Evaluating neuropsychiatric symptomology in HIV-positive patients on efavirenz in public-sector clinics and psychiatric hospitals
- Authors: Gaida, Razia , Grobler, Christoffel
- Date: 2017
- Subjects: Drugs -- Side effects -- South Africa , HIV (Viruses) -- Enzymes , Antiretroviral agents -- South Africa , Anti-infective agents -- Side effects -- South Africa
- Language: English
- Type: Thesis , Doctoral , DPhil
- Identifier: http://hdl.handle.net/10948/29772 , vital:30776
- Description: Background: South Africa has the highest number of people living with human immunodeficiency virus (HIV) infection in the world. In 2014, an estimated 10.2% of the population was HIV-positive which amounted to 5.51 million people. Efavirenz forms part of the triple therapy backbone used in South Africa and is part of the firstline treatment for HIV. Efavirenz has been strongly associated with causing neuropsychiatric side effects in at least 50.0% of patients to whom it is prescribed. These side effects cause hesitation amongst healthcare professionals to prescribe this agent to patients with active mental illnesses. Aim: The aim of the study was to evaluate the neuropsychiatric side effects of efavirenz in HIV-positive psychiatric and non-psychiatric patients and to determine whether this drug may be recommended for use in an HIV-positive psychiatric patient population. Method: The study was divided into two parts, namely a quantitative portion and a qualitative portion. The quantitative study was a prospective drug utilisation study, while the qualitative portion consisted of semi-structured interviews carried out with healthcare professionals working with people living with HIV/AIDS (PLWHA). The study included five municipal clinics in the Nelson Mandela Metropole as well as two public-sector psychiatric facilities in the Eastern Cape where medical records were reviewed to obtain the information required. Patients were followed in both instances for a period of 24 weeks with follow-up assessments carried out at two, four, 12 and 24 week intervals. In terms of the qualitative study, nurses at the clinics and doctors at the hospitals were contacted and appointments for interviews were made. The interviews were recorded using a voice recorder and were transcribed and analysed using theoretical framework analysis. Results: The review of 126 medical records at the clinics revealed that no patient had suffered from or complained of a neuropsychiatric side effect. This may indicate that patients were not suffering from clinically significant side effects, side effects were not being adequately recorded by healthcare staff, or the healthcare staff were not questioning patients regarding side effects. A total of 26 hospitalised patients were followed for 24 weeks in the psychiatric facilities. Almost half of the patients using efavirenz experienced an improvement in symptoms to the extent that they were iii discharged from the facility. The majority of patients (66.7%) not on an efavirenzcontaining regimen did not improve to the point of discharge. Healthcare staff were vague when providing a definition of neuropsychiatric side effects. There were conflicting ideas on whether or not efavirenz should be used in patients with an active psychiatric illness. Conclusions: Further studies need to be performed in public-sector institutions to obtain a clearer picture of the side effects experienced by patients using efavirenz. Healthcare staff need to be encouraged to keep complete records to allow for meaningful analysis. The further integration of mental health services into existing HIV programmes is essential for holistic treatment. Patients in psychiatric hospitals demonstrated that even patients with psychiatric disorders on efavirenz can experience positive outcomes and stabilisation of psychiatric symptoms, which may indicate that these may not have due to efavirenz use. Further elucidation concerning the use of efavirenz in patients with psychiatric disorders, a description of the neuropsychiatric side effects, as well as management strategies must be provided in subsequent HIV guidelines.
