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Magister Artium (Psychology) - MA(Psych) / The Human Immuno-deficiency Virus (HIV) that leads to Acquired Immuno-Deficiency Syndrome (AIDS) is considered to be spreading at a high rate in South Africa. Research indicates that this disease is highly prevalent among people 15 and 49. It is estimated that one in five adults in South Africa is HIV positive. Community or home-based care nurses manage the treatment of sufferers at their homes while under the care of their family members, friends, spouses and significant others. The present study explored the experiences and coping strategies of HIV/AIDS primary caregivers. / South Africa

Introduction: A culturally competent survey currently does not exist to characterize the burden of Adverse Childhood Experiences (ACEs) among a HIV/AIDS population receiving care at a local Center of Excellence (COE). Methods: A qualitative study was conducted including 11 interviews involving opinions on national surveillance questions to develop a culturally competent survey. Purposive sampling, reactive probing, and analysis of transcribed interviews were completed using structured coding to determine which questions were kept, modified, or removed in the final survey. Results: The final 55-question survey contained more generalized ACE questions, topics pertaining to barriers to HIV care, and a list that patients could select from to indicate what they need to improve their HIV care. Conclusion: The final survey provided the opportunity to characterize the burden of ACEs at a COE. Future directions involve piloting the survey as a quality improvement tool with the goal of increasing retention rates through more individualized HIV care.

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Introduction: Factors contributing to the HIV continuum of care (HCC) for adults in Tennessee (TN) have not been studied in depth with known predictors for HIV risk, specifically adverse childhood experiences (ACEs), among low annual income or sexual minority groups [lesbian, gay, bisexual, or transgender (LGBT)]. Methods: A mixed methods study design was used to assess factors related to the HCC. Quantitative analysis used the TN Behavioral Risk Factor Surveillance System data to examine at risk and ever tested for HIV, to (1) investigate ACEs among adults with low-income (<$25,000 annually) in 2016-2017 and (2) among LGBT in 2018. Descriptive statistics and multiple logistic regression (MLR) analysis stratified by TN grand division were performed. Qualitative analysis included 11 interviews with persons living with HIV (PLWH) receiving care at a local clinic to evaluate surveillance questions related to ACEs and the HCC to develop a culturally appropriate survey. Results: Quantitative results found that among LGBT (N=262) and low-income (N=3258) adults living in TN, the proportion at risk for HIV and ever tested for HIV was highest in East TN (LGBT at risk – 45.53%; LGBT ever tested for HIV – 58.32%; low-income at risk – 8.14%; low-income ever tested – 52.05%). Among adults with low-income, MLR revealed 1-3 ACEs decreased the odds of HIV risk in East (aOR: aOR: 0.54, 95% CI: 0.52-0.56) whereas 4+ ACEs increased odds of being at risk in Middle TN by 32 times (aOR: 31.86, 95% CI: 29.83-34.02) compared to adults with no ACEs. Among LGBT, MLR estimated odds of HIV testing were 33 times higher among adults in West TN at risk for HIV compared to those not at risk (West TN, aOR: 33.59; 95% CI: 31.97-35.96). Qualitative analysis results provided a 55-question survey related to ACEs, HIV transmission risk, and barriers to HIV care. Discussion: Regional differences were revealed among LGBT and low-income populations; low-income and ACEs were associated with being at risk and ever tested for HIV. ACEs and HCC surveillance were considered relevant by PLWH at the clinic. Additional research including piloting the survey and longitudinal studies are necessary to improve the HCC and quality of life among PLWH in TN.

South Africa has one of the highest HIV prevalence rates globally, with nearly 2.5 million people accessing antiretroviral treatment (ART) at the end of 2013. Retaining patients on ART has become a major problem in this country. When patients no longer show up for ART for unknown reasons, they are considered lost to follow-up (LTF). LTF is the highest contributor to ART attrition. This study, guided by the health belief model, evaluated the effectiveness of a technology-based, mobile health (mHealth) appointment reminder intervention on LTF among patients accessing ART services. The study ascertained differences in 6- and 12-month LTF rates between patients enrolled in the mHealth intervention (n = 832) and those in the standard of care comparison group (n = 918). A quantitative, retrospective cohort approach was used to answer the research questions using binary logistic regression analyses. The mHealth intervention was found to be significantly linked to lower likelihood of 6- and/or 12-month LTF among patients. There were 2 other key findings: a positive correlation between pregnancy and LTF, and a positive correlation between viral load increases and LTF. This study added evidence to the existing literature on the effectiveness of using mHealth-based interventions to improve HIV/AIDS care. Based on these findings, professionals should pay special attention to pregnant women and those clients with increasing viral loads to ensure they are not LTF. Positive social change that may result from this study is better health outcomes for patients on ART due to reduced risk of HIV related complications and other illnesses. This awareness would improve the lives of the patients, and positively impact their families, communities, and ultimately the global community, by reducing the overall impact of HIV disease.

