Home > The Prevalence and Factors Associated With Nonadherence With Arv Treatment and Cotrimoxazole Preventive Therapy Among Hiv Infected Adolescents Attending Out-Patient Hiv Clinics in Kenya
The Prevalence and Factors Associated With Nonadherence With Arv Treatment and Cotrimoxazole Preventive Therapy Among Hiv Infected Adolescents Attending Out-Patient Hiv Clinics in Kenya
Background: There is an increase in the burden of HIV infected adolescents, both those perinatally infected as well as those acquiring HIV during adolescence. Female adolescents continue to be at the highest risk for acquiring HIV; in many Southern African countries, they have a three fold risk of acquiring HIV compared to their male counterparts. Adherence to treatment among adolescents has been shown to range between 30-70%, which is unacceptably low for antiretroviral therapy (ART). Psychosocial wellbeing and social support have been shown to be possible contributing factors to adherence to ART. This relationship has not been previously evaluated among Kenyan adolescents. Objectives: The overall objective of this study was to determine prevalence of non-adherence to medication among HIV infected adolescents aged 13-18 years attending selected outpatient HIV clinics in Kisumu, Kenya. The secondary objectives included determining the effect of psychosocial well being on adherence, and determining factors, including peer group support and their effect on adherence to medication. Methods We conducted a multi-center retrospective cohort study at seven outpatient HIV clinics in Kisumu, Kenya; enrolling 285 adolescents aged 13-18 years. Adherence data was obtained from pharmacy refill data and for each subject and a percentage adherence computed as the proportion of completed scheduled pharmacy visits. The main v predictor variable, psychosocial well being data was collected using a validated tool and a psychosocial score calculated using the corresponding score sheet and categorized as good (score was >22), moderate (15-22) and poor (<15). The maximum possible score was 30. Demographic data on potential determinants of adherence were collected in a face-to-face interview using a structured questionnaire. Characteristics of study participants were summarized using means and standard deviations for continuous variables; counts and proportions for categorical variables. The associations between adherence, psychosocial well-being and other factors were assessed using univariate and multivariate logistic regression. Results: The mean age of the participants was 15 years (mode 13, median15), 59% of whom were female. The majority (67%) had been enrolled into care when less than 12 years old and therefore considered to have been infected perinatally; 52% were on ART. The overall average adherence was 86%. Adolescents were categorized as adherent (adherence >95%) or non-adherent (adherence <95%) and 65% of them were adherent. Poor psychosocial well being was associated with increased likelihood of poor adherence (OR 3.37 CI 1.17 to 9.69; p=.017). Mental health showed a tendency to affect adherence negatively (p=.09). Other
سر آغا خان سر آغا خان کی وفات سے مسلمانوں کی ایک بڑی شخصیت اُٹھ گئی، وہ ایک اسلامی فرقہ کے امام و مذہبی پیشوا اور لاکھوں انسانوں کا مرکز عقیدت تھے، ان کی شخصیت بین الاقوامی تھی یورپ کے تمام ملکوں میں ان کا بڑا اعزاز تھا اور وہاں کے بڑے بڑے لوگوں سے ان کے دوستانہ تعلقات تھے، اس زمانہ کا کوئی بڑا سے بڑا اعزاز ایسا نہیں ہے جو ان کو حاصل نہ رہا ہو، ان کی پوری زندگی یورپ کے گہوارہ عیش و نشاط میں گزری، مگر اس میں پڑکر وہ اپنے فرائض سے کبھی غافل نہیں ہوئے۔ وہ بڑے مدبر اور بیدار مغز تھے، سیاست پر گہری نظر رکھتے تھے، علم و فن سے بھی ذوق تھا، کئی زبانوں سے واقف تھے، قومی و ملی جذبہ بھی رکھتے تھے اور مسلمانوں کے عمومی معاملات میں کبھی فرقہ کی تفریق نہیں کی، اپنے فرقہ کی فلاح و بہبود کے ساتھ عام مسلمانوں کے معاملات سے بھی دلچسپی اور عملی ہمدردی رکھتے تھے، چنانچہ مسلم یونیورسٹی کے قیام کی کوشش سے لے کر ہندوستان کی آزادی اور پاکستان کے قیام تک مسلمانوں کے بہت سے معاملات میں ان کی امداد و رہنمائی کی جس سے ان کو فائدہ پہنچا، ان کے خود نوشت حالات سے معلوم ہوتا ہے کہ دینی عقیدہ میں راسخ اور بعض مذہبی معمولات کے پابند تھے، اسلام کی تبلیغ بھی کرتے تھے اور ان کے ہاتھوں پر بہت سے غیرمسلم مشرف باسلام ہوئے، اﷲ تعالیٰ ان کے ان نیک اعمال کے صلہ میں ان کی مغفرت فرمائے، مسلمانوں میں اتنی بڑی شخصیت مدتوں میں پیدا ہوگی۔ (شاہ معین الدین ندوی، اگست ۱۹۵۷ء)