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- Date Issued: 2017
"Soap operas as a platform for disseminating health information regarding ART and the use of 'reel' versus 'real' role models"
- Authors: Deiner, Catherine Anne
- Date: 2015
- Subjects: Isidingo (Television program) , Television soap operas -- South Africa , Health in mass media , Mass media in health education -- South Africa , Antiretroviral agents -- South Africa , Public health -- Moral and ethical aspects , HIV-positive women -- South Africa -- Grahamstown
- Language: English
- Type: Thesis , Masters , MA
- Identifier: vital:3542 , http://hdl.handle.net/10962/d1017783
- Description: The media, through development communication and edutainment, plays a critical role in the transformation of societies. In line with this, this thesis discusses the extent to which commercially driven prosocial soap operas can provide a platform for public health messaging, in the context of the HIV/AIDS epidemic in South Africa, for antiretroviral treatment (ART) and for encouraging ART adherence to foster national development. Furthermore, this thesis examined the potential of celebrities as HIV/AIDS ambassadors and the potential of both fictional characters and ‘real-life’ celebrities to disseminate these health messages. Although the HIV/AIDS epidemic in South Africa is stabilising, this is not the time to relax the communication around the disease, particularly regarding adherence to ARVs, considering that South Africa has the largest ARV rollout in the world. The qualitative methodological approach taken for this thesis is a three-step approach examining the intended message, the text and the appropriated message by viewers. Firstly, a thematic content analysis of an episode of Isidingo, that illustrated Nandipha as HIV-positive and the side-effects that came with her ART adherence, and the 3Talk interview with Lesego Motsepe, where she announced that she was weaning herself off ART, was done in order to understand the intended health messaging in the soap opera and the health message disseminated by an HIV-positive actress with regards to ART. Thereafter interview responses by the production team as well as by HIV-positive viewers, using ARVs, were thematised. In addition media texts which provided commentary on the use of a celebrity as a HIV-positive role model were examined. In doing this, this thesis has offered up the meanings of how HIV-positive women taking ARVs and living in Makana experience and understand the media, particularly health messaging relating to ARVs. The findings of this study suggest that commercial soap operas are the perfect platform to address HIV/AIDS and that prosocial health messaging regarding ARV adherence is still necessary in this country. Soap operas have the potential to have an educational angle. Although, HIV-positive individuals serve as better role models as they are authentic; given human nature, fictional characters, such as Nandipha Matabane in Isidingo, may be more sustainable role models as their message can be scientifically-based and well-researched. Realistic characters serve as role models whose behaviour is to be emulated. Soap operas appeal to a wide audience and so storylines can be tailor-made according to the times and the needs in terms of health issues and messaging. Thus, soap operas are not a single platform but rather one which can be exploited to maximum advantage for public health messaging.
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- Date Issued: 2015
Illustrated medicines information for HIV/AIDS patients: influence on adherence,self-efficacy and health outcomes
- Authors: Barford, Kirsty-Lee
- Date: 2012
- Subjects: AIDS (Disease) -- Treatment -- South Africa , HIV infections -- Treatment -- South Africa , AIDS (Disease) -- Patients -- South Africa , HIV-positive persons -- South Africa , AIDS (Disease) -- Study and teaching -- South Africa , Antiretroviral agents -- South Africa , Communication in medicine -- South Africa , Communication in public health -- South Africa
- Language: English
- Type: Thesis , Masters , MPharm
- Identifier: vital:3863 , http://hdl.handle.net/10962/d1015678
