Browsing by Subject "HAART"
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- ItemRestrictedFertility Intentions and Reproductive Health Care needs of People Living with HIV in Cape Town, South Africa: Implications for Intergrating reproductive Health and HIV Care Services(2009) Cooper, D D; Moodley, J R; Zweigenthal, V; Bekker, L; Shah, I; Myer, LTailoring sexual and reproductive health services to meet the needs of people living with the human immuno-deficiency virus (HIV) is a growing concern but there are few insights into these issues where HIV is most prevalent. This cross-sectional study investigated the fertility intentions and associated health care needs of 459 women and men, not sampled as intimate partners of each other, living with HIV in Cape Town, South Africa. An almost equal proportion of women (55%) and men (43%) living with HIV, reported not intending to have children as were open to the possibility of having children (45 and 57%, respectively). Overall, greater intentions to have children were associated with being male, having fewer children, living in an informal settlement and use of antiretroviral therapy. There were important gender differences in the determinants of future childbearing intentions, with being on HAART strongly associated with women’s fertility intentions. Gender differences were also apparent in participants’ key reasons for wanting children. A minority of participants had discussed their reproductive intentions and related issues with HIV health care providers. There is an urgent need for intervention models to integrate HIV care with sexual and reproduction health counseling and services that account for the diverse reproductive needs of these populations.
- ItemOpen AccessThe impact of HAART on the reproductive decision making process of HIV positive people in Zimbabwe in Bulawayo, Zimbabwe(2006) Ndlovu, VezumuziThis article explores how the advent of HAART has impacted the fertility plans of people with HIV/AIDS in Zimbabwe. It argues that HAART has had a significant impact on the outlook that HIV-positive people have on reproduction and health in general especially among those who intend to continue with childbearing. The results section presents responses from HIV-positive people who intend to continue with child bearing with regard to how the advent of HAART has impacted their views and decisions on this issue. The discussion evaluates, from a broader perspective, whether the views concerning HAART and reproduction expressed by those who intend to reproduce are justifiable. The article concludes that it is mainly the availability and efficacy of HAART that has motivated some HIV-positive people to continue pursuing their childbearing plans..
- ItemOpen AccessThe impact of highly active antiretroviral treatment (HAART) on employment in Khayelitsha(2007) Coetzee, CelesteThis paper examines the impact of Highly Active Antiretroviral Treatment (HAART) on labour force participation of people living with HIV/AIDS in Khayelitsha, South Africa. Cox Proportional Hazard Models with stratum effects for three medical clinics, and Accelerated Failure Time Models with individual specific unobserved shared effects (frailty), are estimated for transitions from inactivity to unemployment, and transitions from unemployment into employment, using a longitudinal data set. The findings of this study indicate that HAART leads to greater activity in the labour market, but there was not a strong effect on re-entry into employment.
- ItemRestrictedImproving the Efficiency of Monitoring Adherence to Antiretroviral Therapy: A Case Study of the Introduction of Electronic Technologies in Gugulethu, South Africa(2007) Wessels, Xanthe; Nattrass, Nicoli; Rivett, UlrikeThis paper presents a case study of the efficiency gains resulting from the introduction of electronic technologies to monitor and support adherence to highly active antiretroviral therapy (HAART) in Guguletu, South Africa. It suggests that the rollout of HAART to such resource-poor communities can be assisted significantly by the introduction of modified cellphones (to provide home based support to people on HAART and improve the management of adherence data) and simple barcoding and scanning equipment (to manage drug supplies). The cellphones have improved the management of information, and simplified the working lives of therapeutic counsellors, thereby enabling them to spend less time on administration and to devote a constant amount of time per patient even though their case loads have risen threefold. It has helped integrate the local-level primary health service provision of HAART with the kind of centralised data capture and analysis that could potentially support a national HAART rollout.
