The purpose of this study was to identify factors contributing to non-compliance to TB treatment amongst pulmonary TB patients in Waterberg district, Limpopo. The health-belief model was the conceptual framework which guided this study. A quantitative, cross-sectional, descriptive study design was used. Data was collected using a structured questionnaire administered by trained data collectors. Data was collected from 215 respondents. Informed consent was obtained from each respondent prior to data collection. MS Excel and SPSS were used to analyse data. Findings on significant factors contributing to noncompliance to TB treatment include; non-availability of food whilst taking TB treatment, disbelief in the fact that TB can result in death if not treated, belief in traditional medicine for curing TB, bad healthcare worker attitudes, long distance to the clinic for treatment, belief that TB treatment takes very long and the pill burden / Health Studies / M.A. (Public Health)

The purpose of this study was to identify factors contributing to non-compliance to TB treatment amongst pulmonary TB patients in Waterberg district, Limpopo. The health-belief model was the conceptual framework which guided this study. A quantitative, cross-sectional, descriptive study design was used. Data was collected using a structured questionnaire administered by trained data collectors. Data was collected from 215 respondents. Informed consent was obtained from each respondent prior to data collection. MS Excel and SPSS were used to analyse data. Findings on significant factors contributing to noncompliance to TB treatment include; non-availability of food whilst taking TB treatment, disbelief in the fact that TB can result in death if not treated, belief in traditional medicine for curing TB, bad healthcare worker attitudes, long distance to the clinic for treatment, belief that TB treatment takes very long and the pill burden / Health Studies / M.A. (Public Health)

The purpose of this study was to analyse the tracking systems used to identify patients with tuberculosis who missed a clinic appointment at primary health care facilities in Waterberg District. A quantitative descriptive correlation design was used to determine if there was an association between the tracking systems used and the defaulter rates. Data was collected using a questionnaire with nurses from 46 primary health care facilities, defaulter rates were accessed from the ETR.Net and the two sets of data were correlated. The results showed that the blue folder yielded the lowest mean defaulter rate while the green card yielded the highest mean defaulter rate. Nurses were unaware of the true defaulter rate in their facilities as they underestimated these rates. They therefore did not implement relevant intervention strategies to recall patients or find ways to improve the tracking systems used to reduce the defaulter rate in their health facilities. / Health Studies / M.A. (Health Studies)

The introduction of Antiretroviral (ARV) treatment has allowed for many children living with human immunodeficiency virus (HIV) to survive to adolescence. However for this to be a reality adherence to treatment is important. Many studies suggest that during adolescence adherence can be very challenging. However not much research has been done within the South African context to understand what HIV positive adolescents are experiencing, particularly in relation to ARV adherence. The aim of this research study was to explore the experiences of adolescents on antiretroviral therapy (ART) in order to understand what helps them to adhere to their medication and the challenges that they may have with adherence. This was achieved by carrying out 5 semi-structured in-depth interviews with HIV positive adolescents on ARVS at a shelter for HIV positive women and children in Johannesburg. A thematic content analysis was used to analyse the transcribed interviews. The results indicated several factors that both assist with adherence and those that challenge adherence. The participants reflected on the importance of full disclosure which increases their understanding of the importance of adherence, having people they trust whom they can confide in and who also support them to take and adhere to the ARVs, and having a positive experience at the hospital when they go for their regular checkups. Certain defence mechanisms adopted by the adolescents to help them cope with living with HIV and having to take medication every single day of their lives were also identified. The fact that acceptance is a process was also suggested by the research findings. The challenges the adolescents face were those of stigma and a fear of being rejected, bad experiences associated with taking medication, such as the negative side effects and the disruption of their leisure time, and negative experiences from going to the hospital. This study yielded some rich information that may aid in understanding what adolescents are experiencing and facing which may inform future research studies on this topic and policies which may assist with an increase in adherence.

