Factors associated with adherence to ARV treatment in people living with HIV/AIDS in a rural area (Koula-Moutou) in East Gabon

The goal of this study was to evaluate the impact of socio-clinical factors on adherence to antiretroviral treatment in people living with HIV/AIDS in Koula-Moutou (a rural area of Gabon). Two adherence assessment methods based on patient declaration and compliance with pharmacy visits were used to determine qualitative and quantitative aspects of adherence to antiretroviral therapy (ART). The quantitative (82.2%) and qualitative (79.5%) adherences to ART declared by patients were higher than those obtained through pharmacy visit assessment methods (15.8% and 45.2%, respectively). Moreover, the declarative and pharmacy visit compliance methods showed fair agreement (quantitative Kappa = 0.317; qualitative Kappa = 0.311). A better quantitative or qualitative declarative adherence was associated with a lower level of education (P = 0.05 and P = 0.025 respectively). This study reported for the first time the factors influencing adherence to ART in a rural area of East Gabon. We recommend further investigations in a large cohort to better assess the impact of socio-clinical factors on ART adherence in a vulnerable group of patients

Retrospective clinical analysis of adverse drug reactions associated with antiretroviral therapy in Tlokwe district, South Africa

Background: South Africa has the highest number of patients on antiretroviral therapy (ART) globally. Various obstacles were identified that influence effective reporting of adverse drug reactions (ADRs) in resource-limited countries. This investigation aimed to identify, classify and analyse the prevalence of ART-related ADRs. Methods: This observational, quantitative and retrospective descriptive investigation utilised ADR forms completed by healthcare professionals in various healthcare facilities in the Tlokwe district, South Africa (January 2010 to December 2014). Descriptive and inferential analyses were carried out. Results: A total of 770 ART-related ADRs were included in the final analysis. The mean age was 40.1 (± 10.1%) years, with significantly higher ADRs reported in females (70.8%). In this study, 99% of the ADRs were reported by doctors. Abnormal fat distribution (58%), peripheral neuropathy (21.6%) and renal dysfunction (6.6%) were most frequently reported. Females presented with abnormal fat distribution and peripheral neuropathy at a significantly younger age (38.1 ± 4.6 vs. 43.4 ± 5.7 years, p < 0.0001 and 39.7 ± 1.1 vs. 45.1 ± 9.2 years, p < 0.001) respectively compared with males. Gender difference was practically significant (Cramer's V = 0.3) for all three of the major reported ADRs. Conclusions: Gender was highly dependent among the major reported ADR categories, and women presented with abnormal fat distribution and peripheral neuropathy at a significantly earlier age than males. This retrospective analysis can serve as aplatform for future ADR studies within this district. Sustainable and continuous efforts should be made to train and create more awareness among healthcare workers in this district

Assessing the Effects of Anti-Homosexuality Legislation in Uganda on HIV Prevention; Treatment; and Care Services

Uganda's response to the HIV epidemic has been lauded for its robustness and achievements. However; a key component of HIV prevention programming has been missing; for men who have sex with men (MSM). The main reason cited has been criminalization of male homosexual behavior. In 2009; the Anti-Homosexuality Bill (AHB) was introduced in the parliament to enhance existing anti-homosexuality law. A multi-disciplinary team made a Health Impact Assessment of the proposed AHB. The bill as tabled would severely increase punishments; increased closeting. Social capital of MSM would be eroded by clauses mandating reporting by friends; relatives; and acquaintances. Health-care professionals would have to inform on homosexuals. Mandatory HIV testing would be a blow to programming. Probable disclosure of HIV status in a public space (court) would also be a deterrent. Heftier punishments for those testing positive increases stigma and hobbles subsequent care. The AHB argues for exclusion; and more discrimination targeting persons living with HIV and sexual minorities. It will exacerbate the negative public health consequences of the existing legislation. The government of Uganda should review guidance documents published by authoritative bodies including the World Bank; World Health Organization to develop and bring to scale Human rightsaffirming HIV prevention; treatment; and care responses

Are Antiretrovirals Prescribed According to the Recommended Prescribed Daily Doses in the Private Healthcare Sector in South Africa