- ItemOpen AccessKeeping health staff healthy: evaluation of a workplace initiative to reduce morbidity and mortality from HIV/AIDS in Malawi(BioMed Central Ltd, 2011) Bemelmans, Marielle; van den Akker, Thomas; Pasulani, Olesi; Tayub, Nabila; Hermann, Katharina; Mwagomba, Beatrice; Jalasi, Winnie; Chiomba, Harriet; Ford, Nathan; Philips, MitBACKGROUND: In Malawi, the dramatic shortage of human resources for health is negatively impacted by HIV-related morbidity and mortality among health workers and their relatives. Many staff find it difficult to access HIV care through regular channels due to fear of stigma and discrimination. In 2006, two workplace initiatives were implemented in Thyolo District: a clinic at the district hospital dedicated to all district health staff and their first-degree relatives, providing medical services, including HIV care; and a support group for HIV-positive staff. METHODS: Using routine programme data, we evaluated the following outcomes up to the end of 2009: uptake and outcome of HIV testing and counselling among health staff and their dependents; uptake and outcomes of antiretroviral therapy (ART) among health staff; and membership and activities of the support group. In addition, we included information from staff interviews and a job satisfaction survey to describe health workers' opinions of the initiatives. RESULTS: Almost two-thirds (91 of 144, 63%) of health workers and their dependents undergoing HIV testing and counselling at the staff clinic tested HIV positive. Sixty-four health workers had accessed ART through the staff clinic, approximately the number of health workers estimated to be in need of ART. Of these, 60 had joined the support group. Cumulative ART outcomes were satisfactory, with more than 90% alive on treatment as of June 2009 (the end of the study observation period). The availability, confidentiality and quality of care in the staff clinic were considered adequate by beneficiaries. CONCLUSIONS: Staff clinic and support group services successfully provided care and support to HIV-positive health workers. Similar initiatives should be considered in other settings with a high HIV prevalence.
- ItemRestrictedModelling the relationship between antiretroviral treatment and HIV prevention: limitations of the Spectrum AIDS Impact Model in a changing policy environment(2007) Nattrass, NattrassThis paper shows how two publicly available epidemiological modelling packages, namely the Spectrum AIDS Impact Model and the ASSA2003 AIDS and Demographic Model, predict very different impacts from rolling out highly active antiretroviral treatment (HAART) on new HIV infections. Using South Africa as a case study, it shows that the ASSA2003 model predicts a significant drop in new HIV infections as HAART is rolled out, whereas the Spectrum model assumes that HAART does not have a preventative impact (and in fact generates a small increase in new HIV infections). Users will thus draw different conclusions about the public health benefits of HAART depending on which modelling package they use. Despite being presented as a policy-oriented modelling tool capable of exploring 'what if' questions about the impact of different policy choices, the Spectrum model is illequipped to do so with regard to a HAART rollout. Unlike Spectrum, ASSA2003 is more flexible and its assumptions are clear. Better modelling and more information (including about the relationship between HAART and sexual risk behaviour) is required to develop appropriate public-policy modelling for the HAART era.
- ItemRestrictedModelling the relationship between antiretroviral treatment and HIV prevention: The limits of Spectrum's AIDS Impact Model in a changing policy environment(National Inquiry Services Centre, 2007) Nattrass, NicoliThis paper shows how two publicly available epidemiological modelling packages, namely the Spectrum AIDS Impact Model and the ASSA2003 AIDS and Demographic Model, predict very different impacts from rolling out highly active antiretroviral treatment (HAART) on new HIV infections. Using South Africa as a case study, it shows that the ASSA2003 model predicts a significant drop in new HIV infections as HAART is rolled out, whereas the Spectrum model assumes that HAART does not have a preventative impact (and in fact generates a small increase in new HIV infections). Users will thus draw different conclusions about the public health benefits of HAART depending on which modelling package they use. Despite being presented as a policy-oriented modelling tool capable of exploring 'what if' questions about the impact of different policy choices, the Spectrum model is illequipped to do so with regard to a HAART rollout. Unlike Spectrum, ASSA2003 is more flexible and its assumptions are clear. Better modelling and more information (including about the relationship between HAART and sexual risk behaviour) is required to develop appropriate public-policy modelling for the HAART era.
- ItemOpen AccessThe neurobiology of HIV dementia: implications for practice in South Africa(OMICS International, 2011) Joska, J A; Hoare, J; Stein, Dan J; Flisher, A JIn this review, the neuropathogenesis of HIV dementia (HIV-D) is discussed in the context of the local epidemic. HIV-D continues to be prevalent in the era of highly active anti-retroviral therapy. HIV neuro-invasion into the central nervous system may result in the development of separate HIV genotypes in an individual through compartmentalisation. The blood brain barrier continues to limit penetration of anti-retroviral drugs into the cerebrospinal fluid. Individuals with active neuro-inflammation appear to respond well to HAART. In some cases low grade neuro-degeneration persists with consequent clinical deterioration. In South Africa, the emergence of a sub-epidemic of HIV-D is being driven by various factors, including the incomplete coverage of HAART to all who need it, the late stage presentation of people living with HIV/AIDS (PLWHA) and a co-occurring methamphetamine epidemic. Differences in viral subtype do not appear to confer protection against HIV-D. Implications for PLWHA who are at risk for HIV-D in South Africa are explored, with a view to providing suggestions for improving practice and research into this area.