Thesis (Ph. D. (Sociology)) -- University of Limpopo, 2014. / This study investigated the challenges to antiretroviral therapy adherence. Qualitative and quantitative research methodologies were applied in the study. Purposive sampling was used to select clients on antiretroviral therapy, convenience sampling was applied to select clients who participated in the focus group discussions and health care workers and lay counsellors were selected through the simple random sampling method. In-depth interviews were conducted with 31 clients on antiretroviral therapy at 8 health facilities, 2 focus group discussions comprising of 7 members each were conducted at two health facilities, medical records of all respondents on antiretroviral therapy were reviewed and a stigma scale was administered. A questionnaire was distributed amongst 17 health care workers and lay counsellors. Most of the respondents who participated in this study were females. Data gathered in this study confirmed that women are more vulnerable to HIV than men. The majority of the respondents were poor African people. The predominant language amongst the respondents was the Xitsonga language; hence the world-view of the Va-Tsonga people was assessed. HIV and AIDS cause many social problems in communities. Some of the major findings are that: Literacy levels were found to be very low as most of the respondents pointed out that they had only obtained grade 7 or below. However, this did not have an impact on treatment adherence. Some respondents indicated that they were unemployed; the majority said they were employed. Even though the stigma and discrimination experienced by the respondents was very low, the few who experienced it had very traumatic and cruel experiences perpetrated by their own family members and people in the community. In terms of disclosure, data indicates that most people prefer disclosing to their mothers as they feel that they will get support. The majority of the respondents disclosed to female family members and they were supported by the people they disclosed to. viii Social support is very crucial for people who are on antiretroviral therapy (ART), most of the respondents indicated that they had treatment supporters. Institutional support was very minimal in that most pointed out that they did not belong to any support groups. There were some who did not even know about the existence of any support groups at the health facilities where they were receiving their treatment. Most of the respondents indicated that they disclosed to their colleagues and others had not as they feared that they would lose their jobs. Those who had disclosed indicated that they needed support from their colleagues and employers with regard to compliance with their clinic appointments. Most of the respondents had sexual partners, and had also disclosed to their sexual partners, and disclosure was almost immediately after being diagnosed HIVpositive. There are those who had not disclosed to their sexual partners as they feared rejection or violent reaction. There were sero-discordant couples amongst the respondents who supported each other regarding adherence. Most of the respondents indicated that they had taken care of a family member living with HIV. HIV prevalence also varies amongst health facilities. Strategies employed by health facilities to monitor and evaluate HIV and AIDS programmes differ. Health Care Workers and lay counsellors provided contrasting information. Primary Health Care facilities have been accredited to provide ART, however the down-referral system seems to be failing as some clinics now have more clients on ART than hospitals. Health Care Workers and counsellors also need to be familiarized with the World Health Organization (WHO) standards. The level of adherence acceptable for an individual on ART is 95%; there is however health facilities that indicated the adherence level far below the required level.

The purpose of this study was to analyse the tracking systems used to identify patients with tuberculosis who missed a clinic appointment at primary health care facilities in Waterberg District. A quantitative descriptive correlation design was used to determine if there was an association between the tracking systems used and the defaulter rates. Data was collected using a questionnaire with nurses from 46 primary health care facilities, defaulter rates were accessed from the ETR.Net and the two sets of data were correlated. The results showed that the blue folder yielded the lowest mean defaulter rate while the green card yielded the highest mean defaulter rate. Nurses were unaware of the true defaulter rate in their facilities as they underestimated these rates. They therefore did not implement relevant intervention strategies to recall patients or find ways to improve the tracking systems used to reduce the defaulter rate in their health facilities. / Health Studies / M. A. (Health Studies)

