Browsing by Subject "adherence"
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- ItemOpen AccessAdherence to antiretroviral treatment (ART) among HIV-infected pregnant women starting treatment immediately vs delayed: a cohort study(2016) Langwenya, Nontokozo; Myer, Landon; Phillips, TammyIntroduction: Use of highly effective antiretroviral drugs to eliminate new paediatric HIV infections is the keystone of all prevention of mother-to-child transmission (PMTCT) programmes. Time on antiretroviral treatment (ART) before delivery reduces maternal viral load and decreases the risk of transmission in utero, during labour and whilst breastfeeding. Currently, many PMTCT programmes across Africa initiate HIV-infected pregnant women on lifelong antiretroviral therapy (ART) on the first day of antenatal care ("same-day" initiation). However concerns have been raised regarding patient readiness and whether same-day initiation in pregnancy may contribute to subsequent ART non-adherence. Methods: As part of a larger study of ART in pregnancy, consecutive ART-eligible pregnant women making their first antenatal care (ANC) visit at a primary care facility in Cape Town, South Africa were enrolled into a prospective cohort between March 2013 and June 2014. Before July 2013, eligibility was based on CD4 cell count ≤350 cells/μL ("Option A"), with a 1-2 week delay from the first ANC visit to ART initiation; thereafter all women were eligible regardless of CD4 cell count ("Option B+") and typically offered ART on the same day as first ANC visit. All women received standardized counselling before starting a fixed-dose regimen. Study interviews were conducted separately from the ART service through one week postpartum with self-reported adherence from 30- day recall. Results: Among 625 consecutive ART-eligible women (median age, 28 years; median gestation, 21 weeks; 55% newly diagnosed with HIV), 72% of women started ART same-day; this proportion was higher under "Option B+" versus "Option A" (p< 0.001). Of those with adherence assessments data available (n=618), 29% reported at least one missed ART dose during pregnancy. Missed doses were reported more frequently among women with previous use of PMTCT (p=0.014), of younger age (p=0.029) and starting ART under Option B+ (p=0.019). In women initiating ART same-day, 31% reported a missed dose compared to 23% among women who delayed ART start following first ANC visit (odds ratio, 1.07; 95% CI: 0.61 – 1.88). This finding did not vary after adjustment for demographic and clinical measures, and was consistent when restricted to women with CD4 cell counts ≤350 cells/μL. Conclusions: These results suggest same-day ART initiation in pregnant women is not associated with increased non-adherence during the antenatal period. While these results are reassuring for ART programmes implementing "Option B+", further research is required to examine adherence over time, particularly postpartum.
- ItemOpen AccessCommon mental disorders and barriers to adherence to HIV medications among emerging adults living with HIV using healthcare services in Harare(2020) Saruchera, Emily Wendy; Schneider, Marguerite; Abas, Melanie; Madhombiro, MunyaradziBackground: Emerging adulthood (18 to 29 years old) is a critical age group in relation to the Human Immunodeficiency Virus (HIV) epidemic and to mental health. A major public health concern globally, in management of HIV, is that emerging adults have suboptimal antiretroviral therapy (ART) adherence, yet they are the largest group initiating ART. In addition, common mental disorders (CMDs), including depression and anxiety have their peak incidence during this period and they have been found to increase risk of non-adherence to ART. Those with CMDs may have different types of barriers than those without CMDs. Furthermore, those with CMDs might be more likely to have a greater number of barriers to adherence than those without because of the way symptoms of CMDs impact on memory, problem solving skills and concentration. Aims: The main aim of this study was to describe barriers to adherence to ART in emerging adults living with HIV with probable CMDs (i.e. depression and/or anxiety) and accessing HIV treatment at a government clinic in Harare, Zimbabwe, compared to emerging adults