MSc (Microbiology) / Department of Microbiology / Background: Antiretroviral treatment (ART) has grown to be one of the most effective tool in the fight to control HIV/AIDS morbidity and mortality worldwide. However, due to the emergence of drug resistant HIV, ART efficacy can be jeopardized. Drug resistant HIV strain has a potential of becoming a major public threat, as its limit treatment options on people living with HIV. With several findings worldwide reporting drug resistant HIV to be currently being transmitted to ART-naïve persons, measures have been taken to genotype drug resistant HIV prior to treatment initiation. However, in resource limited countries such measures are not executed especially in public sectors due to the costs associated with the required assays for genotyping. Objective: The objectives of the study was to establish a deep sequencing protocol (Next Generation Sequencing-NGS) using an Illumina MiniSeq Platform and subsequently apply it to genotype HIV in chronically infected drug naïve persons for resistance mutations and viral genotypes Methods: HIV positive Individuals without any exposure to ART (Treatment-naive) were recruited. Partial pol fragment (complete protease and ~1104bp reverse transcriptase) were amplified and purified. Libraries were prepared using Nextera XT library preparation kit, fragmented, tagmented, pooled and denatured then sequenced with Illumina MiniSeq instrument. Consensus sequences were derived, aligned and phylogenetically analysed. The Stanford HIV Drug Resistance Algorithm was used to infer the presence of drug resistant mutants, at the viral minority and majority population levels. Results and discussion: An NGS protocol to generate nucleotide sequences for drug resistance inference was established. No major drug resistance mutations were detected against protease, reverse transcriptase inhibitors in the study subjects investigated. Nevertheless, V179D change was observed in one patient (8.3%). V179D has been shown to impact a low-level resistance to NNRTI. On the other hand, several secondary and unusual mutations at known drug sites were detected even at minority threshold level of <20%. Conclusion: No major drug resistance mutations was detected in the drug naïve study population. This finding suggests that there is no risk of treatment failure to the investigated subjects, however it is important to assess the potential phenotypic v | P a g e significance of the identified secondary resistance mutations in the context of HIV-1 subtype C. The established NGS protocol should be applied in subsequent HIV drug resistance studies. / NRF

PhDH / Department of Public Health / Background: Since the introduction of three-tiered systems appointments, there are a large number of missed appointments among Human immunodeficiency virus-positive clients on Antiretroviral. However, no one knows why these clients missed their scheduled times. Missing of appointments predicts poor adherence and is associated with poor clinical outcomes. Objectives: The proposed study aimed at developing a strategy for reducing the missing of appointments among adults on Antiretroviral Therapy in the Limpopo Province, South Africa. The objectives of the study are to determine patients’ behaviour, the socio-environmental and economic factors that contribute to the missing of appointments and develop strategies to enhance compliance with appointments by Human immunodeficiency virus-positive clients on Antiretroviral therapy in the Limpopo Province. Method: A qualitative research design was used to address the study objectives. Non-probability purposive sampling was used to sample health care centres in Limpopo Province, patients, Professional Nurses and Community Health Workers. Individual interview and focus group discussions strengthened the triangulation of data obtained from the participants. Creswell’s model provided details for data analysis and interpretation. Trustworthiness and Ethics: Measures to ensure data quality, such as credibility, dependability, conformability and transferability, were observed. The researcher ensured compliance with ethical standards to protect the rights of the participants. Approval for this study was obtained from the University of Venda Research Ethics Committee and the Limpopo Department of Health Research Ethics. Results: The study revealed various factors that contribute to the missing of appointments by Human immunodeficiency virus positive-clients on Antiretroviral Therapy. Specific socioeconomic, behavioural, environmental and health service-related factors appear to prevent adherence to appointments. These factors include a lack of family support and client engagement, the absence of financial means, and cultural and religious beliefs. Lack of client involvement in planning their care and poor referral of clients to community health workers were ranked high as being the most contributing factors to clients missing their appointments. Strategy development: Phase 2 of this study dealt with the development of the strategy aimed at reducing the missing of appointment by adults on Antiretroviral Therapy based on the findings of the study. The strengths, weaknesses, opportunities and threats matrix was triangulated in Political, Environmental, Social, Technological and Legal analysis to develop this approach to reduce the missing of appointments among adults on Antiretroviral therapy. A transtheoretical framework illustrated how to implement the strategy. Validation of the developed strategy ensured that the system is free of errors and checked the applicability of the strategies utilising a quantitative design. A simple random sampling approach was used to select the population to participate in this study using the questionnaire developed by the researcher. Almost all respondents agreed that the strategy would facilitate reduced missing appointments by adults on Antiretroviral therapy. Recommendations: Clients involvement and engagement throughout the process of a treatment plan is essential to identify some of the barriers that might contribute to poor adherence to appointment by clients on Antiretroviral therapy. Community health workers and nurses should be capacitated with knowledge and skills to identify the clients at risk of defaulting treatment and appointments and provide counselling that will facilitate behaviour modifications. / HWSETA

