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http://www.webmedcentral.com/images/Header_Logo.giftext/html2015-06-23T14:18:24+01:00http://www.webmedcentral.com/Dr. Felix I Woke MD, Ph.DSocio-demographic Determinants of Anti-Retroviral Therapy Adherence in South Africa: A Systematic Review from 2009-2014
http://www.webmedcentral.com/article_view/4927
Background: South Africa has the highest number of people on ART in the world and the number is increasing especially with the upward review of CD4 for the initiation of ART in positive persons. Considering this increasing number, there is increased effort to ensure adherence to ART. Despite this, the adherence of South Africans to ART is unsatisfactory and socio-demographic factors play a major role. To assess this association, we did a systematic review of literatures to determine the socio-demographic factors that impact ART adherence. Methods: PubMed, Cochrane, PLoS one, BMC, ProQuest and Google scholarwere searched to ascertain studies in South Africa from 2009 to 2014 on socio-demographic determinants of ART and selected 22 relevant articles for this review.
Results: The results of the demographic determinants were inconsistent and depended on the population group, setting and the context of the patients.However, social factors at material, informational and emotional levels were consistent and necessary determinant of ART adherence in most settings.
Conclusion: Social and demographic factors are necessary determinants of ART adherence. Social factors were alluded to in all studies reviewed as a necessary, enabling or sustaining factor through whichotherfactorsimpact adherence. The evidence in this review suggests that adherence to ART could be improved if social and material supportis available at all cadre of society.text/html2011-09-21T19:06:25+01:00http://www.webmedcentral.com/Dr. Ahmed A KhalilHIV Infection Amongst Youth in Sudan: What needs to be done
http://www.webmedcentral.com/article_view/2226
As a country in Sub-Saharan Africa, Sudan contributes a large share to the global burden of HIV infection amongst youth. Several factors specific to the country may be responsible for this, and thus the need for appropriate interventions to reduce the HIV wave in the country cannot be overstated.In general, there seems to be a low level of knowledge about family planning, reproductive health and STDs among Sudanese youth.[i] Special groups such as rickshaw drivers, who are mostly otherwise unemployed (and often illiterate) adolescents, are abundant in Sudan and have been found to have poor knowledge about HIV/AIDS.[ii] Refugees, who are present mostly in the eastern parts of the country and who have been displaced by conflict or famine, have also been found to be a group with reduced awareness about AIDS and condom use.[iii] These mobile populations seem to be very susceptible to STDs and HIV infection. Moreover, this mixing of populations seems to have created new HIV-1 subtypes previously detached in Africa, with possible implications on the response to treatment.[iv] Pregnant women, who in Sudan are commonly in the younger age groups, have also been found to be less knowledgeable about HIV than their older counterparts, and less willing to undergo voluntary testing.[v] Females aged 15-24 years in Sudan have a considerably higher prevalence of HIV infection (1.3%) compared to males (0.5%)[vi]. Knowledge of HIV has been found to be inadequate even amongst the most educated of the population, including in one study, dental students.[vii] Men who have sex with men, though a marginalized community within Sudan, are also at high risk – their consistent condom use rates are extremely low (3.3%) and more than half did not recognize an association between anal sex and HIV infection[viii]. Interestingly, most MSM in Sudan were found to be students (i.e. youth) at the university level.It seems that the main factors which make youth in Sudan vulnerable to HIV infection are the lack of knowledge and awareness on the matter. Also, HIV infection remains a social and religious stigma that hampers young people from seeking safe sex practices and from undergoing voluntary testing. This may force them to adopt high-risk behaviour that may be easily avoided if the matter of HIV infection were opened to a free and non-judgmental discussion with youth. Other stigmata including that associated with homosexuality also hampers the ability of MSM groups to seek safe sex or HIV services. Economic factors also play a role – these are closely linked to the level of education of Sudanese youth, which is only about 40% enrolled in secondary school.