Magister Public Health - MPH / The study aimed to assess the level of adherence and to identify the barriers to adherence and the motivations for good adherence to antiretroviral therapy, amongst women who commenced treatment while pregnant at research clinics in Molepolole, Mochudi, Lobatse and Gaborone. / South Africa

Philosophiae Doctor - PhD / The HIV/AIDS pandemic has been a torment to the African developmental agenda, especially the Southern African Development Countries (SADC), for the past two decades. The disease and condition tends to affect the productive age groups. Children have also not been spared from the severe effects associated with the disease. The advent of antiretroviral treatment (ART) has brought a great relief to governments and patients in these regions. More people living with HIV/AIDS have experienced a boost in their survival prospects and hence their contribution to national developmental projects. Survival analysis methods are usually used in biostatistics, epidemiological modelling and clinical research to model time to event data. The most interesting aspect of this analysis comes when survival models are used to determine risk factors for the survival of patients undergoing some treatment or living with a certain disease condition. The purpose of this thesis was to determine prognostic risk factors for patients' survival whilst on ART. The study sought to highlight the risk factors that impact the survival time negatively at different survival time points. The study utilized a sample of paediatric and adult datasets from Namibia and Zimbabwe respectively. The paediatric dataset from Katutura hospital (Namibia) comprised of the adolescents and children on ART, whilst the adult dataset from Bulawayo hospital (Zimbabwe) comprised of those patients on ART in the 15 years and above age categories. All datasets used in this thesis were based on retrospective cohorts followed for some period of time. Different methods to reduce errors in parameter estimation were employed to the datasets. The proportional hazards, Bayesian proportional hazards and the censored quantile regression models were utilized in this study. The results from the proportional hazards model show that most of the variables considered were not signifcant overall. The Bayesian proportional hazards model shows us that all the considered factors had different risk profiles at the different quartiles of the survival times. This highlights that by using the proportional hazards models, we only get a fixed constant effect of the risk factors, yet in reality, the effect of risk factors differs at different survival time points. This picture was strongly highlighted by the censored quantile regression model which indicated that some variables were significant in the early periods of initiation whilst they did not significantly affect survival time at any other points in the survival time distribution. The censored quantile regression models clearly demonstrate that there are significant insights gained on the dynamics of how different prognostic risk factors affect patient survival time across the survival time distribution compared to when we use proportional hazards and Bayesian propotional hazards models. However, the advantages of using the proportional hazards framework, due to the estimation of hazard rates as well as it's application in the competing risk framework are still unassailable. The hazard rate estimation under the censored quantile regression framework is an area that is still under development and the computational aspects are yet to be incorporated into the mainstream statistical softwares. This study concludes that, with the current literature and computational support, using both model frameworks to ascertain the dynamic effects of different prognostic risk factors for survival in people living with HIV/AIDS and on ART would give the researchers more insights. These insights will then help public health policy makers to draft relevant targeted policies aimed at improving these patients' survival time on treatment.

This study emanates from the need to understand the socio-economic factors that might have contributed to the patients dropping out of the MASA antiretroviral therapy programme in Botswana. The aim of the study was to explore the socio-economic factors that are involved in compliance to antiretroviral therapy. It is crucial to know what these factors are and the strategies that can be deployed to address them. This will assist in the achievement of the programme goals. The type of research that was used is applied research. One of the primary rationales of applied research is that the study may have some practical use. The purpose of applied research is to contribute knowledge that will help people understand the nature of the problem in order to intervene, and this was the main motivation for this study. Since the MASA programme was launched, there were some patients who were ‘lost to follow-up’. As a result, there was a need to understand the reasons behind this phenomenon, so that the patients who are enrolled on the programme are retained. In order to gain an in-depth understanding of how the socio-economic factors affect compliance with antiretroviral therapy, phenomenology was used as a research strategy. Using the phenomenological strategy helps in understanding the nature or meaning of the respondents’ everyday experiences and to transform experiences into consciousness. The sampling method that was used is probability sampling, utilising availability sampling. The population for this study was HIV positive adults who had dropped out of the MASA Programme at Princess Marina Hospital, IDCC clinic in Botswana. The data collection instrument that was used was the interview schedule. From the conclusions, it is apparent that the socio-economic factors are crucial and should therefore be given more attention if better compliance is to be realised. In the same breath, patients require counselling that will focus, not only on the medical aspects of HIV/AIDS but also on the socio-economic factors. As shown in this study it is predominantly the socio-economic factors that led to patients dropping out of the programme. Social workers can play a critical role in this regard as they are equipped with counselling skills. Lastly, the conclusions and recommendation arising from this study are provided. / Dissertation (MA (Social Health Care))--University of Pretoria, 2007. / Social Work and Criminology / unrestricted

