Browsing by Author "Gray, Andrew Lofts."

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Antibiotic prophylaxis in a primary level hospital: a medicines use evaluation to assess compliance in caesarean sections.
(2016) Govender, Seshnee.; Gray, Andrew Lofts.
Introduction: Caesarean section births are the most important known common factor that has been linked with post-partum bacterial infections. According to the current Standard Treatment Guidelines, the prophylactic dose in surgical prophylaxis is a single dose of cefazolin, equal to the standard therapeutic dose, and given as a single stat dose prior to surgery. Multiple-dose regimes are associated with higher costs compared to a single-dose regime, not just in terms of acquisition costs but also in terms of staff time. Aim: To contribute to the rational use of antibiotics, through the application of a medicines use evaluation in a district hospital. Methods: A retrospective Medicine Use Evaluation (MUE) was carried out at Heidelberg Hospital in Gauteng. The quantitative data was collected over a 3 month study period in which the medical records of 120 female patients who delivered through Caesarean section was captured using the Medicine Use Evaluation data sheet. The qualitative phase involved structured interviews with medical officers to establish reasons for non-compliance. A total of 7 medical officers participated in the interviews. Results: None of the 120 patients received the stipulated regimen as recommended in The Standard Treatment Guidelines. Patients either received: 1 day of cefazolin, administered every 8 hours intravenously (83/120, 69.2%) or 3 days’ of cefazolin administered every 8 hours (37/120, 30.8%). Every HIV-uninfected woman (83/120, 69.2%) received 3 doses of cefazolin, whereas every HIV-infected woman received 9 doses of cefazolin and metronidazole intravenously. All patients also received 5 days’ of oral antibiotics on discharge. Eighty-five percent of patients did not have a justifiable reason for receiving a full therapeutic course. Discussion: Clear evidence was provided that the administration of antibiotic prophylaxis for Caesarean section deliveries at Heidelberg Hospital was irrational. Using MUE methods, the study identified different elements of non-compliance with the national recommendations. The study did not provide any justifications for the therapeutic use of antibiotics in patients without established or suspected infections post-operatively. Recommendations: The Standard Treatment Guidelines should provide unambiguous recommendations for the use of prophylaxis in women undergoing Caesarean sections in addition to the management of women suspected of having an established infection, and who deserve a full therapeutic course of antibiotics.
The assessment of knowledge and attitudes of health legislation (HL) among private family practitioners (FP) working in a defined geographical area.
(2011) Mahomed, Mahomed Faruk.; Gray, Andrew Lofts.
Introduction Since the 1994 change in power in South Africa, there have been many necessary changes in health legislation (HL), in accordance with the principles enshrined in the Constitution, Such changes have been recognized as being both complex and fraught with stakeholder interests. There is a perception that private family practitioners (FP) generally harbour negative attitudes towards HL that has been brought into effect in recent years. It is also possible that FP, in general, lack knowledge regarding HL. The aim of the study was to assess the knowledge and attitudes of private family practitioners (FP) to health legislation (HL) within a localized geographical area of the eThekweni Metro, KwaZulu-Natal Province. The specific objectives were: To determine family practitioners’ knowledge of health legislation. To determine family practitioners’ attitudes towards health legislation. To assess the correlation between family practitioners’ knowledge and attitudes. To compare the self-reported knowledge of health legislation with the objective assessment of knowledge and attitudes. To establish practitioners’ perceptions of the future of the profession, and of family practice in particular. Methods A cross-sectional descriptive and analytical study was performed, using a pre-tested, validated, structured questionnaire. This instrument was personally hand-delivered to each of a group of private family practitioners practising within a confined geographical area. The sample comprised of 101 family practitioners. Data were analysed using SPSS version 15.0 (SPSS Inc., Chicago, Illinois). Results The study revealed that private FP possess limited knowledge about HL and have a negative attitude in general towards HL. The mean knowledge score was 55% (standard deviation 12.2%). The mean score for attitudes towards health legislation was 46,3% (standard deviation 4.2%). The correlation coefficient between knowledge and attitudes was 0.244 (p=0.022). Therefore, there was a weak positive, but statistically significant, correlation between knowledge and attitudes. Thus, in general, as knowledge increased, so did attitudes improve and become more positive. The self reported knowledge and attitudes of FPs seemed to show some unexpected though non-statistically significant anomaly, in that FPs who considered themselves “well aware” of certain parts of HL, together with those who were “not aware”, reporting a more negative attitude towards HL than those who considered themselves to be “aware”. FPs’ perceptions of the future of the profession, and of family practice in particular, were generally reported as being reasonable to poor. Financial viability and sustainability of FP, in particular, were reported as being reasonable to poor. The attractiveness of the profession to the youth of today was reported as being poorer than in the past. However, the majority of FP held the perception that medicine as a profession was distinct as it responds to a calling to serve society at large, giving this aspect of the question a ranking of “reasonable to good”. Conclusion and Recommendations The study revealed that this group of FPs attained an overall mean knowledge score of 55% with respect to HL. FPs’ knowledge of HL requires improvement, which can be achieved through effective education and training programmes. Private FPs need to embrace the change process, but also need to be more pro-active in vocalizing their opinions. The Health Ministry and relevant authorities and policymakers need to play a greater role in creating an atmosphere that embraces and facilitates change by involving iii relevant stakeholders. Lastly, it is recommended that this study serve as a template for a broader research project involving larger numbers of participants and a wider geographical area. In addition, an intervention tool should be devised. Such a tool could take the form of a structured education programme on HL, with an associated monitoring and evaluation aspect, which would enable an assessment of the intervention programme in terms of its value and the influence it has on improving knowledge and attitudes.
