This research focuses on the psychosocial factors that affect adherence to highly active antiretroviral therapy (HAART) amongst HIV/AIDS patients at Kalafong Hospital. Even though the development of such regimens has helped turn HIV infection in the United States into a relatively manageable, though still serious chronic disease, compliance remains one of the major challenges in managing medication for those patients living with HIV/AIDS. This is particularly relevant given the high adherence rate (95%) required to obtain a successful long-lasting effect. In South Africa non-compliance to HAART is an under-explored phenomenon. Consequently, an understanding of factors influencing compliance is still incomplete. A qualitative study that investigates non-adherence to medication in HIV/AIDS patients was undertaken at Kalafong Hospital. This study aimed to understand patients’ psychosocial difficulties resulting in non-adherence. The study was approached in terms of the health belief model (HBM), which addresses individual characteristics pertaining to change, the transtheoretical change model (TTM) and the motivational interviewing model (MI), which address both individual and social contexts pertaining to change. The findings are designed for use by healthcare professionals as a proactive compliance enhancement tool. Participants were recruited through referrals by the medical staff to the researcher. The criteria included that participants had relapsed due to non-compliance with drug therapy. Participants that were currently experiencing difficulties with adherence were also included in the study. Males and females aged between 20 and 40 were included in the study. Fifteen participants between the ages of 20 and 40 participated in the study (13 females and two males). The data were collected by means of semi-structured interviews and follow-up unstructured questions. The interviews were audio recorded and field notes were taken. Data were analysed qualitatively. Sixteen themes emerged and were further classified into two categories: individual and social context. The themes were then compared and integrated with the literature. The study concludes that psychosocial factors such as support from family, friends and healthcare workers was found to be of utmost importance in encouraging adherence. Medication can only prolong a patient’s life if the psychosocial context in which the patient is embedded is considered in the treatment plan. / Dissertation (MA)--University of Pretoria, 2008. / Psychology / unrestricted

With the worldwide increase in numbers of individuals infected with the human-immune deficiency virus (HIV) and acquired immune deficiency syndrome (AIDS), the need for more information became essential. The devastating influences and fatal outcome of this disease is inevitable. These individuals are confronted with mortality and various disabling conditions. One of these disabling conditions is the possible development of a hearing loss. Loss of hearing sensitivity related to HIV/AIDS is only one of numerous effects the virus may have on humans and their quality of life. Therefore increased awareness of HIV/AIDS and the influences of this disease is inevitable for the modern audiologist. The precise nature and the extent of the influence that HIV/AIDS and antiretroviral therapy (ART) has on the hearing ability of a person are unknown to date. Even though a relationship between hearing loss, HIV/AIDS and the administration of relevant medication is expected, no clear explanation is available to provide the public or clinicians with the necessary information on assessments, interventions and aural rehabilitation techniques. Without being able to identify the specific cause, symptoms and place of lesion of the hearing loss, it will be difficult to ensure appropriate monitoring and treatment. Information regarding the influences of HIV/AIDS and ART on hearing sensitivity had to be established to ensure appropriate intervention and rehabilitation options. The first part of this research project reviews the evidence available regarding the possible influences of HIV/AIDS on hearing. Throughout the research a cross-sectional design with quantitative and qualitative approaches were followed comprising of a structured interview, basic and specialized audiometric battery to obtain the necessary case history, as well as results for these different audiological tests that were conducted. The specialised tests included immittance measurements, distortion-product otoacoustic emission (DPOAE) and auditory brainstem response (ABR). The results of this study were discussed in terms of the three sub aims in accordance with the different audiological tests that were conducted. The results indicated that those participants with ART exposure had a significantly higher incidence of hearing loss. The pure tone averages were mainly found within normal limits but decreased with the progression of the final stages of HIV/AIDS. The high and low frequencies of the audiogram were often affected with loss of hearing sensitivity