The purpose of the study was to describe the determinants and practice of HIV self-testing among health care workers (HCWs) in Nyeri provincial hospital, Kenya. A descriptive cross-sectional study was conducted to determine the rate of HIV self-testing, explore the factors influencing the practice and describe access to HIV psychosocial support, care and treatment. The study was guided by the concepts of the protection motivation theory. Data was collected from 348 HCWs and analysed by means of logistic regression. Results showed that 65.8% of the HCWs had practiced HIV self-testing among themselves. Age, self efficacy and response efficacy were found to be significant predictors of HIV self-testing. Willingness to access HIV psychosocial support (71.3%) and care and treatment (73.9%) was high. Self-testing is highly practiced by HCWs. / Public Health / M.A. (Public Health)

Thesis (M. Tech. (Biomedical technology)) - Central University of technology, Free State, 2013 / INTRODUCTION: The renal effects of Tenofovir Disoproxil Fumarate (TDF) and antiretroviral treatment (ART) outcomes remain under-reported in African settings. The study sought to assess immunological outcomes and to compare renal function outcomes between patients exposed to TDF and unexposed patient group. METHODS: Phase 1 of the study was a retrospective case control analysis of serum creatinine data for 312 ART naïve adult patients exposed to TDF and 173 unexposed patients enrolled on ART between Dec 2006 and Jan 2011 at Roma Health Service Area in Lesotho. Sub-optimal renal function outcomes were serum creatinine clearance values <50 ml/min calculated using the Cockcroft-Gault equation. Phase 2 was based on re-sampling of the study population and analysis of CD4 counts of 516 adult naïve HIV-positive patients. Univariate logistic regression (p<0.1) and multivariate analyses (p<0.05) were performed using STATA® version 11 software. RESULTS: Overall, 153 (31.5%) patients had moderate baseline (30-60 ml/min) renal insufficiency. Renal function improved by +2 ml/min at 24 months. Almost 18% (n=312) of the patients on TDF were erroneously put on TDF. The use of TDF was a marginally significant factor (p=0.054) associated with CrCl<50 ml/min outcomes in univariate analysis but was insignificant (p=0.122) in multivariate analysis. Female gender (p=0.016), high blood pressure (p=0.009), ages over 60 (p=0.004), and underweight (p<0.001) were significantly associated with CrCl<50 ml/min outcomes. The proportion of patients who developed immunological failure in this study was low (6.8%, n=516). The mean CD4 count increased significantly after treatment (p<0.001). Baseline CD4 count below 50 cells/mm3 (p=0.049) and male gender (p=0.005) were significantly associated with sub-optimal immunological outcomes. CONCLUSIONS: TDF is a weak contributing factor associated with renal impairment outcomes compared to other variables such as hypertension, older age, underweight and female gender. More research on long term effects of TDF is recommended. Baseline renal function screening should be improved to minimise leakages of patients contraindicated of TDF. Although the patients’ immunological status generally improved, males and patients with low baseline CD4 counts should be monitored closely while on ART.

No abstract available / Jurisprudence / LL.M.

The purpose of this research was to explore HIV/AIDS stigma in the workplace, with a special focus on the stigmatised. The sample consisted of 10 HIV/AIDS positive employees. A qualitative interview schedule was designed. The interview guide was used to facilitate one-on-one interviews with each participant. An analysis of the data revealed that the majority of the participants were shunned by family, friends and partners. Others were too ashamed or afraid to reveal their positive status. The majority of the participants did not feel comfortable revealing their positive status to their line managers and to their co-workers. All participants felt that others viewed people living with HIV/AIDS as dirty and unclean and many had been exposed to stigmatising behaviours towards them due to their HIV/AIDS positive status. As a coping mechanism, most participants noted that they would walk away if stigmatised against. Recommendations were made to address HIV/AIDS stigma in the workplace. / Industrial & Organisational Psychology / M. A. (Industrial and Organisation Psychology)

The study aimed to explore and describe the factors influencing disclosure of Human Immunodeficiency Virus (HIV) status to sexual partners by people infected with HIV in Botswana, by undertaking an exploratory and descriptive qualitative study. Data was collected through in-depth interviews with people infected with HIV who had disclosed their HIV status to their partners. The major findings of the study confirmed disclosure as a multi-stage process. People infected with HIV experienced mainly positive and some negative outcomes following disclosure. Disclosure was associated with the discloser’s motivations, personal and cultural beliefs, risk-benefit assessment, individual circumstances (context), previous experiences, and perceived degree of control over private information. The communication privacy management (CPM) theory helped explain the findings. The key factor influencing disclosure was protecting others. Non-disclosers had also seriously considered disclosing to partners. / Health Studies / M.P.H