living with HIV without probable CMDs. The specific objectives were: a. to determine the prevalence of probable CMDs among emerging adults living with HIV, b. to describe the prevalence, severity and common barriers to ART adherence, measured using the 22-item Barriers to Adherence (BARTA scale) in emerging adults living with HIV with probable CMDs and to compare this with those without probable CMDs. Methods: A representative sample of 223 emerging adults aged 18 to 29 years were recruited in a crosssectional study using the random sampling technique. The Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7) and Barriers to Adherence Scale (BARTA scale) were used to assess probable depression, probable anxiety and barriers to adherence respectively. Data Analysis: Univariate Descriptive statistics were used to describe the socio-demographic, prevalence of probable CMDs, prevalence of barriers to adherence, overall median of total BARTA score (severity of barriers to ART adherence) for the whole sample and overall median number of barriers to ART adherence for the whole sample. Chi-square analyses were used to compare the prevalence of barriers (no barrier vs. at least one) between participants with and without probable CMDs. Non-parametric Wilcoxon rank-sum tests and Kruskal Wallis tests (for variables with more than two categories) were used to I. Compare the number of barriers to ART adherence between participants with and without a probable CMDs; II. Compare the severity of barriers to ART adherence between participants with and without probable CMDs, using overall scores on the BARTA scale III. Assess the relationship between demographic variables, HIV related variables, Substance Use Disorders (SUD) and total BARTA scores. Variables which were significantly associated with BARTA scores were entered into a negative binomial regression model, to assess the relationship between CMDs and severity of barriers to ART adherence, this time controlling for possible demographic confounding factors. Results: The prevalence of probable CMDs (i.e. probable depression and/or probable anxiety) was 33.2%. Specifically, 31.8% had probable depression and 16.1% had probable anxiety. Results: showed that 76.2 % of the sample experienced at least one barrier to ART adherence and that 94.5% of those with CMDs experienced at least one barrier to adherence compared to 67.1% of those without CMDs (p>0.001). We found a significant difference (U=-7.209, p<0.001) between the number of barriers experienced by participants with and without CMDs: participants with a CMD reported a greater number of barriers (median (md) =5, IQR=3-7) compared to those without CMDs (md= 1, IQR=0-4). A statistically significant difference was also found in total BARTA scores between participants with and without CMDs: participants with a CMD reported a greater BARTA score (md=7, IQR=4-12) compared to those without a CMD (md= 2, IQR=0-4; U=-7.415, p<0.001). The most frequent barriers reported by emerging adults living with HIV with probable CMDs were 'forgetting' (68.0%), 'thinking too much' (49.0%), 'having to take ART in front of others' (41.0%) and 'not having a reminder' (39.0%). The most frequent barriers for emerging adults living with HIV without probable CMDs were 'forgetting' (30%), 'not having medications with them' (21%), 'not wanting others to know their status' (20%) and 'not having a reminder' (19%). Although 'forgetting' and 'not having a reminder' were among the top barriers in both groups, those with probable CMDs reported them more frequently. Conclusion: This study has shown that firstly, CMDs and barriers to ART adherence are prevalent among emerging adults living with HIV. Secondly, emerging adults living with HIV with probable CMDs experience a high number of barriers to ART adherence and more severely than those without probable CMDs. Finally, emerging adults with CMDs reported barriers such as forgetting and not having a reminder more frequently than those without CMDs. This calls for routine screening for probable CMDs and barriers to ART adherence in HIV clinics. Furthermore, there is need to come up with tailored psychological interventions that can simultaneously treat CMDs and reduce barriers to ART adherence among emerging adults living with HIV.