suggesting the presence of a high and low frequency slope. The final three stages of HIV/AIDS had a significantly higher incidence of bilateral hearing loss. ART exposure were associated with more severe degrees of hearing loss. The DPOAE and ABR indicated that cochlear and retro-cochlear damage existed often among these participants. Only 20% participants had abnormal tympanograms suggestive of conductive pathology. The results revealed that the type of pathology varied across the stages of HIV/AIDS. The conclusions and implications of this study are discussed. Recommendations incorporate the development of HIV/AIDS awareness campaigns that includes audiological information on the possible influences, where to refer or where to seek assistance; issues regarding the improvement of the modern audiologists’ knowledge in terms of the management of the audiological needs of individuals with HIV/AIDS and the application of these results in the industrial setting to utilize when they consider granting compensation claims. / Dissertation (MCommunication Pathology)--University of Pretoria, 2008. / Speech-Language Pathology and Audiology / unrestricted

Orientador: Maria Rita de Camargo Donalisio / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-04T02:24:43Z (GMT). No. of bitstreams: 1 Oliveira_TiagoFeitosade_M.pdf: 646726 bytes, checksum: 4689e80905264ac5b08fc1258252b586 (MD5) Previous issue date: 2004 / Resumo: A oferta de testes sorológicos tem sido colocada como uma das estratégias de combate à epidemia de HIV/aids. Inicialmente a testagem dava-se apenas nos serviços especializados, os chamados COAS ou CTA mas, devido à magnitude alcançada pela epidemia de HIV/aids, bem como a necessidade de diagnóstico precoce dos casos, fez-se necessário a disponibilização do teste anti-HIV na rede básica de saúde. O aconselhamento tem sido apontado como uma técnica a ser aplicada na oferta e na entrega do resultado do teste. Este se baseia na mudança de comportamento de pessoas e grupos sociais, proporcionando-lhes a oportunidade de adotarem práticas sexuais mais seguras ou reduzindo o dano de um determinado comportamento de risco. Através de pesquisa qualitativa, analisamos a oferta do teste para detecção do HIV nas Unidades de Saúde da Família da rede municipal de saúde de Recife-PE, sob a ótica dos profissionais de saúde. Verificamos que a indicação do referido teste se dá, quase sempre no consultório, durante a consulta clínica. O que motiva a oferta do teste é, geralmente um quadro sindrômico compatível com a aids ou o programa de assistência ao pré-natal. Os profissionais revelaram dificuldades em absorver a demanda espontânea pelo teste. A maioria dos entrevistados desconhece o aconselhamento, quanto técnica para ofertar o exame, reverter comportamentos de risco e dar o resultado do teste anti-HIV. Isso aponta para a necessidade urgente de qualificar a oferta do teste na rede básica, fazendo com que ela seja, de fato, instrumento de combate ao avanço da epidemia do HIV/aids / Abstract: The offering of serologic tests has been placed as one of the strategies in the HIV/AIDS epidemic disease combat. At first, the testate were applied in the specialized services only, the called COAS or CTA, however, with the magnitude reached by the HIV/AIDS epidemy, as well the necessity of a precocious diagnostic to the cases, the availability at the health public service of the anti-HIV test was necessary. The counselling has been pointed as a technique to be applied in the offering and delivery of the test result. That is based in the behaviour changed of social groups and people, providing them the opportunity to adopt safe sexual practices or reducing the damage of determinate risk behaviour. Through the qualitative search, we analyse the test offering to detect the HIV in the Family Health Units in the municipal public health of Recife-PE, under the health professional¿s optics. We realised that the indication of the referred test happens, almost often, in the doctor¿s office during the procedure. What motivate the test offering is, in general, a syndromic diagnostic compatible with AIDS or the pre-natal assistance program. The professions revelled some difficult in absolving the spontaneous demand for the test. The majority of the interviewed does not know the counselling as a technique to offer the exam, revert behaviour risks and give the anti-HIV result. This points to the urgent necessity of qualify the test offering into the public service, turning it to a combative instrument against the HIV/AIDS epidemy advance, indeed. / Mestrado / Saude Coletiva / Mestre em Saude Coletiva

