Thesis (MSc. (Physiology)) -- University of Limpopo, 2016 / Relevance: An increase in the number of HIV positive patients receiving HAART raises important concerns about the metabolic impact of these regimens. The treatment effectively reduces viral load and increase CD4+ count; unfortunately it seems to disrupt carbohydrate and lipid metabolic pathways thereby increasing the risk for CDL by placing an already chronically ill HIV population at risk of more chronic diseases. As a developing country, accessibility to safer regimens of HAART is limited thus patients exposed to toxicities from long term exposure to sub-optimal regimens are even at greater risk. The aim of this study was to assess the long term effects of HAART on biochemical parameters and body composition as an indication of carbohydrate and lipid metabolism. Methods: A prospective cohort of 87 patients receiving HAART for 12 months or more was conducted at baseline and follow-up. Venous blood was collected after an overnight fast. An automated enzymatic colorimetric test was used to analyse plasma glucose and serum TC, HDL-C and TG. The LDL-C levels were calculated from TC and HDL-C. Leptin levels were analysed using human leptin radioimmunoassay kit. Insulin was analysed using an automated access ultrasensitive insulin assay. Anthropometric measurements were taken for the determination of body fat distribution and BMI. All statistical analyses were performed using SPSS version 23. Results: Total cholesterol, LDL-C, and waist circumference significantly decreased from baseline to follow-up (p<0.05). Triglycerides and LDL-C levels were significantly affected by durations between 24–47 and 49–72 months respectively. There were no significant changes in the mean levels of leptin observed within the two lines of regime. Mean leptin levels were 11.36±8.52 ng/ml and 9.67±6.42 ng/ml at baseline and follow-up respectively. Furthermore, the duration of HAART significantly affected BMI and WC at 49–72 months. Patients that met the criteria for diagnosis of DM were only found in PI containing regimens at 6.3% and 5.9% baseline and follow-up respectively. In the first line regimen, the prevalence of DM was only found at follow-up. Conclusion: The present study demonstrated that longer duration between months 49–72 has significant negative effects on the glucose and lipid metabolism of HIV positive patients. The study also highlighted that patients on combinations containing PIs and NRTIs such as stavudine and zidovudine are at higher risk of developing metabolic diseases. / University of Limpopo

Department of Advanced Nursing Science / MCur

PhDH / Department of Public Health / Background: Since the introduction of three-tiered systems appointments, there are a large number of missed appointments among Human immunodeficiency virus-positive clients on Antiretroviral. However, no one knows why these clients missed their scheduled times. Missing of appointments predicts poor adherence and is associated with poor clinical outcomes. Objectives: The proposed study aimed at developing a strategy for reducing the missing of appointments among adults on Antiretroviral Therapy in the Limpopo Province, South Africa. The objectives of the study are to determine patients’ behaviour, the socio-environmental and economic factors that contribute to the missing of appointments and develop strategies to enhance compliance with appointments by Human immunodeficiency virus-positive clients on Antiretroviral therapy in the Limpopo Province. Method: A qualitative research design was used to address the study objectives. Non-probability purposive sampling was used to sample health care centres in Limpopo Province, patients, Professional Nurses and Community Health Workers. Individual interview and focus group discussions strengthened the triangulation of data obtained from the participants. Creswell’s model provided details for data analysis and interpretation. Trustworthiness and Ethics: Measures to ensure data quality, such as credibility, dependability, conformability and transferability, were observed. The researcher ensured compliance with ethical standards to protect the rights of the participants. Approval for this study was obtained from the University of Venda Research Ethics Committee and the Limpopo Department of Health Research Ethics. Results: The study revealed various factors that contribute to the missing of appointments by Human immunodeficiency virus positive-clients on Antiretroviral Therapy. Specific socioeconomic, behavioural, environmental and health service-related factors appear to prevent adherence to appointments. These factors include a lack of family support and client engagement, the absence of financial means, and cultural and religious beliefs. Lack of client involvement in planning their care and poor referral of clients to community health workers were ranked high as being the most contributing factors to clients missing their appointments. Strategy development: Phase 2 of this study dealt with the development of the strategy aimed at reducing the missing of appointment by adults on Antiretroviral Therapy based on the findings of the study. The strengths, weaknesses, opportunities and threats matrix was triangulated in Political, Environmental, Social, Technological and Legal analysis to develop this approach to reduce the missing of appointments among adults on Antiretroviral therapy. A transtheoretical framework illustrated how to implement the strategy. Validation of the developed strategy ensured that the system is free of errors and checked the applicability of the strategies utilising a quantitative design. A simple random sampling approach was used to select the population to participate in this study using the questionnaire developed by the researcher. Almost all respondents agreed that the strategy would facilitate reduced missing appointments by adults on Antiretroviral therapy. Recommendations: Clients involvement and engagement throughout the process of a treatment plan is essential to identify some of the barriers that might contribute to poor adherence to appointment by clients on Antiretroviral therapy. Community health workers and nurses should be capacitated with knowledge and skills to identify the clients at risk of defaulting treatment and appointments and provide counselling that will facilitate behaviour modifications. / HWSETA

