Health information exchange (HIE) has the potential to improve care quality through improved information sharing and coordination of care. In Phase 1, a sociotechnical analysis was conducted at one HIV clinic to explore the interrelated factors that affect the consent of persons living with HIV (PLWH) to electronically share their protected health information (PHI) through a HIE. The findings of the sociotechnical analysis revealed that there is not a single solution that can adequately address the complex, interrelated issues that affect PLWH decision to electronically share PHI. Improvement in the consent process was selected as the target of intervention for Phase 2, which focused on designing and pilot testing a prototype HIE eConsent iPad app at the HIV clinic. A one-group post-test design examined if HIV clinic patients preferred the eConsent or the paper consent. Semi-structured interviews were used to assess overall comprehension of HIE after reading both consents. Over half of the participants favored eConsent as compared to paper consent. The proportion of participants who were able to verbalize essential components of HIE were as follows: more than one component – 35%, one component - 20%, and no component – 45%. While racially and ethnically diverse, the sample was well-educated (50% with a college degree); however, the low comprehension levels suggested that educational attainment was insufficient for HIE comprehension. A hybrid approach that integrates discussion with knowledgeable personnel and multimedia usage may be useful to convey complex information and facilitate HIE comprehension.

Introduction: In the US, Black/African Americans comprise the largest proportion of People Living with HIV (PLWH). Depressive symptoms and fatigue are highly prevalent among PLWH. Depressive symptoms are linked to progression of HIV disease, and fatigue is linked to severity of depressive symptoms. Resistance exercise is known to have psychological benefits in non-HIV depressed populations, and these benefits are hypothesized to be intensity-dependent. That is, moderate intensity exercise seems to stimulate better psychological outcomes compared to other exercise intensities. To date, no study has examined the acute psychological effects of resistance exercise intensity with depressed PLWH. Purpose: To test the acute effects of resistance exercise intensity on affect, perceived activation, and perceived distress among sedentary Black/African American PLWH who experience depressive symptoms. Methods: Twenty-five men and 17 women ages 24-66 (47.5±11.2) with a Center for Epidemiologic Studies Depression Scale score of ≥10 completed a battery of questionnaires and 10-repetition maximum (10-RM) muscular strength tests. Participants were randomized into a moderate intensity resistance exercise group (i.e., 70% of 10-RM), n=21, or vigorous intensity resistance exercise group (i.e., 100% of 10-RM), n=21. Both groups completed 3 sets of 10 repetitions for 5 exercises at the assigned intensity. Exercises include squat, chest press, lat pull-down, dumbbell shoulder press, and dumbbell biceps curl. Affect, perceived activation, and perceived distress were measured with the Feeling Scale, Felt Arousal Scale, and Subjective Units of Distress Scale, respectively. Measures were administered at PRE, MID, POST, at 15-minute DELAY, and at 30-minute DELAY. Changes were analyzed using repeated measures ANOVA, with Bonferroni adjustments for post-hoc analyses. Results: There were significant Time x Group interactions for affect (F=2.6, p=0.03, η2=0.1), and perceived distress (F=5.5, p<0.01, η2=0.1), and a main effect of Time for perceived activation (F=16.2, p<0.001, η2=0.3). In the moderate intensity group, affect improved PRE to POST (t=3.2, p<0.01, d=0.7), PRE to DELAY 15 (t=4.1, p<0.01, d=0.9), and PRE to DELAY 30 (t=4.1, p<0.001, d=0.7). In addition, perceived distress was reduced from PRE to MID (t=4.2, p<0.001, d=0.9), PRE to POST (t=5.5, p<0.001, d=1.2), PRE to DELAY 15 (t=5.6, p<0.001, d=1.2), and PRE to DELAY 30 (t=6.7, p<0.001, d=1.5). In the vigorous intensity group, affect declined PRE to MID (t=2.9, p<0.01, d=-0.6), while perceived distress improved PRE to DELAY 15 (t=4.8, p<0.001, d=1.0) and PRE to DELAY 30 (t=3.5, p<0.01, d=0.7). Perceived activation increased in both groups similarly PRE to MID (t=5.1, p<0.01, d=1.5), and PRE to POST (t=6.1, p<0.001, d=1.8). Conclusions: Results suggest that an acute bout of moderate intensity resistance exercise is more effective than vigorous intensity resistance exercise in improving affect, increasing energy, and reducing distress in depressed Black/African American PLWH. However, vigorous intensity resistance exercise also appears to have distress-reducing benefits, but this appears to only occur after exercise. These findings should be considered when prescribing exercise for depressive symptom management in this population.

