Browsing by Author "Naidoo, Panjasaram."

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Adherence-monitoring practices by private healthcare sector doctors managing HIV and AIDS patients in the eThekwini metro of KwaZulu-Natal.
(MedPharm, 2009) Naidoo, Panjasaram.; Taylor, Myra.; Jinabhai, Champaklal Chhaganlal.
Background: The danger of poor adherence to treatment by patients with HIV infection is that poor adherence correlates with clinical and virological failure. Understanding how private-sector doctors monitor adherence by their HIV-infected patients could assist in developing interventions to improve adherence by these patients. Information about such practices amongst private-sector doctors in the province of KwaZulu-Natal, however, is limited. This study was, therefore, undertaken to assess the private-sector doctor adherence-monitoring practices of HIV-infected patients in the eThekwini metro of KwaZulu-Natal. Methods: A descriptive cross-sectional study was undertaken amongst private general practitioners (GPs) and specialists managing HIV/AIDS patients in the eThekwini metro. Anonymous semi-structured questionnaires were used to investigate adherence-monitoring practices by these doctors and their strategies to improve adherence. Results: A total of 171 doctors responded, with over 75% in practice for over 11 years and 78.9% indicating that they monitored adherence. A comparison between the GPs and the specialists found that 82.6% of the GPs monitored adherence compared with 63.6% of the specialists (p = 0.016). The doctors used several approaches, with 60.6% reporting the use of patient self-reports and 18.3% reporting the use of pill counts. A total of 68.7% of the doctors indicated that their adherence monitoring was reliable, whilst 19.7% indicated that they did not test the reliability of their monitoring tools. The most common strategy used to improve adherence by their patients was through counselling. Other strategies included alarm clocks, SMSs, telephone calls to the patients, the encouragement of family support and the use of medical aid programmes. Conclusions: Private-sector doctors managing HIV/AIDS patients in the eThekwini metro of KwaZulu-Natal do monitor adherence and employ strategies to improve adherence.
Collaboration with and integration of African traditional healers into the South African health care system.
(2016) Gandugade, Pradnya V.; Naidoo, Panjasaram.; Nlooto, Manimbulu.
The use of traditional, complementary and alternative medicine (TCAM) is widespread in many countries of the world, specifically amongst patients with chronic or long term illnesses. Research has found that allopathic medical doctors in rural areas regularly encounter patients who visit traditional doctors initially before presenting themselves to allopathic-medical doctors. The degree of interaction between TCAM and allopathic modalities in the effective treatment of patients visiting both allopathic practitioners and Traditional health practitioners (THPs) are unknown. This poses a major challenge in effectively managing patients. Therefore, a good collaborative relationship between these two different health practitioners and healthcare systems is needed to optimally treat patients. However, THPs have not shown great enthusiasm to collaborate with Western medicine. The reasons for this and if there are any barriers that prevent THPs from actually getting into western system has not been explored. It is commonly known that, doctors from Western medicine always disagree in terms of quality, efficacy and safety of drugs used by THPs hence their scepticism about THPs. This study therefore aimed at unpacking the reasons and barriers that THPs forward as to why they do not want to be incorporated into the mainstream health care system. A descriptive cross-sectional study was carried out with traditional health practitioners (THPs) working in the eThekwini Metro & surrounding areas, of KwaZulu-Natal, South Africa. Interviews were carried out with traditional health practitioners (THPs) using a structured coded questionnaire. The questionnaire and interviews were administered by interviewers in the language of the THPs (Zulu and English). All responses were recorded in the data sheets. Confidentiality of data was maintained at all times and the THPs remained anonymous. The collected data was entered onto excel sheet and exported onto SPSS and analysed using the SPSS statistical programme for window, version 22. The data was presented in frequency distribution tables. Categorical variables are presented as bar graphs. A total of 171 traditional health practitioners were interviewed. Seventy-six percent of THPs (130/171) reported willingness to collaborate with allopathic medical practitioners. The majority of the THPs (83.6 % [143/171]) thought that western medical practitioners and THPs could work together, whilst 81.3 % (139/171) of the THPs perceived that collaboration between allopathic medical practitioners and THPs would be beneficial for patients. Sixty-eight per cent of THPs (117/171) indicated willingness to work side by side with allopathic medical practitioners in clinics. However, 72% (124/171) of the THPs reported that if THPs worked with allopathic medical practitioners, then THPs would lose their identity and if THPs and allopathic medical practitioners worked in the same place 76 % (130/171) then THPs felt that allopathic medical practitioners would steal their knowledge. Over 87% (149/171) of THPs indicated a willingness to learn allopathic medicine. This study found that traditional healers were willing to collaborate with western doctors as they felt that this collaboration would be beneficial for patients in South Africa. However, there was concern that the collaboration may lead to THPs losing their identity and the possibility of their knowledge being taken away by allopathic medical practitioners.
Evaluation of the clinical and drug management of HIV/AIDS patients in the private health care sector of the eThekwini Metro of KwaZulu-Natal : sharing models and lessons for application in the public health care sector.
(2010) Naidoo, Panjasaram.; Jinabhai, Champaklal Chhaganlal.; Taylor, Myra.
