The purpose of this study was to assess the impact of virologic monitoring frequencies on treatment failure, adherence to therapy, and the emergence of drug resistance in HIV-1 infected patients. A quantitative, meta-analysis was conducted to investigate the virologic outcomes of infrequent and frequent Viral Load (VL) testing among patient on combination antiretroviral therapy (cART). Data was collected through a self-designed data collection form. Two comparison groups emerged being guided by the VL monitoring frequency. In group I, the health outcomes were compared for (≥3 VLs per year) versus (≤2 VLs per year) and (2 VLs per year) versus (≤1 VLs per year) for group II. Data were analysed using the Cochrane's statistical software, RevMan v5.3. The findings support (2 VLs per year) as the optimal VL monitoring strategy for stable and virologically suppressed patients and there is nothing to be gained by (≥3 VLs per year). / Health Studies / M.P.H.

The existence of HIV related stigma and discrimination in institutions of learning across the world is well-documented in the literature. It is also well known that factors such as knowledge about stigma and discrimination, fear of infection, social judgment, legal and policy environment act as actionable drivers and facilitators of HIV related stigma and discrimination. However, research works focusing on how various actionable drivers and facilitators are related to different forms of HIV related stigma and discrimination at universities in Nigeria are scanty. The purpose of this study was to explore and describe the individual correlates of HIV-related stigma among undergraduate students at a public university in Nigeria. Methods: Quantitative cross-sectional descriptive design was used. Ethical clearance was obtained from the Research Ethics Committee of the University of South Africa. Permission to access the participants was obtained. The study was conducted at Ambrose Alli University which has a population of over 20,000 students. Informed consent was obtained from the participants. Simple random sampling was used to select 404 participants who were handed self-administered questionnaire. Collected data was analysed using All Pearson Chi-square test and Fishers Exact Test (p<0.05). Validity and reliability were also considered. A total of 391 questionnaires (97%) were returned and considered for analysis. Descriptive summary statistics and cross tabulations were used to analyse The results showed that a high proportion of undergraduate students still have stigmatising behaviours toward people living with HIV. These stigmatising behaviours are associated with certain individual characteristics. Recommendation: There is an urgent need for political leaders and heads of universities to implement policies and programmes that will enhance knowledge regarding HIV AND AIDS and thereby reduce stigmatizing attitudes among undergraduate students. / Health Studies / M.P.H.

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 and 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

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)

Purpose of the study - Identify predictors of mortality and develop a related care plan for patients who are on antiretroviral therapy (ART) in Gondar, Ethiopia. Design - A quantitative, retrospective cohort study was conducted analysing medical records of HIV patients who presented to Gondar University Hospital (GUH), Gondar, and started ART between 1 January 2007 and 30 June 2010. Results - In defining the predictors of mortality, the findings in bivariate analysis revealed: female sex, CD4 cell count ≤ 50/μl, CD4 cell count 51-199/μl, a haemoglobin concentration ≤8g/dl, a history of oral candidiasis, tuberculosis and Cryptococcus meningitis were all statistically significant. A female sex, CD4 cell count ≤ 50/μl and CD4 cell count 51-199/μl maintain their significance level in the multivariate analysis. Conclusions - The study therefore recommends that clinicians and case managers be vigilant of these predictors of mortality while managing HIV patients who are on ART / Health Studies / M.A. (Public Health)

