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- Volume 14, Issue 4, 2013
Southern African Journal of HIV Medicine - Volume 14, Issue 4, 2013
Volumes & issues
Volume 14, Issue 4, 2013
Author Francesca ConradieSource: Southern African Journal of HIV Medicine 14 (2013)More Less
I have spoken before about where we are in the HIV epidemic in South Africa (SA) today. The heady days when there were scientific breakthroughs every few months are over. The excitement surrounding increased treatment access, improved antiretroviral therapy (ART) regimens and nurse-initiated management of antiretroviral therapy (NIMART) have settled; HIV no longer makes the news every other day. What we have achieved is truly remarkable: SA has the largest antiretroviral (ARV) programme in the world, with estimates of as many as 2.4 million people receiving ART. HIV healthcare workers can be proud of the contributions they have made - and continue to make - to lessen the burden of this disease.
Source: Southern African Journal of HIV Medicine 14, pp 151 –154 (2013)More Less
Health-facility-based HIV counselling and testing does not capture all children and adolescents who are at risk of HIV infection. Self-testing involves conducting an HIV test at home or in any other convenient space without the involvement of a third party. It is increasingly being argued that it should be incorporated into national HIV-prevention programmes as one of a range of HIV counselling and testing approaches. Although this model of HIV testing is being seen as a new way of reaching under-tested populations, no studies have been conducted on offering it to children. HIV self-tests are now available in South Africa and are sold without the purchaser having to be a certain age. Nevertheless, all HIV testing in children must comply with the norms set out in the Children's Act (2005). Here we explore whether offering self-testing to children would be lawful, by outlining the four legal norms that must be met and applying them to self-HIV testing. We conclude that, although children above the age of 12 years could consent to such a test, there would be two potential obstacles. Firstly, it would have to be shown that using the test is in their best interests. This may be difficult given the potential negative consequences that could flow from testing without support and the availability of other testing services. Secondly, there would need to be a way for children to access pre- and post-test counselling or they would have to be advised that they will have expressly to waive this right. The tests are more likely to be lawful for a small sub-set of older children if: (i) it assists them with HIV-prevention strategies; (ii) they will be able to access treatment, care and support, even though they have tested outside of a health facility; and (iii) psychosocial support services are made available to them via the internet or cell phones.
Source: Southern African Journal of HIV Medicine 14, pp 155 –165 (2013)More Less
High rate of virological re-suppression among patients failing second-line antiretroviral therapy following enhanced adherence support : a model of care in Khayelitsha, South Africa : original articleSource: Southern African Journal of HIV Medicine 14, pp 166 –169 (2013)More Less
Objective. To describe and evaluate the outcomes of a support programme for patients with virological failure while receiving second-line antiretroviral therapy (ART) in South Africa.
Method. We described a comprehensive medical and counselling patient support programme for patients receiving second-line ART and with two consecutive viral loads (VLs) >1 000 copies/ml. Patients with >3 months follow-up and at least one VL measurement after inclusion in the programme were eligible for analysis.
Results. Of 69 patients enrolled in the programme, 40 had at least one follow-up VL and no known drug resistance at enrolment; 27 (68%) of these re-suppressed while remaining on second-line ART following enhanced adherence support. The majority (18/27; 67%) achieved re-suppression within the first 3 months in the programme. Five patients with diagnosed second-line drug resistance achieved viral re-suppression (<400 copies/ml) after being switched to third-line ART. Seven patients (7/40; 18%) did not achieve viral re-suppression after 9 months in the programme: 6 with known adherence problems (4 without drug resistance on genotype) and 1 with a VL <1 000 copies/ml. Overall, 3 patients (4%) died, 3 (4%) were lost to follow-up and 2 (3%) were transferred out.
Conclusion. Our experience from a routine programme demonstrates that with targeted adherence support, the majority of patients who were viraemic while receiving second-line ART returned to an undetectable VL within 3 months. By increasing the time receiving second-line ART and decreasing the need for genotypes and/or third-line ART, this intervention may reduce costs.
Perceived adherence barriers among patients failing second-line antiretroviral therapy in Khayelitsha, South Africa : original articleSource: Southern African Journal of HIV Medicine 14, pp 170 –176 (2013)More Less
Background. The recent scale-up of antiretroviral therapy (ART) coverage in resource-limited settings has greatly improved access to treatment. However, increasing numbers of patients are failing first- and second-line ART.