- ItemOpen AccessCompliance with surgical antibiotic prophylaxis guidelines: a prospective descriptive study at a tertiary level hospital in Cape Town, South Africa(2020) Schuster, Delia; Piercy, Jenna; Fagan JohannesBackground: The aim of surgical antibiotic prophylaxis (SAP) is to prevent surgical site infection (SSI) by administering an appropriate antimicrobial agent perioperatively. However, SAP may be associated with adverse effects and incurs added costs. The primary objective of this prospective study is to establish whether clinicians are adhering to existing perioperative antibiotic prophylaxis guidelines in terms of indication, dosage and timing of SAP. Secondary objectives are to determine the proportion of patients receiving inappropriate antibiotics; and to evaluate correct practice concerning re-dosing and duration of SAP. Methods: A cross-sectional prospective audit of the anaesthetic records and prescription charts of surgical patients was conducted at Groote Schuur Hospital, a tertiary level teaching hospital in Cape Town, South Africa, over a period of one week. Data were collected by anaesthetists – blinded to the study objectives – and the investigators; then captured on Excel spread sheets and compared to existing SAP guidelines. Descriptive statistics and binary logistic regression were used for analysis. Results: Of the 192 patients consented, 180 questionnaires were completed for data analysis. The median age of participants was 44.5 years (IQR: 31.5-58), with a preponderance of females (58.7%). SAP was administered in 149 cases (82.8%) and withheld in 31 (17.2%). This was appropriate in 91.9% (137/149) and 77.4% (24/31) respectively. Twelve patients (6.7%) received inappropriate antibiotics and in seven (3.9%) it was inappropriately withheld. Of the 156 patients who should have received SAP, choice of drug was correct in 121 (77.6%), dosage in 110 (70.5%) and timing in 87 (55.8%). Absolute compliance was achieved in 44.4% (80/180). Errors were mostly related to timing, re-dosing and duration of SAP. Conclusion: Anaesthetists and surgeons at Groote Schuur Hospital demonstrate variable adherence to surgical antibiotic prophylaxis guidelines. Interventions aimed at improving compliance are warranted.
- ItemOpen AccessEvaluation of adherence to an evidence-based bundle of care for the treatment of staphylococcus aureus bacteraemia at Groote Schuur Hospital(2022) Gatley, Elizabeth M; Raubenheimer, PeterBackground Staphylococcus aureus bacteraemia (SAB) is associated with high hospital mortality. Improvements in outcome have been described with standardised bundles of care. Objectives To study adherence to a standardised bundle of care (BOC) recommendations using a consultation proforma, for all patients admitted with SAB to Groote Schuur hospital over a year. To describe in-hospital and 90-day mortality in these patients Methods A retrospective audit of all unsolicited infectious disease consultations for patients with SAB admitted to Groote Schuur hospital during 2018. Adherence to recommendations of a standard care bundle were audited. Results Eighty six patients were included; 61 (71%) with healthcare-associated infection and 25 (29%) with community associated infection. Over 80% of adherence to treatment recommendations was achieved regarding antibiotic (including vancomycin) usage, source control and use of echocardiography as required. In-hospital mortality was 16% while overall 90-day mortality was 18%, with only age an independent predictor of mortality. No association with adherence to the recommendations and outcome was seen. Conclusion Adherence to a simple BOC is good, when using standardised a proforma as a communication tool. SAB mortality may be reduced by such an approach.
- ItemOpen AccessFactors influencing adherence to dietary guidelines: a qualitative study on the experiences of patients with type 2 diabetes attending a clinic in Cape Town(Medical and Pharmaceutical Publications, 2014) Ebrahim, Z; De Villiers, A; Ahmed, TObjective: The purpose of this study was to explore the experiences of patients with type 2 diabetes mellitus attending the Groote Schuur Hospital Diabetes Clinic in relation to contextual factors that promote or impede adherence to nutrition care guidelines. Subjects and setting: Eight diabetic patients (four males and four females) attending the Groote Schuur Hospital Diabetes Clinic who were between 40-70 years old. Outcome measures: Qualitative analysis of factors influencing adherence to dietary guidelines. Method: An explorative study, using a qualitative approach with eight semi-structured interviews, was used. Patients were interviewed at the diabetes outpatient clinic in Cape Town. Semi-structured interviews were recorded and transcribed, and thereafter analysed using ATLAS/ti®. Results: Various themes as to what influences adherence to dietary guidelines emerged. An ecological analysis is offered to understand the different levels of influence on participants’ dietary behaviour. The main identified factors at individual level were motivation, individual knowledge, perceptions of moderation, self- responsibility, taste concept or cravings, and temptations. At small group (family and friends) level, family relations with the patients were identified as the main support system used to manage the diabetes. At the organisational or health systems level, long waiting times and the theme of seeing different doctors emerged as problematic factors, but overall, patients were satisfied with the clinic service. At community and policy level, culture and the cost of food were identified as key influential factors with regard to adherence to nutrition care guidelines. Conclusion: This study shows the usefulness of adopting an ecological model in identifying factors that influenced adherence to dietary guidelines by patients with type 2 diabetes. Some factors acted as enablers and others as barriers. These had an impact on patient adherence to nutrition care guidelines. These factors should be considered by diabetes educators, including dietitians and nurses and doctors, when planning treatment modalities for patients with type 2 diabetes mellitus.
