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Document Type

Open Access Dissertation

Degree Name

Doctor of Philosophy (PhD)

Degree Program

Nursing

Year Degree Awarded

2017

Month Degree Awarded

May

First Advisor

Donna Zucker

Second Advisor

Jeungok Choi

Third Advisor

Krishna Poudel

Subject Categories

Nursing

Abstract

ABSTRACT

COMPARISON OF THE EFFICACY OF ARV MEDICATIONS ALONE AND IN COMBINATION WITH HERBAL MEDICATIONS IN THE TREATMENT OF HIV AMONG NIGERIAN HIV+ PATIENTS

MAY 2017

ABDULFATTAH B. DUROJAIYE, BSN, UNIVERSITY OF MEDICINE & DENTISTRY OF NJ (NOW RUTGERS UNIVERSITY)

BSc, UNIVESITY OF AGRICULTURE, ABEOKUTA, NIGERIA

MSc, UNIVERSITY OF IBADAN, NIGERIA

PhD, UNIVERSITY OF MASSACHUSETTS, AMHERST

Directed by Prof. Donna Zucker

Background/Purpose: There is disproportionate incidence of HIV in Sub-Saharan Africa in comparison to the rest of the world. Of the estimated 35.3 million people living with HIV, Sub-Saharan Africa has the highest level of HIV infections, accounting for 69% of global HIV infection in spite of having only 12% of the global population. Nigeria, with over 3.2 million people living with HIV, has the second highest HIV/AIDS burden in the world, next only to South Africa (5.6 million) whose population is approximately one third of Nigeria’s population. According to the World Health Organization (WHO) an estimated 80% of Africans reportedly use herbal therapies in the treatment of many diseases (WHO, 2002). The use of herbal remedies in the treatment of HIV has gained currency in Nigeria. The purpose of this study was to investigate the efficacy of ARV- only therapy and a combined therapy of ARV and herbal medications and to also investigate the effect of these treatment modalities on HIV symptoms and patients’ quality of life among HIV patients in Nigeria.

Methods: This is a comparative analysis study designed to compare the efficacy of conventional antiretroviral (ART) medications with a combination therapy of ART and herbal therapies as they are already used by Nigerian HIV patients. The World Health Organization Quality of Life Instrument for HIV (WHOQOL-HIV BREF) and the Sign and Symptom Check-List for persons with HIV disease (SSC-HIV BREF) questionnaires were administered to 110 participants drawn from two groups of Nigerian HIV patients: those using conventional antiretroviral medications only and those using a combination of herbal remedies and conventional antiretroviral medications. Each group was composed of 55 participants. Physiological data (CD4 counts) was also collected for the two groups. Data generated from the study was analyzed using IBM SPSS Statistics 22 software. Both descriptive and inferential data analyses were used to analyze study results. Descriptive statistics was used to analyze the demographic data (age, gender, and ethnicity) while inferential statistics was used to draw conclusion from study data. Paired Sample test was used to determine the differences between baseline CD4 counts and post-treatment CD4 counts in both groups. Analysis of covariance (ANCOVA) was used to statistically adjust and control the differences noted in baseline CD4 counts between the two groups before comparative analyses of the two groups’ CD4 counts were done. Independent t-test was used to compare the differences between ARV group and combined group.

Findings: There was a statistically significant difference between baseline CD4 counts and post- treatment CD4 counts after treatment with ARV only and combined therapies. However, no statistically significant difference was noted in the overall quality of life of patients receiving ARV only and those receiving combined therapies (p=.211). Statistically significant difference was noted in social relationship domain (p=.028) and health satisfaction domain (p=.049) of the WHOQOL BREF instruments. No statistically significant difference was noted in all the sign and symptom factors evaluated except in the fever factor (p=.003) and sore throat factor (p=.013).

Conclusion: Findings from this study have shown that a vast majority of patients on combined therapy do so without disclosing the use of herbal remedies to their physicians and care providers. It is expected that physicians and care providers would incorporate this knowledge into their care model, build trusting and supportive relationships with patients and specifically solicit information about the use of herbal therapy in combination with ARV. This knowledge will enable physicians, nurses and other care providers to explore possible side effects and cross reactions between ARV and herbal remedies.

Keywords: HIV, ARV, Herbal Medications, Nigeria

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