Knowledge, attitudes and perceptions of pharmacy and nursing students towards male circumcision and HIV in a KwaZulu-Natal University, South Africa

Background: Male circumcision is currently being promoted in South Africa as a Human Immunodeficiency Virus (HIV) prevention method. Effective implementation requires that healthcare providers should believe in the procedure's efficacy and should possess a positive attitude. A study was undertaken amongst pharmacy and nursing students with different objectives. Objectives: To ascertain students' knowledge; attitudes and perceptions regarding male circumcision and (HIV) prevention. Method: A descriptive cross-sectional study using anonymous questionnaires was undertaken amongst 4th year pharmacy and nursing students studying at a university in KwaZulu-Natal; after obtaining their consent. Data were captured and analysed using SPSS version 15. Results: A response rate of 83.18and a mean knowledge score of 66.43with relatively positive attitudes (62.7) were obtained; 85.4of the respondents felt that promoting male circumcision is appropriate; with all Muslim students (n 11) supporting the promotion of male circumcision. Even though all Muslim students supported male circumcision; only 3 students were willing to perform the procedure if adequately trained (p 0.03). The majority of the female students were unwilling to perform the procedure (p 0.005). A third of the respondents indicated that male circumcision would both undermine existing protective behaviours and strategies as well as increase riskier sexual behaviour. Over 54of the respondents believed that the South African Health System would be able to cope with the massive male circumcision drive. The majority of the respondents favoured the procedure to be done at birth. Pain was cited as the most important reason for not wanting to be circumcised. Conclusion: Pharmacy and nursing students have a moderate knowledge of male circumcision and HIV prevention with relatively positive attitudes. The majority felt that promoting male circumcision is appropriate and should be encouraged

Focus Group Discussion with Private Sector Doctors in the eThekwini Metro of KwaZulu-Natal on the Management of HIV/AIDS Patients

Background: Highly active antiretroviral treatment (HAART) is essential in the treatment of HIV/AIDS; however; a holistic approach to HIV/AIDS management is important. This study was done to confirm the findings of two studies done previously in the eThekwini Metro of KwaZulu-Natal on private sector doctors' management of HIV-infected patients and to obtain morein in depth information about their nonpharmacological management of HIV-infected patients. Methods: Two focus group discussions were conducted amongst private sector doctors in the eThekwini Metro; after obtaining their consent. The focus group sessions were scripted; audio-taped and transcribed verbatim. Prevalent themes were identified and reported. Results: Eight doctors participated. Of the total patient population seen annually by the majority of the doctors; an average of 43.8 was HIV infected. Doctors in this study managed their patients both pharmacologically and nonpharmacologically. Seventy-five per cent of doctors indicated that the taste of medicine played an important role in nonadherence to treatment; but all agreed that cultural beliefs also influenced the patient's adherence to medication. Theft of medicines and the outof-stock situation prevented antiretroviral drug access; which impacted negatively on adherence. Five doctors mentioned that depressed patients abused alcohol; resulting in nonadherence. One doctor reported that he used the biopsychosocial approach to improve adherence in his patients. Doctors indicated that the disability grant given by the South African Government caused patients not to adhere to treatment in order to maintain a CD4 count of 200 or less so as to qualify for the grant. Conclusions: The study confirmed the previous study findings in that it showed that private sector doctors manage their HIV-infected patients both pharmacologically and nonpharmacologically. It further provided new and interesting information with regard to the nonpharmacological methods employed in HIV/AIDS management; that is the incorporation of cultural beliefs in the management of HIV-infected patients to improve adherence to treatment; and the role of the disability grant and pharmaceutical formulations in contributing to nonadherence by HIV-infected patients

The willingness of private-sector doctors to manage public-sector HIV/AIDS patients in the eThekwini metropolitan region of KwaZulu-Natal

