Browsing by Author "Barnett, Whitney"

Now showing 1 - 4 of 4
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    Open Access
    Barriers to adherence in patients failing second-line antiretroviral treatment in a township in South Africa: a qualitative research study
    (2012) Barnett, Whitney; Colvin, Christopher J
    The recent scale-up of ART coverage in resource-limited settings has greatly improved access to treatment. However, literature indicates that patients on ART have high rates of non-adherence (32% to 67%), virological failure (5.2%, to 47%) and resistance to ARVs (5.4% to 80%). These patients are failing first- and second-line ART, leaving no treatment options for successful virus suppression. Yet, literature addressing facilitators and barriers faced by patients on secondline ART is scarce. This study examined factors affecting adherence to second-line ART from the perspective of clinic staff as well as second-line failure patients, assessing both individual and structural barriers. Research was conducted at a large primary-care clinic in Khayelitsha, a periurban township in Cape Town, South Africa. A literature review was conducted to present 1) rates of non-adherence, virological failure and resistance and 2) to present known facilitators & barriers faced by patients on ART, with a specific focus on second-line patients. The literature was found via PubMed and Cochrane Central Register of Controlled Trials (CENTRAL), with a preference for studies in low and middle income countries and those including second-line ART populations. The primary research used participants who were drawn from an MSF-run program to support patients failing second-line treatment.
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    Open Access
    Investigating associations between maternal mental health on wheeze through two years of age in a South African birth cohort study
    (2017) Macginty, Rae; Lesosky, Maia; Zar, Heather J; Stein, Dan J; Barnett, Whitney
    Background: Wheezing is one of the most common respiratory illnesses in children worldwide. Severe wheeze can result in significant morbidity, caregiver burden and increased health care costs. In addition, early childhood wheeze may be associated with reduced lung function, diminished airway responsiveness, increased risk of asthma in late childhood and subsequent respiratory disease including asthma in adulthood. This is particularly true in those experiencing recurrent wheeze episodes, which in the presence of viral respiratory tract infections, are believed to lead to asthma diagnosis. Thus, it is imperative to understand the risk factors for early childhood wheeze to reduce the increasing burden of respiratory illness. Recent research has seen a shift to maternal psychosocial risk factors and the impact these have on child respiratory health outcomes, such as wheeze. Various studies, largely conducted in High Income Countries (HIC), have found associations between antenatal or postnatal psychosocial risk factors, such as depression, psychological distress, and Intimate Partner Violence (IPV), and child wheeze and/or asthma diagnosis in early stages of life. However, these studies predominantly considered those in low-income urban regions that were predisposed to respiratory illnesses, including wheeze and asthma. Utilising the techniques and knowledge gained from previous studies, this research considers the relationship between antenatal or postnatal maternal psychosocial exposures and the onset and recurrence of child wheeze in a South African setting. In the study population used for this research, the reported prevalence of antenatal psychological distress and depression was 23% and 20%, respectively, while 34% of the women were exposed to antenatal IPV. Often those suffering from poor mental health in these contexts are not recognised and therefore remain untreated. In addition, service provision in these settings is also generally poor. The combination of low levels of social and psychiatric support, with unique political and socio-economic risk factors, may result in more persistent and severe forms of psychosocial exposure in Low Middle Income Countries (LMIC). Given the high prevalence of psychosocial risk factors, as well as the high prevalence of child wheeze, South Africa provides an excellent platform to investigate the association between maternal antenatal or postnatal psychosocial exposure and the development and recurrence of child wheeze in an LMIC context. Methods: The data used for this research was provided by the Drakenstein Child Health Study (DCHS), a prospective birth cohort study conducted in the Drakenstein region, a peri-urban region outside of Paarl in the Western Cape of South Africa. Pregnant women over 18 years old, between 20-28 weeks' gestation, living in the region were enrolled in a parent study, in order to investigate the epidemiology and aetiology of respiratory illnesses in children. The parent study considered various risk factors, including psychosocial risk factors such as maternal depression, psychological distress and IPV, which were measured antenatally and postnatally by validated questionnaires. In the context of this research, wheeze was considered to be present if it was identified during any routine study follow-up visit, as well as at an unscheduled lower respiratory tract infection (LRTI) episode visit during the first two years of life. Recurrent wheeze was defined as experiencing two or more episodes of wheeze in a 12-month period. Logistic regression was used to investigate the relationship between antenatal and postnatal psychosocial risk factors and child wheeze. Results: From the results, postnatal psychological distress and IPV were associated with experiencing at least one episode of child wheeze (adjusted OR = 2.10, 95% CI: 1.16-3.79 and 1.60, 95% CI: 1.11-2.29 respectively) and recurrent wheeze (adjusted OR = 2.33, 95% CI: 1.09- 4.95 and 2.22, 95% CI: 1.35-3.63 respectively), within the first two years of life. No associations were found between antenatal psychosocial risk factors and child wheeze. Of clinical covariates explored, maternal smoking and household smoke exposure, birth weight, gestational age, sex and population group were associated with the presence of wheeze. All of these clinical covariates, as well as alcohol consumption were associated with recurrent child wheeze. Conclusion: Maternal postnatal psychological distress and postnatal IPV had the strongest impact on predicting wheeze outcomes. These findings suggest that screening and treatment programs which address maternal postnatal psychosocial risk factors may lessen the burden of childhood wheeze in LMIC settings.
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    Open Access
    Maternal participant experience in a South African birth cohort study enrolling healthy pregnant women and their infants
    (BioMed Central, 2016-07-19) Barnett, Whitney; Brittain, Kirsty; Sorsdahl, Katherine; Zar, Heather J; Stein, Dan J
    Background: Critical to conducting high quality research is the ability to attract and retain participants, especially for longitudinal studies. Understanding participant experiences and motivators or barriers to participating in clinical research is crucial. There are limited data on healthy participant experiences in longitudinal research, particularly in low- and middle-income countries. This study aims to investigate quantitatively participant experiences in a South African birth cohort study. Methods: Maternal participant experience was evaluated by a self-administered survey in the Drakenstein Child Health Study, a longitudinal birth cohort study investigating the early life determinants of child health. Pregnant mothers, enrolled during the second trimester, were followed through childbirth and the early childhood years. Satisfaction scores were derived from the participant experience survey and quantitatively analyzed; associations between satisfaction scores and sociodemographic variables were then investigated using a linear regression model. Results: Data were included from 585 pregnant mothers (median age 26.6 years), who had participated in the study for a median time of 16 months. Overall participant satisfaction was high (median score 51/60) and associated with increased attendance of study visits. Reasons for participating were a belief that involvement would improve their health, their child’s health or the health of family and friends. Potential reasons for leaving the study were inconvenience, not receiving clinical or study results, and unexpected changes in study visits or procedures. Variables associated with higher overall satisfaction scores were no prior participation in research, higher socioeconomic status, less intensive follow-up schedules and having experienced stressful life events in the past year. Conclusions: Satisfaction scores were high and associated with increased visit attendance. Participants’ perceived benefits of study participation, most notably the potential for an improvement in the health of their child, were a significant motivator to enroll and remain in the study. The consistent theme of perceived health benefits as a motivator to join and remain in the study raises the question of whether participation in research results in actual improvements in health.
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    Treatment Failure and Adherence in Second- Line Patients
    (2012-10) Barnett, Whitney
    Results from an interview and photo-based research study looking at barriers and facilitators to adherence for second-line patients.