Thesis (M.A. (Clinical Psychology)) --University of Limpopo, 2013 / Studies have indicated that help-seeking behaviour of people living with HIV is not predictable and linear and may entail the utilization of western medicine, traditional medicine and/or complementary medicine. The aim of this study was to explore pre- and post- HIV diagnosis help-seeking behaviour by patients receiving antiretroviral treatment at Witbank Hospital in Mpumalanga Province (South Africa).A qualitative, descriptive phenomenological approach was utilized in the study. Ten participants (male = 5; female = 5, and aged between 30 and 50 years)diagnosed with HIV and who came to the hospital to collect their treatment and for medical review were interviewed using semi-structured interviews. Interpretive analysis method was used to analyse the data. The results suggest the preference for western medicine pre-and post-HIV diagnosis. The results further suggest that help-seeking behaviour is a dynamic process embedded mainly in the conceptualization of the health problem, perception of its severity, the treatment given, and social support experienced.

Thesis (MPH.) --Univesity of Limpopo, 2014 / Background: The main goal of HAART is to achieve maximal viral suppression. However, with poor adherence to therapy the chances of achieving and maintaining successful viral suppression are decreased, leading to virological failure. And virological failure has been recognized by WHO as one of the early warning signs of drug resistance. This operational research sought to explore virological failure as a treatment outcome to evaluate program performance at a facility level. Methods: Purposive sampling as per inclusion and exclusion criteria was used to retrospectively review clinical records of the first 700 adult HIV positive patients (350 males and 350 females) who initiated antiretroviral treatment between April 2004 and December 2007 at this adult HIV clinic, were followed up for at least 3 years and treated according to the South African government’s National Department of Health 2004 HIV treatment guidelines for adults and adolescents. Major Results: 268 clinical records, 97 (27.71%) male and 171 (58.86%) female records were eligible for inclusion in the study. The proportion of females was higher (63.8%) than males (32.8%) with an average age of 38.95 years. 24 (8.9%) patients in the study sample experienced virological failure during the study period; 11 (11.3%) males and 13 (7.6%) females. Two-thirds (66.6%) of patients who failed to suppress at their first viral load measurement proceeded to develop virological failure. Overall, there was no association of statistical significance between age, sex, baseline CD4 cell count and baseline regimen, and virological failure at various intervals, p> 0.05. Conclusion: It was a challenge to keep patients in care but those that remained in care had good treatment outcomes with only 8.9% developing virological failure. Failure to suppress at first viral load preceded virological failure in the majority of patients.

Health Studies / (M.P.H. (Health Studies))

Thesis (Ph.D. (Physiology and Environmental Health)) -- University of Limpopo, 2021 / Background: Human immunodeficiency virus (HIV)-infection remains a major public health burden where approximately 38 million people are affected globally. Human immunodeficiency virus infection is associated with chronic inflammation which can lead to endothelial dysfunction and thrombosis, which are precursor events for cardiometabolic abnormalities such as dysglycaemia and dyslipidaemia. The degree of chronic inflammation, endothelial dysfunction, and hypercoagulation among HIVpositive adults on highly active antiretroviral therapy are not well understood in Sub- Saharan Africa. The objective of this study was to determine the effect of highly active antiretroviral therapy (HAART) on chronic inflammation, endothelial dysfunction, and hypercoagulation among HAART-exposed adult South African participants in a rural setting. Aim: The study aimed to determine the effects of HAART on early biomarkers of cardiovascular disease in the HIV-positive subjects. Methods: The study was cross-sectional, descriptive, and quantitative in design. The research population consisted of 158 participants of males and females within the age range of 18 – 81 years from Mankweng Hospital and surrounding clinics. The study population comprised of three groups, HIV-negative (control group), HIV-positive treatment naïve (HAART-naïve group), and HIV-positive participants on HAART (HAART-exposed group). Weight and height were measured using Omron BF 400 and a portable stadiometer respectively, to calculate the body mass index. Glucose and lipid levels were determined on Cobas® Integra 400 plus auto-analyser. The CD4+ T cell count was determined on the Cytomics FC500 Flow Cytometer Multi-Platform loader. The concentration of fibrinogen, c-reactive protein (CRP), L-selectin, D-dimers, P-selectin, von Willebrand factor (VWF), soluble intercellular adhesion molecule (sICAM-1), and soluble vascular cell adhesion molecule (sVCAM-1) in serum samples were determined on the Luminex 200TM. Data were analysed using SPSS version 25.0. Descriptive statistics were performed on all variables and analysis of covariance was used to determine differences across all groups. Correlation coefficients and multiple regression analyses were used to determine associations. Results: Body mass index (BMI) and glucose metabolism were not significantly affected by HAART exposure. However, the HAART-exposed group had significantly increased LDL-C (F (2, 154) = 7.501, p = 0.001) and TC (F (2, 154) = 9.174, 0.0002) levels. The prevalence of high LDL-C levels was significantly elevated in the HAART-exposed group (29.6%) (p = 0.041). The prevalence of pre-diabetes (11.3%) was the highest among the HAART-exposed group (non-significant), although, no significant difference was observed. While P-selectin was significantly reduced in the HAART-exposed group (F (2, 154 = 7.253, p = 0.001). On the other hand, the HAARTexposed group also significantly increased VWF (F (2, 154 = 4.556, p = 0.011). The HAART-exposed group showed no significant effect on L-selectin, sICAM-1, sVCAM- 1, CRP, fibrinogen and D-dimer levels. However, D-dimer was negatively associated with HAART (r = -0.249, p = 0.011). There were significant independent association between the combined HAART regimens and P-selectin (Std β = 0.219, p = 0.032), first-line regimen with both P-selectin (Std β = 0.434, p = 0.004) and sVCAM-1 Std β = 0.328, p = 0.031), second-line regimens with L-selectin (Std β = 1.032, p = 0.005) and, a positive independent association between first-line regimen and D-dimer (β = 0.741, p = 0.0001). Although BMI and glucose metabolism were not significantly affected in both the HAART-exposed and HAART-naïve groups, dyslipidaemia was present across the three groups (HAART-exposed, HAART-naïve and control). HAART-exposure showed a protective effect by reducing endothelial dysfunction (ED) and hypercoagulation. Yet, ED was still present among this rural South African HAART-exposed population. The HAART-exposed group may be at increased risk for CVD. Therefore, CVD should be regularly monitored in the HAART-exposed population. / National Research Fund, the Health and Welfare Sector Education and Training Authority, and the University of Limpopo (UL)