- Description: South Africa has an estimated 920 000 patients on antiretrovirals (ARVs), the largest number of patients in any country. ARV therapy demands adherence levels in excess of 95% to avoid development of drug resistance, but adherence to ARV therapy is estimated to be only between 50% and 70%. Poor medication adherence is acknowledged as a major public health problem, reducing the effectiveness of therapy and promoting resistance to ARVs. More than two thirds of the South African population have marginal reading skills and this significantly influences a patient’s ability to read and understand health-related information. Patient education materials tailored for the South African population could be a useful aid in facilitating communication with patients and perhaps impact positively on their medicine-taking behaviour. This behaviour is influenced by patient knowledge, beliefs, attitudes and expectations and includes self-management, self-efficacy and adherence. Self-efficacy, which refers to patient confidence in the ability to self-manage medicine taking, is a key factor influencing adherence. This study aimed to develop illustrated patient information leaflets (PILs) and medicine labels for all first-line ARV regimens used in the public health sector in South Africa and, using a randomised control study design, to investigate the impact of these illustrated information materials on knowledge, medication-taking behaviours and health outcomes in HIV/AIDS patients taking ARVs. To achieve this aim, the objectives were to assess HIV/AIDS and ARV-related knowledge, as well as self-efficacy and adherence to ARV therapy; to assess the influence of demographic variables on knowledge, adherence and self-efficacy; to assess the influence of the information materials on knowledge, self-efficacy and adherence and to assess the association of knowledge with health outcomes. Medicine labels and PILs, both English and isiXhosa, were developed for ARV regimens 1a, 1b, 1c and 1d. The 8-item Morisky Medication Adherence Scale (MMAS-8) and HIV Treatment Adherence Self Efficacy Scale (HIV-ASES) instruments for measuring respectively adherence and self-efficacy, were modified to optimize clarity, simplicity and cultural acceptability and were translated into isiXhosa using a multi-stage translation-back translation. The questions and the rating scales, for both the MMAS and HIV-ASES, underwent preliminary qualitative evaluation in focus group discussions. Patients were recruited from local Grahamstown clinics. A pilot study to evaluate applicability of the instruments was conducted in 16 isiXhosa AIDS patients on ARVs and the results from this study informed further modifications to the instruments. One hundred and seventeen patients were recruited for the randomised control trial and were randomly allocated to either control group (who received standard care) or experimental group (who received standard care as well as pictogram medicine labels and the illustrated PIL). Interviews were conducted at baseline and at one, three and six months. Data were analysed statistically using the t-test, chi-squared test and ANOVA (Analysis of Variance) at a 5% level of significance. Correlations were determined using Pearson and Spearman rho correlations. Approval was obtained from Rhodes University Ethical Standards Committee, Settlers Hospital Ethics Committee and the Eastern Cape Department of Health. The results of this research showed that illustrated PILs and medicine labels enhanced understanding of HIV/AIDS and ARV information, resulting in a mean overall knowledge score in the experimental group of 96%, which was significantly higher than the 75% measured in the control group. Variable knowledge scores were measured in three areas: baseline knowledge of general HIV/AIDS-related information was good at 87%, whereas knowledge scores relating to ARV-related information (60%) and side-effects (52%) were lower. These scores improved significantly in the experimental group over the 4 interviews during the 6 month trial duration, whereas in the control group, they fluctuated only slightly around the original baseline score. There was no significant influence of gender on knowledge score, whereas health literacy, education level and age tested (at one and three months) had a significant influence on knowledge. Self-efficacy and adherence results were high, indicating that the patients have confidence in their ability to adhere to the ARV therapy and to practice optimal self-care. Age, gender and education, in most cases, significantly influenced self-efficacy, but were found to have no effect on adherence. The CD4 count improved over the trial duration which may have been influenced by a number of factors, including better knowledge of ARVs and improved adherence. No significant parametric correlation was found between knowledge score and change in CD4 count, however, Spearman's rho showed significance (rs=0.498; p=0.022). Both patients and healthcare providers were highly enthusiastic about the illustrated labels and PILs, and indicated their desire for such materials to be routinely available to public sector HIV/AIDS patients. The isiXhosa version of the PIL was preferred by all the patients. These simple, easy-to-read leaflets and illustrated medication labels were shown to increase understanding and knowledge of ARVs and HIV/AIDS in low-literate patients, and their availability in the first-language of the patients was central to making them a highly useful information source.
