After 25 years of existence, the Human Immuno-deficiency Virus (HIV) has become a global challenge. Yearly, about 3 million people in the sub Saharan region become infected with the disease each year, while 2 million die of the disease. The young, sexually active and those in the economically active group are mostly affected although other categories are also affected. Over the years efforts have been made to turn HIV infection from a death sentence to a manageable chronic disease through the use of antiretro viral treatment (ART). Despite the fact that this treatment is a life-long commitment with adherence being crucial to its effectiveness, some patients still default. This research study sought to identify the characteristics of HIV positive patients who are lost to follow up after the initiation of antiretroviral treatment over a 2-year period (2007-2008). A tick sheet was used to collect data from all the files of patients lost to follow up and 20 variables were tested. The conclusion reached is that age, sex, distance of residence to the ART site and economic capability contribute to ‘lost to follow-up’.

The medico-scientific advances made in the treatment of HIV and AIDS, which emerged in the mid 1990s, were significant. The Highly Active Anti-Retroviral Treatments (HAART) or anti- HIV treatments have been positioned as resources that changed the way HIV is now medically and socially constructed. Although HIV remains incurable, it is now constructed as a chronic disease that is treatable, manageable and people are no longer positioned as living with a ‘death sentence’. The research on which this thesis is based explores the subjective lived experiences of people with HIV living in urban Australia in the context of this change. The effects that the treatments have had on corporeality have also changed the ways people are now living with HIV in the post-treatment era. It is an era in which treatments for HIV are taken-for-granted, but issues, doubts and concerns relating to treatment use are firmly embedded in the everyday life of people with HIV. The findings suggest that whilst AIDS-related mortality has decreased since the availability of effective treatments, the notion of ‘quality of life’, as subjectively constituted and defined, is an ongoing negotiation that is predicated on people locating meaningfulness in their everyday lives. Despite the decreased threat of failing health and death, the findings also suggest that people are continuing to be confronted by, and therefore positioned as, having to make sense of complex issues embedded in living with a disease for which there is no cure. / Doctor of Philosophy (PhD)

This dissertation aimed to describe nonverbal behaviours in South African multicultural HIV treatment contexts. It also aimed to identify the most appropriate method for nonverbal behaviour data analysis and transcription. The study used a single-case, parallel design, which incorporated three qualitative methodological tools; ethnography, a modified form of conversational analysis and interviews. Data used was from a preexisting videotaped database, belonging to a larger research project. Data consisted of 4 videotaped interactions between doctors and caregivers of children with HIV/Aids at the Red Cross Children’s Hospital. Through the use of polyphonic transcription, five nonverbal domains - eye gaze, body posture, facial expression, gesture and head posture – were analysed. Patterns and trends of these transcripts were crosschecked with data from the existing set as well as with data and findings from this and other research sites. Findings identified correlations between nonverbal behaviour patterns, interpersonal dynamics and communicative transfer. Specific critical moments of collaboration between caregiver and practitioner as well as nonverbal behaviour roles in communicative and interactional dynamics were also identified. Study findings thus posses the potential to; facilitate effective medical interactions, direct future nonverbal behaviour research and guide the development of medical education and policy.

Magister Pharmaceuticae - MPharm / Access to antiretroviral therapy (ART) for HIV positive patients has brought hope and a chance to a healthier longer life with improved quality of life (QoL). In this study we explored the difference in health related quality of life (HRQoL) between participants eligible for ART and those not yet eligible for ART as per the 2015 South African HIV treatment guidelines. We also considered the impact of ART access on HRQoL and the effect of employment status and education level. The study was conducted at one tertiary hospital and two primary health care facilities in Johannesburg, South Africa.

Magister Public Health - MPH / Background: The recognition of HIV/AIDS as a chronic life-long condition globally in recent years has demanded a different perception and an alignment to its association with other chronic diseases. Both HIV and other chronic non-communicable diseases are significant causes of morbidity and mortality. Their combined DALY contributions for Botswana would be significant if research and strategies in controlling these conditions are not put in place. Natural aging and specific HIV-related accelerated aging of patients who are on antiretroviral treatment means that age-related diseases will adversely affect this population. Princess Marina Hospital Infectious Diseases Care Clinic has been in operation since 2002. The clinic has initiated over 16 000 patients on anti-retroviral treatment (ART) since 2002. The current study estimated the prevalence of non-AIDS defining conditions (NADCs) in the attendees of the clinic in 2013. The majority of patients that attended the clinic had been on treatment for over three years with some patients more than ten years. These ART experienced patients were more likely to be susceptible to chronic non-communicable diseases, including non-AIDS defining conditions. The nomenclature used in classification of NADCs in the current study was appropriate for resource-limited settings; because the study setting offered HIV treatment under resources constraints. Aim: The current study characterised non-AIDS defining conditions, and determined their associations with virologic treatment failure in a cohort of patients that were enrolled at Princess Marina Hospital antiretroviral clinic in Gaborone, Botswana. Methods: A retrospective cross sectional study of records of patients who attended the Princess Marina Infectious Diseases Care Clinic in 2013. Stratified random sampling of a total of 228 patients’ records was achieved from a total population of 5,781 records. Data was transcribed into a Microsoft Excel Spreadsheet and then exported to Epi-Info statistical software for analysis. Results: Eighty (35%) cases of NADCs were reported/diagnosed in the study sample; with 27% (n=62) of the patients having at least one condition, 6.7% (n=17) two conditions, and 0.4% (n=1) three conditions. The top prevalent conditions were hypertension (n= 40), hyperlipidaemia (n=7) and lipodystrophy (n=7). The prevalence of NADCs on the various categories of patients compared with the total sample population was as follows: active patients (prevalence ratio= 0.70), transferred out patients (prevalence ratio = 1.24), patients who died (prevalence ratio=2.04) and patients who were lost to follow-up (prevalence ratio =2.86). The prevalence of NADCs was significantly associated with increasing age (p<0.001); having social problems (p=0.028); having been on treatment for over three years (p=0.007); an outcome of death (p = 0.03) and being lost to follow-up (p=0.007). The study showed that being controlled on second line or salvage regimen (p=0.014) and the presence of adherence problems in the past was associated with virologic failure (p=0.008). There was no association of presence of NADCs to virologic failure. Conclusions: There was significant morbidity of non-AIDS defining conditions in the Princess Marina Infectious Diseases Care Clinic shown by a prevalence of NADCs in the clinic of 35% in 2013.The significant associations of the presence of NADCs and virologic failure with outcomes of death and loss to follow-up illustrate the adverse effects that NADCs are having, and calls for strategies to address multi-morbidities in HIV patients on antiretroviral treatment.

