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HIV Seropositivity: HELP
Articles by Karl Peltzer
Based on 13 articles published since 2010
(Why 13 articles?)
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Between 2010 and 2020, K. Peltzer wrote the following 13 articles about HIV Seropositivity.
 
+ Citations + Abstracts
1 Review Adherence to antiretroviral therapy during and after pregnancy in low-income, middle-income, and high-income countries: a systematic review and meta-analysis. 2012

Nachega, Jean B / Uthman, Olalekan A / Anderson, Jean / Peltzer, Karl / Wampold, Sarah / Cotton, Mark F / Mills, Edward J / Ho, Yuh-Shan / Stringer, Jeffrey S A / McIntyre, James A / Mofenson, Lynne M. ·Department of International Health, Global Disease Epidemiology and Control Program, Johns Hopkins University Bloomberg School of Public Health, 615N. Wolfe Street, Suite W5031, Baltimore,MD21205, USA. jnachega@jhsph.edu ·AIDS · Pubmed #22951634.

ABSTRACT: OBJECTIVE: To estimate antiretroviral therapy (ART) adherence rates during pregnancy and postpartum in high-income, middle-income, and low-income countries. DESIGN: Systematic review and meta-analysis. METHODS: MEDLINE, EMBASE, SCI Web of Science, NLM Gateway, and Google scholar databases were searched. We included all studies reporting adherence rates as a primary or secondary outcome among HIV-infected pregnant women. Two independent reviewers extracted data on adherence and study characteristics. A random-effects model was used to pool adherence rates; sensitivity, heterogeneity, and publication bias were assessed. RESULTS: Of 72 eligible articles, 51 studies involving 20 153 HIV-infected pregnant women were included. Most studies were from United States (n =  14, 27%) followed by Kenya (n = 6, 12%), South Africa (n = 5, 10%), and Zambia (n = 5, 10%). The threshold defining good adherence to ART varied across studies (>80, >90, >95, 100%). A pooled analysis of all studies indicated a pooled estimate of 73.5% [95% confidence interval (CI) 69.3-77.5%] of pregnant women who had adequate (>80%) ART adherence. The pooled proportion of women with adequate adherence levels was higher during the antepartum (75.7%, 95% CI 71.5-79.7%) than during postpartum (53.0%, 95% CI 32.8-72.7%; P = 0.005). Selected reported barriers for nonadherence included physical, economic and emotional stresses, depression (especially postdelivery), alcohol or drug use, and ART dosing frequency or pill burden. CONCLUSION: Our findings indicate that only 73.5% of pregnant women achieved optimal ART adherence. Reaching adequate ART adherence levels was a challenge in pregnancy, but especially during the postpartum period. Further research to investigate specific barriers and interventions to address them is urgently needed globally.

2 Article Prevalence of prenatal depression and associated factors among HIV-positive women in primary care in Mpumalanga province, South Africa. 2016

Peltzer, Karl / Rodriguez, Violeta J / Jones, Deborah. ·a PhD, is a distinguished Research Fellow in HIV/AIDS/STIs and TB (HAST) Research Programme , Human Sciences Research Council , Pretoria , South Africa. · b is a Professor at the ASEAN Institute for Health Development , Mahidol University , Salaya , Thailand. · c is a Research Associate in the Department of Research & Innovation , University of Limpopo , Sovenga , South Africa. · d MSEd, is a Research Associate in Department of Psychiatry & Behavioral Sciences , University of Miami Miller School of Medicine , Miami , USA. · e PhD, is a Professor in Department of Psychiatry & Behavioral Sciences , University of Miami Miller School of Medicine , Miami , USA. ·SAHARA J · Pubmed #27250738.

ABSTRACT: This study aimed to assess the prevalence of depressed symptoms and associated factors in prenatal HIV-positive women in primary care facilities in rural South Africa. In a cross-sectional study, 663 HIV-positive prenatal women in 12 community health centres in Mpumalanga province, South Africa, were recruited by systematic sampling (every consecutive patient after HIV post-test counselling). Results indicate that overall, 48.7% [95% CI: 44.8, 52.6] of women during the prenatal period reported depressed mood (scores of ≥ 13 on the Edinburgh Postnatal Depression Scale 10). In multivariate analysis, not being employed, unplanned pregnancy, not having an HIV-positive child, poor antiretroviral therapy adherence, non-condom use at last sex, and intimate partner violence were associated with depressive symptoms. Potential risk factors among HIV-infected prenatal women were identified which could be utilized in interventions. Routine screening for depression may be integrated into prenatal care settings.

