The association between depression and adherence to antiretroviral therapy in HIV-positive patients, KwaZulu-Natal, South Africa

Background: Depressive disorders are associated with poorer health outcomes in people living with human immunodeficiency virus infection and acquired immunodeficiency syndrome (PLHIV) and have been shown to contribute to non-adherence to antiretroviral therapy (ART) in Western contexts. Limited data from developing countries are available. The aim of this study was to explore whether there was an association between depressive symptoms and adherence to ART among PLHIV in KwaZulu-Natal, South Africa.Method: A cross-sectional analytical study was undertaken in a population of HIV-positive patients accessing ART at a government funded, semi-urban clinic in the eThekwini Municipal District, KwaZulu-Natal, South Africa. The tools used to measure depressive symptoms and adherence were the Centre for Epidemiology Studies Depression Scale (CES-D)and clinic-based pill counts, respectively. Socio-demographic and clinical data were collected during interviews and from patient records.Results: Sixty-two per cent of the sample (n = 146) had higher-than-threshold levels on the depression scale, and 32% were less than 95% adherent to ART. High depression scores were associated with lower levels of education [odds ratio (OR) 2.0; 95% confidence interval (CI), 1.0–4.1] and unemployment (OR 2.8; 95% CI, 1.3–6.0), while non-adherence was associated with unemployment (OR 2.4; 95% CI, 1.0–6.1) and mid-range CD4 counts (200–499 cells/ìl; OR 3.0; 95% CI,1.3–6.9). No significant association was found between depressive symptoms and non-adherence to ART (OR 0.5; 95% CI, 0.2–1.2; p-value, 0.125).Conclusion: The large percentage of participants who scored high on the CES-D suggests a high prevalence of major depression in the study population. No significant association was found between high depression scores and nonadherence to ART. Depressive symptoms were significantly linked to lower levels of education and unemployment, while non-adherence was associated with unemployment and mid-range CD4 counts (200–499 cells/ìl). The study had some limitations. Further studies are needed to determine the prevalence and causes of depression and its impact on PLHIV in this population and in the developing world

Aspects of Arminianism in Scotland

“In view of [the] meagre harvest of writings on Arminianism in Scotland, the study contained in the following pages is an attempt to fill a small part of the hiatus in Scotland's church history. In the general set-up and division of the chapters, the topical approach was followed. There are various disadvantages inherent to this kind of approach. The first is that it gives the work a fragmentary character. This is due to the fact that a system of division based on outstanding events or prominent persons, does not always follow the chronological lines of history, and thus results in an intermittent narrative. Another disadvantage is that there are always certain items which cannot easily be brought under one of these headings, but which are at the same time not broad or important enough to justify a separate division. In this study an attempt was made to overcome these difficulties by constructing the subject divisions within a chronological framework, and thereby trying to relate Arminianism chronologically to the main ecclesiastical events. This study covers only the seventeenth and eighteenth centuries because after the eighteenth-century Arminianism exerted very little new influence, and excited very little interest in Scotland. The theological trends of the nineteenth century were virtually an intensified extension of eighteenth-century currents. Finally, it should be pointed out that the following discussion of Arminianisn in Scotland does not purport to be exhaustive* In fact, it is very incomplete because, as the title indicates, only some aspects of Arminianism connected with certain persons and events are coming under observation.” – From the Preface

How to plan a health education programme

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John Wesley se Aldersgate-ervaring: ’n Herwaardering

John Wesley’s Aldersgate experience: A reassessment The well-known experience of Wesley at Aldersgate Street on 24 May 1738 is widely considered to be his conversion. In this article an attempt is made to determine the following: » whether this experience can be styled a conversion » whether there is support for another localization for Wesley’s conversion; » what the nature of the Aldersgate experience was if not a conversion. In order to achieve these ends the evidence on the following aspects of Wesley’s life is considered: » the Aldersgate experience itself; » the events prior and subsequent to Aldersgate; » changes in Wesley’s theological understanding of salvation. The conclusion opposes the popular view on Aldersgate