Blood-borne HIV: Risks and Prevention

By Mariette Correa, David Gisselquist and Deodatta Hari Gore. Hyderabad: Orient Longman Private Ltd. ISBN 13: 978-81-250-3462-9 and ISBN 10: 81-250-3462-5This is a 91-page book written to fill the gap that exists in public education about HIV prevention. The book focuses on the country of India, where public discussion of HIV risk concentrates on sexual transmission and overlooks blood exposures

The social and clinical characteristics of patients on antiretroviral therapy who are ‘lost to follow-up’ in KwaZulu-Natal, South Africa: a prospective study

A significant proportion of those initiating antiretroviral treatment (ART) for HIV infection are lost to follow-up. Causes (including HIV symptoms, quality of life, depression, herbal treatment and alcohol use) for discontinuing ART follow-up in predominantly rural resource-limited settings are not well understood. This is a prospective study of the treatment-naïve patients recruited from three (one urban, one-semi-urban and one rural) public hospitals in Uthukela health district in KwaZulu-Natal from October 2007 to February 2008. The aim of this study was to investigate predictors of loss to follow-up or all caused attrition from an ART programme within a cohort followed up for over 12 months. A total of 735 patients (217 men and 518 women) prior to initiating ART completed a baseline questionnaire and 6- and 12-months’ follow-up. At 12-months follow-up 557 (75.9%) individuals continued active ART, 177 (24.1%)were all cause attrition, there were 82 deaths (13.8%), 58 (7.9%) transfers, 7 (1.0%) refused participation, 8 (1.1%) were not yet on ARTand 22 (3.0%) could not be traced. Death by 12-months of follow-up was associated with lower CD4 cell counts (risk ratio, RR=2.05, confidence intervals, CI=1.20 - 3.49) and higher depression levels (RR=1.05, CI=1.01 - 1.09) at baseline assessment. The high early mortality rates indicate that patients are enrolling into ART programmes with far too advanced immunodeficiency; median CD4 cell counts 119 (IQR=59 - 163). Causes of late access to the ART programme, such as delays in health care access (delayed health care seeking), health system delays, or inappropriate treatment criteria, need to be addressed. Differences in health status (lower CD4 cell counts and higher depression scores) should be taken into account when initiating patients on ART. Treating depression at ART initiation is recommended to improve treatment outcome

Data Resource Profile: The World Health Organization Study on global AGEing and adult health (SAGE)

Population ageing is rapidly becoming a global issue and will have a major impact on health policies and programmes. The World Health Organization's Study on global AGEing and adult health (SAGE) aims to address the gap in reliable data and scientific knowledge on ageing and health in low- and middle-income countries. SAGE is a longitudinal study with nationally representative samples of persons aged 50+ years in China, Ghana, India, Mexico, Russia and South Africa, with a smaller sample of adults aged 18-49 years in each country for comparisons. Instruments are compatible with other large high-income country longitudinal ageing studies. Wave 1 was conducted during 2007-2010 and included a total of 34 124 respondents aged 50+ and 8340 aged 18-49. In four countries, a subsample consisting of 8160 respondents participated in Wave 1 and the 2002/04 World Health Survey (referred to as SAGE Wave 0). Wave 2 data collection will start in 2012/13, following up all Wave 1 respondents. Wave 3 is planned for 2014/15. SAGE is committed to the public release of study instruments, protocols and meta- and micro-data: access is provided upon completion of a Users Agreement available through WHO's SAGE website (www.who.int/healthinfo/systems/sage) and WHO's archive using the National Data Archive application (http://apps.who.int/healthinfo/systems/surveydata

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

Perceived stigma among patients receiving antiretroviral therapy: a prospective study in KwaZulu-Natal, South Africa

The aim of this study is to examine whether internalized AIDS stigma among HIV patients one year after antiretroviral therapy (ART) initiation is associated with sociodemographic characteristics, health status, social support, quality of life (QoL), and ARV adherence. This is a prospective study of all treatment-naive patients (N=735) recruited from all three public hospitals in Uthukela health district in KwaZulu-Natal and followed up at 6 and 12 months being on ART. Results indicated that despite a decrease in stigma seen in this study (may be due to ART) the level of stigma and discrimination remains high, and stigma reduction interventions are urgently needed in this population. CD4 cell counts significantly increased and HIV symptoms reduced significantly but depression symptoms remained high and even increased after 12 months on treatment. In multivariate analysis lower CD4 cell counts (odds ratio 0.5, 0.3-0.9), severe depression (5.6, 2.5-12.5) and low QoL (0.6, 0.5-0.8) were associated with internalized AIDS stigma. These findings may suggest that HIV care should include counseling and support that includes stigma concerns, depression, and QoL prior to and during the first year following diagnosis.

A look at sexual debut in South Africa: trends and current determinants of age at sexual debut among youth from three national studies between 2005-2012

Paper presented at the AIDS Impact Conference, Amsterdam, 28 July-1 Augus

Alcohol use trends in South Africa

The purpose of this review is to synthesize the prevalence data from five national surveys and local surveys on alcohol use in South Africa over the past 12 years. Systematic review. Results indicate that life time, current (past month) use and binge drinking remained similar over the years for both adolescents and adults. Binge drinking was between 7-11% and risky drinking also remained stable over the years (6%) with larger sex, geographic and racial differences. Risky drinking in pregnant women was 2.5% nationally but particularly high among urban dwellers (4.1%), Coloureds (11.6%) and in the Northern Cape province (24.9%). Local surveys among adolescents, university students, clinic populations and mine employees seem to all generally indicate higher levels of risky drinking than in the national surveys. The burden of alcohol was found to be high: Hazardous or harmful drinking and binge drinking were associated with multiple/indiscriminate (irregular) sex partners among persons living with HIV; alcohol related death in transport and homicide of 50% and fetal alcohol syndrome from 10-74 per 1000 in local surveys. Alcohol production/per capita remained stable with 8 litres but there is relatively high alcohol consumption considering an additional 3-4 litres unrecorded production/consumption, and that high amounts are consumed by a small population since most abstain from drinking in South Africa. Although no significant increase of alcohol use over the past 12 years was found, a high burden of alcohol abuse was found.

Cannabis use trends in South Africa

The purpose of this review is to synthesise cannabis use data from surveys, specialised alcohol and drug treatment centres, cannabis-related trauma unit admissions and arrestee studies over the past 12 years in South Africa. Results indicate that cannabis is the most common illicit substance used in South Africa, with particularly high use among the youth. Current self-reported cannabis use was 5 -10% among adolescents and 2% among adults, higher among men than women, higher in urban than rural areas, higher in the urban provinces of Western Cape and Gauteng than the other provinces and higher among coloureds and whites than other racial groups. Cannabis is commonly misused by trauma patients (29 - 59%) and is often associated with crime (39%). There has been an increase in seizures and treatment demand for cannabis. The current (2006) treatment demand for the whole country was 17% for cannabis and 3.4% for cannabis and mandrax (methaqualone), which has implications for treatment service delivery. Screening and brief intervention of substance (cannabis) use should be included in health care settings.