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- Date Issued: 2012
Response and adherence of HIV positive women to cervical cancer treatment
- Authors: Ngugi, Pearl
- Date: 2011
- Subjects: HIV infections -- Chemotherapy -- South Africa , Patient compliance -- South Africa , Cervix uteri -- Cancer -- Treatment , HIV-positive women -- South Africa , Antiretroviral agents -- South Africa
- Language: English
- Type: Thesis , Masters , MPharm
- Identifier: vital:10162 , http://hdl.handle.net/10948/d1014129
- Description: It is estimated that 6742 South African women are diagnosed with cervical cancer and 3681 women die from the disease every year. In 1993, The Centers for Disease Control declared cervical cancer an Acquired Immunodeficiency Syndrome defining illness. Apart from persistent human papillomavirus infection, HIV infection is the most common co-factor contributing to cervical cancer in South Africa. Studies have noted that in HIV positive women, there has been an occurrence of faster progression to more advanced stages of cervical cancer with high cases of treatment failure and recurrence. There is limited literature available regarding the prognosis of HIV positive women who suffer from cervical cancer. Women who are HIV positive and have cervical cancer have not been evaluated in detail regarding their response and adherence to cervical cancer treatment. Standard treatment protocols for this set of patients have not been defined. The aim of this study was to assess how HIV positive women who have been diagnosed with cervical cancer responded and adhered to cervical cancer therapy which includes: curative radiotherapy; curative chemotherapy; concurrent chemoradiation or palliative radiotherapy. The study also evaluated the effects of the concurrent use of antiretrovirals and cervical cancer treatment. This was done to determine whether invasive cervical cancer in women who were HIV positive could be managed using the same treatment protocols as patients who were HIV negative. A historical cohort design was employed for the study. The study was conducted at the Oncology Department of a tertiary level hospital located in the Eastern Cape Province, South Africa. The total sample consisted of 196 medical records of women diagnosed with cervical cancer between 2005 and 2008. One hundred women were HIV negative, 83 were HIV positive and the HIV status of 13 women could not be determined. The records were audited over a period of two years from the date of diagnosis. The term „complete response‟ referred to patients who had no recurrence of cervical cancer and no evidence of metastases after undergoing treatment. At one month following treatment there was a significant difference in the incidence of complete response between the HIV positive patients and the HIV negative patients (Chi2 = 16.4, d.f. = 1, p = 0.00005, Cramer‟s V = 0.31). The significant difference in response to treatment between the HIV positive patients and the HIV negative patients was maintained at six months after treatment (Chi2 = 15, d.f. = 1, p = 0.00011, Cramer‟s V = 0.34), 12 months after treatment (Chi2 = 20.5, d.f. = 1, p = 0.00001, Cramer‟s V = 0.37), 18 months after treatment (Chi2 = 9.8, d.f. = 1, p = 0.00173, Cramer‟s V = 0.28) and 24 months after treatment (Chi2 = 5.0, d.f. = 1, p = 0.02571, Cramer‟s V = 0.26). At each of these intervals, cases of treatment failure and metastases were significantly higher in the HIV positive women than in the HIV negative women. Although there was no significant difference in the incidence of adherence between the HIV negative women, the HIV positive women who were on HAART and the HIV positive women who were not on HAART, there was a significant difference in the incidence of the various reasons for non adherence between the various groups. These reasons included: missed scheduled appointments (Chi2 = 2.9, d.f. = 2, p = 0.02385, Cramer‟s V = 0.31); low blood count (Chi2 = 4.0, d.f. = 2, p = 0.01327, Cramer‟s V = 0.15); radiotherapy induced skin breakdown (Chi2 = 0.6, d.f. = 2, p = 0.04581, Cramer‟s V = 0.16) and radiotherapy induced diarrhoea (Chi2 = 6.9, d.f. = 2, p = 0.03118, Cramer‟s V = 0.19). According to the 2004 National Antiretroviral Treatment Guidelines, cervical cancer patients would fall into the WHO stage IV category of HIV disease thus all patients with confirmed diagnosis of invasive cervical cancer should be commenced on antiretrovirals as soon as the cancer diagnosis is made regardless of their CD4 count. However, in the current study, 13 percent (n= 83) of the HIV positive women were not on antiretrovirals. The study concluded that HIV positive women had a higher incidence of both treatment failure and metastases to cervical cancer treatment. Standard radiotherapy and concurrent chemoradiation cervical cancer treatment protocols should be still be used in both HIV negative patients and HIV positive patients so as not to compromise tumour control. Furthermore, in accordance with the antiretroviral treatment guidelines, all HIV positive patients with cervical cancer should receive antiretrovirals irrespective of their CD4 count.
