The Association between Depression and Adherence to Antiretroviral Therapy in HIV-Positive Patients; Kwazulu-Natal; South Africa

Background: Depressive disorders are associated with poorer health outcomes in people living with human immunodeficiency virus infection and acquired immunodeficiency syndrome (PLHIV) and have been shown to contribute to non-adherence to antiretroviral therapy (ART) in Western contexts. Limited data from developing countries are available. The aim of this study was to explore whether there was an association between depressive symptoms and adherence to ART among PLHIV in KwaZulu-Natal; South Africa.Method: A cross-sectional analytical study was undertaken in a population of HIV-positive patients accessing ART at a government funded; semi-urban clinic in the eThekwini Municipal District; KwaZulu-Natal; South Africa. The tools used to measure depressive symptoms and adherence were the Centre for Epidemiology Studies Depression Scale (CES-D) and clinic-based pill counts; respectively. Socio-demographic and clinical data were collected during interviews and from patient records.Results: Sixty-two per cent of the sample (n = 146) had higher-than-threshold levels on the depression scale; and 32 were less than 95 adherent to ART. High depression scores were associated with lower levels of education [odds ratio (OR) 2.0; 95 confidence interval (CI); 1.0-4.1] and unemployment (OR 2.8; 95 CI; 1.3-6.0); while non-adherence was associated with unemployment (OR 2.4; 95 CI; 1.0-6.1) and mid-range CD4 counts (200-499 cells/?l; OR 3.0; 95 CI; 1.3-6.9). No significant association was found between depressive symptoms and non-adherence to ART (OR 0.5; 95 CI; 0.2-1.2; p-value; 0.125).Conclusion: The large percentage of participants who scored high on the CES-D suggests a high prevalence of major depression in the study population. No significant association was found between high depression scores and nonadherence to ART. Depressive symptoms were significantly linked to lower levels of education and unemployment; while non-adherence was associated with unemployment and mid-range CD4 counts (200-499 cells/?l). The study had some limitations. Further studies are needed to determine the prevalence and causes of depression and its impact on PLHIV in this population and in the developing world

Retention of Knowledge of and Skills in Cardiopulmonary Resuscitation among Healthcare Providers after Training

This study assesses the retention of core knowledge and skills among healthcare providers (HCPs) who attended a Basic Life Support (BLS) course. The format for teaching this course changed in 2006 and a review of the effectiveness and acceptability of the new course was considered vital. Studies indicate that early and effective cardiopulmonary resuscitation improves the chances of survival in cardiac arrest victims; however; the knowledge and skills of HCPs in basic life support vary. International recommendations on the BLS course were that HCPs repeat the course every two years. However; no studies have been conducted in South Africa to determine the ideal time when HCPs should be re-evaluated to ensure that they retain adequate knowledge and skills. This study was conducted at a training centre in a hospital in KwaZulu-Natal; where a new format for training was introduced in 2006. Participants were HCPs who had completed a BLS course. The sample was taken sequentially from half of the annual intake of a BLS course three months after completion of the course. Data were collected using the accredited American Heart Association written test and the Critical Skills Checklist; and a further questionnaire was developed to collect variables such as demography and profession. Results indicate that skills retention was good and; although there was some fall-off in skills and knowledge; there was no significant difference between the scores at the end of the course and retest scores. Staff working in accident and emergency departments had more practical experience and their knowledge and skills retention was better than that of staff working in other areas of the hospital. Nurses performed nearly as well as doctors and are an important skills resource in the management of patients who need to be resuscitated. All participants were satisfied with the new format and had no suggestions on how to improve it