Thesis (MTech (Environmental Health))--Cape Peninsula University of Technology, 2010 / This study aimed to evaluate the "Antiretroviral Programme" in two informal townships, Du Noon and Doombacht, in the Westem Cape, South Africa. It evaluated how AIDS patients access Antiretroviral Therapy (ART'), their knowledge of ART's efficacy, their adherence to ART as well as their experiences of the quality of service at the Du Noon Clinic. Employing a questionnaire survey among 124 (12%) respondents on ART of the registered 1, 050 clients at the Du Noon Clinic, a systematic sampling of every 9th client (of the 1,050) was done. To generate findings of a qualitative nature, the study also used focus group discussions with a total of 36 AIDS patients on ART (18 of this number were also part of the survey), 11 community health/home-based workers and in-depth interviews with 2 nurses in charge of the rollout programme at the Clinic. Based on the survey results, the study determined that 93% (n=115) of AIDS patients access ART at the Du Noon Clinic, 75% (n=93) of respondents reported to ART adherence and 75% (n=93) displayed an understanding of ART's efficacy. It also revealed that 77% (n=95) of AIDS patients made good comments regarding the quality of service at the Du Noon Clinic. However, 25% (n=31) of AIDS patients were not adhering to ART. A Mann Whitney U test confirmed a significant relationship between the respondents' length of time on ART and the increase in CD4 count (p=0.01). However, AIDS patients who adhered to ART with the same length of time on ART have a higher CD4 count difference (p=0.04). The focus group discussions revealed AIDS patients' experiences of lack of confidentiality at the Du Noon Clinic. In addition, in five of the six focus group discussions, respondents expressed concern over disability grants not being awarded to patients with CD4 counts 200 cells lML and below². Notably, more than half of the respondents have been on treatment for more than one year. The study concluded that ART access is humanizing in the Western Cape and controversial AIDS treatment discourse has not significantly influenced the perceptions of AIDS patients regarding ART's efficacy. A high percentage (75%) of AIDS patients were adhering to ART in Du Noon and Doombacht. Addressing concerns over lack of confidentiality when accessing ART at the Du Noon Clinic, as well as the quest for disability grants within the context of AIDS treatment, could have further improved ART adherence in these communities. The study recommends that monitoring and evaluation (M&E) should involve measuring factors that influence adherence alongside accessibility to ART. Secondly, there should be mechanisms in place to maintain confidentiality in accessing ART as it is with Voluntary

Thesis (MPH.) --University of Limpopo, 2018 / Background: The prevalence of HIV in South Africa has increased largely due to the combined effect of new infections, and a successfully expanded antiretroviral treatment programme, which has increased survival among people living with HIV. As the up-scaling of patients on ART has been increased, the aim of the current study was to investigate the variations of the clinical outcomes between patients initiated with CD4 < 350 and of those above 350 after the implementation of the new eligibility criteria for ARV therapy. Methods The current study used quantitative approach to retrospectively review a total of 488 records of adult patient who were registered in health facilities which were purposefully sampled from Sekhukhune District of Limpopo Province. SPSS version 23.0 was used to analyse data. Results Approximately 60% of the patients initiated on ART were having CD4 count <350 and male patients were more at 74% as compared to females at 54.7%. Patients who started ART with a baseline CD4 >350 had a high rate of lost to follow up within 3 months after start of ART at 15% than those with a baseline CD4 <350 at 10.2. More patients were lost to follow-up shortly after starting treatment at 3 months at an average of 13.8% in both CD4 counts. Majority of patients retained in care were those who started ART treatment with a baseline CD4<350 at 87.4%. Viral load completion rate at 12 months was higher than that of 6 months, at 86.8 and 80.5 respectively. Patients with a baseline CD4 >350 suppressed more than those who started ART with a baseline CD4 <350 at both 6 and 12 months at >90% suppression rate. Lastly, most of the patients died within 3 months of ART treatment and had a baseline CD4 < 350 than at 2.4% those with a baseline CD4 >350 at 0.6%. Conclusions The implementation of the new eligibility criteria of ART initiation improves the clinical outcome of patients on ART. There are still patients that are missed to be monitored viral load bloods which play a key role in determining the clinical outcomes of patients. Clinicians and nurses should adhere to the recommended time frames for monitoring of ART patients to improve clinical outcomes. Keywords: HIV/AIDS, antiretroviral therapy, clinical outcome, ART initiation; Eligibility Criteria;