Introduction: South Africa is currently experiencing one of the most severe AIDS epidemics in the world with South Africa‘s public sector under great stress and under-resourced whilst there exists a vibrant private healthcare sector. Private healthcare sector doctors have a pivotal role to play in the management of HIV and AIDS infection. However not much is known about the extent of private healthcare sector doctor involvement in the management of HIV and AIDS patients. In addition these doctors need to have an accurate knowledge of the management of the infection, and a positive attitude towards the treatment of persons with HIV and AIDS. With the availability of antiretroviral drugs only since around 1996, many of the doctors who were trained prior to 1996 would not have received any formal training in the management of HIV and AIDS patients, further it is very important that these doctors constantly update their knowledge and obtain information in order to practise high-quality medicine. Although private sector doctors are the backbone of treatment service in many countries, caring for patients with HIV brings a whole new set of challenges and difficulties. The few studies done on the quality of care of HIV patients, in the private sector in developing countries, have highlighted some problems with management thus it becomes important to ascertain these doctors‘ training needs together with where these doctors source information on HIV/AIDS to stay updated. In South Africa two thirds of the doctors work in the private sector. To address some of the resource and personnel shortages facing the public sector in South Africa, partnerships between the public and private sectors are slowly being forged. However, little is known about the willingness on the part of private sector doctors in the eThekwini Metro of KwaZulu-Natal, to manage public sector HIV and AIDS patients. Though many studies have been undertaken on HIV/AIDS, fewer have been done in the private sector in terms of the management of this disease which includes doctors‘ adherence monitoring practices, their training needs and sources of information and their willingness to manage public sector patients. A study was therefore undertaken to assess the involvement of private sector doctors in the management of HIV, their training needs and sources of HIV information, the quality of HIV clinical management that they provided, together with their strategies for improving adherence in patients. Further the study assessed factors that affect adherence in patients attending private healthcare, and finally investigated whether private sector doctors are willing to manage public sector HIV infected patients. A literature review of the barriers that prevent doctors from managing HIV/AIDS patients was also undertaken. Method: A descriptive cross sectional study was undertaken using structured self reported questionnaires. All private sector doctors practising in the eThekwini Metro were included in the study. The study was divided into different phases. After exclusions a valid sample of 931 participants was obtained in Phase 1. However only 235 of these doctors indicated that they managed HIV infected patients, of which only 190 consented to be part of Phase 2 of the study. In Phase 2 the questionnaires were administered by trained field workers to the doctors after confirming doctors‘ consent. The questionnaires were thereafter collected, the data captured and analysed using SP55 version 15. Results: Although 235 (71.6%) doctors managed HIV and AIDS patients, 93 (28.4%) doctors did not, and of the latter 48 (51.61%) had not encountered HIV and AIDS patients, twenty five (26.88%) referred such patients to specialists, six (6.45%) cited cost factors as reasons for not treating such patients, whilst twelve (12.90%) doctors, though they indicated that there were other reasons for not managing HIV infected patients, did not specify their reasons. Two doctors (2.15%) indicated that due to inadequate knowledge they did not manage HIV and AIDS patients. Significantly younger (recently qualified) doctors rather than older (qualified for more years) doctors treated HIV/AIDS patients (p<0.001). Most doctors (76.3%) expressed a need for more training/knowledge on the management of HIV patients. Eighty five doctors (54.5%) always measured the CD4 count and viral load levels at diagnosis. Both CD4 counts and viral load were always used by 76 doctors (61.8%) to initiate therapy. Of the doctors 134 (78.5%) initiated therapy at CD4 count < 200cells/mm3. The majority of doctors prescribed triple therapy regimens using the 2 NRTI +1 NNRTI combination. Doctors who used CD4 counts tended to also use viral load (VL) to assess effectiveness and change therapy (p<0.001). At initiation of treatment 68.5% of the doctors saw their patients monthly and 64.3% saw them 3-6 monthly when stable. The majority of the doctors (92.4%) obtained information on HIV and AIDS from journals. Continuing Medical Education (CME), textbooks, pharmaceutical representatives, workshops, colleagues and conferences were identified as other sources of information, while only 35.7% of doctors were found to use the internet for information. GPs and specialists differed significantly with regard to their reliance on colleagues (52.9% versus 72.7%; p < 0.05) and conferences (48.6% versus 78.8%; p < 0.05) as sources of HIV information. Of the respondents, 78.9% indicated that they monitor for adherence. Comparison of GPs and specialists found that 82.6% of the GPs monitor for adherence compared to 63.6% of the specialists. (p=0.016). Doctors used several approaches with 60.6% reporting the use of patient self reports and 18.3% pill counts. Doctors (68.7%) indicated that their adherence monitoring is reliable, whilst 19.7% stated they did not test the reliability of their monitoring tool. The most common strategy used to improve adherence of their patients was by counseling. Other strategies included alarm clocks, SMS, telephoning the patient, encouraging family support and the use of medical aid programmes. One hundred and thirty three (77.8%) doctors were willing to manage public sector HIV and AIDS patients, with 105 (78.9%) reporting adequate knowledge, 99 (74.4%) adequate time, and 83 (62.4%) adequate infrastructure. Of the 38 (22.2%) that were unwilling to manage these patients, more than 80% cited a lack of time, knowledge and infrastructure to manage them. Another reason cited by five doctors (3.8%) who were unwilling was the distance from public sector facilities. Of the 33 specialist doctors, 14 (42.4%) indicated that they would not be willing to manage public sector HIV and AIDS patients, compared with only 24 (17.4%) of the 138 GPs (p < 0.01). There was no statistical difference between adherence to treatment and demographics of the respondent patient such as age, gender and marital status. In this study 89.1% of patients were classified as non-adherent and reasons for non-adherence included difficulty in swallowing medicines (67.3%) (p = 0.01); side effects (61.8%) (p = 0.03); forgetting to take medication (58.2%) (p = 0.003); and not wanting to reveal their HIV status (41.8%) (p = 0.03). Common side effects experienced were nausea, dizziness, insomnia, tiredness or weakness. Reasons for taking their medicines included that tablets would save their lives (83.6%); they understood how to take the medication (81.8%); tablets would help them feel better (80.0%); and that they were educated about their illness (78.2%). All participants that were on a regimen that comprised protease inhibitors and two NRTIs were found to be non-adherent. Conclusion: All doctors in the private healthcare sector were not involved in the management of HIV/AIDS patients. Doctors indicated that they required more training in the management of HIV/AIDS patients. However private sector doctors in the eThekwini Metro do obtain information on HIV from reliable sources in order to have up-to-date knowledge on the management of HIV-infected patients, with the majority of private sector doctors being compliant with the current guidelines, hence maintaining an acceptable quality of clinical health care. These doctors do monitor for adherence and employ strategies to improve adherence in their patients who do have problems adhering to their treatment due to various factors. Many private sector doctors are willing to manage public sector HIV and AIDS patients in the eThekwini Metro, potentially removing some of the current burden on the public health sector.
Evaluation of the clinical management of HIV-infected patients by private sector doctors in the eThekwini Metro, KwaZulu-Natal.
(MedPharm, 2009) Naidoo, Panjasaram.; Esterhuizen, Tonya.; Jinabhai, Champaklal Chhaganlal.; Taylor, Myra.
Background: Although private sector doctors are the backbone of treatment service in many countries, caring for patients with HIV entails a whole new set of challenges and difficulties. The few studies done on the quality of care of HIV patients, in the private sector in developing countries, have highlighted some problems with management. In South Africa, two-thirds of doctors work in the private sector. Though many studies on HIV/AIDS have been undertaken, few have been done in the private sector in terms of the management of this disease. Therefore, a study was undertaken to evaluate the clinical management of HIV-infected patients by private sector doctors. Methods: A descriptive cross-sectional study was undertaken in the eThekwini Metro in KwaZulu-Natal, South Africa, with 190 private sector doctors who, in the first phase of the study, indicated that they manage HIV and AIDS patients and would be willing to participate in the second phase of the study. The HIV guidelines of the Department of Health and Human Services and the South African National Department of Health were used to compare the treatment of HIV patients by these doctors. Results: Eighty-five doctors (54.5%) always measured the CD4 count and viral load levels at diagnosis. Both CD4 counts and viral load were always used by 76 doctors (61.8%) to initiate therapy. Of the doctors, 134 (78.5%) initiated therapy at CD4 count < 200 cells/mm3. The majority of doctors prescribed triple therapy regimens using the 2 NRTI + 1 NNRTI combination. Doctors who utilised CD4 counts tended to also use viral load (VL) to assess effectiveness and change therapy (p < 0.001). At initiation of treatment, 68.5% of the doctors saw their patients monthly and 64.3% saw them every three to six months, when stable. Conclusion: The majority of private sector doctors were compliant with current guidelines for HIV management, hence maintaining an acceptable quality of clinical healthcare.
