Assignment (MPhil)--University of Stellenbosch, 2006. / ENGLISH ABSTRACT: The aim of this study was to investigate practical methods of monitoring AIDS related wasting and lipodystrophy in a resource-poor clinical setting with HIV infected women as the population group of interest. Measurement of body composition changes using anthropometry is both cost- and time-efficient. Various different skinfolds were taken and two different equations (the equations of Pollock et al. (1975) and Durnin and Womersley (1974) for calculating body fat were used to determine the most promising method or methods of monitoring body composition changes in a clinical setting. Detailed anthropometric measurements were performed, as well as selected measurements for haematological parameters and quality of life (QoL) for a group of 8 participants on antiretroviral medication (ART group) and 6 participants who were not on treatment (TN group). New variables namely, intra-abdominal indicator (IAI) and a percent of ideal body mass to percent of ideal arm circumference ratio (%IBW:%IAC) were investigated as possible indicators of lipodystrophy. Although measurements were taken at various timepoints, three specific time-points were chosen for data-analysis for the ART group and two time points for the TN group. These three time-points were, baseline (on the day of recruitment for TN participants and within one month before the initiation of treatment for ART participants), short-term (2 to 12 weeks after treatment initiation or the baseline measurement or for the ART and the TN participants) and long-term (within one and a half year of treatment initiation for the ART group). ART and TN participants did not differ for many variables at baseline. The major differences between ART and TN were in measured and derived variables of the arm, especially percent of ideal arm circumference (%IAC) and upper arm fat area (UAFA), which were significantly lower in the ART group. CD4+ and QoL improved significantly for the ART participants from baseline to long-term. This was not associated with changes in muscle mass, but rather some fat mass variables. Participants on antiretroviral medication exhibited changes relating to abdominal obesity. It was concluded that antiretroviral therapy contributed greatly to the QoL of the participants and it probably aided in the recovery from wasting for at least one participant in this study. Measures of the arm can be used in a rural clinical setting to effectively monitor patients with regard to AIDS related wasting. The new variables IAI and %IBW:%IAC could be helpful in the monitoring of lipodystrophy and should be investigated in future research. / AFRIKAANSE OPSOMMING: Die doelwit van hierdie studie is om praktiese metodes te ondersoek om VIGS-verwante uittering en lipodistrofie te meet in ‘n plattelandse kliniese omgewing (waar hulpbronne dikwels beperk is) met MIV ge-infekteerde vroue as populasiegroep. Die gebruik van antropometrie om veranderinge in liggaamssamestelling te meet is beide koste- en tydeffektief. Verskeie velvoumetings is geneem en twee verskillende vergelykings (die vergelykings van Pollock et al. (1975) en Durnin en Womersley (1974)) is gebruik om liggaamsvetinhoud te bereken, met die doel om ‘n belowende metode te vind om veranderinge in liggaamssamestelling te meet in ‘n kliniese omgewing. Verskeie antropometriese metings is geneem, sowel as uitgesoekte hematologiese en lewenskwaliteitmetings (QoL) vir ‘n groep van agt deelnemers wat antiretrovirale medikasie ontvang het (ART groep) en ses deelnemers wat nie hierdie behandeling ontvang het nie (TN groep). Nuwe veranderlikes (binnebuikindikator (IAI) en die verhouding van persentasie van ideale liggaamsmassa tot persentasie van ideale armomtrek (%IBW:%IAC)) is ondersoek as moontlike aanwysers van lipodistrofie. Drie spesifieke tydpunte vir die ART groep en twee tydpunte vir die TN groep is gekies uit die verskeie tydpunte waarby metings geneem is, nl. basislyn (gedefinieer as die dag wat TN deelnemers in die studie opgeneem is en 0 tot 4 weke voor die begin van behandeling vir die ART deelnemers), korttermyn (2 tot 12 weke nadat behandeling begin is of na die basislyn meting) en lang-termyn (binne een en ‘n half jaar nadat behandeling begin is vir die ART groep). By die basislyn tydpunt het min van die ART en TN deelnemers se gemete veranderlikes verskil. Die ART en TN groepe het hoofsaaklik verskil ten opsigte van veranderlikes wat betrekking het op die arm, veral persentasie van ideale armomtrek (%IAC) en bo-arm vetarea (UAFA). Hierdie twee veranderlikes was beduidend laer in die ART groep as in die TN groep. CD4+ seltelling en lewenskwaliteit tellings het beduidend verbeter vir die ART deelnemers van die basislyn tot die lang-termyn tydpunt. Hierdie veranderinge is nie samehangend met veranderinge in spiermassa nie, maar eerder met sommige vetmassa veranderlikes. Deelnemers wat antiretrovirale medikasie ontvang het, het veranderinge getoon wat gedui het op ‘n verhoogde neerlegging van vet in die buikarea. Ten slotte is bevind dat antiretrovirale medikasie bygedra het tot die verbeterde lewenskwaliteit van die deelnemers en dat dit waarskynlik ook die omkeer van uittering van ten minste een deelnemer aangehelp het. Daar is ook bevind dat armverwante metinge gebruik kan word in die plattelandse kliniese omgewing om pasiënte suksesvol te monitor ten opsigte van VIGSverwante uittering. Die nuwe veranderlikes, IAI en %IBW:%IAC kan moontlik gebruik word om lipodistrofie-verwante veranderings te meet en die gebruik van hierdie veranderlikes behoort ondersoek te word in verdere navorsing.

