The HIV/AIDS epidemic is described as a crisis by the Global Report (UNAIDS 2004:13). Swaziland¡¦s King Mswati III also declared the HIV/AIDS epidemic as a disaster when the HIV/AIDS prevalence rate increased from 3.9% in 1992 to 42.6% in 2004 (MOHSW 2004:3). In responding to the increasing numbers, the Government of Swaziland established various programmes; one of them being the Voluntary Counselling and Testing (VCT) services to meet societal needs. The MOHSW designed guidelines to be utilized when training nurses to be pre and post HIV test counselors (TASC 2003:2). The period of training ranges between 1 to 2 weeks, after which they are deployed to the VCT centres where nurses provide counseling and testing, treatment of opportunistic infections and distributing antiretroviral drugs. Much research has been done in Swaziland on HIV/AIDS however; there is insufficient knowledge on the impact of HIV/AIDS on nurses working at the VCT services. The objectives of the study were to: ,,« Explore and describe the experiences of nurses working in the VCT services. ,,« Explore and describe the experiences of clients receiving VCT services. ,,« Design and develop an empowerment programme for nurses working in the VCT services in Swaziland. ,,« Formulate and describe guidelines for the implementation of the programme. In this qualitative study, the exploratory descriptive and contextual methodology was utilized to look into lived experiences of nurses and clients. This was done within the adaptation of the intervention Design and Development genre proposed by Rothman and Thomas (1994). Data was collected through purposive sampling and analysed according to Tesch¡¦s methods (Tesch 1990:890) The study revealed one major theme; constant experience of stress that was related to psychological and physical factors (categories). Nurses identified the complexity of HIV/AIDS, shortage of staff, lack of social support, lack of a supportive working environment, and a need for staff development under psychological factors. Clients identified stigma and discrimination. Constant exhaustion and development of medical conditions were identified as physical factors that led to constant experience of stress. Conclusions drawn from the data analysis revealed that nurses were stressed and felt disempowered at working in the VCT services. An empowerment programme was designed and developed to enable these nurses to deal with issues and VCT services for rendering quality care and enjoy the work they do. Guidelines were formulated to implement the empowerment programme. The study concluded with the identification of limitations and recommendations for future endeavours. / Health Studies / D.Litt. et Phil.

The aim of the study was to determine the factors that influence adherence to ART among adolescents who contracted HIV through vertical transmission. Qualitative research using descriptive phenomenology was conducted at Botswana-Baylor Children’s Clinical Centre of Excellence. Data was collected using in-depth individual semi-structured interviews. Eight (8) adolescents between 14 and 19 years who had been on ART for minimum of 4 years were interviewed. Thematic analysis of data was done and five (5) themes emerged from the participants' description of the experience of taking ART over a long period of time. The themes that emerged indicated the factors that influence adherence to ART, and they included knowledge and positive beliefs about ART, need for support, ART difficult treatment regimen, having a regular doctor and psychosocial emotional needs. The findings suggested that the adolescents who contracted HIV through vertical transmission require support while continuing on a simplified long-term ART regimen after an assessment of their psychological well beings and periodic checks. / Health Studies / M.A. (Public Health)