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)

Introduction An estimated 11.4% of South Africans are infected with HIV. As of 2007, 1.7 million people required antiretroviral therapy (ART) and only 460 000 were reported to be on ART. ART can improve the quality of life and socio-economic status for HIV positive patients. This study aimed at evaluating the role played by the different factors in influencing treatment adherence among HIV patients on ART. Methods The study was conducted on patients receiving out-patient ART in two district hospitals (one urban and the other rural) of Mpumalanga Province, South Africa. The study project was approved by the Research and Ethics Committee of the University of Pretoria as well as by the Mpumalanga Provincial Department of Health. This was an analytical, cross-sectional study. The sample size for the study was 490 (245 per site). Facility-based patient appointment registers for the period June-August 2008 were used as the sampling frame. The respondents were selected through systematic random sampling. An interviewer directed standardised questionnaire was administered to the respondents after securing voluntary informed consent. Data were also extracted from the attendance registers in the two facilities. Adherence was measured using the Patient Medication Treatment Adherence Questionnaire. The Pearson chi-square test of association and binary logistic regression analysis were used for identifying significant predictors of non-adherence variables. Results Four hundred and twenty nine questionnaires of the 488 returned questionnaires were analysed. Sixty one questionnaires were disqualified due to incompleteness of data. The response rate was 99.7% in both study areas and participants reported adherence was 92.54%. The median age of the respondents was 36 (IQR, 13), gender distribution was 21.13% males and 78.87% females. The median duration of treatment (in months) with ART was 15 months (IQR, 18). Treatment adherence was higher in the urban than in the rural hospital. The variables that were significantly associated with non-adherence were ‘urban residence’ (OR 0.39 [0.2-0.8]); ‘lack of social support’ (OR 2.74 [1.3-5.7]); Discussion There were also some qualitative variables that had a bearing on quality of healthcare services that could explain differences between the rural and urban sites. Social support and urban residence demonstrated association with treatment adherence. Copyright / Dissertation (MMed)--University of Pretoria, 2010. / School of Health Systems and Public Health (SHSPH) / Unrestricted

South Africa is in dire need of a public umbilical cord blood stem cell bank (UCB SCB). A severe shortage of genetically compatible samples for BM transplantation precludes the majority of South Africans from receiving the relevant medical care. UCB is a viable alternative to BM but is currently disposed of post-delivery. UCB could furthermore serve as a resource of genetically compatible haematopoietic progenitor cells (HPCs) that could be used in gene therapy approaches directed towards a cure for HIV-1. Knowing whether HIV-1 affects or infects primitive HPCs is vital to determine the course of action for transplantation of UCB-derived genetically resistant HPCs. Collecting and storing UCB in a public UCB bank could thus serve as a vital resource of genetically compatible samples for BM transplantation. It was thought that the high incidence of HIV-1 in South African patients and the persistent stigma surrounding HIV-1 would be problematic for collecting sustainable numbers of UCB units and subjecting units to compulsory screening for infectious diseases. This was however, not the case. In the South African context, we are faced with unique and rich challenges relating to cultural and religious differences that are further augmented by linguistic constraints and educational insufficiencies. Nevertheless, the majority of patients within the interviewed patient cohort were supportive of the idea of establishing a public UCB SCB in SA and were willing to undergo additional HIV-1 screening. The Ultrio-Plus® assay was verified in this study for screening UCB units for HIV-1 and could be used in routine analyses of UCB units prior to banking. Conflicting results in the literature exist with regard to HIV-1’s ability to infect or affect haematopoietic progenitor cells. Results from this study revealed that HIV-1 was not only able to affect HPCs’ ability to form colonies in vitro, but was also capable of infecting CD34+ HPCs in some individuals. These results substantiate the theory that some CD34+ HPCs serve as viral reservoirs which could account for residual viraemia in patients on antiretroviral therapy. Results suggest that allogeneic transplantation of HIV-1 infected individuals with UCB-derived, genetically modified HPCs, should be pursued. / Thesis (PhD)--University of Pretoria, 2012. / Immunology / unrestricted

