Development of an antiretroviral solid dosage form using multivariate analysis
- Authors: Nqabeni, Luxolo
- Date: 2007
- Subjects: Analysis of variance , Experimental design , Multivariate analysis , Antiretroviral agents -- South Africa
- Language: English
- Type: Thesis , Masters , MSc
- Identifier: vital:10145 , http://hdl.handle.net/10948/705 , Analysis of variance , Experimental design , Multivariate analysis , Antiretroviral agents -- South Africa
- Description: The aim of pharmaceutical development is to design a quality product and the manufacturing process to deliver the product in a reproducible manner. The development of a new and generic formulation is based on a large number of experiments. Statistics provides many tools for studying the conditions of formulations and processes and enables us to optimize the same while being able to minimize our experimentation. The purpose of this study was to apply experimental design methodology (DOE) and multivariate analysis to the development and optimization of tablet formulations containing 150 mg lamivudine manufactured by direct compression.
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- Date Issued: 2007
Disclosure of HIV status and adherence to antiretroviral therapy
- Authors: Kubashe, Nomachina Theopatra
- Date: 2009
- Subjects: HIV-positive persons -- South Africa , Self-disclosure -- South Africa , Antiretroviral agents -- South Africa
- Language: English
- Type: Thesis , Masters , MPharm
- Identifier: vital:10142 , http://hdl.handle.net/10948/1174 , HIV-positive persons -- South Africa , Self-disclosure -- South Africa , Antiretroviral agents -- South Africa
- Description: The Human Immunodeficiency Virus (HIV)/Acquired Immune Deficiency Syndrome (AIDS) is one of the leading chronic diseases affecting people in South Africa and throughout the world. This study aimed to investigate the effect disclosure of HIV status had on antiretroviral therapy (ART) adherence. A convenience sample of 65 HIV positive adult patients currently taking ART at a public Primary Health Care (PHC) clinic in the Nelson Mandela Metropole was selected. Participation was voluntary and confidentiality was maintained at all times. Data was collected using three tools/techniques: (1) a Patient Questionnaire (PQ) to extract information on patient's demographics, HIV disclosure status, regimen the patient was on and self-reported adherence to ART; (2) an audit of a Patient Medical Record (PMR) for information on the regimen the patient was on, the period during which the patient had been on ART medication, the adherence to ART care and the level of the patient‟s biological markers; and (3) Pill Counts (PC) performed on the patient's medical supply to validate the self-reported adherence to ART. There was no significant relationship between the disclosure of HIV status and adherence to ART (p= 0.59; Chi²). However, the relationship between the adherence to ART and increase in the CD4 count levels of patients on ART in this population was significant (p=0.03; Chi²). It can be concluded that no direct relationship was found between the disclosure of HIV status and adherence to ART in this population. However, several factors affected the reasons and decisions of individuals to disclose their HIV status and this influenced their daily taking of medication.
