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- Southern African Journal of HIV Medicine
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- Volume 14, Issue 2, 2013
Southern African Journal of HIV Medicine - Volume 14, Issue 2, 2013
Volumes & issues
Volume 14, Issue 2, 2013
Author Landon MyerSource: Southern African Journal of HIV Medicine 14 (2013)More Less
This June edition of SAJHIVMED is being released to coincide with the 6th South African AIDS Conference, held in Durban. The conference programme is filled with renowned speakers from a range of backgrounds, and the focus of the meeting - integration of policies and systems in response to HIV - is particularly critical at this stage of our response to the epidemic.
Author Francesca ConradieSource: Southern African Journal of HIV Medicine 14 (2013)More Less
Mid-year and the cold is settling in. The hype about the introduction of fixed-dose combinations (FDCs) has passed. We have started giving these combinations to the first priority group; so newly diagnosed HIV-infected patients and pregnant women are starting on one tablet once a day. While this is very exciting and without a doubt the way forward, there are still reports of stock-outs of other medications.
ART adherence clubs : a long-term retention strategy for clinically stable patients receiving antiretroviral therapy : forumAuthor L.S. WilkinsonSource: Southern African Journal of HIV Medicine 14, pp 48 –50 (2013)More Less
The ART-adherence club model described here provides patient-friendly access to antiretroviral therapy (ART) for clinically stable patients. It reduces the burden that stable patients place on healthcare facilities, increasing clinical human resources for new patients, and those clinically unstable and at risk of failing treatment. In the model, 30 patients are allocated to an ART club. The group meets either at a facility or community venue for less than an hour every 2 months. Group meetings are facilitated by a lay club facilitator who provides a quick clinical assessment, referral where necessary, and dispenses pre-packed ART. From January 2011 to December 2012, after adoption for phased roll-out by the Western Cape Government, more than 600 ART clubs were established in Cape Town, providing ART care to over 16 000 patients. This extensive, rapid roll-out demonstrates active buy-in from patients and facility staff. South Africa should consider a similar model for national roll-out.
Source: Southern African Journal of HIV Medicine 14, pp 52 –57 (2013)More Less
Health programming for men who have sex with men (MSM) in South Africa has been ignored or absent until fairly recently, despite this population being at high risk for HIV acquisition and transmission. Anova Health Institute, with support from the US President's Emergency Plan for AIDS Relief (PEPFAR)/United States Agency for International Development (USAID) and in collaboration with the South African National Department of Health, launched the first state sector MSM-targeted sexual health clinic in 2010. The clinic has been successful in attracting and retaining MSM in care, and lessons learned are described in this article. Components contributing to the creation of MSM-appropriate healthcare services are discussed.
A suicide risk screening scale for HIV-infected persons in the immediate post-diagnosis period : original articleSource: Southern African Journal of HIV Medicine 14, pp 58 –63 (2013)More Less
Background. The risk of suicidal tendencies in HIV-infected persons appears high and may parallel the increasing prevalence of suicidal behaviour in South Africa.
Objective. To construct a brief suicide risk screening scale (SRSS) as a self-administered instrument to screen for suicidal ideation in recently diagnosed HIV-infected persons.
Methods. An SRSS was developed, drawing 14 items from two established screening tests, and assessed using a sample of 150 HIV-infected consenting adults identified at a voluntary counselling and testing (VCT) clinic at an academic district level hospital in Durban, South Africa. Participants returned three weeks after their initial assessment for a re-assessment.
Results. The internal consistency of the SRSS was good (Cronbach's alpha, 0.87), and its sensitivity (81%) was higher than its specificity (47%). The findings suggest that, despite certain limitations, the SRSS may be a valuable screening tool for suicidal ideation at VCT clinics.
Conclusion. Screening for suicide risk and possible suicidal behaviour in HIV-positive persons may form a routine aspect of comprehensive patient care at VCT clinics to assist with effective prevention and treatment.
Challenges to delivering quality care in a prevention of mother-to-child transmission of HIV programme in Soweto : original articleSource: Southern African Journal of HIV Medicine 14, pp 64 –69 (2013)More Less
Background. There has been little focus on the quality of care provided in the prevention of mother-to-child transmission (PMTCT) of HIV services in South Africa (SA).
Objective. To assess the quality of care in PMTCT services in Soweto, SA, focusing on the knowledge and experiences of healthcare workers and HIV-infected pregnant women accessing the services.
Methods. A cross-sectional survey was conducted in November - December 2009. A total of 201 HIV-infected pregnant women and 80 healthcare workers from 10 antenatal clinics were interviewed using standardised questionnaires.
Results. Among the HIV-infected pregnant women, the median gestational age was 20 weeks at the first antenatal visit and 32 weeks at the time of the interview. The majority of the women interviewed (71.5%) discovered that they were HIV-infected in the index pregnancy, and 87.9% disclosed their HIV status. Overall, 97.5% received counselling and 33.5% were members of a support group. Knowledge of antenatal and intra-partum PMTCT interventions was accurate in 62.7% and 43.3% of the women, respectively. Support group membership and current use of antiretroviral prophylaxis did not impact on the quality of knowledge. Of the healthcare workers, 43.8% were professional nurses and 37.5% were lay counsellors. The majority (80.0%) felt satisfied with their knowledge of the PMTCT guidelines and 96.3% felt competent in managing HIV-infected pregnant women. Yet, there were important deficiencies in the knowledge of the guidelines.