3 Article Evaluation of the HIV lay counselling and testing profession in South Africa. 2015

Mwisongo, Aziza / Mehlomakhulu, Vuyelwa / Mohlabane, Neo / Peltzer, Karl / Mthembu, Jacque / Van Rooyen, Heidi. ·School of Public Health, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa. aziza.mwisongo2@wits.ac.za. · Wits Health Consortium-Clinical HIV Research Unit (CHRU), Department of Medicine, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa. aziza.mwisongo2@wits.ac.za. · HIV/AIDS, STIs, and TB (HAST) Research Programme, Human Sciences Research Council (HSRC), Pretoria, Cape Town, Durban, Port Elizabeth, South Africa. vmehlomakhulu@hsrc.ac.za. · HIV/AIDS, STIs, and TB (HAST) Research Programme, Human Sciences Research Council (HSRC), Pretoria, Cape Town, Durban, Port Elizabeth, South Africa. nmohlabane@hsrc.ac.za. · HIV/AIDS, STIs, and TB (HAST) Research Programme, Human Sciences Research Council (HSRC), Pretoria, Cape Town, Durban, Port Elizabeth, South Africa. kpeltzer@hsrc.ac.za. · Department of Research & Innovation, University of Limpopo, Turfloop, South Africa. kpeltzer@hsrc.ac.za. · ASEAN Institute for Health Development, Madidol University, Salaya, Phutthamonthon, Nakhonpathom, 73170, Thailand. kpeltzer@hsrc.ac.za. · HIV/AIDS, STIs, and TB (HAST) Research Programme, Human Sciences Research Council (HSRC), Pretoria, Cape Town, Durban, Port Elizabeth, South Africa. jmthembu@hsrc.ac.za. · HIV/AIDS, STIs, and TB (HAST) Research Programme, Human Sciences Research Council (HSRC), Pretoria, Cape Town, Durban, Port Elizabeth, South Africa. hvanrooyen@hsrc.ac.za. ·BMC Health Serv Res · Pubmed #26197722.

ABSTRACT: BACKGROUND: With the launch of the national HIV Counselling and Testing (HCT) campaign in South Africa (SA), lay HIV counsellors, who had been trained in blood withdrawal, have taken up the role of HIV testing. This study evaluated the experiences, training, motivation, support, supervision, and workload of HIV lay counsellors and testers in South Africa. The aim was to identify gaps in their resources, training, supervision, motivation, and workload related to HCT services. In addition it explored their experiences with providing HIV testing under the task shifting context. METHODS: The study was conducted in eight of South Africa's nine provinces. 32 lay counsellors were recruited from 67 HCT sites, and were interviewed using two questionnaires that included structured and semi-structured questions. One questionnaire focused on their role as HIV counsellors and the other on their role as HIV testers. RESULTS: Ninety-seven percent of counsellors reported that they have received training in counselling and testing. Many rated their training as more than adequate or adequate, with 15.6% rating it as not adequate. Respondents reported a lack of standardised counselling and testing training, and revealed gaps in counselling skills for specific groups such as discordant couples, homosexuals, older clients and children. They indicated health system barriers, including inadequate designated space for counselling, which compromises privacy and confidentiality. Lay counsellors carry the burden of counselling and testing nationally, and have other tasks such as administration and auxiliary duties due to staff shortages. CONCLUSIONS: This study demonstrates that HCT counselling and testing services in South Africa are mainly performed by lay counsellors and testers. They are challenged by inadequate work space, limited counselling skills for specific groups, a lack of standardised training policies and considerable administrative and auxiliary duties. To improve HCT services, there needs to be training needs with a standardised curriculum and refresher courses, for HIV counselling and testing, specifically for specific elderly clients, discordant couples, homosexuals and children. The Department of Health should formally integrate lay counsellors into the health care system with proper allocation of tasks under the task shifting policy.

4 Article Improving PMTCT uptake in rural South Africa. 2014

Weiss, Stephen M / Peltzer, Karl / Villar-Loubet, Olga / Shikwane, Molatelo E / Cook, Ryan / Jones, Deborah L. · ·J Int Assoc Provid AIDS Care · Pubmed #23778240.

ABSTRACT: INTRODUCTION: Despite the widespread availability of prevention of mother-to-child transmission (PMTCT) programs, many women in sub-Saharan Africa do not participate in PMTCT. This pilot study aimed to utilize partner participation in an intervention to support PMTCT uptake. METHODS: Couples (n ¼ 239) were randomized to receive either a comprehensive couples-based PMTCT intervention or the standard of care. RESULTS: Compared to the standard of care, participants receiving the intervention increased HIV- and PMTCT-related knowledge (F1,474 ¼ 13.94, p ¼ .004) and uptake of PMTCT, as defined by infant medication dosing (74% vs. 46%, w2 ¼ 4.69, p ¼ .03). DISCUSSION: Results indicate that increasing male attendance at antenatal clinic visits maybe "necessary but not sufficient" to increase PMTCT uptake. Increasing HIV knowledge of both partners and encouraging active male participation in the PMTCT process through psychoeducational interventions may be a strategy to increase the uptake of PMTCT in South Africa.