Philosophiae Doctor - PhD / The continued success of antiretroviral programmes in the treatment of HIV is dependent on access to a cost-effective HIV drug resistance test (HIV-DRT). HIVDRT involves sequencing a fragment of the HIV genome and characterising the presence/absence of mutations that confer resistance to one or more drugs. HIV-DRT using conventional DNA sequencing is prohibitively expensive (~US$150 per patient) for routine use in resource-limited settings such as many African countries. While the advent of ultra deep pyrosequencing (UDPS) approaches have considerably reduced (3-5 fold reduction) the cost of generating the sequence data, there has been an even more significant increase in the volume of data generated and the complexity involved in its analysis. In order to address this issue we have developed Seq2Res, a computational pipeline for HIV drug resistance test from UDPS genotypic data. We have developed QTrim, software that undertakes high throughput quality trimming of UDPS sequencing data to ensure that subsequently analyzed data is of high quality. The comparison of QTrim to other widely used tools showed that it is equivalent to the next best method at trimming good quality data but outperforms all methods at trimming poor quality data. Further, we have developed, and evaluated, a computational approach for the analysis of UDPS sequence data generated using the novel Primer ID that enables the generation of a consensus sequence from all sequence reads originating from the same viral template, thus reducing the presence of PCR and sequencing induced errors in the dataset as well as reducing. We see that while the Primer ID approach does undoubtedly reduce the prevalence of PCR and sequencing induced errors, it artificially reduces the diversity of the subsequently analysed data due to the large volume of data that is discarded as a result of there being an insufficient number of sequences for consensus sequence generation. We validated the sensitivity of the Seq2Res pipeline using two real biological datasets from the Stanford HIV Database and five simulated datasets The Seq2Res results correlated fully with that of the Stanford database as well as identifying a drug resistance mutations (DRM) that had been incorrectly interpreted by the Stanford approach. Further, the analysis of the simulated datasets showed that Seq2Res is capable of accurately identifying DRMs at all prevalence levels down to at least 1% of the sequence data generated from a viral population. Finally, we applied Seq2Res to UDPS resistance data generated from as many as 641 individuals as part of the CIPRA-SA study to evaluate the effectiveness of UDPS HIV drug resistance genotyping in resource limited settings with a high burden of HIV infections. We find that, despite the FLX coverage being almost three times as much as that of the Junior platform, resistance genotyping results are directly comparable between both of the approaches at a range of prevalence levels to as low as 1%. Further, we find no significant difference between UDPS sequencing and the "gold standard" Sanger based approach, thus indicating that pooling as many as 48 patient's data and sequencing using the Roche/454 Junior platform is a viable approach for HIV drug resistance genotyping. Further, we explored the presence of resistant minor variants in individual's viral populations and find that the identification of minor resistant variants in individuals exposed to nevirapine through PMTCT correlates with the time since exposure. We conclude that HIV resistance genotyping is now a viable prospect for resource limited setting with a high burden of HIV infections and that UDPS approaches are at least as sensitive as the currently used Sanger-based sequencing approaches. Further, the development of Seq2Res has provided a sensitive, easy to use and scalable technology that facilitates the routine use of UDPS for HIV drug resistance genotyping.

The study emanates from the need to identify the biopsychosocial factors that influence patients’ adherence to antiretroviral therapy (ART) within the South African context The specific goal of the study was to explore these in order to make recommendations to enhance service delivery. Applied research was conducted, with its primary task being to stimulate thought and action concerning the challenges faced by patients who are on ART. In order to gather comprehensive data, the researcher engaged in a combination of the qualitative and quantitative approaches. For the qualitative case study the researcher made use of semi-structured interviews, utilizing the non-probability sampling method, aiming to understand and interpret the meaning that the multidisciplinary team accorded to matters of antiretroviral treatment. For the quantitative part of the study the probability random sampling method was made use of for the quantitative descriptive survey. Questionnaires were employed to collect data from 201 patients already on antiretroviral medication. The conclusions, which were drawn from the research findings, identified challenges to adherence to ART: the study confirmed that since the advent of combination antiretroviral therapy (HAART), HIV/AIDS has been transformed into a manageable and chronic condition, and has undoubtedly extended and improved the quality of life for people living with HIV/AIDS. However, it also confirmed that ART, is a complex intervention, which is accompanied by severe biopsychosocial implications, requiring near-perfect