Browsing by Subject "HIV"
Now showing items 1-8 of 8
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Scott, Vera; Zweigenthal, Virginia; Jennings, Karen (Wiley-Blackwell, 2011)[more][less]
Abstract: BACKGROUND: While much is written about the scale up of HIV counselling and testing (HCT) and antiretroviral therapy (ART), little research has been done on the expansion of routine preART HIV care. OBJECTIVE: To assess the quality of preART care in Cape Town and its continuity with HCT and ART. METHODS: The scale up of the HCT, preART and ART service platform and programmatic support in Cape Town is described. Data from the August 2010 routine annual HIV/TB/STI evaluation, from interviews with 133 facility managers and a folder review of 634 HCT s who tested positive and 1115 clients receiving preART HIV care are analysed. RESULTS: Historically the implementation and management of preART care has been relatively neglected compared with the scale-up of HCT and ART. The CD4 count was done on 77.5% positive HCT clients and 46.6% were clinically staged - crucial steps that determine the care path. There were: gaps in quality of care - 32.2% of women had a PAP smear; missed opportunities for integrated care - 67% were symptomatically screened for tuberculosis; and positive prevention - 48.3% had contraceptive needs assessed. Breaks in the continuity of care of preART clients occurred with only 47.2% of eligible clients referred appropriately to the ARV service. CONCLUSION: While a package of preART care has been clearly defined in Cape Town, it has not been fully implemented. There are weaknesses in the continuity and quality service delivered that undermine the programme objectives of provision of positive prevention and timeous access to ART. URI: http://hdl.handle.net/10566/261 Files in this item: 2
Scott_2011_HIV and VCT.pdf (156.2Kb)ScottPreART2011.pdf (5.794Mb) -
Uwimana, Jeannine; Jackson, Debra; Hausler, Harry; Zarowsky, Christina (Wiley-Blackwell, 2012)[more][less]
Abstract: In South Africa, the control of TB and HIV co-infection remains a major challenge despite the availability of international and national guidelines for integration of TB and HIV services. This study was undertaken in KwaZulu-Natal, one of the provinces most affected by both TB and HIV, to identify and understand managers’ and community care workers’ (CCWs) perceptions of health systems barriers related to the implementation of collaborative TB⁄ HIV activities, including prevention of mother to child transmission of HIV (PMTCT). We conducted 29 in-depth interviews with health managers at provincial, district and facility level and with managers of NGOs involved in TB and HIV care, as well as six focus group discussions with CCWs. Thematic analysis of transcripts revealed a convergence of perspectives on the process and the level of the implementation of policy directives on collaborative TB and HIV activities across all categories of respondents (i.e. province-, district-, facility- and communitybased organizations). The majority of participants felt that the implementation of the policy was insufficiently consultative and that leadership and political will were lacking. The predominant themes related to health systems barriers include challenges related to structure and organisational culture; management, planning and power issues; unequal financing; and human resource capacity and regulatory problems notably relating to scope of practice of nurses and CCWs. Accelerated implementation of collaborative TB⁄ HIV activities including PMTCT will require political will and leadership to address these health systems barriers. URI: http://hdl.handle.net/10566/457 Files in this item: 1
UwimanaHealthSystemBarriers2012.pdf (205.7Kb) -
Schneider, Helen; Lehmann, Uta (Routledge, 2010)[more][less]
Abstract: One of the consequences of massive investment in antiretroviral access and other AIDS programmes has been the rapid emergence of large numbers of lay workers in the health systems of developing countries. In South Africa, government estimates are 65,000, mostly HIV/TB care-related lay workers contribute their labour in the public health sector, outnumbering the main front-line primary health care providers and professional nurses. The phenomenon has grown organically and incrementally, playing a wide variety of care-giving, support and advocacy roles. Using South Africa as a case, this paper discusses the different forms, traditions and contradictory orientations taken by lay health work and the system-wide effects of a large lay worker presence. As pressures to regularise and formalise the status of lay health workers grow, important questions are raised as to their place in health systems, and more broadly what they represent as a new intermediary layer between state and citizen. It argues for a research agenda that seeks to better characterise types of lay involvement in the health system, particularly in an era of antiretroviral therapy, and which takes a wider perspective on the meanings of this recent re-emergence of an old concept in health systems heavily affected by HIV/AIDS. URI: http://hdl.handle.net/10566/458 Files in this item: 1
