Measurement of and factors affecting patients' adherence to anti-retroviral therapy in Helen Joseph Hospital, Johannesburg

Faculty of Health Science School of Public Health 0310820y [email protected]: A study of adherence was conducted at the HIV Clinic of Helen Joseph Hospital, Johannesburg between June and September 2004. First it measured the level of adherence of patients (referred to as participants in this report) to antiretroviral medications. The relationship between adherence results and the viral load of the participants was explored. Factors such as treatment regimens, patient-provider relationship, patients’ knowledge of HIV treatment, disclosure of HIV status and support for HIV positive individuals were also studied with regard to adherence to antiretroviral therapy. Methods: Out of a total eligible pool of 198 patients, 184 patients were included in the study, representing 92.9% response rate. Participants were interviewed using a questionnaire and their HIV RNA concentrations (viral loads) ascertained. Adherence was defined as >= 95% (higher adherence) if a participant missed 0-2 medication doses and < 95% (lower adherence) if >2 doses were missed over a 23-day recall period. Results: Reported missed medication doses = 0 for 82.6% (152/184), 1 for 9.6% (14/184), 2 for 2.2% (4/184), 3 for 3.8% (7/184), 4 for 2.2% (4/184), 5 for 1.1% (2/184) and 11 for 0.5% (1/184) of the sample. The adherence level of 92.4% (170/184) of the sample was >= 95% and that of 7.6% (14/184) was < 95% of expected doses. A total of 116 participants had undetectable HIV RNA concentrations (i.e. viral load <50 copies/ml) and 64 had detectable viral load. Among the higher adherence category of participants 67.7% (113/167) had undetectable viral load compared with 23.1% (3/13) of the lower adherence category (χ2 = 10.46; p = 0.002). Participants who reported lower adherence had a mean log10 viral load of 2.90 compared to the higher adherence category with a mean log10 viral load of 0.81 (p<0.001). The mean duration of treatment for lower adherence category of participants was v 7.2 months compared with 13.3 months for the higher adherent participants (p = 0.025). Overall, participants with higher adherence were over six times more likely than those with lower adherence of achieving undetectable plasma HIV RNA (OR = 6.98; p = 0.004). Inadequate knowledge about HIV treatment where participants never heard of treatment adherence (p = 0.001), viral load (p = 0.001), or Cd4 cell count (p < 0.001); where participants believed that drugs cure HIV (p = 0.026), that one can stop treatment if one feels better (p < 0.001); and participants not knowing that HIV treatment is for life (p < 0.001) were associated with lower adherence. Other factors which predicted lower adherence were dietary restrictions (p = 0.007), drug side effects (p < 0.001), forgetting medication doses (p = 0.001) and missing clinic appointments (p = 0.001). Higher adherence was more likely to be reported where provider could speak patients’ preferred language (p = 0.035), assist patients with treatment difficulties (p = 0.002) and where provider was seen to be not too busy to listen to patients (p = 0.044). The method by which patients received information about HIV and its treatment did not affect reported adherence levels (p = 0.805). Disclosure of HIV status to both partner and family member (p < 0.001), and receiving social support from family members (p = 0.007) were found to be associated with reported higher adherence. Socio-demographic characteristics such as age (p = 0.174), gender (p = 0.159), level of formal education (0.107) as well as economic characteristics such as earning money (p = 0.104) and having a telephone (p = 0.124) were not associated with adherence to antiretroviral medications. Conclusion: This study suggests that the HIV-positive patients in the HIV clinic of Helen Joseph Hospital can maintain a high level of adherence to regimen of antiretroviral treatment. However, there is a need to develop strategies to enhance educational vi programmes and strengthen knowledge of HIV treatment among lower adherence category of patients, and to improve patients’ self-management and care for mediation pills. Further research is recommended to assess broader psychosocial factors predicting adherence in this population, and to ascertain what really happens to ARV pills dispensed to patients

Market interest rate fluctuations : impact on the profitability of commercial banks.