M.A. / AIDS, the acquired immunodeficiency syndrome, has become a serious public health concern in most cities in countries worldwide. Since the discovery of AIDS there have been impressive advances in the understanding of the AIDS virus, its routes of transmission and its methods of prevention. But even these hard-won-discoveries have not yet led to a drug that can cure this deadly disease or to a vaccine that can prevent it. In the light of this it would appear that a different approach to the management of AIDS is currently of utmost necessity. AIDS can be prevented by empowering individuals with the knowledge of AIDS transmission and prevention, thereby eliminating their ignorance and increasing their understanding, empathy and compassion for those currently involved in dealing with this struggle. The implications of AIDS and the HI-virus (human immunodeficiency virus) range far beyond the AIDS/HIV patients themselves. The affects of HIV and AIDS are felt by family members, partners and friends whose relationships are placed under immense strain, co-workers who are confronted with their own fear and compassion and by those at high risk for the disorder who are continually faced with ridicule and discrimination. This study focused specifically on the workforce of South Africa whose economic productivity is essential for South Africa's continual development and existence. In the absence of a fully developed and integrated social infrastructure, South Africa is reliant on its workforce for its monetary contribution in support of the unemployed, underprivileged, disabled and desolate of this country. The aim of this study was to obtain a better level of understanding of the workforce's knowledge regarding HIV and AIDS, to become aware of misunderstandings and myths which could hamper prevention and to review current methods of public education in order to enhance future methods of knowledge empowerment. A healthy workforce can constitute a strong support network, and thereby not place further strain on an already overwhelmed economy and government.

Submitted in fulfillment of the requirements for the degree of Doctor of Philosophy (PhD) Health Science, Durban University of Technology, Durban, South Africa, 2017. / Background: The HIV pandemic has attracted unprecedented scale-up in resources to curb its escalation and manage those afflicted. Although evidence from developing countries suggests that public health systems have been strengthened as a result of scale-up, only anecdotes exist in other countries. Despite scale-up, the prevalence of HIV/AIDS is still high and the resultant mortality and morbidity demands a refocus. Furthermore, the HIV/AIDS epidemic has severely strained vulnerable health systems in developing countries leading to concerns among policy makers about non-HIV priority services. Although anecdotally, it is clear that HIV scale-up has had profound effects on health systems, available evidence does not allow for an assessment of the impact of such effects on health care access, service delivery or medical outcomes for non- HIV conditions. The aim of this study was to determine the impact of HIV/AIDS scale-up on non-HIV priority services in the former Nyanza Province, Kenya. Additionally we determined the benefits and detriments of HIV programmes, and identified the elements of successful HIV programs and their effect on scale-up and last but not least determined the perceptions, attitudes and experiences of health care staff towards scale-up and integration of health care services. The first part of the main sequential study reviewed practices during scale-up by looking at public health facilities within the Province at Nyanza in Kenya. This looked at health management information systems (HMIS) and routine health facility client records for five years, 2009-2013 with a comparison of trends in 2009 to that in 2013. This data was reviewed in order to show trends in delivery of HIV priority and non-HIV services. The second part of the study utilized a prospective cross sectional survey to determine perceptions, attitudes and experiences xi of facility personnel towards HIV/AIDS scale up. Randomly sampled facilities involved in the delivery of any aspects of HIV diagnosis care and treatment were investigated. Self-administered questionnaires and in-depth interviews were used to obtain information on impact of HIV services on non-HIV priority services on health managerial staff in the facilities and key informants who have shaped scale up. We created a qualitative codebook based on three major themes identified from the data: (1) Meaning and importance of HIV scale-up (2) Perspectives of scale-up on service delivery on non-HIV services and (Ministry of State for Planning) Health facility staff awareness. The findings indicate that the interventions that were utilized in the scale-up of HIV in 2009 resulted in significant increases in uptake of the service in 2013 (p<0.01) and total integration of HIV and non-HIV services at all the health facilities thereby contributing to improved health outcomes beyond those specifically addressed by HIV programs. This study has also shown that utilization of both HIV and non-HIV services increased significantly for both years after integrated HIV care was introduced in the health facilities (p<0.01). Notable increases were found for ANC utilization (p=0.09), family planning (p=0.09), screening for tuberculosis and malaria (p<0.01) and provision of support services (p<0.01) to HIV infected people. The scale up of HIV in the region had several human resource policy implications resulting from staff turnover and workload. Stakeholder engagement and sustainability are critical in the sustenance of these initiatives. Strategic alliances between donors, NGOs and the government underpinned the scale-up process. Policies around scale-up and health service delivery were vital in ensuring sustainability of scale- up and service integration. This study has attempted to provide evidence on the impact of HIV scale-up on non-HIV service delivery in three different settings, in two different time periods and it therefore concludes that the evidence is mixed with most of the impact being positive with some aspects that still needs development. It is critical to pursue the integration of HIV and non- HIV services in a strategic and systematic manner so as to maximize the public health impact of these efforts. The proposed model, best practices and practices requiring improvement will be communicated to the relevant ministries to ensure its integration into policy. / D