Challenges in the integration of municipal health services in the uMgungundlovu District Municipality, KwaZulu-Natal.
(2011) Chapi, Nompumelelo.; Gray, Andrew Lofts.; Blanchard, Catherine.
The National Health Act (Act 61 of 2003) defined Municipal Health Services and gave full responsibility for this function to district municipalities and metropolitan municipalities. District municipalities were required, by law, to provide municipal health services which were previously rendered by local municipalities and the Provincial Department of Health. This, therefore, required the transfer of staff, assets and liabilities from local municipalities and the Provincial Department of Health to district municipalities. The purpose of the study was to identify barriers to and facilitating factors for the transfer of municipal health services from the seven local municipalities and the Provincial Department of Health to the uMgungundlovu district municipality. A cross-sectional, descriptive study design was employed. A structured questionnaire was used to collect quantitative data from local municipalities and the Provincial Department of Health on the package of environmental health services offered and the available human resources. Qualitative data was collected through in-depth interviews and focus group discussions with key role players in the provision of environmental health within the district. The key findings of the study were: There were no changes to the package of environmental health services offered by local municipalities and the Provincial Health following the definition of Municipal Health Services. The Provincial Department of Health continues to play an important role in the provision of Municipal Health Services in the district There was a lot of awareness-raising on the integration process; however planning for the integration was very poor. The lack of progress in integration has had a negative impact on service delivery and on the environmental health personnel involved. The relationship between district and local municipalities, a lack of understanding of environmental health, budget allocation, communication, lack of commitment, capacity, and lack of a champion were seen as the main barriers to the integration process. The study was able to identify possible gaps in the planning process that, if revisited could assist the district municipality in better handling the process.
Changes to antiretroviral drug regimens during integrated TB-HIV treatment: results of the SAPiT trial.
(International Medical Press., 2014) Naidoo, Anushka.; Naidoo, Kogieleum.; Yende-Zuma, Fortunate Nonhlanhla.; Gengiah, Tanuja Narayansamy.; Padayatchi, Nesri.; Gray, Andrew Lofts.; Bamber, Sheila.; Nair, Gonasagrie.; Abdool Karim, Salim Safurdeen.
Background—Frequency of drug changes in combination antiretroviral therapy among patients starting both tuberculosis (TB) and human immunodeficiency virus (HIV) therapy, as a result of treatment-limiting toxicity or virological failure, is not well established. Methods—Patients in the Starting Antiretroviral Therapy at Three Points in Tuberculosis (SAPiT) trial were randomized to initiate antiretroviral therapy either early or late during TB treatment or after completion of TB treatment. Drug changes due to toxicity (defined as due to grade 3 or 4 adverse events) or virological failure (defined as viral load > 1000 copies/ml on two occasions, taken at least 4 weeks apart) were assessed in these patients. Results—A total of 501 TB-HIV co-infected patients were followed for a mean of 16.0 (95% confidence interval (CI): 15.5 to 16.6) months after antiretroviral therapy (ART) initiation. The standard first-line ARVs used, were efavirenz, lamivudine and didanosine. Individual drug switches for toxicity occurred in 14 patients (incidence rate: 2.1 per 100 person-years; 95% (CI): 1.1 to 3.5), and complete regimen changes due to virological failure in 25 patients (incidence rate: 3.7 per 100 person-years; CI: 2.4 to 5.5). The most common treatment limiting toxicities were neuropsychiatric effects (n=4; 0.8%), elevated transaminase levels and hyperlactatemia (n= 3; 0.6%), and peripheral neuropathy (n=2; 0.4%). Complete regimen change due to treatment failure was more common in patients with CD4+ cell count <50cells/mm3 (p<0.001) at ART initiation and body mass index greater than 25 kg/m2 (p=0.01) at entry into the study. Conclusion—Both drug switches and complete regimen change were uncommon in patients cotreated for TB-HIV with the chosen regimen. Patients with severe immunosuppression need to be monitored carefully, as they were most at risk for treatment failure requiring regimen change.
