Effective symptom management is essential to decrease symptom severity and improve health-related quality of life for persons living with HIV (PLWH). A mobile health (mHealth) application (app) has the potential to be an effective delivery mode of an existing paper-based symptom management manual with self-management strategies for underserved PLWH. The quality of the mHealth app requires a thorough understanding of the needs of the intended end-users and ensuring the app’s usability. The purpose of this study was to translate paper-based health information into an mHealth app for symptom self-management in underserved PLWH, entitled mVIP (mobile Video Information Provider), and assess its usability. To achieve this goal, usability was evaluated rigorously throughout the development process of mVIP. Based on a stratified view of health information technology (IT) usability evaluation framework, usability evaluation was sequentially conducted with the following three levels: 1) user-task, 2) user-task-system, and 3) user-task-system-environment. At level 1 (user-task), we applied a user-centered design method to guide the information architecture of mVIP. Using a reverse in-person card sorting technique, symptoms and self-management strategies from a paper-based HIV/AIDS symptom management manual were ranked. The rank order of the 13 symptoms and 151 self-management strategies determined the order of appearance to end-users of the mVIP app, with higher-ranked symptoms and strategies appearing first. Based on the findings, we developed a prototype of mVIP as following: 1) once users log in, they are guided by an avatar through a series of 13 symptom questions ascertaining the nature and severity of their symptoms, and 2) the avatar recommends three self-management strategies for each symptom reported. At level 2 (user-task-system), we conducted a usability evaluation of the mVIP prototype in a laboratory setting through end-user usability testing and heuristic evaluation. In end-user usability testing, we used an eye-tracking and retrospective think-aloud method to examine task performance by 20 PLWH. For the heuristic evaluation, five usability experts in informatics assessed the user interface. In the two usability evaluations conducted in a laboratory setting, we found strong user acceptance of the mVIP prototype while identifying a number of usability issues with this prototype. Based on the recommendations from the end-users and heuristic evaluators, we iteratively refined the app’s content, functionality, and interface. We then inserted videos of the finalized symptom self-management strategies into the refined mVIP prototype. At level 3 (user-task-system-environment), the usability of the refined mVIP prototype was evaluated in a real-world setting. Through 10 in-depth interviews and four focus groups conducted at the conclusion of a three-month randomized controlled trial, we explored in-depth understandings of users’ experiences, perceptions, and satisfaction of mVIP use. Findings from the study showed that first, mVIP is useful for HIV-related symptom self-management and has the potential for being used as a communication tool with healthcare providers; and second, mVIP is easy to use to monitor symptom experience over time. At the same time, participants suggested mVIP be more sensitively tailored based on years from initial diagnosis of HIV, an individuals’ age, and conditions. The overall user satisfaction with the mVIP prototype was high, which reflects strong user acceptance of mVIP. Integral to the findings from the three-level usability evaluation, we assessed the quality of the mVIP prototype in use and found the prototype was highly accepted by PLWH with high user satisfaction. This study will add to the body of literature on translation of evidence-based health information into an mHealth app and its usability assessment, which highlights the importance of the use of mobile technology for PLWH, specifically racial and ethnic minorities and those from low-socioeconomic groups who have limited health literacy and low level of education.

Thesis (Ph.D. (Psychology)) -- University of Limpopo, 2015 / The study aims at assessing the stress and dysfunction among families affected by the sudden reality of experiencing physically deteriorating family members due to HIV/AIDS progression, and to identify resilience factors that moderate the impact. Three-hundred and sixteen families were conveniently selected to participate in this study. The experimental group of the HIV/AIDS affected families (n=122), with two control groups of families caring for family members ailing because of a non- HIV/AIDS physical ailment (n=132) and the families not involved in the caring of any family member (n=62). Family resilience and stress questionnaires were used to collect the data. Family resilience questionnaires included Family Hardiness Index (FHI), Social Support Index (SSI), Relative and Friend Support (RFS), F-COPES, Family Time and Routine Index (FTRI), Family Problem Solving Communication (FPSC) Family Attachment and Changeability Index 8 (FACI 8). The family caregiver stress was measured by the Relative Stress Scale. Univariate and multivariate regression analysis were used to determine the moderating effect of the family qualities on the stress levels, and specific qualities unique in the families that bounce back. Stress was found to be high in the HIV/AIDS affected families when compared with the control families. Furthermore, the demographic information indicated that more stress was experienced in the HIV/AIDS affected families with a younger sick member and in poor economic conditions as well as when the sick person was a breadwinner. This indicated that stress elevation in the HIV/AIDS affected families was a function of economic conditions in the families and that caregivers may have experienced stress due to lack of proper resources and the stress of having sympathy for a young sick person who was expected to have a long life ahead of him or her. Social support (SSI), relative and friend support (RFS), and spending time together and engaging in similar routine collectively (FTRI) were found to moderate stress in HIV/AIDS affected families. Further research is needed to highlight the dynamics and the relationship with stress elevation around the new trend of HIV/AIDS infection of the younger age group as well as the economic burden or the impact of lack of resources in caring for the infected. More in-depth research must also be done with an emphasis on the dynamics between stigmatisation, stress moderation and resilience of families using more diverse families engaging in various caregiving situations of sick family members within various ecological and socio economic conditions.

