scholarly journals Barriers to tuberculosis and human immunodeficiency virus treatment guidelines adherence among nurses initiating and managing anti-retroviral therapy in KwaZulu-Natal and North West provinces

Curationis ◽  
2018 ◽  
Vol 41 (1) ◽  
Author(s):  
Lufuno Makhado ◽  
Mashudu Davhana-Maselesele ◽  
Jason E. Farley
Keyword(s):  
Human Immunodeficiency Virus ◽  
Treatment Guidelines ◽  
Resistance To Change ◽  
Care Providers ◽  
Adherence To Treatment ◽  
North West ◽  
Tb Treatment ◽  
Kwazulu Natal ◽  
Immunodeficiency Virus ◽  
Guidelines Adherence

Background: Nurses, as front-line care providers in the South Africa’s health care system, are called upon to deliver integrated interventions for tuberculosis and human immunodeficiency virus (TB and HIV) including nurse-initiated management of anti-retroviral therapy (NIMART) and anti-TB treatment. Adherence to treatment guidelines and factors associated with non-adherence to treatment guidelines among nurses remain under explored.Purpose: To explore and describe barriers to treatment guidelines adherence among nurses initiating and managing anti-retroviral therapy and anti-TB treatment in KwaZulu-Natal and North West provinces.Design: This study employed a qualitative exploratory descriptive design.Methods: Four semi-structured focus group interviews were conducted during 2014 each consisting of four to eight NIMART trained nurses. Audiotaped interviews were transcribed verbatim and analysed using Atlas T.I. software.Findings: During data analysis, two themes emerged: (1) NIMART trained nurses’ distress about TB and HIV guidelines adherence that is inclusive of lack of agreement with guidelines, poor motivation to implement guidelines, poor clinical support and supervision, resistance to change, insufficient knowledge or lack of awareness and (2) exterior factors inhibiting nurses’ adherence to treatment guidelines which incorporated organisational factors, guidelines-related factors and patient-related factors.Conclusion: This qualitative study identified that nurses have substantial concerns over guideline adherence. If NIMART trained nurses’ barriers inhibiting adherence to treatment guidelines cannot be remedied, patient outcomes may suffer and South Africa will struggle to meet the 90-90-90 targets.

scholarly journals A Narrative Review of Continuing Professional Development Needs for Pharmacists with Respect to Pre-exposure Prophylaxis (PrEP) for Human Immunodeficiency Virus (HIV)

Pharmacy ◽  
2020 ◽  
Vol 8 (2) ◽  
pp. 84 ◽  
Author(s):  
Kyle J. Wilby ◽  
Alesha J. Smith
Keyword(s):  
Professional Development ◽  
Human Immunodeficiency Virus ◽  
Patient Care ◽  
Treatment Guidelines ◽  
Continuing Professional Development ◽  
Care Providers ◽  
Manual Search ◽  
Immunodeficiency Virus ◽  
High Risk Populations ◽  
Exposure Prophylaxis

Pre-exposure prophylaxis (PrEP) for the human immunodeficiency virus (HIV) is rapidly increasing in use worldwide, with many countries now publicly funding use for high risk populations. Pharmacists, as front-line care providers, must have the necessary knowledge, skills and attitudes to effectively provide care to PrEP patients. The aim of this review was to identify priority areas and key gaps for continuing professional development (CPD) needs relating to PrEP for practicing pharmacists. An electronic search of PubMed, EMBASE, International Pharmaceutical Abstracts and CPD-related journals was supplemented with a manual search of references to identify articles describing pharmacists’ knowledge, perceptions and experience with PrEP. A total of eight articles were identified across four countries. Pharmacists were consistently found to lack knowledge and awareness of PrEP, express low confidence/comfort with patient care practices, report a lack of experience and/or intentions to provide patient care, but overall had positive perceptions of PrEP therapy. Older pharmacists with more experience commonly reported greater knowledge gaps than recently trained pharmacists. CPD should therefore aim to increase pharmacists’ baseline knowledge and awareness of PrEP and treatment guidelines, as well as be directed towards older pharmacists with more experience.

scholarly journals Risk Factors for Unfavorable Treatment Outcomes among the Human Immunodeficiency Virus-Associated Tuberculosis Population in Tashkent City, Uzbekistan: 2013–2017

