What have we learnt from the last ten years of ART?

No Abstrac

The natural history of HIV infection

No Abstract

Thai me up, Thai me down — The XV IAS Conference in Bangkok

No Abstract Southern African Journal of HIV Medicine Vol. 5(3) 2004: 28-3

Low-dose stavudine trials: A public health piority for developing countries

No Abstract

Forum: Enabling HIV self-testing in South Africa

In a South African context, we consider the implications of the United States Food and Drug Administration’s recent approval of the OraQuick HIV self-testing kit. We argue that current law and policy inhibit the roll-out of accurate and well-regulated self-testing kits, and create a loophole for sale in supermarkets, but not pharmacies

New antiretrovirals: What\'s in it for southern Africa

The rise of novel antiretrovirals (ARVs) has introduced a new evolutionary phase in HIV care. In developed countries, the 1980s and early 1990s were characterised by palliative care and opportunistic infection prophylaxis; the late 1990s by an attempt to use a limited and toxic antiretroviral arsenal effectively while cycling through high levels of resistance; and finally, the first half of this decade by working out the easiest-to-take regimens, using the steadily rising number of safer drugs. At present, there are 8 nucleoside analogues (NRTIs), 3 non-nucleoside analogues (NNRTIs), 10 protease inhibitors (PIs), and one each of the fusion, entry and integrase inhibitors to choose from, along with a new drug pipeline that targets both existing and new targets in the viral replicative cycle. The choice may seem quite vast, but the reality is that many of these drugs cannot be used simultaneously or in patients with extensive drug resistance. In addition, some drugs have unacceptable toxicities and are not favoured in current treatment regimens. Southern African Journal of HIV Medicine Vol. 9 (4) 2008: pp. 44-4

Symptomatic hyperlactataemia in adults on anti-retroviral therapy: A single centre experience

Objective. There are limited data on symptomatic hyperlactataemia caused by antiretroviral therapy (ART) in resource-limited settings. We assessed individuals who developed symptomatic hyperlactataemia on ART in an outpatient clinic in South Africa. Design. A retrospective record review was performed on patients attending the clinic from January 2004 to December 2005. Results. Thirty-five patients, all on stavudine-containing regimens, developed symptomatic hyperlactataemia. The incidence in this population was 20.5 cases per 1 000 personyears of ART with an associated mortality of 21%. The major risk factor was being female (risk ratio (RR) 3.27). Significant clinical symptoms preceding symptomatic hyperlactataemia include nonspecific gastrointestinal symptoms, weight loss, and development of symptomatic neuropathy. Conclusions. The incidence of symptomatic hyperlactataemia in our population was high. Simple clinical measures, such as neuropathy symptoms and monitoring of weight, may alert the clinician to impending symptomatic hyperlactataemia. Early diagnosis expedites safe outpatient care and switching of ART regimens without interruption, in many cases. South African Medical Journal Vol. 98 (10) 2008: pp. 795-80

Healthcare for truck drivers: Assessing accessibility and appropriateness of South African Roadside Wellness Centres

Background Truck drivers occupy a pivotal role in the economies of southern Africa, due to limited rail, water and other forms of transport of goods. The occupational nature of truck driving limits access to healthcare. North Star Alliance (North Star) offers a tailored primary healthcare service for truck drivers along the sub-Saharan trucking corridor. Objectives The overall objective of this study was to explore truck drivers’ views regarding access to, and appropriateness of, selected South African North Star Roadside Wellness Centres (RWCs) coupled with understanding their health-seeking behaviour. Methods We conducted semi-structured interviews with two groups of purposively-sampled truck drivers: 24 who accessed North Star RWCs and 22 who knew about the centres but did not use them. The interviews explored access, health-seeking behaviour, and healthcare experiences. Additional information on risk perceptions emerged. Qualitative data were organised into four themes: client satisfaction, health-seeking behaviour, risk perception and behaviour, and service delivery strengthening. Results The majority of those interviewed were older (36–65 years old), South African, with secondary education, employed full-time, in stable relationships, and having children. Overall users were satisfied with RWC locations, operating hours, infrastructure, and healthcare worker attitudes. Half of the non-users did not access routine healthcare anywhere. Non-users primarily did not access the RWCs because they did not know the operating times and preferred local facilities. Both groups used traditional healers and pharmacies. RWC users accessed traditional healers and pharmacies for services not available to them at the RWCs. Both groups reported not using private general practitioners or specialists. Both groups provided recommendations for strengthening the service delivery model including an increased focus on non-communicable diseases and occupationally-required health services including vaccinations. Conclusion Comprehensive care packages delivered through accessible satellite facilities should form the foundation of service delivery models for truck drivers and other mobile populations

