A retrospective chart review on the homoeopathic management of concomitant ailments occurring in HIV positive patients, at a homoeopathic community health centre

Abstract

Statistically, South Africa has the largest human immunodeficiency virus (HIV) epidemic worldwide and in 2018 reportedly had the highest number of HIV positive (HIV+) cases at 7.7 million. According to the Human Sciences Research Council (HSRC) (2018), HIV prevalence is highest in KwaZulu-Natal (KZN) and subprovincially in eThekwini municipality of KZN (Shisana et al. 2014). The South African health care system is overwhelmed with its HIV treatment programme and faces the challenges of being under resourced and health care workers being overworked. Mainstream antiretrovirals (ARV) used in the management of HIV have clinically significant drug interactions with mainstream medical drugs used to treat concomitant disease, which then require monitoring and adjustment of doses due to reduced therapeutic outcome or adverse effects or contraindicating relevant drugs which increase in toxicity (SAMF 2020 and Schaleppi et al. 2020). Further consideration is the growing problem of antibiotic resistance amongst PLWH due to over prescription, whether clinically indicated or for prophylactic purpose for commonly seen HIV concomitant ailments. Upon review of the literature, it was evident that there has been no published study undertaken to establish the trends in the homoeopathic management of HIV concomitant pathology at a community health centre in KZN. The aim of this study was to determine trends which could highlight the benefit of complementary homoeopathic treatment of HIV concomitant ailments within the South African health care context. In doing so, homoeopathy may then be considered on a larger scale as a contribution to the possible improvement of patient well-being, in terms of reduction of medical costs, and alleviation on strained health care human resources. Thus, this study undertook a retrospective chart review for the period 2015 to 2016 of newly treated HIV+ patients at Ukuba Nesibindi Homoeopathic Community Health Centre (UNHCHC). UNHCHC is a Durban University of Technology (DUT) satellite homoeopathic community health centre (HCHC) offering free homoeopathic healthcare service. It is located in Warwick junction within the eThekwini municipality. The Centre shares premises with LifeLine which provides free HIV counselling, testing as well as HIV counselling skills training, thus placing UNHCHC in a prime position to treat referrals therefrom. This was therefore a suitable site for data collection for this study. Aim of the study The aim of this study was to determine the homoeopathic management of concomitant ailments occurring in new patients that are HIV+, at a homoeopathic community health centre within the period 2015 to 2016. The aim was guided by the following objectives: • ascertain the demographics, • the concomitant clinical conditions or ailments occurring in these HIV+ cases, • the homoeopathic prescriptions for these ailments, • and the guiding symptoms that supported the homoeopathic management. The results of the study were analysed to establish whether any trends emerged by virtue of how commonly occurring the ailments and prescriptions were noted. Methodology The methodology employed for this study was a retrospective chart review which entailed the gathering and subsequent organisation of pre-documented data, i.e., review of existing data. A total of 113 case files of HIV+ patients who had newly attended UNHCHC in the period between 2015 and 2016 were first identified, reviewed, and data collated using a standard rubric (Appendix E). Data on the demographics, concomitant conditions, homoeopathic posology, and case symptoms, was recorded to extract guiding symptoms for the homoeopathic prescription. The data obtained was organised and summarised through spreadsheet tabulation and descriptive statistics were presented through graphs using Microsoft Excelâ (MS Excel). Further thematic analysis was conducted to infer, discuss and compare patterns and trends in the description and treatment of HIV concomitant pathologies. The homoeopathic management employed based on the guiding symptoms was discussed by comparing the arising symptoms with existing homoeopathic materia medica. The study thus explored, analysed and described HIV concomitant pathology patterns, homoeopathic prescription trends, and comparative materia medica prescription verification, to ascertain the trends of homoeopathic management of the diverse HIV concomitant ailments seen at a community health centre facility such as UNHCHC. Results and conclusion In this retrospective chart review the sample size was 113 HIV positive cases with 81% of the sample group being female, 19% male, 97% black African, and the largest age group was 30-34 years of age (21%). Slightly more participants were employed (44%) than unemployed (41%. The majority of participants were single (72%). Of the 113 HIV positive cases reviewed, 124 concomitant conditions emerged in the dataset. The distribution of these conditions as per systemic categorisation was the respiratory system (22%), followed by, dermatological (20%) and gastrointestinal (16%). Overall, the most common ailments were influenza (15%), dermatitis (8%), headache (7%), urinary tract infection (UTI) (6%), leucorrhoea (4%) and herpes zoster (4%). Analysis of the posology of homoeopathic medicine prescription revealed that overall Bryonia alba (11%) and Natrum muriaticum (7%), were most frequently prescribed for various concomitant ailments. The most frequently prescribed potency was 200CH. Bryonia alba was prescribed most frequently for the influenza cases (29%), while Sulphur was frequently prescribed for dermatitis (45%). Cantharis versicatoria was frequently prescribed for UTI (57%). Echinaforceâ was the most commonly prescribed adjunctive herbal medicine (22%). Thus, the aim and the objectives of this study were achieved.