Clinical pharmacy services in a South African private hospital group, and the factors hindering their progress.
(2015) Van der Walt, Kenneth Trevin.; Gray, Andrew Lofts.
Clinical pharmacy and the provision of patient-focused pharmaceutical care services is a hospital pharmacist’s role that is slowly developing in South African private hospitals. The clinical pharmacist, as a valuable member of the health care team, has been shown to improve patient clinical outcomes. However, a number of factors hinder the progression of clinical pharmacy services in these hospitals. To promote the implementation of clinical pharmacy services in South African private hospitals by identifying those factors perceived by South African hospital pharmacists as barriers. This observational mixed methods research study was conducted between September 2015 and February 2016, across 52 private hospitals within the same purposively selected private hospital group. Pharmacy managers were recruited for semi-structured interviews during the first qualitative phase. The second quantitative phase consisted of the distribution of a survey questionnaire to 243 hospital pharmacists and pharmacy managers. The overall response rate was poor, with only 15.9% and 30.4% recorded for the qualitative and quantitative phases, respectively. The median percentage of time that hospital pharmacists spend providing a clinical service at ward level was only 17.5%, and 76.1% of respondents stated that availability of time was negatively impacting clinical pharmacy progression. All survey respondents agreed that further formal education and training was required to progress clinical pharmacy. Hospital management support in clinical pharmacy progression was emphasised by 83.6% of the respondents. The lack of a recognised clinical pharmacist specialist registration category was identified by 70.8% of respondents as having a negative impact on clinical pharmacy progression. The perceived structural and behavioural barriers to clinical pharmacy service progression were identified as being educational requirements, human resource allocation and the need for hospital and governmental support. The FIP Basel Statements on the Future of Hospital Pharmacy require local adaptation in order to be used as a tool to monitor clinical pharmacy practice in hospitals in South Africa, but should be promoted to further expose the identified barriers and initiate corrective action. The perceived barriers and steps for remedial action to educational needs, human resource allocation and hospital and governmental support are provided. Addressing these barriers will further promote and strengthen the role of the clinical pharmacist in South African private hospitals.
Cost-effectiveness of initiating antiretroviral therapy at different points in TB treatment in HIV-TB co-infected ambulatory patients in South Africa.
(Wolters Kluwer., 2015) Naidoo, Kogieleum.; Grobler, Anna Christina.; Deghaye, Nicola.; Reddy, Tarylee.; Gengiah, Santhanalakshmi.; Gray, Andrew Lofts.; Abdool Karim, Salim Safurdeen.
Abstract available in pdf.
Cost-minimization analysis of Imipenem/Cilastatin versus Meropenem in moderate to severe infections at a tertiary care hospital in Saudi Arabia.
Joosub, Imraan.; Gray, Andrew Lofts.