Conclusion. In our study, the knowledge of PMTCT interventions was low in both clients and healthcare workers. This points to the need to improve quality of care in PMTCT services, especially with increasingly complex PMTCT interventions recommended by international policies.
Parental presence within households and the impact of antiretroviral therapy in Khayelitsha, Cape Town : original articleSource: Southern African Journal of HIV Medicine 14, pp 70 –74 (2013)More Less
Background. While household support is an important component of effective care and treatment in HIV/AIDS, there are few insights from Southern Africa into how household support arrangements change over time for patients starting antiretroviral therapy (ART).
Objective. We hypothesised that patients initiating ART are more likely to be living with family, especially their mothers, compared with the general population, but that over time these differences disappear.
Methods. A panel survey of ART patients was matched by age, gender and education to a comparison sample drawn from adults in Khayelitsha, Cape Town.
Results. The results show that there is a substantial potential burden of care on the families of patients starting ART, particularly mothers, and that the use of ART appears to reduce this burden over time. But, even after their health is restored, ART patients are significantly less likely to have a resident sexual partner and more likely to be living in single-person households than their counterparts in the general population.
Guideline for the prevention, diagnosis and management of cryptococcal meningitis among HIV-infected persons : 2013 update : guidelineSource: Southern African Journal of HIV Medicine 14, pp 76 –86 (2013)More Less
Six years after the first Society guidelines were published, cryptococcal meningitis (CM) remains an important cause of morbidity and mortality among HIV-infected adults in South Africa. Several important developments have spurred the publication of updated guidelines to manage this common fungal opportunistic infection. Recommendations described here include: (1) screening and pre-emptive treatment; (2) laboratory diagnosis and monitoring; (3) management of a first episode of CM; (4) amphotericin B deoxycholate toxicity prevention, monitoring and management; (5) timing of antiretroviral therapy among patients with CM; (6) management of raised intracranial pressure; (7) management of relapse episodes of CM.
Author P. BarnardtSource: Southern African Journal of HIV Medicine 14, pp 87 –88 (2013)More Less
An estimated 30 - 40% of HIV-infected patients are likely to develop cancer during the progression of their disease. The occurrence of malignancy among these patients represents a difficult challenge in their care. Kaposi's sarcoma (KS) - currently the most common tumour observed with an estimated incidence of 15 - 20% - represents the first manifestation of AIDS in 30 - 40% of patients. Any organ may be involved, but the gastrointestinal tract and lung remain the most frequently involved locations. The case described here presented a clinical and ethical dilemma where visceral KS, pregnancy and medical complications required multi-disciplinary management.
Source: Southern African Journal of HIV Medicine 14, pp 90 –92 (2013)More Less
The South African National Prevention of Mother-to-Child Transmission of HIV programme has resulted in significant reductions in vertical transmission, but new infant HIV infections continue to occur. We present two cases of HIV sero-conversion during late pregnancy, demonstrating the limitations of the current programme. These could be mitigated by expanding the programme to include maternal testing at delivery and at immunisation clinic visits as we pursue the elimination of mother-to-child transmission.
Progressive HIV infection in the presence of a raised CD4+ count : HIV/HTLV-1 co-infection : case reportSource: Southern African Journal of HIV Medicine 14, pp 92 –94 (2013)More Less
There are a number of pathophysiological causes for a normal or raised CD4 count in the context of progressive HIV infection. These include various co-infections, previous splenectomy, and lymphoproliferative disorders. Such circumstances can both confound HIV diagnosis and delay initiation of chemoprophylaxis and highly active antiretroviral therapy (HAART). We describe the case of a patient co-infected with HIV and human T-cell lymphotropic virus type 1 (HTLV-1) who, prior to HAART initiation, was found to have progressive immune deficiency associated with a raised CD4 count.
Source: Southern African Journal of HIV Medicine 14, pp 95 –97 (2013)More Less
Editor's note : In this section of the Journal, we present complex, real-world HIV medicine cases to two experienced clinicians working in very different environments, and ask them to describe the approach that they would take if they saw the case in their local hospital setting. In our first edition, a patient with deteriorating liver function is presented by Prof. Francois Venter and Dr Ntsakisi Masingi, and then discussed by Dr Sarah Stacey in Johannesburg and Dr Sarah Fidler in London.
HIV & TB Drug Resistance & Clinical Management Case Book, T. Rossouw, R.J. Lessells, T. de Oliveira : book reviewSource: Southern African Journal of HIV Medicine 14 (2013)More Less
South Africa (SA) is home to the highest number of HIV-infected people in any country, and has the largest HIV treatment program worldwide, with 2 million patients currently receiving combination antiretroviral therapy (ART). The country also has a massive tuberculosis (TB) epidemic, and TB/HIV co-infection is a common challenge for clinicians. The increasing number of patients who are infected with drug-resistant strains of TB and/or HIV in Southern Africa poses a mounting threat to successful treatment. Drug-resistance testing for patients failing therapy is available at reference laboratories, which contrasts the situation in many countries in sub-Saharan Africa. This provides an important tool to protect the sustained effectiveness of available TB and HIV therapies; however, interpretation of drug resistance reports is complex and expert guidance to clinicians may be required for optimal clinical management.