Health Studies / (M.P.H. (Health Studies))

Master of Public Health - MPH / Background: Zimbabwe has one of the highest HIV prevalence rates in sub-Saharan Africa, with the adult prevalence rate at 15%. The HIV prevalence is highest among adult women, at 18%. Mother-to-child transmission is the second leading cause of HIV in Zimbabwe. Therefore, provision of anti-retroviral therapy to pregnant women is important in reducing mother-to-child transmission. In 2012, the World Health Organisation formally adopted ART guidelines known as "Option B Plus", where triple therapy is provided to pregnant women for life, regardless of CD4 count. Zimbabwe subsequently adopted Option B Plus in September 2013. However, the success of ART depends on adherence to treatment. Lack of adherence to treatment leads to an increased risk of opportunistic infections and drug resistance, which is costly to treat. The aim of the study was to explore pre-and post-partum barriers to anti-retroviral therapy for HIV-positive women initiated onto Option B Plus in Harare, Zimbabwe. Methodology: Descriptive qualitative methods were used to explore the barriers to ART adherence for pre-and post-partum HIV-positive women initiated onto Option B Plus in Harare, Zimbabwe. In-depth, semi-structured interviews were conducted in Shona with 20 non-adherent pre-and post-partum HIV-positive women and four key informants who are health workers from two identified health facilities (Edith Opperman Polyclinic and Kuwadzana Polyclinic). The interviews were recorded, transcribed and translated into English. The data was analysed using inductive thematic analysis. Results: Health facility and individual factors emerged as barriers to adherence. Heavy workload and staff shortages, negative health worker attitude, cost of accessing health facilities, medicine shortages and detrimental health facility policies were all health facility related barriers identified by both key informants and the women. Individual barriers were related to difficulty in navigating the early days after diagnosis and treatment, stigma, intimate partner dynamics and religion. Conclusion: Despite free, decentralised provision of ART, barriers to adherence still exist. Many of the barriers have been articulated in previous research that focused on prevention of- mother-to-child transmission regimens, as well as ART regimens for the general population. The fact that the barriers remain suggests that the barriers are complex and addressing them will require tackling social constraints such as stigma and gender roles that pose a significant barrier to adherence.

The health care industry in Nigeria is increasingly grappling with challenges of meeting end users’ requirements and expectations for quality antiretroviral therapy (ART) service provision. This study sought to explore and describe the quality of antiretroviral therapy in public health facilities in Nigeria and the perceptions of the end users. A descriptive qualitative research design was used in the study in order to generate ideas from end users for improving quality of ART service provision, and prompt additional research activities. Unstructured focus group discussions were conducted with end users (n=64) in 6 locations across the 6 geopolitical zones of Nigeria. Data was analysed using the framework approach because it reflects the original accounts and observations of the end users and the Weft QDA version 1.0.1 software to validate the results. Findings revealed that end users were satisfied with uninterrupted antiretroviral drug supplies, courtesy treatment, volunteerism of support group members and quality counselling services. End users expect public health facilities to accept diagnostic results from collaborating facilities, implement continuous quality improvement (CQI), maintain clean and adequate health infrastructure, reduce end user waiting time, reduce stigma, comprehensively assess end users during each clinic visit and ensure uninterrupted ART services. They also expect effective collaboration between healthcare providers and support group members, to enhance the quality of life of people living with HIV (PLHIV). End users identified the following as quality gaps in ART service provision: weak health facility leadership, non-attractive ART service infrastructure, frequently interrupted laboratory services, demotivated and inadequate health care workers, long waiting time, interrupted medicine supplies and inadequate procedure for complaints management. In conclusion, the following recommendations were proffered: deploy and train additional health care workers, integrate ART into regular health services, improve supply chain management of health commodities, and reduce end user overload in clinics. Finally, a best practice guideline for the provision of end user focused ART service provision was developed. / Health Studies / D.Litt. et Phil. (Health Studies)