The purpose of this study is to explore the EAP environment and provide a better understanding of the related roles of the Employee Assistant Practitioners/Professionals (EAPs) in respect of their treatment of various forms of illnesses in the workplace – particularly HIV and AIDS. The EAP role is not aligned to any individual profession, as it is designed to match employees’ holistic needs. It is in this context that the repertoire of EAP roles would include caring, psycho-social, therapeutic and technical skills. The EAP role is therefore endowed with the potential to meet a range of inter-departmental and multi-disciplinary needs – such as Nursing, Allied Health Professions, and Healthcare Sciences. A generic Assistant Practitioners Performance Management system (scorecard) had to be developed and agreed to with the City of Johannesburg’s (CoJ) Management in order to maintain consistency when developing APE programmes and roles. Notwithstanding the fact that the Employee Assistant Practitioners do also address the growing HIV/AIDS concerns in the workplace – including psycho-social problems of employees and their families – there is minimal acknowledgment of the EAPs’ roles, and little recognition of their welfare and well-being programmes. Drawing eclectically from various inter-related disciplinary terrains, the study centripetally explores the roles of EAPs as well as HIV/AIDS frameworks in the workplace. Quantitative and qualitative descriptive research methods were employed to assess challenges encountered by the City of Johannesburg (C.o.J) employees and their dependants. Questionnaires were used for the data collection of this study. The repertoire of participants in the study (n=55) comprised of doctors, social workers, nurses, HR officers, and other CoJ employees themselves. vi The questionnaire became the pivotal quantitative data analysis reference point ias it focused on numbers or quantities, and less on the qualitative analysis, which focused on differences in quality. The results of the study are based on numeric analysis and statistics to quantify the qualitative analysis. The prevalence of fewer participants was largely influenced by the depth of the data collection process, which did not allow for large numbers of research participants. The findings of the study revealed, amongst other factors, that there was an unsurpassed need to integrate different HIV/AIDS frameworks in order that the roles of EAPs becomes more effectively and efficiently defined and executed. The roles of EAPs were hitherto not well defined, resulting in duplication and confusion of service delivery to some employees utilising the EAP services. However, some of the EAP roles are highly appreciated and increasingly supported by managers and employees. Based on the findings of the study, recommendations were made for clarifying and extending the criticality of EAP roles and functions. / Health Studies / Ph. D. (Health Studies)

Adherence to antiretroviral therapy is crucial to ensure viral suppression. In the scientific community it is widely accepted that an adherence level of at least 90% is necessary to achieve viral suppression. This study uses pharmacy refill records to describe antiretroviral adherence in HIV-positive patients in Ugu District and to describe pharmacy refill records as reliable monitoring method of antiretroviral therapy. In total, 61 patients’ records were reviewed. Overall, 82% of participants (n=50) achieved an optimum adherence level of at least 90%. Although 38% (n=19) of these participants did not show any related viral suppression. A statistically significant relationship between adherence and viral suppression was not demonstrated. Therefore, pharmacy refill records cannot be recommended as an alternative method of monitoring response to antiretroviral therapy, but laboratory tests including CD4 cell count and or viral load must be combined to pharmacy refill method for monitoring of antiretroviral therapy in HIV-positive patients / Health Studies / M.A. (Public Health)

The purpose of this study was to determine and compare the outcomes of tuberculosis (TB) treatment among Human Immunodeficiency Virus (HIV) co-infected TB patients, and identify factors associated with these outcomes. A quantitative cross-sectional analytic design was used. Patient level secondary data was collected and analysed for the study. A total of 575 TB patients, including 360 non-HIV infected, 169 HIV co-infected and 46 without a documented HIV status, were enrolled. The overall treatment success rate was 91.5%, and HIV co-infected TB patients had a high rate (11.8%) of unfavourable outcomes. The cure rate was significantly lower (10.1% versus 24.2%) and the death rate higher in HIV co-infected patients (8.3% versus 2.5%). Age and TB classification were significantly associated with treatment outcome. No association was found with starting ART, Cotrimoxazole prophylactic treatment or enrolment in HIV care, but 22% of HIV co-infected TB patients were taking ART when they developed TB disease / Health Studies / M.A. (Public Health)

The purpose of the study was to evaluate the IMB skills model for its relevance to the Ethiopian context. According to the model, adherence-related information and motivation work through adherence-related behavioural skills to affect adherence to ART. Quantitative, analytical, observational, cross-sectional, institution-based study was conducted to evaluate the model by assessing those patients who have and do not have the right information, motivation, and behavioural skills whether they have or do not have good adherence to ART. Data was collected using structured questionnaires where a total of 400 randomly selected participants provided data on adherence-related information, motivation and behavioral skills as well as adherence behavior per se. Data was analysed using the Statistical Package for Social Sciences (SPSS) version 20.0. Both descriptive and inferential statistics used in the study. Only 90.75 % of the total sample population reported ART adherence rate of more than or equal to 95% in this study. Free and restricted model tests, through bivariate and multivariate analyses, used to assess the propositions of the IMB model of ART adherence and provided support for the interrelations between the elements proposed by the model. The study has supported the applicability of the IMB model of adherence to the Ethiopian context highlighting its application in adherence-promotion intervention efforts. The findings revealed the need for on-going educational, informational and other interventions to address the knowledge, motivation and adherence behavioural skills of patients in order to improve the current levels of ART adherence behaviour. / Health Studies / D. Litt. et Phil. (Health Studies)