Background:- The HIV and AIDS epidemic is a major catastrophe that affects millions of people worldwide. Antiretroviral medication combinations have revolutionised HIV treatment since 1996, transforming the virus from a death sentence to a manageable condition. In order to obtain full therapeutic benefits it is vitally important that patients adhere to their prescribed medication. Being informed about the disease and medication contributes to patient adherence and management. Pharmacists are considered to be the most accessible health professional and can help HIV -infected patients deal with barriers to medication access, manage adverse effects and medication interactions, and adhere to medication regimens by appropriate counselling. The public sector is defined as that part of an economy that is controlled by the state. At the study site, which is a public sector facility, the roll out of antiretroviral medication started in 2006. At the time all patients were counselled by trained counsellors, before seeing a doctor. At the pharmacy the medication was collected with no intense counselling by a pharmacist as the patients would have visited the trained counsellors first. Subsequently it was found that there were many queries regarding HIV and AIDS. It was then decided in October 2007, that the pharmacist support the counselling done by the counsellors in that they should reinforce what was said by the counsellors, together with giving detailed information to patients on their health and medication. This study was therefore undertaken to measure pharmacists' role in the management and adherence of HIV infected patients at this institutional facility. Method: The study was undertaken at a public sector health facility using anonymous structured questionnaires and was divided into 3 phases: Pre-Intervention, Intervention and Post-Intervention phases. After obtaining patient consent the questionnaires were administered during the 1st phase. A month later all patients visiting the pharmacy were counselled intensely on various aspects of HIV and the antiretroviral medication. Thereafter patients who took part in phase 1 were asked to participate in the 2nd phase. After obtaining their consent again, the same questionnaire was administered to them. Quantitative variables were compared between pre and post intervention using paired t-tests or Wilcoxon signed ranks tests. Categorical variables were compared using McNemar's chi square test (Binary) or McNemar-Bowker test for ordinal variables. Results: A response rate of 87.5% was obtained with the majority of the patients being female. Almost 70% of the participants were in the age-range of 21-40 years old. The majority of the participants did not have post school education. Most of the participants (95.4%) did not know that HIV is a virus that causes AIDS in the pre intervention phase, but this decreased to 93.7% in the post intervention phase. The participants knowledge of people who have sexually transmitted diseases are least at risk of getting HIV, healthy food will cure HIV and smoking and drinking alcohol will weaken the HIV virus, increased significantly from the pre-intervention phase to the post intervention phase. Knowledge on the modes of transmission either increased or remained unchanged. Overall the mean knowledge score on the disease itself had increased significantly (SD 6.6%) [p<0.01] after the pharmacists' intervention (pre-intervention was 82.1 %, post-intervention was 86.3%). In both phases, over 40% of all patients stored their medication in the cupboard. The majority of the patients took their medication either with or without food at both phases of the study. After the intervention, the frequency of taking medication with a fatty meal or any time they remember was decreased to 0. A significant improvement was noted in the overall knowledge score with regards to medication taking and storage (p<0.05). Conclusion: Pharmacist intervention had a positive impact on HIV infected patients' HIV and AIDS knowledge on the disease and on the antiretroviral medication use and storage. / Thesis (M.Pharm.)-University of KwaZulu-Natal, Durban, 2011.

The HIV and AIDS pandemic have become not only a health concern but educational and social concern as well. According to Beyers and Hay (2011, p. 99) many school-going children are not only affected by HIV but a large number of adolescents are also either HIV positive or have AIDS. Other researchers argue that education should act as a vaccine against new HIV infections (Kendall and O’Gara, 2007, p. 6). This argument comes with the expectation that all teachers are willing and ready to work with learners made vulnerable by HIV and AIDS; without considering the lived realities of the teachers in relation to HIV and AIDS. While many teachers make a difference in the lives of affected and infected learners through the way in which they deal with the learners concerned, some may not take up the challenge to assist the learners, while others might unknowingly and unintentionally do harm. This study, therefore, aimed at exploring high school teachers’ experiences of working with learners made vulnerable by HIV and AIDS in order to generate guidelines to assist teachers to effectively deal with vulnerable learners in their classrooms.