Bakgrund. En effektiv behandling för hiv kom år 1996. Behandlingen för hiv kan orsaka en rad biverkningar som skulle kunna påverka följsamheten. Minskad följsamhet har lett till läkemedelsresistens. Syfte. Syftet är att undersöka upplevelser av följsamhet hos personer som lever med hiv under antiretroviral tablettbehandling (ART). Metod. En litteraturstudie med kvalitativ ansats. Resultat. 12 vetenskapliga artiklar ligger till grund för litteraturstudiens resultat. Majoriteten av personer som lever med hiv (PLH) hittade egna strategier för att hitta motivation till att uppnå följsamhet. Depressiva symtom och substansberoende var i flertalet fall en hindrande faktor för PLH:s följsamhet. PLH:s omgivning och nätverk var både en motverkande faktor och en hjälpsam faktor för PLH:s följsamhet. För PLH, som inte hade råd med mat eller som hade en instabil levnadssituation, upplevde svårigheter med att uppnå följsamhet. Hur PLH kände sig bemötta av vårdgivare påverkade följsamheten. För PLH var det viktigt för PLH att känna sig delaktiga i sin vård gällande ART och biverkningar. Hjälpmedel och patientutbildning var verktyg som kunde underlätta för PLH att uppnå följsamhet. Rutiner visade sig vara väsentligt för PLH att uppnå följsamhet. Slutligen var biverkningar till följd av ART en hindrande faktor för att uppnå följsamhet. Konklusion. Biverkningar, samsjuklighet med psykisk ohälsa samt stigma var de främsta faktorerna som hindrade PLH att uppnå följsamhet. Vidare kunskapsutveckling behövs för att minska biverkningar, behandla samsjuklighet och motarbeta stigmatisering för att PLH lättare ska upprätthålla följsamheten. Endel av kunskapsutvecklingen är att den grundutbildade sjuksköterskan behöver bredare kunskap. / Background. The effective treatment for HIV was available in 1996. The treatment for HIV causes several side effects that could have an impact on adherence. Low adherence has led to medical resistance. Aim. The aim is to explore experiences of adherence by people living with HIV with ongoing antiretroviral pill treatment (ART). Method. A literature study with a qualitative approach. Result. This study is based on 12 scientific articles. The majority of people living with HIV (PLH) discovered their own strategies to find motivation in being adherent. Depressed mood and substance addiction were a hindering factor in being adherent. The network and surrounding of PLH were either a discouraging or facilitating factor to adherence. PLH with food insecurity and homelessness experienced difficulties adhering to ART. Clinicians approach to PLH influenced the rate of adherence. It was essential that PLH was involved in their own care regarding ART and side effects. Utilities and patient education were useful tools to facilitate adherence. Routines were shown to be essential for PLH in being adherent. Lastly, side effects due to ART were a hindering factor in achieving adherence. Conclusion. Side effects, comorbidity with mental illness and stigma were the main factors hindering PLH in achieving adherence. Further research is needed to reduce side effects, treat comorbidity and counteract stigma to facilitate adherence. The further research is needed to broaden the knowledge of registered nurses.

Thesis (MPH.) -- University of Limpopo, 2022 / Background: Tuberculosis(TB) and Human Immunodeficiency virus(HIV) continues to be a public health concern globally. There is no data on TB outcomes on HIV programme outcome in Lebowakgomo hospital of Limpopo Province. The main objective of this study was to determine the TB treatment outcomes in TB/HIV co-infected people at Lebowakgomo hospital in Limpopo Province. Methodology: A quantitative retrospective design was used in the study in which a sample size of 180 patients’s files who are 18 years and above and TB/HIV co-infected were reviewed. A self-designed data collection tool was used to collect data. The tool covered variables such as age, gender, HIV status, CD4 cell count, type TB, duration on TB treatment and the outcome. Data was analysed using the STATA statistical software version 12 for Windows (STATA Corporation, College Station, Texas). Results: The majority of records were age group 35-44 years at 32%. There was a statistical significance differences (p˂0.001) between males and females in relation to age groups. TB treatment success rate was 68.9% and mortality 16.9%. Females were more likely to complete TB treatment successfully than males. Overall age, gender, previous TB infections, TB type, duration on ART and CD4 Count were not significantly associated with treatment outcomes amongst TB/HIV co-infected people. Conclusion: This study has revealed that TB treatment success rate in HIV co-infected is lower (68.3%) than the WHO target of 85%.