Current antiretroviral treatment (ART) guidelines recommend different combinations that have led to major improvements in the management of HIV and AIDS in the developed and developing world. With the rapid approval of many agents; health care providers may not be able to familiarise themselves with them all. This lack of knowledge leads to increased risk of dose- prescribing errors; especially by non-HIV and AIDS specialists. The purpose of this retrospective non-experimental; quantitative drug utilisation study was to evaluate if antiretrovirals (ARVs) are prescribed according to the recommended prescribed daily doses (PDDs) in a section of the private health care sector in South Africa (SA). Analysed ARV prescriptions (49995; 81096 and 88988) for HIV and AIDS patients were claimed from a national medicine claims database for the period 1 January 2005 through to 31 December 2007. ARV prescriptions prescribed by general practitioners (GPs) with PDDs not according to the recommended ARV dosing increased dramatically; from 12.33 in 2005 to 24.26 in 2007. Those prescribed by specialists (SPs) increased from 15.46 in 2005 to 35.20 in 2006 and decreased to 33.16 in 2007. The highest percentage of ARV prescriptions with PDDs not according to recommended ARV dosing guidelines was identified in ARV regimens with lopinavir-ritonavir at a PDD of 1066.4/264 mg and efavirenz at a PDD of 600 mg prescribed to patients in the age group of Group 3 (19 years age ? 45 years). These regimens were mostly prescribed by GPs rather than SPs. There is a need for more education for all health care professionals and/or providers in the private health care sector in SA on recommended ARV doses; to avoid treatment failures; development of resistance; drug-related adverse effects and drug interactions

Nigerian Health Workers' Views Concerning Factors Influencing Paediatric Adherence to Anti-Retroviral Therapy

New studies have focused on paediatric anti-retroviral therapy (ART) adherence in Nigeria; probably because of the ethical challenges involved in studying children. The study aimed to identify factors that influence paediatric ART adherence as perceived by health care workers providing ART services in two cities in Nigeria. Knowledge about such factors would be used to formulate recommendations for enhancing paediatric ART adherence in Nigeria; for facilitating the tasks of the health care workers and for enhancing the ART programme's effectiveness. An exploratory descriptive qualitative research design was used to identify and to describe health care workers' views in Kano and Lagos; Nigeria. Three focus group discussions were conducted at two clinics that provide free paediatric ARVs (antiretroviral drugs). The transcribed data were analysed by using the framework approach of data analysis. Health care providers perceived poverty; illiteracy; stigma; discrimination; inappropriate care approaches; and parental dynamics as factors that influence paediatric ART adherence. Paediatric ART adherence levels in Nigeria could be enhanced by emphasising paediatric ART adherence counselling and by adopting a comprehensive family centred care approach; by improving free paediatric ART services and by empowering parents and reducing stigma and discrimination

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

Scaling up antiretroviral therapy for HIV-infected children in Côte d'Ivoire: determinants of survival and loss to programme

Objective: To investigate deaths and losses to follow-up in a programme designed to scale up antiretroviral therapy (ART) for HIV- infected children in Cote d'Ivoire. Methods Between 2004 and 2007; HIV-exposed children at 19 centres were offered free HIV serum tests (polymerase chain reaction tests in those aged 18 months) and ART. Computerized monitoring was used to determine: (i) the number of confirmed HIV infections; (ii) losses to the programme (i.e. death or loss to follow-up) before ART; (iii) mortality and loss-to-programme rates during 12 months of ART; and (iv) determinants of mortality and losses to the programme. Findings The analysis included 3876 ART-naive children. Of the 1766 with HIV-1 infections (17aged 18 months); 124 (7.0) died; 52 (2.9) left the programme; 354 (20) were lost to follow-up before ART; 259 (15) remained in care without ART; and 977 (55) started ART (median age: 63 months). The overall mortality rate during ART was significantly higher in the first 3 months than in months 4-12: 32.8 and 6.9 per 100 child-years of follow-up; respectively. Loss-to-programme rates were roughly double mortality rates and followed the same trend with duration of ART. Independent predictors of 12-month mortality on ART were pre-ART weight- for-age z-score -2; percentage of CD4+ T lymphocytes 10; World Health Organization HIV/AIDS clinical stage 3 or 4; and blood haemoglobin 8 g/dl. Conclusion The large-scale programme to scale up paediatric ART in Cote d'Ivoire was effective. However; ART was often given too late; and early mortality and losses to programme before and just after ART initiation were major problems

Disclosure of HIV Status between Parents and Children in Uganda in the Context of Greater Access to Treatment

