Masters Degrees (Family Medicine and Primary Care)

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Browsing Masters Degrees (Family Medicine and Primary Care) by Subject "AIDS (Disease) -- Treatment"

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    Causes of non-adherence to antiretroviral therapy in Wellness Clinic, Tshepong Hospital, Klerksdorp
    (Stellenbosch : University of Stellenbosch, 2009-12) Das, C. R.; Strini, Govender; University of Stellenbosch. Faculty of Health Sciences. Dept. of Interdisciplinary Health Sciences. Family Medicine and Primary Care.
    ENGLISH ABSTRACT: HIV/AIDS is the leading cause of death in Sub-Saharan Africa. According to 2001 estimates, there are 28.5 million people living with HIV in Africa, comprising more than 70% of the world’s HIV-infected population. HIV/AIDS remains one of the most important social and public health threats in Sub-Saharan Africa. UNAIDS 2006 estimates that 5.5 million people are living with HIV, and almost 1,000 AIDS deaths occur every day in South Africa. South Africa is currently one of the most severely affected countries in the world. Antiretroviral therapy (ART) is currently the only treatment available for HIV. It does not cure HIV infection, but reduces HIV related mortality and morbidity.
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    Measuring adherence levels to antiretroviral treatment (ART) and assessing certain factors affecting adherence in a state primary health care clinic, Mitchells Plain Community Health Centre, South Africa
    (Stellenbosch : Stellenbosch University, 2008-12) Engel, Tania; Schlemmer, Arina; Stellenbosch University. Faculty of Health Sciences. Dept. of Interdisciplinary Health Sciences
    ENGLISH ABSTRACT: Objective. Measuring adherence levels and assessing the impact on adherence to ART (antiretroviral treatment) of the factors: disclosure to partner, partner support, other support and length of time between diagnosis and ART commencement, in a state-run ART clinic at Mitchells Plain Community Health centre. Design. A retrospective case control study was conducted and the information was obtained by means of a file audit. Methods. Every 5th file was selected for the study and 199 participants were chosen based on the inclusion and exclusion criteria. Adherence for each patient was measured using a formula documented in a published study. For the comparison group 82 cases (non-adherent patients) were matched for age and gender with 82 adherent controls. Results. The mean adherence for the initial group of 199 participants was 80.1%. Disclosure to a partner and partner support were not found to significantly affect adherence. The time between HIV diagnosis and ART commencement was also not found to make a statistically significant difference to adherence. There appeared to be an association, though not statistically significant, between other support (not from the partner) and >95% adherence (p= 0.0579). Conclusion. It can be concluded that adherence is probably influenced by a wide variety of factors. More qualitative studies or larger samples are recommended to better assess the impact of partner support and acceptance of HIV on adherence. Approaches to partner disclosure prior to commencing ART should be reviewed. The mean adherence level of 80.1% is an indication that more work is urgently needed to improve adherence levels in state-run clinics in South Africa.
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    The prevalence of established factors associated with adherence to Highly Active Antiretroviral Therapy (HAART) in non-adhering patients at the ARV clinic of Madzikane KaZulu Memorial Hospital
    (Stellenbosch : Stellenbosch University, 2015-07) Anizoba, O. O.; Pather, Michael; Stellenbosch University. Faculty of Health Sciences. Dept. of Interdisciplinary Health Sciences.
    ENGLISH ABSTRACT: Background Adherence to HAART is key to any successful HAART programme. In Madzikane KaZulu Memorial Hospital ARV Clinic, there is an increasing number of patients on HAART and an increasing number of patients still awaiting HAART initiation. With the paucity of healthcare personnel in this rural district hospital, suboptimal patient’s preparation for HAART often occurs, and the HAART defaulter rate is on the increase. This is may be attributed to an interplay of factors affecting HAART adherence. Aim and Objectives The aim of this research was to determine the prevalence of established factors associated with adherence to Highly Active Antiretroviral Therapy (HAART) in non-adhering patients at the Madzikane KaZulu Memorial Hospital (MKMH) ARV clinic. The objectives were: • To conduct an audit on all case files of patients on HAART over the study period. • To explore the behavioural aspects of poor HAART adherence in a focused group discussion. • To describe the factors associated with good HAART adherence Methods Study design: A cross-sectional descriptive study which focused on determining the prevalence of established factors( patient-related, therapy-related and facility-related factors) affecting HAART adherence at the ARV clinic was carried out among identified HAART non-adhering patients. Patients that were not adhering with HAART between the period of January 2009 and December 2010 were selected for the study. These patients were 19 years or more and had been on HAART for at least two months. The study was carried out between November and December 2010. The result of the focused group discussion was utilized to refine the development of the questionnaire. Setting: The study was conducted at the Madzikane KaZulu Memorial Hospital ARV clinic. This is a modern 269 bed district hospital in the Mount Frere, Alfred Nzo district, Eastern Cape Province of South Africa. This is a predominantly rural region. Results: Data for analysis was provided by 215 patients that fulfilled the inclusion criteria. The prevalence rate of the factors affecting HAART adherence at the hospitals ARV clinic was 24%. A total of 60% of the patients were females. Majority of the patients (86.1%) had treatment supporters, and more than half of the patients (57.2%) were unemployed and not on disability grant. A total of 62.8% of the patients prefer to take their ARV at a clinic near them, and the majority of these patients (96.3%) want to start taking their ARV in a nearby clinic within 6months. The female gender, unemployment not on disability grant, longer period on HAART, Regimen 1A ARV( stavudine or tenofovir plus lamivudine and efavirenz according to the National ART guideline 2004 and its modified version of April 2010) single marital status and probably poorly selected unprepared treatment supporters, are associated with poor HAART adherence at this ARV clinic. Conclusion The study revealed that the prevalence rate of the factors affecting HAART adherence at the Madzikane KaZulu Hospital ARV clinic was 24% amongst HAART non-adhering patients. These patients had the prevalence rate of patient-related factors (12.4%) more than double of the prevalence rates of therapy related factors (5.8%), and facility related factors (5.7%). Topmost amongst the associated factors for not adhering to HAART were: not belonging to a support group, the pills making the patient feel unwell, and the ARV clinic being too far from where the patients live. Efforts should be targeted at enrolling the patients in support groups, encouraging the use of HAART regimens that have good tolerability profiles, and establishing the down referral.