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The Effect of a Maturing Antiretroviral Program on Early Mortality for Patients with Advanced Immune-Suppression in Soweto, South Africa
Kennedy N. Otwombe, Fatima Laher, Thandeka Tutu-Gxashe, Glenda Gray, Lerato Mohapi
PLOS ONE , 2013, DOI: 10.1371/journal.pone.0081538
Abstract: Objective We hypothesize that time to initiate care and maturity of a treatment program impact on outcome of severely immuno-compromised patients with higher risk of mortality. Design We conducted a retrospective cohort analysis at the Perinatal HIV Research Unit Adult ART clinic, Soweto, South Africa. Methods Eligibility criteria for this analysis were: attendance for minimum one visit between August 2004 and August 2010, age >18 years, CD4 count < 50 cells/mm3 and ART-na?ve at screening. We followed participants up to one year after ART initiation. We defined years 2004-2007 and 2008-2010 as the early and late eras respectively. Chi-square test and survival analysis methods were used for mortality comparisons between eras. Results Of 2357 patients eligible for antiretroviral treatment, 395 (17%) had CD4 counts < 50 cells/mm3 and ART-na?ve at screening. Overall 261 (66%) were women. Patients had similar median age (35 vs. 33.5 years, p=0.08), time to HAART initiation (7 days, p=0.18) and baseline CD4 count (20 vs. 23 cells/mm3, p=0.5) between eras. Overall 63 (16%) patients died in their first year of treatment (2 per 100 person-months) and the main cause of death was tuberculosis (n=23, 37%). The proportion of deaths (52/262 vs. 11/133, p=0.003) and time to death from enrolment (logrank p=0.04) were significantly different between eras. Conclusion Mortality decreased as the ART program matured in Soweto while time to initiation of treatment remained similar in both eras. Because ART guidelines were consistent during both eras, it is possible that with time, management of patients improved as expertise was gained.
Adherence to Drug-Refill Is a Useful Early Warning Indicator of Virologic and Immunologic Failure among HIV Patients on First-Line ART in South Africa
Ziad El-Khatib,David Katzenstein,Gaetano Marrone,Fatima Laher,Lerato Mohapi,Max Petzold,Lynn Morris,Anna Mia Ekstr?m
PLOS ONE , 2012, DOI: 10.1371/journal.pone.0017518
Abstract: Affordable strategies to prevent treatment failure on first-line regimens among HIV patients are essential for the long-term success of antiretroviral therapy (ART) in sub-Saharan Africa. WHO recommends using routinely collected data such as adherence to drug-refill visits as early warning indicators. We examined the association between adherence to drug-refill visits and long-term virologic and immunologic failure among non-nucleoside reverse transcriptase inhibitor (NNRTI) recipients in South Africa.
CD4 Counts and Viral Loads of Newly Diagnosed HIV-Infected Individuals: Implications for Treatment as Prevention
Sarishen Govender, Kennedy Otwombe, Thandekile Essien, Ravindre Panchia, Guy de Bruyn, Lerato Mohapi, Glenda Gray, Neil Martinson
PLOS ONE , 2014, DOI: 10.1371/journal.pone.0090754
Abstract: Objective To report the viral load and CD4 count in HIV-infected, antiretroviral na?ve, first -time HIV-testers, not immediately eligible for treatment initiation by current South Africa treatment guidelines. Design This was a cross-sectional study in a high-volume, free-of-charge HIV testing centre in Soweto, South Africa. Methods We enrolled first time HIV testers and collected demographic and risk-behaviour data and measured CD4 count and viral load. Results Between March and October 2011, a total of 4793 adults attended VCT and 1062 (22%) tested positive. Of the 1062, 799 (75%) were ART na?ve and 348/799 (44%) were first-time HIV testers. Of this group of 348, 225 (65%) were female. Overall their median age, CD4 count and viral load was 34 years (IQR: 28-41), 364 (IQR: 238-542) cells/mm3 and 13,000 (IQR: 2050-98171) copies/ml, respectively. Female first time HIV testers had higher CD4 counts (419 IQR: 262-582 vs. 303 IQR: 199-418 cells/mm3) and lower viral loads (9,100 vs. 34,000 copies/ml) compared to males. Of 183 participants with CD4 count >350 cells/mm3, 62 (34%) had viral loads > 10,000 copies/ml. Conclusions A large proportion of HIV infected adults not qualifying for immediate ART at the CD4 count threshold of 350 cells/mm3 have high viral loads. HIV-infected men at their first HIV diagnosis are more likely to have lower CD4 counts and higher viral loads than women.
