Thesis (MPhil)--Stellenbosch University, 2011. / ENGLISH ABSTRACT: People diagnosed as being HIV positive or having AIDS develop depression as they attempt to cope with their daily lives. Some studies have indicated the prevalence of depression and anxiety in people living with HIV/AIDS is higher than in the general population. An evaluation of gender related factors that lead to depression after a diagnosis with HIV/AIDS will highlight the incidences and frequency of what individuals experience in their daily lives. The research is a descriptive study in which the factors that cause depression after HIV/AIDS diagnosis were identified and related to gender. Both quantitative and qualitative methods were used to analyse the responses elicited from the participants in the sample. Twenty five PLHAs who had been diagnosed with depression were selected from patients attending both Nthabiseng and Luthando Clinics at Chris Hani Baragwanath Hospital in Soweto, Johannesburg. A questionnaire was designed to gather demographic as well as information regarding family, social and economic history. A short interview was also conducted with selected patients to determine in their own words what causes their depression. The selected patient hospital charts were analysed to gain additional information to complete the equation. A semi structured interview was conducted with 13 selected health care professionals to gather information on how they see depression in the presence of HIV and whether they are adequately equipped to detect and manage this condition. The findings from this study supported the view depression is present or develops after a positive HIV diagnosis and a difference was detected in the causes of depression in women and that of men. Common causes of depression after HIV diagnosis were denial, fear of death and social insecurity. Women were more likely to attribute their depression to denial and worry about work and family responsibility. Men attributed their depression to failure to provide for their family and loss of social status. Recognising the causes of and gender differences in the causes of HIV-related depression may help in designing more effective counselling strategies and improve management and care of PLHAs. / AFRIKAANSE OPSOMMING: Daar is 'n aantal mense wat nie aan depressie ly voordat hulle met HIV gediagnoseer word nie. Meeste studies dui aan dat die voorkoms van depressie en angstigheid by mense wat lewe met MIV en VIGS heelwat hoër is as die algemene MIV populasie. Baie mense, insluitende gesondheidsorgwerkers, neem aan dat depressie 'n onontsnapbare newe-effek is van MIV/VIGS diagnose. Dus mag dit gebeur dat depressie ongesiens verby gaan, onbehandeld, met die gevolg van oneffektiewe behandeling, riskante optrede, swak bestuur van MIV/VIGS en 'n lae lewenskwaliteit vir hierdie pasiënte. Hierdie navorsingsartikel kyk na die geslags-verwante faktore wat lei tot depressie na die diagnosering van MIV/VIGS. Die navorsing is 'n beskrywende studie waarin faktore wat depressie in MIV/VIGS gediagnoseerde pasiënte veroorsaak identifiseer en gedifferensieer word afhangende van geslag. Kwantitatiewe asook kwalitatiewe metodes is gebruik. Dertig PLHAs wat met depressie gediagnoseer is, word behandel in Nthabiseng asook Luthando Kliniek by die Chris Hani Baragwanath Hospitaal in Soweto, Johannesburg. Nthabiseng is die MIV Kliniek en Luthando is die psigiatriese kliniek vir MIV/VIGS pasiënte. 'n Vraelys is saamgestel om demografiese asook familie, sosiologiese en ekonomiese inligting te verkry. 'n Kort onderhoud is ook met sommige pasiënte gehou om in hul eie woorde te hoor wat hul glo hul depressie veroorsaak. Die geselekteerde pasiënte se hospitaal kaarte is geanaliseer, met die doel om die dokter se insette of redes te kry oor die pasiënte se depressie. 'n Semi-gestruktureerde onderhoud was gedoen met gesondheidsorgwerkers in Luthando- en Nthabiseng klinieke om inligting te verkry oor hoe hierdie professionele gesondheidsorgwerkers depressie sien by MIV/VIGS pasiënte en of hul bevoegd is om dit te identifiseer en te behandel. Die studie het bevind dat daar 'n verskil is by oorsake van depressie by vroue en oorsake van depressie by mans. Mees algemene oorsake van depressie by MIV/VIGS pasiënte is ontkenning, vrees van dood en sosiale onstabiliteit. By die vroue het ontkenning en bekommernis oor werk- en familie verantwoordelikhede meestal bygedra tot hierdie depressie, en by die mans was dit meer asof daar 'n algemene terleurstelling geheers het in hul gemoed. 'n Terleurstelling deurdat hul nie vir hul families sal kan sorg nie asook die vernedering in die sosiale netwerk. Om die verskille in MIV-geassosieerde depressie gebasseer op geslag te kan herken mag bydra tot die ontwerp van meer effektiewe beradingstrategië.