2021 ◽  
Vol 18 (9) ◽  
pp. 4623
Author(s):  
Sherali Massavirov ◽  
Kristina Akopyan ◽  
Fazlkhan Abdugapparov ◽  
Ana Ciobanu ◽  
Arax Hovhanessyan ◽  
...  
Keyword(s):  
Risk Factors ◽  
Human Immunodeficiency Virus ◽  
Treatment Outcomes ◽  
Sputum Smear ◽  
People Living With Hiv ◽  
Tb Treatment ◽  
Cell Counts ◽  
Cd4 Cell Counts ◽  
Immunodeficiency Virus ◽  
Positive Sputum Smear

Tuberculosis (TB) and human immunodeficiency virus (HIV) co-infection poses a growing clinical challenge. People living with HIV have a higher chance of developing TB, and once the disease has progressed, are at greater risk of having unfavorable TB treatment outcomes. Data on TB treatment outcomes among the HIV-associated TB population in Uzbekistan are limited. Thus, we conducted a cohort study among 808 adult patients with HIV-associated TB registered at the Tashkent TB referral hospital from 2013–2017 to document baseline characteristics and evaluate risk factors for unfavorable TB treatment outcomes. The data were collected from medical records and ambulatory cards. About 79.8% of the study population had favorable treatment outcomes. Antiretroviral therapy (ART) coverage at the admission was 26.9%. Information on CD4-cell counts and viral loads were largely missing. Having extrapulmonary TB (aOR 2.21, 95% CI: 1.38–3.53, p = 0.001), positive sputum smear laboratory results on admission (aOR 1.62, 95% CI: 1.07–2.40), diabetes (aOR 5.16, 95% CI: 1.77–14.98), and hepatitis C (aOR 1.68, 95% CI: 1.14–2.46) were independent risk factors for developing unfavorable TB treatment outcomes. The study findings provide evidence for targeted clinical management in co-infected patients with risk factors. Strengthening the integration of TB/HIV services may improve availability of key data to improve co-infection management.

scholarly journals Impact of Next-generation Sequencing Defined Human Immunodeficiency Virus Pretreatment Drug Resistance on Virological Outcomes in the ANRS 12249 Treatment-as-Prevention Trial

2018 ◽  
Vol 69 (2) ◽  
pp. 207-214 ◽  
Author(s):  
Anne Derache ◽  
Collins C Iwuji ◽  
Kathy Baisley ◽  
Siva Danaviah ◽  
Anne-Geneviève Marcelin ◽  
...  
Keyword(s):  
Human Immunodeficiency Virus ◽  
Clinical Trials ◽  
Transcriptase Inhibitor ◽  
Hiv Positive ◽  
Treatment As Prevention ◽  
Kwazulu Natal ◽  
Immunodeficiency Virus ◽  
Virological Outcomes ◽  
Reverse Transcriptase Inhibitor ◽  
Generation Sequencing

Abstract Background Previous studies in human immunodeficiency virus (HIV)-positive individuals on thymidine analogue backbone antiretroviral therapy (ART) with either nevirapine or efavirenz have suggested poorer virological outcomes in the presence of pretreatment drug resistance (PDR). We assessed the impact of PDR on virological suppression (VS; <50 copies/mL) in individuals prescribed primarily tenofovir/emtricitabine/efavirenz in rural KwaZulu-Natal within a treatment-as-prevention trial. Methods Among 1557 HIV-positive individuals who reported no prior ART at study entry and provided plasma samples, 1328 individuals with entry viral load (VL) >1000 copies/mL had next-generation sequencing (NGS) of the HIV pol gene with MiSeq technology. Results were obtained for 1148 individuals, and the presence of PDR was assessed at 5% and 20% detection thresholds. Virological outcome was assessed using Cox regression in 837 of 920 ART initiators with at least 1 follow-up VL after ART initiation. Results PDR prevalence was 9.5% (109/1148) and 12.8% (147/1148) at 20% and 5% thresholds, respectively. After a median of 1.36 years (interquartile range, 0.91–2.13), mostly on fixed-dose combination tenofovir/emtricitabine/efavirenz, presence of both nonnucleoside reverse transcriptase inhibitor (NNRTI)/nucleoside reverse transcriptase inhibitor PDR vs no PDR was associated with longer time to VS (adjusted hazard ratio [aHR], 0.32; 95% confidence interval [CI], 0.12–0.86), while there was no difference between those with only NNRTI PDR vs no PDR (aHR, 1.05; 95% CI, 0.82–1.34) at the 5% threshold. Similar differences were observed for mutations detected at the 20% threshold, although without statistical significance. Conclusions NGS uncovered a high prevalence of PDR among participants enrolled in trial clinics in rural KwaZulu-Natal. Dual-class PDR to a mainly tenofovir/emtricitabine/efavirenz regimen was associated with poorer VS. However, there was no impact of NNRTI PDR alone. Clinical Trials Tegistration NCT01509508; South African National Clinical Trials Register: DOH-27-0512-3974.

