Views of Medical Doctors Regarding the 2013 WHO Adult HIV Treatment Guidelines Indicate Variable Applicability for Routine Patient Monitoring, for Their Family Members and for Themselves, in South-AfricaReport as inadecuate




Views of Medical Doctors Regarding the 2013 WHO Adult HIV Treatment Guidelines Indicate Variable Applicability for Routine Patient Monitoring, for Their Family Members and for Themselves, in South-Africa - Download this document for free, or read online. Document in PDF available to download.

South African doctors n = 211 experienced in antiretroviral therapy use were asked via an online questionnaire about the WHO 2013 adult antiretroviral integrated guidelines, as well as clinical and personal issues, in three hypothetical scenarios: directing the Minister of Health, advising a family member requiring therapy amidst unstable antiretroviral supplies, and where doctors themselves were HIV-positive. Doctors 54% favoured the 500 cells-μl WHO initiation threshold if advising the Minister; a third recommended retaining the 350 cells-μl threshold used at the time of the survey. However, they favoured a higher initiation threshold for their family member. Doctors were 4.9 fold more likely to initiate modern treatment, irrespective of their CD4 cell count, for themselves than for public-sector patients 95%CI odds ratio = 3.33–7.33; P<0.001, although lower if limited to stavudine-containing regimens. Doctors were equally concerned about stavudine-induced lactic acidosis and lipoatrophy. The majority 84% would use WHO-recommended first-line therapy, with concerns split between tenofovir-induced nephrotoxicity 55%, and efavirenz central nervous system effects 29%. A majority 61%, if HIV-positive, would pay for a pre-initiation resistance test, use influenza-prophylaxis 85%, but not INH-prophylaxis 61%, and treat their cholesterol and blood pressure concerns conventionally 63% and 60%. Over 60% wanted viral loads and creatinine measured six monthly. A third felt CD4 monitoring only necessary if clinically indicated or if virological failure occurred. They would use barrier prevention 83%, but not recommend pre-exposure prophylaxis, if their sexual partner was HIV-negative 68%. A minority would be completely open about their HIV status, but the majority would disclose to their sexual partners, close family and friends. Respondents were overwhelmingly in favour of continued antiretrovirals after breastfeeding. In conclusion, doctors largely supported adult WHO guidelines as public policy, although would initiate treatment at higher CD4 counts for their family and themselves. Resistance to INH-prophylaxis is unexpected and warrants investigation.



Author: Willem Daniel Francois Venter , Lee Fairlie , Charles Feldman , Peter Cleaton-Jones , Matthew Chersich

Source: http://plos.srce.hr/



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