Promoting adherence to antiretroviral therapy: the experience from a primary care setting in Khayelitsha, South Africa.

OBJECTIVE: To describe the approach used to promote adherence to antiretroviral therapy (ART) and to present the outcomes in the first primary care public sector ART project in South Africa. DESIGN: The study is a prospective open cohort, including all adult patients naive to previous ART who received antiretroviral treatment in Khayelitsha, from May 2001 to the end of 2002. Patients were followed until their most recent visit before 31 July 2003. METHODS: Plasma viral load was determined at 3, 6, 12, 18 and 24 months after ART was initiated, and CD4 cell counts 6-monthly. Kaplan-Meier estimates were determined for the cumulative proportions of patients surviving, and patients with viral load suppression and viral rebound. RESULTS: A total of 287 patients were initiated on triple therapy. The probability of survival was 86.3% at 24 months. The median CD4 cell count gain was 288 cells/microliters at 24 months. Viral load was less than 400 copies/ml in 89.2, 84.2 and 69.7% of patients at 6, 12 and 24 months, respectively. The cumulative probability of viral rebound (two consecutive HIV-RNA measurements above 400 copies/ml) after achieving an HIV-RNA measurement below 400 copies/ml was 13.2% at 18 months. CONCLUSION: The study shows that, with a standard approach to patient preparation and strategies to enhance adherence, a cohort of patients on ART can be retained in a resource-limited setting in a developing country. A high proportion of patients achieved suppression of viral replication. The subsequent probability of viral rebound was low

The prevention of mother-to-child HIV transmission programme and infant feeding practices

Since the first cases of HIV transmission through breastfeeding were documented, a fierce debate has raged on appropriate guidelines for infant feeding in resource-poor settings. A major problem is determining when it is safe and feasible to formula-feed, as breast-milk protects against other diseases. A cross-sectional survey of 113 women attending the programme for the prevention of mother-to-child transmission in Khayelitsha, Cape Town, was conducted. Over 95% of women on the programme formula-fed their infants and did not breast- feed at all. Seventy per cent of women said that their infant had never had diarrhoea, and only 3% of children had had two episodes of diarrhoea. Focus groups identified the main reasons for not breast-feeding given by women to their families and those around them. Formula feeding is safe and feasible in an urban environment where sufficient potable water is available

STD care in the South African private health sector

Objectives. To establish the accessibility and quality of sexually transmitted disease (SID) care provided by private general practitioners (GPs) and workplace health services in South Africa.Design. Structured telephone interviews were conducted with a random national sample of 120 GPs and 244 occupational health nurses (OHNs) between May and July 1997. The interview schedules covered indicators of access (including utilisation) and processes (drug treatment, partner management, counselling and condom promotion) of STD care.Results. An estimated 5 million STD-related visits were made to private general practices in 1997. Reported treatment of STDs was assessed for effectiveness using well established syndromic case management guidelines. Only 28% of GPs reported effective treatment for urethral discharge. This dropped to 14% for genital ulcer and 4% for pelvic inflammatory disease. Fifty-five per cent of the OHNs interviewed indicated that their workplace clinics provided STD care. Nurses provided this care, with or without the support of doctors, in 87% of clinics. Reported urethral discharge and genital ulcer treatment regimens were assessed as effective in 34% and 14% of responses, respectively.Conclusions. The private sector is a major provider of STD care and is key to national efforts to achieve better STD control, thereby preventing the spread of HIV. However, the results of the research suggest that the poor quality of STD care may be underminlng attempts to control these epidemics in our society. Although a complex task, strategies need to be found to improve the quality of care provided within the private sector

(m-Phenyl­enedimethyl­ene)bis­(triphenyl­phospho­nium) bis­[chlorido(penta­fluoro­phen­yl)aurate(I)] dichloro­methane disolvate

The title compound, (C44H38P2)[AuCl(C6F5)]2·2CH2Cl2, crystallizes with a twofold rotation axis through the central benzene ring in the bis-phospho­nium dication. In the crystal, the dications and anions are ordered into columns running parallel to the c axis by contacts of the pro-ylidic CH2 groups with the Cl atom of one and an ortho-F atom of another anion. The space between the columns is occupied by CH2Cl2 solvent mol­ecules