MPM / Oliver Tambo Institute of Governance and Policy Studies / See the attached abstract below

PhD (Health) / Department of Public Health / The Government of South Africa in response to a prevalent human immunodeficiency virus (HIV) has adopted an approach of integrating HIV/AIDS service into primary health care, as a key to achieving universal access to antiretroviral treatment (ART). Despite the government’s efforts of integrating HIV service into Primary Health Care (PHC), insufficient numbers of PHC staff and inadequate infrastructure is challenging when integrating HIV/AIDS service into PHC. This study explored the extent of HIV service integration into PHC and whether the clinic/health centre’s environment is enabling to integrate HIV service into PHC. Barriers to HIV/AIDS services integration as well as attitudes of PHC nurses were assessed. The overall purpose of this study was to develop guidelines to facilitate the integration of HIV/AIDS services into PHC in Vhembe district of Limpopo province, South Africa. An exploratory sequential mixed methods design was used. The qualitative data was collected and analysed before and results for qualitative approach used to build a subsequent quantitative phase. The current study revealed that HIV/AIDS services are integrated into every existing programme at the PHC clinic and health centres; these include: Immunisation programme, Family planning, PMTCT and ANC programmes, STIs, minor ailments and chronic illness and TB. The study further revealed that the environments at PHC clinics and health centres are not enabling the integration of HIV/AIDS services into PHC due to insufficient staff and inadequate infrastructure. Guidelines to facilitate the integration of HIV/AIDS services based on the findings was developed. The study recommendations comprise; increasing knowledge of HIV serostatus, accelerating HIV prevention, accelerating the scale-up of HIV treatment and care, creating of enabling environment for the integration of HIV/AIDS services into PHC, nursing education and training and nursing education and training.

MPH / Department of Public Health / See the attached abstract below

MPH / Department of Public Health / Background: Young people in sub-Saharan Africa are most-at risk of HIV infection. This elevated risk in the young black population may be explained by the lack of HIV/AIDS-related knowledge, attitudes towards the epidemic and risky sexual behaviours. Purpose: The aim of the study was to assess the level of knowledge, attitude and behaviour among youth towards HIV infection and to explore the possible aetiological factors associated with the youth’s vulnerability to HIV infection. Methods and materials: This survey adopted a descriptive, cross-sectional design and a quantitative approach.The survey population comprised of all youth aged 15-24 years visiting two Namakgale clinics. An expected sample of (n=152) youths was recruited through convenience sampling. Pretesting of the questionnaire was conducted on 15 youths at Mashishimale Clinic. Data was collected using self-completed questionnaire. The data was captured using Microsoft Excel and then analyzed using the Statistical Package for Social Sciences, version 22. Results: Knowledge on HIV: The majority (77%) of the respondents could distinguish HIV and AIDS and had knowledge that HIV could cause AIDS. The majority of respondents (80%) had knowledge of how HIV was transmitted. The majority of the respondents, (84.9%) knew that HIV/AIDS could not be cured. However, misconceptions about HIV transmission still exist for example, 13.2 % of youth stated that mosquito bites could transmit HIV and whilst 22.4% believed that witchcraft could cause HIV. The main source of HIV information was television (89%). Attitudes towards PLHIV: About 82.9% disagreed that all PLHIV should live away from Namakgale while 72. 4% stated that if their relative had HIV they would care for them. Overall, Namakgale youth held positive attitudes towards PLHIV. Risky sexual behaviours: About 61.8% of females, compared to their male counterparts (38.2%) ever had sex. 61.8% of females compared to 50.0% of males have had sex before their 15th birthday. 36.5% have had 3-5 lifetime sexual partners in comparison to 29.6% of their female counterparts. 44.2% of males did not use condoms at last sex compared to their female counterparts (33.3%). iv Recommendations: There is an urgent need for intensifying awareness campaigns on HIV and AIDS as well as school-based interventions for youths who still harbour myths and misconceptions about HIV transmission. Policy makers and the media should focus more on late adolescents (15- 19 years) risky sexual practices such as intergeneration sex (age group between sexual partners is 10 years or more), transactional sex etc.