Thesis (MPH.) --Univesity of Limpopo, 2014 / Background: The main goal of HAART is to achieve maximal viral suppression. However, with poor adherence to therapy the chances of achieving and maintaining successful viral suppression are decreased, leading to virological failure. And virological failure has been recognized by WHO as one of the early warning signs of drug resistance. This operational research sought to explore virological failure as a treatment outcome to evaluate program performance at a facility level. Methods: Purposive sampling as per inclusion and exclusion criteria was used to retrospectively review clinical records of the first 700 adult HIV positive patients (350 males and 350 females) who initiated antiretroviral treatment between April 2004 and December 2007 at this adult HIV clinic, were followed up for at least 3 years and treated according to the South African government’s National Department of Health 2004 HIV treatment guidelines for adults and adolescents. Major Results: 268 clinical records, 97 (27.71%) male and 171 (58.86%) female records were eligible for inclusion in the study. The proportion of females was higher (63.8%) than males (32.8%) with an average age of 38.95 years. 24 (8.9%) patients in the study sample experienced virological failure during the study period; 11 (11.3%) males and 13 (7.6%) females. Two-thirds (66.6%) of patients who failed to suppress at their first viral load measurement proceeded to develop virological failure. Overall, there was no association of statistical significance between age, sex, baseline CD4 cell count and baseline regimen, and virological failure at various intervals, p> 0.05. Conclusion: It was a challenge to keep patients in care but those that remained in care had good treatment outcomes with only 8.9% developing virological failure. Failure to suppress at first viral load preceded virological failure in the majority of patients.

The aim of the thesis was to undertake an evaluation of the neuropsychological functioning of non-demented and demented patients with advanced HIV-infection who have been treated with Highly Active Antiretroviral Therapy (HAART) for several years. One hundred and one non-demented HIV-infected individuals and 23 patients with mild or moderate AIDS Dementia Complex (ADC), from the outpatient clinics and Neurology department at St. Vincent's Hospital, Sydney, Australia were randomly selected to participate in a prospective study of the neurological and neuropsychological complications of HIV disease. All had advanced HIV-infection and all had been on HAART for five years on average. Thirty-one seronegative controls were recruited as controls. All participants completed a standard neuropsychological examination assessing nine cognitive domains. Non-demented advanced HIV-infected individuals participated in three follow-up visits. In addition, we report the results of a multi-centre cohort of 78 patients with mild to moderate ADC on HAART (Abacavir ADC trial). The main findings of our research were that the prevalence of neuropsychological impairment in advanced HIV-infected individuals remains equivalent to the era that preceded the introduction of HAART. Moreover, while complex attention / psychomotor speed remained a marker of HIV-related neuropsychological impairment in the HAART era, impairment in learning, memory and aspects of complex attention may be new indicators of HIV-associated neurocognitive impairment. While progression of neuropsychological impairment is associated with past HIV-related history of brain involvement, we demonstrated that deterioration does not occur in a linear fashion and that over a 27 month period neuropsychological performance stabilizes in the majority. Stabilization of performance may be related to relapses in the course of HIV-associated neurocognitive impairment and HAART optimization especially with antiretrovirals that have good brain tissue penetrance. Our research showed that plasma viral load and current CD4 cell count were generally not associated with the neuropsychological performance, but rather that nadir CD4 cell count was associated with neuropsychological performance suggesting a relation between past immune deterioration and current cognitive status. Cerebrospinal markers of immune and virological activity were found to be partly dissociated from current neurological in contrast to what was observed in the pre-HAART era. Future studies will need to evaluate new factors for underlying HIV-associated neurocognitive impairment as well as factors for underlying partial recovery.

Thesis (Ph. D.)--Ohio State University, 2006. / Title from first page of PDF file. Includes bibliographical references (p. 130-152).