Submitted in fulfilment of the requirements for the Degree of Doctor in Public Management, Durban Universit of Technology, 2017. / HIV-AIDS has infected more than 37 million individuals globally and has resulted in approximately 35 million HIV-AIDS related deaths globally since its discovery 35 years ago. HIV-AIDS remains a global and local health crisis as, despite innovative and accessible HIV-AIDS prevention efforts, the disease continues to spread. UNAIDS estimated over 2 milliion new HIV-AIDS infections with 700 000 of these infections occurring in young African women in 2015, revealing that the burden of HIV-AIDS is far from over (UNAIDS, 2016). As more individuals become infected with HIV-AIDS, more infected individuals are living longer, productive lives due to the international rollout and scale-up of life-saving antiretroviral (ARV) therapy aimed at halting disease progression. In 16 years, the world has initiated over 16 million HIV-infected individuals onto ARV programmes across the world aimed at preserving first line drug effectiveness of treatment, less resistance and lower mortality and morbidity rates( UNAIDS, 2016). This number is set to double as countries across the globe take bold steps to provide ARV treatment for all, based on latest WHO guideline changes. The initiative of ARV roll out for all HIV-positive individuals globally, brings with it the challenges and complexities of infrastructure support, resource allocation, uninterrupted drug supply, global access and clinical training requirements for HIV-AIDS programmes across the globe. Quality management systems with monitoring and evaluation frameworks in particular play a pivotal role in planning, allocating and utilising resources for optimal health benefits.This research study reviews available data on the prevalence of quality management systems in HIV-AIDS healthcare and identifies gaps and smart practises towards recommendations for comprehensive global HIV-AIDS standards development. This research study aims to propose a conceptual monitoring and evaluation framework derived from quality management systems for management of HIV-AIDS private sector programmes that can be used in both public and private healthcare sectors through analysis of current conceptual frameworks in the HIV-AIDS healthcare and the HIV-AIDS programmes within the South African context of HIV-AIDS healthcare provision. / D

M.A. (Counselling Psychology) / This study is an examination of the context of the gay male individual with HIV illness. A psychosocial model is used to investigate the effects of HIV disease on the individual, his partner and the relationship. The model includes a discussion of variables which are related to adjustment to the disease." These include the special characteristics of HIV disease such as the stigma and the progressive nature of the disease. Furthermore the personality characteristics of the individual and the characteristics of his situation are examined. These factors together contribute to making HIV positive diagnosis a crisis for the individual in his context. A case study approach was used to research the subjective experiences of an HIV infected gay man and his partner. In depth interviews were conducted in order to obtain qualitative data on the individuals within the context of their relationship. The data obtained from the interviews supports the literature in many respects. Of special importance is the impact of an HIV positive diagnosis on intimacy in the relationship. Also important are the changes which occur in the sexual relationship as a result of fear of transmission of the HIV virus. Other important changes include adapting to the uncertainty of living with HIV disease and coping with the emotional reactions, which follow HIV diagnosis. The study highlights the importance of emotional support within the primary relationship as well as the role of friends and family in adjusting to HIV disease. The study also demonstrates the importance of effective communication in dealing with the various stresses associated with HIV disease. Lastly therapeutic interventions have been suggested for counselling the gay infected person and his partner in order to help them to cope with the crisis of HIV disease.