Thesis (MSc)--Stellenbosch University, 2015. / ENGLISH ABSTRACT: Successful antiretroviral therapy (ART) depends on appropriate use of antiretroviral agents; which ultimately prevents replication of Human Immunodeficiency Virus (HIV) thus delaying clinical progression of the disease. This study explored how HIV status disclosure affects adherence to antiretroviral therapy at Mamelodi Hospital, using a convenience sampling method with a sample size of 50 adults above 18 years who were on treatment for a minimum of two years prior to the study. An interview protocol was used to uncover patients’ demographics, sexual orientation, and HIV status disclosure, adherence to antiretroviral drugs, drug side effects, how often they missed their doses and how HIV status disclosure / non-disclosure affected their adherence to treatment. Patients’ medical records were assessed to validate and correlate the information obtained from the interviews. The scientific test results used were the CD4count and Viral loads which are used to monitor the HIV/AIDS disease progression. All partakers involved in the study made their HIV status known and reported taking their medicines regularly. The patients’ CD4 count and VL were verified, the CD4 count has shown an upward trend while the VL load showed a downward trend in keeping with patients who are adhering to ART. The majority of participants (54% or 27 patients) reported they had never skipped taking their medication. The participants also reported they had taken their medicine in front of other people and they constituted 74% (37) of the group. Of this 74%, 78.38% (29 patients) said it was because they had disclosed their status. This observation supports the fact that if you have disclosed your HIV status, you have better chances of adhering to prescribed medication. Findings from the study at Mamelodi Hospital revealed that for as long as one has disclosed their HIV status, the outcome of treatment adherence will be better. The only shortfall noted was lack of partakers who did not divulge their HIV status thus a comparison could not be done. It was acknowledged that some participants in the study might have reported disclosure of their HIV status to be in good favour of the researcher to create an impression that they are adhering to their medication. The study has confirmed the existence of a relationship between HIV status disclosure and adherence to ART. / AFRIKAANSE OPSOMMING: Suksessvolle antiretrovirale terapie (ART) hang af van die toepaslike gebruik van antiretrovirale middels, wat replikase van die MI-virus verhoed, en dus die kliniese vordering van die siekte vertraag. Hierdie studie het ondersoek hoe die bekendmaking van MIV-status die gehoorsaamheid tot ART beïnvloed het by die Mamelodi Hospitaal. ‘n Gerieflikheid-streekproef met ‘n groote van 50 volwassenes bo 18 jaar is gebruik en die deelnememers moes ten minste vir twee jaar voor die studie reeds op behandeling gewees het. Data is deur middel van onderhoude ingesamel, met die doel om pasiënte se demografiese inligting, seksuele orientasie, MIV-status, gehoorsaamheid tot ART en newe-effekte van ART in te samel. Pasiënte se mediese rekords is nagegaan om die inligting wat uit die onderhoude verkry is te bevestig. Die wetenskaplike toetse wat gebruik is, was die CD4-telling en virale lading wat gebruik word om MIV/Vigs te monitor. Al die deelnemers het hul MIV-status bekend gemaak en aangedui dat hul hul medikasie gereeld gebruik. Die pasiënte se CD4-tellings en virale lading is bevestig, die CD4-tellings het ‘n opwaartse neiging getoon terwyl die virale lading ‘n afwaartse neighing getoon het. Die meerderheid van die deelnemers (54%) het aangedui dat hul nog nooit hul medikasie oorgeslaan het nie. 74% van die deelnemers het aagedui dat hul hul medikasie voor ander mense neem - hul noem dat dit as gevolg van die feit is dat hul hul status bekend gemaak het. Dit ondersteun die feit dat mense wie hul status bekend maak beter kanse het om gehoorsaam hul medikasie te gebruik. Die studie by die Mamelodi Hospitaal toon dat solank mense hul MIV-status bekend maak, hul meer gehoorsaam is teenoor die gebruik van hul medikasie. Die studie bevestig dus die verband tussen bekendmaking van MIV-status en gehoorsaamheid tot ART.