Effective symptom management is essential to decrease symptom severity and improve health-related quality of life for persons living with HIV (PLWH). A mobile health (mHealth) application (app) has the potential to be an effective delivery mode of an existing paper-based symptom management manual with self-management strategies for underserved PLWH. The quality of the mHealth app requires a thorough understanding of the needs of the intended end-users and ensuring the app’s usability. The purpose of this study was to translate paper-based health information into an mHealth app for symptom self-management in underserved PLWH, entitled mVIP (mobile Video Information Provider), and assess its usability. To achieve this goal, usability was evaluated rigorously throughout the development process of mVIP. Based on a stratified view of health information technology (IT) usability evaluation framework, usability evaluation was sequentially conducted with the following three levels: 1) user-task, 2) user-task-system, and 3) user-task-system-environment. At level 1 (user-task), we applied a user-centered design method to guide the information architecture of mVIP. Using a reverse in-person card sorting technique, symptoms and self-management strategies from a paper-based HIV/AIDS symptom management manual were ranked. The rank order of the 13 symptoms and 151 self-management strategies determined the order of appearance to end-users of the mVIP app, with higher-ranked symptoms and strategies appearing first. Based on the findings, we developed a prototype of mVIP as following: 1) once users log in, they are guided by an avatar through a series of 13 symptom questions ascertaining the nature and severity of their symptoms, and 2) the avatar recommends three self-management strategies for each symptom reported. At level 2 (user-task-system), we conducted a usability evaluation of the mVIP prototype in a laboratory setting through end-user usability testing and heuristic evaluation. In end-user usability testing, we used an eye-tracking and retrospective think-aloud method to examine task performance by 20 PLWH. For the heuristic evaluation, five usability experts in informatics assessed the user interface. In the two usability evaluations conducted in a laboratory setting, we found strong user acceptance of the mVIP prototype while identifying a number of usability issues with this prototype. Based on the recommendations from the end-users and heuristic evaluators, we iteratively refined the app’s content, functionality, and interface. We then inserted videos of the finalized symptom self-management strategies into the refined mVIP prototype. At level 3 (user-task-system-environment), the usability of the refined mVIP prototype was evaluated in a real-world setting. Through 10 in-depth interviews and four focus groups conducted at the conclusion of a three-month randomized controlled trial, we explored in-depth understandings of users’ experiences, perceptions, and satisfaction of mVIP use. Findings from the study showed that first, mVIP is useful for HIV-related symptom self-management and has the potential for being used as a communication tool with healthcare providers; and second, mVIP is easy to use to monitor symptom experience over time. At the same time, participants suggested mVIP be more sensitively tailored based on years from initial diagnosis of HIV, an individuals’ age, and conditions. The overall user satisfaction with the mVIP prototype was high, which reflects strong user acceptance of mVIP. Integral to the findings from the three-level usability evaluation, we assessed the quality of the mVIP prototype in use and found the prototype was highly accepted by PLWH with high user satisfaction. This study will add to the body of literature on translation of evidence-based health information into an mHealth app and its usability assessment, which highlights the importance of the use of mobile technology for PLWH, specifically racial and ethnic minorities and those from low-socioeconomic groups who have limited health literacy and low level of education.

Thesis (Ph. D. (Social Work)) --University of Limpopo, 2018 / Despite the laudable progress on HIV and AIDS interventions encountered in South Africa, new HIV infection remains a challenge. Limpopo Department of Agriculture is not an exception as far as new HIV infections are concerned, regardless of the intervention efforts made. This study aimed at exploring on perceptions of LDA employees on social-behavioural and structural core drivers of HIV infection. Qualitative research methodologies were applied. A purposive sample of twenty participants (10 men and 10 women) was selected from Department of Agriculture, Mopani District, Limpopo Province. Constructivism and structuralism theoretical framework were used to navigate the study. Semi-structured, face-to-face interviews were designed. Data was collected through interviews, audio-recorded and transcribed. Eight steps of data analysis were followed as proposed by Creswell. Guidelines for the prevention of new HIV infection were developed. Some of the major findings are that: the socio-behavioural core drivers that place all partners at risk of contracting new HIV infections is the Multiple Sexual Partnerships (MSPs). Age-disparate relationships in a workplace were also socio-behavioural drivers of new HIV infection. Young women and men who enter into age-disparate relationships have intention of obtaining permanent employment. Patriarchy was found to be amongst the structural core drivers of new HIV infections. The fact that men are not tested involuntarily is viewed as a structural barrier towards eliminating the spread of new HIV infections. Stigma has been also found to be a core driver of new HIV infections. Some conclusions made are: MSPs is a closed sexual network system, characterised by “secrecy” and “trust”. Despite some reforms purporting to improve women’s status, patriarchal domination is still at its toll. Unsymbolised stigma remains a threat towards elimination of the spread of HIV infections. The major recommendations are that working women still require empowerment in number of areas of their social functioning, and the leadership involvement in the fight against the spread of new HIV infections.