Thesis (M.B.A.)-Business Studies Unit, Durban Institute of Technology, 2005 xii, 127 leaves / The knowledge, attitude and training needs of line managers at the South African Sugar Association (SASA) with regards to the management of HIV/AIDS infected employees. Background: The rapid spread of HIV/AIDS is having an increasingly adverse impact on the operations of companies. Due to the changing environment in which line managers have to operate as a result of HIV/AIDS, line managers will increasingly be faced with handling HIV/AIDS infected employees and all the issues surrounding this epidemic. The research investigates the knowledge, attitude and training needs of line managers in SASA with regards to the management of HIV/AIDS infected employees. Objective: The goals of the research are; 1). To ascertain the prevailing level of knowledge, attitude and training needs of line managers at SASA with regards to the management of HIV/AIDS infected employees. 2). To establish the relationship between the biographic variables and knowledge, attitude and training needs with regards to the management of HIV/AIDS infected employees.

Introduction: South Africa is currently experiencing one of the most severe AIDS epidemics in the world with South Africa‘s public sector under great stress and under-resourced whilst there exists a vibrant private healthcare sector. Private healthcare sector doctors have a pivotal role to play in the management of HIV and AIDS infection. However not much is known about the extent of private healthcare sector doctor involvement in the management of HIV and AIDS patients. In addition these doctors need to have an accurate knowledge of the management of the infection, and a positive attitude towards the treatment of persons with HIV and AIDS. With the availability of antiretroviral drugs only since around 1996, many of the doctors who were trained prior to 1996 would not have received any formal training in the management of HIV and AIDS patients, further it is very important that these doctors constantly update their knowledge and obtain information in order to practise high-quality medicine. Although private sector doctors are the backbone of treatment service in many countries, caring for patients with HIV brings a whole new set of challenges and difficulties. The few studies done on the quality of care of HIV patients, in the private sector in developing countries, have highlighted some problems with management thus it becomes important to ascertain these doctors‘ training needs together with where these doctors source information on HIV/AIDS to stay updated. In South Africa two thirds of the doctors work in the private sector. To address some of the resource and personnel shortages facing the public sector in South Africa, partnerships between the public and private sectors are slowly being forged. However, little is known about the willingness on the part of private sector doctors in the eThekwini Metro of KwaZulu-Natal, to manage public sector HIV and AIDS patients. Though many studies have been undertaken on HIV/AIDS, fewer have been done in the private sector in terms of the management of this disease which includes doctors‘ adherence monitoring practices, their training needs and sources of information and their willingness to manage public sector patients. A study was therefore undertaken to assess the involvement of private sector doctors in the management of HIV, their training needs and sources of HIV information, the quality of HIV clinical management that they provided, together with their strategies for improving adherence in patients. Further the study assessed factors that affect adherence in patients attending private healthcare, and finally investigated whether private sector doctors are willing to manage public sector HIV infected patients. A literature review of the barriers that prevent doctors from managing HIV/AIDS patients was also undertaken. Method: A descriptive cross sectional study was undertaken using structured self reported questionnaires. All private sector doctors practising in the eThekwini Metro were included in the study. The study was divided into different phases. After exclusions a valid sample of 931 participants was obtained in Phase 1. However only 235 of these doctors indicated that they managed HIV infected patients, of which only 190 consented to be part of Phase 2 of the study. In Phase 2 the questionnaires were administered by trained field workers to the doctors after confirming doctors‘ consent. The questionnaires were thereafter collected, the data captured and analysed using SP55 version 15. Results: Although 235 (71.6%) doctors managed HIV and AIDS patients, 93 (28.4%) doctors did not, and of the latter 48 (51.61%) had not encountered HIV and AIDS patients, twenty five (26.88%) referred such patients to specialists, six (6.45%) cited