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- Date Issued: 2009
Effect of a South African medicinal plant on antiretroviral drug induced abnormalities in rats
- Authors: Van Gend, Tania Anli
- Date: 2008
- Subjects: Medicinal plants -- South Africa , Antiretroviral agents -- South Africa , Materia medica, Vegetable -- South Africa , HIV infections -- Alternative treatment -- South Africa , Rats as laboratory animals , Rats -- Metabolism
- Language: English
- Type: Thesis , Masters , MTech
- Identifier: vital:10121 , http://hdl.handle.net/10948/1080 , Medicinal plants -- South Africa , Antiretroviral agents -- South Africa , Materia medica, Vegetable -- South Africa , HIV infections -- Alternative treatment -- South Africa , Rats as laboratory animals , Rats -- Metabolism
- Description: The worldwide AIDS epidemic is known to have had a profoundly negative social, economic and personal impact and has taken a heavy toll on existing health care systems, particularly in developing countries. South Africa is experiencing an HIV epidemic with enormous social and economic consequences. Lopinavir/ritonavir antiretroviral treatment has been accredited with having a significantly positive effect and is a key advance in controlling HIV morbidity and mortality. An indigenous South African medicinal plant, Sutherlandia frutescens, known for its anti-diabetic properties and immune-boosting effects, is used for treating HIV positive patients suffering from opportunistic infections. Despite the use of the medicinal plant extract as homeotherapeutic medication, there is little evidence of toxicity testing that identifies its potential for interaction with antiretroviral drugs. However, scientific data relating to the mechanism through which Sutherlandia frutescens acts on the immune system has not been comprehensively documented. The aim of this study was to investigate lopinavir/ritonavir induced metabolic abnormalities in rats and whether the introduction of a plant extract of Sutherlandia frutescens would counteract the side effects of ARV medication. The results indicated that the rodents did not become insulin resistant, however, biochemical analysis indicated that extended ARV drug treatment would have caused insulin resistance. Significant morphological changes were found in the livers, kidneys and pancreases of rats exposed to the lopinavir/ritonavir. Rats exposed to the Sutherlandia frutescens plant extract showed improved histopathology with minimal abnormalities.
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- Date Issued: 2008
Evaluating neuropsychiatric symptomology in HIV-positive patients on efavirenz in public-sector clinics and psychiatric hospitals
- Authors: Gaida, Razia , Grobler, Christoffel
- Date: 2017
- Subjects: Drugs -- Side effects -- South Africa , HIV (Viruses) -- Enzymes , Antiretroviral agents -- South Africa , Anti-infective agents -- Side effects -- South Africa
- Language: English
- Type: Thesis , Doctoral , DPhil
- Identifier: http://hdl.handle.net/10948/29772 , vital:30776
- Description: Background: South Africa has the highest number of people living with human immunodeficiency virus (HIV) infection in the world. In 2014, an estimated 10.2% of the population was HIV-positive which amounted to 5.51 million people. Efavirenz forms part of the triple therapy backbone used in South Africa and is part of the firstline treatment for HIV. Efavirenz has been strongly associated with causing neuropsychiatric side effects in at least 50.0% of patients to whom it is prescribed. These side effects cause hesitation amongst healthcare professionals to prescribe this agent to patients with active mental illnesses. Aim: The aim of the study was to evaluate the neuropsychiatric side effects of efavirenz in HIV-positive psychiatric and non-psychiatric patients and to determine whether this drug may be recommended for use in an HIV-positive psychiatric patient population. Method: The study was divided into two parts, namely a quantitative portion and a qualitative portion. The quantitative study was a prospective drug utilisation study, while the qualitative portion consisted of semi-structured interviews carried out with healthcare professionals working with people living with HIV/AIDS (PLWHA). The study included five municipal clinics in the Nelson Mandela Metropole as well as two public-sector psychiatric facilities in the Eastern Cape where medical records were reviewed to obtain the information required. Patients were followed in both instances for a period of 24 weeks with follow-up assessments carried out at two, four, 12 and 24 week intervals. In terms of the qualitative study, nurses at the clinics and doctors at the hospitals were contacted and appointments for interviews were made. The interviews were recorded using a voice recorder and were transcribed and analysed using theoretical framework analysis. Results: The review of 126 medical records at the clinics revealed that no patient had suffered from or complained of a neuropsychiatric side effect. This may indicate that patients were not suffering from clinically significant side effects, side effects were not being adequately recorded by healthcare staff, or the healthcare staff were not questioning patients regarding side effects. A total of 26 hospitalised patients were followed for 24 weeks in the psychiatric facilities. Almost half of the patients using efavirenz experienced an improvement in symptoms to the extent that they were iii discharged from the facility. The majority of patients (66.7%) not on an efavirenzcontaining regimen did not improve to the point of discharge. Healthcare staff were vague when providing a definition of neuropsychiatric side effects. There were conflicting ideas on whether or not efavirenz should be used in patients with an active psychiatric illness. Conclusions: Further studies need to be performed in public-sector institutions to obtain a clearer picture of the side effects experienced by patients using efavirenz. Healthcare staff need to be encouraged to keep complete records to allow for meaningful analysis. The further integration of mental health services into existing HIV programmes is essential for holistic treatment. Patients in psychiatric hospitals demonstrated that even patients with psychiatric disorders on efavirenz can experience positive outcomes and stabilisation of psychiatric symptoms, which may indicate that these may not have due to efavirenz use. Further elucidation concerning the use of efavirenz in patients with psychiatric disorders, a description of the neuropsychiatric side effects, as well as management strategies must be provided in subsequent HIV guidelines.
