Background: South Africa has a generalised HIV epidemic which is managed through free Antiretroviral Therapy (ART). Adherence to ART has emerged as a crucial issue in HIV/AIDS therapeutics. Purpose: The aim of the study was to explore determining factors for poor and excellent adherence to ART for HIV positive patients residing in Barberton, a mining town in Mpumalanga Province. Methodology: A generic qualitative research design was undertaken. Data was collected through in-depth qualitative interviews from a purposive sample of 13 ART patients. Qualitative interpretive analysis was employed. Findings: The study found that excellent adherence to ART is significantly associated with the availability, effectiveness and comprehensiveness of HIV services, psychological support and medical advances. Side effects of ART, opportunistic infections and alcohol and drug use hinder adherence. However, longer duration on ART enhanced self-efficacy and facilitated adherence. Successful ART is dependent on taking ARVs as prescribed and executing necessary lifestyle changes. / Health Studies / M.P.H.

South Africa's HIV prevalence rate is estimated to be 5.7 million and at the end of2007 a total of 45845 HIV/AIDS adult patients were taking antiretroviral therapy (ART). The global incidence of HIV/AIDS has been slowly decreasing over the years but is still widespread. This disease is still more prevalent in sub-Saharan Africa than in other parts of the world, with more than 60% people living with HIV/AIDS. Highly active antiretroviral therapy (HAART), the treatment of choice, slows the progression of the human immunovirus but demands a high adherence rate in excess of 95%. Patients who are poorly informed about antiretrovirals (ARVs) and misunderstand medicine-taking instructions or experience unexpected side effects may interrupt therapy, predisposing them to the development of resistance. Such patients need information but, given the poor literacy skills prevalent in South Africa, written information is often not fully comprehended and is often written at too high a reading level. The objectives of this research project were to design, modify and evaluate HIV / AIDS patient education materials for low-literate isiXhosa speaking adults residing in Grahamstown and to examine their impact on the understanding of various aspects of the disease and its treatment. Pictograms illustrating common side effects of ARVs (e.g. stavudine, efavirenz, lamivudine), as well as various sources 'for purchasing nonprescription medicines, storage and medicine-taking instructions were designed and evaluated both qualitatively, using group discussions, and quantitatively through individual interviews where interpretation of the pictograms was assessed. These pictograms were incorporated in a patient information leaflet (PIL) which had been specifically designed for people with limited reading skills and was a simple document containing the minimum of essential text. A previously developed PIL was modified in collaboration with the target population and two versions were produced, one incorporating pictograms illustrating side effects, the other with none. Pictograms were used in both to illustrate other medicine-taking instructions. The PILs were tested objectively to assess the readability, format, content, and general design. They were translated into isiXhosa prior to being qualitatively and quantitatively evaluated in a low-literate isiXhosa speaking population. Understanding of the PILs was assessed by asking a series of questions about the PIL content. Participant opinion of the readability and appearance of the PIL was recorded. The relationship between PIL understanding and selected demographic variables was investigated. Findings from this study illustrated that well designed pictograms assist in the location of information in written leaflets and they may enhance understanding of the information. It was further demonstrated that education influences total understanding of PIL content thus emphasizing the need for tailor-written information in accordance with the education level of the target population. A desire to receive PILs incorporating pictograms was expressed by the majority of participants. Collaboration with the intended target population is essential to design culturally acceptable, easily interpreted pictograms and to produce user-friendly, easy-to-read, comprehensible patient education materials. The rigorous, iterative design, modification and testing process described in this study is one that should be adopted in producing all health-related education materials.