<p>The Human Immuno-deficiency Virus (HIV) that leads to Acquired Immuno-Deficiency Syndrome (AIDS) is considered to be spreading at a high rate in South Africa. Research indicates that this disease is highly prevalent among people 15 and 49. It is estimated that one in five adults in South Africa is HIV positive. Community or home-based care nurses manage the treatment of sufferers at their homes while under the care of their family members, friends, spouses and significant others. The present study explored the experiences and coping strategies of HIV/AIDS primary caregivers.</p>

<p>The Human Immuno-deficiency Virus (HIV) that leads to Acquired Immuno-Deficiency Syndrome (AIDS) is considered to be spreading at a high rate in South Africa. Research indicates that this disease is highly prevalent among people 15 and 49. It is estimated that one in five adults in South Africa is HIV positive. Community or home-based care nurses manage the treatment of sufferers at their homes while under the care of their family members, friends, spouses and significant others. The present study explored the experiences and coping strategies of HIV/AIDS primary caregivers.</p>

Introduction: Evidences indicate that human immuno-deficiency virus (HIV) and diabetes (DM) impact pregnancy outcomes but no experience on the integrated service delivery of HIV, DM and pregnancy care. This study explored the domains and levels of integration among DM, HIV and pregnancy care to prepare a service delivery model in Ethiopia. Methods: A sequential exploratory mixed method and the integration theoretical framework guided the study. An exploratory qualitative phase used focused group discussion, in-depth interview and observation to explore the level of integration and to refine a questionnaire for the quantitative phase. The data were transcribed and coded for theme-based analysis. The descriptive quantitative phase described HIV, DM and pregnancy care services, and determined the burden of DM among HIV patients and the prevalence of pregnancy and pregnancy outcomes. Data was analysed using Epi-info. The findings were triangulated, discussed and interpreted. Results: Seven themes were generated: joint plan, shared budget, monitoring system, structural location, the need of policy guide, the practice of integrated service delivery and suggested integration approaches. A coordinated HIV and pregnancy care services were noted. There was a linkage between diabetes and HIV, and diabetes and pregnancy care. The 1.5% of diabetes among HIV, the low number of pregnancies per a mother in diabetes (1.8) and HIV (1.3); the high adverse pregnancy outcomes among HIV (13.4% abortion, 12.4% low birth weight (LBW), 3.5% pre-term birth, 2.1% congenital malformation) and diabetes (3.2% big baby, 3.2% LBW, 3.1% Cesarean-section); the respective absent and low (16.2%) diabetes screening service at anti-natal and HIV clinics, the absent pregnancy care service for diabetic females justified the development of the tripartite integrated service delivery model of diabetes, HIV and pregnancy care. Conclusions: The model suggests active diabetes screening, evaluation and treatment at HIV and antenatal clinics. It considers the coordination between non-communicable diseases (NCD), HIV and maternal health units. Pregnancy care could be coordinated at HIV and NCD units. Full integration can be practiced between HIV and pregnancy care units. Preparing policy guide, building the capacity of health providers, advocating and piloting the model may be prioritized before the implementation of the model. / Health Studies / D. Litt. et Phil. (Health Studies)

Postnatal care provides the opportunity for protecting the health of women and their babies by optimising human immunodeficiency virus (HIV) treatment and management. This study intended to explore the implementation of postnatal care to HIV positive women by explicating nurses’ views regarding their practices with the aim of improving the programme. The study was conducted at three clinics in Mangaung. An evaluative case study design was used to provide a detailed account on implementation of postnatal care to HIV positive clients. The purposive non-probability sampling was used. Semi-structured methods using focus group interviews were used to collect data. Data were reviewed through thematic analysis. The study found that nurses understood guidelines, used them to direct their practice and challenges were highlighted. It was concluded that the system limitations needed to be addressed, skills of health care providers improved and linkages with community based services strengthened to improve effectiveness of care. / Health Studies / M.PH.