Department of Public Health / MCur

MAAS / M.E.R. Mathivha Centre for Languages Arts and Culture

See the attached abstract below

MSCAGR (Agricultural Economics) / Department of Agricultural Economics and Agribusiness / See the attached abstract below

Thesis (Ph.D. (Social Work)) -- University of Limpopo, 2021 / Background information: Persistent poor health outcomes among People Living with HIV and AIDS (PLWH) is a concern for service users and the HIV care system. Since its discovery, different AIDS response strategies were implemented but the level of poor health outcomes among PLWH prompts the need for other dimensions in the AIDS response. Purpose: The purpose of this study was to explore and describe ‘lived experiences’ of PLWH in order to utilise their personal experiences to develop a user- led intervention model. Methods: From a phenomenological orientation, an in-depth interview was used to gather data from seventeen PLWH who are living in communities. Purposive sampling was used to locate the participants. The compiled data collected was then analysed using the Collaizzi’s seven-step data analysis strategy. This was followed by a focus group discussion session which was held with nine of the seventeen participants. Findings: The study found that communities’ meaning of HIV and AIDS is outdated as it is still loaded with stigma and discrimination. Consequently, it alienates PLWH living in communities, and thus compounds poor health outcomes among PLWH. Many PLWH view themselves through their communities’ meaning of HIV and AIDS. the shared meaning of HIV and AIDS by communities created a complex task for PLWH to reconcile their prior meaning of living with HIV and the ‘new’ meaning they acquired post-diagnosis. Due to this, many PLWH experience high levels of intrapersonal and interpersonal challenges. Intrapersonal challenges manifest as self and anticipated stigma while the interpersonal ones result in poor relationships in different setting. It was also found that the availability of antiretroviral treatment significantly changed the meaning of living with HIV and AIDS for many PLWH as it provided tangible medical support to mitigate the impact of HIV and AIDS. In addition, the availability of different types of social support from family and non-family sources reassured and gave them hope for a better life. However, the availability of medical treatment and social support could not completely buffer the intrapersonal and interpersonal challenges experienced by PLWH in their daily lives. They had to continually fight for their social space post diagnosis through activation of two major coping strategies, namely emotion and problem-solving focussed strategies. Significant features of these strategies are that they changed their thinking patterns and engaged in actual activities to improve the quality of their lives. Through these strategies, many PLWH attained relative post traumatic growth. This study found that through their lived experiences, they command personal competence to guide user-led HIV care interventions as they clearly articulated the design, content and approach for user-driven HIV care. Conclusions and recommendations: The psychosocial dimension of living with HIV and AIDS in HIV care is not adequate as many PLWH who are in care experience poor health outcomes long after they have been diagnosed until they received psychosocial support from other PLWH. On this basis, a psychosocial seven-step user-led intervention model was designed to provide psychosocial education, care and support to PLWH, families, support groups and community mobilisation for HIV care. The implementation of a true psychosocial user-led intervention model in the continuum of care which recognises the interaction between the three dimensions of the health condition should be located at the point of entry into HIV care to ensure timeous access by PLWH and their families.

