Thesis (M. A. (Clinical Psychology)) --University of the North, 2002 / Refer to the document

Thesis (Ph.D. (Nursing Science)) -- University of Limpopo, 2018 / Introduction: Health care workers have a pivotal role in the management of Human Immune Deficiency Virus (HIV) and Acquired Immune Deficiency Syndrome (AIDS) and their well-being is consequently crucial as it could impact negatively on the quality of caregiving. With the development of a care and support model, the needs of health care workers can be identified and catered for, and quality patient care will be rendered through well-cared and supported health care workers. Purpose: The purpose of this study was to develop a care and support model for health care providers of patients diagnosed with HIV and AIDS in the public hospitals of the Limpopo Province. A key step in the development of a model for care and support is to explore and describe the experiences of professional nurses regarding care and support they receive while providing care to HIV and AIDS patients in the public hospitals of Limpopo Province Methods: A qualitative, descriptive, exploratory and contextual design was the method used which guided the development of the model. The population of the study were the professional nurses in five public hospitals from each district of the Limpopo Province. These hospitals were selected because they all shared similar characteristics of having clinics where HIV and AIDS patients receive care. The sample was purposively selected. The sample size was 20 professional nurses which was determined by data saturation, meaning that four professional nurses who worked for 24 months or more per public hospital were selected. Data were collected through face-to-face interviews and an audiotape was used to record all unstructured interview sessions conducted. Analysis of data were done through using an open-coding method in accordance with Tech’s qualitative data methodology to develop a model. Results: The research findings revealed emotional and physical strain due to shortage of staff and heavy workload which was exacerbated by staff turnover and high absenteeism. Exhaustion, fatigue, development of work-related vi illnesses and increased level of stress were also challenges experienced which led to increased customer complaints and decreased quality of service provided to patients. Many professional nurses were not trained in the management of patients with HIV and AIDS, but were expected to execute their activities competently. There was also lack of counselling, debriefing sessions, recognition and rewarding systems for the health professionals who were taking care of those patients. Recommendations: This Care and Support Model provides strategies to be used by the managers in public hospitals of Limpopo Province to enhance care and support to health care providers of HIV and AIDS patients. The model should be implemented at various public hospitals throughout Limpopo Province and feedback provided so that it could be further developed and refined. Conclusion: The results indicated that health care providers of HIV and AIDS patients were deprived of the necessary care and support during provision of care to HIV and AIDS patients. A model for care and support as a strategy to assist the managers to offer care and support to health care providers of HIV and AIDS has been developed. The model is a contribution to the nursing management, the government and it serves as a guideline for improving the quality of patient care through well-cared and supported health care workers.

With greater advancement in medical treatments for individuals with Human Immunodeficiency Virus (HIV) and Acquired Immunodeficiency Syndrome (AIDS), a growing numbers of individuals living with HIV/AIDS are contemplating returning to the workplace. However, they have been faced with barriers to employment and have demonstrated a need for vocational rehabilitation (VR) services. The purpose of this study was to identify predictors of employment outcomes of individuals living with HIV/AIDS, who used the state/federal VR program services, using the Rehabilitation Services Administration (RSA-911) data file from Fiscal Year 2006. Data analyses were conducted using descriptive statistics, bivariate analyses (chi-square analyses, independent t-tests, and ANOVAs), and binary logistic regression using cross validation. Results of the study indicated that of socio-demographic, health, and VR service variables, service variables were only found to be significantly related to employment outcomes. Job search assistance, job placement assistance, and on the job support were found to be significant predictors of successful employment outcomes at closure. In addition, higher costs of purchased services increased the likelihood of being employed at closure. However, the longer the length of VR program participation was, the lower the likelihood of being employed at closure was. Among participants with successful employment outcomes at closure, differences were significant between participants earning less than $200.00 per week and participants earning equal to or higher than $500.00 per week. Participants with less than $200.00 of weekly earnings were more likely to be African Americans, to have lower education levels than an associate degree at closure, to have service occupations or clerical and sales occupations, and to receive SSI, SSDI, Medicaid, and Medicare. On the other hand, participants with equal to or more than $500.00 weekly earnings were more likely to be White, to have higher education levels than an associate degree, and to have professional and managerial occupations and were less likely to receive SSI, SSDI, Medicaid, and Medicare. In addition, they were more likely to receive assessment, VR counseling and guidance, college or university training, job search assistance, transportation, maintenance, and information and referral services compared to those with less than $200.00 weekly earnings. Implications for practice and suggestions for future research are discussed. / text

Source: Masters Abstracts International, Volume: 46-05, page: 2669. Adviser: Jan M. Risser. Includes bibliographical references.