Evaluation of the management of HIV/AIDs with diabetes as a comorbid condition in public health facilities in eThekwini Metro of KwaZulu-Natal: defining contributory factors to patient outcomes.
(2020) Umar, David Mohammed.; Naidoo, Panjasaram.
Introduction HIV/AIDS has remained a huge burden. It is still affecting large population of people globally with mortality of over 35 million people. South Africa is the most affected country. Substantial progress has been made in HIV antiretroviral therapy which is now capable of suppressing viral replication and prevent transmission. Great efforts and significant successes have been recorded in the fight against HIV/AIDS especially in South Africa. With effective medications, PLWH now have increased longevity, this makes them susceptible to chronic diseases like diabetes. The burden of diabetes is also high in KwaZulu-Natal, which also comes with its attendant complications. Despite the progress made, the scourge of HIV/AIDS and diabetes still persists. Hence this study aimed to evaluate the management of HIV/AIDS and diabetes as a comorbid condition, and to determine factors that contribute to patient outcomes. Methodology The study was conducted in 4 HIV clinics attached to Public Sector Hospitals in the eThekwini Metro of Kwazulu-Natal (KZN) South Africa after obtaining ethical approval. A total of 1,203 adult, non-pregnant patients living with HIV and were receiving antiretroviral therapy for at least 6 months between 2005 and 2019 were randomly selected and recruited in the study after obtaining written consent from them. Data was collected using questionnaire and from patient chart. The statistical package for social sciences (SPSS) software version 26 was used to analyze the data using descriptive statistics, Chi square and logistic regression. Results were presented, discussion and conclusion were made as appropriate. Results There were 770 (64%) females and 405 (33.7%) males included in this study, with 29 to 48 years as the largest age group (60.2%). Clinicians prescribed the recommended add regimens in all cases. TDF + FTC + EFV was the most recommended regimen at 65%. On the average 43.85% of HIV patients were initiated on ART at CD4 count <200 cells/µL. Male gender and baseline CD4 count were the predictors of ART regimen changes. It was found that 40.8% of PLWH on ART were virally suppressed. The probability of achieving viral suppression was significantly less in younger patients, the less educated and those with baseline CD4 cells count less than 200cells/µL, while the likelihood of achieving viral suppression was about 4 times higher for those that received encouragement from family to adhere to ART. The prevalence of immunologic failure among PLWH on ART was 8.6 % (CD4 cell count <200 cells/µL). CD4 cells count outcome was statistically significantly associated with gender, poor adherence to ART and baseline CD4 cells count. The probability of immunologic decline for those who did not strictly adhere to ART was more than 3 folds higher than those who adhered to ART; and the probability of immunologic failure was more than 8 folds higher for those who had baseline CD4 cells <200 cells/µL than those who had baseline CD4 cells ≥200 cells/µL. The prevalence of diabetes among PLWH on ART was 9%. Over 47% of those who had diabetes, had uncontrolled blood sugar, with a mean fasting blood sugar (FBS) of 11.7 mmol/L. The predictors of diabetes among PLWH on ART were, gender and age. Male PLWH had 65% less chances of having diabetes and those who were between the ages of 18 and 48 years were 88% less probable to have diabetes compared to those who were older than 48 years. Conclusion and Recommendations Clinicians adhered to the national treatment guidelines, but significant percentage of the patients were initiated on ART late resulting in poor outcome. Those who test positive for HIV should be informed on the benefits of initiating ART early, the possible consequence of late initiation of ART and Clinicians must ensure everyone who needs ART is offered one without delay. The prevalence of immunologic failure was 8.6%. Predictors to immunologic failure were nonadherence and late initiation of ART (CD4 cells <200 cells/µL). Prevalence of viral suppression was low (40.8%). The chances of virological failure was higher among younger, less educated, patients who started ART late (<200cells/µL) and patients who received encouragement from family to adhere to ART. Young PLWH should be regularly counselled on the benefits of adherence to ART, those that are not educated should be taught in languages they best understand, and pictorial illustrations should be used for counselling and family members should be involved in the follow up and encouragement of patients. That should be done with the permission of patients. The prevalence of diabetes among PLWH was high (9%) and 47% of these did not have glyacemic control (mean FBS was 11.7 mmol/L). The predictors were male gender and older age. Those who test positive to HIV should also be screened for diabetes before commencement of ART and treatment for diabetes should be initiated as ART is initiated and blood sugar should be monitored regularly to ensure glycaemic control, which is essential for the prevention of diabetic complications.
Evaluation of the pharmacokinetics of ketamine for the treatment of major depressive disorder.
(2018) Naidoo, Vivian Campbell.; Baijnath, Sooraj.; Naicker, Tricia.; Naidoo, Panjasaram.; Kruger, Hendrik Gerhardus.
Recent reports have demonstrated ketamine’s potential use in the treatment of major depressive disorder (MDD), as it elicits potent antidepressant effects via a different mechanism compared to conventional antidepressants. Ketamine’s hypothesized antidepressant effect is elicited by a neurochemical cascade involving the antagonization of the N-methyl-D-aspartate (NMDA) receptors and the subsequent activation of the α-amino-3-hydroxy-5-methyl-4-isoxazole propionic acid (AMPA) receptors; resulting in the disinhibition of glutamate signalling due to the suppression of tonic glutamate input into the GABAergic interneurons, providing rapid symptomatic relief as opposed to the two-week delay with conventional treatments. There is a large escalation in the number of individuals being diagnosed with treatment resistant depression (TRD) even after numerous trials on conventional antidepressant therapy. Health care professionals are now resorting to unconventional treatments, such as ketamine’s off-label use, to achieve therapeutic outcomes and provide symptomatic relief. MDD’s increasing prevalence has been associated with significant public health costs and morbidity rates and therefore alternative, effective treatments are now essential. Many reports have been published on the intranasal (IN) efficacy of ketamine in the treatment of major depressive disorder, however there have been no studies investigating the effects on the route of administration in drug delivery to the brain. The purpose of this study was to investigate pharmacokinetics of ketamine following oral, intraperitoneal and intranasal administration. A dose of 15mg/kg (body weight) was administered to healthy male Sprague-Dawley rats, and ketamine concentrations were quantified in both plasma and brain tissue homogenates at time intervals of 5, 15, 30, 60, 120, 240 minutes post-treatment. The results showed that with intraperitoneal administration, concentrations of 524,58 ng/mL and 352,06 ng/mL, were achieved in plasma and brain tissue, respectively. Surprisingly, IN administration which is believed to favour drug delivery to the brain only exhibited moderate levels post administration; whereas, oral administration produced significantly lower levels due to extensive first-pass metabolism of ketamine in the liver and intestines. These results show that parenteral administration should be used for the administration of ketamine in the treatment of MDD. The findings of the study provide a platform for future investigations assessing alternative routes of administration of ketamine; and its use in clinical practice for the treatment of MDD. This paves the way forward to optimize treatment and provide symptomatic relief were conventional antidepressants have failed those suffering with MDD.