[ix]On the positive side, male circumcision is widespread in Sudan – while data before the separation of Southern Sudan indicates a 60% percentage of men who are circumcised, it is an almost universal practice in Northern Sudan[x].The appropriate interventions for reducing HIV infection among youth in Sudan are:1. Enhance young people’s communication skills on sex and prevention techniques. They must be empowered to make conscious, life-changing decisions to reduce their risk, or otherwise enhance their access to relevant medical care. This would help provide them with the comprehensive correct knowledge on HIV that is lacking in the country. This can be done by organising support groups for those at most risk, providing anonymous voluntary counselling services and educating the general public on HIV, in the hopes of gradually diminishing the stigma. School-based programmes may also be of benefit, but the low percentage of youth in secondary schools may limit its efficacy.2. Access to condoms is especially limited in Sudan, despite a recent increase in availability – they are present in pharmacies only (and are imported and thus, unlikely to be affordable to those in most need). Encouraging the local production and cheap distribution of condoms may also be of benefit. The free distribution of condoms in centres, though it has been heard that certain organisations have been doing so, is not practically available in Sudan (perhaps linked to the social stigma mentioned).3. Encouraging policy makers to make HIV prevention a priority, and to adequately provide the necessary services on a widespread scale. In a country as large and diverse as Sudan, this may prove a difficult issue, as coverage and access to such services is patchy at the moment. This availability of supply, combined with enhancing the demand for these services by the aforementioned interventions, is likely to improve overall utilization of HIV services.text/html2011-12-19T15:45:21+01:00http://www.webmedcentral.com/Ms. Mei H EAntifungal Use for Opportunistic Infection in HIV Patients: Comparison of Efficacy and Safety
http://www.webmedcentral.com/article_view/2674
Background: Fungal infections always occur in HIV patients due to depressed immunity. The most common fungal infections are candidiasis, cryptococcal meningitis and histoplasmosis.Objectives: To compare the efficacy and safety of the antifungal available for the three most common opportunistic fungal infections in HIV patients.Methods: The databases that we used to gather the information are PubMed, Lancet, Clin Infect Dis, SpringerLink, Ann Intern Med, J Clin Microbiol, Pediatr Infect Dis J and Int J Dermatol.Results: Based on our review, candidiasis can be sub-divided into localized (oropharyngeal and vulvovaginal) and systemic candidiasis. Fluconazole is found to be the most common used due to its high efficacy treating candidiasis. Prophylaxis of crytococcal meningitis can be done by administering ketoconazole or itraconazole depending on whether it is primary or secondary prophylaxis. Treatment using flucytosine in combination with amphotericin B has additive effect and appears to be the most effective regimen for cryptococcal meningitis therapy. Histoplasmosis is characterized by pulmonary and disseminated histoplasmosis and the mainstrays of therapy for histoplasmosis are amphotericin B and itraconazole. The most prominent side effects of amphotericin B include nephrotoxicity, acute toxicity and hypokalemia. Flucytosine and itraconazole induces gastrointestinal side effects and bone marrow depression while hepatotoxicity is found to be the major side effect of flucytosine and ketoconazole. Ultimate care must be taken when administering ketoconazole as it has considerable drug interactions with other medications. In patients treated with fluconazole, the most common adverse effects include phlebitis, headache and nausea, abdominal pain, diarrhoea and rashes. Conclusions: From our review, it appears to have different drug of choice of antifungals for different opportunistic fungal infections. Besides, it is found that different efficacy of different drugs form the basis guideline for the therapeutic regimen in treating opportunistic fungal infections. However, therapeutic regimens recommended also induce various types of adverse reactions or side effects. Therefore, dose adjustment and therapeutic drug monitoring must be performed accordingly and routinely to avoid unnecessary complications.Key words: HIV, opportunistic fungal infection, comparison, efficacy, safety.
