatisation); and having psychiatric morbidity (and possibly with less social support) are more likely to be non-adherent. Furthermore, individuals without electricity and those without piped water supply, implying low income, are at risk for non-adherence / Health Studies / M.A. (Public Health)

The earlier optimism generated by the efficacy of antiretroviral drugs in human immuno-deficiency virus (HIV) patients has been dissipated in the face of the enormous chal-lenge of maintaining a nearly perfect adherence indefinitely. This study set to determine the influence of HIV adherence self-efficacy and beliefs about medicines on antiretrovi-ral therapy adherence, with the aim of developing a framework for enhancing antiretrovi-ral therapy (ART) adherence through focused intervention on modifiable factors from study variables that are strongly associated with ART adherence. A descriptive correlational design was used to assess the predictive relationships of HIV adherence Self-Efficacy, Beliefs about Medicines and ART adherence among 232 HIV-infected patients in a large public health facility in Pretoria. Participants' medication be-liefs were assessed using the Beliefs about Medicines Questionnaire, HIV adherence self-efficacy was assessed with HIV adherence self-efficacy scale (HIV-ASES) and ART adherence was assessed using the AIDS Clinical Trial Group questionnaire. Pearson correlation analysis was used to assess bivariate associations among the variables, and multiple regression analysis was used to examine the relationships among the inde-pendent variables and ART adherence. Mean adherence for the 232 participants was 95% (SD=13.2). Correlation analysis re-vealed positive bivariate associations between perceived general harm and overuse of medications, and ART adherence (p<0.05); between specific necessity and concerns about ARVs, and perceived general harm and overuse of medications (p<0.05); be-tween HIV adherence self efficacy and ART non-adherence (p<0.05). Multiple regres-sion analysis showed significance for perceived general harm and overuse of medica-tions on ART adherence (F(1;231)=11,583;p<0,001) with perceived general harmful ef-fects and overuse of medications explaining 4.8% of the variance. There was signifi-cance for HIV adherence self-efficacy on ART non-adherence (F(1;41)=4.440; p<0.041), with HIV-ASES explaining 9,8% of the variance. Based on the results, a framework for enhancing ART adherence was developed. Activities in the framework consist of baseline screening for adherence facilitators and barriers using the beliefs about medicine questionnaire and HIV ASES, this is followed by focused interventions on identified barriers of ART adherence / Health Studies / D.Litt. et Phil. (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

This study assessed healthcare providers’ knowledge, attitudes and practices towards IPT provision for people living with HIV (PLHIV) in Addis Ababa, the capital city of Ethiopia. A quantitative, descriptive, cross-sectional study design was used for the study and data was collected using a self-administered questionnaire from 104 clinicians working in ART clinics. The findings show that healthcare providers who participated in this study had a mean value of high knowledge, positive attitude and good practice towards IPT provision for PLHIV. Significant association was found between knowledge and attitude (P=0.000) but no significant associations were found between knowledge and practice, attitude and practice as well as between the type of facility (public/private) and level of practice. This implied that, the low level of IPT implementation in Addis Ababa doesn’t seem due to health care providers’ lack of knowledge and resistance to provide IPT for people living with HIV. As a result, the researcher recommends for further researches of other possible factors like; the reliability of IPT information/data management, drug supply and the leadership and governance of the health system that IPT program is a direct concern. / Health Studies / M. Public Health (with specialisation in Medical Informatics)

The purpose of the study was to describe factors contributing to mortality among HIVinfected people on Isoniazid Preventive Therapy (IPT) in Botswana. A quantitative, explorative, descriptive study was used and 80 records of deceased IPT respondents were reviewed through the use of a checklist. The demographic factors, baseline physical examination, hospitalisation and drug history were taken into consideration. Out of the deceased patients, 75% were female. The major findings showed that 100% (N=80), the most highly indicated causes of death were gastroenteritis (18.75%), cryptococcal meningitis (17.5%) andpneumonia (16.25%). Of the patients (28.75%) who died before completing the six months of IPT. The causes of death were gastroenteritis (21.7%), symptoms and signs of bacterial pneumonia (17.4%), cryptococcal meningitis (13%), Pulmonary Tuberculosis (PTB) (13%), septicaemia (13%), and murder (13%). It has been recommended that there should be reorganisation of services of care for HIV-infected persons, such as provision of Cotrimoxazole Prophylaxis Therapy (CPT) and Antiretroviral Therapy (ART) to ensure holistic approach care. The future study should include HIV-infected children on IPT using the same or modified objectives. The conclusion drawn was that disintegrated interventions of IPT, CPT and ART and lack of holistic care for PLHIV lead to opportunistic infections that caused mortality on patients on IPT. / Department of Health Studies / M.A. (Public Health)

