Henry Fomundam

Use of traditional complementary and alternative medicine for HIV patients in KwaZulu-Natal, South Africa.

BackgroundTraditional medicine use has been reported is common among individuals with moderate and advanced HIV disease. The aim of this cross-sectional study was to assess the use of Traditional Complementary and Alternative Medicine (TCAM) for HIV patients prior to initiating antiretroviral therapy in three public hospitals in KwaZulu-Natal, South Africa.MethodsUsing systematic sampling, 618 HIV-positive patients were selected from outpatient departments from three hospitals and interviewed with a questionnaire.ResultsTCAM was commonly used for HIV in the past six months by study participants (317, 51.3%) and herbal therapies alone (183, 29.6%). The use of micronutrients (42.9%) was excluded from TCAM since mostly vitamins were provided by the health facility. Herbal therapies were the most expensive, costing on average 128 Rand (US

Efficacy of a lay health worker led group antiretroviral medication adherence training among non-adherent HIV-positive patients in KwaZulu-Natal, South Africa: Results from a randomized trial

16) per patient per month. Most participants (90%) indicated that their health care provider was not aware that they were taking herbal therapies for HIV (90%). Herbal therapies were mainly used for pain relief (87.1%) and spiritual practices or prayer for stress relief (77.6%). Multivariate logistic regression with use of herbs for HIV as the dependent variable identified being on a disability grant and fewer clinic visits to be associated with use of herbs, and TCAM use for HIV identified being on a disability grant, number of HIV symptoms and family members not contributing to main source of household income to be associated with TCAM use.ConclusionTraditional herbal therapies and TCAM are commonly used by HIV treatment naïve outpatients of public health facilities in South Africa. Health care providers should routinely screen patients on TCAM use when initiating ART and also during follow-up and monitoring keeping in mind that these patients may not fully disclose other therapies.

Follow-up Survey of Women Who Have Undergone a Prevention of Mother-to-Child Transmission Program in a Resource-Poor Setting in South Africa

There is a lack of theory-based randomized controlled trials to examine the effect of antiretroviral adherence in sub-Saharan Africa. We assessed the effectiveness of a lay health worker lead structured group intervention to improve adherence to antiretroviral therapy (ART) in a cohort of HIV-infected adults. This two-arm randomized controlled trial was undertaken at an HIV clinic in a district hospital in South Africa. A total of 152 adult patients on ART and with adherence problems were randomized 1:1 to one of two conditions, a standard adherence intervention package plus a structured three session group intervention or to a standard adherence intervention package alone. Self-reported adherence was measured using the Adult AIDS Clinical Trials Group adherence instrument prior to, post intervention and at follow-up. Baseline characteristics were similar for both conditions. At post-intervention, adherence information knowledge increased significantly in the intervention condition in comparison to the standard of care, while adherence motivation and skills did not significantly change among the conditions over time. There was a significant improvement in ART adherence and CD4 count and a significant reduction of depression scores over time in both conditions, however, no significant intervention effect between conditions was found. Lay health workers may be a useful adjunct to treatment to enhance the adherence information component of the medication adherence intervention, but knowledge may be necessary but not sufficient to increase adherence in this sample. Psychosocial informational interventions may require more advanced skill training in lay health workers to achieve superior adherence outcomes in comparison standard care in this resource-constrained setting.

Remodeling pharmaceutical care in Sub-Saharan Africa (SSA) amidst human resources challenges and the HIV/AIDS pandemic.

&NA; The aim of this study was to investigate the implementation of a prevention of mother‐to‐child transmission (PMTCT) program and to evaluate the uptake and adherence to single‐dose nevirapine in a cohort sample that had undergone PMTCT in five public clinics in a resource‐poor setting, Quakeni Local Service Area, O.R. Tambo District in the Eastern Cape, South Africa. Results indicated that 116 women (15.3% of the sample) were infected with HIV, 642 (84.7%) were uninfected, and 552 (42.1%) had an unknown HIV status. Almost all of the women had received information about HIV and HIV testing prenatally, but 552 (42%) had not been tested for HIV, and their HIV status was unknown. Only 66 (57%) of the HIV‐infected pregnant women had been provided with nevirapine. It is recommended that the quality of HIV counseling be improved and the program of maternal self‐medication with nevirapine tablets at onset of labor and maternal provision of nevirapine syrup to newborns be encouraged.

Use of traditional complementary and alternative medicine (TCAM) by HIV patients prior to initiating ART in KwaZulu-Natal, South Africa

Pharmaceutical care, meant to complement a proper drug supply system, is a key component of a robust health care system and is the direct, responsible provision of medication-related care designed to achieve definite outcomes that improve a patients quality of life. Beyond simply dispensing medicine, pharmaceutical care promotes adherence to therapeutic regimens and addresses problems such as overdosage, sub-therapeutic dosage, adverse drug reactions, medication errors, and untreated indications. The dearth of health care workers trained in pharmaceutical care coupled with inadequate access to medications creates multiple disease management challenges in Sub-Saharan Africa (SSA), which has 25% of the worlds disease burden but only 1.3% of the worlds health workforce. To prevent and treat HIV/AIDS, TB, malaria, and other maladies, the need is urgent to train and integrate the contributions of current workers who handle medications for major and minor health problems, especially those in licensed pharmacies and drug shops. On the aggregate in SSA, pharmaceutical care is in a nascent stage in most countries but needs to grow as a discipline as well as be tailored to specific country needs. The SSA solution lies in establishing health care system components where cadres of workers engage in pharmaceutical care practices, as well as store and distribute medications. Curriculum changes in pre-service education, more continuing education for the health workforce in place, and training pharmacists to supervise a lower cadre of assistants and others are among the elements in a pharmaceutical care paradigm shift which is the focus of this article.

TRADITIONAL COMPLEMENTARY AND ALTERNATIVE MEDICINE AND ANTIRETROVIRAL TREATMENT ADHERENCE AMONG HIV PATIENTS IN KWAZULU-NATAL, SOUTH AFRICA

Purpose of the study Traditional medicine use has been reported as common among individuals with moderate and advanced HIV disease [1,2]. Funded by Tibotecs REACH Initiative, this cross-sectional study aimed to assess the use of traditional complementary and alternative medicine (TCAM) by HIV patients prior to initiating antiretroviral therapy in three public hospitals in KwaZulu-Natal, South Africa.