There are many functions of the financial system, with the basic function of transferring loanable funds from lender to borrowers (Rose et al, 1995). This financial transaction can be carried out directly or semi directly between lenders and borrowers. The shortcomings of direct and semi direct financing have opened doors for a third method—financial intermediation, which is done by financial intermediaries. Commercial bank is the classic example of financial intermediary at work. To achieve the goal of owners’ wealth maximization, banks should manage their assets, liabilities, and capital efficiently. In doing this, the bank should be conscious of the gap or spread between the interest income and the interest expenses paid, which is called net interest income (NII). Net interest income is a major part of banks’ profit, this is basically why the financial intermediaries try to offer lowest returns to savers and lend funds to borrowers at the highest possible interest rates. It is measured as net interest margin (NIM), which is NII divided by the average earning assets. This study examines the interest rate sensitivity of commercial banks’ interest profitability (Net Interest Margin) and net worth at the theoretical level and attempt to measure empirically the extent to which the interest profitability and net worth of commercial banks have been affected during the period of changing interest rates between 2001 and 2010. It as well measures the extent to which the factors that determine interest rate movement affect interest rate and which of the factors has more effect on interest rate. The measure of profitability captures the essence of lend-long borrow-short without directly including other determinants of bank income, such as loan loss and loan volume, which may be correlated with interest rates. It is also important to note that NIM is not a measure of total banks’ profits since it does not include non-interest income and expenses. A software package stata 10.0 was used to conduct the hypothesis testing, trend, and correlation analysis. The sampled banks are fourteen commercial banks and one investment bank in South Africa. The sampled banks were later divided into two groups (big and small), based on their assets size as at the year-end 2010. There are five (5) big banks with asset size of more than R100 billion and ten (10) small banks with asset size of less than R100 billion iii as at the year-end 2010. Analysis was further carried out separately on both the big and small banks to see the effect of interest rate fluctuations on them. Data required by the model was obtained from annual financial statements of the sampled banks for the period of ten years. It was found that fluctuations on interest rate (repo rate) affect the profit of commercial banks, but this effect is huge on small banks than the big banks. As the repo rate increases, the profit of commercial banks increases. Such effect of repo rate on profit of commercial banks was found to be statistically significant. It was also found that interest rate changes as well affect the net worth of commercial banks. The macroeconomic factors the determine the interest rates do not have direct effect on the banks’ profit, but have significant effect on the banks’ net worth, especially that of the small banks. As the rate of inflation, the rate of money supply, and uncertainty increase, the net worth of the small commercial banks in South Africa also increase. It could be advised that to maximize owners’ equity, South African commercial banks (big and small) should concentrate more on forecasting and controlling the determinants of the interest rates, rather than the interest rates themselves. It was also found that among the internal factors affecting profit and net worth of commercial banks, the liquidity ratio is most significant relative to capital ratio, competition, and non-performing loan

Money laundering, Tax havens, Transparency and Board of Directors of Banks

Among other characteristics, money laundering notably occurs across national borders and primarily through banks, and mainly because banks, which are both legitimate and ‘ubiquitous’ financial services institutions, engage primarily in financial intermediation. We ask, are the levers of control over banks’ involvement in money laundering and other financial crimes, more effective when pulled from the outside by government agencies or is there a less arm’s-length role for banks’ board of directors, by way of appropriately nuanced corporate governance? To answer this question, we first attempt to understand money laundering, its antecedents, its support mechanisms, and then how it may be tamed; with emphasis on the potential productive role of banks’ boards. At a general and/or high level, we recommend that the intervention of banks’ boards must focus (i.e., insist) on: (i) the primacy of transparency and upholding of both real and perceived reputational capital of the bank, and (ii) ascertaining that their banks’ relations with corresponding banks distributed across several national borders or association with banks domiciled in notorious tax havens, are demonstrably above board

Money laundering, Tax havens, Transparency and Board of Directors of Banks

Among other characteristics, money laundering notably occurs across national borders and primarily through banks, and mainly because banks, which are both legitimate and ‘ubiquitous’ financial services institutions, engage primarily in financial intermediation. We ask, are the levers of control over banks’ involvement in money laundering and other financial crimes, more effective when pulled from the outside by government agencies or is there a less arm’s-length role for banks’ board of directors, by way of appropriately nuanced corporate governance? To answer this question, we first attempt to understand money laundering, its antecedents, its support mechanisms, and then how it may be tamed; with emphasis on the potential productive role of banks’ boards. At a general and/or high level, we recommend that the intervention of banks’ boards must focus (i.e., insist) on: (i) the primacy of transparency and upholding of both real and perceived reputational capital of the bank, and (ii) ascertaining that their banks’ relations with corresponding banks distributed across several national borders or association with banks domiciled in notorious tax havens, are demonstrably above board

Treatment And Prevention for female Sex workers in South Africa: protocol for the TAPS Demonstration Project.

