Barriers to HIV Care and Treatment by Doctors: A review of the literature.

This paper provides a review of the reported barriers that prevent doctors from managing HIV infected patients. The four most commonly reported barriers were: fear of contagion, fear of losing patients, unwillingness to care, and inadequate knowledge /training about treating HIV patients. Barriers to treating HIV infected patients is frequently reported in many countries and it is important for developing countries such as South Africa to learn from these experiences by identifying local problems so that constructive interventions and strategies can be developed to address these barriers, thereby improving the quality of patient care. Further research in respect of the local situation is required.IntroductionOver the last two decades acquired immunodeficiency syndrome (AIDS) has emerged as one of the most serious public health problems in the world, and by the end of 2003 it was estimated that 5.3 million South Africans were human immunodeficiency virus (HIV) positive, which corresponds to 21.5% of the population.1 In the early phase of the HIV epidemic few doctors saw infected patients and treatment options were limited. As a result many doctors were reluctant to provide care to HIV infected patients and homophobia amongst doctors, fear of contact with patients and unwillingness to care were frequently reported.2 However, there has been an exponential increase in the number of HIV and AIDS related cases and more doctors are encountering infected individuals. This review summarizes our current knowledge of barriers to treatment of HIV infected patients by doctors.MethodA comprehensive literature review was undertaken by searching the MEDLINE database, Psychlit, ISI Web, EBSCOHost, and Sabinet on line, for English language literature published between 1985 and 2004. The database search terms included keywords such as fear/s, barrier/s, concern, HIV, AIDS, attitudes, physician/s (doctor/s), practice, treatment, care and knowledge. A variety of combinations of these words were entered. All duplicate articles were removed and only studies that used doctors as the sample population were considered. Titles expressing comment, news items, opinion pieces or letters were rejected.ResultsThirty two relevant studies were identified from the literature search. The four most commonly reported barriers were: fear of contagion, fear of losing patients, unwillingness to care, and inadequate knowledge /training about treating HIV patients.Keywords: barriers; fear; knowledge; doctors; losing patientsFor full text, click here:SA Fam Pract 2006;48(2):55-55

Focus group discussion with private sector doctors in the eThekwini Metro of KwaZulu-Natal on the management of HIV/AIDS patients

Background: Highly active antiretroviral treatment (HAART) is essential in the treatment of HIV/AIDS; however, a holistic approach to HIV/AIDS management is important. This study was done to confirm the findings of two studies done previously in the eThekwini Metro of KwaZulu-Natal on private sector doctors’ management of HIV-infected patients and to obtain more in-depth information about their nonpharmacological management of HIV-infected patients.Methods: Two focus group discussions were conducted amongst private sector doctors in the eThekwini Metro, after obtaining their consent. The focus group sessions were scripted, audio-taped and transcribed verbatim. Prevalent themes were identified and reported.Results: Eight doctors participated. Of the total patient population seen annually by the majority of the doctors, an average of 43.8% was HIV infected. Doctors in this study managed their patients both pharmacologically and nonpharmacologically. Seventy-five per cent of doctors indicated that the taste of medicine played an important role in nonadherence to treatment, but all agreed that cultural beliefs also influenced the patient’s adherence to medication. Theft of medicines and the outof-stock situation prevented antiretroviral drug access, which impacted negatively on adherence. Five doctors mentioned that depressed patients abused alcohol, resulting in nonadherence. One doctor reported that he used the biopsychosocial approach to improve adherence in his patients. Doctors indicated that the disability grant given by the South African Government caused patients not to adhere to treatment in order to maintain a CD4 count of 200 or less so as to qualify for the grant.Conclusions: The study confirmed the previous study findings in that it showed that private sector doctors manage their HIV-infected patients both pharmacologically and nonpharmacologically. It further provided new and interesting information with regard to the nonpharmacological methods employed in HIV/AIDS management, that is the incorporation of culturalbeliefs in the management of HIV-infected patients to improve adherence to treatment, and the role of the disability grant and pharmaceutical formulations in contributing to nonadherence by HIV-infected patients.Keywords: focus group; private sector doctors; HIV/AIDS; cultural; biopsychosocial; adherenc

