Epidemiological impact of HIV on second - line drug resistance in patients with multidrug resistant tuberculosis in high HIV prevalent settings in South Africa

Read abstract on the attached document.Dissertation (MSc)--University of Pretoria, 2014.lk2014School of Health Systems and Public Health (SHSPH)MScUnrestricte

Teachers becoming lay practitioners of school community psychology

This article reports on a study that explored how a community-based intervention with ten teachers could enhance their knowledge and skills related to supporting community members coping with HIV/ AIDS. We conducted a case study using participatory action research methods. Individual interviews, observation, field notes, visual data and reflective journals were utilised as data sources. We found that the participating teachers displayed a willingness to support their community in coping with HIV/AIDS, yet did not perceive themselves as being adequately equipped to do so, and therefore refrained from acting intuitively. The intervention did, however, show signs of an emergent sense of ‘becoming’ lay practitioners in the face of the social upheaval brought on by the pandemic

Serious treatment related adverse drug reactions amongst anti-retroviral naïve MDR-TB patients.

BACKGROUND: Globally treatment outcomes for multidrug-resistant Mycobacterium tuberculosis (MDR-TB) remain poor and this is compounded by high drug toxicity. Little is known about the influence of adverse drug reactions (ADRs) on treatment outcomes in South Africa. METHODS: We evaluated the impact of severe ADRs among a prospective cohort of MDR-TB patients in South Africa (2000-2004). The HIV-infected study participants were anti-retroviral naïve. RESULTS: Of 2,079 patients enrolled, 1,390 (66.8%) were included in this analysis based on known HIV test results (39.1% HIV-infected). At least one severe ADR was reported in 83 (6.9%) patients with ototoxicity being the most frequent ADR experienced (38.9%). CONCLUSIONS: We found that being HIV-infected but antiretroviral naïve did not increase occurrence of SADRs in patients on second-line anti-tuberculosis drugs. Early screening and proactive management of ADRs in this patient population is essential, especially given the rollout of decentralized care and the potential for overlapping toxicity of concomitant MDR-TB and HIV treatment

Frequency of Serious Adverse Drug Reactions by HIV status and months of treatment.

<p>Frequency of Serious Adverse Drug Reactions by HIV status and months of treatment.</p

Baseline Demographic and Clinical Characteristics of patients with and without Serious Adverse Drug Reactions (SADR), N = 1390.

<p>Baseline Demographic and Clinical Characteristics of patients with and without Serious Adverse Drug Reactions (SADR), N = 1390.</p

Study plan stratified by HIV status.

<p>Study plan stratified by HIV status.</p

Adherence to Concurrent Tuberculosis Treatment and Antiretroviral Treatment among Co-Infected Persons in South Africa, 2008-2010.

BACKGROUND:Adherence to tuberculosis (TB) treatment and antiretroviral therapy (ART) reduces morbidity and mortality among persons co-infected with TB/HIV. We measured adherence and determined factors associated with non-adherence to concurrent TB treatment and ART among co-infected persons in two provinces in South Africa. METHODS:A convenience sample of 35 clinics providing integrated TB/HIV care was included due to financial and logistic considerations. Retrospective chart reviews were conducted among persons who received concurrent TB treatment and ART and who had a TB treatment outcome recorded during 1 January 2008-31 December 2010. Adherence to concurrent TB and HIV treatment was defined as: (1) taking ≥80% of TB prescribed doses by directly observed therapy (DOT) as noted in the patient card; and (2) taking >90% ART doses as documented in the ART medical record during the concurrent treatment period (period of time when the patient was prescribed both TB treatment and ART). Risk ratios (RRs) and 95% confidence intervals (CIs) were used to identify factors associated with non-adherence. RESULTS:Of the 1,252 persons receiving concurrent treatment, 138 (11.0%) were not adherent. Non-adherent persons were more likely to have extrapulmonary TB (RR: 1.71, 95% CI: 1.12 to 2.60) and had not disclosed their HIV status (RR: 1.96, 95% CI: 1.96 to 3.76). CONCLUSIONS:The majority of persons with TB/HIV were adherent to concurrent treatment. Close monitoring and support of persons with extrapulmonary TB and for persons who have not disclosed their HIV status may further improve adherence to concurrent TB and antiretroviral treatment

Study Population Included in TB/HIV Concurrent Treatment Analysis, 2008–2010.

<p>Study Population Included in TB/HIV Concurrent Treatment Analysis, 2008–2010.</p

Multivariate analysis of the relationship between characteristics of persons receiving concurrent TB/HIV treatment in selected THAT’SIT clinics and non-adherence to concurrent TB and HIV treatment (N = 1252).

<p>TB = tuberculosis, HIV = human immunodeficiency virus.</p

Demographic, clinical, and social characteristics of patients receiving concurrent TB/HIV treatment in selected THAT’SIT clinics, South Africa, 2008–2010 (N = 1,252).

<p>BMI = body mass index; TB = tuberculosis; IRZE = isoniazid, rifampin, pyrazinamide, ethambutol; DOT = directly observed therapy; WHO = World Health Organization; HIV = human immunodeficiency virus; ARV = antiretroviral; D4T/3TC/EFV = stavudine, lamivudine, efavirenz; D4T/3TC/NVP = stavudine, lamivudine, nevirapine.</p