Family Medicine and Primary Care

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Browsing Family Medicine and Primary Care by Subject "AIDS (Disease)"

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    Adherence of HIV/AIDS patients to antiretroviral therapy in a district hospital in Nankudu, Namibia
    (Stellenbosch : Stellenbosch University, 2014-04) Okebie, C. O.; Pather, Michael; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Interdisciplinary Health Sciences. Family Medicine and Primary Care.
    ENGLISH SUMMARY : Background: Non-adherence to highly active antiretroviral therapy (HAART) is a strong predictor of progression to AIDS and death. It remains the most important potentially alterable factor that determines treatment outcome. AIM: The main purpose of this study is to determine the current frequency of adherence to HAART in a major HIV/AIDS treatment center in Nankudu District and to identify the local factors contributing to non-adherence. OBJECTIVES: To assess and measure the adherence to antiretroviral therapy. To assess and describe the defaulter rate To assess and describe the interruption rate To describe the local barriers to sub-optimal adherence in the sample patients Methods: The study was a descriptive survey of the below mentioned three methods used to assess adherence to HAART and the determination of local barriers to adherence. The three methods used to measure HAART adherence were: pill counts, pharmacy refill data and self-report. The participants CD4 counts and viral loads were also evaluated. It included a randomly selected sample of 225 adult patients receiving HAART treatment in the Communication for Disease Control (CDC)-HIV clinic of Nankudu district hospital of Namibia. Results: A total of 90% of the patients had an adherence >95% comparable to those reported in most sub-Saharan Africa. The major local barriers to adherence included: distance from clinic (100%), lack of food (100%), lack of money (100%), poverty (100%), occupational factors-migration (100%), travel (81%), ran out of medicine (69%), too busy (69%), medication side effects (56%), felt better ( 56%) and too sick (50%). The major reasons given by the treatment defaulters were similar to those given by the treatment interrupters except for stigma (100%), compared to 19% for the treatment interrupter. Conclusion: The level of HAART adherence in the Communication Diseases Control (CDC)- HIV Clinic, of Nankudu District Hospital in Namibia is comparable to those reported in most sub-Saharan Africa, which is the recommended 95%. The pattern of non-adherence is characterized by treatment defaulters and interrupters. The study revealed that there were more treatment interrupters than defaulters. Financial constraints, travel, running out of ARV medicine, food insecurity, poverty, distance from the clinic, were the major reasons given by the treatment interrupters, while occupational factors, lack of transport, stigma, and long distance of the health facility were the major reasons given by the treatment defaulters.
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    Attitudes to sexual coercion and rape within the Anglican Church, Cape Town: a cross sectional survey
    (Stellenbosch : Stellenbosch University, 2012-03) Okwuosa, Odili Sabastine; Mash, Bob; Mash, Rachel; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Interdisciplinary Health Sciences. Family Medicine and Primary Care.