Human beings are the masterpieces of the Creator of the universe and He enjoined them to preserve human life. One form of the preservation of life is the utmost care for the rights of even an embryo. The study of the rights of the embryo laid down in the primary scriptures of Islam suggests that the embryo is accorded respect like living people. The rights of children start well before their birth. At present, cases ofabortion are reported daily. Muslim jurists have dwelled on ordinances about abortion for the benefit of people. At present, medical science has revealed all the stages of childbirth from conception to delivery. The effects of abortion, both positive and negative, are not hard to grasp in the light of modern scientific research Not to talk of living people, Islam guarantees the life of the early developmental stage of a baby within the uterus of the mother. This extraordinary care for a child during its embryonic period demonstrates that Islam attaches high priority to human life even before its start on the face of the Earth. Should one abort without a legitimate cause, the legal experts from the main schools of Islamic jurisprudence hold that the perpetrator will pay a fine and make compensation. If, on the other hand, a fetus is removed from the womb to end a pregnancy as it may harm a woman physically, it is allowable; only a healthy mother may give birth to healthy babies. In a like manner, when a couple feels unable to train and educate somany kids, they may have an operation to end a pregnancy by removing an embryo. However, while resorting to abortion, parents must not lose sight of the do’s and don’ts of abortion jurists have laid down and not just fall victim to the catchy slogan of “family planning”.
Background: Cervical cancer is a main concern of women’s health globally. In Kenya, Cervical cancer is the second most common cancer in women and the leading causes of cancer related deaths.
Several screening methods exist including cytology, human papilloma virus DNA test and visual inspection with Acetic Acid or Lugol’s Iodine (VIA/VILI). The current screening rate uptake in Kenya is poor, HPV DNA self-sampling may have a role in increasing the screening uptake as many studies have shown that self-sampling for HPV DNA testing is acceptable, though some others favoured over self-sampling. This study aims to assess whether vaginal HPV self-sampling is acceptable to women, and if the results are adequate compared to cervical samples taken by health care provider (HCP).
Study objective: Primary objective: to determine the acceptability of vaginal self-sampling for HPV DNA testing in cervical cancer screening among women attending tertiary hospital clinics in Kenya.
Secondary objective: to determine the adequacy of self-sampling for HPV DNA compared to HCP sampling.
Materials and Methods: A Cross sectional study was conducted at the gynaecology clinic from December 2018 to February 2019. One hundred twenty-four (124) women between 30 to 65 years of age were recruited. Women underwent self-sampling for HPV DNA, HCP sampling and Pap smear. Afterwards, the participants filled a post self-sampling acceptability questionnaire. A Likert scale was used to assess patient’s acceptance to self-collected sampling.
Results: The mean age of the participants was 40.3years. The overall acceptability score for self-sampling was 23.2 out of 25 indicating a high acceptability rate for HPV DNA self-sampling. For the adequacy, a Cohen kappa of 0.935 was found which indicates a high level of agreement among the self –sampling and HCP collected samples. The HPV DNA prevalence was 15.3% in HCP samples and 13.7 in self-samples.
Conclusion: The study demonstrated that HPV DNA self – sampling was highly acceptable and concordance rate was high between the self –sampling and the HCP sample results. Therefore, it is hoped that self- collection may have potential for increasing cervical cancer screening in Kenya.