- ItemOpen AccessFactors that influence the utilisation of ototoxicity monitoring services for patients on treatment for drug-resistant tuberculosis(2015) Nhokwara, Primrose Tinashe; Rogers, Christine; Ramma, LebogangMulti-drug resistance is increasingly becoming a challenge to tuberculosis control programmes globally. Treatment of multi-drug resistance tuberculosis (MDR-TB) includes aminoglycoside antibiotics which are known to cause hearing loss. Ototoxicity monitoring services are often provided to patients undergoing treatment for MDR-TB for early detection of ototoxic hearing loss to facilitate alerting the patients and relevant medical staff about the presence and progression of any hearing loss. Previously, models of managing patients with MDR-TB required mandatory hospitalization for at least 6 months. This made it relatively easy to monitor the hearing status of patients during their stay in the hospital. However, with recent introduction of policy guidelines that support management of patients with MDR-TB on an outpatients basis, ototoxicity monitoring for these patients will need to be reorganized to align with the new policy guidelines. The extent of the uptake of these services when patients are accessing them as outpatients is however, unknown. This study therefore aimed to describe the patterns of utilisation and explore the barriers and factors that facilitate the use of ototoxicity monitoring services when provided on an outpatient basis in the Cape Town Metropolitan area, Western Cape, South Africa.
- ItemOpen AccessImpact of immune reconstitution inflammatory syndrome on antiretroviral therapy adherence(2012) Nachega, Jean B; Morroni, Chelsea; Chaisson, Richard E; Goliath, Rene; Efron, Anne; Ram, Malathi; Maartens, GaryObjectiveWe determined the impact of immune reconstitution inflammatory syndrome (IRIS) on antiretroviral therapy (ART) adherence in a cohort of 274 human immunodeficiency virus (HIV)-infected South African adults initiating ART.MethodsWe carried out a secondary analysis of data from a randomized controlled trial of partially supervised ART in Cape Town, South Africa. Monthly pill count adherence, viral suppression (HIV viral load < 50 c/mL), and IRIS events were documented. Poisson regression was used to identify variables associated with ART adherence below the median in the first 6 months of ART.ResultsWe enrolled 274 patients: 58% women, median age 34 years, median CD4 count 98 cells/μL, 46% World Health Organization clinical stage IV, and 40% on treatment for tuberculosis (TB). IRIS and TB-IRIS developed in 8.4% and 6.6% of patients, respectively. The median cumulative adherence at 6 months for those with an IRIS event vs no IRIS was 95.5% vs 98.2% (P = 0.04). Although not statistically significant, patients developing IRIS had a lower 6-month viral load suppression than those without IRIS (68% vs 80%, P = 0.32). ART adherence below the median of 98% was independently associated with alcohol abuse (relative risk [RR] 1.5; 95% confidence interval [CI] 1.2–1.9; P = 0.003) and IRIS events (RR 1.7; 95% CI 1.2–2.2; P = 0.001).ConclusionAlthough IRIS events were associated with slightly lower adherence rates, overall adherence to ART remained high in this study population. Concerns about IRIS should not deter clinicians from early ART initiation.