text/html2012-05-10T06:46:18+01:00http://www.webmedcentral.com/Dr. Brijesh SathianSocio-Demographic Characteristics of Clients of Female Sex Workers and their Perspectives, Behaviors and Attitude on HIV and AIDS in Pokhara Valley: A Necessary Enquiry
http://www.webmedcentral.com/article_view/3349
The current situation of HIV in Nepal is different from when the first case was diagnosed in 1988. Till date (2009) total positive cases reported are 14787 out of which 13005 are receiving HIV care. There are gaps and challenges to be addressed in the fight against HIV and AIDS. In this context, clients of Female Sex Workers have no sincere knowledge of STIs, HIV and AIDS and their practices of safer way while visiting Female Sex Workers. Due to emerging sex market and number of Female Sex Workers exposure centers in Pokhara, the number of their clients is also unexpectedly growing. The sex practice depends upon the knowledge and behavior themselves and awareness toward such sexual complications, how to be safe from STI and HIV amongst Clients of FSW. The research should be to identify certain hidden facts which motivate to the clients to engage such activities. text/html2014-11-07T09:30:40+01:00http://www.webmedcentral.com/Dr. Gwinyai MasukumeCan males ever be a vulnerable group? HIV/AIDS conspiracy of silence
http://www.webmedcentral.com/article_view/4748
"Girls and women are almost universally less powerful, less privileged, and have fewer opportunities than men." [1,2] But does this prevent people from recognizing and acting if gender inequality affects males? [3]
Let us take the case of HIV/AIDS in South Africa a country which has less than 1% of the world's population, but accounts for about 15% of this disease's global burden [4].
Commonly, it is stated that the brunt of the HIV epidemic is mainly felt by females [5]. Michel Sidibé the Executive Director of UNAIDS, the organization which essentially co-ordinates the global response to HIV/AIDS said, "This epidemic unfortunately remains an epidemic of women" [6]. It is true that the prevalence (proportion of cases) of HIV is higher in females (14.4%) than in males (9.9%), according to the comprehensive 2012 South African National HIV Prevalence, Incidence and Behaviour Survey [7]. According to this survey 71.5% and 59.0% of females and males respectively above 15 years of age had ever been tested for HIV; males are less likely to be aware of their HIV status.
There is virtually no doubt or discussion that anti-retroviral therapy has turned around the course of the HIV epidemic for the better; in fact those who start therapy early enough have an almost normal life expectancy [8]. According to the before-mentioned survey, 25.7% and 34.7% of males and females respectively living with HIV were on anti-retroviral therapy. Clearly males are (very) disadvantaged with respect to being on anti-retroviral therapy.
Turning to a specific South African population that has been closely monitored and followed up over time [9]. As expected, in this population, we find that the prevalence of HIV is higher in females than in males [10]. However, in this very population it is males who die more from HIV/AIDS and pulmonary tuberculosis (related to HIV infection) [11].
Clearly males are vulnerable when it comes to HIV/AIDS and this vulnerability is not just confined to South Africa or to HIV/AIDS [3,12].
Coming back to the core questions. Is it entirely true that females mainly bear HIV's brunt? No. Is it true that largely people fail to recognize and act if inequality affects males? Yes.
Why should the situation be like this? Perhaps another illustration is apt.
In May 2014 Solange Knowles (a prominent American entertainer) physically attacked her brother-in-law, Jay Z (one of the world's most successful entertainers) [13]. Solange was not arrested and did not have to appear in court. Had it been the other way round - Jay Z physically attacking Solange - most likely, Jay Z's career would have been (severely) impaired.
Males have been said to have poor health seeking behavior compared to females [14] although this is very debatable [15]. Even if we accept that males do not seek health care as much as females, we cannot blame males for the HIV/AIDS situation they find themselves in just as we cannot blame females for their position in society. In conclusion, addressing the substantial anti-retroviral therapy gap in males does not only benefit them but it can also help limit HIV's spread because those on adequate treatment are less likely to transmit the virus to their sexual partner(s) [16].text/html2014-12-26T08:16:23+01:00http://www.webmedcentral.com/Dr. Amitav BanerjeePrevention of HIV infection in dental practice
http://www.webmedcentral.com/article_view/4787
Since the HIV epidemic started in 1981, in Haiti; America, about 75 million people have been infected with the HIV virus and about 36 million people have died of HIV.[1]Globally 35.3 million people were living with HIV at the end of 2012.[1]
In view of the magnitude of the HIV problem globally, apprehension among professionals in the field of dentistry (which involves a lot of invasive procedures), regarding occupational risk of HIV transmission needs to be allayed. At the same time, dental workers should be fully conversant with universal precautions as applicable to their practice.
Prevention of Occupational Exposure to HIV
The unique nature of dental practice may require specific strategies directed to the prevention of blood borne infections among dental workers and thier patients. Available data suggest that the risk of blood borne transmission among workers and patients in dental practice is low.[2] However in dental procedures there may be more exposure to a variety of microorganisms or in blood or oral secretions.
