Thesis (MPH.) -- University of Limpopo, 2022 / Human Immunodeficiency Virus (HIV) has affected all parts of the world, and as of 2019, more than 76 million people have been infected by HIV. South Africa has the largest population of people living with human immunodeficiency virus (HIV) in the world and the highest infected group were aged 24 to 49, and females had the highest percentage in viral load suppression for all age groups. HIV infection leads to advanced loss of CD4 T cells and the roll out of antiretroviral therapy (ART) has bring about in significant cutbacks in HIV-associated complications by recovering the CD4+ T cell count. Some patients may not be successful in attaining this result, and some may accomplish it only after a number years of treatment. The disease progression and the health conditions amongst People Living with HIV-AIDS (PLWA) has improved substantially in the past two decades. The purpose of this study was to evaluate the disease progression of the patients initiated on ART from 2017 to 2019 at the University of Limpopo Health Centre, in Limpopo province. Methodology: A descriptive retrospective investigation was carried out which followed a quantitative approach in which secondary data from medical files of 259 patients initiated on ART at University of Limpopo Health Centre was used. where outcomes of ART initiation assessed and evaluated in association with characteristics of patients. Data analysis was done using the STATA statistical software version 12 for Windows (STATA Corporation, College Station, Texas). Frequency tables were used to make comparisons between groups for continuous and categorical variables using student t-test, and chi-square test. P-value less than 0.05 at 95% confidence level were regarded as significant. Results: The research finding revealed 80.0% of the study participants were females and the mean age group of participants diagnosed HIV positive was 28.28 years with standard deviation of ±7.5. The mean of the CD4 count cells at baseline for females was 411.4 cells/μL while for males was 341.2 cells/μL (p=0.212). The mean CD4 count cells at last ART visit for females was 613.7 cells/μL while for males was 452.9 cells/μL (p<0.001). There has been significant increase of the CD4 cell count from the baseline to the last ART visit as it is noted in the increase in proportion of patients with CD4 cell count of more than 500 in all the years. The proportion of patients with baseline CD4 cell count of 200 to 350 (moderate immunodepression) were high in 2019 and 2017 at 40.6% and 40.3% respectively. Majority of the patients were transferred out to other facilities at 79.4% as most patients are students and only 2.3% mortality rate has been reported for the study period. Majority of the patients initiated on ART at University of Limpopo were in WHO stage 2 at 45.5% followed by those in stage 3 and stage 1 at 22.2% and 21.8% respectively. Patients who were 24 years or older were 1.1 times more likely to have improved CD4 cell count at the last date of ART visit as compared to younger patients but not statistically significant while males were 3.5 times more likely to have improved CD4 cell count at the last date of ART visit as compared to females which was statistically significant. Patients who were initiated on ART at WHO stage 4 were 6.67 more likely to have improved CD4 cell count at the last date of ART visit as compared to those who were initiated on ART at WHO stage 1. Conclusion: The treatment progression in the study setting was found to be convincing and acceptable which is similar to the findings reported in other studies in many other countries. The significance of CD4 cell counts monitoring for HIV patients cannot be overemphasised. This study recommends a strengthened testing and treatment programme targeted males amongst the university community, enhance provider provider relationship when patients are transferred out to other health facilities, enhance the collection of baseline and progressive data on both the CD4 cell count and viral load.

