HIV symptoms and health-related quality of life prior to initiation of HAART in a sample of HIV-positive South Africans.

This study investigates the relationship between current symptom status (no symptoms vs. symptoms present) and dimensions of health-related quality of life and overall quality of life (QoL) (poor vs. good) of 612 people living with HIV, just prior to initiating highly active antiretroviral therapy at three public hospitals in KwaZulu-Natal, South Africa. The mean number of symptoms reported on the day of interview was 8.4. Experiencing symptoms was most reported by patients in receipt of a disability grant, patients who did not have enough money to meet basic needs, who experienced negative feelings less, who had prayed in the last 6 months and who reported better QoL. Higher QoL was in turn associated with experiencing negative feelings less, praying, receiving a disability grant and having enough money to meet basic needs. Physical health and independence were important predictors of higher QoL for patients both with and without symptoms. Psychological health and spirituality may however mediate the effects of HIV symptoms and socioeconomic stressors

Antiretroviral treatment adherence among HIV patients in KwaZulu-Natal, South Africa

<p>Abstract</p> <p>Background</p> <p>Successful antiretroviral treatment is dependent on sustaining high rates of adherence. In the southern African context, only a handful of studies (both quantitative and qualitative) have looked at the determinants including a health behaviour theory of adherence to antiretroviral therapy. The aim of this study is to assess factors including the information, motivation and behavioural skills model (IMB) contributing to antiretroviral (ARV) adherence six months after commencing ARVs at three public hospitals in KwaZulu-Natal, South Africa.</p> <p>Methods</p> <p>Using systematic sampling, 735 HIV-positive patients were selected prior to commencing on ART from outpatient departments from three hospitals and followed-up at six months and interviewed with a questionnaire.</p> <p>Results</p> <p>A good proportion of patients were found to be adherent using both adherence instruments (visual analog scale = VAS 82.9%; Adult AIDS Clinical Trials Group = AATCG 70.8%). After adjusting for significant socio-economic variables, both the VAS and the dose, schedule and food adherence indicator found levels of adherence amongst urban residents to be almost 3 times greater than that of rural residents. After adjusting for health-related variables, for both indicators better adherence was associated with low depression and poorer adherence was associated with poor environmental factors. Adjusted odds ratios for adherence when taking into account different behavioural variables were for both adherence indicators, discrimination experiences were associated with lower adherence, and higher scores in adherence information and behavioural skills were associated with higher adherence. For the VAS adherence indicator, higher social support scores were associated with higher adherence. For the dose, schedule and food adherence indicator, using herbal medicines for HIV was associated with lower adherence.</p> <p>Conclusion</p> <p>For the patients in this study, particularly those not living in urban areas, additional support may be needed to ensure patients are able to attend appointments or obtain their medications more easily. Adherence information and behavioural skills as part of the IMB model should be strengthened to improve adherence. Further psychological support is also required and patients' perceived need for ARTs should be routinely assessed.</p

"So they believe that if the baby is sick you must give drugs…" The importance of medicines in health-seeking behaviour for childhood illnesses in urban South Africa.

A mixed method approach was used to investigate the treatment of childhood illnesses in Johannesburg and Soweto. In 2004, in-depth interviews were held with caregivers (n = 5), providers of traditional (n = 6) and Western (n = 6) health care, as well as 5 focus groups with black caregivers of children under 6 years. An utilisation-based survey was conducted with 206 black caregivers of children under 6 years of age at 1 public clinic in Soweto (n = 50), 2 private clinics (n = 50) in Johannesburg, 2 public hospitals (n = 53) from Johannesburg and Soweto and 2 traditional healers (n = 53) from Johannesburg and Orange Farm, an informal settlement on the outskirts of Johannesburg. Caregivers reported how they would respond to 4 common child health problems. Home treatments would be a common first resort particularly for diarrhoea (79%, mostly salt and sugar solution) and constipation (53%). In the case of constipation, the spuit [enema] was cited as a particularly effective home treatment method, particularly amongst TMP patients. Approximately 50% of caregivers would access a health care provider as a first resort for coughs. OTC medicines are commonly used for fever (63%), less-so for coughs (37%). Overall, higher SES respondents would be more likely to use over-the-counter (OTC) medicines and less likely than other groups to use home treatments. Shortages of medicines at clinics and caregiver beliefs about the efficacy of medicines affect health-care seeking behaviour. Medicines are not always used as intended or according to instructions and some products such as household detergents may be used medicinally. As well as the need for improving facility-readiness for delivering IMCI (Integrated Management of Childhood Illnesses), the patient-provider relationship is instrumental in improving the treatment of childhood illnesses