Evidence suggests that the prevalence of certain non-communicable diseases, such as hypertension, is increasing rapidly, and that patients with these diseases are making significant demands on the health services of the nations in sub-Saharan Africa. However, these countries also face other health-related challenges such as communicable diseases and underdevelopmentrelated diseases. Developing countries like South Africa have limited resources, in terms of man power and financial capital, to address the challenges that they are facing. Non-communicable diseases cannot be ignored and since health care providers cannot meet the challenges, it is worthwhile to empower patients to be involved in the management of their conditions. Patient education is a tool that can be used to enable patients to manage their chronic conditions and thereby reduce the morbidity and mortality rates of these conditions. The aim of this study was to investigate the effect of a patient education intervention on participants’ levels of knowledge about hypertension and its therapy, beliefs about medicines and adherence to anti-hypertensive therapy. The intervention consisted of talks and discussions with all the participants as one group and as individuals. There was also written information given to the participants. Their levels of knowledge about hypertension and its therapy were measured using one-on-one interviews and self-administered questionnaires. Beliefs about medicines were measured using the Beliefs about Medicines Questionnaire (BMQ) whilst adherence levels were measured using pill counts, elf-reports and prescription refill records. The participants’ blood pressure readings and body mass indices were also recorded throughout the study. The parameters before and after the educational intervention were compared using statistical analyses. The participants’ levels of knowledge about hypertension and its therapy significantly increased whilst their beliefs about medicines were positively modified after the educational intervention. There were also increases, though not statistically significant, in the participants’ levels of adherence to anti-hypertensive therapy. Unexpectedly, the blood pressure readings and body mass indices increased significantly. The participants gave positive feedback regarding the educational intervention and indicated a desire for similar programmes to be run continuously. They also suggested that such programmes be implemented for other common chronic conditions such as asthma and diabetes. This study proved that patient education programmes can be implemented to modify patients’ levels of knowledge about their conditions and the therapy, beliefs about medicines and adherence to therapy. However, such programmes need to be conducted over a long period of time since changes involving behaviour take a long time.

It is estimated that 6742 South African women are diagnosed with cervical cancer and 3681 women die from the disease every year. In 1993, The Centers for Disease Control declared cervical cancer an Acquired Immunodeficiency Syndrome defining illness. Apart from persistent human papillomavirus infection, HIV infection is the most common co-factor contributing to cervical cancer in South Africa. Studies have noted that in HIV positive women, there has been an occurrence of faster progression to more advanced stages of cervical cancer with high cases of treatment failure and recurrence. There is limited literature available regarding the prognosis of HIV positive women who suffer from cervical cancer. Women who are HIV positive and have cervical cancer have not been evaluated in detail regarding their response and adherence to cervical cancer treatment. Standard treatment protocols for this set of patients have not been defined. The aim of this study was to assess how HIV positive women who have been diagnosed with cervical cancer responded and adhered to cervical cancer therapy which includes: curative radiotherapy; curative chemotherapy; concurrent chemoradiation or palliative radiotherapy. The study also evaluated the effects of the concurrent use of antiretrovirals and cervical cancer treatment. This was done to determine whether invasive cervical cancer in women who were HIV positive could be managed using the same treatment protocols as patients who were HIV negative. A historical cohort design was employed for the study. The study was conducted at the Oncology Department of a tertiary level hospital located in the Eastern Cape Province, South Africa. The total sample consisted of 196 medical records of women diagnosed with cervical cancer between 2005 and 2008. One hundred women were HIV negative, 83 were HIV positive and the HIV status of 13 women could not be determined. The records were audited over a period of two years from the date of diagnosis. The term „complete response‟ referred to patients who had no recurrence of cervical cancer and no evidence of metastases after undergoing treatment. At one month following treatment there was a significant difference in the incidence of complete response between the HIV positive patients and the HIV negative patients (Chi2 = 16.4, d.f. = 1, p = 0.00005, Cramer‟s V = 0.31). The significant difference in response to treatment between the HIV positive patients and the HIV negative patients was maintained at six months after treatment (Chi2 = 15, d.f. = 1, p = 0.00011, Cramer‟s V = 0.34), 12 months after treatment (Chi2 = 20.5, d.f. = 1, p = 0.00001, Cramer‟s V = 0.37), 18 months after treatment (Chi2 = 9.8, d.f. = 1, p = 0.00173, Cramer‟s V = 0.28) and 24 months after treatment (Chi2 = 5.0, d.f. = 1, p = 0.02571, Cramer‟s V = 0.26). At each of these intervals, cases of treatment failure and metastases were significantly higher in the HIV positive women than in the HIV negative women. Although there was no significant difference in the incidence of adherence between the HIV negative women, the HIV positive women who were on HAART and the HIV positive women who were not on HAART, there was a significant difference in the incidence of the various reasons for non adherence between the various groups. These reasons included: missed scheduled appointments (Chi2 = 2.9, d.f. = 2, p = 0.02385, Cramer‟s V = 0.31); low blood count (Chi2 = 4.0, d.f. = 2, p = 0.01327, Cramer‟s V = 0.15); radiotherapy induced skin breakdown (Chi2 = 0.6, d.f. = 2, p = 0.04581, Cramer‟s V = 0.16) and radiotherapy induced diarrhoea (Chi2 = 6.9, d.f. = 2, p = 0.03118, Cramer‟s V = 0.19). According to the 2004 National Antiretroviral Treatment Guidelines, cervical cancer patients would fall into the WHO stage IV category of HIV disease thus all patients with confirmed diagnosis of invasive cervical cancer should be commenced on antiretrovirals as soon as the cancer diagnosis is made regardless of their CD4 count. However, in the current study, 13 percent (n= 83) of the HIV positive women were not on antiretrovirals. The study concluded that HIV positive women had a higher incidence of both treatment failure and metastases to cervical cancer treatment. Standard radiotherapy and concurrent chemoradiation cervical cancer treatment protocols should be still be used in both HIV negative patients and HIV positive patients so as not to compromise tumour control. Furthermore, in accordance with the antiretroviral treatment guidelines, all HIV positive patients with cervical cancer should receive antiretrovirals irrespective of their CD4 count.