Introduction: The aim of this study was to compare the costs of management of moderate to severe infections in patients treated with imipenem/ cilastatin (IC) and meropenem (MEM). Pharmacoeconomic studies in Saudi Arabia are scarce. Available hospital data illustrate that carbapenem antibiotics are among the most expensive medicines being procured. The current hospital formulary at the King Abdulaziz National Guard Hospital, Al-Ahsa, Saudi Arabia, contains 2 carbapenems: IC and MEM. These antibiotics share a similar spectrum of activity, with the unit cost of IC (500mg/ 500mg) being less than that for MEM (1 gram). There are conflicting reviews with regard to the relative cost-effectiveness of these 2 agents. An unpublished pharmacoeconomic review at our institute has shown that an interchange programme substituting MEM with IC would lead to a cost saving of SAR2 306 257 per year. Methods: A retrospective, single-centre cohort study of 88 patients, applying cost-minimization analysis, of IC versus MEM in moderate to severe infections was conducted at the King Abdulaziz National Guard Hospital, Al-Ahsa. In accordance with cost-minimization analysis methods, the assumption of equivalent efficacy was demonstrated by literature retrieved and cited. Direct costs related to the management of the infections were included in the study. Adult patients (≥18 years old) diagnosed with moderate to severe infection, including skin and skin structure infections (SSIs), sepsis, intra-abdominal infections (IAIs), respiratory tract infections, urinary tract infections (UTIs) and hospital-acquired infections (HAIs), who were prescribed IC 500mg every six hours intravenously (2 gram per day) or MEM 1 gram every eight hours (3 gram per day), were included in the study. Results: Overall there was no difference in the mean total daily costs between IC (SAR 4 784.46, 95% CI 4 140.68, 5 428.24) and MEM (4 390.14, 95% CI 3 785.82, 4 994.45;, p = 0.37). The study showed no significant difference in terms of mean daily critical care hospital stay costs. Mean general ward costs were significantly lower in the IC group. Significantly lower medicine acquisition vial cost of IC was observed when compared to MEM, however there was a significantly higher cost attached to administration sets used in the IC group than the MEM group. Consultation, nursing and physician costs were not significantly different between the groups. No differences were observed in costs associated with adverse drug events (ADEs). Conclusion: This study has shown that while acquisition costs of IC at a dose of 500mg q6h may be lower than for MEM 1 gram q8h, mean total costs per day were not significantly different between IC and MEM, indicating that medicine costs are only a small element of the overall costs of managing moderate to severe infections. Enforcing the Pharmacy and Therapeutic Committee (PTC) recommendations will assist in selecting the most appropriate carbapenem, while at the same time minimize drug costs. Further pharmacoeconomic research within the Kingdom of Saudi Arabia is essential in selecting cost-effective medicines.
Enrolling adolescents in research on HIV and other sensitive Issues: lessons from South Africa.
(Plos., 2006) Singh, Jerome Amir.; Abdool Karim, Salim Safurdeen.; Abdool Karim, Quarraisha.; Mlisana, Koleka Patience.; Williamson, Carolyn.; Gray, Clive M.; Govender, Michele.; Gray, Andrew Lofts.
The article discusses the challenge of enrolling adolescents in HIV studies in South Africa. It is practically impossible in some instances to seek parental consent or to determine who, if anyone, is the legal guardian to authorize an adolescent's participation in research. The South African Medical Research Council research ethics guidelines prescribe 14 years of age as the autonomous age of consent for therapeutic research but not observational studies.
The influence of tuberculosis treatment on efavirenz clearance in patients co-infected with HIV and tuberculosis.
(Springer-Verlag., 2011) Gengiah, Tanuja Narayansamy.; Holford, Nicholas H. G.; Botha, Julia Hilary.; Gray, Andrew Lofts.; Naidoo, Kogieleum.; Abdool Karim, Salim Safurdeen.
Purpose: Drug interactions are of concern when treating patients co-infected with human immunodeficiency virus (HIV) and tuberculosis. Concomitant use of efavirenz (EFV) with the enzyme inducer rifampicin might be expected to increase EFV clearance. We investigated the influence of concomitant tuberculosis treatment on the plasma clearance of EFV. Methods: Fifty-eight patients were randomized to receive their EFV-containing antiretroviral therapy either during or after tuberculosis treatment. Steady-state EFV plasma concentrations (n = 209 samples) were measured, 83 in the presence of rifampicin. Data were analyzed using a non-linear mixed effects model, and the model was evaluated using non-parametric bootstrap and visual predictive checks. Results: The patients had a median age of 32 (range 19–55) years and 43.1% were women. There was a bimodal distribution of apparent clearance, with slow EFV metabolizers accounting for 23.6% of the population and having a metabolic capacity 36.4% of that of the faster metabolizers. Apparent EFV clearance after oral administration in fast metabolizers was 12.9 L/h/70 kg whilst off tuberculosis treatment and 9.1 L/h/70 kg when on tuberculosis treatment. In slow metabolizers, the clearance estimates were 3.3 and 4.7 L/h/70 kg in the presence and absence of TB treatment, respectively. Overall there was a 29.5% reduction in EFV clearance during tuberculosis treatment. Conclusion: Unexpectedly, concomitant rifampicin-containing tuberculosis treatment reduced apparent EFV clearance with a corresponding increase in EFV exposure. While the reasons for this interaction require further investigation, cytochrome P450 2B6 polymorphisms in the population studied may provide some explanation.
Initiating antiretrovirals during tuberculosis treatment: a drug safety review.