The potential of community-based organisations (CBOs) to provide lasting solutions in the field of Human Immune Virus (HIV) and Acquired Immune Deficiency Syndrome (AIDS) has long been recognised. As interest in the role of CBOs has increased, so have attempts to build their capacity and increase their stability and sustainability. Capacity-building initiatives which aim to strengthen CBOs as if they were identical to formal, more established organisations have often proved ineffective, and even at times destructive, because they have ignored the very differences that make CBOs potentially the most effective agents of development change at community level. This study is a qualitative exploration of a new mentoring-based approach to CBO capacity-building, which is currently being used extensively with CBOs in the Eastern Cape of South Africa. The research is inductive, beginning with an exploratory, descriptive and contextual study of the personal experiences and perceptions of CBO leadership team members from four sample CBOs which have graduated from the Barnabas Trust mentoring programme. Data was collected using a combination of face-to-face unstructured interviews and focus group discussion, with the objective of exploring the subjects’ experiences and their perceptions of the impact of the Barnabas Trust mentoring programme on the sustainability of their organisations. The insights and findings arising from the research process are then applied as the basis for a series of recommendations for the adaptation of the Barnabas trust mentoring approach and materials. The findings of this study appear to show that the mentoring-based approach has been an effective strategy for capacity-building towards sustainability for the CBOs in the sample, bringing positive change at the individual, organisational and community levels.

The human immunodeficiency virus / acquired immune deficiency syndrome pandemic (HIV/AIDS) continues to increase in prevalence worldwide, particularly in South Africa. There is a concurrent and distinct increase in the prevalence of HIV/AIDS and HIV-related diseases in the paediatric population in South Africa, particularly those using public sector health services, with a corresponding increase in morbidity and mortality rates (Abdool Karim & Abdool Karim, 2010:363), which impacts greatly on paediatric healthcare services. Adding to this, the provision of paediatric antiretroviral care has numerous stumbling blocks, not least of which is lack of decentralisation of facilities to provide treatment. There is the additional shortage of staff, which includes staff that are comfortable dealing with children, lack of training programmes on the provision of antiretroviral therapy to children, and minimal on-site mentorship of staff regarding HIV/AIDS disease in children. This lack of capacity in the healthcare system means that not all of those who require treatment will be able to access it, and this is particularly pertinent to paediatric patients (Meyers et al., 2007:198). Therefore the purpose of this research was to develop a nursing model that would assist healthcare professionals, in particular professional nurses, to optimise the comprehensive treatment, care and support for HIV-positive children who require antiretroviral therapy at PHC clinics. To achieve the purpose of this study, a theory-generating design based on a qualitative, explorative, descriptive and contextual approach was implemented by the researcher to gain an understanding of how the healthcare professionals and parents/caregivers of HIV-positive children experienced the comprehensive treatment, care and support provided at primary healthcare clinics. The information obtained was used to develop a chronic care coordination model for the optimisation of comprehensive treatment, care and support for HIV-positive children requiring antiretroviral therapy. The study design comprised the following four steps: Step One of the research design focused on the identification, classification and definition of the major concepts of the study. This involved describing and selecting the research population and the sampling process prior to conducting the field work which comprised in-depth interviews with two groups of participants, namely healthcare professionals and parents/caregivers who accompany their HIV-positive children to PHC clinics in order to receive antiretroviral therapy. Step Two of the research design focused on the development of relationship statements in order to bring clarity and direction to the understanding of the phenomenon of interest. Step Three of the design concentrated on the development and description of the chronic care coordination model for optimising comprehensive treatment, care and support for HIV-positive children who require antiretroviral therapy in order to ensure a well-managed child on ART. A visual representation of the structure of the model for chronic care coordination was given and described as well as a detailed description of the process of the model. Step Four was the last step of the research design and its focus was the development of guidelines for the operationalisation of the model for chronic care coordination for the optimisation of comprehensive treatment, care and support for HIV-positive children requiring antiretroviral therapy at PHC clinics. Guidelines and operational implications for each of the five sequential steps of the model were developed. The evaluation criteria of Chinn & Kramer (2008:237‒248) were used to evaluate the model. It is therefore concluded that the researcher succeeded in achieving the purpose for this study because a chronic care coordination model that is understandable, clear, simple, applicable and significant to nursing practice has been developed for use by healthcare professionals, particularly professional nurses, in order to optimise the comprehensive treatment, care and support for HIV-positive children requiring antiretroviral therapy at primary healthcare clinics.