- ItemOpen AccessA mixed methods study to explore the outcomes, experiences and perceptions of women who attended a new counselling model for HIV-positive pregnant women accessing antenatal services in Khayelitsha, Cape Town, South Africa(2016) Kirya, Viola; Stinson, KathrynObjectives: The aim of this study was to explore the experiences and perceptions of counsellors and patients towards a new counselling model for HIV-positive pregnant women on Option B+ at an antenatal clinic in South Africa and to describe the cohort of HIV-positive pregnant women who experienced the new counselling model. Methods: A mixed methods study design was employed. The quantitative data collection involved using retrospective cohort quantitative data of women that were initiated on Option B+ during the period of 1 October 2013 to 30 June 2014. The variables of interest included: age, gravidity, antiretroviral therapy initiation date, viral load result and number of counselling sessions completed. These were obtained from patient folders and from the Department of Health patient electronic health record. The data was analysed using STATA 12. The qualitative data involved semi-structured interviews of patients and counsellors who had experienced the counselling model. Results: The number of women who completed a total of 1, 2, 3 or 4 counselling sessions was 25%, 26%, 48% and 1% respectively. The percentage of women that were retained in care for more than 8 weeks postnatal was 53%. Of the women with VL results, 92% were virally suppressed. The Fisher's exact test showed a P-value of 0.05 at a level of significance of P ≤ 0.05. Therefore there is sufficient evidence to show that there is a positive association between the number of counselling sessions completed and number of postnatal days in care. The study also found that from the counselling, the women gained social support, knowledge about: antiretroviral therapy, HIV, drug side effects and infant feeding. Conclusion: The poor uptake of the counselling intervention includes poor communication, service delivery challenges and social factors. The main motivation for initiating ART and maintaining adherence to treatment was to protect the baby and as a result, some women maintained adherence despite not completing the counselling. Women valued the education that they received during the counselling sessions and this influenced their adherence. Psychosocial support from the counsellors and peers was found to be vital to the women and this highlighted the need to incorporate a support group for the pregnant women, as part of the intervention. The findings also suggest that when offering counselling interventions to pregnant women, a balance between psychosocial support, practical support and patient education needs to be struck. Finally, education of the community on the importance of counselling is important in order to improve the uptake of the counselling because interventions aimed at mothers do not always take into account the influence of the social environment on the uptake of the intervention.
- ItemOpen AccessStatins: Adherence and side-effects(South African Academy of Family Physicians, 2011) Blom, D JMany patients either do not adhere to, or fail to persist with, long-term lipid-lowering therapy. This unfavourable medication utilisation behaviour compromises potential treatment benefit. In retrospective studies, patients aged 50-65 had the highest adherence rates, while both younger and older patients had lower rates. Patients with pre-existing cardiovascular disease adhere better than those in primary prevention. Financial barriers may impair adherence. At the individual patient level, health beliefs, perceptions of own cardiovascular risk and need for medication, concerns about side-effects and inconvenience of treatment may influence adherence. In clinical trials, regular reminders to patients have been shown to improve adherence, but each patient will require an individually tailored treatment strategy. Myopathy is the most common clinically relevant adverse effect of statins. The clinical severity of statin myopathy is highly variable, ranging from mild muscle ache to rare instances of rhabdomyolysis. Risk factors for statin myopathy include age, statin dose, hypothyroidism, medications that inhibit statin metabolism, combined statin and fibrate therapy, and renal impairment. Alternative causes of myopathy should be excluded before muscular symptoms are ascribed to statins. The management of statin myopathy is guided by the severity of symptoms and the creatine kinase level. Potential management strategies include statin dechallenge and rechallenge, statin dose reduction, statin switching, non-daily dosing and use of alternative lipid-lowering agents, such as ezetimibe. Statins rarely cause severe liver disease. Mild liver enzyme elevations are seen relatively frequently in patients starting statins, but are usually not clinically important. Patients with persistently elevated liver enzymes should be investigated to determine the cause of liver disease. Patients with stable, well-compensated liver disease can be prescribed statins, provided they are closely monitored.
