Browsing by Author "Wood, R"

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    Community health care workers in South Africa are at increased risk for tuberculosis
    (2010) Kranzer, Kathar; Bekker, Linda-Gail; van Schaik, N; Thebus, L; Dawson, M; Caldwell, J; Hausler, H; Grant, R; Wood, R
    Many sub-Saharan African countries face a severe shortage of qualified HCWs as a result of the dual HIV/TB epidemic, which has triggered task shifting to a range of lay community health care workers (CHWs) – for example, home-based care workers, lay counsellors and adherence supporters, for both TB and highly active antiretroviral therapy (HAART). CHWs may experience a considerable occupational TB risk; however, their risk of TB disease and HIV prevalence has never been documented.
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    Outcomes of the South African National Antiretroviral Treatment Programme for children: The IeDEA Southern Africa collaboration
    (2009) Davies, M; Keiser, O; Technau, K; Eley, B; Rabie, H; Van Cutsem, G; Giddy, J; Wood, R; Boulle, A; Egger, M; Moultrie, H
    Objectives: To assess paediatric antiretroviral treatment (ART) outcomes and their associations from a collaborative cohort representing 20% of the South African national treatment programme. Design and setting: Multi-cohort study of 7 public sector paediatric ART programmes in Gauteng, Western Cape and KwaZulu-Natal provinces. Subjects: ART-naïve children (≤16 years) who commenced treatment with ≥3 antiretroviral drugs before March 2008. Outcome measures: Time to death or loss to follow-up were assessed using the Kaplan-Meier method. Associations between baseline characteristics and mortality were assessed with Cox-proportional hazards models stratified by site. Immune status, virologic suppression and growth were also described by duration on ART. Results: The median (IQR) age of 6078 children with 9368 child-years of follow-up was 43 (15 – 83) months, with 29% being <18 months. Most were severely ill at ART initiation. More than 75% of children were appropriately monitored at 6-monthly intervals with viral load suppression (<400 copies/ml) being 80% or above throughout 36 months of treatment. Mortality and retention in care at 3 years were 7.7% (95%CI: 7.0% – 8.6%) and 81.4% (80.1% - 82.6%) respectively. Together with young age, all markers of disease severity (low weight-for-age z-score; high viral load; severe immune suppression, stage 3/4 disease and anaemia) were independently associated with mortality. Conclusions: Dramatic clinical benefit for children accessing the national ART programme is demonstrated. Higher mortality in infants and those with advanced disease highlights the need for early diagnosis of HIV infection and commencement of ART.
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    Quality of life of HIV-infected individuals in a community-based antiretroviral programme
    (BioMed Central Ltd, 2008) Pitt, Jennifer; Myer, Landon; Wood, R
    Purpose of the study: The impact of HAART on health-related quality of life (HRQoL) has been widely researched in the developed world, however, there is limited data coming out of the developing world and, in particular, sub-Saharan Africa, where the vast majority of HIV-infected individuals live. This study examined HRQoL among HIV-positive individuals initiating HAART at the Hannan Crusaid Treatment Centre in Gugulethu, Cape Town, and explored the impact of HAART-related drug toxicities on HRQoL. Methods: HRQoL was assessed using a standardised questionnaire, the Medical Outcomes Survey Short Form 36 (MOS SF36). Physical health summary (PHS) scores and mental health summary (MHS) scores were compared pre-HAART and at regular intervals during the first 48 weeks of HAART. The impact of drug toxicities on HRQoL was described and assessed both in unadjusted bivariate and adjusted multivariate analyses. Summary of results: This study reported a significant increase in HRQoL during the first 48 weeks on HAART with the bulk of this increase occurring during the first 16 weeks. Although there was a general improvement in HRQoL on HAART, 23% of participants reported a decline in PHS score, and 34% a decline in MHS score. Average drops in median PHS and MHS scores were 8.4 units (SD 9.31) and 9.9 units (SD 11.4), respectively. Eleven (4%) participants reported drug toxicity. Most toxicities (63%) occurred between weeks 32 and 48, and 73% were related to stavudine. Participants who experienced drug toxicity reported lower PHS scores than participants without a drug toxicity at all time points. However, only 27% (three) of participants with drug toxicity reported a decline in HRQoL between pre-HAART and week 48. Drug toxicities had little impact on MHS scores. Conclusion: This study confirmed the HRQoL benefits of HAART in a community ARV clinic in South Africa. While the majority of patients experienced a significant improvement in HRQoL on HAART, up to a third of patients reported declines in HRQoL. HAART-related drug toxicities (including those secondary to the use of stavudine) did not have a significant negative impact on HRQoL during the first 48 weeks of HAART supporting the ongoing use of stavudine in the national ARV roll-out programme.
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    Special Report on the State of HIV/AIDS in South Africa
    (2012) Navario, P; Bekker, L; Blecher, M; Darkoh, E; Hecht, R; McIntyre, J; Nattrass, N; Ramjee, G; Rees, H; Venter, F; Whiteside, A; Wolvaardt, G; Wood, R
    It is axiomatic that the global fight against HIV/AIDS cannot be won without a decisive victory in South Africa, home to 20 percent of all people living with HIV/AIDS. So how is South Africa doing? And what is the likelihood it will meet the demand for essential prevention and treatment interventions by 2015? On Jan. 21 in Cape Town, Council on Foreign Relations Global Health Fellow Dr. Peter Navario convened a meeting of South Africa's foremost HIV/AIDS thinkers, policy-makers and practitioners to discuss the state of prevention and treatment at the epicenter of the pandemic. In this article, the experts weigh in on program gaps, the major challenges to achieving universal coverage of essential prevention and treatment interventions, and what it will take to surmount these challenges.
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    The spectrum and prognosis of AIDS-defining illnesses in Cape Town
    (2005) Badri, M; Maartens, G; Bekker, L G; Wood, R
    Objectives. To describe the incidence, spectrum and prognosis of AIDS-defining illnesses (ADI) in patients without access to antiretroviral therapy (ART). Design. Prospective cohort study. Subjects. 1 215 HIV-infected patients attending adult HIV clinics affiliated to the University of Cape Town in the New Somerset and Groote Schuur Hospitals from 1992 to 2000. Main outcome measures. Incidence rate (IR) of ADIs and survival after the ...