Immunologic monitoring is part of the standard care for patients on antiretroviral treatment. Yet, little is known about the routine implementation of immunologic monitoring in Ethiopia. This study assessed the pattern of immunologic monitoring, immunologic response, level of immunologic treatment failure and factors related to it among patients on antiretroviral therapy in selected hospitals in southern Ethiopia. A retrospective longitudinal analytic study was conducted using documents of patients started on antiretroviral therapy. A total of 1,321 documents of patients reviewed revealed timely immunologic monitoring were inadequate. Despite overall adequate immunologic response, the prevalence of immunologic failure was 11.5% (n=147). Having WHO Stage III/IV of the disease and a higher CD4 (cluster differentiation 4) cell count at baseline were identified as risks for immunologic failure. These findings highlight the magnitude of the problem of immunologic failure. Prioritizing monitoring for high risk patients may help in effective utilisation of meager resources / Health Studies / M.A. (Public Health)

Immunologic monitoring is part of the standard care for patients on antiretroviral treatment. Yet, little is known about the routine implementation of immunologic monitoring in Ethiopia. This study assessed the pattern of immunologic monitoring, immunologic response, level of immunologic treatment failure and factors related to it among patients on antiretroviral therapy in selected hospitals in southern Ethiopia. A retrospective longitudinal analytic study was conducted using documents of patients started on antiretroviral therapy. A total of 1,321 documents of patients reviewed revealed timely immunologic monitoring were inadequate. Despite overall adequate immunologic response, the prevalence of immunologic failure was 11.5% (n=147). Having WHO Stage III/IV of the disease and a higher CD4 (cluster differentiation 4) cell count at baseline were identified as risks for immunologic failure. These findings highlight the magnitude of the problem of immunologic failure. Prioritizing monitoring for high risk patients may help in effective utilisation of meager resources / Health Studies / M. A. (Public Health)

Poor decision making among clinicians to transferring human immune deficiency virus (HIV) patients into second-line antiretroviral therapy (ART) has led to an increase in morbidity and mortality to people living with HIV (PLHIV). No clear barriers are known for clinicians not switching their patients. This is a descriptive qualitative research aimed to discover obstacles that influence clinicians' decision making to transferring patients into second-line ART despite higher level resistance to first-line ART. The researcher applied a participatory action research framework to solve the identified barriers with clinicians. Using the research questions the researcher explored reasons, perceived barriers and enabling factors for clinicians delay in making decision to transferring HIV patients into second-line ART. In-depth semistructured interviews were conducted with 30 participants. Six thematic areas (a) clinicians' capacity to diagnose treatment failure, (b) laboratory investigations, (c) availability, access, and tolerability to second-line ART, (d) clinicians' perceptions on ARV medicines, (e) clients' readiness for ARV medicines, and (f) adherence and retention to ARV medicines were analysed using STATA. Readiness, adherence and retention to ART, knowledge, competence and experience on ART , lack of viral load testing, and shortage of second-line ART were the common major barriers for clinicians in determining transferring patients into second-line ART. The government of Tanzania should acknowledge and create participation, responsibility, and commitment strategies to reduce the observed barriers. Findings of this study generates knowledge and provide actionable plans to help clinicians easily identify HIV patients who are in need of second-line ART.