5 Article Sexual behaviour among HIV-infected new mothers in South Africa 3-12 months after delivery. 2014

Peltzer, Karl. ·a Human Sciences Research Council , Pretoria , South Africa. ·AIDS Care · Pubmed #23724951.

ABSTRACT: The aim of this study was to assess sexual activity, condom use and disclosure of HIV infection status among HIV-infected women 3-12 months after delivery and to identify factors associated with unsafe sex. A cross-sectional study was carried out on 480 HIV-positive sexually active new mothers in 48 primary health care clinics in Nkangala District. Post-natal women were recruited by systematic sampling (every consecutive patient over a period of 2 months) and responded to a questionnaire. Overall, 31.9% reported unsafe sex with an HIV-uninfected of unknown-status partner. In multivariate regression analysis, not having disclosed their HIV status, having experienced physical partner violence, lack of male involvement and not having attended a support group were associated with unsafe sex. Several risk factors for unsafe sex post-natally have been identified and can be utilised in post-partum sexual health education programmes.

6 Article Reducing the risk of HIV infection during pregnancy among South African women: a randomized controlled trial. 2013

Jones, D L / Peltzer, K / Villar-Loubet, O / Shikwane, E / Cook, R / Vamos, S / Weiss, S M. ·Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA. djones@med.miami.edu ·AIDS Care · Pubmed #23438041.

ABSTRACT: Mpumalanga Province, South Africa has one of the highest HIV/AIDS diagnosis rates among pregnant women (~29.4%). This study sought to enhance male involvement in pregnancy to increase HIV disclosure, sexual communication, HIV knowledge and reduce unprotected sex. Participants attending Antenatal Clinics (ANC) completed HIV counseling and testing and were enrolled with male partners (n=239 couples, 478 individuals). Twelve ANCs were randomly assigned to provide a prevention of mother-to-child transmission (PMTCT) intervention or the standard of care, health education sessions plus PMTCT. Participants were assessed at baseline and post-intervention (approximately 6-8 weeks post-baseline) on demographics, sexual behavior, HIV-related knowledge, and conflict resolution strategies. Experimental participants increased HIV knowledge, use of negotiation, and decreased intimate partner violence. Additionally, they were more likely to have increased condom use from baseline to post-intervention (OR=5.1, 95% CI=[2.0, 13.3]). Seroconversions in the control condition exceeded experimental (6 vs. 0). HIV serostatus disclosure to partner did not increase over time for men or women within the experimental or control condition. Male involvement in pregnancy may be an important strategy to reduce sexual risk behavior and HIV transmission. Results support the utility of group interventions to enhance communication and HIV knowledge among pregnant couples.

7 Article HIV knowledge and sexual risk behavior among pregnant couples in South Africa: the PartnerPlus project. 2013

Villar-Loubet, Olga M / Cook, Ryan / Chakhtoura, Nahida / Peltzer, Karl / Weiss, Stephen M / Shikwane, Molatelo Elisa / Jones, Deborah L. ·Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, FL, USA. ovillar2@med.miami.edu ·AIDS Behav · Pubmed #23161209.

ABSTRACT: In sub-Saharan Africa, 60 % of people living with HIV are women and most are of childbearing age. Alarmingly, seroconversion rates during pregnancy are high and increase as pregnancy progresses, highlighting the importance of increasing HIV-knowledge among pregnant women and their partners. This study compared sexual risk behavior, HIV knowledge and condom use pre- to post-partum among South African couples (n = 239 couples) randomly assigned to an intervention or an enhanced standard of care with the PMTCT protocol at rural community health antenatal clinics. Consistent condom use and HIV-related knowledge increased baseline to post-intervention and was maintained at long term follow up post-partum among participants in the intervention condition. HIV knowledge mediated the relationship between the intervention and consistent condom use. Results from this pilot study provide support for the integration of HIV risk reduction interventions for both women and men into existing PMTCT services during and following pregnancy.

8 Article HIV disclosure, sexual negotiation and male involvement in prevention-of-mother-to-child-transmission in South Africa. 2013

Villar-Loubet, Olga M / Bruscantini, Laura / Shikwane, Molatelo Elisa / Weiss, Stephen / Peltzer, Karl / Jones, Deborah L. ·Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA. OVillar2@med.miami.edu ·Cult Health Sex · Pubmed #22974414.