Understanding the nature, frequency, and circumstances of occupational exposure specific to dental procedures is important in evaluating the risk of disease transmission. Percutaneous exposure poses the greatest risk for infection.
Frequency of injury to dental workers
Retrospective, observational and prospective studies of injuries among general dentists, oral surgeons and dental hygienists have shown that injury rates among dental professionals are less than among general surgical personnel. Data from a prospective observational study among general dentistry and oral surgery residents found that dental residents experienced about 2 injuries per 1000 working hours of observation,[3] a much lower rate of percutaneous injuries than general surgery personnel, who in another similar study, experienced 34 injuries per 1000 working hours of observation.[4]
Instruments associated with injuries among dental workers.[2]
The types of instruments most commonly associated with injuries are dental burs, syringe needles and sharp instruments. Most of these injuries occur to the dentist's fingers or hand. Among oral surgeons, dental wiring is associated with most injuries. Injuries occur more frequently during fracture reductions. No association with the experience of the dentist, as measured by years in practice, has been reported.
Prevention of occupational blood exposures
Strategies to prevent occupational blood exposures in dentistry require improved engineering controls, safer work place practices, and improved personal protective equipment. Some of the strategies include use of safer devices, such as self-sheathing hollow-bore needles and dental units with designs that shield burs in hand pieces placed in the unit. Safe practices should discourage uncontrolled movements of instruments, such as scalers or laboratory knives, under force or the use of fingers to retract or suture tissues in the operative field. Placement of cork or other covers on exposed dental wiring should be explored as a preventive measure during oral surgery. Since most injuries involve the fingers and hands, the continued development of personal protective equipments such as puncture-resistant gloves and thimbles may be explored. Once developed, these preventive interventions must be evaluated to determine if sharps injuries among dental workers are reduced without adversely affecting patient care.
Patient to patient transmission
Reusable medical or dental instruments contaminated with blood or tissue during use have the potential to transmit infection to a subsequent patient if these instruments are not appropriately cleaned and disinfected or sterilized after each use.
HIV in saliva
Trace amounts of HIV are infrequently isolated from saliva or HIV-infected persons. No epidemiologic evidence exists, however, to indicate that saliva is an effective medium for HIV transmission [4]. HIV titers in saliva are much lower than in blood, and several studies have demonstrated HIV inhibitory activity in human saliva. Despite the absence of clinical evidence of HIV transmission by the oral route, most dental procedures produce various amounts of blood in the oral cavity. For this reason, continued adherence to recommended infection control practices is essential during delivery of dental services.
Principles of infection control
Because all infected persons cannot be identified by medical history, physical examination or laboratory tests, it is recommended that all patients be treated as if they were infectious, and proper infection control procedures should be used on all patients at all times while they are receiving dental care. Dental workers should adhere to following principles of dental infection control.
(a) Avoid blood contact with bare hands
(b) Decontamination
(c) Immunization as indicated
(d) Post-exposure prophylaxis
(e) Proper waste management
(f) Use universal precautions for HIV
Avoid contact with blood
Medical gloves should be worn whenever the potential exists for contacting blood, blood-contaminated saliva, or mucous membranes. Sterile gloves should be used when performing surgical operations; non sterile gloves are appropriate for examination and other nonsurgical procedures. Medical gloves should be changed between patients and should never be washed, disinfected, or sterilized for reuse.
Surgical masks and protective eyewear should be worn when splashing or spattering of blood or other body fluids is likely, as is common in dentistry.
Contaminated sharp items, such as needles, scalpels, and wires, should be considered potentially infective and handled with care to prevent injuries. Needles should never be recapped or otherwise manipulated using both hands or using any other technique that involves directing the point of a needle toward any part of the body.
The spread of blood and saliva contaminated with blood can be minimized by planning ahead and anticipating the treatment needs of each patient. Impervious backed paper, aluminum foil, or plastic covers should be used to protect items and surfaces such as light handles or x-ray equipment that may become contaminated during use and that are difficult or impossible to clean and disinfect. Between patients, the coverings should be removed and discarded and then replaced by new covering. The use of rubber dams, high velocity air evacuation, and proper patient positioning can minimize the formation of droplets, spatter, and aerosols during patient treatment.