cost factors as reasons for not treating such patients, whilst twelve (12.90%) doctors, though they indicated that there were other reasons for not managing HIV infected patients, did not specify their reasons. Two doctors (2.15%) indicated that due to inadequate knowledge they did not manage HIV and AIDS patients. Significantly younger (recently qualified) doctors rather than older (qualified for more years) doctors treated HIV/AIDS patients (p<0.001). Most doctors (76.3%) expressed a need for more training/knowledge on the management of HIV patients. Eighty five doctors (54.5%) always measured the CD4 count and viral load levels at diagnosis. Both CD4 counts and viral load were always used by 76 doctors (61.8%) to initiate therapy. Of the doctors 134 (78.5%) initiated therapy at CD4 count < 200cells/mm3. The majority of doctors prescribed triple therapy regimens using the 2 NRTI +1 NNRTI combination. Doctors who used CD4 counts tended to also use viral load (VL) to assess effectiveness and change therapy (p<0.001). At initiation of treatment 68.5% of the doctors saw their patients monthly and 64.3% saw them 3-6 monthly when stable. The majority of the doctors (92.4%) obtained information on HIV and AIDS from journals. Continuing Medical Education (CME), textbooks, pharmaceutical representatives, workshops, colleagues and conferences were identified as other sources of information, while only 35.7% of doctors were found to use the internet for information. GPs and specialists differed significantly with regard to their reliance on colleagues (52.9% versus 72.7%; p < 0.05) and conferences (48.6% versus 78.8%; p < 0.05) as sources of HIV information. Of the respondents, 78.9% indicated that they monitor for adherence. Comparison of GPs and specialists found that 82.6% of the GPs monitor for adherence compared to 63.6% of the specialists. (p=0.016). Doctors used several approaches with 60.6% reporting the use of patient self reports and 18.3% pill counts. Doctors (68.7%) indicated that their adherence monitoring is reliable, whilst 19.7% stated they did not test the reliability of their monitoring tool. The most common strategy used to improve adherence of their patients was by counseling. Other strategies included alarm clocks, SMS, telephoning the patient, encouraging family support and the use of medical aid programmes. One hundred and thirty three (77.8%) doctors were willing to manage public sector HIV and AIDS patients, with 105 (78.9%) reporting adequate knowledge, 99 (74.4%) adequate time, and 83 (62.4%) adequate infrastructure. Of the 38 (22.2%) that were unwilling to manage these patients, more than 80% cited a lack of time, knowledge and infrastructure to manage them. Another reason cited by five doctors (3.8%) who were unwilling was the distance from public sector facilities. Of the 33 specialist doctors, 14 (42.4%) indicated that they would not be willing to manage public sector HIV and AIDS patients, compared with only 24 (17.4%) of the 138 GPs (p < 0.01). There was no statistical difference between adherence to treatment and demographics of the respondent patient such as age, gender and marital status. In this study 89.1% of patients were classified as non-adherent and reasons for non-adherence included difficulty in swallowing medicines (67.3%) (p = 0.01); side effects (61.8%) (p = 0.03); forgetting to take medication (58.2%) (p = 0.003); and not wanting to reveal their HIV status (41.8%) (p = 0.03). Common side effects experienced were nausea, dizziness, insomnia, tiredness or weakness. Reasons for taking their medicines included that tablets would save their lives (83.6%); they understood how to take the medication (81.8%); tablets would help them feel better (80.0%); and that they were educated about their illness (78.2%). All participants that were on a regimen that comprised protease inhibitors and two NRTIs were found to be non-adherent. Conclusion: All doctors in the private healthcare sector were not involved in the management of HIV/AIDS patients. Doctors indicated that they required more training in the management of HIV/AIDS patients. However private sector doctors in the eThekwini Metro do obtain information on HIV from reliable sources in order to have up-to-date knowledge on the management of HIV-infected patients, with the majority of private sector doctors being compliant with the current guidelines, hence maintaining an acceptable quality of clinical health care. These doctors do monitor for adherence and employ strategies to improve adherence in their patients who do have problems adhering to their treatment due to various factors. Many private sector doctors are willing to manage public sector HIV and AIDS patients in the eThekwini Metro, potentially removing some of the current burden on the public health sector. / Thesis (Ph.D.)-University of KwaZulu-Natal, Durban, 2010.