(Informa UK, Ltd., 2011) Gengiah, Tanuja Narayansamy.; Gray, Andrew Lofts.; Naidoo, Kogieleum.; Abdool Karim, Quarraisha.
Introduction: Integrating HIV and tuberculosis (TB) treatment can reduce mortality substantially. Practical barriers to treatment integration still exist and include safety concerns related to concomitant drug use because of drug interactions and additive toxicities. Altered therapeutic concentrations may influence the chances of treatment success or toxicity. Areas covered: The available data on drug--drug interactions between the rifamycin class of anti-mycobacterials and the non-nucleoside reverse transcriptase inhibitor and the protease inhibitor classes of antiretrovirals are discussed with recommendations for integrated use. Additive drug toxicities, the impact of immune reconstitution inflammatory syndrome (IRIS) and the latest data on survival benefits of integrating treatment are elucidated. Expert opinion: Deferring treatment of HIV to avoid drug interactions with TB treatment or the occurrence of IRIS is not necessary. In the integrated management of TB--HIV co-infection, rational drug combinations aimed at reducing toxicities while effecting TB cure and suppressing HIV viral load are possible.
Integration of antiretroviral therapy with tuberculosis treatment.
(Massachusetts Medical Society., 2011) Abdool Karim, Salim Safurdeen.; Naidoo, Kogieleum.; Grobler, Anna Christina.; Padayatchi, Nesri.; Baxter, Cheryl.; Gray, Andrew Lofts.; Gengiah, Tanuja Narayansamy.; Gengiah, Santhanalakshmi.; Naidoo, Anushka.; Jithoo, Niraksha.; Nair, Gonasagrie.; El-Sadr, Wafaa M.; Friedland, Gerald H.; Abdool Karim, Quarraisha.
Background. We previously reported that integrating antiretroviral therapy (ART) with tuberculosis treatment reduces mortality. However, the timing for the initiation of ART during tuberculosis treatment remains unresolved. Methods. We conducted a three-group, open-label, randomized, controlled trial in South Africa involving 642 ambulatory patients, all with tuberculosis (confirmed by a positive sputum smear for acid-fast bacilli), human immunodeficiency virus infection, and a CD4+ T-cell count of less than 500 per cubic millimeter. Findings in the earlier- ART group (ART initiated within 4 weeks after the start of tuberculosis treatment, 214 patients) and later-ART group (ART initiated during the first 4 weeks of the continuation phase of tuberculosis treatment, 215 patients) are presented here. Results. At baseline, the median CD4+ T-cell count was 150 per cubic millimeter, and the median viral load was 161,000 copies per milliliter, with no significant differences between the two groups. The incidence rate of the acquired immunodeficiency syndrome (AIDS) or death was 6.9 cases per 100 person-years in the earlier-ART group (18 cases) as compared with 7.8 per 100 person-years in the later-ART group (19 cases) (incidence-rate ratio, 0.89; 95% confidence interval [CI], 0.44 to 1.79; P = 0.73). However, among patients with CD4+ T-cell counts of less than 50 per cubic millimeter, the incidence rates of AIDS or death were 8.5 and 26.3 cases per 100 person-years, respectively (incidence-rate ratio, 0.32; 95% CI, 0.07 to 1.13; P = 0.06). The incidence rates of the immune reconstitution inflammatory syndrome (IRIS) were 20.1 and 7.7 cases per 100 person-years, respectively (incidence-rate ratio, 2.62; 95% CI, 1.48 to 4.82; P<0.001). Adverse events requiring a switching of antiretroviral drugs occurred in 10 patients in the earlier-ART group and 1 patient in the later-ART group (P = 0.006). Conclusions. Early initiation of ART in patients with CD4+ T-cell counts of less than 50 per cubic millimeter increased AIDS-free survival. Deferral of the initiation of ART to the first 4 weeks of the continuation phase of tuberculosis therapy in those with higher CD4+ T-cell counts reduced the risks of IRIS and other adverse events related to ART without increasing the risk of AIDS or death.
Knowledge, attitudes and practices of community pharmacists in Harare regarding the reporting of adverse drug reactions.
(2017) Mafundikwa, Tafadzwa Christine.; Gray, Andrew Lofts.