Thesis (M.Med. (Family Medicine)) -- University of Limpopo, 2017 / Objectives: To assess adherence to Isoniazide Prevention Therapy (IPT) among HIV positive patients in Rethabile Community Health Centre in the Capricorn District of the Limpopo Province. Methods: A cross-sectional study with qualitative and quantitative data collection methods was conducted among HIV positive patients in Rethabile Community Health Centre from January 2013 to December 2013. Consecutive sampling was used to select 90 participants. Adherence was assessed using patient self-rated adherence to IPT, and confirmed by urine tests for isoniazid metabolites. Data was collected using an interviewer administered questionnaire. Information was also obtained from health care works regarding the perception about reason for non- adherence to IPT. Data was analysed using STATA software and thematic analysis. Results: Self-rated adherence to IPT among the participant was 80% where as urine test was positive for Isoniazid metabolites in 73%. While 84% of participants reported that transportation was the main reason for non adherence, 70% also reported distance from the health care as their main reasons for non-adherence to IPT. However, health care providers reported that many patients do not adhere to treatment due to: Lack of money for transport, missed clinic appointment due to rain and fear of losing jobs, use of traditional medicine, wrong belief about IPT, medicine side effects and alcohol consumption. Conclusion: Self – rate adherence to IPT was suboptimal and appears over – estimated among study participants. Interventions to improve adherence to IPT must ensure easy access to healthcare facilities, address wrong perceptions and promote healthy social behaviours

Thesis (M. A. (Clinical Psychology)) --University of the North, 2002 / Refer to the document

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.

Department of Public Health / MCur

Adherence to antiretroviral therapy is crucial to ensure viral suppression. In the scientific community it is widely accepted that an adherence level of at least 90% is necessary to achieve viral suppression. This study uses pharmacy refill records to describe antiretroviral adherence in HIV-positive patients in Ugu District and to describe pharmacy refill records as reliable monitoring method of antiretroviral therapy. In total, 61 patients’ records were reviewed. Overall, 82% of participants (n=50) achieved an optimum adherence level of at least 90%. Although 38% (n=19) of these participants did not show any related viral suppression. A statistically significant relationship between adherence and viral suppression was not demonstrated. Therefore, pharmacy refill records cannot be recommended as an alternative method of monitoring response to antiretroviral therapy, but laboratory tests including CD4 cell count and or viral load must be combined to pharmacy refill method for monitoring of antiretroviral therapy in HIV-positive patients / Health Studies / M.A. (Public Health)

Adherence to antiretroviral therapy is crucial to ensure viral suppression. In the scientific community it is widely accepted that an adherence level of at least 90% is necessary to achieve viral suppression. This study uses pharmacy refill records to describe antiretroviral adherence in HIV-positive patients in Ugu District and to describe pharmacy refill records as reliable monitoring method of antiretroviral therapy. In total, 61 patients’ records were reviewed. Overall, 82% of participants (n=50) achieved an optimum adherence level of at least 90%. Although 38% (n=19) of these participants did not show any related viral suppression. A statistically significant relationship between adherence and viral suppression was not demonstrated. Therefore, pharmacy refill records cannot be recommended as an alternative method of monitoring response to antiretroviral therapy, but laboratory tests including CD4 cell count and or viral load must be combined to pharmacy refill method for monitoring of antiretroviral therapy in HIV-positive patients / Health Studies / M.A. (Public Health)