Introduction: Adherence to Highly Active Antiretroviral Therapy (HAART) is critical for optimal therapeutic outcomes. A possible factor in adherence is the impact of HAART on sexual functioning. Methods: A mixed methods approach was used. A cohort of 14 people living with HIV/AIDS (PLWHA) in Grahamstown was identified. Two semi-structured interviews and two structured questionnaires were administered. In-depth interviews were conducted with two HIV counsellors in so as to obtain a different perspective on the topics. The theoretical framework used three health behaviour models: the Health Belief Model, Leventhal‘s Common-Sense Model of self regulation and the Transtheoretical model. Results: The participants were between 27 and 49 years old and had been on HAART for between 9 months and 10 years. Six participants were support staff members from Rhodes University and eight from the Raphael Centre – a local NGO which assists PLWHA.In most of the participants HAART was associated with increased libido and improved sexual functioning (sexual activity and sexual enjoyment). The use of alcohol increased risky sexual behaviour. Issues of adherence were seemingly not directly affected by the effects of HAART on sexuality. PLWHA, especially women, face challenges related to their sexuality, some of which are not directly related to their illness and treatment. The fear of transmitting drug resistant HIV or getting re-infected, stigma, disclosure issues,difficulties negotiating for safe sex among women, HAART-related lipodystrophic changes that affect one‘s sense of self and unmet reproductive needs are some of the problems that were reported. The men‘s dislike for condoms was overt and blatant. Discussion: Being diagnosed with HIV and reaching a point where treatment is requiredare life-changing events. Making decisions about one‘s life (including adherence to HAART, alcohol use and knowingly partaking in risky sexual encounters) become all the more significant in the context of AIDS. Intentional non-adherence is informed by the individual‘s assessment of the costs and benefits of taking treatment. Cultural influences,gendered power relations and misconceptions strongly influence sexual behaviours. Conclusion: The general lack of attention among health care providers concerning issues related to PLWHA‘s sexuality and reproductive issues needs to be addressed. Insights fromthe theoretical models should be integrated with empirical findings in designing adherence interventions.

The purpose of this study was to determine factors affecting non-adherence to Anti-retroviral therapy among AIDS patients. A cross sectional quantitative survey, was used. Structured interviews were conducted with 300 ART patients. Data were analysed using SPSS version 13 and presented in charts, graphs and frequency tables. Motivators of good adherence were identified as disclosure of HIV positive status to more than one person, frequent adherence counselling, self-efficacy to adhere to ART, positive interactions between patients and healthcare providers; and using an adherence partner. Barriers to adherence were forgetfulness, transportation costs to and from the clinic, time away from work and side effects. There was a strong positive correlation between adherence, CD4 counts and viral load. Adherence was closely tied to immunologic and virologic improvements. Respondents with poor adherence were likely to have unsuppressed viral loads (OR 12.98, 95%, CI 4.9-34). / Health Studies / Masters of Public Health

Indiana University-Purdue University Indianapolis (IUPUI) / Shelby County has the fastest growing rate of HIV infection in the State of Tennessee and the majority of the people with HIV/AIDS are African Americans. 2011 CDC report stated Memphis had the fifth highest proportion of new HIV infections. The African American church is a natural and potentially powerful venue to facilitate health awareness. The purpose of this qualitative study was to explore the views of African American faith-based leaders (FBLs) toward offering HIV prevention services in faith-based organizations (FBOs). The theoretical framework for this study was the Consolidated Framework for Implementation Research (CFIR). The fourth domain of CFIR, characteristics of the individuals, is concerned with organizational change which occurs on the individual level. CFIR provided a means to ensure effective implementations, data coding and analysis. Interpretative Descriptive (ID) design, which seeks to discover associations, relationships, and patterns within the described phenomenon, was used. The targeted population was African American Faith-based Leaders from areas known to have high rates of HIV and sexually transmitted infections (STIs). Purposeful sampling was employed to recruit participants. Data was generated through face-to-face, semi-structured interviews. The researchers categorized and analyzed the data to form the concepts and themes identified using a coding scheme which was applied to all data. Faith-based leaders revealed that they had a role in HIV prevention. The themes that emerged were their role to provide education on HIV, minister with compassion, teach Biblical doctrine, maintain a community focus, and partner with expert healthcare professionals. Perceived barrier concepts identified were lack of knowledge, denial, stigma, fear, keeping issues private, and the breakdown of family and community values. Findings suggest that FBLs had some knowledge of the health disparities and ongoing stigma concerning HIV remains a major barrier. The participants interviewed were open to HIV preventions on different levels to address HIV but needed more education.