One of the greatest challenges facing sub-Saharan Africa, which incorporates South Africa, is the AIDS pandemic. The devastation wrought by this disease is unsurpassed in recent times. The health and social development structures, already overburdened, are totally overwhelmed by the needs of povertystricken households and communities affected by AIDS. Caregivers attempting to support those affected and infected are also facing unique challenges and demands, particularly relating to dealing with the large numbers of deaths due to this disease. Experiences for these caregivers are likely to be varied, ranging on a continuum from positive to negative, for instance, the recovery of patients versus the death of patients. The objectives of this study are to explore and describe the lived experiences of caregivers working with AIDS patients, particularly patients who die from this disease whilst resident in a formal institution. The research is based on a qualitative, explorative, descriptive and contextual research design. The study is grounded in a phenomenological approach to inquiry. Caregivers working fulltime in a formal institution caring for patients who are dying from AIDS were interviewed in an in-depth, unstructured manner in order to gather spontaneous, rich descriptions of their experiences. Through this study the researcher wants their voices to be heard, the potential richness of their reflections acknowledged and the generated data to be applied to the benefit of the field of HIV/AIDS – both for staff and patients. Thirteen in-depth, unstructured interviews provided saturated data, which was then transcribed and coded to yield the central and sub-themes that were identified in this study. One central theme identified the fact that in their daily duties (at their place of work), caregivers experience various challenges as a result of having to deal with the death and dying of their patients suffering from AIDS. These caregivers face the death of their patients daily, from a disease that causes untold suffering to the patient, family members and to the caregivers themselves, who wish they could prevent the anguish, the pain and the inability of the medical profession to do more than they are at present towards curing this disease. ii By describing the lived experiences of these caregivers by means of the research interviews, the researcher gained a clear picture of the AIDS environment. The information shared by the participants formed the foundation of the broad guidelines that were formulated. These are intended to provide support for the caregivers centering around the equipping of mentors of the caregivers, to enable them to support the caregivers in their daily task of caring for patients dying from AIDS. These caregivers, thus supported, will then be in a position to provide optimal care for these dying patients. These broad guidelines are intended to provide support by focusing firstly on the physical environment in which these caregivers work; secondly in providing education for the caregivers to enable them to fulfill their duties, and thirdly to provide adequate counselling to ensure that they do not succumb to caregiver fatigue/burnout, a constant threat in this type of environment. The study concludes with recommendations regarding the areas of nursing practice, education and research.

This study was designed to investigate what course of action therapists and physicians report they would take in reconciling their conflicting duties to maintain confidentiality and protect third parties from harm in HIV-related situations. The physicians surveyed were licensed to practice medicine in Texas and board certified in Internal Medicine. The therapists surveyed were licensed professional counselors in Texas and members of one of three selected divisions within the Texas Counseling Association. A survey instrument developed by the researcher was mailed to 200 subjects randomly selected from each group.

Submitted in fulfillment of the requirements for the Degree of Master of Technology: Biomedical Technology, Durban University of Technology, 2012. / Antiretroviral therapy (ART) was introduced because it has shown to reverse the Acquired Immunodeficiency syndrome (AIDS), by reducing the HIV replication, allowing the regeneration of the patient’s immune system. ART is given to patients for the rest of their lives as part of HIV clinical care, but the use of ART has shown evidence of metabolic side effects which range from manageable to life threatening complications. Aims and objectives of the study The aim of the study was to investigate whether patients on ART developed metabolic side effects such as pancreatitis, dyslipidaemia and hepatotoxicity. These metabolic side effects were determined by laboratory testing of blood levels of specific biomarkers at stipulated intervals. Any significant change in the blood levels of these specific biomarkers was identified. Methodology : The study included 92 patients who were already selected for the ART programme which is in accordance to the South African National Antiretroviral Therapy Guidelines of 2003 Laboratory blood analysis was conducted. The repeated measures analysis of variance (ANOVA) was used to compare changes in biomarkers over time. The severity of each side effect was assessed by grading each biomarker laboratory result through the use of an established toxicity grading table. Results : It was found that the biomarker blood levels were not significantly altered within 12 months of ART, however, there was a gradual increase of most biomarker values, indicating that abnormalities may be detected after a longer period of treatment. Conclusion : Within 12 months of treatment, life-threatening toxicities were not detected. It may be speculated that if ART is monitored correctly, life-threatening toxicities may be avoided in many patients.