Submitted in partial fulfillment of the requirements for the Degree of PhD (Community Psychology), Faculty of Arts, University of Zululand, 2008. / HIV and AIDS present a catastrophic public health threat that is reaching crisis proportions among adolescents and young adults. There is a need to educate pre adolescent female learners before they reach puberty, as females are especially at risk of contracting HIV because of the interplay of biological, economic and cultural factors. This study explored the nature and extent of the pre-adolescent female learner's knowledge, attitudes and skills regarding HIV and AIDS. An experimental research design, namely, a no-treatment group design with pre test and posttest was applied. An HIV and AIDS prevention intervention programme was designed and implemented. The objectives were to help learners acquire knowledge, attitudes and skills to make informed decisions and practice health promoting behaviours. Life skills, sex and sexuality education and HIV and AIDS as a gendered epidemic were addressed. The science and art of health education was used to frame the intervention and ensured that the learner not only received the correct message but also incorporated it into her repertoire of behaviour. The findings of the study highlighted five critical areas that were vital within an HIV and AIDS education intervention. Firstly, pre adolescent female learners were very interested in sex and sexuality and information on physiological changes during puberty must be disseminated. The issue of morality was attached to sex and sexuality and this reinforced the biopsychosocial and cultural factors that came into play. The importance of peer education was emphasised, as parents were reticent to address these issues. It was found that basic information on all dimensions of HIV and AIDS education was still a powerful tool. It was vital to incorporate more than the ABC messages and look at the social constructs of health promotion and focus on critical thinking and an education for liberation. A manual with a set of guidelines was formulated and presented to educators for use with preadolescent female learners. This would help reduce the casualties of HIV and AIDS, as early intervention would protect a vulnerable group in society.

HIV/Aids is a worldwide pandemic and as South Africans we are at the epicentre of this global health crisis. The harrowing statistics are useful as a means to quantify a horrific situation; however, what these facts do not do is provide connection amidst the uncertainty surrounding the disease. This research aims to bridge the disconnection and break the silence that weaves a net around the illness and those infected by it. This is done by deconstructing one man’s story of his journey with HIV; by looking at his personal epistemology; and by contextualising his story within his family and within the society in which he lives, South Africa. Finally, it is my reflections and interpretations that form the bridge between a construct of HIV/Aids and a life lived with the disease. / Psychology / M. A. (Clinical Psychology)

This study investigated the exposure of employees in the South African Police Service (SAPS) to the HIV/AIDS workplace programme, levels of knowledge of HIV/AIDS, perceptions of stigma and discrimination and of participation by stakeholders in programme implementation. The researcher subscribes to the view that stigma and discrimination are major obstacles to the successful implementation of the HIV/AIDS workplace programme as this notion has been substantiated by numerous studies. Self-administered questionnaire was used as means of data collection. Findings suggest that the employees of SAPS based at the National Head Office have high levels of knowledge on HIV/AIDS. However, the majority of the respondents indicated that they would not feel comfortable to disclose their HIV positive status, fearing the consequences thereof. / Sociology / M.A. (Social Behaviour Studies in HIV/AIDS)

Text in Afrikaans / Summaries in Afrikaans and English / VIGS is 'n gesondheidsprobleem wat 'n impak uitoefen op alle gebiede in die samelewing. Voorkoming is die enigste vorm van bekamping. As gevolg hiervan, word VIGS-voorkoming binne die funksies van primere gesondheidsorg geplaas. Die persoon wat die funksies van primere gesondheidsorg uitoefen, is die gemeenskapsgesondheidswerker. Binne hierdie raamwerk is die terme primere gesondheidsorg, gemeenskapsgesondheidswerker en VIGS bespreek en die onderlinge interaksie is aangetoon. Die opleiding wat die gemeenskapsgesondheidswerker op VIGS-gebied ondergaan, is meegemaak. Die prioriteite wat op nasionale, provinsiale en plaaslike vlak bestaan is deur middel van onderhoude nagevors. Die effektiwiteit van die VIGS-voorkomingsboodskap soos oorgedra deur die gemeenskapsgesondheidswerker is tydens 'n inligtingsessie van hoerskoolleerlinge bepaal. Gevolgtrekkings en aanbevelings is in elk van bogenoemde gevalle gemaak. VIGS-voorkomingsinisiatiewe is nog in die kinderskoene in Suid-Afrika, maar het 'n belangrike rol te speel. / AIDS is a health problem that impacts on all societal spheres. Prevention is the only form of combat. Therefore, AIDS prevention falls within the functions of primary health care. The person performing these functions is the community health worker. Within this framework the terms primary health care, community health worker and AIDS were discussed and their interrelatedness illustrated. A session during which community health workers received training in aspects of AIDS was attended. Priorities existing at national, provincial and local levels were researched through interviews. The effectiveness of the community health worker in spreading the AIDS prevention message was determined during an information session for secondary school pupils. Conclusions and recommendations were made in each of these cases. AIDS prevention initiatives are still in its infancy in South Africa, but has an important role to play. / Health Studies / M.A. (Ontwikkelingsadministrasie)