Comparison of the Performance of Two Service Disciplines for a Shared Bus Multiprocessor with Private Caches
Angel Vassilev Nikolov,Lerato Lerato
International Journal of Computer Science Issues , 2010,
Abstract: In this paper, we compare two analytical models for evaluation of cache coherence overhead of a shared bus multiprocessor with private caches. The models are based on a closed queuing network with different service disciplines. We find that the priority discipline can be used as a lower-level bound. Some numerical results are shown graphically.
Comparison of the Performance of Two Service Disciplines for a Shared Bus Multiprocessor with Private Caches
Angel Vassilev Nikolov,Lerato Lerato
Computer Science , 2010,
Abstract: In this paper, we compare two analytical models for evaluation of cache coherence overhead of a shared bus multiprocessor with private caches. The models are based on a closed queuing network with different service disciplines. We find that the priority discipline can be used as a lower-level bound. Some numerical results are shown graphically.
Nevirapine- Versus Lopinavir/Ritonavir-Based Initial Therapy for HIV-1 Infection among Women in Africa: A Randomized Trial
Shahin Lockman ,Michael Hughes,Fred Sawe,Yu Zheng,James McIntyre,Tsungai Chipato,Aida Asmelash,Mohammed Rassool,Sylvester Kimaiyo,Douglas Shaffer,Mina Hosseinipour,Lerato Mohapi,Francis Ssali,Margret Chibowa,Farida Amod,Elias Halvas,Evelyn Hogg,Beverly Alston-Smith,Laura Smith,Robert Schooley,John Mellors,Judith Currier,the OCTANE (Optimal Combination Therapy After Nevirapine Exposure) ACTG A5208/OCTANE Study Team
PLOS Medicine , 2012, DOI: 10.1371/journal.pmed.1001236
Abstract: Background Nevirapine (NVP) is widely used in antiretroviral treatment (ART) of HIV-1 globally. The primary objective of the AA5208/OCTANE trial was to compare the efficacy of NVP-based versus lopinavir/ritonavir (LPV/r)-based initial ART. Methods and Findings In seven African countries (Botswana, Kenya, Malawi, South Africa, Uganda, Zambia, and Zimbabwe), 500 antiretroviral-na?ve HIV-infected women with CD4<200 cells/mm3 were enrolled into a two-arm randomized trial to initiate open-label ART with tenofovir (TDF)/emtricitabine (FTC) once/day plus either NVP (n = 249) or LPV/r (n = 251) twice/day, and followed for ≥48 weeks. The primary endpoint was time from randomization to death or confirmed virologic failure ([VF]) (plasma HIV RNA<1 log10 below baseline 12 weeks after treatment initiation, or ≥400 copies/ml at or after 24 weeks), with comparison between treatments based on hazard ratios (HRs) in intention-to-treat analysis. Equivalence of randomized treatments was defined as finding the 95% CI for HR for virological failure or death in the range 0.5 to 2.0. Baseline characteristics were (median): age = 34 years, CD4 = 121 cells/mm3, HIV RNA = 5.2 log10copies/ml. Median follow-up = 118 weeks; 29 (6%) women were lost to follow-up. 42 women (37 VFs, five deaths; 17%) in the NVP and 50 (43 VFs, seven deaths; 20%) in the LPV/r arm reached the primary endpoint (HR 0.85, 95% CI 0.56–1.29). During initial assigned treatment, 14% and 16% of women receiving NVP and LPV/r experienced grade 3/4 signs/symptoms and 26% and 22% experienced grade 3/4 laboratory abnormalities. However, 35 (14%) women discontinued NVP because of adverse events, most in the first 8 weeks, versus none for LPV/r (p<0.001). VF, death, or permanent treatment discontinuation occurred in 80 (32%) of NVP and 54 (22%) of LPV/r arms (HR = 1.7, 95% CI 1.2–2.4), with the difference primarily due to more treatment discontinuation in the NVP arm. 13 (45%) of 29 women tested in the NVP versus six (15%) of 40 in the LPV/r arm had any drug resistance mutation at time of VF. Conclusions Initial ART with NVP+TDF/FTC demonstrated equivalent virologic efficacy but higher rates of treatment discontinuation and new drug resistance compared with LPV/r+TDF/FTC in antiretroviral-na?ve women with CD4<200 cells/mm3. Trial registration ClinicalTrials.gov NCT00089505 Please see later in the article for the Editors' Summary
Poverty and HIV/AIDS in South Africa: an empirical contribution
Lerato Sonia Tladi
SAHARA J (Journal of Social Aspects of HIV/AIDS Research Alliance) , 2006,
Abstract: This study sets out to establish and explain the empirical link between HIV/AIDS and poverty using data collected by the 1998 South African Demographic and Health Survey (SADHS).Analysis is restricted to women of reproductive age (15 - 49 years).The results indicate an increased risk of HIV infection among the poor, due to poverty-related characteristics of low education and low knowledge of the means of avoiding HIV infection, as opposed to the non-poor. Moreover, the poor and the less educated were found to be more likely not to use condoms than the non-poor. The results do not, however, provide the reasons for these relations and as such further research is required. One possible explanation was financial dependence on their partners, as it was found that women who received money from their partners, as well as those who came from households where hunger was a common phenomenon, were more likely not to use condoms because their partners disliked condoms, than those who did not receive money from their partners. The results also hinted at the intricacy of the poverty- HIV/AIDS relationship, so that it was not only low socio-economic status that increased susceptibility to HIV infection but also high socio-economic status.