<p>In 2018, the World Health Organization (WHO) reported approximately 37 million people are living with the Human Immunodeficiency Virus (HIV). Suppressing replication of the virus down to undetectable levels was achieved by combination antiretroviral therapy (cART) which effectively reduced the mortality and morbidity rates of HIV positive individuals. Despite the improvements towards combatting HIV/AIDS, no successful treatment exists to eradicate the virus from an infected individual. Treatment regimens are lifelong and prompt less than desirable side effects including but not limited to; drug-drug interactions, toxicity, systemic organ complications, central nervous system HIV triggered disorders and most importantly, drug resistance. Current therapies are becoming ineffective against highly resistant HIV strains making the ability to treat long-term viral suppression a growing issue. Therefore, potent and more effective HIV inhibitors provide the best chance for long-term successful cART. </p> <p>HIV-1 protease (PR) enzyme plays a critical role in the life cycle and replication of HIV. Significant advancements were achieved through structure-based design and X-ray crystallographic analysis of protease-bound to HIV-1 and brought about several FDA protease inhibitors (PI). Highly mutated HIV-1 variants create a challenge for current and future treatment regimens. This thesis work focuses on the design, synthesis, and evaluation of two new classes of potent HIV-1 PIs that exhibit a novel bicyclic oxazolidinone feature as the P2 ligand and a novel bis squaramide scaffold as the P2/P3 ligand. Several inhibitors displayed good to excellent activity toward HIV-1 protease and significant antiviral activity in MT-4 cells. Inhibitors 1.65g and 1.65h were further evaluated against a panel of highly resistant multidrug-resistant HIV-1 variants and displayed antiviral activity similar to Darunavir. X-ray crystal structures of inhibitor 1.65a and inhibitor 1.65i were co-crystallized with wild type HIV-1 protease and solved at a 1.22 Å and 1.30 Å resolution and maintained strong hydrogen bond with the backbone of the PR enzyme. </p>

Magister Legum - LLM

Magister Artium (Development Studies) - MA(DVS) / Malawi had an estimated HIV prevalence of 9.6% with about 9.2% of its adult population living with HIV/AIDS in 2018. HIV Counselling and Testing (HCT) is essential to the prevention of HIV infection, HIV treatment and access to care and support services. However, despite the availability of free HCT services, the uptake of HCT services has been low among men in Malawi. This study assessed barriers and enablers of HCT uptake among men aged 18-49 in Chileka Health Area in Lilongwe District.

Thesis (M.A. (Clinical Psychology)) --University of Limpopo, 2013 / Studies have indicated that help-seeking behaviour of people living with HIV is not predictable and linear and may entail the utilization of western medicine, traditional medicine and/or complementary medicine. The aim of this study was to explore pre- and post- HIV diagnosis help-seeking behaviour by patients receiving antiretroviral treatment at Witbank Hospital in Mpumalanga Province (South Africa).A qualitative, descriptive phenomenological approach was utilized in the study. Ten participants (male = 5; female = 5, and aged between 30 and 50 years)diagnosed with HIV and who came to the hospital to collect their treatment and for medical review were interviewed using semi-structured interviews. Interpretive analysis method was used to analyse the data. The results suggest the preference for western medicine pre-and post-HIV diagnosis. The results further suggest that help-seeking behaviour is a dynamic process embedded mainly in the conceptualization of the health problem, perception of its severity, the treatment given, and social support experienced.

This qualitative exploratory study explored adolescents’ perceptions of the HIV youth friendly centre at a hospital in Lesotho in order to improve adolescent-friendly health care services in Lesotho. Data was obtained through interviewing nine purposively selected adolescents aged 18–19 years who accessed health care services at the centre, and was analysed using an adapted version of Colaizzi’s seven-step thematic analysis. Six themes emerged from this study: attributes experienced during adolescents’ visits to health care facilities, adolescents’ perceptions of the health care facility, waiting times, facts related to HIV pre-test counselling, description of services available for adolescents’ health, and challenges faced by adolescents in relation to their HIV positive status. The adolescents explained the factors that encouraged them to be tested, and to commit to HIV management and treatment. The findings showed that it is important to reserve a dedicated space for adolescents, to provide comprehensive health services at one site, to ensure adolescents’ privacy and confidentiality, to indicate patient flow clearly, to indicate the service offering clearly, to offer flexible operating hours and days, to involve youth in the service provision, to keep queues short, and to establish peer support groups. / Health Studies / M.A. (Public Health)