scholarly journals Factors facilitating trained NIMART nurses’ adherence to treatment guidelines: A vital matter in the management of TB/HIV treatment in South Africa

2020 ◽  
Author(s):  
LUFUNO MAKHADO ◽  
Mashudu Davhana-Maselesele ◽  
Rachel Tsakani Lebese ◽  
Sonto Maria Maputle
Keyword(s):  
South Africa ◽  
Treatment Guidelines ◽  
Behavioural Change ◽  
Hiv Treatment ◽  
World Health ◽  
Adherence To Treatment ◽  
African Region ◽  
Continuous Training ◽  
North West ◽  
Training Support

Abstract Background: Globally, the burden of tuberculosis or human immunodeficiency virus (TB/HIV) is at 24% and this alarming rate compelled the World Health Organization (WHO) to declare the African region as a critical workforce shortage area. To facilitate adherence to treatment guidelines, WHO recommended a strategy of task shifting for countries with high health workforce shortages. The strategy aimed at the redistribution of health care tasks to available workers. The study aimed to determine the factors facilitating nurse-initiated management of antiretroviral therapy (NIMART) trained nurses’ adherence to TB/HIV treatment guidelines. Methods: The study employed an exploratory-descriptive design. The study was conducted in Ugu and Ngaka Modiri Molema Districts of KwaZulu-Natal (KZN) and North West (NW) Provinces of South Africa. The population comprised of 24 participants who were purposively selected. The in-depth focus group discussions were conducted and ATLAS T.I. was used for data analysis following the basic steps of notice-collect-think (NCT) analysis. Trustworthiness and adherence to ethics were ensured. Results: The singular theme of factors facilitating NIMART trained nurses’ adherence to treatment guidelines which included positive attitudinal needs and positive behavioural change emerged from raw data. Conclusion: Continuous training, support supervision, and improved relationships with colleagues need to be enhanced to enable NIMART trained nurses to adhere to treatment guidelines.

Head and neck tuberculosis in KwaZulu-Natal, South Africa

2014 ◽  
Vol 128 (1) ◽  
pp. 86-90 ◽  
Author(s):  
Z B Khuzwayo ◽  
T K Naidu
Keyword(s):  
South Africa ◽  
Human Immunodeficiency Virus ◽  
Head And Neck ◽  
Cervical Lymphadenopathy ◽  
Neck Region ◽  
Cervical Lymphadenitis ◽  
Kwazulu Natal ◽  
Immunodeficiency Virus ◽  
Normal Chest ◽  
Chest X Ray

AbstractObjective:To describe the clinical features of head and neck tuberculosis in KwaZulu-Natal, South Africa.Study design:Retrospective, observational study.Method:The study included 358 patients who received a histopathologically and/or microbiologically confirmed diagnosis of tuberculosis in the head and neck region between 1 January 2007 and 31 December 2011.Results:A total of 358 new cases of head and neck tuberculosis were identified during the study period, involving 196 males (54.7 per cent) and 162 females (45.3 per cent). These patients had a median age of 31 years (range, 3 months to 83 years). Testing for human immunodeficiency virus was positive in 233 (65.1 per cent) and negative in 125 (34.9 per cent). Right-sided cervical lymphadenitis was the commonest form of presentation of head and neck tuberculosis.Conclusion:In this study, right-sided cervical lymphadenopathy was the commonest presentation of head and neck tuberculosis in both human immunodeficiency virus infected and non-infected individuals. Head and neck tuberculosis should not be excluded solely based on a normal chest X-ray, nor on the absence of constitutional symptoms.

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