Complex patient are becoming more and more of a challenge to the health care system given the amount of care they require and the amount of documentation needed to keep track of their state of health and treatment. Record keeping using the EHR makes this easier but mounting amounts of patient data also means that clinicians are faced with information overload. Information overload has been shown to have deleterious effects on care, with increased safety concerns due to missed information. Patient record summarization has been a promising mitigator for information overload. Subsequently, a lot of research has been dedicated to record summarization since the introduction of EHRs. In this dissertation we examine whether unsupervised inference methods can derive patient problem-oriented summaries, that are robust to different patients. By grounding our experiments with HIV patients we leverage the data of a group of patients that are similar in that they share one common disease (HIV) but also exhibit complex histories of diverse comorbidities. Using a user-centered, iterative design process, we design an interactive, longitudinal patient record summarization tool, that leverages automated inferences about the patient's problems. We find that unsupervised, joint learning of problems using correlated topic models, adapted to handle the multiple data types (structured and unstructured) of the EHR, is successful in identifying the salient problems of complex patients. Utilizing interactive visualization that exposes inference results to users enables them to make sense of a patient's problems over time and to answer questions about a patient more accurately and faster than using the EHR alone.

This study aims to examine the production of HIV/AIDS lessons on Tsha Tsha Entertainment-Education and their reception by HIV-positive men in Soweto, and to find out whether this response impacts on their perception of their roles and responsibilities in HIV/AIDS. The rationale behind this study is that gender and HIV/AIDS has been critical in interventions aimed at combating the disease. Studies in South Africa on gender have revealed that versions of masculinity can be implicated in the increasing infection rates of HIV/AIDS making efforts to combat the disease problematic. A qualitative methodology is used. This method included interviews and focus group discussions. Five interviews were done with programme producers and researchers of Tsha Tsha to find out the major considerations in production. An average of seven HIV-positive men were exposed to 12 episodes of Tsha Tsha to find out their responses in six focus group discussions, and whether these indicated a changed perceptions in their roles and responsibilities in HIV/AIDS. Their responses were then examined under Bandura’s (1971) social learning theory and Hall’s (1977) encoding-decoding theory .This theories explain the considerations in the production of lessons in Tsha Tsha and how audiences respond to those lessons respectively. The findings reveal that audiences (HIV-positive) men identify with lessons around HIV-testing, disclosure, support and those that challenge stigma and masculinity in HIV/AIDS. Disclosure emerges as a major theme and is compared with sub themes of testing, stigma, masculinity and social support to form categories that are presented as the findings. While HIV-disclosure is seen as challenging HIV/AIDS stigma and masculinity, where men accept their condition, and take responsibility to continue occupying their space as men, E-E production can reinforce lessons around disclosure and other coping strategies to combat HIV/AIDS.