AIM The aim of the study was to conduct a process evaluation of the implementation of the HIV/AIDS counselling and treatment program (HCT) for employees to ensure the delivery of standardised, high quality and ethical HIV counselling and testing services at a selected Regional Hospital in KwaZulu-Natal. METHOD A quantitative, non-experimental descriptive evaluative design was used to conduct the study. The study consisted of a two (2) questionnaire survey of a sample of 140 participants; One for the staff working in the HCT clinic (n=8) to evaluate the implementation of the HCT activities and the other for the staff that are employed at the selected public hospital (n=132) to evaluate their knowledge, attitudes and practise towards the HCT program. A checklist of the venue was also completed to evaluate the resources available at the HCT clinic. Informed consent was obtained from each participant. SPSS version 19 was used for data analysis. RESULTS The study revealed that the implementation practises of the HCT program were not according to the National Policy for HIV Counselling and Testing Guidelines (Department of Health, 2009) with regards to the availability of resources at the HCT clinic such as HIV test kits, chairs, gloves and sharps containers were available. Privacy was maintained while resources including condoms; directions such as posters to the clinic; pamphlets and reading material were unavailable. Nurse’s knowledge and attitude was neutral. There were no correlations between nurses that attended a HIV course and those that did not. The distribution of knowledge was the same across all categories of experience and level of education. The majority of nurses had an HIV test voluntarily and found out the results. The finding of the study does not indicate whether or not the HIV test was done at the staff HCT clinic or elsewhere. A small minority reported that they tested for employer and insurance purposes. A significant proportion of participants did not test because they were afraid that a person they know may test them and tell others and also because they did not think that the medical and nursing staff kept their testing information confidential. CONCLUSIONS AND RECOMMENDATIONS For the HCT program to be successfully implemented, resources and supplies must be available at the HCT clinic should an employee wish to use its services. It is recommended that funds be made available and budgeted for to increase the supplies of HIV test kits; provide condoms, books, pamphlets and reading material at the clinic. The researcher also recommends courses be offered to nurses that are interested; include HIV/AIDS courses in the curriculum of nurses attending the college; provide in-service education/training for employees regarding the HCT program, its resources and activities; provide anti-retro viral treatment (ART) to employees at the HCT clinic in order to decrease untimely AIDS deaths. / Thesis (M.N.)-Unversity of KwaZulu-Natal.