Assignment (MPhil)--University of Stellenbosch, 2006. / Bibliography. Also available via the Internet.

This study examines the lifestyle decisions of people who are diagnosed with HIV/AIDS in King Williams Town, Eastern Cape. The study was motivated by the ever growing number of people who are now living with HIV/AIDS. Therefore the researcher intended to examine their decisions regarding sexual choices, reproductive health, diet, physical fitness and their coping strategies. The study found that there is very low uptake of Voluntary Counseling and Testing (VCT). Most people only get tested if they are compelled by other factors, like illness and pregnancy. It also found that HIV positive people continue to engage in risky sexual behaviour regardless of their positive status. In addition it also found that HIV positive status does not affect sexual activity and social support from family and friends is a very important factor that is helping the respondents to cope with HIV diagnosis.

Thesis (MPH.) -- University of Limpopo, 2021 / Introduction: HIV/AIDS remains a disease of public health importance and mother-to-child transmission (MTCT) is one of the major problems. Sub-Saharan Africa is the most severely affected region, accounting for more than 90 percent of paediatric HIV infections. Most of these infections occurred during pregnancy, delivery or breastfeeding making the prevention of mother-to-child transmission (PMTCT) a public health priority. Over the last few years, efforts have been made in Sub-Saharan countries to improve PMTCT and the success of prevention of mother‐to‐child transmission of HIV (PMTCT) is dependent upon high retention of mother‐infant pairs within the PMTCT cascade. Assessing the risk factors for MTCT will help to decrease child morbidity and mortality and strengthen PMTCT programs as there is dearth of evidence regarding factors determining MTCT HIV infection to infants born to HIV positive mothers. The purpose of this study was to investigate the determinants for the human Immunodeficiency Virus positivity rates in the Greater Letaba Municipality. The study objectives were to describe the demographic characteristics of mothers and babies who tested polymerase chain reaction test (PCR)-positive in the Greater Letaba Municipality during the two-year period from 2015 to 2016, in order to determine maternal and neonatal factors associated with high positive PCR; and to determine health system-related factors associated with a high positive PCR result. Methodology The current study followed a quantitative approach in which convenient and purposive sampling was used, focusing on records of infants born from HIV-positive women in all clinics at Greater Letaba Municipality were reviewed. All records of infants who were tested for HIV and the PCR results were positive from birth up to 12 months of age were retrospectively reviewed and for the health care workers, all nurses working as managers of a clinic were interviewed. The Statistical Package for the Social Sciences (SPSS) version 23 computer software and Stata 15 was used. for comparison of categorical variables was done using a Chi-Squared test, whereas continuous variables were compared using a t-test and P-value of <0.05 was considered significant. To determine maternal and neonatal factors associated with high positive PCR, Factor analysis was used with rotated factor loadings done using the Varimax method. Results: A total of 107 records were retrieved and audited. Fisher’s exact test was used to determine the relationship between selected variables, where p<0.05 was set as level of significance. The findings reveal that the number of infants exposed to HIV during pregnancy has steadily increased. The current study further indicates that health system factors such as unskilled or untrained NIM-ART nurses in the facilities is a contributory factor to infant’s positivity rate in Greater Letaba hospital. Equal proportions of both male and female babies were found to be PCR positive at 6 weeks. The study further revealed that the highest proportion of the mothers who gave birth to PCR positive babies for the reporting period were married mothers, in the age group 25-29 years (46.1%). The second largest proportion of mothers who gave birth to PCR positive babies were single mothers in the age group 25-29 years (38.4%). The results show that high PCR positivity can be attributed to about 5 main Factors namely: maternal antenatal history (22% contribution to total variance), maternal HIV care history (18% contribution to total variance), measures of adherence to treatment (17% contribution to total variance), maternal exposure to HIV (14% contribution to total variance) and lastly the ART regimen (12% contribution to total variance). Conclusion: The study findings revealed that there is still vertical transmission of HIV to infants and the prevalence of HIV among infants born from seropositive mothers despite the availability of the latest Prevention of Mother to Child Transmission (PMTCT) Guidelines in all health care facilities. Even though transmission is reduced to the meaningful number (< 5%), there are still appropriate measures that should be taken to reduce the transmission of HIV from mothers to infants. The delayed diagnosis, adherence to ART by mothers, infant ARV prophylaxis at birth and feeding practices contributed the vertical transmission of HIV to infants. Strengthening of the PMTCT of HIV programme, increasing antenatal HIV screening and linking it to care and treatment of HIV positive mothers to obtain zero infant HIV prevalence in the region. Infant prophylaxis and maternal PMTCT interventions should be provided to all exposed infants and mothers based on the guidelines by the health institutions. Nurse-initiated management of antiretroviral treatment (NIM-ART) training of professional nurses is being offered by the Department of Health in South Africa, but it does not yield positive results as far as the PMTCT is concerned. This may be due to shortage of staff, especially trained professional nurses (PN), as well as the workload. Key concepts: Infant and Human immune deficiency virus

