Optimal antiretroviral treatment (ART) adherence is critical in achieving virologic suppression. Most people living with HIV (PLWH) experience HIV-related challenges which may be compounded by the experience of stressful life events (SLE) with adverse effects on their ART adherence and therefore affecting viral suppression. The highest concentration of people living with HIV (PLWH) is in low-and-middle income countries (LMIC) which are challenged with high rates of poverty and unemployment. Limited published data is available on the impact of the stressful life events experienced by PLWH in LMIC on ART adherence and viral load. A secondary analysis was conducted using data collected in a randomised control trial (RCT) which investigated the impact of a real-time electronic adherence monitoring device (EAMD) on ART adherence in ART-naïve individuals to assess the impact of SLE on ART adherence and viral load. Part A of this dissertation includes the study proposal/ protocol as approved by the Departmental Research Committee and the Human Research Committee at the University of Cape Town. Part B details the literature review which examined all published studies which report on stressful life events in PLWH, with ART adherence or a viral load as an outcome. The review included published literature from 2008 to 2019. Part C includes the publish-ready manuscript which details the statistical analysis, results and interpretation of the secondary analysis of impact of SLEs on ART adherence and viral load among 200 individuals living with HIV. Part D, appendices were included as supporting documentation necessary for the conduct of this research and as required for the completion of this dissertation. The American Psychological Association (APA) 6th Edition referencing style was used for Part A and B. The Vancouver referencing style was used for Part C as per the instructions for authors by the Aids and Behaviour journal guidelines.

The Clinical Infectious Diseases Research Group [CIDRI] has conducted high impact research over the last decade in Cape Town specifically in the townships of Khayelitsha and Mannenberg. None of this research would have been possible without robust strategies to recruit and retain study participants. Four different completed studies with different study designs have been selected, which will show the different approaches to participant recruitment into clinical research. This review will evaluate this process in relation to the approved protocol recruitment strategy, the amendments, which were required for modifications, the ability to retain participants to the end and the composition of staff used to achieve study outcomes. This entire process has been recognised as a necessary research skill and the term recruitmentology has become a practice pivotal to the research process. Recruitmentology has been unpacked to illustrate how minorities have been recruited, overlooked and over researched in the United States (US), and that experience has given a new perspective to the processes involved. Although in the South African context we do not have the identical issues to the US, these ideas can be translated in our circumstances, as both research populations can be considered as marginalised. We are challenged in the township of Khayelitsha with service disparities, which are generally impacted by the presence of clinical research groups. Although Khayelitsha has three large Day Hospital facilities, a newly built 150 bedded secondary level hospital and 11 local clinics, offering a consistently high standard of care; it remains a challenge. The CIDRI group partnered with the health services, supporting them with extra staff in the way of nurses, doctors and clinical research workers, while in return benefiting from the health system by being able to conduct effective studies. This has been and continues to be a mutually beneficial relationship, as CIDRI has been supportive to health services and the service has been a research partner of many research protocols including one of the studies being reviewed. Through the process of reviewing the databases of these four different CIRDI studies, we can examine the successes, challenges and a possible model of recruitment in the township of Khayelitsha. These studies have been chosen as they have been successfully completed by CIDRI and the databases have been locked. Each study has a different study design, from a pragmatic randomised control study, a cross sectional study, a seasonal follow-up and longitudinal study. Close attention will be paid to proposed recruitment strategy as per approved protocols, amendments (which impacted the recruitment process), staff structure, time frames of recruitment, retention and impact on study outcomes. This review will attempt to answer the following: 1. Was the proposed recruitment strategy followed as per study design and approved study protocol? 2. Was the overall recruitment impacted by staffing structure and allocated recruitment time frames? 3. How were study outcomes impacted by recruitment and retention? 4. Tuberculosis/Human Immuno-deficiency Virus TB/HIV were the diseases of study in all four studies, do these two diseases have specific challenges which impact recruitment and retention?

Background: There is a high incidence of Mycobacterium tuberculosis (M tb) infection and active Tuberculosis (TB) disease among adolescents in high TB burden countries, such as South Africa (SA), which indicates that clinical trials assessing vaccine-induced protection are critical in this age group. In educating adolescents regarding TB and clinical trials it is important to ensure that this population has received some relevant prior information if they are approached for clinical research, as well as for the benefits to their own health. Method: Applied theatre was used to educate and inform adolescents to improve their knowledge about TB and clinical research. The script used was based on a young mother's decision to enroll her baby as a participant in a TB vaccine trial and the questions asked by her family and the community. The story played itself out in public transport, a local clinic and the participants' household, using singing, dancing and rap in the local dialect. The message was visually delivered by actors from the Worcester Senior Secondary (WSS) School's drama class in an adolescent-friendly format to learners. A pre-performance multiple choice knowledge survey was completed by the study population before they watched the play and approximately seven days after the play the same knowledge survey was completed as a post-test. Results: Of the total study population 4.56% of the adolescents had had TB previously and 39.15 % had been involved in TB research. A high number of the adolescents (97. 7 0 %) had heard about TB and 78. 39 % indicated that they heard about TB at school. The majority of adolescents knew that TB is contagious: 82.92 % in pre-and 97.26 % in post-test. The results for mode of prevention (covering your mouth when coughing / sneezing) in the pre-test for all the schools were above 9 1.28 %. In all tested schools combined there was a slight knowledge increase from pre-to post-test that TB is curable. There was a significant knowledge improvement (P=0.009) for the question: "TB can easily be cured if you take your treatment?" Reassuringly, 9 4.84 % (pre-test) and 9 2.78 % (post-test) indicated that they would consult a medical doctor or go to the clinic if they thought they had TB. Clinical research knowledge did not improve. Conclusion: Using applied theatre to sensitize a rural adolescent population to TB-related clinical research was a novel approach to educate and convey sensitive information to potential study participants. Through theatre, SATVI raised awareness and established strong partnerships with the Department of Basic Education (DoE), school principals, teachers and adolescents as well as indirectly with their parents. It created a platform to engage with the adolescents as well as sensitizing them for a future clinical trial.