Thesis presented in partial fulfilment for the degree of Master of Management (in the field of Public Sector Monitoring and Evaluation) to the Faculty of Commerce, Law, and Management, University of the Witwatersrand 2016 / The purpose of this research was to assess outcomes of the antiretroviral treatment intervention in Mankweng. The antiretroviral treatment intervention was conceived with the aim to reduce HIV transmission through viral load suppression. Literature has shown that viral load is used as a tool to measure the performance of the intervention and studies on viral load outcomes in rural settings of Limpopo are limited. For this reason, the research was focused on viral load suppression with the aim of (1) determining the proportion of adults with viral load suppression among people taking antiretroviral treatment for 12 months, and (2) identifying factors associated with failure to achieve viral load suppression among people on antiretroviral treatment for 12 months. Binomial logistic regression model was used to identify factors associated with failure to suppress viral load. This study used the theory of change to interpret its findings as well as theories of behavioural planning and self-regulation models to understand the logic that underpins the theory of change. The findings revealed that the majority (78%) of adults achieved viral load suppression, and a quarter of the individuals failed to suppress the viral load. There was no significant difference in baseline characteristics between people who achieved viral load suppression and those who did not. In addition, males, with a low CD4 and opportunistic illnesses when in the primary disease stages were more likely to fail to suppress the viral load. Moreover, people who were initiated on a 3-pill containing treatment and do not have social support were also likely to fail to achieve viral load suppression. Although the study showed a trend of likelihood towards failure to achieve viral load suppression, the estimates were not statistically significant. Theoretical arguments from this study suggest that failure to achieve viral load was attributed to poor adherence to treatment. This is supported by the logic that underpins the theory of change, in which the assumption of adherence was possibly violated. However, the results chain framework highlighted that the implementation of the intervention was effective as it led to good outcomes and an effective intervention. Drawing all this together, the study highlights the need for intensified adherence counseling during treatment in order to improve the performance of the intervention. Author: Ramatsobane Johanna Ledwaba, Thesis Title: Outcomes of the antiretroviral treatment intervention in Mankweng, Johannesburg, March 2016 / GR2018

As the economic hub of South Africa, Johannesburg attracts cross-border migrants in search of improved livelihoods; over half the population of some of its inner-city suburbs are made up of cross border migrants. Globally as well as locally, foreigners have been blamed for the spread of diseases such as HIV. As a result, they have suffered challenges in accessing public healthcare, particularly antiretroviral treatment (ART) for HIV. Studies have shown that despite these challenges - foreigners experienced better ART outcomes than nationals. There is a need to explore the ways in which cross border migrants use to access and to stay on treatment, given the wide-range of challenges that they face during their stay in Johannesburg. Semi-structured interviews with five nurses and ten cross-border migrants currently receiving ART, along with non-participant observations, were used to collect data from two public clinics in inner-city Johannesburg. Analysis suggests that the family network in the country of origin remains critical, as cross border migrants are not disclosing their status in the city in which they live, but do so to their families in their countries of origin. Data shows that when it comes to accessing and staying on treatment, cross-border migrants go to the clinic every month as do nationals; ask for more treatment from nurses when going home temporarily; eat healthily; but hide when taking medication, and negotiate confidentiality and trust within their families in countries of origin. Some are found to access treatment in their countries of origin while staying in Johannesburg. Despite the lack of social networks in the inner city, this data suggests that cross-border migrants are successful in accessing and continuing with ART. There is need for future research to look at social networks for internal migrants, so as to compare results.