Thesis (M.Dev.) --University of Limpopo, 2011 / Refer to document.

Thesis (MPH.) --University of Limpopo, 2013 / Setting: The study was undertaken in St Rita’s Hospital, a district hospital for healthin Makhuduthamaga Municipality, Sekhukhune District, Limpopo Province. The purpose of the study was to describe client experiences of HIV-positive post-disclosure tosexual partners at St Rita’s Hospital, Limpopo Province. Research design and methodology: A qualitative, descriptive and phenomenological design was used. Purposive sampling was used to select 15 HIV-positive clients to participate in the study. Semi-structured interviews were conducted for data collection until saturation was reached. Data analysis was done using Techs open-coding method. Research findings: The study found that most of the clients were shocked and worried after testing HIV-positive. Participants whose sexual partners were aware that they were sick, indicated their wish to test and to immediately disclose their HIV-positive status. The study identified that some women found it difficult to disclose their HIV-positive status to sexual partners and continued to have unprotected sex in spite of ongoing counselling and support provided at the clinic. Some women participants who disclosed to sexual partners were accepted and some were rejected by sexual partners. Some women who disclosed their HIV-positive status to sexual partners were unable to motivate sexual partners to be counselled together and have mutual disclosure. These participants therefore continued to have unprotected sex with sexual partners and some became pregnant as sexual partners indicated that they tested HIV-negative elsewhere and were not keen to use condoms. Female participants did not indicate the use of female condoms as part of their responsibility to prevent transmission of HIV. Implications, recommendations and conclusions: The barriers which female participants face to disclose their HIV-positive status to sexual partners and not being able to insist on the use condoms may contribute to a high rate of HIV transmission and disease incidence. There should be establishment of consortiums at community level to provide quality support and follow up to vii clients who face challenges or fear to disclose their HIV-positive status to sexual partners. KEYWORDS • Clients’ experiences • Disclosure • Experiences, • Sexual partner • HIV-positive

Thesis (MPH.) --University of Limpopo, 2013 / Setting: The study was undertaken in St Rita’s Hospital, a district hospital for healthin Makhuduthamaga Municipality, Sekhukhune District, Limpopo Province. The purpose of the study was to describe client experiences of HIV-positive post-disclosure tosexual partners at St Rita’s Hospital, Limpopo Province. A qualitative, descriptive and phenomenological design was used. Purposive sampling was used to select 15 HIV- positive clients to participate in the study. Semi-structured interviews were conducted for data collection until saturation was reached. Data analysis was done using Techs open-coding method. Research findings: The study found that most of the clients were shocked and worried after testing HIV-positive. Participants whose sexual partners were aware that they were sick, indicated their wish to test and to immediately disclose their HIV-positive status. The study identified that some women found it difficult to disclose their HIV-positive status to sexual partners and continued to have unprotected sex in spite of ongoing counselling and support provided at the clinic. Some women participants who disclosed to sexual partners were accepted and some were rejected by sexual partners. Some women who disclosed their HIV-positive status to sexual partners were unable to motivate sexual partners to be counselled together and have mutual disclosure. These participants therefore continued to have unprotected sex with sexual partners and some became pregnant as sexual partners indicated that they tested HIV-negative elsewhere and were not keen to use condoms. Female participants did not indicate the use of female condoms as part of their responsibility to prevent transmission of HIV. Implications, recommendations and conclusions: The barriers which female participants face to disclose their HIV-positive status to sexual partners and not being able to insist on the use condoms may contribute to a high rate of HIV transmission and disease incidence. There should be establishment of consortiums at community level to provide quality support and follow up to clients who face challenges or fear to disclose their HIV-positive status to sexual partners. KEYWORDS • Clients’ experiences • Disclosure • Experiences, • Sexual partner • HIV-positive