The prevalence of smoking and the knowledge of smoking hazards and smoking cessation strategies among hiv positive patients in johannesburg, south africa

Background: While the detrimental effects of smoking among HIV positive patients have been well documented, there is a paucity of data regarding cigarette smoking prevalence among these patients in South Africa. Objectives: To establish the frequency, demographics, and knowledge of harmful effects and of smoking cessation strategies among HIV-positive patients in Johannesburg, South Africa. Methods: A prospective cross-sectional survey, using a structured questionnaire interview, of HIV-positive patients attending the HIV Clinic at the Charlotte Maxeke Johannesburg Academic Hospital between 1 July 2011 and 31 October 2011. Results: Of 207 HIV positive patients attending an ARV roll-out clinic, 31 (15%) were current smokers (23% of the males and 7.5% of the females) and a further 45 (21.7%) were ex-smokers. Most of the current smokers (30/31 patients) indicated their wish to quit smoking, and among the group as a whole most patients were aware of the general (82.5%) and HIV-related (77.8%) risks of smoking and of methods of quitting smoking. Despite this, however, most (61.8%) were not aware of whom they could approach for assistance and advice. Conclusions: Given the relatively high prevalence of current and ex-smokers amongst HIV positive patients there is a need for the introduction of smoking cessation strategies and assistance at HIV-rollout clinics in South Africa

Quality of counselling and support provided by the South African National AIDS Helpline: Content analysis of mystery client interviews

Background. Telephone helplines can facilitate referral, education and support for patients living with HIV or those concerned about the infection. The anonymity of helplines facilitates discussion of sensitive issues that are difficult to raise face to face. These services could support the expansion of HIV self-testing. However, maintaining quality and standardising messages in rapidly evolving fields such as HIV is challenging. Objectives. To evaluate the quality of the South African (SA) National AIDS Helpline. Methods. Mystery clients posing as members of the public made 200 calls to the service in 2014. They presented several scenarios, including having received HIV-positive results from a doctor’s secretary or through self-testing. Following the call, ‘clients’ completed a semistructured questionnaire on the information received and the caller-counsellor interaction. Results. Calls were answered within a median of 5 seconds (interquartile range 2 - 14). Conversations took place in 8 of the 11 SA official languages, though mainly in English. Overall, 75% of callers felt that with the information they received they could locate a nearby clinic for further services. Counsellors expressed appropriate levels of concern about inadequate counselling that callers had received and confidentiality breaches in some scenarios. Eight counsellors incorrectly mentioned the need for a waiting period to confirm a positive result. Consistent with policy, almost all said that being foreign would not affect HIV treatment access. About 90% explained the need for CD4+ testing and antiretroviral therapy, but only 78% discussed HIV prevention. Counsellors were mostly empathetic (83%), though some adopted a neutral tone (10%) or were brusque (6%) or unhelpful (2%). Conclusions. Overall, helpline counsellors were proficient at providing information about local clinics, HIV testing and steps needed for initiating ART. Dissatisfaction with the caller-counsellor interactions, instances of incorrect information and the relatively low attention accorded to HIV prevention are worrying, however. Training for both refreshing and updating knowledge, and supervision and monitoring of calls, could target these areas.S Afr Med J 2018;108(7):596-60