Health-related quality of life in HIV/AIDS patients on antiretroviral therapy at a tertiary care facility in Zimbabwe.

Health-related quality of life (HRQoL) is a broad concept reflecting a patient's general subjective perception of the effect of an illness or intervention on physical, psychological and social aspects of their daily life. HRQoL among patients infected with HIV has become an important indicator of impact of disease and treatment outcomes. A cross-sectional survey was carried out at Chitungwiza Central Hospital, Zimbabwe, to assess HRQoL in patients with HIV/AIDS receiving antiretroviral therapy (ART), using two validated instruments. The HIV/AIDS-targeted quality of life (HAT-QoL) and EuroQoL Five-dimensions-Three-level (EQ-5D-3L) instruments were used to assess HRQoL. Internal consistency reliability and convergent validity of the two instruments were also evaluated. For construct validity, the relationships between HRQoL scores and socio-economic and HIV/AIDS-related characteristics were explored. The median scores for the HAT-QoL dimensions ranged from 33.3 (financial worries) to 100 (HIV mastery). A considerably low HAT-QoL dimension score of 50.0 was observed for sexual function. There were ceiling effects for all HAT-QoL dimension scores except for financial worries and disclosure worries. Floor effects were observed for financial worries and sexual function. The median of the EQ-5D-3L index and visual analogue scale (VAS) was 0.81 and 79.0, respectively. There were no floor or ceiling effects for both the EQ-5D-3L index and VAS. The overall scale Cronbach's alpha was 0.83 for HAT-Qol and 0.67 for EQ-5D-3L. HAT-QoL demonstrated good convergent validity with EQ-5D index (0.58) and VAS (0.40). A higher level of HRQoL was positively and significantly related to income, education and employment. The patients' self-reported HRQoL was generally satisfactory in all the HAT-QoL dimensions as well as the two components on the EQ-5D-3L instrument. The two instruments demonstrated good measurement properties in HIV/AIDS patients receiving ART and have potential for use, alongside biomarkers, in monitoring outcomes of interventions.

Assessing compliance with national guidelines in diabetes care: A study leveraging data from south Africa's National Health Laboratory Service (NHLS).

Diabetes is a major global health issue. We evaluated compliance to laboratory-based management guidelines for diabetes (type 1 and 2), essential for effective treatment and reducing diabetes-related morbidity and mortality. Our study utilized South Africa's National Health Laboratory Services (NHLS) data, focusing on patients from birth to age 80 years who underwent initial diabetes laboratory testing between January 1, 2012-January 1, 2016. Patients were categorized into type 1 (<30 years) or type 2 (≥30-80 years) diabetes based on age at first diabetes test. National diabetes guidelines recommend blood glucose to be checked every three-six months post laboratory-diagnosis. We employed a sharp regression discontinuity design to estimate the effect of a laboratory-diagnosis of diabetes on the likelihood of having a follow-up laboratory test 24 months post-diagnosis. Among patients with type 2 diabetes, the probability of a diabetes follow-up laboratory test within 24 months was 52.4% for patients presenting above the diabetes diagnosis threshold vs 31.1% for those presenting below. Although the likelihood of repeat testing rose with higher HbA1c and glucose levels, at the diagnostic threshold there was no clinically meaningful difference (risk difference: -2.2%, 95% CI: -3.3%, -1.2%). These results were consistent among patients with type 1 diabetes, those living with and without HIV, and healthcare setting. In a national laboratory cohort, diabetes laboratory-diagnosis did not lead to increased monitoring as recommended in national guidelines. Strategies to improve patient education, healthcare provider communication, and healthcare system support are essential to enhance guideline compliance and overall diabetes management.

Use of antidepressant agents and the risk of type 2 diabetes.

PURPOSE: To determine whether there is an association between antidepressant use and the risk of developing type 2 diabetes. METHODS: This study was a retrospective cohort analysis using the Texas Medicaid prescription claims database. Data were extracted for new users of either antidepressant agents (exposed) or benzodiazepines (unexposed) from January 1, 2002 through December 31, 2009. Patients aged 18-64 years without a prior history of diabetes were included. Cox proportional hazards regression was used to examine the association between diabetes incidence among exposed and unexposed groups, while controlling for demographic and clinical covariates. RESULTS: Among the total study population (N = 44,715), the majority were in the exposed (N = 35,552) versus the unexposed (N = 9,163) group. A total of 2,943 patients (6.6%) developed type 2 diabetes during the follow-up period. Antidepressant use was associated with an increase in the risk of diabetes when compared to benzodiazepine use (adjusted hazard ratio [HR] 1.558, 95% confidence interval [CI] 1.401-1.734). The association was observed with tricyclic antidepressants (TCAs; HR 1.759, 95% CI 1.517-2.040), serotonin-norepinephrine reuptake inhibitors (SNRIs; HR 1.566. 95% CI 1.351-1.816), selective serotonin reuptake inhibitors (SSRIs; HR 1.481, 95% CI 1.318-1.665), and "other" antidepressants (HR 1.376; 95% CI 1.198-1.581). CONCLUSIONS: The results of this study suggest that antidepressant use is associated with an increased risk of diabetes. This association was observed with use of TCAs, SNRIs, SSRIs, and "other" antidepressants.