The study sought to identify factors motivating young people aged 14-25 years to use voluntary counseling and testing (VCT) for HIV in Malawi by interviewing 145 young people. The study identified barriers affecting and strategies promoting young people's access to VCT. The research results indicate that young people go for VCT mainly to know their HIV status. The availability of VCT services, and the provision of VCT services by peers motivate young people to access VCT. Some young people do not access VCT services due to fears of being found HIV+ve and because of the poor attitudes of the health service providers. Providing more information about VCT, involving young people as VCT providers, using youth friendly health service providers, providing VCT in a separate room for young people and through mobile services will increase young people's access to VCT services in Malawi. / Health Studies / M.A. (Public Health)

Thesis (PhD)--Stellenbosch University, 2011. / ENGLISH ABSTRACT: The aim of the current study was to investigate factors that help single-parent families cope with the news that a family member has been diagnosed with HIV. The theoretical model that underpinned the study is the Resiliency Model of Family Stress, Adjustment and Adaptation of McCubbin and McCubbin (1996). A salutogenic perspective offers a view of human suffering that moves away from pathology to focus on factors that support successful coping, hence the focus of the current study on resilience. A cross-sectional survey research design was used, incorporating a combination method inclusive of both a qualitative and quantitative component. A total of 109 families, represented by an adult and a child, answered a qualitative question about what they considered to have helped them cope, and completing a biographical questionnaire and five questionnaires based on the theoretical model. Analyses included the Grounded Theory Method, a qualitative analysis method of Strauss and Corbin (1994; 1998), Pearson correlations and ANOVAs (for a categorical independent variable – employment status) to compute the significance of correlations between a dependent variable and a number of independent variables, and regression analysis. The results of the qualitative investigation revealed that families considered internal strength (or hardiness), social supports, communication, a sense of hope, using denial (both positive and negative behaviours to get on with life despite the presence of hardship), changing or reframing thoughts about the stressor, and material support to have been helpful. The quantitative results supported the qualitative results and showed that family hardiness (working together, viewing stressors as challenges and having a belief in own coping abilities), the availability of social support, supportive communication, use of reframing, accepting help from others and spiritual support all contributed to families functioning well under adverse conditions. It was also shown that inflaming types of communication, such as fighting and doing nothing about a crisis situation, negatively influenced the family functioning. It was interesting to note that family size had a significant, positive correlation with the parents’ views of family functioning, and that the higher the children’s level of education, the lower they rated their family functioning to