MSc (Microbiology) / Department of Microbiology / 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.

MA (Psychology) / Department of Psychology / The aim of the study was to explore the psycho-social experiences of children living with vertically transmitted HIV/AIDS in Messina Hospital, South Africa. The study utilised the qualitative approach, in particular the exploratory research design. The population of the study comprised both male and female children between the ages of 12-17 years, who are receiving care and support at Fountain of Hope Clinic in Messina Hospital. Non-probability sampling, in particular its sub-type, purposive sampling, was used to select the children who participated in the study. Eleven participants (11) were interviewed, and the sample size of the study was guided by data saturation during data collection. Semi-structured, open-ended face to face interviews were used to collect data. In order to analyse data, the researcher adopted thematic content analysis, following Tech’s eight steps of qualitative data analysis. Three main themes emerged from the raw data, namely living with HIV/AIDS infection; challenges of living with HIV/AIDS infection; and coping with HIV/AIDS. Sub-themes emerged from the main themes. Ethical considerations were observed and trustworthiness was ensured in the study. The study results were analysed and recommendations based on the results were formulated to enhance the experiences of children living with vertically transmitted HIV/AIDS. / NRF

Department of Microbiology / PhD (Microbiology) / Human herpes virus type 8 (HHV-8), also known as Kaposi’s sarcoma associated herpes virus (KSHV), is the etiologic agent of Kaposi’s sarcoma (KS), and AIDS related Kaposi’s sarcoma (AIDS-KS). HHV-8 which is a member of the Herpesviridae family, exhibits extensive genetic diversity globally. In endemic regions, infection with HHV-8 occurs very early on in life, which is an indication of both environmental and vertical routes of transmission. The advent of HIV leads to the classification of an AIDS-KS defining condition in HIV infections. This suggests that in regions where HIV and HHV-8 are endemic, KS may become common in a mature HIV epidemic. Just like the prevalence of HIV in Northern South Africa is generally high as in most regions of the country, as the HIV epidemic matures in South Africa, it is important to understand the burden and distribution of HHV-8 infection, and the likely genotypes infecting the population. The main objective of the thesis was to establish the epidemiology and infecting genotypes of HHV-8 in Northern South Africa (Limpopo Province), where no data exists. First, a systematic review of the literature was carried out for the entire African continent to determine the seroprevalence and genotype distribution of HHV-8 in all African countries (n=53). In this review, Sudan and South Sudan were considered as one country. Articles were searched using the PRISMA guideline and exported using an article grid. More than two-thirds (64%) of the studies reported on seroprevalence, 29.3% on genotypes; and 9.5% were on both seroprevalence and genotypes. About 45% (24/53) of the African countries had data on HHV-8 seroprevalence exclusively, and more than half (53%) had data on either seroprevalence or genotypes. Almost half (47%) of the countries had no data on HHV-8 infection. There was high heterogeneity in the types of tests and interpretation algorithms used in determining HHV-8 seropositivity across the different studies. Generally, seroprevalence ranged from 2.0% in a group of young children in Eritrea to 100% in a small group of individuals with KS in the Central Africa Republic and a larger group of KS in individuals in Morocco. Approximately, 16% of all the studies reported on children. The difference in seroprevalence across the African region was not significant (95% CI, X2 =0.86; p =0.35), although specifically, a relatively significant ETTA MASHU ELIZABETH, PHD IN MICROBIOLOGY|UNIVERSITY OF VENDA, 2019|VIII level of infection was observed in HIV-infected children. About 38% of the countries had data on K1 genotypes A, A5, B, C, F and Z which occurred at frequencies of 5.3%, 26.3%, 42.1%, 18.4%, 5.3% and 2.6% respectively. Twenty-three percent of the countries had data for K15 genotypes, whereas genotypes P, M and N occurred at frequencies of 52.2%, 39.1% and 8.7% respectively. Data on HHV-8 inter-genotype recombinant is scanty. Our finding suggests that HHV-8 is endemic on the entire African continent, and in HIV endemic regions, but there is need for a harmonized testing protocol for better understanding of HHV-8 seropositivity. HHV-8 genotype A5 and B for K1 gene and genotype P and M for K15 gene are the most predominant genotypes in Africa. The review, for the first time, has provided information on HHV-8 burden on the entire African continent, and suggests that vaccine development efforts for Africa should focus on genotypes B and P. The second component of the investigation focused on the burden of HHV-8 in an HIV population in Northern South Africa (Limpopo Province). Plasma from 3501 HIV infected individuals from 5 districts in Limpopo Province were assessed for antibodies to both the lytic antigen (ORFK8.1) and the latent antigen (ORF73). The distribution of infection was analyzed based on demographic, socioeconomic, and immunological parameters. Statistical inferences for significant differences were determined by Chisquare at a confidence interval of 95%. P-values less than 0.05 were considered significant. About 19.0% of the study population was positive for antibodies to either the lytic or latent antigens or both. Prevalence of antibodies to the lytic antigen was significantly higher than prevalence of antibodies to the latent antigen (17.3% vs 4.1%; p=0.0001). Significant differences were observed for age groups, racial population groups, districts and year of sample collection (p=<0.0001, p=<0.0001, p=<0.0001 and p=0.0385) respectively. Associations were found between both antigens in comparison to the different variables such as age group, racial population groups and districts (R2 value ranging between 0.886 and 1.0). The burden of HHV-8 has now been established for the first time in Northern South Africa. The third aspect of the investigation was a meta-analysis of HHV-8 seroprevalence in Southern Africa in order to understand the impact of geographical location (urban vs rural) on infection. The analysis revealed a significant association between urban settings and HHV-8 infection (p=0.0001). ETTA MASHU ELIZABETH, PHD IN MICROBIOLOGY|UNIVERSITY OF VENDA, 2019|IX The fourth component of the thesis examined the detection of HHV-8 antigen through polymerase chain reaction (PCR) in 534 participants in HIV infected and HIV noninfected populations. A selection of mouthwash DNA samples were subjected to Next Generation Sequencing (NGS) for subsequent genotype inference. Mouth wash samples were obtained from each consenting individual before eating or smoking, and their DNA was purified. A 233bp fragment of the ORF26 gene of HHV-8 was amplified by PCR. HHV-8 was detected in 150 of the 534 participants (28.1%). A significant difference in detection was observed for gender, HIV status, district and the level of education (p=0,0003; p=0.0094; p=0.0002 and p=0.0095) respectively. Consensus sequences were derived from NGS reads for 13 samples. The genotyping results revealed that genotype Q, B, E and N are the genotypes predominant in the study population. As such no mixed infections were detected. Therefore, from the investigations foregoing have demonstrated for the first time the following: (1) HHV-8 is endemic in the entire African continent, which suggest a coendemicity in regions already endemic for HIV; (2) HHV-8 is endemic in Northern South Africa; (3) Urban settings in Southern Africa are associated with high HHV-8 infection; (4) HHV-8 genotypes Q, B, E and N may be predominant in Northern South Africa, with B and P common on the entire African continent. Hence, studies should focus on the generation of full length HHV-8 genomes of the common genotypes to support the selection of genes for vaccine design and development. / 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