Objective. To examine factors affecting adherence to second-line ART from the perspective of clinic staff and patients, assessing both individual and structural perceived barriers.
Methods. Research was conducted at a large primary care tuberculosis (TB)/HIV clinic in Khayelitsha, a peri-urban township in Cape Town, South Africa. Participants were drawn from a Médecins Sans Frontières-run programme to support patients failing second-line ART. A qualitative research approach was used, combining multiple methodologies including key informant interviews with staff (n=11), in-depth interviews with patients (n=10) and a Photovoice workshop (n=11). Responses and photographs were coded by content; data were transformed into variables and analysed accordingly.
Results. Staff identified drinking, non-disclosure, not using condoms and pill fatigue as barriers to ART adherence, while patients identified side-effects, not using condoms and a lack of understanding concerning medication timing. With respect to service delivery, staff identified a need for continued counselling and educational support following ART initiation. Patients were concerned about missing medical records and poor staff attitudes in the clinic.
Conclusion. These findings identify discrepancies between provider and patient perceptions of barriers to, and facilitators of adherence, as well as of service delivery solutions. This highlights the need for on-going counselling and education following ART initiation, improved quality of counselling, and improved methods to identify and address specific barriers concerning medication adherence.
Source: Southern African Journal of HIV Medicine 14, pp 176 –178 (2013)More Less
Background. The majority of HIV-positive women in South Africa are of reproductive age, and pregnancies among women using antiretroviral therapy (ART) are common. However, there are mixed data regarding the impact of ART on pregnancy outcomes.
Objective. To examine the impact of ART on pregnancy outcome according to the timing of initiation of treatment.
Methods. A retrospective cohort study was conducted among women delivering at a tertiary hospital from 1 October 2008 to 31 March 2009.
Results. A total of 245 mothers were receiving ART: 76 mothers (31%) started ART pre-conception and 169 mothers (69%) started ART after the first trimester. No significant differences were observed in the rates of preterm delivery and low birth weight (LBW) between the pre- and post-conception groups (21% v. 24% and 21% v. 25%, respectively).
Conclusion. In this cohort of women receiving ART in pregnancy, timing of ART initiation did not have any adverse effect on the measured pregnancy outcomes such as preterm delivery and LBW.
Analysis of queries from nurses to the South African National HIV & TB Health Care Worker Hotline : original articleSource: Southern African Journal of HIV Medicine 14, pp 179 –182 (2013)More Less
Background. Since 2008, the Medicines Information Centre (MIC) has run the South African National HIV & TB Health Care Worker Hotline which provides free information on patient treatment to all healthcare workers in South Africa. With the introduction of nurse-initiated management of antiretroviral therapy (NIMART) in the public sector, the need for easy access to HIV and tuberculosis (TB) information has increased, especially among nurses. The hotline aims to provide this, most importantly to nurses in rural areas, where clinical staff often have little access to peer review.
Objective. To describe the queries received from nurses by the hotline between 1 March and 31 May 2012 and identify problem areas and knowledge gaps where nurses may require further training.
Methods. All queries received from nurses during the study period were analysed. An experienced information pharmacist reviewed all queries to identify knowledge gaps.
Results. During the study period, the hotline received a total of 1 479 HIV- and TB-related queries from healthcare workers. Of these, 386 were received from nurses, of which 254 (66%) were NIMART-trained. The most common query subtopic was initiating antiretroviral therapy (ART) (20%), followed by adverse drug reactions (18%). The most common knowledge gap identified was the ability to interpret laboratory results before initiating ART (10%).
Discussion. We conclude that the hotline is providing clinical help to an increasing number of nurses on the topic of treating HIV and TB throughout South Africa. In addition, queries directed to the hotline may assist in identifying knowledge gaps for the further training of nurses.
Source: Southern African Journal of HIV Medicine 14, pp 183 –188 (2013)More Less
There is growing evidence of a significant burden of human papillomavirus (HPV) infection and associated disease in men. High rates of HPV infection have been observed in men from sub-Saharan Africa where HIV prevalence is high. HIV infection increases HPV prevalence, incidence and persistence and is strongly associated with the development of anogenital warts and anal, penile and head and neck cancers in men. Despite increasing access to antiretroviral therapy, there appears to be little benefit in preventing the development of these cancers in HIV-positive men, making prevention of infection a priority. New prevention options that are being introduced in many African countries include male circumcision and HPV vaccination. However, more data are needed on the burden of HPV disease in men before boys are included in HPV vaccination programmes.