The Influence of Antiretroviral Treatment on Willingness to Test: a Qualitative Study in Rural KwaZulu-Natal; South Africa

Previous quantitative studies suggest a mutually reinforcing relationship between HIV counselling and testing (HCT) and antiretroviral treatment (ART). HCT is the entry into ART; and access to ART appears to increase HIV-testing uptake in settings with historically low uptake. Adopting a qualitative approach; this study examined the influence of ART on willingness to test for HIV; in a rural community in South Africa. Ninety-six in-depth interviews from a large community-based HIV-prevention trial were analysed. The data provide insight into the community members' views; perceptions and experiences regarding ART; and how they draw on these in making decisions about HIV testing. Several key factors that supported a positive relationship between ART and HIV testing were noted. These included the beliefs that ART brings hope and that it prolongs life; the powerful positive effect of witnessing the recovery of someone on treatment; and that ART encourages early HIV-testing behaviour. A few negative factors that could potentially weaken the effects of this positive relationship between ART and HCT uptake were the disclosure difficulties experienced by those enrolled in treatment; beliefs that ART does not cure HIV disease; and the travel distance to testing and treatment facilities from where people live and work. HIV/AIDS-service providers and programme planners should actively draw on these observations; to encourage increased HIV testing in communities and to ensure that the maximum number of people get the HIV treatment and care services that they require

Assessment of the Health System to Support Tuberculosis and AIDS Care. A Study of Three Rural Health Districts of Burkina Faso

There is increasing evidence demonstrating the importance of healthcare systems for improvement of chronic illness care. The aims of this study were to develop a comprehensive assessment of the health services capacity to provide tuberculosis (TB) and human immunodeficiency virus (HIV) care but also to enhance patient empowerment; social network and community support. A cross-sectional study was conducted from 1 to 31 of August 2007 in 3 districts of Burkina Faso. We used a step-by-step model and the assessment of chronic illness care (ACIC) scale to assess capacities of 24 first line health centres (FLHC) and 3 district hospitals (DH) for providing TB and HIV/AIDS care. Data for the step-by-step model were extracted from medical records of 75 TB and 66 HIV patients. The ACIC scale was completed by health professionals; 6 medical doctors and 18 nurses; working at the DH level and at the FLHC level; respectively. The biological test for confirmation was free of charge for all the TB patients but only for 10.6(7/66) HIV cases. Up to the time of the survey; 5 TB (6.6) and 18 HIV+ patients (27.3) have been hospitalised for care at least once; 64 TB (85.3) had been declared cured and 38 HIV (54.5) were under antiretroviral treatment. Health care process organisation for TB and HIV care had distinct areas of weaknesses. From a maximum ACIC score of 11; the overall score for TB care ranged between 1.9 and 4.9 with a median of 3.7 and for HIV care between 2.1 and 6.7 with a median of 4.1. This study provides an illustration of assessing the HIV and TB care combining data from the routine information system and from the chronic illness care assessment tool; to encompass both disease control and patient health perspective. It provides to health managers arguments for clear conclusions and sufficient data for action

L' introduction de plantes medicinales dans le traitement de l'infection a VIH : une approche reussie au Burkina Faso

La recherche et le developpement de medicaments traditionnels anti-VIH/SIDA est un processus complexe qui integre de nombreux defis. Ce processus comprend les evaluations precliniques et cliniques ainsi que la valorisation industrielle; avec la mise sur le marche de medicaments respectant des normes de qualite; d'innocuite et d'efficacite therapeutique. Si de nombreuses plantes africaines ont deja fait l'objet d'evaluations precliniques avec des resultats encourageants; les etudes cliniques comparatives sont encore insuffisantes. L'espoir est cependant permis; comme nous le montre l'experience du Burkina Faso; notamment a travers le developpement de deux medicaments qui ont franchi aujourd'hui avec succes l'etape d'essai clinique Phase II; et surtout l'identification des plantes medicinales pouvant avoir une interference negative avec les traitements antiretroviraux

Antiretroviral Treatment and Level of Transaminase in HIV-infected Out-Patients Attending the Central Hospital of Yaounde; Cameroon