Adverse drug reactions (ADRs) cause considerable morbidity which contributes significantly to health expenditure. Worldwide, there is under-reporting of ADRs by healthcare workers and Zimbabwe is no exception. In Zimbabwe, ADRs are mainly detected by use of a spontaneous reporting system. There is a greater need for enhanced pharmacovigilance (PCV) in Africa, where weak health systems are likely to contribute to medicine-related harm. The aim of the study was to contribute to the safe use of medicines by strengthening reporting of adverse drug reactions by pharmacists in Harare, by identifying knowledge, attitudes and practices that hinder their involvement at present. The objectives of the study are to determine if pharmacists practicing in private community pharmacies in Harare, Zimbabwe, know how to identify and when to report ADRs and whether they are reporting ADRs to the relevant authorities. In addition, the study seeks to determine their attitudes towards identification and reporting of ADRs and finally, to make recommendations for interventions to improve the knowledge, attitudes and practices of pharmacists in relation to the identification and reporting of ADRs. The study was designed as an observational, cross-sectional, analytical study. This design was used since it offered a cost-effective way of gathering information from many people in a relatively short period. Study Population and sampling: The study took place in Harare, Zimbabwe, where over 44% of the country’s private community pharmacies are located. A census approach was used as little is known about the subject locally. A self-administered questionnaire was designed to establish the socio-demographics of the respondents, their knowledge on ADR reporting and their attitudes and practices regarding ADR reporting. The questionnaires were distributed via electronic mail and at a continuing professional development session to a combined total of 129 community pharmacists. Data were analysed using Statistical Package for the Social Sciences (SPSS) version 16 and Microsoft Excel 2007. The respondents displayed poor knowledge of ADR reporting and hence there is under-reporting of ADRs. Factors such as post-graduate training and years of experience post- graduation have no bearing on the knowledge possessed by the respondents regarding ADR reporting. Although the respondents showed an appreciation of the importance of ADR reporting, there are barriers such as lack of knowledge and fear of legal liability that prevent pharmacists from reporting ADRs. Discussion: Lack of knowledge is the main barrier to reporting of ADRs by community pharmacist in Zimbabwe. To address this gap, interventions such as education for community pharmacists are required for both undergraduate pharmacist students and qualified pharmacists. There is a low level of knowledge and poor attitudes and practices amongst Zimbabwean pharmacists with respect to ADR reporting. Multi-sectoral interventions are required to overcome the barriers that community pharmacists encounter in reporting ADRs.
The potential for cost savings by extensively using generics for chronic conditions in South Africa.
(2006) Nicolosi, Elizabeth.; Manion, Gillian Lesley Colenso.; Gray, Andrew Lofts.
Economic factors are a major constraint to quality health care in Africa. One of the aims of the Department of Health in South Africa is to increase availability and affordability of medicine. One way of reducing the cost of drugs is by introducing legislation to control the price of drugs and by the promotion of generics (interchangeable multisource medicines which are cheaper copies of the original brand name drug). Protocols for the Prescribed Minimum Benefits (PMBs) for the 27 conditions on the Chronic Disease List as published in the Government Gazette in 2003, were legally binding from 1 January 2004 and these conditions must be covered by all medical schemes. Medication prescribed for these conditions may have one or more generic substitutes and Government has allowed certain measures to be introduced by the medical schemes in order to contain costs. This study investigates the potential savings if generics are extensively used for these chronic conditions. A census was conducted on the 25 chronic diseases for which algorithms are available. The empirical quantitative data collected was calculated to quantify potential costs savings in respect of each algorithm. The major findings show that there are large cost differentials between originator drugs and their generic equivalents (97% in the case of prednisone) and smaller cost differentials between generics themselves (54.6% in the case of formoterol). This study also shows that there is a correlation between the number of generic equivalents an originator drug has and the percentage cost differential. A total of 67.5% of all cost differentials between originator and generics are greater than the Department of Health's proposed 40% benchmark pricing. The results support the recommendations that government needs to implement various measures to encourage increased use of generics in this country and to look at realistic benchmark price controls.
Primary school teachers' knowledge of asthma in Umdoni subdistrict, KwaZulu-Natal.
(2011) Govender, Desiree.; Gray, Andrew Lofts.