ABSTRACT: HIV-seroconversion during pregnancy is a serious concern throughout South Africa, where an estimated 35 to 40% of pregnant women have HIV/AIDS and drop-out is high at all stages of the prevention-of-mother-to-child-transmission (PMTCT) process. The likelihood of PMTCT success may be linked to partner support, yet male involvement in antenatal care remains low. This qualitative study examined the influence of pregnant couples' expectations, experiences and perceptions on sexual communication and male involvement in PMTCT. A total of 119 couples participated in a comprehensive intervention in 12 antenatal clinics throughout South Africa. Data were collected between December 2010 to June 2011 and analysed using a grounded theory approach. Findings point to the importance of sexual communication as a factor influencing PMTCT male involvement. Analysis of themes lends support to improving communication between couples, encouraging dialogue among men and increasing male involvement in PMTCT to bridge the gap between knowledge and sexual behaviour change.

9 Article Sexual risk, serostatus and intimate partner violence among couples during pregnancy in rural South Africa. 2013

Peltzer, Karl / Jones, Deborah / Weiss, Stephen M / Villar-Loubet, Olga / Shikwane, Elisa. ·HIV/AIDS/STI and TB (HAST) Research Programme, Human Sciences Research Council, Pretoria, South Africa. kpeltzer@hsrc.ac.za ·AIDS Behav · Pubmed #22488126.

ABSTRACT: The aim of this study was to describe sexual risk behavior among 239 couples during pregnancy and to examine the relationship of sexual risk behavior with HIV serostatus and intimate partner violence. One-third (31.8 %) of pregnant women and 20.9 % of male partners were HIV positive. HIV risk factors included lack of knowledge of partners' HIV serostatus, unprotected sexual intercourse and multiple sexual partners. Among men, multivariate logistic regression identified awareness of HIV negative partner status, multiple sexual partners and low levels of partner violence and among women Zulu or Swati ethnicity were associated with unprotected intercourse. HIV positive concordance was associated with protected sex and in multilevel analysis of couples HIV positive status and awareness of the partner's HIV positive status were associated with protected sex. High levels of HIV risk behaviour was found among couples during pregnancy calling for HIV risk reduction interventions.

10 Article Efficacy of a lay health worker led group antiretroviral medication adherence training among non-adherent HIV-positive patients in KwaZulu-Natal, South Africa: results from a randomized trial. 2012

Peltzer, Karl / Ramlagan, Shandir / Jones, Deborah / Weiss, Stephen M / Fomundam, Henry / Chanetsa, Lucia. ·Psychology at Free State University. kpeltzer@hsrc.ac.za ·SAHARA J · Pubmed #23234350.

ABSTRACT: There is a lack of theory-based randomized controlled trials to examine the effect of antiretroviral adherence in sub-Saharan Africa. We assessed the effectiveness of a lay health worker lead structured group intervention to improve adherence to antiretroviral therapy (ART) in a cohort of HIV-infected adults. This two-arm randomized controlled trial was undertaken at an HIV clinic in a district hospital in South Africa. A total of 152 adult patients on ART and with adherence problems were randomized 1:1 to one of two conditions, a standard adherence intervention package plus a structured three session group intervention or to a standard adherence intervention package alone. Self-reported adherence was measured using the Adult AIDS Clinical Trials Group adherence instrument prior to, post intervention and at follow-up. Baseline characteristics were similar for both conditions. At post-intervention, adherence information knowledge increased significantly in the intervention condition in comparison to the standard of care, while adherence motivation and skills did not significantly change among the conditions over time. There was a significant improvement in ART adherence and CD4 count and a significant reduction of depression scores over time in both conditions, however, no significant intervention effect between conditions was found. Lay health workers may be a useful adjunct to treatment to enhance the adherence information component of the medication adherence intervention, but knowledge may be necessary but not sufficient to increase adherence in this sample. Psychosocial informational interventions may require more advanced skill training in lay health workers to achieve superior adherence outcomes in comparison standard care in this resource-constrained setting.

11 Article HIV risk reduction intervention among medically circumcised young men in South Africa: a randomized controlled trial. 2012

Peltzer, Karl / Simbayi, Leickness / Banyini, Mercy / Kekana, Queen. ·Human Sciences Research Council, Pretoria, South Africa. KPeltzer@hsrc.ac.za ·Int J Behav Med · Pubmed #21638159.