Student Number : 9402058P - M Med Research Report - School of Clinical Medicine - Faculty of Health Sciences / Objective In view of recent suggestions that HIV infection may protect against pre-eclampsia, this study was done to estimate whether untreated HIV positive pregnant women have a lower rate of preeclampsia-eclampsia than HIV negative women. Methods Subjects for this study were pregnant women from Soweto, South Africa, who gave birth from March to December 2002 at midwife-run clinics or at the Chris Hani Baragwanath Hospital, and in whom the HIV status was known. A sample size calculation indicated that 2588 subjects would be required to show statistical significance at P<0.05 with a power of 80% for a reduction in the rate of preeclampsia from 8% to 5% with HIV seropositivity, assuming an HIV seroprevalence rate of 30%. Data collection was by record review from randomly selected patient files and birth registers. Results In the total sample of 2600 women, 1797 gave birth at the hospital and 803 at the midwife-run clinics. The HIV seroprevalence rate was 27.1%. Hypertension was found in 17.3% of women, with 5.3% having preeclampsia-eclampsia. The rates of preeclampsia-eclampsia were 5.2% in HIV negative and 5.7% in HIV positive women (P=0.61). CD4 count results were available for only 13 women (0.5%). Conclusion HIV seropositivity was not associated with any reduction in the risk of developing preeclampsia-eclampsia.

In the context of decreasing mortality and increasing prevalence, prevention of HIV-transmission represents a public health priority. In the United States, the majority of infections are sexually-acquired, with men who have sex with men and minorities disproportionately affected. Although a number of promising biomedical prevention approaches have emerged over the past decade, a further 20 years could be needed before a suitable product becomes widely available. Evidence from vaccine and microbicide trials has shown that success in one population may not be replicated in another. To understand surprising or unexpected results, investigators need chronologically concordant evidence of both study product adherence and viral exposure. Since exposure to HIV cannot yet be independently verified, in seeking to measure this variable, investigators target the sexual behaviors through which it takes place deriving data for these surrogate measures from study participants' voluntary self-reports. Likely sources of reporting bias and efforts to minimize this phenomenon in the context of HIV-prevention research are critically reviewed in Chapter 1. Research describing the role of cognitive and affective functioning in the preparation of responses to potentially threatening questions is examined. Studies investigating techniques such as the use of colloquial language to facilitate comprehension, or variation in the length of the reference period to enhance recall are explored. Research comparing the effect of mode of administration on the amount of proscribed behavior reported - widely believed to correlate with validity - is reviewed. Contextual factors facilitating versus inhibiting disclosure of sensitive information are examined. Finally, risk-behavior measurement approaches used in selected HIV-prevention trials are inspected. Thereafter, the dissertation focuses on the properties of risk-assessment items, formulated specifically to elicit Global recall over six months, or Event-Specific (episodic) memory for selected recent episodes of limited duration, to capture sexual behaviors or temporally related activities. The capacity of the different questionnaire item formats to elicit responses with sufficient construct validity to serve as proxies for HIV-exposure is examined. Data for these studies are drawn from a large randomized controlled trial of a behavioral intervention to prevent HIV-transmission among men who have sex with men. Using a subset of 1295 cases and controls, models with good discriminant validity for HIV are derived separately for the Global and Event-Specific items. Thereafter, selected items from the two formats are combined to produce a single model with excellent discriminant validity, suggesting that these items can adequately represent true HIV-exposure. Next, a preliminary investigation of the contribution of psychosocial items to the predictive model based on exposure measures is undertaken. Specifically, interaction with exposure measures and the increase in discriminant validity obtained using data derived from constructs of partner type/relationship status, substance use, depressive symptoms and perceived self-efficacy is examined first in stratified analysis and then in logistic regression analysis using the case-control data. Effect-modification is observed for perceived relationship status and non-injection drug use. Evaluation of psychosocial items continues in a cohort study with prospective analysis of follow-up data from all trial participants who returned for at least one follow-up visit. Informed by the case-control study, a series of items representing psychosocial constructs known for their association with HIV-infection are tested for main effects and effect-modification. Evidence of the interaction observed in stratified analyses and confirmed in ordinary logistic regression persists in separate, topic-specific GEE analyses with assorted exposure measures, but abates in repeated measures analyses drawing on all available psychosocial items. Lastly, a single lagged variable indicating primary relationship status of the most recent partner (with respect to the preceding study visit) provides a significant addition to the model. Significant main effects for all except depressive symptoms and perceived self-efficacy and the increase in discriminant validity obtained for the multivariable model versus the `exposure-only' model are sufficient to warrant continued use of these risk-assessment items. Despite good predictive validity demonstrated for the sexual risk-behavior and psychosocial items, some inconsistent reporting between the Global and Event-specific formats is evident. Likely sources of this reporting bias are considered in light of the literature, and strengths and limitations of the overall study are discussed in the closing chapter.