Thesis (MPH.) -- University of Limpopo, 2021 / Introduction: HIV/AIDS remains a disease of public health importance and mother-to-child transmission (MTCT) is one of the major problems. Sub-Saharan Africa is the most severely affected region, accounting for more than 90 percent of paediatric HIV infections. Most of these infections occurred during pregnancy, delivery or breastfeeding making the prevention of mother-to-child transmission (PMTCT) a public health priority. Over the last few years, efforts have been made in Sub-Saharan countries to improve PMTCT and the success of prevention of mother‐to‐child transmission of HIV (PMTCT) is dependent upon high retention of mother‐infant pairs within the PMTCT cascade. Assessing the risk factors for MTCT will help to decrease child morbidity and mortality and strengthen PMTCT programs as there is dearth of evidence regarding factors determining MTCT HIV infection to infants born to HIV positive mothers. The purpose of this study was to investigate the determinants for the human Immunodeficiency Virus positivity rates in the Greater Letaba Municipality. The study objectives were to describe the demographic characteristics of mothers and babies who tested polymerase chain reaction test (PCR)-positive in the Greater Letaba Municipality during the two-year period from 2015 to 2016, in order to determine maternal and neonatal factors associated with high positive PCR; and to determine health system-related factors associated with a high positive PCR result. Methodology The current study followed a quantitative approach in which convenient and purposive sampling was used, focusing on records of infants born from HIV-positive women in all clinics at Greater Letaba Municipality were reviewed. All records of infants who were tested for HIV and the PCR results were positive from birth up to 12 months of age were retrospectively reviewed and for the health care workers, all nurses working as managers of a clinic were interviewed. The Statistical Package for the Social Sciences (SPSS) version 23 computer software and Stata 15 was used. for comparison of categorical variables was done using a Chi-Squared test, whereas continuous variables were compared using a t-test and P-value of <0.05 was considered significant. To determine maternal and neonatal factors associated with high positive PCR, Factor analysis was used with rotated factor loadings done using the Varimax method. Results: A total of 107 records were retrieved and audited. Fisher’s exact test was used to determine the relationship between selected variables, where p<0.05 was set as level of significance. The findings reveal that the number of infants exposed to HIV during pregnancy has steadily increased. The current study further indicates that health system factors such as unskilled or untrained NIM-ART nurses in the facilities is a contributory factor to infant’s positivity rate in Greater Letaba hospital. Equal proportions of both male and female babies were found to be PCR positive at 6 weeks. The study further revealed that the highest proportion of the mothers who gave birth to PCR positive babies for the reporting period were married mothers, in the age group 25-29 years (46.1%). The second largest proportion of mothers who gave birth to PCR positive babies were single mothers in the age group 25-29 years (38.4%). The results show that high PCR positivity can be attributed to about 5 main Factors namely: maternal antenatal history (22% contribution to total variance), maternal HIV care history (18% contribution to total variance), measures of adherence to treatment (17% contribution to total variance), maternal exposure to HIV (14% contribution to total variance) and lastly the ART regimen (12% contribution to total variance). Conclusion: The study findings revealed that there is still vertical transmission of HIV to infants and the prevalence of HIV among infants born from seropositive mothers despite the availability of the latest Prevention of Mother to Child Transmission (PMTCT) Guidelines in all health care facilities. Even though transmission is reduced to the meaningful number (< 5%), there are still appropriate measures that should be taken to reduce the transmission of HIV from mothers to infants. The delayed diagnosis, adherence to ART by mothers, infant ARV prophylaxis at birth and feeding practices contributed the vertical transmission of HIV to infants. Strengthening of the PMTCT of HIV programme, increasing antenatal HIV screening and linking it to care and treatment of HIV positive mothers to obtain zero infant HIV prevalence in the region. Infant prophylaxis and maternal PMTCT interventions should be provided to all exposed infants and mothers based on the guidelines by the health institutions. Nurse-initiated management of antiretroviral treatment (NIM-ART) training of professional nurses is being offered by the Department of Health in South Africa, but it does not yield positive results as far as the PMTCT is concerned. This may be due to shortage of staff, especially trained professional nurses (PN), as well as the workload. Key concepts: Infant and Human immune deficiency virus

A Thesis submitted in fulfillment of the requirements for the degree of Doctor of Philosophy in Community Psychology in the Department of Psychology at the University of Zululand, 2007. / The major aim of the study was to determine whether broad-based initiatives, such as community based stigma reduction intervention programmes (later) based on the findings of the study, could have an impact on the uptake of HIV-testing and disclosure rate. The total sample comprised of 15 females and 15 males that were chosen from one of the support groups based at one of the selected Hospitals in KwaZulu-Natal Province. With the assistance of the hospital officials, the researcher was able to use the purposive sampling technique in selecting the respondents. From the themes, it became evident that people living with HIV and AIDS are faced with an important dilemma regarding whether or not they should reveal the HIV-positive status to significant others, in-depth interviews with the focus groups produced the following themes as accounts of emotional observations: isolation, social stigma, anger, revenge and depression. In the light of the findings of the study, a need arose for the establishment of an intervention programme aimed at addressing the common barriers associated with HIV disclosure. Community Psychology in particular, played a major role in shaping this study because of its action focus on groups. / National Research Fund (NRF)