Thesis (MCur.) -- University of Limpopo, 2015 / The purpose of this study was to determine the experiences of students in disclosing their HIV-positive status at the University of Limpopo, Turfloop Campus. A qualitative, descriptive, phenomenological design was used to explore, describe, and understand the experiences of the students with regard to the disclosure of their HIV-positive status. A group of 20 students who belonged to the support group were purposively sampled. Semi-structured interviews were conducted for data collection until saturation was reached. Data analysis was conducted according to Techs open-coding method. The study highlights the potential factors that might hinder access to HIV prevention, management, care, and support programmes. The findings reveal that there is a marked societal shift in the perception and understanding of HIV, resulting in disclosure being a less difficult responsibility. However, rejection by sexual partners has also been revealed. This rejection is one of the negative consequences that might hamper future disclosure. It is recommended that counsellors should be highly skilled in counselling HIV-positive people, especially about issues of disclosure. An HIV disclosure model will greatly support the work of these counsellors.

AIMS: HIV diagnoses among men who have sex with men (MSM) in New Zealand increased from the year 2001. The aim of the thesis was to improve understandings of the causes of the increase, in order to inform HIV prevention and identify further research needs. METHODS: Epidemiological data on HIV and AIDS diagnoses among MSM in New Zealand were examined using information from the AIDS Epidemiology Group. A programme of regular behavioural surveillance among MSM was also designed and conducted. RESULTS: Between 1996-2005, HIV diagnoses among MSM by antibody testing where HIV infection was acquired in New Zealand revealed two distinct phases: A very low period between 1997 to 2000 in which around 21 diagnoses were recorded annually; and a resurgent period from 2001 to 2005 where annual HIV diagnoses experienced a sustained rise to 66 at the end of 2005. New adjusted estimates indicated that known prevalent HIV cases among MSM in New Zealand increased from 437 to 588 between 1995 and 2000 (35%), and from 588 to 965 (64%) between 2000 and 2005. This reflected diverging trends from the mid-1990s: Ongoing new HIV infections among MSM which accelerated from the year 2000; and decreased deaths from AIDS due to improved antiretroviral treatments. Unless the growing number of MSM with HIV is counterbalanced by a decrease in the rate of secondary transmission from positive individuals, it will increase the number of new HIV infections. Contrary to this, when expressed as diagnosed incidence-to-prevalence pool ratios (IPRs), the average annual rate of secondary transmission was found to be increasing over time. The behavioural surveillance programme in Auckland surveyed 812 MSM in 2002, 1220 in 2004, and 1228 in 2006. An online module in 2006 additionally surveyed 2141 MSM, 647 of whom lived in Auckland. There were no overall changes in HIV testing over the three offline surveys, suggesting that the increase in HIV diagnoses was not an artefact of testing patterns. There were also no widespread changes in the rate of unprotected anal sex with casual sex partners, or partners described as a "fuckbuddy" or a "boyfriend", among the overall offline samples. However, the proportion of MSM recruited offline who had recently engaged in sex with a man met through the Internet increased significantly from 2002 to 2004 (from 26.6% to 44.8%). When MSM surveyed online in 2006 were examined, they exhibited riskier behaviours compared to offline-recruited respondents. For example, rates of non-condom use and sexual partner concurrency were especially high, and testing rates were lower. CONCLUSION: It is likely that moderate changes involving increases in unprotected sex for some MSM, and alterations to sexual networks and sexual connectivity, have combined to push the reproductive rate of HIV beyond the new epidemic threshold set by the increase in longevity from the mid-1990s. These changes need not have been great if the reproductive rate of HIV was already situated close to the epidemic tipping point. In this case, a resurgent outbreak of HIV may even have been triggered by apparently small and subtle shifts in factors influencing HIV spread.

"8th July 2002." Includes bibliographical references (leaves 276-308) Examines the systematics (taxonomy, phylogeny, and epiemiology) of the genus Candida using a combination of traditional and contemporary methodologies. Assesses these methods to determine their diagnostic potential to unequivocally identify and characterise species and strains of this medically and dentally important yeast genus.