Factors influencing HAART adherence among private health care sector patients in a suburb of the Ethekwini Metro.
(AOSIS, 2008) Naidoo, Panjasaram.
Background: The advent of highly active antiretroviral therapy (HAART) ushered in a new era in the management of the AIDS pandemic with new drugs, new strategies, new vigour from treating clinicians and enthusiasm on the part of their patients. What soon became evident, however, was the vital importance of patient adherence to prescribed medication in order to obtain full therapeutic benefits. Several factors can influence adherence to HIV drug regimens. Many treatment regimes are complex, requiring patients to take a number of drugs at set times during the day, some on a full stomach and others on an empty one. Other factors that could contribute to non-adherence include: forgetting to take medications, cost factor, side effects, incorrect use of drug, social reasons, denial or poor knowledge of drug regime. If the correct regimen is not prescribed and if patients do not adhere to therapy, then the possibility of resistant strains is high. Improving adherence is therefore arguably the single most important means of optimising overall therapeutic outcomes. Although several studies regarding patient adherence have been performed in the public health care sector, data on adherence in patients from the private health care sector of South Africa remain limited. Many factors influence compliance and identifying these factors may assist in the design of strategies to enhance adherence to such demanding regimens. This study aimed to identify these factors among private sector patients. Method: Descriptive cross-sectional study was conducted among all consenting patients with HIV who visited the rooms of participating private sector doctors from May to July 2005. A questionnaire was administered to consenting participants. Participants who reported missing any medication on any day were considered non-adherent. The data obtained was analysed using SPSS 11.5. A probability value of 5% or less was regarded as being statistically significant. Categorical data was described using frequency tables and bar charts. Pearson’s chi-square tests or Fischer’s exact tests were used interchangeably as appropriate to assess associations between categorical variables. The study received ethics approval from the University of KwaZulu-Natal’s Nelson R Mandela School of Medicine Ethics Committee. Results: A total of 55 patients completed the questionnaires and 10 patients refused to participate. There was no statistical difference between adherence to treatment and demographics such as age, gender and marital status. In this study 89.1% of patients were classified as non-adherent and reasons for non-adherence included difficulty in swallowing medicines (67.3%) (p = 0.01); side effects (61.8%) (p = 0.03); forgetting to take medication (58.2%) (p = 0.003); and not wanting to reveal their HIV status (41.8%) (p = 0.03). Common side effects experienced were nausea, dizziness, insomnia, tiredness or weakness. Reasons for taking their medicines included tablets would save their lives (83.6%); understand how to take the medication (81.8%); tablets would help them feel better (80.0%); and were educated about their illness (78.2%). The majority of participants (65.5%) were on two nucleoside reverse transcriptase inhibitors (NRTIs) and one non-nucleoside reverse transcriptase inhibitor (NNRTI). All participants that were on a regimen that comprised protease inhibitors and two NRTIs were found to be non-adherent. Conclusion: Some barriers to adherence among this cohort of private sector patients are similar to those experienced by public sector patients. It will be important for doctors to identify these problems and implement strategies that could improve adherence, e.g. using short message services (SMSs) reminders for those patients prone to forgetting to take their medicines, breaking the tablets into smaller pieces in order to overcome the difficulty of swallowing, if the medication is not available in a liquid form, looking at alternative medication with lesser or more tolerant side effect profiles and greater counselling on the drugs.
Focus group discussion with private sector doctors in the eThekwini Metro of KwaZulu-Natal on the management of HIV/AIDS patients.
(MedPharm, 2010) Naidoo, Panjasaram.
Background: Highly active antiretroviral treatment (HAART) is essential in the treatment of HIV/AIDS; however, a holistic approach to HIV/AIDS management is important. This study was done to confirm the findings of two studies done previously in the eThekwini Metro of KwaZulu-Natal on private sector doctors’ management of HIV-infected patients and to obtain more in-depth information about their nonpharmacological management of HIV-infected patients. Methods: Two focus group discussions were conducted amongst private sector doctors in the eThekwini Metro, after obtaining their consent. The focus group sessions were scripted, audio-taped and transcribed verbatim. Prevalent themes were identified and reported. Results: Eight doctors participated. Of the total patient population seen annually by the majority of the doctors, an average of 43.8% was HIV infected. Doctors in this study managed their patients both pharmacologically and nonpharmacologically. Seventy-five per cent of doctors indicated that the taste of medicine played an important role in nonadherence to treatment, but all agreed that cultural beliefs also influenced the patient’s adherence to medication. Theft of medicines and the out of-stock situation prevented antiretroviral drug access, which impacted negatively on adherence. Five doctors mentioned that depressed patients abused alcohol, resulting in nonadherence. One doctor reported that he used the biopsychosocial approach to improve adherence in his patients. Doctors indicated that the disability grant given by the South African Government caused patients not to adhere to treatment in order to maintain a CD4 count of 200 or less so as to qualify for the grant. Conclusions: The study confirmed the previous study findings in that it showed that private sector doctors manage their HIV-infected patients both pharmacologically and nonpharmacologically. It further provided new and interesting information with regard to the nonpharmacological methods employed in HIV/AIDS management, that is the incorporation of cultural beliefs in the management of HIV-infected patients to improve adherence to treatment, and the role of the disability grant and pharmaceutical formulations in contributing to nonadherence by HIV-infected patients.
Identification of sources from which doctors in the private sector obtain information on HIV and AIDS.
(MedPharm, 2009) Naidoo, Panjasaram.; Jinabhai, Champaklal Chhaganlal.; Taylor, Myra.
