Short-term physical and emotional health outcomes of public sector ART in the Free State province of South Africa

Wouters, Edwin; Meulemans, Herman; Rensburg, H.C.J. van; Heunis, Julia; Mortelmans, Dimitri

doi:10.1007/s11136-007-9260-y

Cited by 35 publications

(28 citation statements)

References 65 publications

(61 reference statements)

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“…The fifth EuroQoL item, measuring anxiety and depression, is used to measure the third component of SWB, the lack of unpleasant affect. This instrument has shown good reliability and construct validity in earlier studies of QoL among ART patients in South Africa (Wouters, Meulemans, van Rensburg, Mortelmans, & Heunis, 2007).…”

Section: Study Populationmentioning

confidence: 90%

State of the ART: clinical efficacy and improved quality of life in the public antiretroviral therapy program, Free State province, South Africa

et al. 2009

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The South African public-sector antiretroviral treatment (ART) program has yielded promising early results. To extend and reinforce these preliminary findings, we undertook a detailed assessment of the clinical efficacy and outcomes over two years of ART. The primary objective was to assess the clinical outcomes and adverse effects of two years of ART, while identifying the possible effects of baseline health and patient characteristics. A secondary objective was to address the interplay between positive and negative outcomes (clinical benefits versus adverse effects) in terms of the patients' physical and emotional quality of life (QoL). Clinical outcome, baseline characteristics, health status, and physical and emotional QoL scores were determined from clinical files and interviews with 268 patients enrolled in the Free State ART program at three time points (6, 12, and 24 months of ART). Age, sex, education, and baseline health (CD4 cell count and viral load) were all independently associated with the ART outcome in the early stages of treatment, but their impact diminished as the treatment progressed. The number of patients classified as treatment successes increased over the first two years of ART, whereas the proportion of patients experiencing adverse effects diminished. Importantly, our findings show that ART had strong and stable positive effects on physical and emotional QoL. These favorable results demonstrate that a well-managed public-sector ART program can be very successful within a high-HIV-prevalence resource-limited setting. This finding emphasizes the need to adopt treatment scale-up as a key policy priority, while at the same time ensuring that the highest standards of healthcare provision are maintained. Healthcare services should also target vulnerable groups (males, less-educated patients, those with low baseline CD4 cell counts, and high baseline viral loads) who are most likely to experience treatment failure.

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Section: Study Populationmentioning

confidence: 90%

State of the ART: clinical efficacy and improved quality of life in the public antiretroviral therapy program, Free State province, South Africa

et al. 2009

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“…They also reported energy and drive impairments in 75% and sleep impairments in 71% of the sample. Also using the ICF, van As et al [26] [32,33]. Two studies [32][33][34] reported improvements in the area of emotional functions, energy and drive while being on treatment; however, one study highlighted how activity limitations continued to affect the patient's life when on ART [33].…”

Section: Impairments Related To Body Structure and Functionmentioning

confidence: 99%

“…Similarly, Nair and Patel reported decreased physical functioning as measured by mobility. [32,33,[48][49][50] reported improvement in mobility upon initiating ART, with participants followed for the first 12 or 18 months. The study by Karbore et al [51] showed that among participants not receiving community services (i.e., food and homebased care), the mean physical functioning score increased by 1.6 points to 11.2 at 12 months but then decreased to 10.6 at 18 months, while the group which received community services improved continuously.…”

Section: Mobility (D4)mentioning

confidence: 99%

HIV-Related Disability in HIV Hyper-Endemic Countries: A Scoping Review

Hanass-Hancock¹,

Regondi²,

Egeraat³

et al. 2013

WJA

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Background: In the era of enhanced access to ART, many people live longer lives but with episodes of disability resulting from HIV, HIV-related conditions, and/or as side-effects of ART. It is crucial to understand the extent of disability among people living with HIV in high-prevalence settings to inform choices regarding care, policy and research. This article presents the results of the first scoping review to examine the extent, nature and range of disability among people living with HIV in HIV hyper-endemic countries. Methods: This scoping review used the World Health Organization's International Classification of Functioning, Disability and Health (ICF) to conceptualize "disability". A systematic search of electronic databases was conducted using specific keyword and subject heading combinations. Identified publications were screened and reviewed according to inclusion/exclusion criteria. Data were systematically extracted and reviewed for quality. Extracted data were reviewed for patterns related to methods or results. Results were aligned with the corresponding ICF code. Results: Forty-one articles were included, reporting data from 38 unique studies. Most (78%) of the studies were conducted in South Africa; five in Botswana, one in Zimbabwe and Lesotho, and none in Swaziland. Almost all studies recruited more females than males. All studies except two were in adults. The studies indicate that people living with HIV experience a variety of disabilities. Impairments in body structure/function comprise the majority of data, with particular focus on mental function. Data on activity limitations and participations restriction were limited, however, they were recorded. They indicate severe impact on people's life and possible adherence. Conclusions: We argue that the time has come to elevate the focus holistically on health and life-related consequences of living with HIV and to integrate disability into the discussions and approaches to HIV care.

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“…[1][2][3][4][5] Preliminary studies in sub-Saharan Africa provide evidence that public-sector ART programs are effective in delivering sustained improvements in patient well being, confirming universal treatment access as a key policy priority in these resource-limited settings. 6,7 However, there is no room for complacency because ART is a highly complex therapy requiring near-perfect and sustained adherence to remain effective.…”

Section: Introductionmentioning

confidence: 99%

Community Support and Disclosure of HIV Serostatus to Family Members by Public-Sector Antiretroviral Treatment Patients in the Free State Province of South Africa

Wouters

Loon

Rensburg

et al. 2009

AIDS Patient Care and STDs

Self Cite

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Recent studies have indicated that the support of close relatives is fundamental in coping with HIV/AIDS and in accessing the emotional and material support necessary for sustained adherence to treatment. Because disclosure to family members is imperative to ensure their support, identifying tools or resources that can minimize the possible risks and maximize the potential benefits of disclosure should be useful in improving the lives of people living with HIV/AIDS. Where health systems require strengthening, engaging the community in HIV/AIDS care could potentially create an environment that encourages disclosure to family members. This study investigated the impact of community support initiatives (community health workers and treatment support groups), patient characteristics (age, gender, and education), and time since first diagnosis on the disclosure of serostatus to family members by a sample of 268 public-sector antiretroviral treatment patients in a province of South Africa between August 2004 and July 2007. Whereas gender, age, and education only weakly influenced disclosure, there was a strong and stable positive association between community support and disclosure to family members. The immediate and long-term impact of community support on the disclosure by seropositive patients to family members indicates that initiatives such as community health workers and HIV support groups run by people living with HIV/AIDS should be strengthened, especially for those patients who cannot disclose their status to immediate family and close friends.

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Short-term physical and emotional health outcomes of public sector ART in the Free State province of South Africa

Abstract: The study suggests that the poorest of the poor are not the first beneficiaries of the public programme. Most importantly, the present findings demonstrate the positive physical and emotional health outcomes of the first 6 months of ART in the Free State, South Africa.

Cited by 35 publications

References 65 publications

State of the ART: clinical efficacy and improved quality of life in the public antiretroviral therapy program, Free State province, South Africa

State of the ART: clinical efficacy and improved quality of life in the public antiretroviral therapy program, Free State province, South Africa

HIV-Related Disability in HIV Hyper-Endemic Countries: A Scoping Review

Community Support and Disclosure of HIV Serostatus to Family Members by Public-Sector Antiretroviral Treatment Patients in the Free State Province of South Africa

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