MCur / Department of Advanced Nursing Science / See the attached abstract below

MCur / Department of Advanced Nursing Science / Historically, cancer is regarded as a disease with very devastating effects on human beings because it leads to many deaths across the world, compared to AIDS, tuberculosis and malaria collectively. Cancer diagnosis has impacted negatively on patients and their immediate families and has caused unbearable consequences. Unlike other chronic diseases, cancer patients undergo different types of treatments which affect their well-being and as a result they tend to have different experiences to those of other chronic diseases sufferers. The study design used was a quantitative cross sectional survey. The purpose was to investigate the impact of cancer diagnosis on cancer patients in Vhembe district. The target population included all patients in the Vhembe District of Limpopo, South Africa who have been diagnosed with cancer in the past six months. Using a probability simple random, a sample of 207 patients diagnosed with cancer, from seven selected hospitals in Vhembe District were selected as respondents and a self -administered questionnaire was used to collect data. Data was analysed using a software package for descriptive statistics (SPSS version 23). Graphs, tables and charts were used to display the results visually and chi-square to compare variables. Ethical principles of privacy, anonymity, informed consent were considered. The findings revealed that cancer diagnosis has negative outcomes as patients experience physical hardship, psychological stress, financial difficulties, as well as interference with family and social life. The study recommended that cancer patients and their families, be supported through the cancer journey. / NRF

PhD (Nursing Science) / Department of Advanced Nursing Science / State patients are admitted to the psychiatric hospital after being declared as such by a court of law in South Africa. After successful rehabilitation of state patients at the psychiatric hospital, they need to be reintegrated into their families. Perceptions of family members of male state patients regarding reintegration including development of a model to support such reintegration, is not largely explored in the scientific body of knowledge. The aim of this study was to develop a model to support reintegration of state patients into their families in Limpopo Province, South Africa. A qualitative approach using descriptive, explorative, and contextual designs was adopted for this study. The study population was family members whose relatives are male state patients admitted and recorded in the admission register of Hayani Hospital, in Limpopo Province. The study was conducted in two phases of which phase one was a situational analysis, and phase two was the development of the model to reintegrate male state patients into their families. This study was conceptualized within the Social Ecological Model (SEM) of human behaviour (Stokols, 2013), the grounded theory for model development outlined in Dickoff et al. (1968), and the approaches outlined in Chinn and Kramer (2008); Walker and Avant (1995). Model evaluation was done by a group of health professionals, some of whom are advanced psychiatric nurses who are doing masters and doctoral studies, and one doctoral graduate who is also an advanced psychiatric nurse. Presentations were made to this group during peer review sessions who in turn gave critical comments regarding the developed model to support reintegration of male state patients until the final model was accepted. Non-probability purposive and convenient sampling were used to sample a hospital and 10 family members of Venda-speaking male state patients. In-depth individual interviews were used as the instrument to collect data which was pretested on one family member who did not form part of the study. Data was analysed using thematic analysis approach. Data was co-coded by an independent doctoral degree graduate to ensure trustworthiness. Conducting home visits by health professionals came up strongly during data analysis. Credibility, dependability, confirmability and transferability to ensure trustworthiness of the study, as well as ethical considerations were adhered to. The findings of the study yielded two themes, being perceptions of participants regarding reintegration of male state patients, and perceptions of participants regarding the support needed from family members to reintegrate male state patients. During phase one, the results indicated that family members accept reintegration and also that they indicated the kind of support needed, that lead to phase two of developing a model to reintegrate male state patients. The study was restricted to only one hospital in the Vhembe District out of the five districts of the Limpopo Province.The researcher acknowledges that this study was contextual and that only family members of male state patients were interviewed, the perceptions of family members of female state patients were not heard. The study concluded that there are perceptions that family members of male state patients have regarding reintegration of these patients into their families. Furthermore, family members of male state patients can describe the kind of support that they need in order to reintegrate male state patients into their families. This should be done using the developed model that should involve family members and the community. The study recommends that psychiatric hospitals should implement the model involving family members of male state patients. Furthermore, a longitudinal study should be conducted for a period of 3-5 years to check the effectiveness of the model. / NRF