The purpose of this study was to develop a laboratory based Comprehensive Care, Management and Treatment of HIV and AIDS (CCMT) programme status reporting system using a methodological research study design. Quantitative data was collected using a request form and qualitative data was collected using structured questionnaires. For the study 1190 eligible CD4 samples were received, of which 1004 (84%) had a valid CCMT programme status. Overall 32% of the CD4 samples had a pre-ART status (n=383) and 52% had an ART status (n=621). The remaining 16% of CD4 samples (n=186) did not have a valid CCMT programme status. A pre-ART register was generated and assessed using a structured questionnaire. Based on the study findings a recommendation has been made to adopt the two-tick design for all NHLS request forms where programmatic data is collected. Additionally the CCMT programme status reporting system is recommended for rollout to other health districts / Health Studies / M.A. (Public Health with specialisation in Medical Informatics)

Thesis (MPhil)--Stellenbosch University, 2013. / ENGLISH ABSTRACT: STUDY AIM The aim of the study is to explore the psychosocial characteristics of HIV positive clients who are yet to achieve viral load suppression after six months of commencing ARV at Sundumbili CHC in order to plan positive intervention strategies. RESEARCH DESIGN Non-experimental quantitative design was used in carrying out the study. The data was collected through retrieval of information from clinic records and completion of questionnaires to clients on ARV who met the inclusion criteria and consented to participating in the study. A total of 51 adults aged more than 18 years that were initiated in 2010/2011 and still access their treatment at Sundumbili CHC were enrolled into the study. They were selected through convenience sampling. FINDINGS Psychosocial challenges still exist among research participants whose viral load results were not suppressed after six months on ARV. This affected the adherence of some of them to their antiretroviral treatment. CONCLUSION Given the rural nature of Sundumbili and surroundings where the bulk of the patients reside, there are several psychosocial challenges affecting the patients. No known previous study has been undertaken to ascertain the psychosocial characteristics of this group of patients and the impact they may have on viral load suppression after six months of treatment. The study is therefore significant as the findings have provided more insight into the plight of the patients. It is envisaged that the recommendations from the study will assist the relevant management staff in the department in planning and subsequently implementing more positive intervention strategies. The strategies should be targeted at improving the quality of care of the HIV positive clients and attending to their psychosocial needs. / AFRIKAANSE OPSOMMING: STUDIEDOELWIT Die doel van die studie was om ondersoek in te stel na die psigososiale kenmerke van MIV-positiewe kliënte wie se virustellings ná ses maande van antiretrovirale (ARV) behandeling by die gemeenskapsgesondheidsentrum op Sundumbili steeds nie onder beheer was nie, ten einde positiewe intervensiestrategieë te beplan. NAVORSINGSONTWERP ’n Nie-eksperimentele kwantitatiewe ontwerp is gebruik om die studie te onderneem. Die data is ingesamel deur die herwinning van inligting uit klinieklêers sowel as die afneem van vraelyste onder kliënte op ARV’s wat aan die insluitingsmaatstawwe voldoen en tot deelname aan die studie toegestem het. Altesaam 51 volwassenes bo die ouderdom van 18 wat in 2010/2011 met ARV behandeling begin het en dit steeds by Sundumbili-gemeenskapsgesondheidsentrum ontvang, is in die studie opgeneem. Dié groep is deur middel van geriefsteekproefneming gekies. BEVINDINGE Psigososiale uitdagings was steeds te bespeur by navorsingsdeelnemers wie se virustellings nog nie ná ses maande op ARV’s onder beheer was nie. Dit het sommige se behandelingsgetrouheid beïnvloed. GEVOLGTREKKING In die lig van die landelike aard van Sundumbili en omgewing, waar die meeste van die pasiënte woon, kom pasiënte voor verskeie psigososiale uitdagings te staan. Daar is klaarblyklik nog nooit vantevore ’n studie onderneem om die psigososiale kenmerke van hierdie groep pasiënte, en die moontlike impak daarvan op die onderdrukking van virustellings ná ses maande van behandeling, te bepaal nie. Hierdie studie is dus waardevol, aangesien die bevindinge groter insig in die lot van die pasiënte bied. Daar word beoog dat die aanbevelings uit die studie tersaaklike bestuurspersoneel in die Departement van Gesondheid sal help om meer positiewe intervensiestrategieë te beplan en gevolglik in werking te stel. Die strategieë behoort daarop afgestem te wees om die gehalte van sorglewering aan MIV-positiewe kliënte te verbeter en in hul psigososiale behoeftes te voorsien.