In the context of HIV high infection rate in South Africa, an assumption can be made that there is a high prevalence of HIV-associated neurocognitive disorders or cognitive linguistic deficits. The aim of this study was to determine assess whether highly active antiretroviral therapy (HAART) affected the cognitive – linguistic abilities of individuals living with HIV and AIDS before and after HAART use; and to determine whether their functional performance in terms of engaging in activities of daily living was affected by HAART use. Adults living with HIV and AIDs were recruited through purposive convenience sampling to participate in the study. They were divided into three groups. The experimental and cross sectional group included participants who were HIV infected and initiated HAART. The comparison group included participants who elected not to start HAART. Participants in all three group were assessed using the Cognitive – Linguistic Quick Test and were also required to fill out a structured interview scale at baseline, four and eight months. For the experimental group 55 participants were tested at baseline, 55 at four months and 52 at eight months after HAART initiation. The comparison group included 21 participants who tested at baseline, ten at four months and nine at eight months. The cross sectional group included different participants who recruited at baseline (55) before HAART initiation, then again at four (44) and eight months (42) after HAART initiation. Descriptive analysis revealed that the mean scores for both the Cognitive – Linguistic Quick Test (CLQT) and the structured interview schedule (IS) in all the cognitive domains increased for all three groups from four and eight months after testing. However the severity ratings provided by the CLQT indicated that neurocognitive deficits were still prevalent among the participants after HAART intiation. The most impaired cogntive – linguistic ability was executive functions and the least impaired was language. One way ANOVA analysis on the CLQT and IS revealed that was a signiifcant difference in performance between the three groups at baseline, four and eight months. Repeated measures analysis revealed significant differences or improvements within participants across the three time periods. The greatest improvement was observed from baseline to eight months especially on the CLQT. ANCOVA analysis on the Cognitive- Linguistic Quick Test indicated that education had a major impact on cognitive – linguistic abilities followed by age and CD4 count. However, ANCOVA analysis on the structured interview scale revealed that the effect of time, participant group and to a lesser extent age influenced the participants cognitive – linguistic abilities when it came to perfroming activities of daily living. Quantitave inquiry using content analysis showed that participants in all three groups cited attention, followed by visual and language problems as hindering their abilities to perform activities of daily living. The implications from this study revealed that even though HAART improves cognitive –linguistic abilities, neurocognitive deficits were still prevalent. Therefore findings suggest that health professionals need to monitor the neurocognitive impairments of their patients so as determine levels of functional performance.

Thesis (Ph.D. (Public Health)) -- University of Limpopo, 2022 / There has a significant rise in the number of HIV-infected adolescents who were missed as children and are diagnosed with perinatally acquired HIV as teenagers. In 2013, perinatally acquired HIV was estimated at around 10 000 infections globally, a figure which ballooned to38 000 by 2017. Adolescents living with perinatal HIV experience emotional upheaval as a result of their positive HIV diagnosis, which is exacerbated by real or perceived negative effects on their relationships, career, and family aspirations. They face the same challenges as other adolescents, along with the added complexity of personal decisions relating to their sexual conduct having a direct impact on the global cause to eradicate HIV/AIDS. An extensive body of literature indicates a need for emotional and psychosocial support as existing management focuses mainly on the physical aspects of infection and treatment. Aim of the study The aim of the study was to explore the challenges faced by adolescents living with perinatal HIV infection and to evaluate the designed user-friendly support programme in response to formative findings of the research in selected clinics and community health centres in the Vhembe District of the Limpopo Province in South Africa. Methodology A mixed-methods sequential exploratory design was employed to fulfil the purpose of the study. Data was collected in two phases. In qualitative phase- a total of 21 participants were interviewed using a semi-structured interview guide. The sample was purposefully selected from adolescents living with HIV/AIDS. In quantitative phase a total of 213 people participated in data collection using a questionnaire. Thematic approach was used to analyse qualitative data using Tesch’s eight steps of qualitative data analysis. Quantitative data was analysed using SPSS version 25. Descriptive statistics was used to explain and summarize data. Fischer’s test was done to establish significance of association between alcohol used, condom use and between age and gender. The results The results revealed that adolescents with perinatally acquired HIV face more challenges. They had psychosocial, emotional and economic challenges more than their peers. The current HIV/AIDS management and care has not yet recognised the specific needs these adolescents have related to their care. They have been incorporated into the general adulthood HIV/AIDS making their transition from childhood adolescence difficult. Suggestions for a mentor, and ARV modification were made and a need for a support programme emerged as one of the major themes