Decontamination
Cleaning, disinfection, and sterilization are all decontamination processes. Cleaning is the first step in all decontamination procedures; it removes debris and reduces the number of microorganisms present. Sterilization kills all microbial life and is the most effective decontamination process available. Disinfection is a process that kills disease-causing microorganisms, although not necessarily all microorganisms. Some nonpathogenic microorganisms may remain on an object after disinfection; the number and type depend on the level of disinfection used. There are three levels of disinfection:
(a) Low-level disinfection does not kill bacterial spores or Mycobacterium tuberculosis var bovis, a test microorganism used to classify the strength of disinfectant chemicals.
(b) Intermediate-level disinfection does kill M tuberculosis var bovis, which indicates that the process also kills more easily killed organisms such as HBV and HIV.
(c) High-level disinfection kills some bacterial spores.
Dental instruments are classified into three categories - critical, semi critical, and noncritical - depending on their use and their risk of transmitting infections. All dental centers should classify instruments as follows:
Critical instruments: used to penetrate soft tissue or touch bone, include forceps, scalpels, bone chisels, scalers, and burs. They should be sterilized after every use.
Semi critical instruments: do not penetrate soft tissues or touch bone, but they do contact oral tissues and mucous membranes. Examples include mirrors and amalgam condensers; they should be sterilized after each use. If sterilization is not feasible because the instrument will be damaged by heat, the instrument should receive, at minimum, high-level disinfection.
Noncritical instruments: instruments that come into contact only with intact skin and include x-ray tube heads and protective eyewear. Because noncritical surfaces have relatively low risk of transmitting infection, they may be reprocessed between patients with intermediate-level or low-level disinfection or with detergent and water washing, depending on the degree and nature of contamination.
Methods of sterilization and disinfection of dental instruments
Cleaning is the first step. Persons decontaminating dental instruments should wear heavy-duty (reusable) gloves, rather than surgical gloves. All critical and semi critical dental instruments that are heat stable should be sterilized between patients by means of steam under pressure (i.e., autoclaving), dry heat, or chemical vapor, following the instructions of the manufacturers of the instruments. Weekly use of biological indicators (i.e., spore tests) to verify proper functioning of sterilization cycles is recommended.
Indications for use of liquid chemical germicides to sterilize instruments are limited. Use of these products may require up to 10 hours of exposure to a liquid chemical agent. When using any of these chemicals to achieve high-level disinfection of heat-sensitive semi critical dental instruments, the manufacturer's directions regarding appropriate concentration and exposure time should be followed.
Cleaning and disinfection of environment surfaces
After each patient and at the end of the work day, counter tops and the dental unit surfaces that may have become contaminated with patient material should be cleaned using an appropriate cleaning agent and water. Fresh solutions of sodium hypochlorite (i.e., household bleach) in concentrations ranging from 500 ppm to 800 ppm of chlorine (1/4th cup bleach to 1 gallon of water) are effective on environmental surfaces that have been cleaned of visible contamination.
Immunization and personal hygiene:
Dental workers can protect themselves from several infections such as hepatitis B by immunization.
Proper hand washing removes microorganisms and helps diminish the likelihood of infection. For most routine dental procedures, hand washing with plain soap and water is adequate. For surgical procedures, an antimicrobial product should be used.
Post Exposure Prophylaxis (PEP): [5, 6, 7]
On exposure to a needle stick injury, blood or blood containing fluids or substances from a known HIV positive person or a person with suspicious HIV status, the dental worker or the supervisor should immediately report to the Infection Control Officer, i/c Hospital Infection Control Committee, (or the Authorized Medical Attendant) [8, 9] who should promptly manage to evaluate the exposure event and provide the post exposure prophylaxis (PEP) based on recent guidelines, to the exposed person.
The three drug PEP should be initiated as soon as possible, ideally within 2 hours and preferably before 72 hours and should not be delayed pending evaluation of the exposure. The PEP now consists of the immediate initiation of three antiretroviral (ARV) drugs, management of the exposed site, evaluation of the exposure, HIV testing of the source person, recording information of the occupational exposure, baseline HIV testing of the exposed person, counseling for HIV testing; adverse drug reactions and treatment adherence and the follow up. The recommended duration of PEP is 28 days. The clinical follow up during PEP should be frequent to find and manage the drug reactions and laboratory follow up needs to be obtained at 6 weeks and 6 months of exposure, in order evaluate the status of HIV infection.