Thesis (Ph.D. (Pharmacy)) -- University of Limpopo, 2022 / Antiretroviral (ARV) management in children is considered a challenging process, and patients receiving ARVs remain at risk of medication errors. Recently, there has also been a noticeable increase in Treatment Failure (TF) and the development of drug resistance amongst children on ART. However, ART failure amongst children seems to be an under-recognised issue, and adherence to treatment guidelines is reported to be a challenge among nurses caring for People Living with HIV (PLWHIV). Hence, the aim of this study was to explore the prescribing practices, and to determine the knowledge, understanding, and competence levels of NIMART-trained nurses’ in the management of children on Antiretroviral Therapy (ART) in Public Health Care (PHC) facilities located in a rural district of Limpopo Province. To attain the purpose of the study, the researcher in this study adopted a mixed-method, in an explanatory sequential manner. The quantitative phase adopted a descriptive cross-sectional and retrospective census of medical records to determine whether or not the children on ART were prescribed the correct ARV regimen, dose, strength, dosing frequency and received the correct quantities to last until the next appointment date. Whereas the qualitative phase embraced a total purposive sampling of the NIMART-trained professional nurses to explore their knowledge, understanding and views of ART management in children. The results highlighted that these children under study even though they were prescribed a correct ARV regimen in (n=7045; 96%) of the cases;they were only correctly dosed in (n=7797; 53%); and prescribed the correct strength (n=9539; 77%), with only (n=2748; 36.9%) having received the correct quantity of treatment to last them until the next appointment date. Most nurses even though they rated themselves very knowledgeable and competent in paediatric HIV/AIDS management. This finding was contradicting the results obtained from the medical records, as well as their responses to the given case scenario depicted some level of non-adherence to treatment guidelines as well as a lack of understanding of ARV management. From the findings of this ARV utilisation review and the implementation of the developed ART dosing and dispensing training programme. The study concludes that the nurse's prescribing practice was irrational in this cohort of children, and most prescriptions did not entirely comply with the 2014/15 HIV/AIDs treatment recommendations. Since, this cohort of children was found to be susceptible to medication related errors such as; Drug omissions in ARV regimens; Incorrect dosing & dosing frequencies; as well as incorrectly supplied quantities. From the study findings it is recommended that ARV stewardship programs should be considered in order to develop and establish a core strategy for enhancing quality improvement in the management of HIV-infected children on ART in resource-limited settings, not only to inundate viral suppression and maintain it, but also to help achieve the UNAIDS 95- 95-95 target in children under 15 year / National Research Foundation (NRF)

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)

The scourge of HIV and AIDS can no longer be underestimated. Its devastating effects have been translated into immeasurable monetary and human costs. Women and children, particularly among the rural communities, have borne most of the brunt accruing from the devastating socio-economic consequences of the disease. PURPOSE This study is intended to highlight the plight of rural communities who are constantly besieged by the demand and supply disequilibrium in the provision of primary health care and preventive interventions. OBJECTIVES To describe, compare and analyse HIV / AIDS health care services provided by fixed and mobile clinics in the Madibeng Sub-District of the North West Province. POPULATION The sampled participants were selected from a universal population among pregnant women. SAMPLING A sample of 100 pregnant women from the fixed and mobile clinics participated in answering the questionnaires during their antenatal care visits. RESEARCH SETTING The Madibeng Sub-District in the North West Province been selected as a suitable research site, as it met most of the selection criteria developed by the researcher's judgement sampling. RESEARCH DESIGN The data recorded on the questionnaires by the participants was used to compare and analyse the pregnant women's feelings about HIV / AIDS services of fixed and mobile clinics. Group discussions were also held prior self completion of questionnaires. Questionnaires were administered by the researcher and the two health promoters. FINDINGS It was found that participants in both mobile and fixed clinic have attended HIV / AIDS health care services. Fixed clinic and mobile clinic are respectively viewed as offering better health care services to pregnant women. CONCLUSIONS The research results from this study indicate that HIV / AIDS services provided at both the fixed clinic and mobile service points, including antenatal or prenatal care, are almost similar. RECOMMENDATIONS It is recommended for improving HIV / AIDS health care services that health care providers at Jericho mobile clinic and Jericho fixed clinic intervene by slowing the progression of HIV infection because it has a negative impact on the lives of women. The Jericho clinic and mobile clinic staff should be encouraged to adopt the perspective that HIV / AIDS is not a death sentence, but a preventable disease, not withstanding its deadly consequences on families and communities. The staff at these clinics is also to be motivated to adopt co-operative health care and psycho-social strategies, in which team work and the involvement and participation of all relevant stakeholders is viewed as an integral part of the struggle against HIV / AIDS and its devastating spread. / Health Studies / M.A. (Health Studies)