adherence in order to prevent the development of resistance. The impact that the various psychosocial needs of millions of HIV/AIDS people living on ART will have on current social structures and services, will tax the available professional social services, particularly the social work profession. The social correlation of HIV/AIDS and poverty is endorsed by the findings, confirming that the high level of unemployment, coupled with families who are headed by women and who receive little support, lead to almost total dependency on social security. The findings further indicate a specific relationship between socio-economic circumstances and the ability to adhere to ART. Empowering HIV/AIDS patients, to be able to adhere to ART, is therefore indicated, as is the further need for a regulator of HIV/AIDS support services, in order to protect and promote high standards of service delivery, especially counselling. / Thesis (DPhil)--University of Pretoria, 2007. / Social Work and Criminology / DPhil / unrestricted

Objectives: The aim of the study was to describe the prevalence and nature of auditory and otological manifestations in adults with HIV/AIDS according to clinical examinations and self-reported symptoms. Auditory profiles of HIV individuals were compared to that of a matched control group. Study design: A descriptive, cross-sectional group design was utilized in the first section of the study while a comparative, control matched research design was used to compare the HIV group and matched control group. Methods: Two hundred HIV positive adult patients attending the Infectious Disease Clinic of the 1 Military Hospital were included through convenience sampling. Participants were interviewed, medical files were reviewed and clinical examinations, including otoscopy, tympanometry, pure tone audiometry and distortion product oto-acoustic emissions, were completed. A control group of 184 individuals were compiled, matched to 184 of the HIV infected participants according to age, gender, ethnicity as well as working environment. Audiological thresholds at 0.5kHz – 4kHz were compared among these groups. Results: A prevalence of self-reported tinnitus (26%), vertigo (25%) hearing loss (27.5%), otalgia (19%) and pruritis (38%) was recorded. The onset of hearing loss was reported to be mostly (82%) of a slow progressive nature. Abnormalities in tympanometry, otoscopy and oto acoustic emissions were found in respectively 41%, 55% and 44% of participants. Hearing loss greater than 25 dB (PTA) was recorded in 14% of participants compared to 39% for hearing loss greater than 15 dB (PTA). Although not statistically significant (p<.05), self reported vertigo, self reported hearing loss, OAE abnormalities, hearing loss (PTA>15dB and PTA>25dB) and occurrence of mild hearing loss occurred throughout the CDC categories which were used as a measure of disease progression. A statistically significant increase (p<.05) in sensorineural hearing loss was seen with disease progression. In the comparative section, statistically significant (p<.05) worse thresholds were found in the HIV group as opposed to the control group at all frequencies (0.5 kHz – 4 kHz). Conclusions: Auditory and otological symptoms occurred frequently in this sample, while an increase in some symptoms as well as hearing loss was seen throughout disease progression. Sensorineural hearing loss increased significantly through disease progression. Hearing loss occurred more frequently in HIV individuals as opposed to individuals in the control group, while hearing loss occur more frequently in the more advanced stages of HIV infection. / Dissertation (MCommunication Pathology)--University of Pretoria, 2011. / Speech-Language Pathology and Audiology / Unrestricted

Resilient Educators Support Programme (REds) for HIV and AIDS affected educators was initiated by the University of North West in 2006 following a research project in 2005 that highlighted the need for a support programme that addresses the challenges of educators affected by HIV and AIDS, as existing support structures were found to be inadequate. REds is implemented in phases, and with each phase it is modified to meet the needs of a broader audience of educators. The first phase was implemented in the Gauteng Province in 2006. Recommendations made from this phase were used to modify it for phase two, that is, implementation in Mpumalanga Province and two additional provinces. The goal of the research project was to evaluate the effectiveness of the Resilient Educators Support Programme (REds) in empowering and supporting HIV and AIDS affected educators in Mpumalanga. Programme evaluation research was adopted, using the dominant-less dominant model of combining both quantitative and qualitative research approaches, with the quantitative approach being the dominant approach. The research design for the quantitative research approach was the quasi-experimental one group pre-test post-test design whilst the collective case study design was used for the qualitative research approach. Quantitative