Thesis (Ph.D. (Physiology and Environmental Health)) -- University of Limpopo, 2021 / Background: Human immunodeficiency virus (HIV)-infection remains a major public health burden where approximately 38 million people are affected globally. Human immunodeficiency virus infection is associated with chronic inflammation which can lead to endothelial dysfunction and thrombosis, which are precursor events for cardiometabolic abnormalities such as dysglycaemia and dyslipidaemia. The degree of chronic inflammation, endothelial dysfunction, and hypercoagulation among HIVpositive adults on highly active antiretroviral therapy are not well understood in Sub- Saharan Africa. The objective of this study was to determine the effect of highly active antiretroviral therapy (HAART) on chronic inflammation, endothelial dysfunction, and hypercoagulation among HAART-exposed adult South African participants in a rural setting. Aim: The study aimed to determine the effects of HAART on early biomarkers of cardiovascular disease in the HIV-positive subjects. Methods: The study was cross-sectional, descriptive, and quantitative in design. The research population consisted of 158 participants of males and females within the age range of 18 – 81 years from Mankweng Hospital and surrounding clinics. The study population comprised of three groups, HIV-negative (control group), HIV-positive treatment naïve (HAART-naïve group), and HIV-positive participants on HAART (HAART-exposed group). Weight and height were measured using Omron BF 400 and a portable stadiometer respectively, to calculate the body mass index. Glucose and lipid levels were determined on Cobas® Integra 400 plus auto-analyser. The CD4+ T cell count was determined on the Cytomics FC500 Flow Cytometer Multi-Platform loader. The concentration of fibrinogen, c-reactive protein (CRP), L-selectin, D-dimers, P-selectin, von Willebrand factor (VWF), soluble intercellular adhesion molecule (sICAM-1), and soluble vascular cell adhesion molecule (sVCAM-1) in serum samples were determined on the Luminex 200TM. Data were analysed using SPSS version 25.0. Descriptive statistics were performed on all variables and analysis of covariance was used to determine differences across all groups. Correlation coefficients and multiple regression analyses were used to determine associations. Results: Body mass index (BMI) and glucose metabolism were not significantly affected by HAART exposure. However, the HAART-exposed group had significantly increased LDL-C (F (2, 154) = 7.501, p = 0.001) and TC (F (2, 154) = 9.174, 0.0002) levels. The prevalence of high LDL-C levels was significantly elevated in the HAART-exposed group (29.6%) (p = 0.041). The prevalence of pre-diabetes (11.3%) was the highest among the HAART-exposed group (non-significant), although, no significant difference was observed. While P-selectin was significantly reduced in the HAART-exposed group (F (2, 154 = 7.253, p = 0.001). On the other hand, the HAARTexposed group also significantly increased VWF (F (2, 154 = 4.556, p = 0.011). The HAART-exposed group showed no significant effect on L-selectin, sICAM-1, sVCAM- 1, CRP, fibrinogen and D-dimer levels. However, D-dimer was negatively associated with HAART (r = -0.249, p = 0.011). There were significant independent association between the combined HAART regimens and P-selectin (Std β = 0.219, p = 0.032), first-line regimen with both P-selectin (Std β = 0.434, p = 0.004) and sVCAM-1 Std β = 0.328, p = 0.031), second-line regimens with L-selectin (Std β = 1.032, p = 0.005) and, a positive independent association between first-line regimen and D-dimer (β = 0.741, p = 0.0001). Although BMI and glucose metabolism were not significantly affected in both the HAART-exposed and HAART-naïve groups, dyslipidaemia was present across the three groups (HAART-exposed, HAART-naïve and control). HAART-exposure showed a protective effect by reducing endothelial dysfunction (ED) and hypercoagulation. Yet, ED was still present among this rural South African HAART-exposed population. The HAART-exposed group may be at increased risk for CVD. Therefore, CVD should be regularly monitored in the HAART-exposed population. / National Research Fund, the Health and Welfare Sector Education and Training Authority, and the University of Limpopo (UL)

Thesis (PhD. (Nursing Science)) --University of Limpopo, 2019 / The ability of professional nurses to support and motivate people living with HIV and AIDS to disclose to sexual partner continue to be a challenge based on the social, economic, psychological and ethical circumstances that surround the process to do so. A qualitative research study using semi-structured interviews with a schedule guide whereby probing questions were used to elicit more data. Two focus groups with 6 professional nurses were also conducted to explore and describe professional nurse’s knowledge and practices as they support People Living With HIV and AIDS (PLWHA) to disclose their positive status to sexual partners. The interviews were carried out in five (5) district hospitals of Limpopo Province, South Africa. Dickoff, James, and Wiedenbach (1968) practice theory guided the study. Study findings revealed that professional nurses do understand the concept but however it is difficult for them to translate and link learning and understanding in the clinical area. Social, economic, psychological and ethical dilemmas pose a challenge for professional nurses to support individuals to disclose to sexual partners. Professional nurses refer individuals with challenges to psychologists and social workers, but however, they do not receive referral back on the outcome. The absence of support groups and link with community-based groups to support PLHWA reduce efforts to improve knowledge on benefits of disclosure to communities led by PLHWA including reduction of stigma and discrimination associated with the diagnosis. The study therefore, recommends a training programme that links the South African Nursing Council statutes, including that of World Health Organization and Department of Health with teaching and learning methods that clarify and simulate real clinical situation to enhance the translation of this policy in the real-life situation. The training programme further suggests a link with community base structures led by PLWHA to enhance disclosure of HIV positive status to a sexual partner, reduction of stigma and discrimination associated with the diagnosis and reduce the incidence of HIV among people living with HIV. Key words: People living with HIV infection, Professional nurses, disclosure of HIV to sexual partners

Thesis (Ph. D. (Statistics)) -- University of Limpopo, 2019 / Refer to document / NRF-TDG