Background: Doctors need to constantly update their knowledge and obtain information in order to practise high-quality medicine. Antiretroviral drugs have been available only since around 1996, therefore many of the doctors who were trained prior to 1996 would not have received any formal training in the management of HIV and AIDS patients. Where doctors source their general medical knowledge has been established, but little is known about where doctors source information on HIV/AIDS. This study investigated where private sector doctors from the eThekwini Metro obtain information on HIV and AIDS for patient management. Methods: A descriptive cross-sectional study among 133 private general practitioners (GPs) and 33 specialist doctors in the eThekwini Metro of KwaZulu-Natal, South Africa, was conducted with the use of questionnaires. The questionnaires were analysed using SPSS version 15. A p value of < 0.05 was considered statistically significant. Results: The majority of the doctors (92.4%) obtained information on HIV and AIDS from journals. Continuing Medical Education (CME), textbooks, pharmaceutical representatives, workshops, colleagues and conferences were identified as other sources of information, while only 35.7% of doctors were found to use the internet for information. GPs and specialists differed significantly with regard to their reliance on colleagues (52.9% versus 72.7%; p < 0.05) and conferences (48.6% versus 78.8%; p < 0.05) as sources of HIV information. More than 90% of doctors reported that CME courses contributed to better management of HIV and AIDS patients. Conclusion: Private sector doctors in the eThekwini Metro obtain information on HIV from reliable sources in order to have up-to-date knowledge on the management of HIV-infected patients.
Impact of Pharmacists’ Intervention on the knowledge of HIV infected patients in a public sector hospital of KwaZulu-Natal.
(AOSIS, 2010) Govender, Saloshini.; Esterhuizen, Tonya.; Naidoo, Panjasaram.
Background: The study site started its roll-out of the human immunodeficiency virus (HIV) prevention of mother-to-child transmission in 2006. All patients were counselled by trained counsellors, before seeing a doctor. At the pharmacy the medicines were collected with no intense counselling by a pharmacist as the patients would have visited the trained counsellors first. Subsequently it was found that there were many queries regarding HIV and acquired immune deficiency syndrome (AIDS). Thus a dedicated antiretroviral pharmacy managed by a pharmacist was established to support the counsellors. Objectives: The objective of the study was to assess the impact of a pharmacist intervention on the knowledge gained by HIV and AIDS patients with regard to the disease, antiretroviral drug use (i.e. how the medication is taken, its storage and the management of side effects) as well as adherence to treatment. Method: This study was undertaken at a public sector hospital using anonymous structured questionnaires and was divided into three phases: pre-intervention, intervention and postintervention phases. After obtaining patient consent the questionnaires were administered during the first phase. A month later all patients who visited the pharmacy were counselled intensely on various aspects of HIV and antiretroviral medication. Thereafter patients who participated in Phase 1 were asked to participate in the second phase. After obtaining their consent again, the same questionnaire was administered to them. Quantitative variables were compared between pre-intervention and post-intervention stages by using paired t-tests or Wilcoxon signed ranks tests. Categorical variables were compared using McNemar’s Chi-square test (Binary) or McNemar-Bowker test for ordinal variables. Results: Overall the mean knowledge score on the disease itself had increased significantly (s.d. 6.6%), (p < 0.01), after the pharmacists’ intervention (pre-intervention was 82.1% and post-intervention was 86.3%). A significant improvement was noted in the overall knowledge score with regard to medicine taking and storage (p < 0.05) and the management of the side effects. There was a non-significant difference between the adherence in pre-intervention and in post-intervention (p = 0.077). Conclusion: Pharmacists’ intervention had a positive impact on HIV infected patients’ HIV and AIDS knowledge on both the disease and on the antiretroviral drug use and storage.
An investigation into the effects of concurrent antiretroviral and African traditional medicines on the CD4 count and viral load of HIV infected persons in eThekwini metropolitan area.
(2016) Sibanda, Mncengeli.; Naidoo, Panjasaram.; Nlooto, Manimbulu.
Background – Traditional Medicines (TM) are often used by people living with HIV/AIDS (PLWA) alone or in combination with antiretroviral therapy (ART) to combat illnesses associated with HIV or the side effects of ART. Very few studies on clinical subjects have been carried out to find out the effects of co-administration of TM with ART Aim To investigate the effects of concurrent use of prescribed antiretroviral medicines (ARVs) and African Traditional medicines (ATM) on the CD4+ lymphocyte Count and Viral Load (VL) of PLWA in the eThekwini Metropolitan area. Method: A descriptive and exploratory study was carried out in two phases at four health facilities offering ART in the eThekwini metro. Phase 1 was a cross sectional descriptive study aimed at collecting information on patient demographics and ATM use. Phase 2 of the study was a longitudinal study which involved collection of data from the patient’s charts using a case report form. The data was collected retrospectively and prospectively in phase 2. Results: 281 patients met the inclusion criteria, gave consent to participate in the study and had usable information in their patient files. The majority of the participants were females (194/281, 69.9%) and almost all (272/281, 96.8%) were of African ethnicity and resided in a local township (64.4%). Fourteen out of the 281 (14/281 4.98%) patients reported concurrent use of ATM with ARVs during the study period. The most commonly used ATM was the African potato (9/14, 64.3%) followed by Sutherlandia (5/14, 21.4%), StamettaTM and uBhejani. The differences between the two means in the cohort taking ARV alone (–ATM) and the cohort which used ATM and ARVs concurrently (+ATM) at each CD4+ cell count measure were not significant at 5% level for Time 0 (p=0.18), Time 2 (p=0.26) and Time 3 (p=0.09). The differences between the two means in the –ATM and +ATM groups were significant at 5% level for Time 0 (p=0.013), marginally significant at Time 1 (p=0.048), significant at Time 2 (p=0.040) and not significant at Time 3 (p=0.069). Conclusion: Concurrent ARV and ATM use is quite low (4.98%) and this may indicate efficient pre-counselling efforts by healthcare professionals before ARV initiation. This study shows that there are no significant differences in CD4+ and inconclusive effects on VL, between patients taking both ARV and ATM concomitantly from those using ARV alone.
An investigation into the neurochemical and behavioural patterns of C57Bl6 mice exposed to "Sugars" and its constituents.
(2020) Chetty, Yvette Yolanda.; Nadar, Anand.; Naidoo, Panjasaram.