If unknown HIV status of the source person, after testing, is established HIV negative, PEP is discontinued and if the baseline HIV testing of the exposed person is found positive, then PEP is needless (considering window period) but such person must be evaluated for antiretroviral therapy (ART) and processed accordingly.
The currently recommended adult regimen consists of Tenofovir 300 mg once daily + Emtricitabine 200 mg once daily Plus Raltegravir 400 mg twice daily or Dolutegravir 50 mg once daily, all drugs to be taken orally. (Lamivudine 300 mg once daily may be substituted for emtricitabine)
The recommended alternative PEP regimens should be used in the setting of potential HIV resistance, toxicity risks, clinician preference, or constraints on the availability of particular agents.
Management of waste material:
Blood, suctioned fluids, or other liquids waste may be poured carefully into a drain connected to a sanitary sewer system. Disposable needles, scalpels or other sharp items should be placed intact into disinfectant containing puncture-resistant containers before disposal. Solid waste contaminated with blood or other body fluids should be placed in sealed, sturdy, impervious bags to prevent leakage of the contained items. All contained contaminated solid wastes should be then disposed of according to requirements established by local, state, or federal regulating agencies.
Universal (Standard) Precautions: [8]
1. WHO standard precautions recommend that all individuals be treated as if they were infected with HIV or other infectious pathogens.
2. Exposures that place health care workers at risk of infection include injuries, such as needle sticks, and contact of infectious fluids with mucous membranes or non intact (cut or abraded) skin.
3. The most effective infection control measure that health care workers can perform is hand washing with soap and water before and after patient contact.
4. Precautions should be taken to avoid having the skin, eyes, and mucous membranes come into contact with blood.
5. Needles should never be recapped, bent, or broken; they should be discarded into sealed, puncture-resistant containers.
6. Spills of blood or other infectious fluids should be cleaned while wearing gloves, using a solution of one part household bleach to 10 parts water.
7. When exposure occurs, the source patient and health care worker should be tested for HIV and for hepatitis B and C.
8. Treatment to reduce the risk of contracting HIV from the exposure depends on the risk of exposure and information about the exposure source.
9. Seroconversion later than 6 months after exposure is rare.
Operational implications
In all dental practice, emphasis should be placed on consistent adherence to above recommended infection-control practices. The following five strategies may provide guidance to achieve this goal.
(i) Each dental office should constitute a Hospital Infection Control Committee under control of an eminent Infection Control Officer that should be vigilant round the clock for infection control program. This officer should have a thorough understanding of the principles of infection control especially for HIV.
(ii) There should be initial training and retraining of the dental staff in the principles of infection control and standard operating procedures. [10]
(iii) A written infection control policy should be developed. This policy should include the use of Hepatitis B vaccinations; safe work practices, such as hand washing and careful handling of sharp instruments; personal protective equipments; engineering controls, such as rigid containers for disposal of sharps; adequate decontamination procedures; and prompt reporting and follow-up of occupational exposure incidents. The last ensures that exposed workers receive appropriate counseling and testing and post-exposure prophylaxis when indicated. Prompt reporting of occupational exposures can help to identify and alter specific work practices that may increase the risk for future exposures.
(iv) A checklist for standard office procedures may assist the dental staff in establishing and ensuring that patterns of performance for each infection control process are followed consistently.
(v) It is important for each dental office to maintain adequate records. Such records may include sterilizer spore test results, autoclave register and injury reports, including occupational exposures to blood or potentially infective material.