    ENGLISH SUMMARY : Introduction: In South Africa 5.6-5.9 million people are currently living with HIV/AIDS, making South Africa the country in the world with the largest number of people living with HIV/AIDS. Despite numerous government measures to curb the pandemic, the prevalence and deaths due to HIV/AIDS have continued to rise to unacceptable levels. South Africa is reported to have one of the highest rates of sexual violence in the world and has the worst known figures for gender–based violence for a country not at war. Violence and coercive practices have been found to dominate sexual relationships in South Africa. Male dominance in sexual relationships as well as the role of traditional masculinity has made women vulnerable and encouraged the spread of HIV/AIDS. Church attendance has been found to have an inverse relationship with domestic violence. This implies that the church through its community engagement could assist with reducing gender based violence and sexual coercion. Aims & Objectives: To determine to what extent the Anglican Church in the Cape Town Diocese is contributing to or challenging rape-supportive attitudes, sexual coercion and gender inequality. Specific objectives were: 1) To determine the beliefs, values and attitudes relevant to rape, sexual coercion and gender inequalities amongst people attending the Anglican Church in the Diocese of Cape Town: clergy, leaders and members of the church. 2) To make recommendations to the church regarding any specific issues that the church should address through its gender desk or other structures. Method: A cross sectional survey, which collected quantitative data. Study population was members of the Anglican Church from the 48 churches within the Diocese of Cape Town. 21churches were selected by simple random sampling that was stratified in terms of the membership numbers and predominant racial composition of the congregation. All people who attended the church on the study day were asked to complete a questionnaire. The data was analysed using Statistica version 8 with the help of the Centre for Statistical Consultation at Stellenbosch University. Results: There were 581 respondents from 21 churches of which 380 were females (65.4%), 184 were males (31.1%) and 17 (2.9%) did not indicate their gender. In general, the Anglican Church in the Diocese of Cape Town espoused progressive attitudes that did not create an environment conducive to sexual coercion, gender violence and rape. For instance, 98.8% of respondents disagreed that a man has good reason to hit his partner if she does not complete her housework to his satisfaction. 94.9% of respondents agreed that the church leadership considers rape and domestic violence to be important, while 98.3% of respondents disagreed that it is okay for a man to have multiple partners. However, the survey did show some potentially discriminatory attitudes amongst the church members towards those living with HIV and that different archdeaconries have different degree of openness in dealing with issues of rape, divorce, marriage and domestic violence. More than half of the respondents agreed that it is okay for a man to ask for a divorce or separation when he is afraid that the partner may infect him with HIV while two-third of respondents agreed that a woman could also do so for the same reason. Conclusion: In general the Anglican Church in the Diocese of Cape Town espoused progressive attitudes towards sexual coercion, rape and domestic violence that stand in contrast to more conservative and discriminatory attitudes reported in other denominations and African countries. Churches were willing to talk openly about the issues and to offer practical support and counselling. This implies that this faith based organization may be a useful ally in addressing these issues in South African society.
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    A survey to explore factors that delay patients from accessing antiretroviral treatment at an East London hospital complex clinic
    (Stellenbosch : Stellenbosch University, 2012-12) Raza, M. Sajjad; Mash, Bob; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Interdisciplinary Health Sciences.
    Introduction This cross-sectional study assessed factors affecting access to antiretroviral therapy (ART) among HIV patients. The aim of this study was to explore factors that delay patients from accessing antiretroviral treatment at an East London Hospital Complex clinic and to determine the pathway that people from communities in the surrounding area take in order to access antiretroviral treatment at the referral hospital ART clinic Methods The study design was a descriptive cross-sectional survey using both open and closed questions to generate qualitative and quantitative data. The survey used a questionnaire administered via a face to face interview. 200 Adult patients (>18years old) from the local population with a CD4 count of ≤100/mm3 referred to the ART clinic at East London Hospital Complex for the first time during May to October 2011 were interviewed. Results With the health system, some issues were structural (staffing, availability of CD4 counts) and most were process related and reflected a poor patient experience and lack of trust in the quality of care. Contextual related issues were mainly geographic accessibility (cost and lack of transport, distance to health care facility), stigma and discrimination about HIV. Patients related factors included misperceptions and false beliefs about HIV, low level of education, socioeconomic factors, lack of family and social support such as unavailability of treatment supporter and status of patient’s general health discouraged people from seeking ART. Coping strategies such as denial of results and reluctant to disclose results to other people came out as a distrust of patients in community. Conclusions This study gives evidence that people living with HIV experience health system, patient and contextual related barriers to access HIV treatment. The majority accessed care via their local primary care clinic and traditional or alternative practitioners did not appear to play a major role. The distance from and cost of transport to the referral hospital ART service was a major issue compounded by the difficulty of travelling when acutely sick. The expectation of long waiting times and sometimes negative staff attitudes reduced motivation. A number of other factors related to the patient, the health service and the community context were also identified. Many of these factors that reduce access to ART are amenable to change.