Sentinel seroprevalence of SARS-CoV-2 in Gauteng Province, South Africa, August - October 2020.

BACKGROUND: Estimates of prevalence of anti-SARS-CoV-2 antibody positivity (seroprevalence) for tracking the COVID-19 epidemic are lacking for most African countries. OBJECTIVES: To determine the prevalence of antibodies against SARS-CoV-2 in a sentinel cohort of patient samples received for routine testing at tertiary laboratories in Johannesburg, South Africa. METHODS: This sentinel study was conducted using remnant serum samples received at three National Health Laboratory Service laboratories in the City of Johannesburg (CoJ) district. Collection was from 1 August to 31 October 2020. We extracted accompanying laboratory results for glycated haemoglobin (HbA1c), creatinine, HIV, viral load and CD4 T-cell count. An anti-SARS-CoV-2 targeting the nucleocapsid (N) protein of the coronavirus with higher affinity for IgM and IgG antibodies was used. We reported crude as well as population-weighted and test-adjusted seroprevalence. Multivariate logistic regression analysis was used to determine whether age, sex, HIV and diabetic status were associated with increased risk for seropositivity. RESULTS: A total of 6 477 samples were analysed, the majority (n=5 290) from the CoJ region. After excluding samples with no age or sex stated, the model population-weighted and test-adjusted seroprevalence for the CoJ (n=4 393) was 27.0% (95% confidence interval (CI) 25.4 - 28.6). Seroprevalence was highest in those aged 45 - 49 years (29.8%; 95% CI 25.5 - 35.0) and in those from the most densely populated areas of the CoJ. Risk for seropositivity was highest in those aged 18 - 49 years (adjusted odds ratio (aOR) 1.52; 95% CI 1.13 - 2.13; p=0.0005) and in samples from diabetics (aOR 1.36; 95% CI 1.13 - 1.63; p=0.001). CONCLUSIONS: Our study conducted between the first and second waves of the pandemic shows high levels of current infection among patients attending public health facilities in Gauteng Province.

Use of cotrimoxazole prophylaxis in HIV infected in patients at a referral hospital.

OBJECTIVE: To assess the extent of use of cotrimoxazole prophylaxis in the prevention of opportunistic infections in HIV infected patients. SETTING: Parirenyatwa Hospital, a major referral and teaching hospital. DESIGN: A retrospective study. SUBJECTS: 234 HIV infected patients admitted between January and June 2004, with a history of symptoms falling into the WHO stage 3 AIDS, were included. MAIN OUTCOME MEASURES: Cotrimoxazole prophylaxis, PCP prevalence, and mortality. RESULTS: 234 patients' records were reviewed and 19% of the patients had received cotrimoxazole prophylaxis. PCP prevalence was 36% which was diagnosed mainly by clinical examination and sometimes with the additional help of chest X-rays. Of those who were on prophylaxis, 75% were on primary prophylaxis and the rest on secondary prophylaxis. All patients on prophylaxis were using cotrimoxazole, with the 960 mg once daily dosing being the most common regimen (96%). Receiving prophylaxis was associated with being female (p = 0.0067), widowed (p = 0.012), and taking ARV therapy (p = 0.0026). Prophylaxis significantly reduced mortality (p = 0.0017). The development of PCP was associated with a history oftuberculosis relapse (p = 0.022). CONCLUSION: Cotrimoxazole prophylaxis is important in reducing hospital admissions due to opportunistic infections and increasing survival especially in areas with limited access to antiretroviral therapy.

Antiretrovial (ARV) drug utilisation in Harare.