MA (Psychology) / Department of Psychology / Background: An estimated 70% of people in Sub-Saharan Africa out of 25 million are living with HIV. HIV is a debilitating disease, however, antiretroviral treatment helps promote effective viral suppression, reduces the risk of transmission and prevents death (WHO, 2013). To ensure positive treatment outcomes, high levels of Anti-Retroviral Therapy (ART) adherence, 95%, is necessary, however, research indicates that 23% of Africans are achieving less than 80% adherence, potentially impacting negatively on prognosis. Aim: The aim of this study was to determine adherence, explore perceptions and behaviour of patients on Antiretroviral Therapy attending Thohoyandou Health Centre, in Vhembe District, Limpopo, South Africa. Methodology: This was a mixed method which employed both quantitative and qualitative research approaches. In quantitative, triangulation was utilised through a questionnaire and patients’ file, simple random sampling was used to select 105 male and female patients aged 18-60 who are on ART at Thohoyandou Health Centre; data were collected and SPSSversion 25 was used to analyse the data through descriptive, cross tabulation and inferential statistics using Chi-square.Qualitative phase – phenomelogical research design was utilised, twenty participants were purposively sampled and individually interviewed, ATLAS. ti program was used to analyse the data collected. Results: 67% of respondents were females, 34% of the respondents’ age range was 50-60 years, 44.8% were single, 48.6% had tertiary education and 69.5% were unemployed. The self-report of ART adherence of 87.6% among patients was indicated, with 19.6% who reported defaulting ART, 14.3% admitted to missing medical appointments. The reasons for missing medical appointments were: forgetfulness, not a convenient time, patient feeling better, transportation challenges and being too sick to attend. The objective evaluation of patients’ CD4 count at baseline revealed that 40.9% of patients had a CD4 count of <200c/mm3, out of 40.9% respondents (15.2%) were those aged between 41-50 years, 31.4% of respondents did not know their CD4 count for various reasons (defaulted on treatment, missed appointments). CD4 count follow-up data after six months revealed that 33% of patients had a CD4 count <200c/mm3 and 39% accounted for unknown CD4 count. vi Three themes emerged from the data, namely: Knowledge of HIV were respondents presented a negaitive and positive perception of ths diagnosis; barriers to ART adherence where sub-themes included discrimination, strigma, rejection, inadequate knowledge about the diagnosis and treatment, side effects; coping strategies where acceptance, religion and social support serve as corner stones for patients. Association was examined and findings did not reveal any significant association between gender, marital status, education, occupation; however, age was significantly associated with non-adherence to ART with X2 = 3.69, df = 1, p = < .002. Recommendations: The study recommends intensification of health education campaign against stigma, discrimination, rejection and other barriers to enhance positive attitude towards HIV patients that wil consequently stimulate adherence and alleviate the burden associated with taking treatment unswervingly. Given the high percentage of infected older respondents, government must also focus its resources to educate illiterate and older people about HIV, adherence and management in order to achieve the golden standardrate of 95% adherence. Strategies to facilitate and normalise adherence among males is indicated. / NRF

The escalating number of people infected by HIV and AIDS poses a challenge to current resources both at the hospital and household level. Community/Home based care is a viable option in response to the scourge of HIV/AIDS to compliment secondary and tertiary care as well as providing support to affected families in coping with the stress of caring for their terminally ill family members. This study explored the effectiveness of the implementation of Community/Home based care services by focusing on three sites at Bushbuckridge i.e. Cunningmore, Maviljan and Hluvukani. Findings revealed that family members were satisfied to have community caregivers entering their homes to provide care and support to their AIDS ill family members. Significant barriers were highlighted by families and community caregivers that hinder effective implementation of the programme, for instance, cultural sensitivity. The study proffered recommendations on how to deal with these issues. / SOCIAL WORK / MA(SS) (SOCIAL WORK)

The escalating number of people infected by HIV and AIDS poses a challenge to current resources both at the hospital and household level. Community/Home based care is a viable option in response to the scourge of HIV/AIDS to compliment secondary and tertiary care as well as providing support to affected families in coping with the stress of caring for their terminally ill family members. This study explored the effectiveness of the implementation of Community/Home based care services by focusing on three sites at Bushbuckridge i.e. Cunningmore, Maviljan and Hluvukani. Findings revealed that family members were satisfied to have community caregivers entering their homes to provide care and support to their AIDS ill family members. Significant barriers were highlighted by families and community caregivers that hinder effective implementation of the programme, for instance, cultural sensitivity. The study proffered recommendations on how to deal with these issues. / SOCIAL WORK / MA(SS) (SOCIAL WORK)