“Sugars” is an illicit drug cocktail that is a low-grade mixture of heroin and other opioids. The composition of this cocktail is highly varied as other ingredients are added during its manufacturing process to add bulk to the mixture and possibly increase profits of the suppliers. This highly addictive cocktail requires only a single use to initiate dependence and if not used timeously thereafter, severe withdrawal symptoms occur as soon as four hours after the last use. Due to the highly variable composition of this drug cocktail, it has been difficult to create a rehabilitation program with a low relapse rate as the physiological mechanisms of action of this cocktail have not been previously investigated. This study therefore aimed to investigate the physiological effects of “Sugars” and its ingredients in an animal model. This would provide novel findings on the pharmacological actions of the components of “Sugars” in the body as well as the physiological changes that may result during administration and withdrawal of the drug. This thesis is comprised of four manuscripts viz. one review paper that discusses the psychosocial issues of “Sugars” from an ethnographic standpoint and three experimental papers that focus on neurophysiology, behaviour, and immunology. The first experimental paper focuses on dopamine concentrations which were analysed using an ELISA assay and the sucrose preference test which can be used to assess the anhedonic behaviour in an animal model. The second paper focuses on the changes in memory function which was assessed using the Morris water maze and hippocampal mass and the third paper discusses changes in circulating immune cells following the analysis of blood samples with a heamotology analyser . The major findings emanating from this study were that administration of “Sugars” resulted in substantial changes in the dopaminergic system, cognitive abilities and haematological parameters involved in immunity; however, it was also observed that these changes were potentially reversed following a withdrawal period of 10 days in a mouse model. The extent of the effects observed may have also been influenced by the ratio of the ingredients in the cocktail. These novel findings can therefore assist in the formation of a targeted rehabilitation program that factors in the changes in the various physiological systems as discussed in this thesis. Key words: “Sugars”, illicit drug cocktail, dopamine, heroin, hippocampus
Investigation of the medication adherence behaviour of private sector patients with communicable and non-communicable diseases.
(2017) Suklal, Kooveshni.; Naidoo, Panjasaram.
Background: Medication adherence continues to be a vital factor contributing towards the achievement of treatment goals in patients with chronic diseases. There is a sparse amount of data available on the adherence behaviour and the types of medications used in private sector patients with communicable and non-communicable diseases in South Africa but this is limited and dated. This study was directed at providing information on the medication adherence rates of such patients and the factors that influence such behaviour. Aim and Objectives: To investigate the medication adherence behaviour of patients suffering from noncommunicable and communicable diseases in the private health care sector of the eThekwini Municipality of KwaZulu-Natal and to describe the reasons for such behaviour. Methods: A self-reported anonymous medication adherence questionnaire was used to obtain data, from 233 private sector patients afflicted with HIV, Type 2 Diabetes Mellitus, Hypertension and Dyslipidaemia in the eThekwini Municipality of KwaZulu-Natal. The questionnaire focused on the adherence behaviour of these participants and factors that influenced their adherence behaviour. Medication adherence was determined by the number of days of medication missed during the last 30 days. Data was collected and analysed using SPSS. Results: Majority of participants were aged between 51-60 years (26.6%), and were of male gender (52.8%). An almost equal number of participants were afflicted with single disease (n=116) or multiple diseases (117). Hypertension was the most prevalent ailment (n=167), followed by Type 2 Diabetes (n=113), Dyslipidaemia (n=94) and HIV (n= 26). Over 62% of participants reported not missing any medication during the last 30 days. More than 21% had stated missing 1-2 days of their medication and 15.9% reported missing 3 or more days of medication during the last 30 days. With regards to single ailment, the highest percentage of adherence was reported in participants afflicted with Hypertension (60.6%), and Type 2 diabetes (58.3%). HIV and Dyslipidaemia had the lowest rates of adherence as 45% (n=9) of HIV only and 57.1% (n=4) of Dyslipidaemia only afflicted participants reported missing 1 or more days of their medication. The highest rate of non-adherence was found amongst the age group of participants 51-60 years old, while the highest rate of adherence was found in the group aged 70 years+. Reasons for non-adherence included cost, forgetting to take medication, running out of medication, stopping medication because it made them feel worse or gave a side effect and having difficulty with time schedules or having medication with/without food. Conclusion: Participants afflicted with communicable and non-communicable diseases in the private health care sector have sub-optimal medication adherence. Although no significant correlations were found between having a particular disease and the rate of adherence, participants afflicted with HIV and Dyslipidaemia alone were the least adherent to their medication. Reasons for their nonadherence were similar to other studies reported.
Knowledge, attitudes and perceptions of pharmacy and nursing students towards male circumcision and HIV in a KwaZulu-Natal University, South Africa.
(AOSIS, 2011) Naidoo, Panjasaram.; Dawood, Farzana.; Driver, Christine.; Narainsamy, Magdalene.; Ndlovu, Sikhanyiso.; Ndlovu, Victor.
Background: Male circumcision is currently being promoted in South Africa as a Human Immunodeficiency Virus (HIV) prevention method. Effective implementation requires that healthcare providers should believe in the procedure’s efficacy and should possess a positive attitude. A study was undertaken amongst pharmacy and nursing students with different objectives. Objectives: To ascertain students’ knowledge, attitudes and perceptions regarding male circumcision and (HIV) prevention. Method: A descriptive cross-sectional study using anonymous questionnaires was undertaken amongst 4th year pharmacy and nursing students studying at a university in KwaZulu-Natal, after obtaining their consent. Data were captured and analysed using SPSS version 15. Results: A response rate of 83.18% and a mean knowledge score of 66.43% with relatively positive attitudes (62.7) were obtained; 85.4% of the respondents felt that promoting male circumcision is appropriate, with all Muslim students (n < 11) supporting the promotion of male circumcision. Even though all Muslim students supported male circumcision, only 3 students were willing to perform the procedure if adequately trained (p < 0.03). The majority of the female students were unwilling to perform the procedure (p < 0.005). A third of the respondents indicated that male circumcision would both undermine existing protective behaviours and strategies as well as increase riskier sexual behaviour. Over 54% of the respondents believed that the South African Health System would be able to cope with the massive male circumcision drive. The majority of the respondents favoured the procedure to be done at birth. Pain was cited as the most important reason for not wanting to be circumcised. Conclusion: Pharmacy and nursing students have a moderate knowledge of male circumcision and HIV prevention with relatively positive attitudes. The majority felt that promoting male circumcision is appropriate and should be encouraged.
Knowledge, attitudes, perceptions and readiness of community pharmacists practising in the Province of KwaZulu-Natal to the National Health Insurance in South Africa.
(2016) Govender, Yanasundri.; Naidoo, Panjasaram.