Stuips, spuits and prophet ropes: The treatment of abantu childhood illnesses in urban South Africa

With a paucity of data on health-seeking behaviour for childhood illnesses in urban South Africa, a mixed method approach was used to investigate the treatment of abantu childhood illnesses in Johannesburg and Soweto between March and June 2004. In-depth interviews were held with caregivers (n = 5), providers of traditional (n = 6) and Western (n = 6) health care, as well as five focus groups with caregivers. A utilisation-based survey was conducted with 206 black African caregivers of children under 6 years of age from one public clinic in Soweto (n = 50), two private clinics in Johannesburg (50 caregivers in total), two public hospitals from Johannesburg and Soweto (53 caregivers in total) and two traditional healers from Johannesburg and Orange Farm (53 caregivers in total), an informal settlement on the outskirts of Johannesburg. The symptoms of several childhood abantu health problems, their treatment with traditional, church and home remedies, and influences on such patterns of resort are described. Despite free primary health care for children under 6 years, the pluralistic nature of health-seeking in this urban environment highlights the need for community and household integrated management of childhood illnesses and a deeper understanding of how symptoms may be interpreted and treated in the context of the local belief system.South Africa Traditional medicine Medical pluralism Childhood illnesses Health-seeking behaviour Abantu Beliefs

Dyke-arrest scenarios in extensional regimes:Insights from field observations and numerical models, Santorini, Greece

Adherence to antiretroviral medication in the treatment of HIV is critical, both to maximize efficacy and to minimize the emergence of drug resistance. The aim of this prospective study in three public hospitals in KwaZulu-Natal, South Africa, is to assess the use of Traditional Complementary and Alternative Medicine (TCAM) by HIV patients and its effect on antiretroviral (ARV) adherence 6 months after initiating ARVs. 735 (29.8% male and 70.2% female) patients who consecutively attended three HIV clinics completed assessments prior to ARV initiation and 519 after six months on antiretroviral therapy (ART) Results indicate that the use of herbal therapies for HIV declined significantly from 36.6% prior to antiretroviral treatment (ART) initiation to 7.9% after being on ARVs for 6 months. Faith healing methods, including spiritual practices and prayer for HIV declined from 35.8% to 22.1% and physical/body-mind therapy (exercise and massage) declined from 5.0% to 1.9%. In contrast, the use of micronutrients (vitamins, etc.) significantly increased from 42.6% to 87.4%. In multivariate regression analyses, ARV non-adherence (dose, schedule and food) was associated with the use of herbal treatment, not taking micronutrients and the use of over-the-counter drugs. The use of TCAM declined after initiating ARVs. As herbal treatment for HIV was associated with reduced ARV adherence, patients&apos; use of TCAM should be considered in ARV adherence management

Antiretrovirals And The Use Of Traditional, Complementary And Alternative Medicine By Hiv Patients In Kwazulu-Natal, South Africa: A Longitudinal Study