A qualitative study following a phenomenological approach was undertaken to explore voluntary counselling and testing nurses' perception of educating HIV+ people about ARVs. Non-probability convenience sampling was used and in-depth semi-structured face-to-face interviews were conducted to collect data from 12 participants. The most important results were: &#61623; The need for extensive education on ARVs since it is a new technology used to curb the infection therefore clients need the information in order to use them effectively. &#61623; Stumbling blocks encountered when educating HIV+ people about the drugs. The problems are mainly due to the nurses lack of current knowledge about the drugs; patients' low economic status; severe side effects; difficulties in behaviour change; poor quality of life on ARVs and medical terminology. &#61623; Inability of clients to comply to the regimen because of severe side effects, complex regimen, lack of support from family and friends, lack of motivation, depression, cultural beliefs, lack of knowledge on how to use them and financial constraints. &#61623; Challenges for continuous education because of current nursing shortage, negative attitudes of some nurses, demotivation and inadequate funding for such activity. Recommendations include provision of continuing education and the incorporation of ARV therapy knowledge in the basic nursing curriculum in nursing education. / Health Studies / MA (HEALTH STUDIES)

The HIV/AIDS epidemic is described as a crisis by the Global Report (UNAIDS 2004:13). Swaziland¡¦s King Mswati III also declared the HIV/AIDS epidemic as a disaster when the HIV/AIDS prevalence rate increased from 3.9% in 1992 to 42.6% in 2004 (MOHSW 2004:3). In responding to the increasing numbers, the Government of Swaziland established various programmes; one of them being the Voluntary Counselling and Testing (VCT) services to meet societal needs. The MOHSW designed guidelines to be utilized when training nurses to be pre and post HIV test counselors (TASC 2003:2). The period of training ranges between 1 to 2 weeks, after which they are deployed to the VCT centres where nurses provide counseling and testing, treatment of opportunistic infections and distributing antiretroviral drugs. Much research has been done in Swaziland on HIV/AIDS however; there is insufficient knowledge on the impact of HIV/AIDS on nurses working at the VCT services. The objectives of the study were to: ,,« Explore and describe the experiences of nurses working in the VCT services. ,,« Explore and describe the experiences of clients receiving VCT services. ,,« Design and develop an empowerment programme for nurses working in the VCT services in Swaziland. ,,« Formulate and describe guidelines for the implementation of the programme. In this qualitative study, the exploratory descriptive and contextual methodology was utilized to look into lived experiences of nurses and clients. This was done within the adaptation of the intervention Design and Development genre proposed by Rothman and Thomas (1994). Data was collected through purposive sampling and analysed according to Tesch¡¦s methods (Tesch 1990:890) The study revealed one major theme; constant experience of stress that was related to psychological and physical factors (categories). Nurses identified the complexity of HIV/AIDS, shortage of staff, lack of social support, lack of a supportive working environment, and a need for staff development under psychological factors. Clients identified stigma and discrimination. Constant exhaustion and development of medical conditions were identified as physical factors that led to constant experience of stress. Conclusions drawn from the data analysis revealed that nurses were stressed and felt disempowered at working in the VCT services. An empowerment programme was designed and developed to enable these nurses to deal with issues and VCT services for rendering quality care and enjoy the work they do. Guidelines were formulated to implement the empowerment programme. The study concluded with the identification of limitations and recommendations for future endeavours. / Health Studies / D.Litt. et Phil.