data was collected through a group administered standardized questionnaire, the Professional Quality of Life Scale (ProQOL) and for qualitative data, a non-standardized questionnaire with drawings, semi-structured interviews, observation and field notes were used. Data was collected before and after the respondents were exposed to REds. The respondents, ten educators from Sozama High School in Middelburg, were recruited using non-probability volunteer sampling method. Additional qualitative data was collected from the five members of school management team using semi-structured interviews, after the respondents were exposed to REds. Although the quantitative empirical research findings showed no significant differences between the pre- and post-test data, it seems from the qualitative approach as if the respondents found the programme addressing their support needs as HIV and AIDS affected educators and they felt empowered with knowledge and skills that they lacked and thus making them resilient. Conclusions drawn from the qualitative research findings indicated that REds Support Programme was effective in meeting the support needs of HIV and AIDS affected educators in Mpumalanga. From a quantitative perspective, it is recommended that the reason/s for the non-significant test results from the standardized questionnaire be investigated. Copyright / Dissertation (MSW)--University of Pretoria, 2008. / Social Work and Criminology / unrestricted

>Magister Scientiae - MSc / Background: Despite the effort of scientific research on HIV therapies and to reduce the rate of HIV infection, AIDS still remains one of the major causes of death in the world and mostly in Sub-Saharan Africa. To date, neither a cure, nor an HIV vaccine had been found and the disease can only be managed by using High Active Antiretroviral Therapy (HAART) if detected early. The need for an effective early diagnostic and non-toxic therapeutic treatment has brought about the necessity for the discovery of additional HIV diagnostic methods and treatment regimens to lower mortality rates. Antimicrobial Peptides (AMPs) are components of the first line of defence of prokaryotes and eukaryotes and have been proven to be promising therapeutic agents against HIV. Methods: With the utility of computational biology, this work proposes the use of profile search methods combined with structural modelling to identify putative AMPs with diagnostic and anti-HIV activity. Firstly, experimentally validated anti-HIV AMPs were retrieved from various publicly available AMP databases, APD, CAMP, Bactibase and UniprotKB and classified according to super-families. Hidden Markov Model (HMMER) and Gap Local Alignment of Motifs (GLAM2) profiles were built for each super-family of anti- HIV AMPs. Putative anti-HIV AMPs were identified after scanning genome sequence databases using the trained models, retrieved AMPs and ranked based on their E-values. The 3-D structures of the 10 peptides that were ranked highest were predicted using 1-TASSER. These peptides were docked against various HIV proteins using PatchDock and putative AMPs showing highest affinity and having the correct orientation to the HIV -1 proteins gp 120 and p24 were selected for future work so as to establish their function in HIV therapy and diagnosis. Results: The results of the in silica analysis showed that the constructed models using the HMMER algorithm had better performances compare to that of the models built by the GLAM2 algorithm. Furthermore, the former tool has better statistical and probability explanation compared to the latter tool. Thus only the HMMER scanning results were considered for further study. Out of 1059 species scanned by the HMMER models, 30 putative anti-HIV AMPs were identified from genome scans with the family specific profile models after elimination of duplicate peptides. Docking analysis of putative AMPs against HIV proteins showed that from the 10 best performing anti-HIV AMPs with the highest Escores, molecules 1,3, 8 and 10 firmly binds the gp120 binding pocket at the VIN2 domain and at the point of interaction between gp120 and T cells, with the 1st and 3rd highest scoring anti-HIV AMPs having the highest binding affinities. However, all 10 putative anti-HIV AMPs bind to the N-terminal domain of p24 with large surface interaction, rather than the C-terminal. Conclusion: The in silica approach has made it possible to construct computational models having high performances, and which enabled the identification of putative anti-HIV peptides from genome sequence scans. The in silica validation of these putative peptides through docking studies has shown that some of these AMPs may be involved in HIV/AIDS therapeutics and diagnostics. The molecular validation of these findings will be the way forward for the development of an early diagnostic tool and as a consequence initiate early treatment. This will prevent the invasion of the immune system by blocking the VIN2 domain and thus designing of a successful vaccine with broad neutralizing activity against this domain.