Changes in the South African healthcare environment are well under way in preparation for the proposed National Health Insurance (NHI) scheme. The successful implementation of the NHI will result in universal health coverage for the population and requires collaboration of all healthcare providers, including private sector community pharmacists. Objectives To determine the knowledge, attitudes, perceptions and readiness of community pharmacists practising in the province of KwaZulu-Natal, towards the proposed National Health Insurance programme in South Africa. Methods A descriptive cross sectional study was conducted by the administration of closed-ended anonymous questionnaires to 310 community pharmacists practising in the province of KwaZulu-Natal. Data were analysed using Stata version13.1. Results The majority were male participants with more than 50% in the age range of 30 to 50 years, having more than 16 years of experience. Whilst 94,08% of respondents were aware of the NHI more than 41% of respondents indicated poor or no knowledge of the NHI, with 64,47% not aware of the health minister’s 10-point plan of action to implement the NHI programme. Television, radio, websites and newspapers in order of preference were found to be the most effective means of communication to disseminate information regarding the NHI. The general attitude of respondents towards the NHI was positive and they perceived its expected transitions as favourable but cited that the shortage of drugs, overcrowding and improving the quality of healthcare as major challenges that could be encountered. Over 76% of the respondents indicated that they possessed the required skills to engage in the NHI programme and almost 70% indicated that they were ready for the NHI with regards to IT support but limited human resources, inadequate infrastructure and the lack of waiting room space may pose barriers to their readiness. Conclusions and Recommendations: Although awareness of the NHI among community pharmacists is high, educational efforts need to be exerted to increase the knowledge and understanding of the proposed NHI programme in order to ensure successful implementation in the pharmacy sector. Pharmacists displayed a positive attitude towards NHI and believe that they are ready for the NHI with regards to skills and IT support but the necessary infrastructure, human resources and waiting room space is lacking.
Measure of adherence to antiretroviral treatment amongst HIV positive patients attending antiretroviral clinics in selected rural, deep-rural and semi-urban areas of Ugu District in KwaZulu-Natal.
(2017) Mthethwa, Phumelele Perseverence.; Naidoo, Panjasaram.
Background The roll-out of antiretroviral (ARV) treatment in public health facilities was initiated in 2004 in the KwaZulu-Natal province. The roll-out made ARV treatment available and accessible to the vast majority of the population which previously could not afford treatment due to their low socio-economic status. Adherence levels need to be monitored timeously in order to ensure that patients are adherent to their treatment. Treatment outcomes are affected by the level of adherence to treatment. Adherence to treatment is essential in providing a sustainable and effective antiretroviral rollout campaign. The ARV roll-out has been initiated in all areas of society in South Africa, and it is a known fact that there are certain factors that affect the level of adherence. It is therefore critical to measure the level of adherence to treatment by patients and to assess the factors that affect adherence. Few studies were done to determine whether geographical location of the patients and their clinics had an effect on adherence. This study was therefore undertaken with the following aims and objectives Aim and Objectives The specific objective of the study was to describe the demographics of the patients attending ART clinics in rural, deep rural and semi-urban areas of Ugu District in KwaZulu-Natal, to measure the level of adherence to ARV therapy, and to determine the factors that affect adherence to the therapy in these areas. Method A retrospective chart analysis of 1020 Human Immunodeficiency Virus (HIV) infected patients (18-60 years of age) who reside in Ugu District within the catchment population of the facility , registered on the ART programme in the facility and have been receiving ART from the facility for at least 2 years were selected to be in the study. The following research sites were chosen: 1 rural hospital, 1 deep-rural clinic and 1 semi-urban community health centre was chosen. Records of the patients from January 2011 to December 2014 were examined in order to select the patients. A closed-ended, coded questionnaire was administered to all patients in the study & was used to record the demographics, level of adherence and factors affecting adherence. After obtaining their consent the questionnaires were administered. The data was captured and analysed using SPSS version 23 software. Results Of the 1020 patients, there were 623 females (61%), with most patients between 18-35 years (56.9%). Almost 70% of the patients were African, with 57.5% single and 75.9% having less than 3 dependants. Forty nine percent of the patients had secondary level education, whilst 61.2% of them were unemployed. More than 62% of the patients use public transport to get to these facilities. Over two thirds of the patients (67%) were on the Fixed Dose Combination treatment, with 70% of the patients already on treatment for 2-4 years, and 30% on treatment for more than 4 years. More than half of the patients (51.7%) had missed between 2-4 appointments to collect their medication from health facilities in the previous 6 months. Although 80.9% of the respondents indicated that they understood the importance of adherence (p=0.008) an overall 58.5% were actually adherent to treatment, with the majority coming from the deep rural area (p=0.001). A number of factors affected the adherence to treatment for patients in the 3 areas, both positively and negatively, the first being their transport to the facility. A larger percentage of patients in the deep-rural (12.4%) area reported taking 2-3 hours (p=0.000) to arrive at these facilities due to transport problems. Over ten percent in the deep-rural area reported having travelled 15-20km (p=0.00).The second reason related to weather, where a much larger proportion of patients (73.8%) in the deep-rural area associated the weather with their ability to reach the health facilities to collect their medication. Other reasons included waiting time, where a great majority of patients from the semi-urban area (87.1%) reported to having waited longer than 2 hours to be attended to. With respect to stock outages 15.4% of patients in all 3 areas were affected by stock outages. Over 40% (42.8%) of the overall patients were affected by family deaths. They could not attend their clinics resulting from having to make arrangements for the burial of their loved ones. This significantly affected patients in the deep rural area (54.4%). Close to 25% of patients were the only caregivers at home, thereby sometimes being unable to collect their medication from the facilities due to having small dependants who cannot be left unattended at home. A greater majority (75.9%) of patients admitted to not collecting their medication from health facilities due to having sufficient treatment at home, with the smaller proportion (66.8%) being in the rural area (p=0.00).Forty two percent of patients related being depressed as one of the reasons for not taking their medication, with the larger proportion (49.4%) being in the semi-urban area (p=0.004). Over half of all patients (50.7%) used traditional medicines with the reported use of alcohol higher in the deep-rural area (93.5%) than in the other areas. Just over a quarter of the participants were involved in substance abuse. A larger proportion (62.4%) of patients who did not disclose their status were in the semi-urban area, compared to the other 2 areas (p=0.008), with 69.8% of patients indicating a fear of loss of social grant if adherent to treatment. This fear was much greater in the deep-rural area (88.5%) than in the other areas (p=0.000). A larger proportion of patients (30.9%) in the semi-urban area reported that they were not granted leave from work to collect their medication. Regimen changes affected adherence in 32% of patients while compliance to treatment for 67.9% of the patients was affected by side-effects. The association between mistrust of the new single tablet and adherence was statistically significant (p=0.023). A lower proportion of urban patients (35.6%) showed mistrust compared to the other areas, and 18.8% of patients taking single agents missed one of the two daily doses, with most (25.9%) of the patients who missed the dose being from the semi-urban area. Over 51% of patients did not see the need of taking their medication due to feeling better. This generally affected all 3 areas. Ninety two percent of patients in the deep-rural area indicated that they felt safe in the facility compared to the other areas. Just over half of the patients attending the semi-urban area clinic liked their facility, compared to 91.8% of the deep-rural area and 95.9% of the rural area patients. Staff attitude affected adherence, where71.2% in the deep-rural area felt that the staff attitude was good compared to the perception of patients in the other two areas (p=0.00). A larger proportion (87%) of the patients in the semi-urban area reported food frequently being available thus enabling them to take their medication, whilst 46.5% of these patients felt that reminder methods were not effective compared to 57.4% (rural) and 58.5% (deep-rural). Conclusion The adherence levels of patients in rural, deep-rural and semi-urban areas are affected by various factors. The area of residence had statistical significance in some of the factors that affected adherence, while some factors were cross-cutting across all the areas of residence.