The purpose of this study was to explore and describe the determinant factors affecting adherence to antiretroviral therapy among HIV infected patients in Addis Ababa, Ethiopia. A cross-sectional study design was used and data were collected by interviewing 290 study participants from two health facilities using structured questionnaire. The research finding revealed 80.0% of the study participants had optimal combined adherence to dose, schedule and dietary instructions in the past three days. And, the non adherence rate was 20.0%. In multivariate analysis only WHO clinical stage, change of ARV medication, knowledge about HIV disease and ART, and use of reminders were found to be independently associated with adherence to antiretroviral therapy. The most common reasons for missing HIV medications in the past one month were forgetfulness (35.1%), being busy with other things (17.5%), and running out of pills (10.5%). Adherence improving interventions should be emphasized to address multi-faceted problems. This study recommends setting of convenient appointment schedule, disclosure of one's HIV status, maintaining confidentiality of patient-related information, enhancing patient-provider relationship, use of reminders including SMS text messages, and engagement of PLHIV in adherence improving interventions through peer support, and providing regular health education to the PLHIV to improve adherence of patients to ART / Health Studies / M.A. (Public Health)

Submitted in fulfillment of requirements for the Degree of Masters in Technology: Nursing, Durban University of Technology. 2013 / This study investigated the factors that impact on the utilisation of voluntary HIV counselling and testing (VCT) service at a wellness centre in a higher education institution. Purpose: The purpose of the study was to identify factors that impact on the utilisation of VCT service in a higher education institution. Methodology: A quantitative descriptive survey research design was used to describe the phenomenon and to establish relationships between variables. Participants were selected randomly in order to obtain a broad representative sample in three strata. A formal structured close-ended questionnaire was used to collect data. The questionnaire was designed to focus on variables such as demographic data, environmental factors, enabling factors, predisposing and behavioural factors. Findings: No significant relationship was identified between knowledge of HIV, AIDS and VCT and high school attended in rural, township and urban areas. There was no significant relationship between environmental factors and utilisation of VCT. There was no association between predisposing factors such as risk of VCT and perceived benefits of VCT utilisation. There was no relationship between knowledge and consistency of condom use and utilisation of VCT. The majority of respondents stated that the VCT service was not user friendly and the attitude of the staff toward students was poor. There was no significant relationship between accessibility of VCT service and utilisation of VCT. There was a lack of utilisation of campus VCT services and the majority of respondents utilised other services. Conclusion: The study showed that respondents who knew about availability of VCT were likely to have used the facility. Respondents who showed positive / Durban University of Technology

Submitted in compliance with the requirements for the Master's Degree in Technology: Nursing, Durban University of Technology, 2014. / Background : Tuberculosis (TB) is a global public health concern and is identified as the leading cause of morbidity and mortality in the population infected with Human Immune Deficiency Virus (HIV). South Africa (SA), particularly the KwaZulu-Natal Province, is burdened with persistently high rates of both TB and HIV infections. In an attempt to improve TB and HIV co-infection outcomes the South African health care system has adopted the World Health Organisation (WHO) guidelines for intensified TB case findings in all HIV positive individuals for regular screening of TB symptoms in order to promptly diagnose and treat active TB disease or to exclude TB for initiation Isoniazid Prophylactic Therapy (IPT). IPT has proven effective in preventing TB disease in People Living with HIV or AIDS (PLWHA). This critical first step of TB symptom screening is regarded as the intervention that could significantly reduce the challenge currently faced with TB-HIV co-infection. The study was conducted in selected eThekwini Municipality Primary Health Care (PHC) facilities with the focus on an investigation to determine the extent of the implementation of the TB symptom screening tool in HIV infected individuals, in addition to identifying treatment initiation or further investigations based on the tool implementation. It has been found during the literature review, that there is a lack of research in SA to show that this critical first step in TB identification has been investigated, yet one in six South African’s is HIV positive and the incidence of TB-HIV co-infection is not declining. Methodology : A quantitative, descriptive approach was utilised to conduct a retrospective patient chart review. A multistage cluster sampling technique comprising three stages was implemented to identify the sample. There was a random selection of clinics, and the required number of client records was obtained through convenience sampling from the selected clinics. Results : The findings of this study revealed there is inadequate implementation of the current national and provincial TB protocols. The study provides varied levels of information about TB symptom screening in HIV infected individuals in the PHC clinics of eThekwini Municipality. It was observed that Health Care Worker’s (HCW) in some facilities carried out TB symptom screening to an extent. However, the inconsistent and partial application of this screening tool warrants improvement to facilitate the broad success of TB-HIV care strategies.