Conclusions
The aim of all precautions is to reduce blood contact, thereby minimizing blood borne pathogen transmission to dental workers or patients. Little research has been done to examine specific prevention strategies. Studies are needed for the development and evaluation of improved designs for dental instruments, equipment, and personal protective equipment. More efficient reprocessing techniques should be considered in the design of future dental instruments and equipment. Systematic evaluation must be ongoing to ensure that new technologies can improve the safety of dental treatment without comprising the quality of patient care.
text/html2015-12-12T09:50:52+01:00http://www.webmedcentral.com/Dr. Felix I Woke MD, Ph.DIs Mobile-Health the answer to Anti-retroviral therapy non-adherence in sub-Saharan Africa: A Systematic Review
http://www.webmedcentral.com/article_view/5030
Background: Literatures have shown that mobile phone technology can improves the adherence of most chronic diseases but its impact on ART adherence is not clear. Although the uptake of cell phone in sub-Saharan Africa is high, there are few studies of high evidential value (randomised control trials) on the use of mobile technology to improve ART adherence. This review will examine good evidence from old literatures to determine how mobile technology impact ART adherence in sub-Saharan Africa.
Methods:I extracted information on randomised controlled trails and cohort studies fromcountries in sub-Saharan Africaon the use of mobile phone technologies in ART adherence. The three main parameters in this review are methodologies, design and country of study. Among databases looked at are Cochrane, MEDLINE, EMBASE, EbscoHOST and PLoS one. Randomised controlled trail from South Africa, Kenya, Cameroun, and Nigeria and cohort studies from Uganda, Ghana and Mozambique were included in this study.
Results:The literatures reviewed showed that m-health can improve ART adherence. However, we need to consider how close the support is to the patient, the use of contextualized messages, confidentiality, infrastructural problems in sub-Saharan Africa and the doctor-patient relationship in considering the use of m-health.
Conclusion:This review recommends and highlighted that mobile health is effective in improving ART adherence but is under-utilized. Personknown to the patients and messages that are contextualized are likely to make the best impact. Message can be motivational, reminders, blood red flags, preventive and educational for bothpatients and supporter. Through mobile devises adherence can be improved; leading to improved ART uptake, reduced resistance, morbidity and mortality associated with HIV/AIDStext/html2016-09-06T13:19:22+01:00http://www.webmedcentral.com/Mr. Sushanta K BarikHuman Immuno-Deficiency Virus Drug Resistance, Nuclesoide Reverse Transcriptase Inhibitors, Non-nuclesoide Reverse Transcriptase Inhibitors and associated drug resistance mutations in the Reverse Transcriptase Gene of Human Immuno Deficiency Virus-1.
http://www.webmedcentral.com/article_view/5177
Resistance develops due to mutations in the reverse transcriptase gene of HIV-1 genome that does not respond towards the presence of effective drugs. Emergence of HIV-1 variants in the presence of effective drugs is a common occurrence. Drug resistance mutation means “the development of resistance mutations in the drug targeted HIV-1 genes” which causes the viruses to overcome the drug pressure. Thus resulting in failure to antiretroviral therapy. The detection of these mutations is possible by genotypic assay and the analysis of the effect of different drug concentrations towards the reverse transcriptase gene is possible by phenotypic assay. Genotyping of these mutations gives the information on therapeutic decision at the population and individual level. The frequency of mutation in the HIV-1 genes varies in the same population of a region or a city. The frequencies of mutations in the reverse transcriptase genes of HIV-1 lead to subtype diversity, drug resistance mutations and formation of recombinant isolates. The frequency of mutations in the reverse transcriptase gene is a cause of treatment failure by nucleoside/ nucleotide reverse transcriptase inhibitors and non-nucleoside reverse transcriptase inhibitors in a population level. The frequency of mutations in the reverse transcriptase gene is directly related to the prevalence of HIV-1 drug resistance mutations in a population or individual level.
This review mainly focuses on the human immunodeficiency virus drug resistance, nucleoside/nucleotide reverse transcriptase inhibitors, non-nucleoside reverse transcriptase inhibitors and associated drug resistance mutations in the reverse transcriptase gene of human immuno-deficiency virus-1.
Abbreviations: HIV: Human Immunodeficiency Virus, AIDS:Aquired Immunodeficiency Syndrome. HIVDR: Human Immuno deficiency virus drug resistance, NRTIs:Nucleoside reverse transcriptase inhibitors, NNRTIs:Non-nucleoside reverse transcriptase inhibitors, RT: Reverse transcriptase, PIs:Protease inhibitors, TAMs: Thymidine analogous mutations, NonTAMs: Non-thymidine analogous mutations.