No description available.

Thesis (M. A. (Sociology)) --University of Limpopo, 2017. / Refer to document

The aim of this study was to explore, describe and interpret the experiences of Immunodeficiency Human Virus (HIV) infected mothers regarding exclusive breastfeeding in the first six months of the infant’s life. This was a qualitative study with phenomenology as a design as the study was about lived experiences. The sample consisted of HIV infected mothers aged 18 years and above who opted for exclusive breastfeeding for the first six months of their infant’s lives. Purposive sampling was used. Data was collected through one to one semi structured interviews of fifteen mothers of babies aged six to twelve months. The study revealed that mothers had both positive and negative experiences which were influenced by among others; the level of support the mothers received, disclosure of HIV status and health education received at the health facility. The findings of the study revealed a low level of understanding of the Infant and Young Child Feeding Policy by health professionals / Health Studies / M. A. (Health Studies)

Thesis (Ph. D.)--University of Montana, 2007. / Title from title screen. Description based on contents viewed Apr. 2, 2007. Includes bibliographical references (p. 87-92).

The current study aims to determine physical activity levels among people living with HIV treated with high active antiretroviral therapy in Kigali, Rwanda. A cross-sectional design using quantitative method was used. The participant’s levels of physical activity participation and their association with anthropometric profiles were measured, using a structured selfadministered questionnaire adapted from the Sub-Saharan Africa Activity Questionnaire. Based on a scientific calculation, 407 clients passing through the clinics were included in the study. A convenient sample of people attending the clinics approached to participate voluntarily in the study. The findings of the current study highlighted the lack of motivation, lack of time and fear of worsening the disease amongst the strong barriers to physical activity participation. The current study recommends education about the benefits of physical activity participation and encouragement of patient treated with high active antiretroviral therapy in Rwanda to be emphasized on to improve their lives.

<p>Disclosure of HIV positive status to male partners is well established as a key element in the success of prevention of mother to child transmission of HIV programmes, as it helps improve adherence to ARVs by the women within these programme. However, partner notification rates remain low in the urban areas of Lusaka, Zambia against a high HIV prevalence of 25%. The purpose of this study was to explore the timing of disclosure as part of the process of disclosure amongst women who were part of the PMTCT services at Kaulu health centre in Lusaka. An exploratory descriptive study using qualitative research methods was conducted. 15 women, who were attending the Kaulu health centre PMTCT programme, were requested to participate in a semi-structured interview. The women, who were purposively selected with the aid of the health centre‟s PMTCT focal point nurse, had to have disclosed their HIV positive status to their partner, either before or during the course of their pregnancy or after delivery. To increase rigour,&nbsp / individual interviews were conducted with 5 health workers associated with the PMTCT programme so as to obtain their perspective and experiences on the issue of HIV disclosure amongst their PMTCT patients. Participation in the study was voluntary and all information obtained during the course of the interviews remained confidential and secure. Potential participants were each provided with an explanation of the purpose and process of the study and their informed written consent obtained before the researcher embarked on the interviews. Content analysis of the transcripts was done so as to develop coding categories and identify emerging themes. Disclosure to male partners is an important step in PMTCT and facilitates adherence to HIV care for the family and should be done as early as possible after the woman receives her HIV test result, though there exists a range of alternative times when it can be done. The relationship existing between a couple is very important in determining the timing of when a woman chooses to disclose. PMTCT services need to provide ongoing counselling for HIV positive women during pregnancy and after giving birth that supports, informs and equips them with the necessary skills to make an informed and timely decision about disclosure to a partner. In addition, the PMTCT service providers need to be encouraged to implement couple counselling as a strategy to facilitate disclosure as well as establishment of a peer support network for HIV positive pregnant women. The study findings will be used to contribute to health workers‟ capacity to support women manage the disclosure process to their male partners, thus helping to increase the disclosure rate and also contributing to improving the positive effect of the PMTCT services, in Lusaka, Zambia</p>