MA (Psychology) / Department of Psychology / Background: Given that there is 57.7 million HIV-diagnosed people living in South Africa and the government has established the largest public antiretroviral programme in the whole world but only 53% are adhering. Adherence remains a challenge, due to presence of mental health issues among HIV diagnosed. Aim: The aim of this study was to investigate adherence to antiretroviral therapy and mental health of HIV-diagnosed patients in Vhembe District, Limpopo Province. Methods: This was a mixed method study using a combination of quantitative and qualitative research approaches. In the quantitative approach, triangulation was utilised in the form of a questionnaire and patients records. Simple random sampling was used to select 134, descriptive analysis using SPSS version 25. For the qualitative approach, a phenomenological research designs was considered and convenience sampling was used to select fifteen participants (15). Data was collected using semi-structured interview; responses were analysed using a computer-aided program called, ATLAS ti. Results: The self-report of adherence was 94.8 %, objectively 39.6% of CD4 count <200c/mm3 at baseline and 34.3% CD4 count after six months was found. 16.5% of females and 2% of males defaulted treatment and 14.9% of missed medical appointments 1-6 times. This study also revealed the mental health issues that HIV-diagnosed patients are struggling with after the diagnosis include the stages of grief, stress, depression, anxiety, mistrust, shame, stigma and discrimination. Recommendation: Effective strategies need to be enhanced and tailor made in effort to encourage patients to take ART diligently. The healthcare providers, community members and the government should be made aware of mental health issues. / NRF

The researcher investigated the knowledge, attitudes and experiences of people living with the Human Immunodeficiency Virus (HIV) towards antiretroviral treatment (ART) and who are accessing antiretroviral treatment at a public health clinic in Limpopo, South Africa. A qualitative method was used. The research findings revealed five themes: experiences, social support, knowledge, attitudes, unemployment and economic themes of the study. Factors reported influencing optimum adherence were the inability of the patients to take medication at work, laziness of the patients to collect medication, unemployment, economic hardship, poverty and lack of knowledge of employers regarding HIV/AIDS. / Health Studies / M.A. (Social Behaviour Studies in HIV and AIDS)

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)