INTRODUCTION: Updated guidelines from the WHO recommend antiretroviral treatment for adults with HIV at any CD4 count and daily oral pre-exposure prophylaxis (PrEP) for people at substantial risk of HIV infection. However, implementation challenges may hinder the ability of programmes to translate these recommendations into successful practice. This demonstration project is the first to integrate PrEP and immediate treatment (ITx) for female sex workers (FSWs) in South Africa to answer operational research questions. METHODS AND ANALYSIS: This is a prospective cohort study where the main outcome is retention at 12 months. The study population is recruited into two arms across two urban sites: (1) PrEP for HIV-negative FSWs (n=400) and (2) ITx for HIV-positive FSWs with CD4 greater than national guidelines (n=300). We investigate process and other health indicators, uptake and use of PrEP and ITx through qualitative research, and evaluate cost-effectiveness analysis combined with estimates of impact through epidemiological modelling. ETHICS AND DISSEMINATION: The Treatment And Prevention for female Sex workers in South Africa (TAPS) Project was designed as an implementation study before emtricitabine/tenofovir disoproxil fumarate was licenced as an indication for PrEP in South Africa. Therefore, clinical trial requirements for ethical and South African Medicines Control Council approvals were followed. Results will be disseminated to participants, local health officials and other stakeholders, as well as in peer-reviewed journals and at conferences

Randomized clinical trial of nitazoxanide or sofosbuvir/daclatasvir for the prevention of SARS-CoV-2 infection

BACKGROUND: The COVER trial evaluated whether nitazoxanide or sofosbuvir/daclatasvir could lower the risk of SARS-CoV-2 infection. Nitazoxanide was selected given its favourable pharmacokinetics and in vitro antiviral effects against SARS-CoV-2. Sofosbuvir/daclatasvir had shown favourable results in early clinical trials. METHODS: In this clinical trial in Johannesburg, South Africa, healthcare workers and others at high risk of infection were randomized to 24 weeks of either nitazoxanide or sofosbuvir/daclatasvir as prevention, or standard prevention advice only. Participants were evaluated every 4 weeks for COVID-19 symptoms and had antibody and PCR testing. The primary endpoint was positive SARS-CoV-2 PCR and/or serology ≥7 days after randomization, regardless of symptoms. A Poisson regression model was used to estimate the incidence rate ratios of confirmed SARS-CoV-2 between each experimental arm and control. RESULTS: Between December 2020 and January 2022, 828 participants were enrolled. COVID-19 infections were confirmed in 100 participants on nitazoxanide (2234 per 1000 person-years; 95% CI 1837-2718), 87 on sofosbuvir/daclatasvir (2125 per 1000 person-years; 95% CI 1722-2622) and 111 in the control arm (1849 per 1000 person-years; 95% CI 1535-2227). There were no significant differences in the primary endpoint between the treatment arms, and the results met the criteria for futility. In the safety analysis, the frequency of grade 3 or 4 adverse events was low and similar across arms. CONCLUSIONS: In this randomized trial, nitazoxanide and sofosbuvir/daclatasvir had no significant preventative effect on infection with SARS-CoV-2 among healthcare workers and others at high risk of infection

Final 192-week efficacy and safety results of the ADVANCE trial, comparing 3 first-line antiretroviral regimens

BACKGROUND: ADVANCE compared 3 World Health Organization-recommended first-line regimens in participants with HIV who were antiretroviral naive. METHODS: This randomized, open-label, noninferiority trial enrolled participants living with HIV with no antiretroviral exposure in the previous 6 months to 1 of the following arms: tenofovir alafenamide (TAF) / emtricitabine (FTC) + dolutegravir (DTG) (2 tablets), tenofovir disoproxil fumarate (TDF) / FTC + DTG (2 tablets), or a fixed-dose combination of TDF / FTC / efavirenz (EFV) (1 tablet). We report the final safety and efficacy data up to 192 weeks. RESULTS: Repeat consent from the original 351 participants randomized to each arm was obtained from 230 participants (66%) in the TAF/FTC + DTG arm, 209 (60%) in the TDF/FTC + DTG arm, and 183 (52%) in the TDF/FTC/EFV arm. At 192 weeks, 213 (61%) of the original 351 participants in the TAF/FTC + DTG arm, 195 (56%) in the TDF/FTC + DTG arm, and 172 (49%) in the TDF/FTC/EFV arm had confirmed RNA <50 copies/mL, with low virologic failure in all groups and no significant integrase inhibitor mutations in any arm. Mean weight gain was 8.9 kg (SD, 7.1) in the TAF/FTC + DTG arm, 5.9 kg (SD, 7.1) in the TDF/FTC + DTG arm, and 3.2 kg (SD, 8.1) in the TDF/FTC/EFV arm at 192 weeks from baseline and was greatest among women, those taking TAF, and those with lower baseline CD4 counts. The weight trajectory slowed after week 96. There were few clinical events and minor laboratory changes and differences among arms after 96 weeks. There were no significant differences in treatment-emergent hypertension or pregnancy outcomes by arm. CONCLUSIONS: High viral suppression was seen across arms, with no resistance to DTG. Weight gain continued but slowed after 96 weeks, with few clinical events or laboratory changes