Thesis (MPH.) -- University of Limpopo, 2021 / Background: The provision and success of Antiretroviral therapy (ART) depend on monitoring and evaluation of treatment programmes which should be assessed during regular patient follow-ups. The treatment of HIV infection can only be effective if patients are retained in care and programme monitoring is adequately undertaken to understand the effectiveness of the emerging treatment. The outcome of patients lost to follow-up (LTFU) has received relatively little attention and it is predicted that these patients may have stopped taking antiretroviral drugs, resulting in high morbidity and mortality. The provision of ART was introduced into South African public health facilities in 2003 and therefore, attention has shifted from the immediate need to get patients into care, to the long-term challenges of keeping patients in care and on treatment. The objective of the current study was to determine the trends at which HIV-positive patients become LTFU on the ART programme at Shiluvana Local Area’s six clinics in the Greater Tzaneen Sub-District, Limpopo Province, South Africa. Methods: A retrospective cohort study approach was used and data was collected from the database of patients who were LTFU from 2012 – 2017 in the electronic data management system of the District Health Information System. Data was collected from 1161 patients. Data analysis was done using SPSS version 25, in which categorical data was presented using frequencies and percentages and comparisons between groups was done using Chi-square test for categorical data, and Student’s t-test for continuous data. A p-value of <0.05 was considered statistically significant. Univariate regression analysis was done to determine the contributory factors to LTFU for a period of more than 3 months. Results: The mean age of the study population was 36.5 years old ranging from 16 years to 87 years old and the age distribution of people who were LTFU for ART showed a significant association (p = 0.001). The study participants’ distribution by gender revealed that majority were females at 71.4%. The study findings also revealed there was a statistically significance difference in health status of the study population and majority of the LTFU were in the younger age group. The CD4 count of LTFU patients showed a statistically significance difference and majority of the LTFU in patients with a CD4 count of less than 200 were in younger age group also. The TB/HIV co-infection in the study population showed a statistically significance difference and majority of LTFU in the study did not have TB/HIV co-infection. The WHO clinical HIV staging in the study population did not show a statistically significance difference. Marital status, TB/HIV co-infection and WHO clinical staging were found to be a strong predictor of LTFU of more than 3 months. Conclusion: The study findings bring with them a number of recommendations such as there is a need to have a standardised tracking method of patients who migrate to other health facilities for their ART treatment. This will provide more accurate information regarding LTFU levels and reduce the misclassification of patients. The age group which is affected by LTFU in all variables was in the 20 – 34 years’ age group. This is of great concern, as this is the age group who are economically active and should contribute to the future economy of the country. It is therefore recommended that a greater focus should be placed in this age group, with policies and programmes that bring them into ART and retain them there. Lastly, educational campaigns, in a form of pamphlets and posters to emphasize adherence to ART and the importance of remaining on ART within designated health facilities. In conclusion, patients should be retained in care for as long as possible to prevent the prevalence of the ARV resistant virus that can impact negatively on the ART programme. Keywords: Antiretroviral treatment. Human immunodeficiency virus, Loss to follow-up, socio-demographic.

Thesis (Ph. D. (Statistics)) -- University of Limpopo, 2019 / Refer to document / NRF-TDG

No description available.

The objectives of the study were (1) to quantify adherence rate among the study participants in the ART unit and (2) to identify factors that contribute to non-adherence. This cross sectional study was carried out at Nekemete referral clinic. Data was collected using a self-developed structured questionnaire where a total of 338 participants grouped into adherent and non-adherent based on a score derived from an adherence assessment were interviewed. Data was analysed using the Statistical Package for Social Sciences (SPSS) version 17.0. By using multivariate analysis of variables identified as correlates of adherence, non-adherence was common among those; with age between 18-30 yrs, with no education, who were not married, who had no pipe water supply, those with no electricity in the house, who perceived had no access to assistance from providers, who perceived the health care providers (HCPs) did not keep information confidentially, who had a language barrier with providers, and who were treated with a psychiatric illness. The study concludes that adherence is multi-factorial and varies significantly by individual and care setting. Psychosocial factors were found to impact adherence and should be analysed in more detail by further studies. Three psychosocial factors were independently associated with poor adherence: the study found that patients perceiving poor access; those perceiving problems in information confidentiality (and possibly experiencing stigmatisation); and having psychiatric morbidity (and possibly with less social support) are more likely to be non-adherent. Furthermore, individuals without electricity and those without piped water supply, implying low income, are at risk for non-adherence / Health Studies / M.A. (Public Health)