Introdução: A adesão à terapia antirretroviral (TARV) é essencial para o sucesso do tratamento do HIV/aids. Apesar das recomendações fornecidas para a promoção da adesão nos serviços de assistência ambulatorial ao HIV/aids do Sistema Único de Saúde (SUS), não há medidas padronizadas para o monitoramento da adesão nos serviços e há pouca informação disponível sobre as atividades de adesão efetivamente realizadas. Este estudo teve como objetivos: descrever medidas nacionais de adesão à TARV e atividades de adesão conduzidas nos serviços de HIV/aids do SUS; investigar relações entre adesão e características dos serviços. Métodos: Entre 2009 e 2011, conduziu-se um estudo transversal da adesão à TARV em amostra nacional de pacientes em tratamento em serviços do SUS. Foram sorteados para participar do estudo: 1) serviços de diferentes níveis de qualidade (segundo avaliação nacional prévia da organização da assistência ao HIV/aids), localizados nas diferentes regiões do país; 2) pacientes sob TARV em acompanhamento nos serviços selecionados, maiores de 18 anos, não gestantes. Para medir a adesão à TARV, utilizou-se o Questionário WebAd-Q, instrumento de autorrelato em linguagem \"Web\", previamente validado, que aborda três dimensões da adesão: medicamentos, dose (número de comprimidos) e horários de tomada. As respostas foram ponderadas de acordo com a probabilidade de seleção amostral dos pacientes. Características dos serviços foram obtidas com base em dois instrumentos autorrespondidos pelos gerentes e equipes de saúde: 1) o Questionário Qualiaids, voltado para a avaliação geral da qualidade organizacional da assistência ao HIV/aids; 2) o Questionário de Atividades de Adesão, que enfoca aspectos especificamente voltados para a promoção da adesão. Outras características dos serviços analisadas foram: região geográfica, porte do serviço (número de pacientes em TARV) e porte do município (número de habitantes). O desempenho dos serviços em relação às atividades de adesão realizadas foi avaliado segundo cinco domínios: monitoramento; investigação da adesão; cuidado multidisciplinar; atividades de grupo e para populações específicas; capacitação e atualização dos profissionais. Associações entre medidas de adesão e características dos serviços foram testadas em modelos de regressão logística (IC 95%, p < 0,05). Associações entre atividades de adesão e demais características dos serviços também foram investigadas. Resultados: De um total de 2.424 participantes, acompanhados em 55 serviços, 61,1% (IC 95% 58,5-63,7) reportaram não adesão a uma ou mais das dimensões analisadas. A dimensão com maior proporção de não adesão foi o horário (50,9%). Os serviços apresentaram desempenho geral mediano em relação às atividades de adesão. Serviços de boa qualidade organizacional e de pequeno porte associaram-se ao melhor desempenho e/ou à realização de atividades específicas. Ao contrário do esperado, houve predomínio de associações inversas da adesão com a qualidade, a complexidade assistencial (segundo o porte) e a realização de atividades de adesão. Discussão: O estudo indicou a necessidade de ações para aprimorar o trabalho em adesão realizado nos serviços, incluindo: promoção da adesão ao horário; priorização de pessoas com dificuldades de adesão e de populações que requerem intervenções específicas; padronização do monitoramento; maior investimento no gerenciamento técnico, no enfoque multidisciplinar, em atividades específicas de apoio à adesão, e em parcerias com a sociedade civil organizada. A exploração de novos modelos de análise em futuros estudos deverá contribuir para a melhor compreensão das relações entre adesão e características dos serviços / Background: Adherence to antiretroviral therapy (ART) is crucial for HIV/AIDS treatment success. In spite of recommendations provided for adherence promotion in HIV outpatient care facilities of the Brazilian Unified Health System (Sistema Único de Saúde - SUS), there are no standard measures for adherence monitoring in the facilities and there is little information available about adherence strategies actually implemented. This study aimed at: describing national ART adherence measures and adherence strategies conducted in public HIV care facilities; investigating relationships between adherence and care site characteristics. Methods: Between 2009 and 2011, a cross-sectional study of ART adherence was conducted with a national sample of patients treated in public health care facilities. Randomly selected study participants were: 1) care sites of different quality levels (according to a previous national evaluation of HIV care organization), located in different country regions; 2) patients receiving ART at selected sites, 18 years or older, non-pregnant. Adherence measurement was based on the WebAd-Q Questionnaire, a pre-validated web-based self-report tool that approaches three adherence dimensions: drugs, dose (number of pills) and time schedule. Answers were weighted according to patients\' probability of selection. Site characteristics were obtained based on two self-report tools answered by managers and health care teams: 1) the Qualiaids Questionnaire, which evaluates HIV care overall organizational quality; 2) the Adherence Strategies Questionnaire, which focuses on aspects specifically related to adherence promotion. Other site characteristics analyzed were: geographic region, site size (number of patients receiving ART) and municipality size (number of inhabitants). Care site performance in relation to adherence strategies was evaluated based on five domains: monitoring; adherence investigation; multidisciplinary care; group activities and strategies for special populations; professionals\' training and update. Associations between adherence measures and site characteristics were tested in logistic regression models (CI 95%, p < 0.05). Associations between adherence strategies and other site characteristics were also investigated. Results: From a total of 2,424 participants, who were receiving care at 55 facilities, 61.1% (CI 95% 58.5-63.7) reported non-adherence to one or more of the dimensions analyzed. The dimension with the largest non-adherence proportion was timing (50.9%). Overall, the facilities presented a medium performance on adherence strategies. Good organizational quality and small size were associated with better site performance and/or with conduction of specific strategies. Contrary to expectations, inverse associations of adherence with quality, care complexity (according to size) and implementation of adherence strategies were predominant. Discussion: This study indicated actions required to improve adherence work developed in the facilities, including: timing adherence promotion; prioritization of people facing adherence difficulties and populations requiring specific interventions; monitoring standardization; more efforts focusing on technical management, multidisciplinary approach, specific strategies to support adherence, and partnerships with organized civil society. The development of new analysis models in future studies should contribute to improve understanding of the relationships between adherence and care site characteristics