Risks of metabolic syndrome in the ADVANCE and NAMSAL trials

IntroductionThe ADVANCE and NAMSAL trials evaluating antiretroviral drugs have both reported substantial levels of clinical obesity in participants. As one of the main risk factors for metabolic syndrome, growing rates of obesity may drive metabolic syndrome development. This study aims to evaluate the risk of metabolic syndrome in the ADVANCE and NAMSAL trials.MethodsThe number of participants with metabolic syndrome was calculated at baseline and week 192 as central obesity and any of the following two factors: raised triglycerides, reduced HDL-cholesterol, raised blood pressure and raised fasting glucose. Differences between the treatment arms were calculated using the χ2 test.ResultsAcross all visits to week 192, treatment-emergent metabolic syndrome was 15% (TAF/FTC + DTG), 10% (TDF/FTC + DTG) and 7% (TDF/FTC/EFV) in ADVANCE. The results were significantly higher in the TAF/FTC + DTG arm compared to the TDF/FTC/EFV arm (p &lt; 0.001), and the TDF/FTC + DTG vs. the TDF/FTC/EFV arms (p &lt; 0.05) in all patients, and in females. In NAMSAL, the incidence of treatment-emergent metabolic syndrome at any time point was 14% (TDF/3TC + DTG) and 5% (TDF/3TC + EFV) (p &lt; 0.001). This incidence was significantly greater in the TDF/3TC/DTG arm compared to the TDF/3TC/EFV arm in all patients (p &lt; 0.001), and in males (p &lt; 0.001)ConclusionIn this analysis, we highlight treatment-emergent metabolic syndrome associated with dolutegravir, likely driven by obesity. Clinicians initiating or monitoring patients on INSTI-based ART must counsel for lifestyle optimisation to prevent these effects

Final 192-Week Efficacy and Safety Results of the ADVANCE Trial, Comparing 3 First-line Antiretroviral Regimens

Background. ADVANCE compared 3 World Health Organization–recommended first-line regimens in participants with HIV who were antiretroviral naive. Methods. This randomized, open-label, noninferiority trial enrolled participants living with HIV with no antiretroviral exposure in the previous 6 months to 1 of the following arms: tenofovir alafenamide (TAF)/emtricitabine (FTC) + dolutegravir (DTG) (2 tablets), tenofovir disoproxil fumarate (TDF)/FTC + DTG (2 tablets), or a fixed-dose combination of TDF/FTC/efavirenz (EFV) (1 tablet). We report the final safety and efficacy data up to 192 weeks. Results. Repeat consent from the original 351 participants randomized to each arm was obtained from 230 participants (66%) in the TAF/FTC + DTG arm, 209 (60%) in the TDF/FTC + DTG arm, and 183 (52%) in the TDF/FTC/EFV arm. At 192 weeks, 213 (61%) of the original 351 participants in the TAF/FTC + DTG arm, 195 (56%) in the TDF/FTC + DTG arm, and 172 (49%) in the TDF/FTC/EFV arm had confirmed RNA <50 copies/mL, with low virologic failure in all groups and no significant integrase inhibitor mutations in any arm. Mean weight gain was 8.9 kg (SD, 7.1) in the TAF/FTC + DTG arm, 5.9 kg (SD, 7.1) in the TDF/FTC + DTG arm, and 3.2 kg (SD, 8.1) in the TDF/FTC/EFV arm at 192 weeks from baseline and was greatest among women, those taking TAF, and those with lower baseline CD4 counts. The weight trajectory slowed after week 96. There were few clinical events and minor laboratory changes and differences among arms after 96 weeks. There were no significant differences in treatment-emergent hypertension or pregnancy outcomes by arm. Conclusions. High viral suppression was seen across arms, with no resistance to DTG. Weight gain continued but slowed after 96 weeks, with few clinical events or laboratory changes