SchneiderHealthSystems2010.pdf (278.2Kb) -
Nkonki, Lungiswa L.; Doherty, Tanya M.; Hill, Zelee; Chopra, Mickey; Schaay, Nikki; Kendall, Carl (BioMed Central, 2007)[more][less]
Abstract: Background: The objective of this study was to examine missed opportunities for participation in a prevention of mother-to-child transmission (PMTCT) programme in three sites in South Africa. A rapid anthropological assessment was used to collect in-depth data from 58 HIV-positive women who were enrolled in a larger cohort study to assess mother-to-child HIV transmission. Semistructured interviews were conducted with the women in order to gain an understanding of their experiences of antenatal care and to identify missed opportunities for participation in PMTCT. Results: 15 women actually missed their nevirapine not because of stigma and ignorance but because of health systems failures. Six were not tested for HIV during antenatal care. Two were tested but did not receive their results. Seven were tested and received their results, but did not receive nevirapine. Health Systems failure for these programme leakages ranged from nonavailability of counselors, supplies such as HIV test kits, consent forms, health staff giving the women incorrect instructions about when to take the tablet and health staff not supplying the women with the tablet to take. Conclusion: HIV testing enables access to PMTCT interventions and should therefore be strengthened. The single dose nevirapine regimen is simple to implement but the all or nothing nature of the regimen may result in many missed opportunities. A short course dual or triple drug regimen could increase the effectiveness of PMTCT programmes. URI: http://hdl.handle.net/10566/429 Files in this item: 1
NkonkiNevirapineStudy2007.pdf (184.6Kb) -
Mugabo, Pierre; Els, Ilse; Smith, Johan; Rabie, Helena; Smith, Peter; Mirochnick, Mark; Steyn, Wilhelm; Hall, David; Madsen, Richard; Cotton, Mark F (Health & Medical Publishing Group, 2011)[more][less]
Abstract: Background. No pharmacokinetic data exist for premature infants receiving single-dose nevirapine (sd NVP) for prevention of mother-to-child transmission (MTCT) of HIV. Aim. To describe NVP decay pharmacokinetics in two groups of premature infants - those whose mothers either received or did not receive NVP during labour. Methods. Infants less than 37 weeks' gestation were prospectively enrolled. Mothers received sd NVP during labour if time allowed. Infants received sd NVP and zidovudine. Blood was collected on specified days after birth and NVP concentrations were determined by liquid chromatography-mass spectrometry. Results. Data were obtained from 81 infants, 58 born to mothers who received sd NVP during labour (group I) and 23 to mothers who did not receive NVP (group II). Of the infants 29.6% were small for gestational age (SGA). Median (range) maximum concentration (Cmax), time to reach maximum concentration (Tmax), area under the plasma concentration-time curve (AUC) and halflife (T) were 1 438 (350-3 832) ng/ml, 25h50 (9h40-83h45), 174 134 (22 308-546 408) ng×h/ml and 59.0 (15.4-532.6) hours for group I and 1 535 (635-4 218) ng/ml, 17h35 (7h40-29h), 168 576 (20 268-476 712) ng×h/ml and 69.0 (22.12-172.3) hours for group II. For group II, the median (range) volume of distribution (Vd) and body clearance (Cl) were 1 702.6 (623.7-6 189.8) ml and 34.9 (6.2-163.8) ml/h. The AUC was higher (p=0.006) and Cl lower (p<0.0001) in SGA infants. Plasma concentrations exceeding 100 ng/ml were achieved over 8 days in 78% infants in group I and 70.0% in group II. The MTCT rate was 4.8%. Conclusion. Women in preterm labour often deliver with little advance warning. Our study suggests that NVP dosing of preterm infants as soon as possible after birth without maternal intrapartum dosing may be as effective as combined maternal and infant dosing. URI: http://hdl.handle.net/10566/405 Files in this item: 1
MugaboPrematureMTCT.pdf (503.0Kb) -
Chopra, Mickey; Kendall, Carl; Hill, Zelee; Schaay, Nikki; Nkonki, Lungiswa L.; Doherty, Tanya M. (Lippincott Williams & Wilkins, 2006)[more][less]
Abstract: Interviews conducted in South Africa found that awareness of antiretroviral therapy was generally poor. Antiretroviral drugs were not perceived as new, but one of many alternative therapies for HIV/AIDS. Respondents had more detailed knowledge of indications, effects and how to access alternative treatments, which is bolstered by the active promotion and legitimization of alternative treatments. Many expressed a lack of excitement about the introduction of antiretroviral therapy, and little change in their attitudes concerning the epidemic. URI: http://hdl.handle.net/10566/478 Files in this item: 1