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 purpose of this study was to evaluate the antiretroviral therapy program in primary health care settings in Lesotho. Mixed methods research using a convergent parallel mixed methods design was used to collect both quantitative and qualitative data which were analysed during the same phase of the research process. Two groups of participants participated in the study, the registered nurse group was composed of registered nurses/midwives/nurse clinicians involved in ART service provision and the second group was composed of adults aged 18 years and older who were HIV/AIDS positive. Quantitative data had a compliance rate of 92% and it were analysed using SPSS (23). Qualitative data were analysed using constant comparison analysis and seven themes, fourteen categories and twenty two sub-categories emerged from the data analysis. Findings of the study revealed that the majority of PHC facilities were staffed by registered nurse midwives and nurse clinicians who were qualified, confident, knowledgeable and competent in the execution of duties. Generally there were a large number of patients that sought ART services which were offered on a weekly basis although there was variation in the actual number of days the services were provided. The time patients spent seeking ART services varied across the facilities and ARVs and other drugs were usually available. Challenges in the delivery of ART services included unsatisfactory staffing resulting in the provision of inadequate services and work overload, lack of knowledge of some patients, use of incentives by some partners and too many partners being involved in ART, inadequate documentary evidence and stigma pertaining to the HIV status of individuals. Furthermore, ARVs were reported to make patients feel hungry hence resulting in lack of satisfaction in ART services, ART services were inadequate due to dysfunctional equipment and some patients had been lost due to inability to screen for cancer and there was incomplete monitoring and evaluation of the ART program. However, participants in this study generally showed their acknowledgement of the ART services as they generally improved their health status despite the many challenges that were being faced. / Health Studies / D.Litt.et Phil. (Health Studies)