The aim of this prospective study (20 months) was to assess HIV patients’ use of Traditional, Complementary and Alternative Medicine (TCAM) and its effect on ARV adherence at three public hospitals in KwaZulu-Natal, South Africa. Seven hundred and thirty-five (29.8% male and 70.2% female) patients who consecutively attended three HIV clinics completed assessments prior to ARV initiation, 519 after 6 months, 557 after 12 and 499 after 20 months on antiretroviral therapy (ART). Results indicate that following initiation of ARV therapy the use of herbal therapies for HIV declined significantly from 36.6% prior to ARV therapy to 8.0% after 6 months, 4.1% after 12 months and 0.6% after 20 months on ARVs. Faith healing methods (including spiritual practices and prayer) declined from 35.8% to 22.1%, 20.8% and 15.5%, respectively. In contrast, the use of micronutrients (vitamins, etc.) significantly increased from 42.6% to 78.2%. The major herbal remedies that were used prior to ART were unnamed traditional medicine, followed by imbiza (Scilla natalensis planch), canova (immune booster), izifozonke (essential vitamins mixed with herbs), African potato (Hypoxis hemerocallidea), stametta (aloe mixed with vitamins and herbs) and ingwe (tonic). Herbal remedies were mainly used for pain relief, as immune booster and for stopping diarrhea. As herbal treatment for HIV was associated with reduced ARV adherence, patient’s use of TCAM should be considered in ARV adherence management

Need, demand and missed opportunities for integrated reproductive health-HIV care in Kenya and Swaziland: evidence from household surveys.

OBJECTIVE: Little is known about the need and demand for integrated reproductive health and HIV services at the population level. DESIGN: Descriptive data analysis of household surveys collected by the Integra Initiative. METHODS: Household surveys were conducted among 18-49-year-olds in Kenya (N = 1752) and Swaziland (N = 779) in 2009. Data on fertility intentions, contraceptive use, sexual behaviours and HIV testing were used to determine unmet needs. Demand for integrated services was defined as wanting reproductive health services with HIV/sexually transmitted infection (STI) services within one visit. RESULTS: At the population level, family planning needs (90%) were higher than HIV/STI prevention needs: 53% (women) and 75% (men). Fewer had unmet family planning needs through non-use of contraceptives: 17% (women) and 27% (men); versus unmet HIV/STI prevention needs through inconsistent condom use: 48 and 26% of women; 51 and 32% of men in Kenya and Swaziland, respectively. Dual need was higher for men: 64% (Kenya) and 73% (Swaziland) versus women (48%) with more unmet in Kenya (43%) compared to Swaziland (25%). Missed opportunities for integrated service provision were high among women: 49 and 57% with unmet family planning needs; and 55 and 32% with unmet HIV/STI prevention needs in Kenya and Swaziland, respectively, used services, but did not receive the needed service. Most men with unmet needs were non-service users. Approximately a quarter of women wanted and received integrated reproductive health-HIV/STI services in both countries. CONCLUSIONS: Demand creation at the community level and provider-initiated integrated service provision are needed, using different strategies for men and women, to address substantial family planning and HIV/STI prevention needs

Stuips, spuits and prophet ropes: the treatment of abantu childhood illnesses in urban South Africa.

With a paucity of data on health-seeking behaviour for childhood illnesses in urban South Africa, a mixed method approach was used to investigate the treatment of abantu childhood illnesses in Johannesburg and Soweto between March and June 2004. In-depth interviews were held with caregivers (n=5), providers of traditional (n=6) and Western (n=6) health care, as well as five focus groups with caregivers. A utilisation-based survey was conducted with 206 black African caregivers of children under 6 years of age from one public clinic in Soweto (n=50), two private clinics in Johannesburg (50 caregivers in total), two public hospitals from Johannesburg and Soweto (53 caregivers in total) and two traditional healers from Johannesburg and Orange Farm (53 caregivers in total), an informal settlement on the outskirts of Johannesburg. The symptoms of several childhood abantu health problems, their treatment with traditional, church and home remedies, and influences on such patterns of resort are described. Despite free primary health care for children under 6 years, the pluralistic nature of health-seeking in this urban environment highlights the need for community and household integrated management of childhood illnesses and a deeper understanding of how symptoms may be interpreted and treated in the context of the local belief system