Thesis (MPhil)--Stellenbosch University, 2005. / ENGLISH ABSTRACT: HIV-positive employees that receive treatment for HIV/AIDS by having their employers pay for the treatment are being taxed on their lifesaving HIV benefits paid by their employer. This comes after the Commissioner of Inland Revenue (CIR) or South African Revenue Service (SARS) identified the provision of treatment by employers as a “fringe benefit” in terms of paragraphs 2(e), 2(h) and 2(i) of the Seventh Schedule to the Income Tax Act1 and as such is taxable if the treatment is given from the work place. The treatment contribution is included in an employee’s remuneration package as a fringe benefit. Pay-as-you-earn (PAYE) and other assessed taxes are calculated from that. The taxable benefit is included on the employees’ annual IRP5 certificates. In order for the employer’s Human Resources department to affect this on the IRP 5 certificates the affected employee has to disclose his HIV/AIDS status and accordingly pay the PAYE on the fringe benefit. In terms of paragraph 2(e) of the Seventh Schedule to the Income Tax Act No. 58 of 1962, any service rendered at the expense of the employer to the employee, whether by the employer or by some other person, which has been utilised by the employee for private or domestic use, such value of the service must be included in the employee’s consideration for remuneration. Paragraph 2(h)2 taxes the employees on debts paid by the employer on behalf of the employees and paragraph 2(i)3 taxes a one third contribution benefit back in the hand of an employee for contributions to medical aids. If the employee were to receive chronic medication from a medical aid for HIV/AIDS treatment this will be included in the fringe benefit tax as a medical contribution.The Employment Equity Act No. 55 of 19984 promotes the elimination of unfair discrimination in the work place and ensures the implementation of Employment Equity to redress the effects of discrimination. Above all it also promotes the constitutional right to equality. In terms of confidentiality of the employees HIV/AIDS status; the Income Tax Act No. 58 of 1962 (Income Tax Act)5 as interpreted seems to be in conflict with the Employment Equity Act No. 55 of 1998. A solution therefore has to be sought where: - The anonymity of an employee in terms of his/her HIV/AIDS status is protected as envisaged by the Employment Equity Act6. - It is also necessary to understand whether there is in fact conflict between the Income Tax Act7 and the Employment Equity Act8. - It is also necessary to establish whether there are any misconceptions in the interpretation of the legislation and - Try to find the best possible solution to minimise the impact of Income Tax and yet protect the confidentiality of the employees concerned. / AFRIKAANSE OPSOMMING: MIV-positiewe werknemers wat behandeling vir MIV/VIGS ontvang by hul werkgewers word belas op hul lewensreddende MIV voordele wat deur hul werkgewers betaal word. Hierdie word bepaal nadat die Kommisaris van Binnelandse Inkomste (KBI) of die Suid- Afrikaanse Belastingsdiens (SAB) die voorsiening van behandeling deur werkgewers ag as ‘n belastingbyvoordeel in terme van paragrawe 2(e), 2(h) en 2(i) van die Sewende Skedule van die Inkomste belastingwet9 indien die diens gelewer word buite die werksplek. Die bydrae tot behandeling word ingesluit in die werknemer se vergoedingspakket as ‘n belasbare byvoordeel. Werknemersbelasting of LBS en ander aangeslaande belastings word hiervandaan bereken. Die byvoordeel word op die werknemer se IRP5 sertifikaat aangedui. Om hierdie aan te dui op die IRP5 sertifikaat van die geaffekteerde werknemer moet die werknemer se MIV status aan die werkgewer se Menslike Hulpbron departement bekend wees om die nodige byvoordeel te bereken. In terme van paragraaf 2(e)10 van die Sewende Skedule van die Inkomste Belastingwet nr. 58 van 1962, word enige diens gelewer deur die werkgewer namens die werknemer, of deur die werkgewer of deur sekere ander persone, wat gebruik word deur die werknemer vir privaat en huishoudelike gebruik geag as vergoeding te wees en die diens moet ingesluit wees in die vergoedingspakket. Paragraaf 2(h)11 belas die werknemers op skuld betaal namens die werknemer deur die werkgewer en paragraaf 2(i)12 belas een derde van die bydrae terug in die hand van die werknemer vir bydraes betaal deur die werkgewer aan mediese fondse. Indien die werknemer kroniese medikasie ontvang van die mediese fonds vir MIV/VIGS behandeling sal dié belas word as ‘n belasbare byvoordeel. Die Gelyke Indiensnemingwet nr 55 van 199813 bevorder die eliminasie van ongeregmatige diskriminasie in die werksplek en verseker dat die implementasie van die wetgewing die impak van diskrimasie reg aanspreek. Die wetgewing bevorder die konstitisionele reg tot gelykheid. In terme van die vertroulikheid van die MIV/VIGS status van werknemers bleik die Inkomstebelastingwet in konflik te wees met die Gelyke Indiensnemingswetgewing. ‘n Oplossing moet dus gevind word, waar: - Die anonimiteit van die werknemers in terme van hul MIV/VIGS status beskerm word soos veronderstel word in die Indiensnemingsekwiteitswetgewing - Dit is ook nodig om te verstaan of daar inderdaad konflik is tussen die onderskeie wetgewings, naamlik die Inkomstebelastingwet en die Indiensnemingsekwiteitswetgewing. - Dit is ook belangrik om te bepaal of daar enige miskonspesies in die interpretasie van die wetgewing is en - Om te probeer om die bes moontlike oplossing te vind om die impak van Inkomstebelasting te verminder en terselfdertyd die konfidensialiteit van die werknemers te verseker.