ChopraARV2006.pdf (1.056Mb) -
Matoti-Mvalo, Tandi; Puoane, Thandi (MedPharm Publications, 2011)[more][less]
Abstract: OBJECTIVE: To explore the perception among black South African women that people who are thin are infected with HIV or have AIDS. SETTING: Khayelitsha, an urban township in Cape Town. SUBJECTS: 513 women aged 18-65 years. METHODS: This was an exploratory study employing both quantitative and qualitative research methodology. Data were collected in two phases. The first phase involved collecting quantitative data among 513 participants. During the second phase, qualitative data were collected in a purposely selected sub-sample of 20 women. For the qualitative data collection, participants were shown eight body figures, ranging from thin to obese, and asked to choose a figure representing the ideal figure, a preferred figure and a figure thought to symbolise health. They were also invited to choose a figure that they thought represented a person infected with HIV or who had AIDS. They had the option of saying that they did not associate any of the figures with people infected with HIV or who had AIDS. Weight and height measurements were also taken. After the quantitative analysis was completed, focus group discussions explored perceptions about body image and the relation to HIV among purposely selected participants. Data were summarised by content based on questions discussed. RESULTS: Sixty-nine per cent of the participants associated a thin figure with a person infected with HIV, or who had AIDS. Only 10.2% thought the thin figure symbolised health. Fifty per cent preferred a normal-weight figure, while 34.2% thought that normal weight symbolised health. Only 2% thought that people in the normal-weight category were infected with HIV or had AIDS.Thirty-four per cent preferred to be overweight and 31% thought that being overweight symbolised health. None of the participants thought the overweight figure represented people infected with HIV or who had AIDS. Only 8% preferred the obese figure. The results of the qualitative data analysis suggested that participants preferred to be overweight and at risk of acquiring cardiovascular diseases, rather than being thin and stigmatised as a person infected with HIV or who had AIDS. CONCLUSION: This study revealed that the stigma associated with HIV and AIDS may undermine strategies for prevention of chronic noncommunicable diseases among urban black South African women. URI: http://hdl.handle.net/10566/271 Files in this item: 1
PuoanePerceptions2011.pdf (304.5Kb) -
Shamu, Simukai; Abrahams, Naeemah; Temmerman, Marleen; Musekiwa, Alfred; Zarowsky, Christina (Public Library of Science, 2011)[more][less]
Abstract: Background: Intimate partner violence (IPV) is very high in Africa. However, information obtained from the increasing number of African studies on IPV among pregnant women has not been scientifically analyzed. This paper presents a systematic review summing up the evidence from African studies on IPV prevalence and risk factors among pregnant women. Methods: A key-word defined search of various electronic databases, specific journals and reference lists on IPV prevalence and risk factors during pregnancy resulted in 19 peer-reviewed journal articles which matched our inclusion criteria. Quantitative articles about pregnant women from Africa published in English between 2000 and 2010 were reviewed. At least two reviewers assessed each paper for quality and content. We conducted meta-analysis of prevalence data and reported odds ratios of risk factors. Results: The prevalence of IPV during pregnancy ranges from 2% to 57% (n = 13 studies) with meta-analysis yielding an overall prevalence of 15.23% (95% CI: 14.38 to 16.08%). After adjustment for known confounders, five studies retained significant associations between HIV and IPV during pregnancy (OR1.48–3.10). Five studies demonstrated strong evidence that a history of violence is significantly associated with IPV in pregnancy and alcohol abuse by a partner also increases a woman’s chances of being abused during pregnancy (OR 2.89–11.60). Other risk factors include risky sexual behaviours, low socioeconomic status and young age. Conclusion: The prevalence of IPV among pregnant women in Africa is one of the highest reported globally. The major risk factors included HIV infection, history of violence and alcohol and drug use. This evidence points to the importance of further research to both better understand IPV during pregnancy and feed into interventions in reproductive health services to prevent and minimize the impact of such violence. URI: http://hdl.handle.net/10566/461 Files in this item: 1
ShamuPartnerViolenceReview2011.pdf (319.5Kb)
Now showing items 1-8 of 8