Thesis (D. Tech. (Clinical Technology )) - Central University of Technology, Free State, 2013 / The HIV pandemic in South-Africa has created a new form of vulnerability for households with regards to food security and nutritional status which are vital components in the general care of HIV-infected individuals. The risk of nutritional deficiencies and malnutrition are predictors of disease progression and treatment in resource limited settings. Furthermore, HIV affects nutritional status by increasing the energy requirements, reducing food intake, affecting nutrient absorption and metabolism inadequacies due to cytokine activity and diarrhea. Several vitamins and minerals are important in fighting HIV infection because they are required by the immune system and major organs to attack infectious pathogens. Many of these micronutrients have been found to be deficient in HIVinfected persons and several studies were launched worldwide to investigate the feasibility of food assistance and nutrient supplementation. Nutritional supplementation has been advocated in HIV-infected persons especially in lowincome countries such as South Africa. Therefore, a study to evaluate the role of nutritional supplementation in HIV-positive patients becomes necessary, especially in a developing country such as South Africa. It is against this background that the present research was initiated to examine the influence of a nutritional supplement on the immune status and health status of HIVpositive/ AIDS adult individuals. The aim of the investigation was to determine if supplementation with a mixture comprised from specific minerals, vitamins and herbs over a period of one year, affected the haematological status, immune status, viral load and pulmonary function in forty (40) HIV-infected individuals living in the Mangaung Metropolitan, RSA. viii A quantitative, open-labeled, before-after clinical trial was conducted at the Central University of Technology, in Bloemfontein, Free State Province in the RSA. Socio-demographic and dietary intake questionnaires were completed. All data pertaining to anthropometric measurements, haematological status, immune status, viral load and pulmonary function were obtained my means of using standard procedures and technological equipment. The data were subjected to parametric and non-parametric statistical analysis. The results of the present investigation show that the eating pattern of this urbanized group of individuals reflects high energy (KJ) and macronutrient intakes coinciding with sub-optimal intake of Vitamin D and iodine. Of all the haematological variables the only statistical significant changes observed were increases in the median erythrocyte sedimentation rate (ESR) (p=0.0219) and mean cell haemoglobin concentration (MCHC) (p=0.0245) after six months of nutritional supplementation. At 12 months a statistical significant decrease in the median CD/CD8 ratio (p<0.0048), median Hematocrit concentration (p<0.0312), median mean cell volume (MCV) (p<0.0359), and median RDW (p<0.0273) accompanied a statistically significant increase in the MCHC (p<0.0003) at 12 months after supplementation. At 6 months 89% (CI95%: 73%; 96%) of the individuals showed a decline in viral load counts with a median percentage decline of 34% (CI95%: 73%; 96%). At 12 months 85% [CI95%: 68%; 94%] of the individuals show a decrease in viral load counts with a median percentage decline of 62.9% (CI95%: 50%; 78.6%) following the intake of the supplement. The main findings of the present investigation reveal that 68% (50%-81%) of the individuals show a statistical median increase (p=0.0302) of 16.9% (11.5%; ix 36.1%) in the Peak Expiratory Flow (PEF) at six months. A significant decrease (p=0.0484) in the median FEF75 of 28.1% (14%; 35.3%) is observed in 70% (53%-83%) of the individuals after 12 months of exposure to the supplement. No statistical significant changes are observed for FVC, FEV1, FEV1/FVC and FEF50 over the entire trial period. The present results suggest that a significant measurable decrease in viral load in HIV-infected individuals can be obtained by means of subjecting individuals to a nutritional fortification supplement strategy for 6 months or more.