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- Date Issued: 2011
Disclosure of HIV status and adherence to antiretroviral therapy
- Authors: Kubashe, Nomachina Theopatra
- Date: 2009
- Subjects: HIV-positive persons -- South Africa , Self-disclosure -- South Africa , Antiretroviral agents -- South Africa
- Language: English
- Type: Thesis , Masters , MPharm
- Identifier: vital:10142 , http://hdl.handle.net/10948/1174 , HIV-positive persons -- South Africa , Self-disclosure -- South Africa , Antiretroviral agents -- South Africa
- Description: The Human Immunodeficiency Virus (HIV)/Acquired Immune Deficiency Syndrome (AIDS) is one of the leading chronic diseases affecting people in South Africa and throughout the world. This study aimed to investigate the effect disclosure of HIV status had on antiretroviral therapy (ART) adherence. A convenience sample of 65 HIV positive adult patients currently taking ART at a public Primary Health Care (PHC) clinic in the Nelson Mandela Metropole was selected. Participation was voluntary and confidentiality was maintained at all times. Data was collected using three tools/techniques: (1) a Patient Questionnaire (PQ) to extract information on patient's demographics, HIV disclosure status, regimen the patient was on and self-reported adherence to ART; (2) an audit of a Patient Medical Record (PMR) for information on the regimen the patient was on, the period during which the patient had been on ART medication, the adherence to ART care and the level of the patient‟s biological markers; and (3) Pill Counts (PC) performed on the patient's medical supply to validate the self-reported adherence to ART. There was no significant relationship between the disclosure of HIV status and adherence to ART (p= 0.59; Chi²). However, the relationship between the adherence to ART and increase in the CD4 count levels of patients on ART in this population was significant (p=0.03; Chi²). It can be concluded that no direct relationship was found between the disclosure of HIV status and adherence to ART in this population. However, several factors affected the reasons and decisions of individuals to disclose their HIV status and this influenced their daily taking of medication.
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- Date Issued: 2009
The experiences of people living with HIV-AIDS with regard to the comprehensive antiretroviral therapy management received from registered nurses at selected public primary heathcare clinics in Nelson Mandela Bay
- Authors: Jackson, Dawne Shirley
- Date: 2009
- Subjects: Antiretroviral agents -- South Africa , Stigma (Social psychology) , Nurses -- South Africa -- Attitudes , HIV-positive persons -- Counseling of -- South Africa , AIDS (Disease) -- Treatment -- South Africa , HIV infections -- Treatment -- South Africa
- Language: English
- Type: Thesis , Masters , MCur
- Identifier: vital:10032 , http://hdl.handle.net/10948/1253 , Antiretroviral agents -- South Africa , Stigma (Social psychology) , Nurses -- South Africa -- Attitudes , HIV-positive persons -- Counseling of -- South Africa , AIDS (Disease) -- Treatment -- South Africa , HIV infections -- Treatment -- South Africa
- Description: Currently South Africa has the highest number of persons living with HIV-AIDS (PLWAs) in the world. Focus-group discussions conducted by Moon (2005:3) in the Eastern Cape indicated that people may not want to get tested for HIV or to access antiretroviral therapy (ART) for fear of disclosure of their HIV-positive status and of stigmatization. These findings prompted the researcher to conduct a study in this field. The objectives of this study are to explore and describe the experiences of PLWAs with regard to the comprehensive ART management received from registered nurses at selected public primary healthcare clinics in Nelson Mandela Bay; and to develop guidelines for registered nurses that could facilitate them in rendering appropriate comprehensive ART management. The research study is based on a qualitative, explorative, descriptive, phenomenological and contextual research design. The research population comprised of HIV-positive patients who received treatment at the selected public primary healthcare clinics. Criterion-based, purposive sampling was used to select participants for the interviews. Ten in-depth unstructured interviews were conducted. Data was then transcribed and coded. One central theme identified the fact that PLWAs experienced both positive and negative experiences at the clinics. The main findings of this research included evidence of various forms of stigma experienced by the PLWAs; distrust of the lay health counselors; but also that PLWAs were generally well-treated and satisfied with the service they had received. Broad guidelines for registered nurses was formulated that could facilitate them in rendering appropriate comprehensive ART management. The study concludes with recommendations made with regards to the areas of nursing practice, education and research. Throughout the study the researcher abided by the ethical considerations. The aspects of trustworthiness implemented in this study, included dependability, credibility, transferability and confirmability (Holloway & Wheeler, 2002:354).
