ABSTRACT
Background: antiretroviral therapy has changed the outlook of AIDS. However, identifying factors that will strengthen its maintenance is vital to treatment success. Advocacy is growing on the need for close attention to immunological progress, prevention of excessive body weight gain and associated immunological and metabolicconsequences for better long-term outcomes among PLWHIV in Africa. Aims: To study prevalence, determinants of adherence, and the existing relationship between body weight and CD4 count among adherents and non-adherent patients on HAART. Methodology: A cross-sectional design for sampling of 270 patients on HAARTS was made and pharmacy based adherence was calculated. Patients were categorized into weight groups according to WHO guideline and CD4 count was determined at baseline, third and sixth months. Result: Calculated overall pharmacy adherence was 62.6% over six months. Disclosure to a close family member (p=0.013) and living outside the city of care (p=0.025) significantly predict adherence. Pretreatment overweight (BMI-25- 29.9) and obesity (BMI>30.0) were temporary beneficial to CD4 constitution at baseline (p=0.004), while overweight (p=0.041) and obesity (p=0.150) were associated with lower CD4count repopulation at six months post- HAART compared to normal body weight (BMI-18.5– 24.9), p˂0.001. Adherent PLWHIV participants had higher body weight increasing effect, but demonstrated lower CD4 lymphocyte count increasing effect compared to the nonadherent at six months post-HAART, (p<0.001). Conclusion: Normal body weight and maintenance during HAART seems beneficial for immune reconstitution at six months post- HAART. While emphasizing good adherence to HAART, it becomes necessary for programme implementers to watch against excessive body weight gain and attendants adverse immunological consequences.
ABSTRACT
Objectives: When compared with the use of a mercury sphygmomanometer; the use of a validated digital blood pressure (BP) measuring device eliminates the risk of exposure to mercury. Digital devices are also associated with a lesser degree of end-digit preference (EDP). EDP refers to the occurrence of a particular end digit more frequently than would be expected through chance alone. There have been only a few reports from Africa on the occurrence of EDP in BP measurement. This study examined EDP in BP taken by nurses before and after the introduction of a digital BP-measuring device.Design: The design was a retrospective study.Settings and subjects: We reviewed the BP readings of 458 patients who presented at the dedicated clinic for people living with human immunodeficiency virus/acquired immune deficiency syndrome of Ladoke Akintola University of Technology Teaching Hospital; Osogbo; Nigeria; before and after the introduction of the digital BP-measuring device.Outcome measures: The prevalence of end-digit zero of systolic and diastolic BP readings before and after the introduction of the digital device was compared using McNemar's test.Results: There was a large and significant fall in end-digit zero when BP readings that were taken using the mercury and digital devices were compared (systolic 98.1 vs. 10.9 ; p-value 0.001; diastolic 97.1 vs. 14.9 ; p-value 0.001 (McNemar's test).Conclusion: There was a significant reduction in the frequency of end-digit zero when BP was taken with the digital device rather than the mercury device. Regular training and certification of healthcare workers in BP measurement is recommended to ensure a high quality BP measurement standard