Executive coaching in diversity from the systems psychodynamic perspective
Lerato Motsoaledi,Frans Cilliers
South African Journal of Industrial Psychology , 2012, DOI: 10.4102/sajip.v38i2.988
Abstract: Orientation: The researcher applied role analysis from the systems psychodynamic perspective to executives in state departments to improve their awareness of the unconscious diversity dynamics that affect their roles. Research purpose: The purpose of this research was to describe the application of systems psychodynamic role analysis and to determine its trustworthiness in assisting executives to work effectively with conscious and unconscious diversity dynamics in their organisations. Motivation for the study: Executives generally struggle to understand the deeper meaning of diversity behaviour that manifests inside and around them, leading to conflict. Without understanding the unconscious meaning of the behaviour, organisations founder easily. Awareness of below-the-surface behaviour leads to insight and taking responsibility for diversity-related behaviours. Research design, approach and method: The researcher coached six executives in South African state departments over a period of 10 months. The coaching addressed and analysed the executives’ organisational roles. She analysed the data using discourse analysis. Main findings: Themes relating to the diversity dynamics of gender, race, ethnicity, authority, disability, language, age, de-authorisation of diversity work and the coaching process emerged. The coaching assisted the executives to gain insights into below-the-surface diversity dynamics, to address diversity in a sustained manner and to take up their organisational roles more effectively. Practical/managerial implications: Coached executives will have a more objective and dynamic experience of diversity issues that manifest in organisations, between colleagues and within themselves. Contribution/value-add: Executive coaching from a systems psychodynamic perspective displays trustworthiness in improving participants’ diversity awareness, especially with regard to gender, race, ethnicity and authorisation. How to cite this article: Motsoaledi, L., & Cilliers, F. (2012). Executive coaching in diversity from the systems psychodynamic perspective. SA Journal of Industrial Psychology/SA Tydskrif vir Bedryfsielkunde, 38(2), Art. #988, 11 pages. http://dx.doi.org/10.4102/sajip.v38i2.988
Lerato P. Ntsala,Andreas Lemmerer
Acta Crystallographica Section E , 2012, DOI: 10.1107/s1600536812031224
Abstract: In the title compound, C6H7N3O, the amide group is rotated such that the carbonyl O atom is syn to the pyridine N atom, with an O—C—C—C torsion angle of 23.55 (18)°. The crystal packing involves four hydrogen bonds of the types N—H...N and N—H...O. Two separate centrosymmetric rings are formed using N—H...N and N—H...O hydrogen bonds that result in a ribbon of 6-aminonicotinamide molecules, joined by the amide and amine functional groups. The remaining two hydrogen bonds are used to generate a three-dimensional packing arrangement.
Application of Non-parametric Analysis Technique amongst Postgraduate Education Research: A Survey of South African Universities
Anass BAYAGA,Liile Lerato LEKENA
Journal of International Social Research , 2010,
Abstract: The objective of this research was to determine factors that influence application of non-parametric analysis technique. The data emanated from research done by postgraduate students over a ten year period (1995-2004) and archived by the project in postgraduate education research (PPER). A Survey of three South African universities was conducted. The classification of researches from chosen prominent universities were made by research title, research topic, target population, data collection method, and other diversity titles which were used to map the position of non parametric analysis. The sample in the three (3) universities included four hundred and twenty-one (421) sampled researches.The first finding indicated that the data presentation chapters of the sampled researches were all analysed using descriptive analysis without application of non-parametric technique. Thus, no sampled research applied non-parametric analysis technique. Secondly, the findings suggested that there was a relationship between research title and data analysis technique. Thirdly, there was association between research titles and target populations, which consequently influence choice of data analysis. Lastly, the dominant themes amongst the sampled researches were age, inclusive education and education.
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