Thesis (MPhil)--Stellenbosch University,2005. / ENGLISH ABSTRACT: The aim of this research is to investigate the impact of HIV/AIDS among different organizations in Lesotho and how they respond to the challenge; and to determine whether these organizations respond positively/effectively to the challenge of the pandemic in their respective organizations and whether they have developed workplace programmes and policies which address the issue, and if they do exist, whether they are effective. Lesotho is one of the countries in the world with a very severe HIV/AIDS infection rate. It is estimated that 28.9% of the entire population was living with HIV/AIDS as of December 2003 (UNAIDS, 2004). The increasing number of HIV/AIDS infectees in the country is affecting the entire labour force; therefore to effectively respond to the pandemic, the government of Lesotho and its development partners and civil society organizations are doing everything within their means to control it. Therefore, work place programmes that deal with HIV/AIDS on the work environment should be an answer to the social capital issue; the most valuable resource being human capital, since the programmes would promote prevention, information, education and training. It would also promote the rights of staff members and their dependants living with and/or affected by the HIV/AIDS pandemic. The population where the investigation was done is made up of corporate places of work stratified into five types of organizations found in Maseru, the capital of Lesotho: o Non-governmental organizations o Private sector o Development partners ( Diplomatic Missions/Donors) o Parastatals o Government The results of the study indicated that the majority of these organizations have workplace programmes and policies which are effective and appreciated by the employees, while others are in the process of drawing up their policies or already have them in draft form. Despite all the efforts being put in place, the feeling among some of the organizations is that HIV infection in Africa will continue to increase because of the way it is being addressed; what they call ‘The Western way’. They feel that if it is addressed situationally, not academically, there will be a slight difference. For example, they claim that Africans do not feel comfortable about bringing their private behaviours in the open; for instance, speaking about sex and sexuality. The belief systems of the Basotho are also identified as great influencers in the pandemic. These include the culture/traditions, relations with the family and pressure from peers, people whom we trust and the fulfilment of women's sexual desires. The conclusion reached is that the different organizations in Lesotho address the challenge of HIV/AIDS positively and in others effectively, and with more effort the pandemic could be brought under control in the near future. The recommendation after viewing the findings, is that the issue of care and support, stigma and discrimination are still issues that need to be worked on, since employees are scared to know their status due to fear of being stigmatized. Therefore, the above cannot be addressed properly unless they are seen in practice. / AFRIKAANSE OPSOMMING: Die doel van hierdie studie is 'n ondersoek na die impak van MIV/Vigs op, en reaksie van verskillende ondernemings in Lesotho. Volgens beraming is die infeksiekoers van Lesotho 28.9% en is die invloed daarvan op die werkersmag beduidend; dit kan selfs katastofies raak indien dit nie doeltreffend aangespreek en bestuur word nie.. Data is versamel by by vyf kategorië van ondernemings in Maseru ten einde te verseker dat al die belangrikste sektore deur die studie betrek word.. Resultate toon aan dat die meeste ondernemings wel werksplekprogramme en MIV/Vigs-beleid in plek het. Die persepsie van werkers binne die ondernemings wat in die ondersoek gebruik is toon egter 'n negatiewe prognose ten opsigte van die doelteffende bestuur van die pandemie. Die gevoel is dat die benadering te reglynig en "Westers" is en dat die metafore en tradisies van Afrika meer effektief in voorkomingsprogramme sal wees. Voorstelle in hierdie verband word gemaak. Voorstelle vir meer doeltreffende voorkomingsprogramme word gemaak en voorstelle vir verdere studies in Lesotho word aan die hand gedoen.