Made available in DSpace on 2014-12-17T14:19:52Z (GMT). No. of bitstreams: 1 AnaLS.pdf: 754560 bytes, checksum: 4352ce162cb36ae915a586c0706ec693 (MD5) Previous issue date: 2009-11-30 / We study the health care focused on care in an intercessor and dialogical relationship with the User, which involves the construction of therapeutic projects essential to the quality of the treatment of the user in health services, and it is necessary individual and collective actions. It is intended to acknowledge and analyze the perception of social subjects, users and professionals on the treatment given to a user of a Specialized Outpatient Service (Servi?o Ambulatorial Especializado SAE) in STD/HIV/AIDS state reference in Natal, RN. The study is structured in a transdisciplinary vision of science and knowledge, theoretical and methodological principles that give meaning to the expression of the institutional features of care and health care reconnecting them to the social context. As a research strategy we seek the expressions of 56 subjects of social research, which agreed to participate in the sample, from a symbolic map of the attention, coupled with the techniques of observation and semi-structured interview. For the analysis of the results, five categories of analysis were established: the meaning of the service, care perception, process of communication and interaction, treatment perception and organization and evaluation of the service. It is argued that the attention and care are developed in a technical health care assistance to the disease, focusing on attention based on treatment, on diagnostic and drug therapy of antiretroviral drugs, reflecting the traditional biomedical paradigm of attention to the disease. This is also the mode of organization of practical actions in daily SAE: the therapy proves to be fragmented in several specialties, vertical and feeds the same model, generating tension and overload for professionals; showing impersonal care focused on structured and informative technology, unrelated to an interactive dialogic. From the speech of the subjects, the SAE is understood as the place of confrontation with the disease, but also enables greater elaboration of the illness by meeting their peers. Living with HIV and AIDS is living with concern, apprehension and fear, but mainly with the stigma, prejudice and exclusion, which require that the disease is kept in secret. There is a movement of forces and power, expressed in the knowledge-power of those who dominate the technical and administrative capabilities, devices that concentrate the maintenance of the medicalization of care, rapid consultations and with little attention, making it difficult to interact with and listen to, combined with structural failures, organizational and inadequate management of the service. We conclude that there are dimensions that are not considered in the internal dynamics of the care service multiple forms, characterized by care conflicting models, marked by individual interventions related to the disease. The subject is not considered together with his speech as technical discourse is imposed and care production based on material technology is observed / Estuda-se a aten??o ? sa?de centrada no cuidar, em uma rela??o intercessora e dial?gica com o usu?rio, que envolve a constru??o de projetos terap?uticos essenciais para a qualidade do tratamento do usu?rio nos servi?os de sa?de, sendo fundamentais a??es individuais e coletivas. Tem-se como objetivo conhecer e analisar a percep??o dos sujeitos sociais, usu?rios e profissionais, sobre o tratamento dispensado ao usu?rio de um Servi?o Ambulatorial Especializado em DST/HIV/Aids, refer?ncia estadual em Natal, RN. Articulam-se, em uma vis?o transdisciplinar da ci?ncia e do conhecimento, referenciais te?rico-metodol?gicos que possam dar sentido ? express?o das caracter?sticas institucionais da aten??o e do cuidado em sa?de, religando-as ao contexto social. Como estrat?gia de pesquisa, buscam-se as express?es dos 56 sujeitos sociais da investiga??o, que aceitaram participar da amostra, a partir de uma cartografia simb?lica da aten??o, associada a t?cnicas de observa??o e entrevista semi-estruturada. Para an?lise dos resultados, estabeleceram-se cinco categorias de an?lise: significado do servi?o, percep??o do atendimento; processo de comunica??o e intera??o; percep??o do tratamento e organiza??o e avalia??o do servi?o. Discute-se que a aten??o e o cuidado desenvolvem-se em uma assist?ncia tecno-assistencial ? doen?a, centrados em uma aten??o focada no tratamento, na solicita??o de exames e na terap?utica medicamentosa dos anti-retrovirais, reflexo do paradigma tradicional biom?dico de aten??o ? doen?a. Este tamb?m ? o modo de organiza??o das a??es pr?ticas no cotidiano do SAE: a conduta terap?utica mostra-se fragmentada nas diversas especialidades, verticalizada e retro-alimentada no mesmo modelo, gerando tens?o e sobrecarga aos profissionais; evidenciam-se atendimentos impessoais focados em tecnologias estruturadas e informativas, desvinculadas da dial?gica interativa. A partir dos discursos dos sujeitos, o SAE ? interpretado como o lugar do confronto com a doen?a, mas tamb?m possibilita maiores elabora??es do adoecer pelo encontro com os iguais. Conviver com o HIV e Aids ? conviver com receios, apreens?o e medo, mas principalmente com o estigma, o preconceito e a exclus?o, o que requer o sigilo da doen?a. H? circula??o de for?as e de poder, expressos no saber-poder t?cnico-profissional e administrativo, dispositivos que concentram a manuten??o da medicaliza??o do atendimento, consultas r?pidas e com pouca aten??o, o que dificulta a intera??o e a escuta, aliados a falhas estruturais, organizacionais e a um gerenciamento inadequado do servi?o. Conclui-se que h? dimens?es n?o consideradas na din?mica interna das m?ltiplas formas do cuidar, caracterizado pelo modelo conflitante da aten??o, marcado por interven??es individuais relacionadas ? doen?a. Desconsidera-se o sujeito de seu discurso, imputando-lhe discursos tecnicistas, e observa-se a produ??o do cuidado baseada na tecnologia material