- ItemRestrictedOfficial government justifications and public ARV provision: a comparison of Brazil, Thailand and South Africa.(2008) Mauchline, KerryThe 2001 Doha Declaration of the World Trade Organisation (WTO) confirmed the right of countries to override patents in the interest of public health (Ford, et al., 2007). Later resolutions from the WTO as well as from the United Nations (UN) reflected the emerging consensus that medicines required to treat pandemic illnesses are a basic human right (Galvao, 2005). International assistance with regard to the public provision of antiretroviral drugs (ARVs) has been closely associated with this shift, resulting in a new hope for the widespread treatment of AIDS. ARV drugs themselves have also undergone substantial technical development. Simpler, combined dosage formats and a greater range of suitable medications provide more options for short-course interventions (to prevent the transmission of HIV from mother to child) and for long-term treatment of AIDS with highly active antiretroviral therapy (HAART).
- ItemRestrictedThe (political) economics of antiretroviral treatment in developing countries(Elsevier, 2008) Nattrass, NicoliDespite unprecedented international mobilisation to support universal provision of highly active antiretroviral therapy (HAART), national governments continue to play the key role in determining access to treatment. Whereas some AIDS-affected countries have performed as well as or better than expected given their level of development, institutional characteristics and demographic challenges (e.g. Thailand and Brazil), others (notably South Africa) have not. This article argues that the 'economics' of antiretroviral drug delivery is at heart a political-economy of access to treatment. It depends on commitment on the part of national governments to negotiate with pharmaceutical companies over patented antiretroviral drug prices, on their policy towards compulsory licensing, and on the approach they adopt to delivering HAART. Civil society has an important role to play in encouraging governments to become, and remain, committed to taking action to ensure sustainable and widespread access to HAART.
- ItemOpen AccessThe quest for healing in South Africa's age of AIDS(Taylor & Francis, 2006) Nattrass, NicoliHighly Active Antiretroviral Therapy (HAART) is the most effective means of extending the lives of people living with AIDS – yet only 25% of those in South Africa estimated to need it are receiving HAART. Those who cannot access HAART (or choose not to take it) may opt to use ‘traditional’ healing instead. Some people will do both. This article reviews the emerging South African literature exploring the interface between biomedical and traditional healing in this age of AIDS. It includes a discussion of recent relevant biographies and books. Particular attention is paid to the contrasting experiences of Edwin Cameron who took HAART and continues to live a productive life, and Fana Khaba, who rejected HAART in favour of untested substances. The paper notes how the diagnosis of AIDS as being caused by witchcraft may have psychological benefits (it shifts blame and responsibility to others) it can also exacerbate social tensions and undermine the health of those living with AIDS. It is argued that the state has an obligation to provide information to AIDS patients about the best scientifically tested medications.
- ItemRestrictedReconstitution of antimycobacterial immune responses in HIV-infected children receiving HAART(2006) Kampmann, B; Tena, G; Nicol, MP; Levin, M; Eley, BSObjective: Recent epidemiological studies in adults suggest that HAART can prevent the development of tuberculosis in HIV-infected individuals, but the mechanisms are incompletely understood and no data exist in children. We investigated whether changes in mycobacterial-specific immune responses can be demonstrated in children after commencing antiretroviral therapy. Design: We measured mycobacterial growth in vitro using a novel whole-blood assay employing reporter-gene tagged bacillus Calmette–Guérin (BCG) in a prospective cohort study in the tuberculosis-endemic environment of South Africa. Key cytokines were measured in supernatants collected from the whole-blood assay using cytometric bead array. Patients: A cohort of 15 BCG-vaccinated HIV-infected children was evaluated prospectively for in-vitro antimycobacterial immune responses before and during the first year of HAART. All children had advanced HIV disease. Nine children completed all study timepoints. Results: Before HAART, blood from children showed limited ability to restrict the growth of mycobacteria in the functional whole-blood assay. The introduction of HAART was followed by rapid and sustained reconstitution of specific antimycobacterial immune responses, measured as the decreased growth of mycobacteria. IFN-γ levels in culture supernatants did not reflect this response; however, a decline in TNF-α was observed. Conclusion: This is the first study using a functional in-vitro assay to assess the effect of HAART on immune responses to mycobacteria in HIV-infected children. Our in-vitro data mirror the in-vivo observation of decreased susceptibility to tuberculosis in HIV-infected adults receiving antiretroviral agents. This model may be useful for further characterizing immune reconstitution after HAART.