Thesis (MPhil)--Stellenbosch University, 2005. / ENGLISH ABSTRACT: The present article is a research study aimed at providing an accurate picture of the problem of HIV and Aids-related stigma and discrimination within a company, by identifying the possible factors that help fuelling it, and describing the relationships among them. On the basis of these findings, I propose initiatives that may help to overcome the main barriers for stigma mitigation within the company, and provide suggestions for inclusion in the company’s HIV and Aids policy of strategies and positions that may thwart stigma among the workforce. / AFRIKAANSE OPSOMMING: Die doel van hierdie studie was om ‘n akkurate beskrywing te gee van stigma en diskriminasie wat romdon MIV/Vigs bestaan. Die studie is in ‘n maatskappy in Maputo, Mosambiek, uitgevoer. Moontlike faktore wat hierdie stigma en diskriminasie aanwakker is gegee en ook die verhouding tussen die faktore. Voorstelle word gegee om stigma binne die maatskappy te verminder en ook om dit by die maatskappy se MIV/Vigs beleid in te sluit.

Increasing HIV infection rates affect government employees as much as workers in other places. While government has responded to the evolving crisis with a number of policy documents, little is known about the implementation of such policies in government departments. This study assessed the HIV/AIDS policy in the Department of Labour and identified weakness in the implementation. The results of the study may be used by the Dept. of Labour to improve its implementation if necessary.

On t.p.: Degree MSc Dental Science (Community Dentistry) / Thesis (MSc)--Stellenbosch University, 2002. / ENGLISH ABSTRACT: The purpose of this review was to investigate the management of oral candidiasis in HIV/AIDS patients and to evaluate the different guidelines that are available for its management. To achieve this aim, three objectives were identified: (i) to identify and report on the different interventions used to manage oral candidiasis, in patients with HIV/AIDS, (ii) to determine the efficacy of these interventions, and (iii) to provide guidelines for management. A thorough systematic search of the literature was carried out and all relevant papers were graded into three levels of evidence (A, B, and C) and scored for quality according to set criteria. A number of topical and systemic antifungal medications are used to treat oral candidiasis in HIV-positive patients. These include the poleyne antibiotics, nystatin and amphotericin B. Milder episodes of oral candidiasis respond to topical therapy with nystatin, clotrimazole troches or oral ketoconazole. Fluconazole has been extensively evaluated as a treatment for candidiasis. With HIV-infection, a cure rate of 82% has been achieved with a daily oral dose of 50 mg. Fluconazole was found to be a better choice of treatment for relapsing oropharyngeal candidiasis, resulting in either better cure rates or better prevention of relapse. Intravenous amphotericin B has been found to be effective therapy in azole refractory candidiasis where it was shown to be safe and well tolerated. Topical therapies were found to be effective treatment for uncomplicated oropharyngeal candidiasis, however patients relapsed more quickly than those treated with oral systemic antifungal therapy. Overall, nystatin appears less effective than clotrimazole and the azoles in the treatment of oropharyngeal candidiasis. With regard to the resolution of clinical symptoms, clotrimazole was found to be just as effective as the azoles, except when patient compliance was poor. Fluconazole-treated patients were more likely to remain disease-free during the fluconazole follow-up period than with those treated with other interventions. Relatively few studies were qualified to address the provision of guidelines for the management of oral candidiasis in primary health care settings. Most of the studies found were of moderate and low quality level of evidence. These studies included the assessment of different guidelines for identification, treatment and dental needs. They stressed that patients with HN need dentists who will act as primary health care providers, together with other providers to ensure adequate overall care. Given the level of interest and importance of candidiasis associated with treatment of HN -positive patients, it is surprising to find that little high quality research has