While disclosure of HIV sero-status is encouraged in the management of the HIV and AIDS epidemic; it remains a challenge; especially among family members. This article examines the moral dilemmas and pragmatic incentives surrounding disclosure of HIV status in contemporary Uganda. Our findings are based on 12 in-depth interviews; 2 focus-group discussions; 6 key informant interviews with AIDS activists; and open-ended responses derived from 148 HIV-positive persons in a quantitative survey. The study was conducted in 2008-2009 in Kampala; Mpigi; and Soroti districts in Uganda. We found both parents and adult children facing dilemmas in disclosure; whether it was parents revealing their own HIV status to their children or the status of their perinatally infected children; or young people infected through sexual intercourse telling their parents. For both groups; there is fear of blame; stigma; discrimination; and shame and guilt related to unsafe sex; while young people also fear loss of privileges. On the other hand; there are practical imperatives for disclosure in terms of gaining access to care; treatment; and material resources. Faced with these dilemmas; HIV-positive people and their families require professional counselling to help them work through the emotional challenges encountered and identify mechanisms of support and coping

The treatment action campaign and the three dimensions of lawyering: Reflections from the rainbow nation

The spread and perpetuation of the HIV/AIDS epidemic in South Africa has hindered the country's social and economic growth after apartheid. This paper documents my experiences while working with the Projects Abroad Human Rights Office and specifically my interactions with the Treatment Action Campaign (TAC); an organization which has taken a multidimensional approach in order to educate people about HIV/AIDS and attempt to provide access to medicines for millions of South Africans afflicted with the disease. I discuss how TAC has used both traditional and non-traditional methods of advocacy to combat the epidemic and equate access to health care to a social justice issue by empowering marginalized communities. The paper's dual purpose is to applaud TAC's continuous success in combating HIV/AIDS with such a multidimensional approach and illustrate how other organizations can utilize such an approach in order to affect social change. To illustrate TAC's approach; I utilize Lucie White's three dimensions of lawyering and equate TAC to a single cause lawyer; signifying that White's characterization of multi-dimensional activism is not limited to individuals; but can rather be applied at the firm level. White's three dimensions include: (a) advocacy through litigation; (b) advocacy in stimulating progressive change; and (c) advocacy as a pedagogic process. From this analysis; I conclude that TAC's multi-dimensional approach and specifically its inherent practice of White's three dimensions has been the root of its success in educating millions about the virus and advocating for access to medicines for those who have contracted HIV. TAC's innovative advocacy has also mobilized a new generation of South African activists who have helped TAC grow into a vibrant and integral organization within the country's post-apartheid culture. Such an example can serve as a framework for future organizations who wish to tackle other challenges that face the country

Acceptance of counseling, voluntary HIV testing and use of prophylactic nevirapine in labour and immediate puerperium at Muhimbili national hospital, Tanzania

Background: Mother to child transmission contributes significantly to the incidence of HIV in our country. A PMTCT program exists in Muhimbili National Hospital (MNH) and some surrounding public hospitals since 2000. Inspite of this it has been observed that a substantial number of women delivering at MNH have not had VCT and therefore cannot benefit from the PMTCT intervention.Objective: To determine the acceptance of counseling; voluntary HIV testing and prophylactic use of Nevirapine among pregnant women during labour / immediate postpartum at Muhimbili National Hospital.Methodology: This descriptive Cross-sectional study was done in the labour ward of MNH.Data collection: Trained counselors invited all women who met inclusion criteria as they were admitted. Patients who had obstetric complications were excluded. Women who accepted counseling were taken to private rooms for discussion and those who consented were screened for HIV using rapid tests. Direct observed therapy with Nevirapine was done. Data was filled in a structured questionnaire and analysed by EPI Info 6 and SPSS software.Results: We recruited 885 women with unknown sero-status through convenient sampling. The overall acceptance of pre-test counseling in labour among women with unknown sero-status was 71.7while acceptance of counseling and voluntary HIV testing was 56.6. Among those who accepted pre-test counseling in labour; 78.9accepted HIV testing and 8.6of these were found to be HIV infected. Eighty-three percent of women diagnosed to be HIV infected accepted Nevirapine. Counselor's experience of more than 3 years had a significant impact on acceptance of counseling and testing of HIV in labour.Conclusion and recommendation: The results of this study show that HIV testing during labour and use of prophylactic ARV is acceptable in our setting. Women with unknown serostatus in labour should be offered counseling and testing in order to prevent MTCT of HIV

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