Inconsistent Counselor Fidelity in Delivering an Evidence-Based Adherence Intervention During a PrEP Trial

AIDS and Behavior - Evidence-based adherence counseling interventions must be delivered with fidelity to ensure that their effectiveness is retained, but little is known regarding how counselors in...     

ART restorations and glass ionomer sealants in Zimbabwe: survival after 3 years

Atraumatic restorative treatment (ART) consists of removing demineralised tooth tissues with hand instruments only, restoring the prepared cavity and sealing the adjacent pits and fissures with an adhesive filling material. This relatively painless, no-handpiece, minimal intervention approach to controlling dental caries is described. ART was applied in an oral health care programme in Zimbabwe that was carried out amongst secondary school students from 1994 to 1997. A new glass ionomer (Fuji IX) was used as the restorative and sealant material. Sealants were placed in high caries risk students using the ‘press-finger’ technique. A total of 297 one-surface ART restorations and 95 glass ionomer sealants were placed in 142 and 66 students, respectively. After 3 years, the lost-to-follow-up percentages for one-surface ART restorations and glass ionomer sealants were 30.6% and 30.5%, respectively. Actuarial (life table) analysis resulted in 3-year survival rates of one-surface ART restorations of 88.3% (95% CI: 92.4%–84.2%), ranging from 94.3% to 65.4% per operator. A total of 28 ART restorations placed in 25 students failed. Reasons for failure related to the material and the operator (11 restorations or 5.3% each), and to caries adjacent to the restoration (one restoration or 0.5%). Reasons for failure were not recorded for five restorations (2.3%). Seal-ants were placed on surfaces diagnosed as early enamel lesions. After 3 years, 71.4% (95% CI: 81.7%–61.1%) of the fully and partially retained sealants survived with a range of 100% to 55.6% per operator. Of the sealed surfaces 96.3% (95% CI: 100%–92.2%) survived 3 years without developing caries. Experienced operators placed better ART restorations than inexperienced operators. This study has demonstrated that ART with a glass ionomer restorative material and sealants provided high quality preventive and restorative dental care to this student population. ART has become one of the treatment modalities available to oral health workers in managing dental caries.     

Alcohol consumption in HIV-I infected persons: a study of immunological markers, Harare, Zimbabwe

OBJECTIVE: To examine the effect of alcohol use in relation to the age, gender and plasma levels of HIV-I RNA and CD4 cells count in HIV-I infected persons as a prognostic indicator for the disease progression to AIDS. DESIGN: A community based cohort study. SETTING: The study was conducted at the Blair Research Institute Clinic from June 1996 to May 1998. SUBJECT: We interviewed 105 volunteers, at a baseline and then followed them up on a three monthly basis. They underwent physical examinations and had blood drawn for laboratory tests. AUDIT Core was used to gain an indication of how much dependence there was on alcohol by patients in relation to demographic and immunological variables. MAIN OUTCOME MEASURES: Frequency of alcohol use and HIV-I disease progression to AIDS using viral loads and CD4 cells counts as measures of immune impairment. RESULTS: The volunteers had a mean (s d) age of 34.9 (7.3) years. Prevalence of alcohol use was 30.5% (n = 34.95% CI = 21.7 to 39.3). Most of the patients with CD4 cells count less than 200 mm3 did not use alcohol (p = 0.023) by the six months follow ups. There were no significant mean differences between users and nonusers of alcohol regarding the levels of both plasma viremia and CD4 cells count. CONCLUSION: Our finding is consistent with previous findings that found no relationship between alcohol use in persons with HIV-I infection and progression of disease to AIDS.     

Acute profound thrombocytopenia following angioplasty: the dilemma in the management and a review of the literature

Abciximab, heparin, and clopidogrel are often used together in the setting of coronary syndromes. These drugs are associated with thrombocytopenia and it is important to quickly discriminate the cause of this complication as it has implications for the management of thrombocytopenia and the coronary syndrome. This case highlights some of the dilemmas that may arise as no test can definitively identify the offending drug, and stopping these drugs can affect the outcome of the coronary event including stent thrombosis.


Keywords: profound thrombocytopenia; abciximab; heparin; clopidogrel     

Household-based cash transfer targeting strategies in Zimbabwe: Are we reaching the most vulnerable children?