OBJECTIVE: To investigate ARV utilisation in Harare in order to gather necessary data to help in the formulation of treatment guidelines to be used in Zimbabwe. DESIGN: A cross sectional study. SETTING: Doctors' rooms and retail pharmacy outlets. SUBJECTS: 68 primary care physicians, 80 pharmacists and 92 patients. MAIN OUTCOME MEASURES: Number of physicians prescribing antiretroviral agents (ARVs) and pharmacists stocking ARVs. Type of ARV utilised, cost to the patient and information on ARV available. RESULTS: Out of the 68 private practitioners interviewed 18 were prescribing ARVs during the period of study. There were 92 patients on ARVs whose mean age was 35 +/- 5 years and consuming an average total of 17 tablets daily. Thirteen out of the 18 doctors had access to laboratory facilities to determine CD4 counts and viral load. The rest were using other approaches to treat and manage HIV/AIDS patients. About a quarter, 27.0%, of the retail pharmacists stocked ARVs. The majority, 82.0%, of the patients appeared to be on Zidovudine (AZT) mainly in combination with other drugs. The most popular combination was that of AZT, Lamivudine (3TC) and Indinavir prescribed to 29.0% of the patients, followed by that of Didanosine (DDI) and hydroxyurea prescribed to 17% of patients. At least 17% of the patients were on AZT monotherapy. There was no significant difference (p = 0.06) in the number of tablets consumed by patients who had other conditions secondary to HIV infection. Only 39 out of the 92 patients reported untoward experiences with ARVs. The major problem being associated gastro-intestinal disturbance which accounted for 56% of the reports. It was not possible to ascertain adherence. CONCLUSION: There appeared to be therapeutic anarchy in the private sector in Harare in the way ARVs were being used. Patients need to be told that deciding to take one of the combinations means making a serious commitment to the drugs on schedule if they want to enjoy the benefit. At the same time there is need to develop and publicize HIV/AIDS treatment guidelines and effective Information, Education and Communication (IEC) materials specific to Zimbabwe.

Adverse drug reactions reporting at a referral hospital in Zimbabwe.

OBJECTIVES: To establish factors influencing voluntary reporting of adverse drug reactions among health workers. A second objective was to establish the level of awareness on adverse drug reaction reporting and attitudes towards the voluntary adverse drug reaction reporting scheme. DESIGN: Cross sectional descriptive study. SETTING: Parirenyatwa Hospital, a major referral and teaching hospital in Harare, Zimbabwe. SUBJECTS: 200 health professionals randomly selected from various departments. MAIN OUTCOME MEASURES: Number of health workers reporting adverse drug reactions; awareness of the adverse drug reaction reporting scheme. RESULTS: 144 (72%) questionnaires were completed. About half (47.2%) of the respondents did not know how to report an adverse drug reaction and 47.1% were unaware of the existence of a formal adverse drug reaction reporting scheme in Zimbabwe. One fifth (20.1%) of the respondents had reported an adverse drug reaction at some point. Two main factors contributing to under-reporting cited by respondents were the poor feedback from the national reporting centre (59%) and inaccessibility of reporting facilities (45.8%). Beliefs that one should only report an adverse drug reaction if certain of causality (46.5%) and that really serious adverse drug reactions are well documented before a drug is marketed (35.4%) could also account for under reporting. However, 75.7%, viewed adverse drug reaction reporting as a professional obligation. CONCLUSION: Lack of awareness of healthcare professionals to the national (Medicines Control Authority of Zimbabwe) adverse drug reaction voluntary reporting scheme, poor feedback and inaccessibility of reporting facilities are the main factors contributing towards underreporting.

An investigation of compliance in type II diabetic patients attending clinic at Church of Scotland hospital.

Thirty Type II diabetic patients attending a clinic at a rural hospital were interviewed, using structured interviews and clinic records. The patients' clinic cards were also used to obtain the required information. The study was conducted to identify the factors that lead to non compliance with the recommended treatment regimen, to establish whether diabetic patients are able to keep appointments and to identify factors that influence patients from keeping appointments. Factors that led to non compliance were financial problems and forgetfulness. Most clients were unemployed while others were pensioners and could not afford the expensive means of transport to the clinic. Additional issues were rough terrain and roads which depended on good weather. The most common complication found in the study was hypertension, which when combined with minor ailments, led to clients taking multiple medications.

Low sale of antibiotics without prescription: a cross-sectional study in Zimbabwean private pharmacies.

OBJECTIVES: To assess the quality of private pharmacy practice with a focus on the extent of antibiotic sales without prescription in private pharmacies in four Zimbabwean cities in relation to two tracer infectious conditions-sexually transmitted infections (STIs) among females and males, and diarrhoea in a child. METHODS: A cross-sectional study including pharmacies in Harare and three other towns. Information about each pharmacy was collected through structured interviews. Staff were interviewed using a different structured interview guide and simulated clients were used to assess staff performance. Data were analysed statistically, and step models to evaluate pharmacist performance were developed. RESULTS: A majority (69%) stated that they would never sell an antibiotic without a prescription and very few actually did in spite of a high patient demand. Few respondents however performed acceptably regarding provision of information and advice in relation to guidelines: 8% for the STI male, 33% for the STI female and 22% for the diarrhoea scenario. CONCLUSIONS: The study revealed low sales of antibiotics without prescription, showing good adherence to the letter of the law. However, few respondents performed acceptably in relation to guidelines when considering information and advice for the tracer conditions.