The HIV/AIDS pandemic has implications at every level of social functioning. It affects individuals, families, communities and organisations. The burden of caring for those exposed, affected and infected is vast, but one of the most significant developments which have the potential to reduce disease burden is antiretroviral therapy. Antiretroviral therapy (ART) is complex and difficult to administer, and requires a learning process which is mediated through a number of means. Vygotskian theory was utilised to better understand the process of adherence through mediated learning, and as a framework for explaining compliance. In this study, mediated learning occurs both in the context of the clinic staff and the clinic attendees, and the caregivers and the child. Therefore Vygotsky‟s theory offers useful insight into this process. This qualitative study aimed to research the factors which contribute to ART adherence in a small sample of HIV positive children who are attending a local clinic. Eight child-caregiver dyads were interviewed, and drawings utilised to better understand child and caregiver factors which contribute to compliance. There were a number of psychosocial factors identified which contribute to compliance, or lack thereof, including social support, stigma, medication fatigue, disclosure, access difficulties, psychoeducation, and motivation. A number of qualitative differences were also identified between children who knew their HIV status and those who did not. These differences emerged primarily through the analysis of the child participants‟ drawings and there appeared to be a number of inter- and intrapersonal benefits to disclosure. The factors identified in this study, if better understood, can inform interventions to improve compliance on ART. / Thesis (M.Soc.Sci.)-University of KwaZulu-Natal, Pietermaritzburg, 2010.

The background. HIV and AIDS is a huge problem in sub-Saharan Africa where an estimated 22.5 million people were living with HIV in 2007.1 South Africa has the worst epidemic in the world.1 There were about 5.5 million people living with HIV and 1000 AIDS deaths daily in South Africa by the end of 2005.17 In 2007 the number of people living with HIV in South Africa increased to 5.7 million.1 The HIV prevalence in Umkhanyakude district, KwaZulu Natal, where Hlabisa subdistrict is situated, amongst public antenatal clinic attenders was 39.8% in 2007.19 AIDS is the cause of 50.0% of deaths in the Hlabisa sub-District.15 In 2003 the South African government decided to provide antiretroviral therapy (ART) in the public health sector, giving hope to thousands of people who are in need of this intervention to improve their quality of life and reduce premature deaths.7,13 However adherence to antiretroviral drugs is essential for successful treatment. Adherence to antiretroviral therapy in South Africa as in other African countries was expected to be low31 (<95.0%), however, in a study that was done in Cape Town during 1996 – 2001, the authors concluded that adherence was high.28 The aim of that study was to identify predictors of low adherence (<95.0%) and failure of viral suppression (>400 HIV copies/mm3). Pill counts and records of treatment refills from pharmacy were used to measure adherence.28 The results revealed no significant difference in adherence between patients on protease inhibitor based regimens and/or those on nonnucleoside based regimens nor with socioeconomic status, sex and HIV stage. Independent predictors of low adherence were English language speaking, age, and three times per day dosing. The following were found to be independent predictors of failure of viral suppression: baseline viral load, <95.0% adherence, age and dual nucleoside therapy.28This study however was done in an urban area before the antiretroviral therapy (ART) roll out in South Africa when the cost of treatment limited the accessibility of ART. These patients may have been different to patients who access free treatment in public health facilities today. Other South African studies have also reported good adherence rates.39,40 In another study in Soweto, South Africa, adherence was high, 88.0% of patients achieved > 95.0% goal, 9.0% achieved 90.0-95.0% adherence and only 3.0% achieved <90.0%.39In a study done at Khayelitsha, adherence was also high, viral load level was < 400 in 88.1%, 89.2%, 84.2%, 75% and 69.7% of patients at 3, 6, 12, 18 and 24 months.40 However, Soweto and Khayelitsha are urban and different from Hlabisa, and it is difficult to generalize these results to the sub-district. This study intended to assess how adherent patients are to antiretroviral therapy in a typical rural district in order to inform policy to enhance adherence to ART. / Thesis (M.Med.)-University of KwaZulu-Natal, Durban, 2008.

Thesis (MSc.(Anatomy)--Faculty of Health Sciences)-University of Pretoria, 2008.] / Includes bibliographical references.

Thesis (M.Sc. (Pharmacy)) - Rhodes University, 2009.

Thesis (Ph.D.)--University of Alberta, 2009. / A thesis submitted to the Faculty of Graduate Studies and Research in partial fulfillment of the requirements for the degree of Doctor of Philosophy, Department of Public Health Sciences. Title from pdf file main screen (viewed on September 20, 2009). Includes bibliographical references.