Background: South Africa is severely affected by the AIDS pandemic and this has resulted in an already under-resourced public sector being placed under further stress, while there remains a vibrant private sector. To address some of the resource and personnel shortages facing the public sector in South Africa, partnerships between the public and private sectors are slowly being forged. However, little is known about the willingness of private-sector doctors in the eThekwini Metropolitan (Metro) region of KwaZulu-Natal, South Africa to manage public-sector HIV and AIDS patients. Objectives: To gauge the willingness of private-sector doctor to manage public-sector HIV and AIDS patients and to describe factors that may influence their responses. Method: A descriptive cross-sectional study was undertaken among private-sector doctors, both general practitioners (GPs) and specialists, working in the eThekwini Metro, using an anonymous, structured questionnaire to investigate their willingness to manage public-sector HIV and AIDS patients and the factors associated with their responses. Chi-square and independent t-tests were used to evaluate associations. Odds ratios were determined using a binary logistic regression model. A p value < 0.05 was considered statistically significant. Results: Most of the doctors were male GPs aged 30­50 years who had been in practice for more than 10 years. Of these, 133 (77.8%) were willing to manage public-sector HIV and AIDS patients, with 105 (78.9%) reporting adequate knowledge, 99 (74.4%) adequate time, and 83 (62.4%) adequate infrastructure. Of the 38 (22.2%) that were unwilling to manage these patients, more than 80% cited a lack of time, knowledge and infrastructure to manage them. Another reason cited by five doctors (3.8%) who were unwilling, was the distance from public-sector facilities. Of the 33 specialist doctors, 14 (42.4%) indicated that they would not be willing to manage public-sector HIV and AIDS patients, compared with only 24 (17.4%) of the 138 GPs (p < 0.01). Conclusion: Many private-sector doctors are willing to manage public-sector HIV and AIDS patients in the eThekwini Metro, potentially removing some of the current burden on the public health sector

Factors influencing HAART adherence among private health care sector patients in a suburb of the Ethekwini Metro

Background: The advent of highly active antiretroviral therapy (HAART) ushered in a new era in the management of the AIDS pandemic with new drugs; new strategies; new vigour from treating clinicians and enthusiasm on the part of their patients. What soon became evident; however; was the vital importance of patient adherence to prescribed medication in order to obtain full therapeutic benefits. Several factors can influence adherence to HIV drug regimens. Many treatment regimes are complex; requiring patients to take a number of drugs at set times during the day; some on a full stomach and others on an empty one. Other factors that could contribute to non-adherence include: forgetting to take medications; cost factor; side effects; incorrect use of drug; social reasons; denial or poor knowledge of drug regime. If the correct regimen is not prescribed and if patients do not adhere to therapy; then the possibility of resistant strains is high. Improving adherence is therefore arguably the single most important means of optimising overall therapeutic outcomes. Although several studies regarding patient adherence have been performed in the public health care sector; data on adherence in patients from the private health care sector of South Africa remain limited. Many factors influence compliance and identifying these factors may assist in the design of strategies to enhance adherence to such demanding regimens. This study aimed to identify these factors among private sector patients.Methods: Descriptive cross-sectional study was conducted among all consenting patients with HIV who visited the rooms of participating private sector doctors from May to July 2005. A questionnaire was administered to consenting participants. Participants who reported missing any medication on any day were considered non-adherent. The data obtained was analysed using SPSS 11.5. A probability value of 5or less was regarded as being statistically significant. Categorical data was described using frequency tables and bar charts. Pearson's chi-square tests or Fischer's exact tests were used interchangeably as appropriate to assess associations between categorical variables. The study received ethics approval from the University of KwaZulu-Natal's Nelson R Mandela School of Medicine Ethics Committee. Results: A total of 55 patients completed the questionnaires and 10 patients refused to participate. There was no statistical difference between adherence to treatment and demographics such as age; gender and marital status. In this study 89.1of patients were classified as non-adherent and reasons for nonadherence included difficulty in swallowing medicines (67.3) (p = 0.01); side effects (61.8) (p = 0.03); forgetting to take medication (58.2) (p = 0.003); and not wanting to reveal their HIV status (41.8) (p = 0.03). Common side effects experienced were nausea; dizziness; insomnia; tiredness or weakness. Reasons for taking their medicines included tablets would save their lives (83.6); understand how to take the medication (81.8); tablets would help them feel better (80.0); and were educated about their illness (78.2). The majority of participants (65.5) were on two nucleoside reverse transcriptase inhibitors (NRTIs) and one non-nucleoside reverse transcriptase inhibitor (NNRTI). All participants that were on a regimen that comprised protease inhibitors and two NRTIs were found to be non-adherent. Conclusions: Some barriers to adherence among this cohort of private sector patients are similar to those experienced by public sector patients. It will be important for doctors to identify these problems and implement strategies that could improve adherence; e.g. using short message services (SMSs) reminders for those patients prone to forgetting to take their medicines; breaking the tablets into smaller pieces in order to overcome the difficulty of swallowing; if the medication is not available in a liquid form; looking at alternative medication with lesser or more tolerant side effect profiles and greater counselling on the drugs