The purpose of this study was to explore and describe the determinant factors affecting adherence to antiretroviral therapy among HIV infected patients in Addis Ababa, Ethiopia. A cross-sectional study design was used and data were collected by interviewing 290 study participants from two health facilities using structured questionnaire. The research finding revealed 80.0% of the study participants had optimal combined adherence to dose, schedule and dietary instructions in the past three days. And, the non adherence rate was 20.0%. In multivariate analysis only WHO clinical stage, change of ARV medication, knowledge about HIV disease and ART, and use of reminders were found to be independently associated with adherence to antiretroviral therapy. The most common reasons for missing HIV medications in the past one month were forgetfulness (35.1%), being busy with other things (17.5%), and running out of pills (10.5%). Adherence improving interventions should be emphasized to address multi-faceted problems. This study recommends setting of convenient appointment schedule, disclosure of one's HIV status, maintaining confidentiality of patient-related information, enhancing patient-provider relationship, use of reminders including SMS text messages, and engagement of PLHIV in adherence improving interventions through peer support, and providing regular health education to the PLHIV to improve adherence of patients to ART / Health Studies / M.A. (Public Health)

Thesis (Ph. D. (Sociology)) -- University of Limpopo, 2014. / This study investigated the challenges to antiretroviral therapy adherence. Qualitative and quantitative research methodologies were applied in the study. Purposive sampling was used to select clients on antiretroviral therapy, convenience sampling was applied to select clients who participated in the focus group discussions and health care workers and lay counsellors were selected through the simple random sampling method. In-depth interviews were conducted with 31 clients on antiretroviral therapy at 8 health facilities, 2 focus group discussions comprising of 7 members each were conducted at two health facilities, medical records of all respondents on antiretroviral therapy were reviewed and a stigma scale was administered. A questionnaire was distributed amongst 17 health care workers and lay counsellors. Most of the respondents who participated in this study were females. Data gathered in this study confirmed that women are more vulnerable to HIV than men. The majority of the respondents were poor African people. The predominant language amongst the respondents was the Xitsonga language; hence the world-view of the Va-Tsonga people was assessed. HIV and AIDS cause many social problems in communities. Some of the major findings are that: Literacy levels were found to be very low as most of the respondents pointed out that they had only obtained grade 7 or below. However, this did not have an impact on treatment adherence. Some respondents indicated that they were unemployed; the majority said they were employed. Even though the stigma and discrimination experienced by the respondents was very low, the few who experienced it had very traumatic and cruel experiences perpetrated by their own family members and people in the community. In terms of disclosure, data indicates that most people prefer disclosing to their mothers as they feel that they will get support. The majority of the respondents disclosed to female family members and they were supported by the people they disclosed to. viii Social support is very crucial for people who are on antiretroviral therapy (ART), most of the respondents indicated that they had treatment supporters. Institutional support was very minimal in that most pointed out that they did not belong to any support groups. There were some who did not even know about the existence of any support groups at the health facilities where they were receiving their treatment. Most of the respondents indicated that they disclosed to their colleagues and others had not as they feared that they would lose their jobs. Those who had disclosed indicated that they needed support from their colleagues and employers with regard to compliance with their clinic appointments. Most of the respondents had sexual partners, and had also disclosed to their sexual partners, and disclosure was almost immediately after being diagnosed HIVpositive. There are those who had not disclosed to their sexual partners as they feared rejection or violent reaction. There were sero-discordant couples amongst the respondents who supported each other regarding adherence. Most of the respondents indicated that they had taken care of a family member living with HIV. HIV prevalence also varies amongst health facilities. Strategies employed by health facilities to monitor and evaluate HIV and AIDS programmes differ. Health Care Workers and lay counsellors provided contrasting information. Primary Health Care facilities have been accredited to provide ART, however the down-referral system seems to be failing as some clinics now have more clients on ART than hospitals. Health Care Workers and counsellors also need to be familiarized with the World Health Organization (WHO) standards. The level of adherence acceptable for an individual on ART is 95%; there is however health facilities that indicated the adherence level far below the required level.