The emergence of liver diseases as one of the major causes of death in people infected with HIV has paralleled the introduction of more effective antiretroviral therapies. This study was carried out with the aim of determining the effects of antiretroviral treatment on liver enzymes (SGOT and SGPT) in patients placed on antiretroviral therapy. A prospective cross-sectional 3 years study was carried out among patients confirmed to be HIV positive and who were to be placed on antiretroviral drugs at the HIV/AIDS out patient clinic of the Yaounde Central Hospital; Cameroon. Levels of transaminases of patients were measured in four phases using the International Federation of Clinical Chemistry (IFCC) protocol. Of the 150 patients who participated in the study; 54.0( 81/150) presented with elevated transaminase at the final phase of the study with respect to aspartate aminotransferase (AST); 77.78(63/81) of whose AST levels only increased after initiation of highly active antiretroviral therapy (HAART). 22.67(34/150) presented with elevated transaminase with respect to alanine aminotransferase (ALT). At the final phase; 70.58of whose ALT levels only increased after HAART initiation. Increase in blood transaminase levels was statistically independent on age group and the drug combinations. Increase in AST levels was associated with an increase in ALT levels upon treatment (r = 0.58). There was a significant positive linear relationship between duration of treatment and concentration of transaminases over the years (r= 0.9). We therefore concluded that highly active antiretroviral therapy (HAART) is associated with low level hepatotoxicity at therapy initiation; regardless of drug class or combination

SISTA South Africa: The Adaptation of an Efficacious HIV Prevention Trial Conducted with African-American Women for isiXhosa-speaking South African Women

Although new HIV treatments continue to offer hope for individuals living with HIV; behavioural interventions shown to reduce HIV risk behaviour remain one of the most powerful tools in curbing the HIV epidemic. Unfortu- nately; the development of evidencebased HIV interventions is a resource-intensive process that has not progressed as quickly as the epidemiology of the disease. As the epidemic continues to evolve; there is a need to expedite the development of evidence-based HIV interventions for populations that are often disproportionately impacted by HIV/AIDS. One mechanism of accelerating the development process is to adapt evidence-based HIV interventions for vulnerable populations. The aim of this paper was to describe the adaptation process of a HIV intervention for African-American women for black South African Xhosa women. For African-American women the intervention was effective in increasing consistent condom use; sexual self-control; sexual communication; sexual assertiveness and partner adoption of norms supporting consistent condom use

Quality Standards in Provision of Facility Based HIV Care and Treatment: A Case Study from Dar Es Salaam Region; Tanzania

Objective: A cross- sectional descriptive study was conducted to assess the quality standards of health facilities providing antiretroviral treatment (ART) in Dar es Salaam from May to July 2005. Methods: All ten health facilities (both public and private) already designated by Ministry of Health (MOH) to provide ART; six of them since October 2004 and four since May 2005; were included in the study purposively . The other two not designated were randomly picked and added. A checklist with the MOH required standards was used to assess the availability of infrastructure (equipment and staff) for provision of ART; and noted the number of patient eligible; started on ART and their follow ups. Results: The study findings indicated that there were inadequate trained personnel; inadequate laboratory equipments; inadequate antiretroviral drugs and isoniazed was under utilized. There were inadequate confidential places for counseling and information system was weak. Not all the eligible patients were able to start ART and comprehensive HIV care and treatment was not provided in all the designated facilities. Conclusion: Quality standards for providing ART in eligible health facilities in Dar es Salaam varied from facility to facility with better quality standards in facilities that were designated earlier than those designated later indicating a potential for improvement in future. However fast Improvement in staff training; infrastructure; equipment and drugs supplies; health management information system is needed if we are to treat estimated more than 400;00 HIV/AIDS patients by the year 2010

Eligibility for HIV/AIDS Treatment among Adults in a Medical Emergency Setting at an Urban Hospital in Uganda

Background: Despite global effort to scale up access to antiretroviral therapy (ART); many people in need of HIV/AIDS care in Uganda have not been reached. HIV testing and ART are not widely offered as routine medical services and data on HIV/AIDS in emergency settings in Sub-Saharan Africa is limited.We determined the HIV prevalence and eligibility for ART in a medical emergency unit at Mulago hospital. Methods: In a cross-sectional study; we interviewed 223 patients who were systematically selected from the patients'register from October through December 2004. HIV testing was offered routinely and results were delivered within 30 minutes.We evaluated HIV infected patients for WHO clinical stage of disease and referred them for HIV/AIDS care. Results: Out of 223 patients; 111 (50) had HIV infection of whom 78 (70) had WHO clinical stage 3 and 4 of disease thereby requiring ART. Overall; 84 out of 111 (76) HIV positive patients had not received any specific HIV/AIDS care. Conclusion: The burden of HIV infection in the medical emergency unit is high and majority of the patients who required ART had no prior HIV/AIDS care.We recommend scale up of HIV/AIDS care in acute care settings in order to increase access to ART

Effets indésirables des thérapies antirétrovirales observés chez les patients infectés par le VIH à Cotonou, Bénin