Private healthcare sector doctors and HIV testing practices in the eThekwini Metro of KwaZulu-Natal.
(MedPharm, 2010) Naidoo, Panjasaram.
Background: Human immunodeficiency virus (HIV) testing has many logistic and ethical challenges. The UNAIDS/WHO policy statement states that the testing of individuals must be confidential, be accompanied by counselling, and be conducted with informed consent. HIV testing is integral to the management of the epidemic, and since KwaZulu-Natal (KZN) has the highest prevalence of AIDS in South Africa, it is vital that doctors in this province are knowledgeable about HIV testing practices. This study was undertaken in view of the lack of data on private sector doctors’ HIV testing practices in KwaZulu-Natal. Method: A descriptive cross-sectional study was conducted among private sector doctors who manage HIV and AIDS patients in the eThekwini Metro of KZN. One hundred private practitioners were randomly selected from a sample of 175 consenting private sector doctors. These doctors were asked to fill in an anonymous questionnaire. The questionnaires were collected and analysed using SPSS® version 15. Results: A response rate of 60% was obtained, with 57 (95%) indicating that they do HIV testing after obtaining patients’ consent. Over 96% of the doctors carried out pre-test counselling, while over 98% did post-test counselling. Eighty-one per cent did a confirmatory test if the patient tested positive, while 49% performed a confirmatory test if the patient tested negative; over 50% did the test after three months. Forty-seven per cent did not know or failed to indicate what confirmatory test they used. The majority did not disclose patient status or do counselling in the presence of others. However, if it was done, it was done with the consent of the patient or the parents in cases where the patient was a minor. The majority stated that they follow the guidelines when testing. Conclusion: The HIV testing practices of private sector doctors who participated in the study are compliant with the UNAIDS/WHO policy statement regarding confidentiality, informed consent and counselling. However, doctors’ knowledge of confirmatory test appears to be inadequate.
Role and contribution of private healthcare sector doctors in the management of HIV-infected patients in the eThekwini Metropolitan area of KwaZulu-Natal.
(MedPharm, 2007) Naidoo, Panjasaram.; Jinabhai, Champaklal Chhaganlal.; Taylor, Myra.
Private healthcare sector doctors have a pivotal role to play in the management of HIV and AIDS infection. These doctors need to have an accurate knowledge of the management of the infection, and a positive attitude towards the treatment of persons with HIV and AIDS. This study investigated the extent of private healthcare sector doctor involvement in the management of HIV and AIDS patients and their training needs. Across sectional descriptive study of private general practitioners and specialists was undertaken in the eThekwini Metro of KwaZulu-Natal. Structured self-report questionnaires were sent to 931 private healthcare sector doctors. Of the 331 (35.6%) responses received, three doctors did not complete the questionnaire, 235 (71.6%) doctors managed HIV and AIDS patients, but 93 (28.4%) doctors did not; of these, 48 (51.61%) had not encountered HIV and AIDS patients, 25 (26.88%) referred such patients to specialists, six (6.45%) cited cost factors as reasons for not treating such patients, whilst 12 (12.90%) doctors, though they indicated that there were other reasons for not managing HIV-infected patients, did not specify the reason. Two doctors (2.15%) indicated that due to inadequate knowledge they did not manage HIV and AIDS patients. Most doctors, 151 (63.5%), managed between 1-20 patients, whilst 19 (8%) managed more than 200 patients. The mean number of years since doctors had qualified was 22.02 (SD 10.58). Significantly more younger (recently qualified) doctors than older (qualified more years) doctors treated HIV/AIDS patients (p<0.001). Most doctors (76.3%) expressed a need for more training/knowledge on the management of HIV patients in areas such as overall HIV care (59%), antiretroviral therapy (53%), side effect management (39%) and therapeutic monitoring (35%); 194 (62.2%) doctors indicated their willingness to participate in a post graduate diploma in HIV and AIDS management. These results suggest that increased private sector doctor involvement in the treatment of HIV/AIDS patients needs to be facilitated. Addressing doctors’ training needs could contribute to achieving this.
The willingness of private-sector doctors to manage public-sector HIV/AIDS patients in the eThekwini metropolitan region of KwaZulu-Natal.
(AOSIS, 2009) Naidoo, Panjasaram.; Jinabhai, Champaklal Chhaganlal.; Taylor, Myra.
Background: South Africa is severely affected by the AIDS pandemic and this has resulted in an already under-resourced public sector being placed under further stress, while there remains a vibrant private sector. To address some of the resource and personnel shortages facing the public sector in South Africa, partnerships between the public and private sectors are slowly being forged. However, little is known about the willingness of private-sector doctors in the eThekwini Metropolitan (Metro) region of KwaZulu-Natal, South Africa to manage public-sector HIV and AIDS patients. Objectives: To gauge the willingness of private-sector doctor to manage public-sector HIV and AIDS patients and to describe factors that may infuence their responses. Method: A descriptive cross-sectional study was undertaken among private-sector doctors, both general practitioners (GPs) and specialists, working in the eThekwini Metro, using an anonymous, structured questionnaire to investigate their willingness to manage public-sector HIV and AIDS patients and the factors associated with their responses. Chi-square and independent t-tests were used to evaluate associations. Odds ratios were determined using a binary logistic regression model. A p value < 0.05 was considered statistically significant. Results: Most of the doctors were male GPs aged 30–50 years who had been in practice for more than 10 years. Of these, 133 (77.8%) were willing to manage public-sector HIV and AIDS patients, with 105 (78.9%) reporting adequate knowledge, 99 (74.4%) adequate time, and 83 (62.4%) adequate infrastructure. Of the 38 (22.2%) that were unwilling to manage these patients, more than 80% cited a lack of time, knowledge and infrastructure to manage them. Another reason cited by five doctors (3.8%) who were unwilling, was the distance from public-sector facilities. Of the 33 specialist doctors, 14 (42.4%) indicated that they would not be willing to manage public-sector HIV and AIDS patients, compared with only 24 (17.4%) of the 138 GPs (p < 0.01). Conclusion: Many private-sector doctors are willing to manage public-sector HIV and AIDS patients in the eThekwini Metro, potentially removing some of the current burden on the public health sector.