be. Recommendations for further studies include a focus on resilience in various family types, a focus on families successfully coping with HIV diagnoses in their families, and the development of intervention programmes, inclusive of Cognitive Behaviour Therapy and Acceptance and Commitment Therapy. / AFRIKAANSE OPSOMMING: Die doel van die huidige studie was om ondersoek in te stel na faktore wat enkelouer gesinne met ‘n MIV-gediagnoseerde gesinslid ondersteun het. Die studie is teoreties gebou op McCubbin en McCubbin (1996) se Resiliency Model of Family Stress, Adjustment and Adaptation. Salutogenese bied ‘n siening of waardering van die manier waarop mense terugslae hanteer wat weg beweeg van die tradisionele fokus op patologie om te fokus op faktore wat suksesvolle aanpassing ondersteun ten spyte van die teenwoordigheid van genoemde krisis. Hierdie benadering bepaal dus die fokus op veerkragtigheid of gesinsveerkragtigheid wat hierdie studie rig. ’n Deursnee- steekproefontwerp is vir die navorsing gebruik en het ‘n kwalitatiewe en kwantitatiewe komponent ingesluit. ‘n Totaal van 109 gesinne is bestudeer, elk deur een volwassene en een kind verteenwoordig. Die deelnemers het ‘n kwalitatiewe vraag beantwoord oor wat hulle as ondersteunend ten opsigte van hulle eie krisishantering beskou het, en het ook ‘n biografiese vraelys en vyf vraelyste wat verskillende aspekte van die teoretiese model gemeet het, voltooi. Die deelnemers se response is ontleed deur middel van Strauss en Corbin (1994; 1998) se Grounded Theory Method vir die kwalitatiewe komponent; Pearson se korrelasies en ANOVA’s (ten opsigte van ‘n katogoriese onafhanklike veranderlike – werkstatus) is gebruik om die korrelasies tussen die afhanklike en ‘n aantal onafhanklike veranderlikes te bereken en regressie-ontledings is gedoen. Die kwalitatiewe resultate het aangedui dat die volgende faktore deur die gesinne beskou is as ondersteunend van hulle vermoë om krisisse te hanteer: innerlike sterkte, sosiale ondersteuning, kommunikasie, ‘n gevoel van hoop, die gebruik van ontkenning (beide positiewe en negatiewe gedrag om met die lewe aan te gaan ten spyte van die swaarkry), verandering van of herbesinning oor die stressor, en materiële ondersteuning. Die kwantitatiewe bevindinge het die kwalitatiewe resultate ondersteun en getoon dat gesinsgehardheid (saamwerk, beskouing van stressors as uitdagings en ‘n vertroue in eie vermoëns), die beskikbaarheid van sosiale ondersteuning, ondersteunende kommunikasie, die gebruik van herbesinning, aanvaarding van hulp van ander en geestelike ondersteuning almal gehelp het om die gesin onder ongunstige toestande goed te laat funksioneer. Daar is ook gevind dat opruiende soorte kommunikasie, soos baklei en niks oor ‘n krisissituasie te doen nie, ‘n negatiewe invloed op gesinsfunksionering gehad het. Dit was interessant om te vind dat gesinsgrootte positief met die ouers se beskouing van gesinsfunksionering gekorreleer het, terwyl ‘n hoër vlak van opvoeding onder die kinders gekorreleer het met ‘n laer skatting van gesinsfunksionering. Aanbevelings vir verdere navorsing sluit in ‘n fokus op gesinsveerkragtigheid in verskillende gesinstipes, ‘n fokus op gesinne wat ‘n MIV-diagnose in die gesin suksesvol hanteer, en die ontwikkeling van ingrypingsprogramme gebaseer op die beginsels van Kognitiewe Gedragsterapie en Acceptance and Commitment Therapy.