Magister Public Health - MPH / Aim: This study aimed to evaluate the effectiveness of the Mobile HIV/AIDS Treatment Teams in initiating and treating patients with HAART at fixed primary health care clinics Amajuba District.

Magister Public Health - MPH / The aim of the study is to explore the barriers associated with low VCT uptake by the TB patients attending primary health care clinics within the Buffalo City municipality. The study population was drawn from TB patients attending the primary health care facilities in Buffalo city municipality in the Eastern Cape Province. Eight participants were purposively selected to include those who had accepted VCT as well as those who did not.

This thesis argues that corporations qua corporations are moral agents sui generis and hence capable of being held morally responsible. I argue that corporations qua corporations are responsible for the actual and foreseen consequences of their actions. I analyse normative theories and the different proscriptive responsibilities they place on moral agents and hence corporations. I examine Kantianism, utilitarianism and virtue ethics. I argue for a unique normative ethical theory that incorporates reasoning from all three of the normative theories. I argue for a broad range of reasons to factor into deciding whether an act is ethical or not. One of the claims of this thesis is that ethical theories must incorporate an agent’s motivation, intention and character traits as relevant to deciding on whether an action is ethical or not. My thesis argues for an indispensable role for the virtues while at the same time incorporating impartial beneficence and universal rationality from utilitarianism and Kantianism. This position I, following the literature, refer to as moderate virtue theory. Having established corporate qua corporate responsibility I question the pharmaceutical corporation’s practice of patenting life saving medication during a state of pandemic in poor countries. The moderate virtue theory position prioritises contexts and the actual human condition and criticises normative theories that attempt to give universal, abstracted answers to ethical problems. It is for this reason and the current (2003) HIV/AIDS pandemic that I focus on a particular context. I examine the practice of patenting life saving medication within South Africa and argue, applying moderate virtue theory, that this act cannot be justified. I argue that a pharmaceutical corporation that patents life saving medication in South Africa cannot justify that action and thus is morally responsible for that action. I also argue that corporations patenting HIV/AIDS medication in South Africa have unethical motivations and intentions.