ABSTRACT: BACKGROUND: Medical male circumcision (MMC) is now considered one of the best available evidence-based biomedical HIV prevention interventions. However, there is some concern about risks for behavioural disinhibition, or risk compensation, following MMC. PURPOSE: The aim of this study was to test a brief one-session (180 min) group culturally tailored HIV risk reduction counselling intervention among men undergoing medical circumcision in South Africa in order to limit behavioural disinhibition. METHODS: A randomized controlled trial design was employed using a sample of 150 men, 75 in the experimental group and 75 in the control group. Comparisons between baseline and 3-month follow-up assessments on several key behavioural outcomes addressed by the intervention were done. RESULTS: Our study found that behavioural intentions and risk reduction skills significantly increased and sexual risk behaviour (reduction of the number of sexual partners and the number of unprotected vaginal sexual intercourse occasions) significantly decreased in the experimental compared to the control condition. However, male role norms did not change among the intervention conditions over time, while AIDS-related stigma beliefs significantly reduced in both conditions over time. CONCLUSION: Study findings show that a relatively brief (one session) and focused HIV risk reduction counselling can have at least short-term effects on reducing sexual risk behaviours in populations at high risk for behavioural disinhibition following medical male circumcision.

12 Article Infant-feeding practices and associated factors of HIV-positive mothers at Gert Sibande, South Africa. 2011

Ladzani, Rendani / Peltzer, Karl / Mlambo, Motlatso G / Phaweni, Khanyisa. ·Human Sciences Research Council of South Africa, Pretoria, South Africa. rladzani@hsrc.ac.za ·Acta Paediatr · Pubmed #21062356.

ABSTRACT: AIM: To assess knowledge, infant-feeding education and practices, factors that affect choice of infant feeding option, determinants of mixed feeding, psychosocial challenges and attitudes of HIV-positive women with infants between ages 3-6 months who attended prevention of mother-to-child transmission of HIV services in Gert Sibande district. METHODS: A cross-sectional study was conducted with 815 HIV-positive mothers at 47 postnatal clinics. Trained field workers collected data at health facilities, using structured questionnaires. HIV-infected women who were at least 18 years of age were interviewed. RESULTS: The mean age was 27.7 years (SD 6.4). Seventy-eight percent agreed that HIV could be transmitted by breastfeeding. Fifty per cent were exclusively formula feeding, 35.6% breastfed exclusively and 12.4% mixed fed. In multivariate analysis, having a vaginal delivery, infant hospital admissions, and currently pregnant were associated with mixed feeding. Being older, knowing the HIV status of the infant and higher knowledge on HIV transmission through breastfeeding were associated with formula feeding. CONCLUSION: The study identified gaps in prevention of mother-to-child transmission (PMTCT) knowledge and infant feeding policy which seem to affect appropriate infant feeding. Various determinants of mixed feeding and exclusive formula feeding in the context of PMTCT were identified that can guide infant feeding counselling and support services of PMTCT programmes.

13 Article Lay counsellor-based risk reduction intervention with HIV positive diagnosed patients at public HIV counselling and testing sites in Mpumalanga, South Africa. 2010

Peltzer, Karl / Tabane, Cily / Matseke, Gladys / Simbayi, Leickness. ·Health Promotion Research Unit, Social Aspect of HIV/AIDS and Health, Human Sciences Research Council, Pretoria, South Africa. KPeltzer@hsrc.ac.za ·Eval Program Plann · Pubmed #20416948.

ABSTRACT: OBJECTIVE: To evaluate the feasibility, fidelity, and effect of a human immunodeficiency virus (HIV) risk reduction intervention delivered to HIV-infected patients by lay counsellors during routine HIV counselling and testing (HCT) public service in Mpumalanga, South Africa. METHODS: A total of 488 HIV-infected patients, aged 18 years and older, receiving HCT service at clinics in Mpumalanga, received an "Options for Health" intervention delivered by clinic lay counsellors. Intervention lay counsellors implemented a brief risk reduction intervention at on average 2.3 sessions to help patients reduce their unprotected sexual behaviour. Questionnaires were administered at baseline and 4 months following the intervention to assess HIV risk behaviour in previous 3 months. RESULTS: A significant increase in AIDS knowledge, behavioural intentions and risk reduction efficacy among participants at follow-up was found. Participants at 4-month follow-up reported a significant reduction of multiple partners, unprotected sex, alcohol or drug use in a sexual context, and transactional sex. In addition, sexual abstinence increased and alcohol use decreased, in the past 3 months. CONCLUSIONS: A lay counsellor-delivered HIV prevention intervention targeting HIV-infected patients seems to be feasible to implement with fidelity in the South African HCT setting and promising at reducing risk behaviour.