The aim of this study was to investigate the perceptions, attitudes, opinions and fears of the adolescent high school learners towards HIV counseling and testing at school.Quantitative, descriptive, exploratory research was conducted to determine if high school learners would like to be tested for HIV at school. Data collection was done using structured questionnaires. The respondents in the study were daytime high school learners (n=120) who were in grade 8 to 12, between ages of 12 to 18 years of age. The study highlighted that adolescents engage in sexual activities at an early age. The results revealed that there is lack of knowledge, unavailability of HCT services for adolescents and the resources to keep a girl child school. This behavior may result in adolescents contracting sexually transmitted infections and HIV, falling pregnant at an early age, which may force adolescent high school learners to drop out of school. However, the study shows that government has more to educate adolescent high school learners about HIV/AIDS to modify their perceptions and attitudes towards HIV counseling and testing. / Health Studies / M.A. (Health studies)

This study investigated the exposure of employees in the South African Police Service (SAPS) to the HIV/AIDS workplace programme, levels of knowledge of HIV/AIDS, perceptions of stigma and discrimination and of participation by stakeholders in programme implementation. The researcher subscribes to the view that stigma and discrimination are major obstacles to the successful implementation of the HIV/AIDS workplace programme as this notion has been substantiated by numerous studies. Self-administered questionnaire was used as means of data collection. Findings suggest that the employees of SAPS based at the National Head Office have high levels of knowledge on HIV/AIDS. However, the majority of the respondents indicated that they would not feel comfortable to disclose their HIV positive status, fearing the consequences thereof. / Sociology / M.A. (Social Behaviour Studies in HIV/AIDS)

HIV/Aids is a worldwide pandemic and as South Africans we are at the epicentre of this global health crisis. The harrowing statistics are useful as a means to quantify a horrific situation; however, what these facts do not do is provide connection amidst the uncertainty surrounding the disease. This research aims to bridge the disconnection and break the silence that weaves a net around the illness and those infected by it. This is done by deconstructing one man’s story of his journey with HIV; by looking at his personal epistemology; and by contextualising his story within his family and within the society in which he lives, South Africa. Finally, it is my reflections and interpretations that form the bridge between a construct of HIV/Aids and a life lived with the disease. / Psychology / M. A. (Clinical Psychology)

Text in Afrikaans / Summaries in Afrikaans and English / VIGS is 'n gesondheidsprobleem wat 'n impak uitoefen op alle gebiede in die samelewing. Voorkoming is die enigste vorm van bekamping. As gevolg hiervan, word VIGS-voorkoming binne die funksies van primere gesondheidsorg geplaas. Die persoon wat die funksies van primere gesondheidsorg uitoefen, is die gemeenskapsgesondheidswerker. Binne hierdie raamwerk is die terme primere gesondheidsorg, gemeenskapsgesondheidswerker en VIGS bespreek en die onderlinge interaksie is aangetoon. Die opleiding wat die gemeenskapsgesondheidswerker op VIGS-gebied ondergaan, is meegemaak. Die prioriteite wat op nasionale, provinsiale en plaaslike vlak bestaan is deur middel van onderhoude nagevors. Die effektiwiteit van die VIGS-voorkomingsboodskap soos oorgedra deur die gemeenskapsgesondheidswerker is tydens 'n inligtingsessie van hoerskoolleerlinge bepaal. Gevolgtrekkings en aanbevelings is in elk van bogenoemde gevalle gemaak. VIGS-voorkomingsinisiatiewe is nog in die kinderskoene in Suid-Afrika, maar het 'n belangrike rol te speel. / AIDS is a health problem that impacts on all societal spheres. Prevention is the only form of combat. Therefore, AIDS prevention falls within the functions of primary health care. The person performing these functions is the community health worker. Within this framework the terms primary health care, community health worker and AIDS were discussed and their interrelatedness illustrated. A session during which community health workers received training in aspects of AIDS was attended. Priorities existing at national, provincial and local levels were researched through interviews. The effectiveness of the community health worker in spreading the AIDS prevention message was determined during an information session for secondary school pupils. Conclusions and recommendations were made in each of these cases. AIDS prevention initiatives are still in its infancy in South Africa, but has an important role to play. / Health Studies / M.A. (Ontwikkelingsadministrasie)