Thesis (DPhil (Psychology))--Stellenbosch University, 2008. / HIV/AIDS has emerged as one of the biggest epidemics in modern human history, and is perhaps the most researched and written about epidemic. Southern Africa is at the epicentre of the global HIV/AIDS epidemic, with almost one third of the world’s HIVpositive population living here. HIV is known to affect predominantly vulnerable populations; thus it is surprising that persons with disabilities have been largely overlooked. Little is known about how HIV/AIDS affects persons with disabilities in South Africa. This dissertation, therefore, aims to explore the extent to which organizations and schools working with persons with disabilities are dealing with HIV/AIDS, and how they are dealing with it. The study made use of an integration of quantitative and qualitative research methods. An existing survey questionnaire used in the World Bank/Yale University Global Survey on HIV/AIDS and Disability was used, with permission, as the survey instrument in a national survey of disability organizations and special needs (LSEN) schools in South Africa. The survey was distributed by post and email to 601 organizations and schools across the country, in all nine provinces. Various contacts and postings of the survey were made to organizations and schools, in an attempt to improve response rates. The response rate from national disability organizations was 57%, while the response rate for regional and local organizations and schools was very poor, with an overall response rate of 18%. The sample, however, was representative of the population. The results of the survey indicate a high level of concern about HIV/AIDS as a risk for persons with disabilities. The majority of organizations and schools were involved in providing HIV prevention education. However, most organizations and schools felt that persons with disabilities were excluded from general HIV prevention campaigns, and were thus receiving less information. A second study, using qualitative research methods, used case studies of three organizations/schools to explore more in-depth staff difficulties, challenges and particularly anxieties related to dealing with sex, sexuality and HIV among persons with disabilities. The case studies were analysed from a psychosocial framework, using social constructionist theory with psychoanalytic theory, to explore how social discourses about HIV and disabilities are internalized by staff. It is theorized that people draw on particular social discourses, in this case about HIV and disability, as a defence against threats to the self. Texts were analysed using discourse analysis to identify social discourses. A further analytic layer used psychoanalytic theory to identify unconscious communication of emotions and defence mechanisms. The case studies found that staff have considerable anxiety with regards raising issues of sex, sexuality and HIV with persons with disabilities. Staff from all three organizations were varyingly anxious about needing to protect the people they work with from harm. Disabled people were constructed as innocent, vulnerable, and needing protection. In other cases disabled people were constructed as deviant and their behaviour needing to be controlled. The use of an integration of qualitative and quantitative methods is useful, in allowing to explore more in-depth the lived experience of research participants. While the survey indicated that organizations were providing HIV prevention education, the case studies revealed much anxiety about this, and in some cases education was partly avoided. The results also suggest that HIV prevention education may be used in a way to control and restrict disabled people’s sexual expression, using a demonizing discourse about sex as dangerous and in some circumstances immoral. This may be done in an absence of a discourse of pleasure, where disabled people may be empowered to have fulfilling sexual lives. The study also highlights sexual abuse and rape of persons with disabilities as a serious issue. The dissertation ends with recommendations for further research, including exploring the experience of disabled people themselves, and the need to address the silence around sexual abuse and rape of persons with disabilities.

Collaborative TB/HIV management is essential to prevent and treat TB among HIV-positive TB patients, and to ensure that HIV-positive TB patients are detected and treated appropriately. This quantitative, descriptive, contextual study identified problems encountered during the implementation of TB case detection among HIV-positive individuals in one Ethiopian hospital. During December 2012, 300 checklists were completed about HIV-positive patients’ TB/HIV collaborative management, as reflected in their files. Only 60.2% of HIV-positive patients, who should have received Isoniazid preventive treatment (IPT), were placed on this treatment. X-rays and laboratory examinations of sputum samples were not done according to the Ethiopian guidelines. Most TB patients’ initial screening was done by nurses, not doctors, and included only symptom screening without CD4 count considerations. Managers and healthcare personnel should improve IPT, especially for those with early HIV infection and timely effective treatment for those suffering from TB, before complications arise / Health Studies / Health Studies / M.A. (Public Health)