Thesis (MPH. (Epidemiology)) -- University of Limpopo, 2022 / Background: Tuberculosis (TB) is a fatal disease globally, if not managed well, with a million or more people dying by the disease annually in low and middle-income countries (LMIC). Around two billion people are thought to be asymptomatically (latently) infected with Mycobacterium tuberculosis, putting them at risk of acquiring active tuberculosis. Tests that identify immunoreactivity to mycobacterial antigens rather than live bacteria, as well as mathematical modelling, are used to estimate the prevalence of latent tuberculosis infection. According to reports, tuberculosis (TB) was the cause of 1.3 million fatalities among HIV-negative people in 2016, surpassing the global number of HIV/acquired immune deficiency syndrome (AIDS) deaths. In addition, TB was a factor in 374,000 HIV-related deaths. Despite the effectiveness of chemotherapy over the last seven decades, tuberculosis remains the world's leading infectious killer. In 2016, 10.4 million new cases were reported, a number that has remained constant since the dawn of the twenty-first century, confounding public health specialists tasked with designing and implementing measures to lessen the global burden of tuberculosis disease. As a result, the current study aims to look into the epidemiology of tuberculosis in Lesotho in order to help policymakers make decisions on TB control in the country. Methodology:. In the current investigation, a cross-sectional, retrospective descriptive study design was used, as well as a probability sampling strategy. The National TB-Database from the Ministry of Health in Lesotho was used as the source of data for this quantitative investigation, which was analyzed using STATA statistical software version 12 for Windows (STATA Corporation, College Station, Texas). A Chi-Squared test was used to compare categorical variables, while a t-test was used to examine continuous variables. A statistically significant P-value of 0.05 was used. Results: A total of 18 836 TB patient records were recovered, with 45 percent of the TB patients being females. The average age of the TB patients was 35.9 years, with a standard deviation of 12.7%, and the ages ranged from one year to 84 years. There vi was a statistically significant difference between the age groups (p value 0.001), with 33.1 percent of TB patents being in the age group 25–34 years, followed by 29 percent, 15.4 percent, 11.2 percent, and 5.5 percent in the age groups 35–44 years, 45–55 years, 15–24 years, and 55–64 years 65 years.. There has been a fluctuating treatment outcome of TB from 63.5% for cured patients in 2012 to 57.2% in 2013 and this rose to 60.4% in 2014 then eventually reached 76.7% in 2019. The TB treatment success rate in Lesotho also showed a similar trend as the cure rate. The overall TB death rates in the current study was found to be increasing on an annual basis from 7.4% in 2012 to 9.2% in 2018 then dropped to 8.5% in 2019. The TB patients who have not been evaluated for treatment outcomes have been decreasing annually from 4.4% in 2012 to 0.8% in 2019. The proportion of TB patients with known HIV status increased from 22.3% in 2015 to 90.5% in 2019 and similarly to the proportion of TB patients with HIV status positive increased from 15.1% in 2015 to 60.4% in 2019. The proportion of TB patients with HIV status positive increased with increasing age group all age groups. Conclusion: TB is still a concern in Lesotho, where treatment target goals have not yet been fulfilled, the findings of this study underline the importance of addressing the underlying socio-economic causes of TB. The most important goal in TB control is to detect 70% and cure at least 85% of sputum smear positive cases. If these goals are met, the prevalence, incidence, transmission, and medication resistance to tuberculosis (TB) could all decrease. Despite the National Tuberculosis Control Programme's attempts to enhance TB patients' access to treatment and adherence to therapy, the percentage of patients who have good treatment outcomes remains low. Despite having an 84 percent detection rate and using the DOTS technique, the available data did not identify the types of tuberculosis, therefore we were unable to forecast multidrug-resistant tuberculosis (MDR-TB).

This study sought to explore and describe the perceptions and beliefs of physicians about adherence to antiretroviral treatment by patients in the South-East district of Botswana. The Health Belief Model (Naidoo & Willis 2003:222) was adapted to suit and be used in the study. A descriptive, exploratory qualitative design was used. Unstructured interviews and unstructured observation data collection methods were applied. Informed consent was obtained prior to data collection. For triangulation purposes, observations were done following interviews, and data analysis was done by two different people. The findings of the study revealed that the perceptions and beliefs of treating physicians contributed towards adherence. Physicians perceived adherence as an important aspect in the success of antiretroviral treatment. Giving patients correct information, personal motivation, patients' understanding of treatment, traditional and religious beliefs were among other factors perceived by physicians to be impacting on adherence. / Health Studies / M.A. (Public Health)