In Swaziland, cases of cervical cancer among Human Immunodeficiency Virus (HIV)-positive adolescent girls and young women (AGYW) are increasing, but there is low uptake of cervical cancer screening. This study was conducted using the systems thinking theory to explore the relationships between the uptake of cervical cancer screening among HIV-positive AGYW in Swaziland and the availability of trained health providers, cervical screening services, and the provision of referrals for cervical screening. The study also investigated any differences in uptake of cervical screening based on age group. For this quantitative cross-sectional study, secondary HIV program data that were collected routinely between January 2016 and March 2018 were accessed. Data were described with univariate analysis while relationships were tested using bivariate analysis and logistic regression. Most facilities (97%) had staff who had been trained; facilities with greater numbers of trained staff were more likely to have a higher uptake (OR: 30.3, p = 0.000). Facilities with cervical screening services were also more likely to have a higher uptake (x2 = 16.94, p = 0.000), and facilities with all the core components for screening had the highest uptake (p = 0.002). AGYW who had a positive screen were referred equally but the referral rate was low (20.45%). There was no difference in uptake by age group. The results of the study can increase knowledge of the institutional factors that contribute to the low uptake of cervical cancer screening among HIV-positive AGYW and has implications for social change by informing interventions for improving cervical cancer screening uptake in HIV-positive AGYW in similar settings, ultimately reducing the high costs, morbidity, and mortality related to cervical cancer in this population.

Thesis (MPH.) -- University of Limpopo, 2022 / Background: Tuberculosis(TB) and Human Immunodeficiency virus(HIV) continues to be a public health concern globally. There is no data on TB outcomes on HIV programme outcome in Lebowakgomo hospital of Limpopo Province. The main objective of this study was to determine the TB treatment outcomes in TB/HIV co-infected people at Lebowakgomo hospital in Limpopo Province. Methodology: A quantitative retrospective design was used in the study in which a sample size of 180 patients’s files who are 18 years and above and TB/HIV co-infected were reviewed. A self-designed data collection tool was used to collect data. The tool covered variables such as age, gender, HIV status, CD4 cell count, type TB, duration on TB treatment and the outcome. Data was analysed using the STATA statistical software version 12 for Windows (STATA Corporation, College Station, Texas). Results: The majority of records were age group 35-44 years at 32%. There was a statistical significance differences (p˂0.001) between males and females in relation to age groups. TB treatment success rate was 68.9% and mortality 16.9%. Females were more likely to complete TB treatment successfully than males. Overall age, gender, previous TB infections, TB type, duration on ART and CD4 Count were not significantly associated with treatment outcomes amongst TB/HIV co-infected people. Conclusion: This study has revealed that TB treatment success rate in HIV co-infected is lower (68.3%) than the WHO target of 85%.

Uganda has experienced substantive shifts in HIV prevention and treatment resulting in marked declines in HIV incidence and mortality rates across the country despite being among the top 5 highest new prevalence rates for HIV transmission and infection among women (Uganda Ministry of Health, 2019). Prior research has revealed that fear of stigma and discrimination, disclosure of HIV status, and quality of services are key factors in women’s healthcare decisions and care-seeking behaviors (Akatukwasa et al. 2021; Lancaster et al., 2016; Grossman & Stangl, 2013). Yet, there continue to be significant knowledge gaps regarding the mechanisms through which intersectional stigma exacerbates health outcomes for people living with HIV. This dissertation draws on baseline data, from the Kyaterekera project an efficacy trial testing the effects of a structural intervention on the HIV-health outcomes of women engaged in sex work within the Masaka region, Uganda. Using an explanatory sequential mixed method design, this study utilized Structural Equation Modeling (SEM) to test the direct and indirect effects of intersectional stigma on mental health, while also evaluating mechanisms (i.e., social support and quality of care) through which stigma impacts mental health, treatment adherence and subsequent viral load. There were no direct or indirect effects of intersectional stigma on mental health, but intersectional stigma was positively associated with social support. Additionally, depression and adherence were negatively associated with viral load. Next, in-depth interviews (n=52) explored personal and community-level factors that may influence women’s care-seeking attitudes and overall health decisions. The following themes were most salient for women: 1) disclosure risk, 2) Intersectional community stigma permeates marginalized women’s health decisions, 3) adaptive behaviors and coping strategies are essential to maximizing care experiences, and 4) the Care Seeking Cost-Benefit Tradeoff. Through an integrative framework, quantitative and qualitative findings were then juxtaposed through a joint display and found to be predominantly complementary (McCrudden, M. T., Marchand, G., & Schutz, P. A., 2021). Findings suggest that a positive association between intersectional stigma and social support may underscore the significant long-term effects of living with HIV. Moreso, holding other stigmatized social statuses. Moreso, this link between intersectional stigma and social support may be due to women anticipating the likelihood of experiencing community-level/interpersonal stigma with HIV disclosure and extensive contact with their social support network. Also, more contact with social networks, particularly those in which stigma norms and discriminatory attitudes are pervasive on the community/ interpersonal level (or perceived to be so) may account for the positive associations between HIV stigma and social support. Sex work had a higher degree of concealability than HIV. As such, sex work was disclosed less frequently than HIV to healthcare providers, family, and friends due to anticipatory community stigma. Despite the finding that the explanatory sequential design produced no direct or indirect effects of intersectional stigma on mental health or viral load via SEM, the exploratory analysis provides substantive insights into the negative impact of HIV-related intersectional stigma on women’s care-seeking experiences and broader health decisions. Women’s care-seeking attitudes and behaviors reveal the intrinsic adaptive skills, strength, and resilience they possess to address individual health needs despite known barriers to care. Overall, this study provides further support for holistic interventions that can enhance and build resilience and successful adaptive strategies to mitigate the effects of HIV-related intersectional stigma.