Objectif : évaluer la tolérance du traitement antirétroviral (ARV) chez les patients traités à Cotonou pour l'amélioration de la qualité de leur suivi. Méthodes : étude rétrospective concernant les patients VIH+ d'âge ≥ 15 ans, traités par les ARV entre février 2002 et janvier 2004 qui ont répondu à au moins un rendez-vous de suivi. Les effets indésirables (EI) signalés par le malade ou constatés par le médecin ont été analysés. Résultats : Sur 130 patients sélectionnés, 62,3% recevaient une trithérapie ARV avec inhibiteur non nucléosidique de la transcriptase inverse et 37,7% une trithérapie avec inhibiteur de protéase. 75,4% ont présenté au moins un EI. L'EI a été grave dans 6 cas (4,6%). La fréquence des EI était significativement différente selon les médicaments utilisés. Les troubles fréquents étaient neurosensoriels (64,6%), digestifs (34,6%) et dermatologiques (14,6%). 2/3 des patients ont présenté les EI dans les 15 premiers jours du traitement. Les patients ont été compliants. Un seul a arrêté le traitement de son propre chef. Conclusion : la fréquence et la nature des EI observés prédisposent les patients à une rupture d'observance. Leur suivi doit donc comporter une éducation et une surveillance orientées par le profil des EI identifiés

Outcome of delivery among HIV positive mothers at Aminu Kano teaching hospital; Kano

BACKGROUND: If a HIV positive mother delivers in a health facility; interventions can be effected to reduce the risk of transmission of HIV to the baby. The study was done to evaluate the interventions offered to HIV positive women who delivered at Aminu Kano Teaching Hospital (AKTH) Kano. METHOD: Retrospective review of the case records of all HIV positive patients that delivered at AKTH over a 27 month period (October 2003 to December 2005) was used. RESULTS: There were 4922 deliveries out of which 125 were HIV positive; giving a prevalence rate of 2.54. Most (75.2) of the patients received Nevirapine alone in labour; 20.8 received a combination of antiretroviral drugs while 4 received none because their records were not available. Majority (88) of the patients had spontaneous vaginal delivery; 10.4 by elective CS and 1.6 by emergency CS. There was no maternal death but 3.2 of the babies were stillbirths. All the babies received a single dose of Nevirapine. Most (96) mothers chose exclusive breast milk substitute. CONCLUSION: HIV positive mothers need to deliver in health facilities to receive the full compliment of care they deserve. Highly Active Antiretroviral therapy (HAART) should be introduced; as it is more effective for PMTCT

Barriers to HIV Care and Treatment by Doctors : a Review of the Literature

This paper provides a review of the reported barriers that prevent doctors from managing HIV infected patients. The four most commonly reported barriers were: fear of contagion; fear of losing patients; unwillingness to care; and inadequate knowledge /training about treating HIV patients. Barriers to treating HIV infected patients is frequently reported in many countries and it is important for developing countries such as South Africa to learn from these experiences by identifying local problems so that constructive interventions and strategies can be developed to address these barriers; thereby improving the quality of patient care. Further research in respect of the local situation is requiredIntroduction: Over the last two decades acquired immunodeficiency syndrome (AIDS) has emerged as one of the most serious public health problems in the world; and by the end of 2003 it was estimated that 5.3 million South Africans were human immunodeficiency virus (HIV) positive; which corresponds to 21.5of the population. In the early phase of the HIV epidemic few doctors saw infected patients and treatment options were limited. As a result many doctors were reluctant to provide care to HIV infected patients and homophobia amongst doctors; fear of contact with patients and unwillingness to care were frequently reported. However; there has been an exponential increase in the number of HIV and AIDS related cases and more doctors are encountering infected individuals. This review summarizes our current knowledge of barriers to treatment of HIV infected patients by doctors.Method: A comprehensive literature review was undertaken by searching the MEDLINE database; Psychlit; ISI Web; EBSCOHost; and Sabinet on line; for eng language literature published between 1985 and 2004. The database search terms included keywords such as fear/s; barrier/s; concern; HIV; AIDS; attitudes; physician/s (doctor/s); practice; treatment; care and knowledge. A variety of combinations of these words were entered. All duplicate articles were removed and only studies that used doctors as the sample population were considered. Titles expressing comment; news items; opinion pieces or letters were rejected.Results: Thirty two relevant studies were identified from the literature search. The four most commonly reported barriers were: fear of contagion; fear of losing patients; unwillingness to care; and inadequate knowledge /training about treating HIV patients

Views of General Practitioners and Pharmacists on the Role of the Pharmacist in HIV/Aids Management