The aim of the study was to determine the factors that influence adherence to ART among adolescents who contracted HIV through vertical transmission. Qualitative research using descriptive phenomenology was conducted at Botswana-Baylor Children’s Clinical Centre of Excellence. Data was collected using in-depth individual semi-structured interviews. Eight (8) adolescents between 14 and 19 years who had been on ART for minimum of 4 years were interviewed. Thematic analysis of data was done and five (5) themes emerged from the participants' description of the experience of taking ART over a long period of time. The themes that emerged indicated the factors that influence adherence to ART, and they included knowledge and positive beliefs about ART, need for support, ART difficult treatment regimen, having a regular doctor and psychosocial emotional needs. The findings suggested that the adolescents who contracted HIV through vertical transmission require support while continuing on a simplified long-term ART regimen after an assessment of their psychological well beings and periodic checks. / Health Studies / M.A. (Public Health)

Health Management Information System (HMIS) in developing countries lags seriously behind as compared to the developed countries; and the existing HMIS in many countries is insufficient to support health management functions. The purpose of this study was to describe the implementation of Anti-retroviral Therapy (ART) pharmacy management information system in public health facilities. Quantitative, descriptive research was conducted at 38 public health facilities. The participants of the study were Pharmacists and Druggists those are working at ART Pharmacy. Data collection was done by using structure questionnaire. 76 respondents were recruited to participate in the study. The participants ages ranged from 26-50 years and all had more than 2 years’ work experience. The study indicated that even if there is a system at most health facilities their utilization of information technology (IT) for pharmacy practice were not appreciated. The findings indicated that the need for creating awareness among professionals in giving more skill oriented and also a formal in-service information technology related trainings for the professionals. To achieve better utilization of information technology at health care delivery system particularly pharmacy practice, government and stakeholder should consider capacity building activities through proper training and it should also viewed as a long term socio-cultural and technical development process. / Health Studies / M.A. (Public Health with specialization in Medical Informatics)

The purpose of the study was to evaluate the IMB skills model for its relevance to the Ethiopian context. According to the model, adherence-related information and motivation work through adherence-related behavioural skills to affect adherence to ART. Quantitative, analytical, observational, cross-sectional, institution-based study was conducted to evaluate the model by assessing those patients who have and do not have the right information, motivation, and behavioural skills whether they have or do not have good adherence to ART. Data was collected using structured questionnaires where a total of 400 randomly selected participants provided data on adherence-related information, motivation and behavioral skills as well as adherence behavior per se. Data was analysed using the Statistical Package for Social Sciences (SPSS) version 20.0. Both descriptive and inferential statistics used in the study. Only 90.75 % of the total sample population reported ART adherence rate of more than or equal to 95% in this study. Free and restricted model tests, through bivariate and multivariate analyses, used to assess the propositions of the IMB model of ART adherence and provided support for the interrelations between the elements proposed by the model. The study has supported the applicability of the IMB model of adherence to the Ethiopian context highlighting its application in adherence-promotion intervention efforts. The findings revealed the need for on-going educational, informational and other interventions to address the knowledge, motivation and adherence behavioural skills of patients in order to improve the current levels of ART adherence behaviour. / Health Studies / D. Litt. et. Phil. (Health Studies)

This study was conducted to determine retention rate and factors associated with loss to follow-up (LTFU) of adult pre-ART patients in St. Luke hospital, Ethiopia. Cross-sectional study with quantitative and qualitative data collection techniques was used. Review of patient records, focus group discussions and review of program guidelines was conducted to determine level of adherence among pre-ART patients. In addition, pre-ART service quality and perceived reasons for discontinuation was explored. The study revealed that only 38.2% of the 335 patients enrolled in the pre-ART care were retained after 12 months of follow-up in the program. More than half (55.6%), of the LTFU occurred during the first 6 months of follow-up. Fear of discrimination, high transportation cost and mistrust in the pre-ART service were perceived reasons for LTFU. Absences of clear pre-ART service package and implementation guideline were also identified as important factors that may be related to LTFU. The findings call for improved quality of care and a better pre-ART service packaging that will address the gaps identified in order to increase patient retention. / Health Studies / MA (Public Health)