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Challenges of Continuum of HIV/AIDS Care and Treatment in Tanzania: The Effects of Parasites Co-Infections, HIV Clinical Manifestations, and Adherence to Antiretroviral Therapy

Idindili, B. (2012) Challenges of Continuum of HIV/AIDS Care and Treatment in Tanzania: The Effects of Parasites Co-Infections, HIV Clinical Manifestations, and Adherence to Antiretroviral Therapy. Doctoral thesis, University of Basel.

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Abstract

In Tanzania, the National AIDS Control Program with the support of Non-Government Organizations is scaling-up Antiretroviral Therapy (ART) services to peripheral (rural) health facilities. The aim of scaling-up is to improve availability, access and adherence to ART by all HIV-infected population. HIV-infected persons in peripheral (rural) areas are at increased risk for several medical co-morbidities including tuberculosis, bacterial and parasitic infections. As ART is successfully made universally available, non-AIDS co-morbidities caused by helminths and malaria will emerge as leading problems that will complicate care, adherence to ART and retention. These challenges can be improved by comprehensive and multidisciplinary management strategies. In addition a range of interventions such as counselling, use of treatment assistants and integrated health services delivery need to be enhanced to improve adherence and treatment of co-morbidities. However, concerns are raised regarding proper HIV/AIDS management in the peripheral (rural) settings which focuses on clinical monitoring and treatment of opportunistic infections. Clinical monitoring is based on WHO clinical stages and CD4+ T-lymphocyte counts. Clinicians in the peripheral (rural) settings faces challenges in accessing CD4+ T-lymphocyte counts, HIV and AIDS clinical features not corresponding with WHO clinical stages, co-infections and co-morbidity. The aim of the work reported in this thesis was to conduct research to investigate effects of concurrent parasites infections and challenges of HIV/AIDS case management on peripheral (rural) patients in order to contribute information towards better care for HIV/AIDS patients in Tanzania. The studies were conducted at Tumbi Hospital and Chalinze Health Centre in Tanzania between April 2008 and June 2009. The research consisted of three sub-studies carried out consecutively utilizing different study designs and populations. The first study examined the effects of parasite co-infection on CD4+ T-lymphocyte counts, WHO clinical staging and haemoglobin. In addition, the study attempted to develop a simplified clinical staging by utilizing local experiences HIV/AIDS clinical manifestation. Adult patients registering for the first time at HIV-clinic were clinically examined for malaria parasites and helminths. CD4 counts and haemoglobin were also analyzed. Patients were initiated on treatments according to their respective diagnosis and followed up for six months. At 6 months, clinical procedures were performed similar to first contact assessment. The second study utilized a case-control design to elucidate factors associated with non-adherence to ART. Adult patients attending care and treatment at the study clinics and being on ART for at least three months were studied. Patients with ART adherence of less than 95%; and those with more than 95% were defined as cases and controls respectively. The third study was an observation study which documented experiences and lessons generated in the process of implementing ART services at Chalinze health centre. Clinical procedures were evaluated and document review was carried out to solicit patients’ characteristics and enrolment rates.

Item Type: Thesis (Doctoral)
Keywords: AIDS Control, Antiretroviral Therapy, HIV-Infection, Tuberculosis, Malaria, HIV/AIDS management, Hospital, Tumbi, Chalinze, Tanzania
Subjects: HIV > Treatment
Divisions: Other
Depositing User: Mr Joseph Madata
Date Deposited: 12 Feb 2013 11:51
Last Modified: 12 Feb 2013 11:51
URI: http://ihi.eprints.org/id/eprint/1116

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