Introduction On the 5th of December 2009, at the 40th Union World Conference on Lung Health in Cancun, Mexico, the American Thoracic Society and the Forum of International Respiratory Societies declared 2010 as the “Year of the Lung”. Asthma features amongst the “big five” of the respiratory diseases worldwide. It is estimated that South Africa has the 25th highest asthma prevalence in the world and the 5th highest case fatality rate in the world. Asthma has been reported as one of the most serious common chronic condition affecting young children. The South African media and government reports states that one in eight children in South Africa has asthma. Children spend a considerable amount of time at school. Teachers are often recognised as in loco parentis at school. Therefore, it is imperative that primary schoolteachers have some knowledge of asthma and its management to ensure that asthmatic school children can be assisted. Aim The aim of this study was to elucidate asthma knowledge and management in primary schools in Umdoni subdistrict. Methods A cross sectional study design was used. Two hundred and twenty six schoolteachers’ from 19 primary schools participated in this paperless survey. An asthma knowledge questionnaire was developed by the researcher in consultation with a paediatric asthma specialist and was fielded using the Mobile Researcher mobile application channel, provided by Clyral. The survey was conducted using cellular telephones that were used to capture teachers’ responses during face-to-face interviews with fieldworkers. The completed surveys were uploaded using general packet radio service (GPRS) to the web-based “Research Centre”. Data were exported to a Microsoft Excel spreadsheet, cleaned and then imported into SPSS 15.10 for analysis. Results This study found that although the majority of primary schoolteachers (61.5%) had above 50% correct answers in the asthma knowledge test, the vast majority (95.1%) felt asthma education was necessary for schoolteachers. The results suggest that although teachers have reasonable knowledge on certain areas regarding asthma, however there is huge gap in their knowledge on the care of a child with an acute exacerbation of asthma. The lack of medical or nursing personnel at these schools means that the initial management of the child during an asthma attack will be in the hands of school personnel. In light of this, it is important to note that 38.5% of participants scored less than 50% on an asthma knowledge test, which denoted poor or limited knowledge of asthma and its management. This study also showed that teachers’ knowledge of asthma and sports was deficient and teachers do have misconceptions about asthmatic children’s abilities. None of the schools had written material to guide the management and care of asthmatic children. Such materials would be necessary, especially in circumstances when prompt action is required in a severe acute asthma attack. Conclusion The results conclude that primary schoolteachers’ knowledge in Umdoni subdistrict is deficient especially in the knowledge of the care of a child with an acute exacerbation of asthma. Teachers in Umdoni subdistrict are in contact with and exposed to asthmatic schoolchildren on a regular basis. Teachers have to cope with asthmatic children who have diverse needs. The importance of enhancing school based asthma health promotion strategies is highlighted by the following recommendations: asthma education training for school personnel, participation and support from Departments of Health and Education and the development and implementation of sound asthma policies in schools.
Ritonavir/saquinavir safety concerns curtail antiretroviral therapy options for tuberculosis–HIV-co-infected patients in resource-constrained settings.
(Lippincott Williams & Wilkins., 2005) Gray, Andrew Lofts.; Abdool Karim, Salim Safurdeen.; Gengiah, Tanuja Narayansamy.
No abstract available.
The SAPIT trial provides essential evidence on risks and benefits of integrated and sequential treatment of HIV and tuberculosis.
(Health and Medical Publications Group., 2010) Abdool Karim, Quarraisha.; Abdool Karim, Salim Safurdeen.; Baxter, Cheryl.; Friedland, Gerald H.; Gengiah, Tanuja Narayansamy.; Gray, Andrew Lofts.; Grobler, Anna Christina.; Naidoo, Kogieleum.; Padayatchi, Nesri.; El-Sadr, Wafaa M.
Boulle et al.(1) queried whether a clinical trial was needed to provide the evidence for the mortality benefits of antiretroviral therapy (ART) initiation during tuberculosis (TB) treatment. While several experts, including foremost TB-HIV scientists from South Africa (2) and the USA,(3) senior World Health Organization (WHO) (4) and UNAIDS (5) officials at the time the study was initiated, the 2003 WHO AIDS Treatment Guidelines Committee Chair (3), the Chair of the Ethics Committee (6) and the researchers,(7) have previously addressed the points raised, the SAPIT (Starting Antiretroviral Therapy at Three Points in Tuberculosis) research team welcomes the opportunity also to address the comments. We hold Boulle and his colleagues in high regard and appreciate their contributions to the field of HIV and tuberculosis co-infection. More importantly, we share with them the common goal of rigorously and relentlessly seeking answers to critically important research questions as we confront the devastating dual AIDS and tuberculosis epidemics. The SAPIT trial,(8) which was developed in 2004, set out to assess whether integrating tuberculosis and AIDS treatment would lead to improved outcomes compared with the widely practised approach of treating them sequentially. The trial’s Safety Monitoring Committee halted the sequential treatment arm in September 2008 because of a 56% lower mortality rate in the integrated treatment arm. We systematically address the queries on equipoise and standard of care.
Timing of initiation of antiretroviral drugs during tuberculosis therapy.