EXPLORING UNPLANNED PREGNANCY AMONGST UNIVERSITY STUDENTS

Unplanned pregnancy poses a multiplicity of problems for students and academic institutions.Using an ecosystemic framework one can uncover the range of costs incurred when a student’sacademic life is disrupted as a result of an unplanned pregnancy. The academic programme isderailed with serious financial costs incurred by the institution, the family and the individual.Through-put targets of the institution may be affected, leaving a trail of deficits that are difficult tomanage, together with a bruised public image that impacts negatively on student intake. At apsycho-social level the individual and family lose standing in the community because of the shameof an unplanned pregnancy and an illegitimate child, or trauma upon learning of a positive HIVdiagnosis accompanying pregnancy. These concerns provided the motivation for this study, whichwas to identify factors that contributed to unplanned pregnancy to reduce its impact and informproactive planning. No such study had been conducted on the University of KwaZulu-Natal’sWestville campus previously. The research was conducted on the Westville Campus of theUniversity of KwaZulu-Natal under the auspices of the Department of Student Counselling fromAugust 2003 to December 2003 to investigate why an increasing number of students werepresenting with unplanned pregnancies. This increase is reflected in the statistics belo

Promoting patient autonomy: Perspectives of occupational therapists and nurses

Background. There has been a turn in the last decade towards autonomy in patient care. Promoting patient autonomy is required as a collaborative endeavour between the patient, healthcare professionals and the families and caregivers of patients. Our current discourse demonstrates patient autonomy as essential.Objective. To explore the concept of autonomy in nurses’ and occupational therapists (OTs)’ individual and collective practice as healthcare professionals.Methods. The study followed a qualitative explorative approach. Fourteen nurses and 12 OTs from 6 facilities in KwaZulu-Natal Province of South Africa were recruited into the study. Following ethical approval, and dependent on the availability of participants, data were collected via focus groups, triad and individual semi-structured interviews and qualitative questionnaires. Data were analysed using inductive thematic analysis per profession initially, and then later merged to develop themes.Results. Two major themes emerged that spoke to the deconstruction of autonomy and deterrents to the promotion of autonomy in clinical practice. An individualistic view of autonomy was embedded within the participants’ understanding of the concept. It included the patient’s right and ability to selfdetermine or direct treatment and various interventions, having appropriate guidance and the relevant information to make  decisions, and opportunities to self-determine their course of treatment. Patient-related and organisational factors served as barriers to the promotion of autonomy.Conclusion. By analysing the experiences of autonomy in practice of these two professions, we may be able to establish new ways of understanding how professional practice can truly become patient-centred and transition from an individualistic understanding of autonomy towards viewing autonomy as relational

The relevance of surveying content in mining engineering education

The University of the Witwatersrand School of Mining Engineering (Wits Mining) has its origins in the South African School of Mines, which was established in 1896. It is currently recognised as one of the world’s top mining engineering schools that educate mining engineering candidates to become qualified to specialise in a variety of disciplines required in a modern mining environment. At undergraduate level, Wits mining offers one degree programme – B.Sc. in mining engineering. The role of Wits Mining has been one of successfully facilitating the continuous professional development of mining engineers and mining specialists like mine surveyors.The paper will highlight the surveying content that is relevant to the mining engineering programme according to the Engineering Council of South Africa (ECSA) by show-casing the surveying content within the Wits Mining programme and comparing this with what is obtainable at other international schools of mining engineering, such as Aachen University (Germany), the University of Mines and Technology (Ghana) and the University of Johannesburg (South Africa). The training of mine surveyors is well established in South Africa, and Wits University is an institution where a mine surveyor can obtain a Master’s degree specialising in any one of 5 mining specialisations, including Mine Surveying. This article attempts to answer the question as to what mining engineers should know about mine surveying. The paper will also explain how mine surveying training is beneficial to a mining engineer’s career development.Keywords: Education; specialisation; degree programme; Wits minin

