A packaged intervention to improve viral load monitoring within a deeply rural health district of South Africa.

BACKGROUND: The KwaZulu-Natal (KZN) province of South Africa has the highest prevalence of HIV infection in the world. Viral load (VL) testing is a crucial tool for clinical and programmatic monitoring. Within uMkhanyakude district, VL suppression rates were 91% among patients with VL data; however, VL performance rates averaged only 38·7%. The objective of this study was to determine if enhanced clinic processes and community outreach could improve VL monitoring within this district. METHODS: A packaged intervention was implemented at three rural clinics in the setting of the KZN HIV AIDS Drug Resistance Surveillance Study. This included file hygiene, outreach, a VL register and documentation revisions. Chart audits were used to assess fidelity. Outcome measures included percentage VL performed and suppressed. Each rural clinic was matched with a peri-urban clinic for comparison before and after the start of each phase of the intervention. Monthly sample proportions were modelled using quasi-likelihood regression methods for over-dispersed binomial data. RESULTS: Mkuze and Jozini clinics increased VL performance overall from 33·9% and 35·3% to 75·8% and 72·4%, respectively which was significantly greater than the increases in the comparison clinics (RR 1·86 and 1·68, p < 0·01). VL suppression rates similarly increased overall by 39·3% and 36·2% (RR 1·84 and 1·70, p < 0·01). The Chart Intervention phase showed significant increases in fidelity 16 months after implementation. CONCLUSIONS: The packaged intervention improved VL performance and suppression rates overall but was significant in Mkuze and Jozini. Larger sustained efforts will be needed to have a similar impact throughout the province.

Ultrastructural changes induced by leaves of Azadirachta indica (Neem) in the testis of albino rats.

The present work was designed to study the effect of Azadirachta indica (Neem) powder on rat testis using the electron microscope. Male albino rats received 100 mg each A. indica leaf powder orally (by gavage). On alternate days, a second group of rats received 0.125 mg testosterone dipropionate intramuscularly. A third group received both A. indica leaf powder by gavage and testosterone dipropionate intramuscularly. Suitable controls were maintained. After autopsy, ultrastructural analysis of the testis revealed that animals treated with testosterone dipropionate showed well-developed Sertoli cells and germ cells with well-developed cytoplasmic organelles. By contrast, in A. indica-treated rats, intracellular spaces and vacuolization were observed in Sertoli cells; whereas in Leydig cells, cytoplasmic inclusions appeared diminished, and the configuration of granular endoplasmic reticulum appeared as a single unbranched tubule. In late spermatids, defects were observed in the mitochondrial sheath. The ultrastructural changes seen in the A. indica-treated group provide a clue that A. indica leaves might affect spermatogenesis through antispermatogenic and antiandrogenic properties.

Effects of Azadirachta indica leaves on the seminal vesicles and ventral prostate in albino rats.

Oral administration of 20, 40, 60, mg of dry Azadirachta indica leaf powder for 24 days resulted in decrease in the weights of seminal vesicles and ventral prostate, reduction in epithelial height, nuclear diameter and the secretory material in the lumen. Biochemically, there was a decrease in total protein, acid phosphatase activities. Seminal vesicles and ventral prostate being androgen dependent, the regressive changes histologically as well as biochemically, suggests the antiandrogenic property of the neem leaves.

Effect of Azadirachta indica leaves on testis and its recovery in albino rats.

Histological and biochemical changes in the testis of rats treated with the leaf powder of A. indica are reported. The pattern of recovery is also studied at 8, 16 and 24 day after withdrawal of the treatment. In the treated rats, a general reduction in the diameters of seminiferous tubule, nuclei of the germinal elements and a mass atrophy of the spermatogenic elements has been observed. The Leydig cells are found to be atrophic. Biochemically, a decrease in the protein content and the activity of acid phosphatase and an increase in the total free sugar, glycogen, cholesterol contents and the activities of alkaline phosphatase and lactate dehydrogenase have been observed. A gradual recovery is observed in both the histological and biochemical parameters after 8.16 and 24 day of cessation of the treatment. The result suggest a possible reversible antiandrogenic property of the leaves of A. indica in male albino rats.

Changes in epididymal structure and function of albino rat treated with Azadirachta indica leaves.

The histological and biochemical changes in the caput and cauda epididymis of albino rat treated with 20, 40 and 60 mg dry powder of the leaves of A. indica per day for 24 days are reported. In the treated rats, the height of the epithelium and the diameter of the nucleus in both the regions were reduced. The lumen of the caput was packed with lymphocytes. Biochemically, a decrease in the protein content and acid phosphatase activity and an increase in the alkaline phosphatase and lactate dehydrogenase activities were observed in both the regions. The effect was dose dependent. Further, serum testosterone concentration in the higher dose treated animals decreased significantly. The results suggest a possible antiandrogenic property of the leaves of A. indica.