(Massachusetts Medical Society., 2010) Abdool Karim, Salim Safurdeen.; Naidoo, Kogieleum.; Grobler, Anna Christina.; Padayatchi, Nesri.; Baxter, Cheryl.; Gray, Andrew Lofts.; Gengiah, Tanuja Narayansamy.; Nair, Gonasagrie.; Bamber, Sheila.; Singh, Aarthi.; Khan, Munira.; Pienaar, Jacqueline C.; El-Sadr, Wafaa M.; Friedland, Gerald H.; Abdool Karim, Quarraisha.
Background. The rates of death are high among patients with coinfection with tuberculosis and the human immunodeficiency virus (HIV). The optimal timing for the initiation of antiretroviral therapy in relation to tuberculosis therapy remains controversial. Methods. In an open-label, randomized, controlled trial in Durban, South Africa, we assigned 642 patients with both tuberculosis and HIV infection to start antiretroviral therapy either during tuberculosis therapy (in two integrated-therapy groups) or after the completion of such treatment (in one sequential-therapy group). The diagnosis of tuberculosis was based on a positive sputum smear for acid-fast bacilli. Only patients with HIV infection and a CD4+ cell count of less than 500 per cubic millimeter were included. All patients received standard tuberculosis therapy, prophylaxis with trimethoprim–sulfamethoxazole, and a once-daily antiretroviral regimen of didanosine, lamivudine, and efavirenz. The primary end point was death from any cause. Results. This analysis compares data from the sequential-therapy group and the combined integrated-therapy groups up to September 1, 2008, when the data and safety monitoring committee recommended that all patients receive integrated antiretroviral therapy. There was a reduction in the rate of death among the 429 patients in the combined integrated-therapy groups (5.4 deaths per 100 person-years, or 25 deaths), as compared with the 213 patients in the sequential-therapy group (12.1 per 100 person-years, or 27 deaths); a relative reduction of 56% (hazard ratio in the combined integrated-therapy groups, 0.44; 95% confidence interval, 0.25 to 0.79; P = 0.003). Mortality was lower in the combined integrated-therapy groups in all CD4+ count strata. Rates of adverse events during follow-up were similar in the two study groups. Conclusions. The initiation of antiretroviral therapy during tuberculosis therapy significantly improved survival and provides further impetus for the integration of tuberculosis and HIV services. (Clinical Trials.gov number, NCT00398996.)
Traditional medicine use in patients on antiretroviral therapy: a cross-sectional study at Thembalethu Wellness Centre, Northdale Hospital.
(2017) Mazibuko, Zethu Yvette Patronica.; Gray, Andrew Lofts.
Introduction Adherence is the primary predictor of treatment success with antiretroviral therapy (ART). It is not known whether the use of traditional medicine use predicts non-adherence to ART. Traditional medicine use has been reported to be common among individuals with moderate and advanced HIV disease. There is some data available on the prevalence and patterns of African Traditional Medicine (ATM) use in patients with HIV/ AIDS. Aim The aim of this cross-sectional study was to describe the prevalence of traditional medicine use amongst patients on antiretroviral therapy, aged 18-49 years and to assess any association between the use of traditional medicines and adherence to antiretroviral therapy in patients seen at Thembalethu Wellness Centre, Northdale Hospital, in KwaZulu-Natal, South Africa. Methods Using systematic sampling, 75 HIV-positive patients on antiretroviral therapy were selected from the pharmacy queue. Data was collected using primarily a semi-structured questionnaire with closed and open-ended questions during a face-to-face interview. The questionnaire was translated to Zulu. Pre-testing of the questionnaire was completed with 5 HIV-infected persons not involved in the study from another hospital. Data from closed-ended questions was collected, coded and captured on computer using the Microsoft Excel spreadsheet programme then all data was imported to SPSS programme for analysis. Results The study findings showed that, of the seven individuals who reported using traditional medicines, three (42.9%) also reported to have missed ART doses with one who reported missing more than three doses in the preceding month. Traditional medicines were mostly used by African men who followed Christian religion. iii Traditional medicines were mainly used for cultural purposes specifically; cleansing purposes for different reasons. Male sex and the use of African traditional medicines were shown to be associated with poor adherence to antiretroviral therapy. Conclusion Although many previous studies have shown that traditional medicines were commonly used concomitantly with antiretroviral drugs by HIV positive patients; in this study only 9.3% of participants admitted having used traditional medicines in the 28 days preceding the survey. Participants were more likely to be non-adherent to ART if they were male and self-reported using traditional medicine.