As rates of HIV transmission have accelerated in Kazakhstan over the past ten years, gay, bisexual, and other men who have sex with men (MSM) in Kazakhstan have experienced a disproportionate burden of the HIV epidemic, including a seven-fold increase in HIV prevalence. Earlier age of first sexual activity (i.e., earlier sexual debut) has been associated with long-term health trajectories among MSM at risk of HIV, however, no previous research has examined associations between earlier sexual debut and HIV-related risk factors among MSM in Kazakhstan. This dissertation tests hypotheses examining whether earlier sexual debut is associated with the following factors associated with HIV infection during adulthood among MSM in Kazakhstan: substance use, exchange sex, and experiences of anti-gay violence. Study data were obtained through a NIDA-funded clinical trial of a behavioral intervention seeking to increase the engagement of MSM who use substances in Kazakhstan in the HIV care continuum. Findings indicate that earlier sexual debut is significantly associated with increased risk of substance use, exchange sex behaviors, and experiences of anti-gay victimization among MSM in Kazakhstan. Future research should examine the contexts of MSM’s sexual debut, including whether this experience was consensual or involved other forms of adverse childhood events. Policy recommendations include increased access to sexual and gender expansive-inclusive comprehensive sexual education, and anti-discrimination policies. Clinical considerations include trauma-informed HIV prevention resources for MSM that recognizes that individuals seeking care may have complex, intersecting, and marginalized life histories, including experiences of violence across the life course.

Thesis (M.Med. (Family Medicine)) -- University of Limpopo, 2017 / Objectives: To assess adherence to Isoniazide Prevention Therapy (IPT) among HIV positive patients in Rethabile Community Health Centre in the Capricorn District of the Limpopo Province. Methods: A cross-sectional study with qualitative and quantitative data collection methods was conducted among HIV positive patients in Rethabile Community Health Centre from January 2013 to December 2013. Consecutive sampling was used to select 90 participants. Adherence was assessed using patient self-rated adherence to IPT, and confirmed by urine tests for isoniazid metabolites. Data was collected using an interviewer administered questionnaire. Information was also obtained from health care works regarding the perception about reason for non- adherence to IPT. Data was analysed using STATA software and thematic analysis. Results: Self-rated adherence to IPT among the participant was 80% where as urine test was positive for Isoniazid metabolites in 73%. While 84% of participants reported that transportation was the main reason for non adherence, 70% also reported distance from the health care as their main reasons for non-adherence to IPT. However, health care providers reported that many patients do not adhere to treatment due to: Lack of money for transport, missed clinic appointment due to rain and fear of losing jobs, use of traditional medicine, wrong belief about IPT, medicine side effects and alcohol consumption. Conclusion: Self – rate adherence to IPT was suboptimal and appears over – estimated among study participants. Interventions to improve adherence to IPT must ensure easy access to healthcare facilities, address wrong perceptions and promote healthy social behaviours