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- Date Issued: 2009
Effect of a South African medicinal plant on antiretroviral drug induced abnormalities in rats
- Authors: Van Gend, Tania Anli
- Date: 2008
- Subjects: Medicinal plants -- South Africa , Antiretroviral agents -- South Africa , Materia medica, Vegetable -- South Africa , HIV infections -- Alternative treatment -- South Africa , Rats as laboratory animals , Rats -- Metabolism
- Language: English
- Type: Thesis , Masters , MTech
- Identifier: vital:10121 , http://hdl.handle.net/10948/1080 , Medicinal plants -- South Africa , Antiretroviral agents -- South Africa , Materia medica, Vegetable -- South Africa , HIV infections -- Alternative treatment -- South Africa , Rats as laboratory animals , Rats -- Metabolism
- Description: The worldwide AIDS epidemic is known to have had a profoundly negative social, economic and personal impact and has taken a heavy toll on existing health care systems, particularly in developing countries. South Africa is experiencing an HIV epidemic with enormous social and economic consequences. Lopinavir/ritonavir antiretroviral treatment has been accredited with having a significantly positive effect and is a key advance in controlling HIV morbidity and mortality. An indigenous South African medicinal plant, Sutherlandia frutescens, known for its anti-diabetic properties and immune-boosting effects, is used for treating HIV positive patients suffering from opportunistic infections. Despite the use of the medicinal plant extract as homeotherapeutic medication, there is little evidence of toxicity testing that identifies its potential for interaction with antiretroviral drugs. However, scientific data relating to the mechanism through which Sutherlandia frutescens acts on the immune system has not been comprehensively documented. The aim of this study was to investigate lopinavir/ritonavir induced metabolic abnormalities in rats and whether the introduction of a plant extract of Sutherlandia frutescens would counteract the side effects of ARV medication. The results indicated that the rodents did not become insulin resistant, however, biochemical analysis indicated that extended ARV drug treatment would have caused insulin resistance. Significant morphological changes were found in the livers, kidneys and pancreases of rats exposed to the lopinavir/ritonavir. Rats exposed to the Sutherlandia frutescens plant extract showed improved histopathology with minimal abnormalities.
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- Date Issued: 2008
Development of an antiretroviral solid dosage form using multivariate analysis
- Authors: Nqabeni, Luxolo
- Date: 2007
- Subjects: Analysis of variance , Experimental design , Multivariate analysis , Antiretroviral agents -- South Africa
- Language: English
- Type: Thesis , Masters , MSc
- Identifier: vital:10145 , http://hdl.handle.net/10948/705 , Analysis of variance , Experimental design , Multivariate analysis , Antiretroviral agents -- South Africa
- Description: The aim of pharmaceutical development is to design a quality product and the manufacturing process to deliver the product in a reproducible manner. The development of a new and generic formulation is based on a large number of experiments. Statistics provides many tools for studying the conditions of formulations and processes and enables us to optimize the same while being able to minimize our experimentation. The purpose of this study was to apply experimental design methodology (DOE) and multivariate analysis to the development and optimization of tablet formulations containing 150 mg lamivudine manufactured by direct compression.
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- Date Issued: 2007