- ItemOpen AccessTravel and adherence to antiretroviral therapy among postpartum women living with HIV in South Africa: a cross-sectional study(2020) Mvududu, Rufaro; Phillips, TamsinIn sub-Saharan Africa, women are disproportionately affected by HIV. Sustained adherence to lifelong antiretroviral therapy (ART) is needed to ensure their own health and prevent transmission of HIV to their partners and their children. However, non-adherence to ART remains a substantial challenge with many associated risk factors. Travel is often reported in the qualitative literature as a barrier to ART adherence among women living with HIV, but few quantitative studies have explored this association. This research aimed to describe travel in the past year among mothers living with HIV in the Long-term Adherence and Care Engagement (LACE) study, to explore factors associated with travel, and to investigate the associations between travel and i) self-reported adherence, and ii) HIV viral load. Part A of this dissertation is the study protocol that introduces the need for this research and presents how the research will be carried out. Part B is a narrative literature review. The review summarises and synthesises existing research relating to HIV treatment and travel in sub-Saharan Africa, giving context to the dissertation. Part C is the journal “ready” manuscript. This section presents an analysis of data from the LACE study, a cross-sectional survey of women living with HIV approximately four years after they had started ART during pregnancy in Gugulethu, Cape Town. At the LACE study visit, data on short-term travel patterns (stayed away from home for 3 or more nights) in the past year and self-reported adherence in the past 30 days (using a validated three-item scale) were collected through structured questionnaires, and a blood specimen was tested for HIV viral load. Poisson regression models with robust standard errors were used to explore factors associated with travel (any versus none), self-reported adherence (100% versus <100%), and viral suppression (≤50 copies/mL). Results were reported as crude risk ratios (RR) and adjusted risk ratios (aRR) with 95% confidence intervals (CI). The results showed that among 353 women enrolled in the LACE study (mean age 32.6 years, 48% employed, 38% married/cohabiting, median 44 months postpartum) 23% (n=81) reported travelling in the past year. Of the women who travelled, most went to the Eastern Cape (90%) and travelled 1-2 times during the year (93%). Women who travelled were more likely to be married/cohabiting than women who had not travelled (aRR = 1.45; 95% Cl: 0.97 - 2.16). Only 9% of women who travelled (7 of 81) reported difficulty with ART adherence due to travel. Overall, 59% of women reported 100% adherence in the past 30 days: 52% of women who had travelled in the past year versus 61% of those who had not travelled (aRR = 0.83; 95% Cl: 0.66-1.04). Only 56% of the cohort were virally suppressed: 60% and 55% of those who had and had not travelled in the past year, respectively (aRR = 1.10; 95% Cl: 0.89-1.36). Travel in the past year was not significantly associated with self-reported adherence or viral suppression in crude or adjusted analyses. These results highlight that poor adherence and viremia were very common in this cohort of women, four years after starting ART in pregnancy. Almost a quarter of women reported travel in the past year but only a v few reported difficulties with adherence related to travel and we found no association between travel in the past year, self-reported adherence in the past 30 days or viremia. Further research is needed to understand adherence patterns during periods of travel and interventions are clearly needed to support women's long-term adherence to ART.
- ItemOpen AccessTreatment Failure and Adherence in Second- Line Patients(2012-10) Barnett, WhitneyResults from an interview and photo-based research study looking at barriers and facilitators to adherence for second-line patients.
- ItemOpen AccessWhy patients struggle with anti-retroviral treatment(2012-10) UCT Knowledge Co-opThis is a Public Health project. The recent increase of anti-retroviral treatment (ART) in public clinics in South Africa means that many more people have access to treatment. If patients become resistant to the standard ART package they are put on an alternative second-line ART; if that fails, there is no further public treatment option to control the HI virus. Yet, literature addressing facilitators and barriers to treatment adherence faced by patients on second-line ART is scarce.