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- Date Issued: 2017
Response and adherence of HIV positive women to cervical cancer treatment
- Authors: Ngugi, Pearl
- Date: 2011
- Subjects: HIV infections -- Chemotherapy -- South Africa , Patient compliance -- South Africa , Cervix uteri -- Cancer -- Treatment , HIV-positive women -- South Africa , Antiretroviral agents -- South Africa
- Language: English
- Type: Thesis , Masters , MPharm
- Identifier: vital:10162 , http://hdl.handle.net/10948/d1014129
- Description: It is estimated that 6742 South African women are diagnosed with cervical cancer and 3681 women die from the disease every year. In 1993, The Centers for Disease Control declared cervical cancer an Acquired Immunodeficiency Syndrome defining illness. Apart from persistent human papillomavirus infection, HIV infection is the most common co-factor contributing to cervical cancer in South Africa. Studies have noted that in HIV positive women, there has been an occurrence of faster progression to more advanced stages of cervical cancer with high cases of treatment failure and recurrence. There is limited literature available regarding the prognosis of HIV positive women who suffer from cervical cancer. Women who are HIV positive and have cervical cancer have not been evaluated in detail regarding their response and adherence to cervical cancer treatment. Standard treatment protocols for this set of patients have not been defined. The aim of this study was to assess how HIV positive women who have been diagnosed with cervical cancer responded and adhered to cervical cancer therapy which includes: curative radiotherapy; curative chemotherapy; concurrent chemoradiation or palliative radiotherapy. The study also evaluated the effects of the concurrent use of antiretrovirals and cervical cancer treatment. This was done to determine whether invasive cervical cancer in women who were HIV positive could be managed using the same treatment protocols as patients who were HIV negative. A historical cohort design was employed for the study. The study was conducted at the Oncology Department of a tertiary level hospital located in the Eastern Cape Province, South Africa. The total sample consisted of 196 medical records of women diagnosed with cervical cancer between 2005 and 2008. One hundred women were HIV negative, 83 were HIV positive and the HIV status of 13 women could not be determined. The records were audited over a period of two years from the date of diagnosis. The term „complete response‟ referred to patients who had no recurrence of cervical cancer and no evidence of metastases after undergoing treatment. At one month following treatment there was a significant difference in the incidence of complete response between the HIV positive patients and the HIV negative patients (Chi2 = 16.4, d.f. = 1, p = 0.00005, Cramer‟s V = 0.31). The significant difference in response to treatment between the HIV positive patients and the HIV negative patients was maintained at six months after treatment (Chi2 = 15, d.f. = 1, p = 0.00011, Cramer‟s V = 0.34), 12 months after treatment (Chi2 = 20.5, d.f. = 1, p = 0.00001, Cramer‟s V = 0.37), 18 months after treatment (Chi2 = 9.8, d.f. = 1, p = 0.00173, Cramer‟s V = 0.28) and 24 months after treatment (Chi2 = 5.0, d.f. = 1, p = 0.02571, Cramer‟s V = 0.26). At each of these intervals, cases of treatment failure and metastases were significantly higher in the HIV positive women than in the HIV negative women. Although there was no significant difference in the incidence of adherence between the HIV negative women, the HIV positive women who were on HAART and the HIV positive women who were not on HAART, there was a significant difference in the incidence of the various reasons for non adherence between the various groups. These reasons included: missed scheduled appointments (Chi2 = 2.9, d.f. = 2, p = 0.02385, Cramer‟s V = 0.31); low blood count (Chi2 = 4.0, d.f. = 2, p = 0.01327, Cramer‟s V = 0.15); radiotherapy induced skin breakdown (Chi2 = 0.6, d.f. = 2, p = 0.04581, Cramer‟s V = 0.16) and radiotherapy induced diarrhoea (Chi2 = 6.9, d.f. = 2, p = 0.03118, Cramer‟s V = 0.19). According to the 2004 National Antiretroviral Treatment Guidelines, cervical cancer patients would fall into the WHO stage IV category of HIV disease thus all patients with confirmed diagnosis of invasive cervical cancer should be commenced on antiretrovirals as soon as the cancer diagnosis is made regardless of their CD4 count. However, in the current study, 13 percent (n= 83) of the HIV positive women were not on antiretrovirals. The study concluded that HIV positive women had a higher incidence of both treatment failure and metastases to cervical cancer treatment. Standard radiotherapy and concurrent chemoradiation cervical cancer treatment protocols should be still be used in both HIV negative patients and HIV positive patients so as not to compromise tumour control. Furthermore, in accordance with the antiretroviral treatment guidelines, all HIV positive patients with cervical cancer should receive antiretrovirals irrespective of their CD4 count.
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- Date Issued: 2011
The experiences of people living with HIV-AIDS with regard to the comprehensive antiretroviral therapy management received from registered nurses at selected public primary heathcare clinics in Nelson Mandela Bay
- Authors: Jackson, Dawne Shirley
- Date: 2009
- Subjects: Antiretroviral agents -- South Africa , Stigma (Social psychology) , Nurses -- South Africa -- Attitudes , HIV-positive persons -- Counseling of -- South Africa , AIDS (Disease) -- Treatment -- South Africa , HIV infections -- Treatment -- South Africa
- Language: English
- Type: Thesis , Masters , MCur
- Identifier: vital:10032 , http://hdl.handle.net/10948/1253 , Antiretroviral agents -- South Africa , Stigma (Social psychology) , Nurses -- South Africa -- Attitudes , HIV-positive persons -- Counseling of -- South Africa , AIDS (Disease) -- Treatment -- South Africa , HIV infections -- Treatment -- South Africa
- Description: Currently South Africa has the highest number of persons living with HIV-AIDS (PLWAs) in the world. Focus-group discussions conducted by Moon (2005:3) in the Eastern Cape indicated that people may not want to get tested for HIV or to access antiretroviral therapy (ART) for fear of disclosure of their HIV-positive status and of stigmatization. These findings prompted the researcher to conduct a study in this field. The objectives of this study are to explore and describe the experiences of PLWAs with regard to the comprehensive ART management received from registered nurses at selected public primary healthcare clinics in Nelson Mandela Bay; and to develop guidelines for registered nurses that could facilitate them in rendering appropriate comprehensive ART management. The research study is based on a qualitative, explorative, descriptive, phenomenological and contextual research design. The research population comprised of HIV-positive patients who received treatment at the selected public primary healthcare clinics. Criterion-based, purposive sampling was used to select participants for the interviews. Ten in-depth unstructured interviews were conducted. Data was then transcribed and coded. One central theme identified the fact that PLWAs experienced both positive and negative experiences at the clinics. The main findings of this research included evidence of various forms of stigma experienced by the PLWAs; distrust of the lay health counselors; but also that PLWAs were generally well-treated and satisfied with the service they had received. Broad guidelines for registered nurses was formulated that could facilitate them in rendering appropriate comprehensive ART management. The study concludes with recommendations made with regards to the areas of nursing practice, education and research. Throughout the study the researcher abided by the ethical considerations. The aspects of trustworthiness implemented in this study, included dependability, credibility, transferability and confirmability (Holloway & Wheeler, 2002:354).
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- Date Issued: 2009