been undertaken. As such, it is hoped that this review would provide researchers, oral health care workers and other health care providers with an overview of the management of oral candidiasis associated with HN/AIDS. / AFRIKAANSE OPSOMMING: Die doelstelling van die oorsig was om ondersoek in te stel na die hantering van orale kandidiase in HIV/AIDS pasiënte asook om die verskillende beskikbare riglyne vir die behandeling daarvan te evalueer. Ter verwesenliking van hierdie doelstelling is drie doelwitte geïdentifiseer: (i) om die intervensies wat gebruik word in die hantering van orale kandidiase behandeling te identifiseer, (ii) om die effektiwiteit van hierdie intervensies te identifiseer en (iii) om op grond hiervan riglyne vir die hantering voor te stel. 'n Sistematiese literatuursoektog is uitgevoer en alle relevante artikels is in drie groepe geklassifiseer (A, B en C) op grond van die data kwaliteit. 'n Verskeidenheid topikale en sistemiese antifungale middels word gebruik om orale kandidiase in HIV-positiewe pasiënte te behandel. 'n Sukseskoers van 82% is met die gebruik van 'n daaglikse dosis van 50 mg medikament gerapporteer. Fluconazole was die beter keuse van middel vir die behandeling van terugkerende orofaringeale kandidiase. Topikale behandeling was effektief in die behandeling van ongekompliseerde orofaringeale kandidiase, hoewel die kans op terugkeer van die toestand groter was as met die sistemiese middels. Pasiënte wat met flukonasool behandel is, het 'n groter kans gehad om siektevry te bly vergeleke met pasiënte op die ander intervensies. Meeste van die studies was van middelmatige tot lae kwaliteit en gevolglik was dit moeilik om behandelingsriglyne te stel. Wat egter wel duidelik is, is dat HIV pasiënte primêre mondsorg benodig wat saam met ander versorging omvattende sorg sal verseker.

Improving the implementation of family planning through integration with HIV services is vital to reduce maternal and child morbidity and mortality that has been a concern especially in developing countries like Ethiopia (UNFPA 2016). The aim of this study was to develop a strategic plan that could facilitate the implementation of an integrated family planning and HIV services at the public health centre level. The researcher utilized an explanatory sequential mixed method design with quantitative data collected in the first phase and qualitative data collected in the second phase. Data were collected from 403 clients in face-to-face structured interviews and from 305 service providers by means of a self-administered questionnaire. Descriptive analysis was applied to describe the findings of the study. Significance testing between variables was computed by odds ratio, p-value and 95% confidence interval. Bivariate and multi-variate logistic regressions were used for the analysis. In Phase 1, awareness of family planning methods, male involvement, marital status, client satisfaction, family income, waiting time, training, awareness of policies/guideline and transport availability were statistically significant challenges identified by clients and service providers. The client and service provider respondents identified previous use of family planning, men’s involvement, client satisfaction, availability of behavioural change communication materials, accessibility, budget, infrastructure and medical resources as opportunities. In phase 2, the researcher utilized the nominal group technique (NGT) to collect qualitative data from programme officers. Twenty-four programme officers from 10 sub city health offices, city and national level participated in two nominal groups, consisting of 12 participants each. Multiple group analysis was used to analyse the data from the nominal groups. The five strategies ranked as the most important were leadership and management; capacity building; implementation of policies and guidelines; advocacy/awareness, and infrastructure. The findings in phase 1 and phase 2 formed the basis for the development of a strategic plan using the process planning model. The strategic plan was developed and validated with the active participation and involvement of programme officers. The plan is intended to be implemented by service providers and programme officers to facilitate the implementation of integrated family planning and HIV services at the public health centre level. / Health Studies / D. Litt et. Phil. (Health Studies)