Census data, collected in July 2009, from 27,672 children were used to compare the effectiveness, coverage and efficacy of three household-based methods for targeting cash transfers to vulnerable children in eastern Zimbabwe: targeting the poorest households using a wealth index; targeting HIV-affected households using socio-demographic information (households caring for orphans, chronically-ill or disabled members; child-headed households); and targeting labour-constrained households using dependency ratios. All three methods failed to identify large numbers of children with poor social and educational outcomes. The wealth index approach was the most efficient at reaching children with poor outcomes whilst socio-demographic targeting reached more vulnerable children but was less efficient.     

Leukemoid reaction response to chemotherapy and radiotherapy in a patient with cervical carcinoma

A white blood cell count more than 50 x 10(9)/l associated with a cause outside the bone marrow is termed a leukemoid reaction. Although it simulates leukemia, most of its causes are benign. Malignancy as a cause of a leukemoid reaction is still a medical dilemma. It is thought to be attributed to granulocyte colony-stimulating factor (G-CSF) secreted by the tumor cells. To our knowledge this is the first time a leukemoid reaction has been reported in association with cervical cancer. We even managed to monitor the leukemoid reaction response to chemotherapy and radiotherapy.     

Quality of life evaluation in patients with HIV-I infection: the impact of traditional medicine in Zimbabwe

OBJECTIVES: To evaluate the impact of phytotherapy (traditional medicine) in persons with HIV infection and to assess the quality of life of those persons with respect to HIV disease progression, including sociodemographic characteristics. DESIGN: A community based open label non-intervention and uncontrolled cohort study. SETTING: Blair Research Institute Clinic. SUBJECTS: A total of 105 HIV infected persons at various stages of HIV infection. Seventy-nine percent were on phytotherapy (PT) and 21% on conventional medical care (CMC). MAIN OUTCOME MEASURES: (a) Assessment of quality of life of HIV infected persons on phytotherapy using the WHOQol instrument, and (b) assessment of quality of life of those persons in relation to the HIV disease progression using CD4 cell counts and viral load as measure of disease progression. METHODS: We interviewed 105 patients with various stages of HIV-I infection in a community based cohort study from June 1996 to May 1998, in Harare. The 96 (91.4%) asymptomatic and six (8.6%) symptomatic patients underwent regular physical examinations and had blood drawn for laboratory tests at the baseline afterwards at three month intervals over a period of two years. RESULTS: The mean (s.d.) age was 34.9 (7.3) years; 64.4% were women and 60.3% were married. In multi variate analyses, age was significantly correlated with the level of independence domains (p = 0.032), whereas, gender was significantly correlated with social relationships' domains (p = 0.034). The type of treatment received was significantly correlated with spiritual domains (p = 0.045). Proportions of scores on five domains measuring different aspects of quality of life for patients on phytotherapy were much lower than those on conventional therapy (p < 0.0001, for all variables). CONCLUSION: Our data support the role of phytotherapy in improving the quality of life of HIV-I infected patients, yet its pharmacological basis is unknown. The WHOQol instrument is a good measure of quality of life for patients with HIV infection.     

Effectiveness of an oral health education programme in primary schools in Zimbabwe after 3.5 years

Many medical and dental professionals in African nations believe that school teachers, through attendance of a short workshop, can be trained to provide oral health education. This increases the number of professionals available and is regarded as an important way forward in improving oral health. OBJECTIVES: The current study assesses the effectiveness of an oral health education programme administered by schoolteachers in a district in Zimbabwe over a period of 3.5 years. METHODS: The experimental group consisted of schools that had sent representatives to a regional workshop on oral health held in 1992. The control group was selected at random from schools not having attended the workshop. A total number of 439 boys and 526 girls were examined in 1992. Follow-up evaluations were carried out in 1993, 1994 and 1996. The dependent variables were plaque accumulation and caries increment in grade 2 and grade 4 children of experimental and control schools. RESULTS: ANOVA test with year of evaluation (1992-94), experiment/control school, age and gender as independent variables showed no statistically significant difference in mean plaque scores in longitudinally examined original grade 2 (P>0.20) and grade 4 children (P=0.06) from experimental and control schools. The mean caries increment score in the experimental and control schools was 0.04 and 0.19, respectively. ANOVA test with fluoride levels and gender as independent variables on caries increment in experimental and control schools did not show a statistically significant difference (P=0.06). CONCLUSION: The one-time training of teachers in aspects of oral health was ineffective in lowering plaque levels over a period of 3.5 years. Considering the low caries increment observed over the study period, the effect of the oral health programme on caries levels in the study group was inconclusive.