Evaluation of Namibia's antiretroviral therapy guidelines' recommendations for switching from first-line to second-line, using predictors of first-line treatment failure: an exploratory study

OBJECTIVES

The objective of this study was to find out the extent to which the antiretroviral therapy (ART) switching guidelines were complied with and to assess whether immediate switching from first- to second-line ART would have been appropriate than attempting to comply with the guidelines.

METHODS

A case-control study. Cases and controls were patients on second- and first-line ART, respectively. Regression analysis was used to identify factors that were associated with switching to second-line ART. Confidence level was 95% and significance at a p-value <0.05.

RESULTS

81 cases and 102 controls were included. VLs at six and 9 months were implemented for 8.2% and 2.7%, respectively. Switching predictors were poor adherence (adjusted Hazard Ratio [aHR] = 20.3 (p = 0.013); a first VL >1000 copies/ml (aHR = 20.2), <0.001); opportunistic infections (aHR = 12.9, p = 0.006); male gender (aHR = 5.2, p = 0.003); and lack of adherence counseling (aHR = 3.8 p = 0.024).

CONCLUSION

AVL >1000 copies/ml was a predictor of switching. New local research is underway, with a large number of patients, to assess whether this finding applies to the dolutegravir-based regimens.

Assessing Adherence to Antihypertensive Therapy in Primary Health Care in Namibia: Findings and Implications

INTRODUCTION

Namibia has the highest burden and incidence of hypertension in sub-Sahara Africa. Though non-adherence to antihypertensive therapy is an important cardiovascular risk factor, little is known about potential ways to improve adherence in Namibia following universal access. The objective of this study is to validate the Hill-Bone compliance scale and determine the level and predictors of adherence to antihypertensive treatment in primary health care settings in sub-urban townships of Windhoek, Namibia.

METHODS

Reliability was determined by Cronbach's alpha. Principal component analysis (PCA) was used to assess construct validity.

RESULTS

The PCA was consistent with the three constructs for 12 items, explaining 24.1, 16.7 and 10.8% of the variance. Cronbach's alpha was 0.695. None of the 120 patients had perfect adherence to antihypertensive therapy, and less than half had acceptable levels of adherence (≥ 80%). The mean adherence level was 76.7 ± 8.1%. Three quarters of patients ever missed their scheduled clinic appointment. Having a family support system (OR = 5.4, 95% CI 1.687-27.6, p = 0.045) and attendance of follow-up visits (OR = 3.1, 95% CI 1.1-8.7, p = 0.03) were significant predictors of adherence. Having HIV/AIDs did not lower adherence.

CONCLUSIONS

The modified Namibian version of the Hill-Bone scale is reliable and valid for assessing adherence to antihypertensives in Namibia. There is sub-optimal adherence to antihypertensive therapy among primary health cares in Namibia. This needs standardized systems to strengthen adherence monitoring as well as investigation of other factors including transport to take full advantage of universal access.

Compliance to guidelines for the prescribing of antibiotics in acute infections at Namibia's national referral hospital: a pilot study and the implications

BACKGROUND

Sub-optimal antibiotic prescribing remains a public health concern in Namibia. The objective was to determine the level and predictors of compliance to guidelines in the prescribing of antibiotics in acute infections at a national referral hospital in Namibia to improve future prescribing.

METHODS

An analytical cross-sectional survey design. The clinical records of patients receiving care were reviewed. Prescribing practices were assessed using a self- administered questionnaire with reference to Namibia Standard Treatment Guidelines (NSTG).

RESULTS

The majority of prescriptions (62%) complied with the NSTGs; however, lower than national targets (95%). Most prescriptions were empiric and prescribers typically made reference to the NSTG (58%). Diagnosed infections were principally respiratory infections (58%) and penicillins were the most used antibiotics. Good concurrence between signs and symptoms with the diagnosis indicated on the prescription - OR=5.2 (95% CI: 1.4, 19.2), a diagnosis of upper respiratory tract (p=0.001), oral-dental OR=0.1(95% CI: 0.03,0.3) and urogenital infections OR=0.3(95% CI: 0.1,0.95) and the prescribing of penicillins (p=0.001) or combination antibiotics and amphenicols were independent predictors of compliance to the NSTGs. The main behaviours associated with antibiotic prescribing were patient influences, clinical state, and access to guidelines.

CONCLUSIONS

Compliance with NSTGs is suboptimal. Prescribing of combination antibiotics, penicillins and diagnosis of oral dental, genitourinary and ear, nose and throat infections were important predictors for NSTG compliance. There is a need to implement antibiotic indicators and stewardship programmes, and ensure access to NSTGs, to improve future antibiotic prescribing in Namibia.

Case report: cholera in a preterm neonate

Falling standards of sanitation resulted in the first outbreak of cholera in Lusaka, Zambia, during the rainy season, February 1990. A total of 2166 cases were handled with 128 (5.9%) deaths. One hundred and eight (108) children, including one preterm neonate, were admitted to the University Teaching Hospital. The neonate went to the Neonatal Intensive Care Unit.