Cardiac biomarkers in acute coronary syndromes

Cardiac biomarkers play a significant role in the diagnosis, risk assessment, and management of patients with acute coronary syndromes (ACS). Several biomarkers identify different components of the pathophysiology of ACS: troponins are markers of myocyte necrosis, natriuretic peptides reflect neurohormonal activation and myocardial dysfunction, and C-reactive protein reflects various inflammatory processes. Whilst there are a number of established and novel biomarkers to assess ischemia, necrosis and myocardial dysfunction in coronary artery disease, it is probable that no single biomarker will emerge that provides appropriate information for all clinical settings of ACS. This suggests that ongoing efforts in plasma-based biomarker research should concentrate on the use of a multimarker approach to enhance our diagnosis, prognostic assessment, and management of patients with suspected ACS, as compared with using individual markers alone. It is recommended that current practice involve the selective use of biomarkers in patients in whom a more complete assessment of risk is desired. At present, routine biomarker measurement is not advocated until further data become available, which will support the benefit of specific therapeutic interventions

Dose-related adverse events in South African patients prescribed clofazimine for drug-resistant tuberculosis

Background. Optimal drug levels and minimal toxicity are critical factors in improving treatment outcomes for patients prescribed new and repurposed medicine for drug-resistant (DR) tuberculosis (TB). The optimal dose and dose-related safety of clofazimine (CFZ), a repurposed medicine for DR TB, in the South African (SA) population are unknown.Objectives. To report on dose-related adverse events in patients receiving CFZ plus a background regimen for DR TB.Methods. In a retrospective review of patient folders from 2012 to 2014, adverse events documented for patients receiving high- (≥200 mg) and low-dose (100 mg) CFZ in a centralised DR TB hospital in KwaZulu-Natal Province, SA, were investigated for an association between dose-weight interactions and adverse events.Results. Of 600 patients included, 78.7% (n=472) weighed ≥50 kg. Of these, 17.4% (n=82) received 100 mg CFZ and 82.6% (n=390) received >200 mg. Of 128 patients (21.3%) who weighed <50 kg, 68.0% (n=87) received 100 mg CFZ and 32.0% (n=41) received ≥200 mg. Of 463 patients (77.2%) who were HIV-positive, 94.0% were on antiretrovirals. There was no difference between the dose-weight cohorts in the background regimen given in addition to high- or low-dose CFZ. The frequency and types of adverse events observed were similar to the published literature. When analysed per dose-weight cohort, patients weighing <50 kg and receiving high-dose CFZ (≥200 mg) had a 2.6 times higher risk of any adverse event (adjusted odds ratio (aOR) 2.57; 95% confidence interval (CI) 1.02 - 6.05; p=0.05: reference category <50 kg and 100 mg). Patients weighing <50 kg and receiving high-dose CFZ had a 3.3 times higher risk of gastrointestinal adverse events than patients weighing <50 kg and receiving 100 mg CFZ (aOR 3.30; 95% CI 1.51 - 7.19; p=0.003). A high risk of chest pain was observed in patients receiving high- and low-dose CFZ, irrespective of weight. Patients weighing <50 kg receiving high-dose CFZ had a slightly higher risk of adverse events related to the skin (aOR 1.2; 95% CI 0.55 - 2.62; p=0.7) There were no documented reports of the CFZ dose being reduced or the drug being stopped due to adverse events in the sample population.Conclusions. There is an association between dose-weight interaction and adverse events. The odds of any adverse event occurring were higher when low-weight patients (<50 kg) received high-dose CFZ (≥200 mg). Gastrointestinal and skin-related adverse events were more common when high-dose CFZ was used in patients weighing <50 kg. Chest pain was reported in patients receiving high- and low-dose CFZ, irrespective of weight, and may be a symptom of cardiac toxicity. Plasma concentrations of CFZ may be affected by drug-drug interactions, so active drug safety monitoring including electrocardiograms is recommended routinely when CFZ is part of the regimen