The researcher investigated the knowledge, attitudes and experiences of people living with the Human Immunodeficiency Virus (HIV) towards antiretroviral treatment (ART) and who are accessing antiretroviral treatment at a public health clinic in Limpopo, South Africa. A qualitative method was used. The research findings revealed five themes: experiences, social support, knowledge, attitudes, unemployment and economic themes of the study. Factors reported influencing optimum adherence were the inability of the patients to take medication at work, laziness of the patients to collect medication, unemployment, economic hardship, poverty and lack of knowledge of employers regarding HIV/AIDS. / Health Studies / M.A. (Social Behaviour Studies in HIV and AIDS)

AIM The purpose of this study was to explore and describe factors that contribute to the non-initiation of Antiretroviral Therapy (ART) amongst Pre-Antiretroviral Therapy eligible patients and to make recommendations for health care workers to enhance early initiation of pre-ART-eligible patients for primary health care facilities in Swaziland. METHOD A qualitative design was applied in rural primary health care (PHC) facilities in the Hhohho region of Swaziland. The target population for this study included nurses who have successfully completed the National Nurse Led Antiretroviral Therapy Initiation in Swaziland (NARTIS) training, and who actively initiated ART to eligible patients in rural PHC facilities. Data was collected through semi-structured interviews and field notes. Purposive, convenient sampling was applied. Eleven respondents were interviewed for the study, and data was collected until data saturation was reached. Data from transcripts and field notes was analysed and categorised with thematic analysis through Tesch’s open coding process. RESULTS The study identified the following three predominant themes: 1) systematic enablers of prompt ART initiation, 2) barriers to prompt ART initiation, 3) sources of support. Categories included public health care (PHC) factors, community level factors, the interdependence of the health care system, patient centred barriers, individual patient agency, and NARTIS nurse support. CONCLUSION The recommendations for health care workers that emerged from the study included continued HIV treatment scale-up and decentralisation to grass roots levels, aggressive treatment prioritisation among pre-ART patients, building the capacity of the local health care system and continued research initiatives. It is hoped that recommendations emerging from the findings of this study will have positive implications for programming and practice regarding the initiation of ART for eligible pre-ART patients in Swaziland. / Health Studies / M. PH.

The purpose of the study was to explore the understanding and implementation of the guidelines by nurses to detect mental disorders in Human Immunodeficiency Virus (HIV) management in the Limpopo Province, South Africa. The study aimed to recommend measures to strengthen implementation practices. Qualitative, exploratory and descriptive approach was conducted. Non-probability purposive sampling was used to select primary health professional nurses trained in HIV programme at primary health care facilities in Capricorn District. Data were collected through focus groups and in-depth individual interviews approach using the interview guide. The interviews started with focus group discussions as primary method and in-depth individual interviews as follow-up. Interviews were tape recorded and transcribed. Data were analysed using Creswell’s data analysis steps. Four themes emerged from data: understanding of HIV management guidelines; implementation of the guidelines; strengthening of mental health screening and competencies required for mental health screening. The study revealed that the nurses who did not have psychiatric nursing as an additional qualification lacked confidence and skills to conduct mental health screening in HIV positive infected individuals. However, they used their background nursing knowledge to manage clients. They all experienced challenges with information provided in the guidelines to screen for mental health in HIV management. Based on the results of this study, it was recommended that there should be integration of mental health and HIV and development of practical assessment tools for mental health screening. The study acknowledges the importance of equipping nurses with adequate skills to diagnose altered mental health states among HIV infected individuals. / Health Studies / M.A. (Nursing Science)