Thesis (MA)--Stellenbosch University, 2013. / ENGLISH ABSTRACT: This study investigates how the new technology of treatment, i.e. antiretroviral therapy (ART), is incorporated into public health care institutions. The success of this technology ideally relies on the notion of the ‘responsibilised’ patient as one who, simply put, consistently maintains the level of ARV-adherence necessary to suppress the viral load and to avoid drug resistance. The stringent management and continual monitoring of treatment adherence necessary to achieve these outcomes lie beyond the direct control of the health care institution. Given that the institution sees its patients irregularly, a patient’s divergence from treatment guidelines is established only after the fact. The institution takes on a supporting role while it is the patient who, on a day-to-day, dose-by-dose basis manages and monitors themselves, making ART a seemingly individual endeavour and responsibility. This shift in responsibility is compatible with the ‘new contract’ between provider and client, necessitated by ART. Even so, the institution attempts to manipulate the day-to-day behaviours of the patient to conform to those required in order to achieve treatment outcomes. This thesis examines how these different aspects of ART play out within two clinics in the Cape Winelands, and more specifically, the institutional intricacies of managing a disease which requires treatment that is not directly observed. / AFRIKAANSE OPSOMMING: Die studie ondersoek hoe die nuwe tegnologie van behandeling, antiretrovirale behandeling (ARB), in publieke gesondheidsorgklinieke geïntegreer word. Die sukses van hierdie tegnologie hang af van die nosie van die ‘verantwoordelike’ pasiënt wat, eenvoudig gestel, die nodige vlak ARV-gebruik handhaaf om die virale lading te onderdruk en weerstand te voorkom. Die streng kontrole oor die toewyding tot behandeling wat nodig is om hierdie uitkomstes te bereik, lê buite die direkte beheer van die gesondheidsorgkliniek. Aangesien die kliniek sy pasiënte slegs periodiek sien, word ʼn pasiënt se afwyking van behandelingsriglyne eers later gemeet. In hierdie opsig neem die kliniek 'n ondersteunende rol in, terwyl dit die pasiënte is wat op 'n daaglikse, dosis-tot-dosis basis hulself moet handhaaf en monitor. Dit maak ARB 'n oënskynlike individuele onderneming en verantwoordelikheid. Hierdie skuif in verantwoordelikheid is in lyn met die nuwe kontrak tussen die gesondheidsorgdiens en die kliënt, wat deur ARB genoodsaak word. In ieder geval probeer die institusie om die daaglikse gedrag van die pasiënt te manipuleer om te pas by die riglyne wat deur die uitkomstes genoodsaak word. Hierdie tesis ondersoek hoe hierdie verskillende aspekte van ARB binne twee klinieke in die Kaapse Wynland uitspeel, en meer spesifiek, die institusionele bestuur van 'n siekte waarvoor behandeling nie direk geobserveer kan word nie.