Thesis (MCur (Interdisciplinary Health Sciences. Nursing Science))--University of Stellenbosch, 2010. / ENGLISH ABSTRACT: Background & rationale: South Africa is faced with the major challenge of HIV/AIDS. Every South African has a vital role to play in managing this public health problem. One of the best ways of managing it is by informing and educating the communities about HIV/AIDS, as the communities lack knowledge about it. Problem statement: Due to the increase in the number of patients infected with HIV/AIDS, an informal caregiver’s programme was introduced to ensure that patients are better cared for at home, in a familiar environment and by their family members. Purpose and objectives: The purpose of the study was to evaluate the effect of an informal caregiver’s programme on the care of patients with HIV/AIDS. The objectives included evaluating the effect of care, physically, socially, spiritually, emotionally, information and educational support given. Methodology: A phenomenological research design was applied to evaluate the effects of an informal caregiver’s programme implemented for the care of patients infected with HIV/AIDS at Mfuleni Township in the Cape Metropolitan area. Population and sampling: The population of this study were HIV/AIDS infected patients who were participating in the informal caregiver’s programme. Ten of these patients, who gave consent, participated in the study. Reliability, validity & pilot study: The trustworthiness of this study was assured with the use of Lincoln and Guba criteria of credibility, transferability, dependability and conformability. A pre-test study was also completed. Ethical considerations: Ethical approval was obtained from the Stellenbosch University and the required consent from the individual participants. Data collection, analysis and results: Data was collected through an interview using an interview schedule based on the objectives. Data was analysed and the findings show that the care given to patients infected by HIV/AIDS at home through an informal caregiver’s programme has a positive outcome. Recommendations and conclusion: On the spot training of participants and their family members is recommended. The community health workers form a very strong support base for the participants. / AFRIKAANSE OPSOMMING: Agtergrond en rasionaal: Suid-Afrika kom te staan voor ’n reuse uitdaging t.o.v. HIV/VIGS. Elke Suid-Afrikaner het ’n belangrike rol te speel in die beheer van hierdie openbare gesondheidsprobleem. Een van die beste maniere om dit te beheer, is om gemeenskappe in te lig en op te voed aangaande MIV/VIGS, aangesien daar ’n gebrek aan kennis hieromtrent is. Probleemstelling: Weens die toename in die aantal pasiënte wat deur MIV/VIGS geaffekteer word, is ’n informele versorgingsprogram daarop ingestel om te verseker dat pasiënte beter tuis versorg word in ’n bekende omgewing en deur hul familielede. Doel en doelwitte: Die doel van hierdie studie was om die effek van ’n informele versorgingsprogram in die versorging van pasiënte met MIV/VIGS te evalueer. Die doelwitte is uiteengesit om die effek van die versorging wat gegee is, te evalueer met verwysing na die fisiese, sosiale, geestelike, emosionele, inligting en opvoedingsondersteuning te evalueer. Metodologie: ’n Fenomenologiese navorsingsontwerp is toegepas om die effekte te evalueer van ’n informele versorgingsprogram wat geïmplementeer is vir die versorging van pasiënte wat deur MIV/VIGS geaffekteer is in die Mfuleni woonbuurt in die Kaapse Metropolitaanse area te evalueer. Bevolking en steekproef: Die bevolking van hierdie studie is MIV/VIGS geaffekteerde pasiënte wat deelgeneem het aan die informele versorger se program. Tien van hierdie pasiënte wat toestemming verleen het, het deelgeneem aan hierdie studie. Betroubaarhied, geldigheid en loodsondersoek: Die betroubaarheid van hierdie studie is verseker deur die gebruik van Lincoln en Guba se kriteria van geloofwaardigheid, oordraagbaarheid, afhanklikheid en ooreenstemmigheid. ’n Aanvoortoets is ook voltooi. Etiese oorwegings: Etiese goedkeuring is van die Stellenbosch Universiteit en die vereiste toestemming van die individuele deelnemers verkry. Dataversameling, analise en uitslae: Data is ingesamel deur gebruik te maak van ’n onderhoudskedule wat gebaseer is op die doewitte. Data is geanaliseer en die bevindinge het bewys dat versorging wat by die huis deur ’n informele versorgingsprogram aan pasiënte gegee word wat met MIV/VIGS geaffekteer is, ’n positiewe uitkoms het. Aanbevelings en gevolgtrekkings: Op-die-plekopleiding van HIV geïnfekteerde pasiente en hul familielede word aanbeveel. Die gemeenskap se gesondheidswerkers bied ’n sterk ondersteuningsbasis aan die deelnemers.