- ItemOpen AccessThe role of HIV literacy: a community health worker perspective(2007) Wienand, AnnabelleHIV literacy has been emphasised as part of HIV/AIDS campaigns throughout the world. The South African Government’s allocation of past and present funding indicates substantial support for HIV/AIDS education with the emphasis on prevention. Commitment to the new HIV and AIDS and STI National Strategic Plan 2007-2011 for addressing the epidemic emphasises the importance of speeding up the delivery of HAART in South. The link between education and the provision of antiretroviral therapy lies in the need for patients to understand the nature of the HI virus and the way the medication works physiologically in order to ensure adherence, control side effects and provide the best care possible for people living with HIV/AIDS. This paper assesses the role of HIV literacy from the perspective of community health workers working in clinics in the Western Cape Province in South Africa. It looks at their daily interaction with clinic patients, as well as their experience of the HAART rollout. It aims to evaluate the impact of HIV literacy on the communities they work in and the limitations of education in supporting the provision of health care for people living with HIV/AIDS.
- ItemOpen AccessSexuality in patients with human immunodeficiency virus at Embhuleni hospital in Mpumalanga province(2013) de Vries, E; Gwyther, L; Mkhabela, MObjectives: This study explored issues of sexuality in people living with AIDS who were on highly active antiretroviral therapy (HAART). Design: This was a descriptive quantitative study. Data were collected with an administered questionnaire and entered in Excel®. Statistical analysis included frequency tables, summary statistics and 95% confidence intervals. Setting and subjects: The respondents were purposively sampled from the 850 patients attending the antiretroviral clinic at Embhuleni Hospital in Mpumalanga province. Outcome measures: The questionnaire included questions on sexual practices, number of partners, sexual experience and fertility wishes, comparing respondents’ experience before and after HAART. Results: There was a response rate of 100%, with 102 questionnaires completed. There was a significant difference between the responses to questions on sexual desire, sexual performance, sexual enjoyment and satisfaction regarding frequency of intercourse before and after HAART. Respondents reported a better sexual experience before HAART (t = 2.4387, p-value = 0.0165). There was a statistically significant difference between the number of partners before and after initiation of HAART (p-value = 0.000). Although 96% of respondents rated condom use as being very important, 11% never used condoms during sex and 21% indicated that they had had unprotected sex in the previous six months. Eighteen per cent of respondents said it was very important for them to have a child and 20% were planning to have a child in the future. A quarter of respondents had not disclosed their HIV status to their partners. The majority (95%) of respondents indicated that it was very important to them that health workers discussed their sexual needs with them. Conclusion: Sexuality in HIV is complex, with components described as the “Ps” of sexuality: practices, partners, pleasure, pressure and pain, procreation and power. In this study, participants reported a better sexual experience before HAART. Healthcare professionals need to develop the skills to discuss sexuality, intimacy and fertility wishes with patients. This discussion will enhance healthcare professionals’ understanding of patients’ experiences of their illness and should allow for a more effective patient-centred approach to care.
- ItemRestrictedSouth Africa's ''Rollout'' of Highly Active Antiretroviral Therapy: A Critical Assessment(Celia Braithwait, 2006) Nattrass, NicoliThe number of people on highly active antiretroviral therapy (HAART) in South Africa has risen from ,2000 in October 2003, to almost 200,000 by the end of 2005. Yet South Africa’s performance in terms of HAART coverage is poor both in comparison with other countries and the targets set by the government’s own Operational Plan. The public-sector HAART ‘‘rollout’’ has been uneven across South Africa’s nine provinces and the role of external assistance from NGOs and funding agencies such as the Global Fund and PEPFAR has been substantial. The National Treasury seems to have allocated sufficient funding to the Department of Health for a larger HAART rollout, but the Health Minister has not mobilized it accordingly. Failure to invest sufficiently in human resources— especially nurses—is likely to constrain the growth of HAART coverage.
- ItemOpen AccessSouth Africa's 'rollout' of highly active antiretroviral therapy: a critical assessment(2006) Nattrass, NicoliThe number of people on highly active antiretroviral therapy (HAART) in South Africa has risen from ,2000 in October 2003, to almost 200,000 by the end of 2005. Yet South Africa’s performance in terms of HAART coverage is poor both in comparison with other countries and the targets set by the government’s own Operational Plan. The public-sector HAART ‘‘rollout’’ has been uneven across South Africa’s nine provinces and the role of external assistance from NGOs and funding agencies such as the Global Fund and PEPFAR has been substantial. The National Treasury seems to have allocated sufficient funding to the Department of Health for a larger HAART rollout, but the Health Minister has not mobilized it accordingly. Failure to invest sufficiently in human resources— especially nurses—is likely to constrain the growth of HAART coverage.