MCur / Department of Advanced Nursing Science / Survival of children with HIV/AIDS has increased considerably with the use of effective antiretroviral therapy. However, the benefits of this therapy are limited by the difficulty of adherence to the treatment. This study sought to explore the role of professional nurses on anti-retroviral therapy adherence among children in Lejweleputswa district: Free State, South Africa. An exploratory descriptive qualitative research design was used to identify and describe role of professional nurses toward anti-retroviral therapy adherence among children. Population for this study included seventeen (17) professional nurses working in four purposively sampled Primary Health Care clinics invited to participate in the study. Four focus group discussions were conducted in which each group had 6 participants. The transcribed data was analysed using the framework approach of data analysis. Professional nurses in Lejweleputswa district report poor knowledge of parents/caregivers of children, perceived poverty, stigma and discrimination, inappropriate care approaches, and parental dynamics as factors influencing poor ART adherence. Recommendations for enhancing children ART adherence levels in Lejweleputswa district included: mainstreaming adherence counselling in children ART and adopting a comprehensive family centered care approach were identified as measures for improving children ART adherence. Other measures included integration of ART services into Primary Health Care (PHC) services, parental empowerment, development of a programme to reduce stigma and discrimination in the community.

MA (Psychology) / Department of Psychology / Background: Given that there is 57.7 million HIV-diagnosed people living in South Africa and the government has established the largest public antiretroviral programme in the whole world but only 53% are adhering. Adherence remains a challenge, due to presence of mental health issues among HIV diagnosed. Aim: The aim of this study was to investigate adherence to antiretroviral therapy and mental health of HIV-diagnosed patients in Vhembe District, Limpopo Province. Methods: This was a mixed method study using a combination of quantitative and qualitative research approaches. In the quantitative approach, triangulation was utilised in the form of a questionnaire and patients records. Simple random sampling was used to select 134, descriptive analysis using SPSS version 25. For the qualitative approach, a phenomenological research designs was considered and convenience sampling was used to select fifteen participants (15). Data was collected using semi-structured interview; responses were analysed using a computer-aided program called, ATLAS ti. Results: The self-report of adherence was 94.8 %, objectively 39.6% of CD4 count <200c/mm3 at baseline and 34.3% CD4 count after six months was found. 16.5% of females and 2% of males defaulted treatment and 14.9% of missed medical appointments 1-6 times. This study also revealed the mental health issues that HIV-diagnosed patients are struggling with after the diagnosis include the stages of grief, stress, depression, anxiety, mistrust, shame, stigma and discrimination. Recommendation: Effective strategies need to be enhanced and tailor made in effort to encourage patients to take ART diligently. The healthcare providers, community members and the government should be made aware of mental health issues. / NRF