Thesis (MSc)--Stellenbosch University, 2011. / ENGLISH ABSTRACT: As the only effective treatment for HIV/AIDS, adherence to antiretroviral therapy (ART) is critical for successful treatment outcomes. Despite its open availability since the national rollout in 2004, adherence to ART has remained sub-optimal and the number of individuals shifted to the more expensive second-line therapy on steady increase. The literature reports more commonly on individual, psychological, and behavioural barriers to treatment. However, there has been a vast interest in the structural barriers that prohibit adherence to ART. In previous research, my colleagues and I identified the following structural barriers to treatment adherence: stigma-related barriers, the disincentives associated with disability grants, poor relationships with clinic staff, lack of privacy at clinics for counselling and treatment, transport difficulties in travelling to the clinic, long patient waiting times, food insecurity, substance abuse and the absence of substance abuse programmes, and migration. The data were arrived at by means of triangulated qualitative interviews obtained from patients, patient advocates, doctors, and nurses. Together, these qualitative data formed phase 1 of this study. The next step or phase 2, in this research was to develop a valid and reliable quantitative instrument based on these qualitative data. Therefore the primary aim of the study presented in this thesis was to identify the underlying factor structure of four scales aimed at measuring adherence at two levels namely, adherence to clinic attendance, and adherence to pill-taking. After sampling a group of almost 300 persons living with HIV (PLWH) four valid and reliable scales assessing structural barriers to adherence to ART were derived at with Cronbach alpha coefficients ranging from 0.87 to 0.91. For each scale, a general or higher order factor was determined by means of hierarchical transformation suggesting that the items on each of the scales were dominated by a single underlying factor. The findings of this research suggest that it is possible to assess the structural barriers to adherence that PLWH face on a daily basis. With a proper means, such as these scales, to assess structural barriers to adherence to ART clinicians may be able to identify patients who are likely to default and provide adequate attention to the most distressing barriers. / AFRIKAANSE OPSOMMING: Antiretrovirale terapie (ART) is die enigste effektiewe behandeling teen MIV/Vigs. Behandeling met hierdie terapie kan slegs suksesvol voltooi word indien die medikasie ononderbroke en gereeld geneem word. Alhoewel medikasie vrylik beskikbaar was sedertdien die nasionale bekendstelling in 2004, het die aantal individue wat na duurder tweede lyn terapie oorgegaan het toegeneem. Die volhoubaarheid van ART was dus nie optimaal nie. Dit kan toegeskryf word aan individuele -, sielkundige - en gedragstruikelblokke tydens behandeling wat tans baie aandag geniet in die literatuur. Om by te voeg, strukturele hindernisse tot ART geniet ook tans baie aandag. Met hierdie as agtergrond, was die primêre doel van die studie om die onderliggende faktor struktuur van vier skale wat strukturele hindernisse tot ART op twee vlakke meet, naamlik getroue kliniek bywoning en neem van medikasie, te indentifiseer. Ons het met vorige navorsing die volgende strukturele hindernisse tot ART geidentifiseer: stigma-verwante hindernisse, hindernisse wat verband hou met ongeskiktheidstoelaes, swak verhoudings met kliniek personeel, die gebrek aan privaatheid by klinieke in terme van berading en behandeling, vervoerprobleme, lang wagtye vir pasiënte, voedselonsekerheid, dwelmmisbruik en die afwesigheid van middelmisbruik-programme, asook migrasie. Data aangaande bogenoemde strukturele hindernisse is ingesamel deur middel van kwalitatiewe onderhoude met pasiënte, pasiënt-advokate, dokters en verpleegsters (fase 1). Gedurende fase 2 van hierdie studie is 'n geldige en betroubare kwantitatiewe instrument op grond van hierdie kwalitatiewe data ontwikkel. 'n Steekproef van ongeveer 300 MIV-geinfekteerde individue het deelgeneem. Vier geldige en betroubare skale is ontwikkel ten opsigte van die assessering van strukturele hindernisse in terme van gereelde gebruik van antiretrivale middels, met Cronbach alpha koëffisiënte tussen 0.87 en 0.91. Vir elke skaal is 'n algemene of hoër-orde faktor bepaal deur middel van hiërargiese transformasie wat daarop dui dat die items op elk van die skale gekenmerk is deur 'n enkele onderliggende faktor. Ons bevindinge dui daarop dat dit moontlik is om die strukturele hindernisse wat MIV individue daagliks tot ART ondervind te meet. Met die gebruik van hierdie skale sal klinici dus in staat wees om pasiënte te identifiseer wat moontlik van ART sal afwyk of die terapie sal staak met die klem op mees onstellende hindernisse.