Background: Sub-Saharan Africa is home to 25.8 million people living with HIV/Aids. In November 2003; the South African government approved The Operational Plan for Comprehensive Treatment and Care for HIV and Aids; which aimed to provide antiretroviral treatment to 500 000 patients by the end of 2007. The successful implementation of this operational plan requires many healthcare providers trained in aspects of HIV. This study aimed to establish and compare the views of general practitioners and pharmacists on the role of the pharmacist in HIV/Aids management and to elucidate an appropriate role for pharmacists. Ethical approval was obtained from the MEDUNSA Research Ethics and Publications Committee.Methods: The study population consisted of general practitioners in the province of Gauteng and community pharmacists in Gauteng and the Western Cape. Two hundred medical practitioners were selected at random from the 7 157 registered in Gauteng. Pharmacist respondents (293 from 879 community pharmacies in Gauteng and 200 from 493 in the Western Cape respectively) were selected randomly. The respondents were contacted individually by telephone and asked to complete a pilot-tested 10-statement questionnaire on their views of aspects relating to a role for pharmacists in HIV/Aids management.Results: Mean values for positive responses were calculated and analysed (two-sided t test). The response rates for general practitioners and pharmacists were 44.5 and 38.1 respectively. The responses were grouped into two categories; dispensing and advice and testing and treatment. Both groups agreed about the dispensing and advice category. Of the general practitioners surveyed; 95.5 agreed that pharmacists should counsel patients on the correct use of medications and 100 agreed that the pharmacist should be aware of all related side effects and drug interactions of HIV medications; i.e. the general practitioners were comfortable with pharmacists providing a dispensing and advisory role. The groups differed significantly about the testing and treatment category.Conclusion: GPs were generally not in favour of pharmacists being involved in the testing and treatment of HIV/Aids. The pharmacists surveyed; on the other hand; indicated their willingness to assume an expanded role in HIV/Aids management. A potential role for pharmacists was elucidated. It complements the role of the pharmacist in HIV/Aids management described in the South African Pharmacy Council Position Paper. The differences in views identified in the survey hold serious implications as South Africa struggles to contend with the HIV/Aids epidemic

Des remedes ancestraux pour une maladie nouvelle: l'integration des guerisseurs traditionnels a la lutte contre le SIDA accroit l'acces aux soins et a la prevention en Afrique de l'Est

Ce document decrit trois initiatives ayant permis de reduire le fosse entre les systemes de sante traditionnel et biomedical au Kenya; en Republique Unie de Tanzanie et en Ouganda. Une composante de la medecine traditionnelle a ete integree dans les programmes de prevention et de soins lies au VIH/sida au Kenya et en Tanzanie. En Ouganda par contre; le projet a porte sur la mise en place de la collaboration entre medecine traditionnelle et medecine biomedicale

Access to treatment for HIV/AIDS: report of a meeting of international experts; 12-13 June 2001; Washington; DC; USA

This publication is a report of an international experts meeting held in 12-13 June 2003 at Washington (USA); which aims to explore and prioritise operations research questions about access to treatment for HIV/AIDS. Even if the discussions focused on treatment with ARVs; many of the issues raised and the research questions identified also pertain to treatment of opportunistic infections and the provision of palliative and end-of-life care

La riposte du secteur prive a l'epidemie:Debswana-une reference mondiale

Ce document decrit la riposte mise en place par une societe miniere d'extraction et de traitement de diamant du Botswana (Debswana) pour lutter contre l'epidemie de sida dans un pays ou le taux de prevalence est estime a 35;8. La mise en place d'un programme d'education et de sensibilisation dont les coordinateurs furent nommes a temps plein; la realisation d'un audit institutionnel de sensibilite et de vulnerabilite; constituent; entre autres; les principales activites de Debswana devenue une reference mondiale en matiere de lutte contre le sida dans le secteur prive

Guidelines for the clinical management of HIV infection and AIDS in adults and children

For quite some time the National AIDS Prevention and Control Programme has felt the need of the module to improve the knowledge and skills of health care providers. The Ministry of Health in conjunction with WHO and USAID has now produced this module for use as a reference manual and teaching guide. It is hoped that this module will help to improve the management of HIV/AIDS at all levels of health care delivery. Infection with HIV and AIDS presents a major challenge to health workers around the world. WHO estimates that 8 to 10 million persons are infected with HIV and almost 50 percent of these are in Africa. Health care workers are called upon to perform many tasks in the face of HIV infection and AIDS. They must diagnose and manage HIV infection and its related illness. In addition; they must deal with psychological; social; legal and ethical issues. The community looks to Health Workers for guidance; for information and education

Low-Dose Oral Interferon Alpha in the Management of Symptomatic HIV-1 Infection

Objectives: To determine whether symptomatic HIV-1 infected persons will benefit from treatment with low doese oral interferon alpha (IFN). Study Design: This was a randomised ; double-blind; placebo controlled trial. Results: a total of 560 patients (45male; 55females) were enrolled between May 1991 and July 1992. At entry the baseline characteristic of age; WHO clinical stage; body weight; Karnofsky score and CD4+ cell count between the 2 groups were similar. Patients were followed up to between 30 and 60 weeks. Survival rates and disease progression was analysed using Kaplan-Meier estimation long-rank test and proportional hazards regression. Symptoms on follow up were analysed using logic regression and adjusted relative risk estimates. The details will be presented. Conclusion: The study did not reveal any significant differences between the group which took IFN and the one on placebo