Thesis (MPA (Public Management and Planning))--University of Stellenbosch, 2010. / ENGLISH ABSTRACT: The accessibility of anti-retroviral drugs to patients and families affected by HIV and AIDS, and the affordability of these drugs, have been challenges to the Du Noon community in the Cape Peninsula. The aim of the study was to assess the effectiveness of primary health care services in addressing HIV/AIDS in the light of these challenges. The focus was on patients registered on the ARV programme and who were receiving treatment at Du Noon Clinic. Interviews were conducted with 15 groups of 10 patients each using a patient questionnaire. During these interviews qualitative and quantitative data were gathered and secondary data was used for quantitative analysis. The results that the data analysis yielded are in keeping with the hypothesis that the HIV/AIDS programme is effective in meeting the needs of the HIV/AIDS patients of Du Noon. After content analysis of qualitative data, two themes related to patient satisfaction emerged: positive and negative feelings that were categorised as satisfied and not satisfied with the service. Most often noted was the feeling of satisfaction with the services rendered at the clinic and that the staff were helpful. The staff rendering the service were also satisfied with the kind of service offered to the patients, but were dissatisfied with the allocation of resources. An increase in enrolment figures of patients was noted in the statistical analysis for the period 2004-2008 with 1,018 patients registered. The statistics illustrate the linear tendency in the enrolment of patients, which indicated the accessibility and affordability of the service. / AFRIKAANSE OPSOMMING: Geredelike toegang tot en die bekostigbaarheid van anti-retrivorale middels (ARM’s) vir pasiënte en families wat deur MIV en VIGS aangetas is, is ‘n uitdaging vir die Du Noon-gemeenskap in die Kaapse Skiereiland. Die doel van die studie was om die doeltreffendheid van primêre gesondheidsorgdienste te bepaal wanneer MIV/VIGS aangespreek word. Die fokus is op geregistreerde pasiënte wat die ARM-program volg en behandeling by die Du Noon Kliniek ontvang. Met behulp van ‘n pasiëntevraelys was onderhoude met 15 groepe van 10 pasiënte elk gevoer. Tydens hierdie onderhoude is kwalitatiewe data versamel en vir kwantitatiewe analise was sekondêre data aangewend. Die resultate wat uit die data analise verkry was, strook met die hipotese dat die MIV/VIGS-program doeltreffend is om die behoeftes van die pasiënte en die gemeenskap van Du Noon aan te spreek. Nadat ‘n inhoudsanalise van die kwalitatiewe data onderneem was, het twee temas rakende positiewe en negatiewe gevoelens – gekategoriseer as tevrede en nie tevrede nie – ten opsigte van die gelewerde diens na vore getree. Veral die gevoel van tevredenheid teenoor die diens gelewer by die kliniek en die personeel as behulpsaam, is opgemerk. Die personeel wat die diens lewer, was ook tevrede met die diens wat aan die pasiënte gelewer word, maar was ontevrede oor die toekenning van hulpbronne. By die statistiese analise is ‘n toename in die inskrywingsgetalle deur pasiënte waargeneem. Toename in inskrywingsgetalle deur pasiënte is gemerk in statistiese analise van 2004 - 2008, met 1,018 pasiënte geregistreer. Die statistiek het die lineêre tendens toegelig ten aansien van die inskrywing van pasiënte wat die toeganklikheid en bekostigbaarheid van die diens uitbeeld.

Thesis (M Social Work (Social Work))--Stellenbosch University, 2008. / South Africa is experiencing a serious HIV/AIDS (Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome) epidemic, with millions of its people living with the disease and dying from related diseases. As there is no cure as yet, counselling as a form of intervention is one of the most powerful ways to address the psychosocial aspects of HIV/AIDS. The motivation for this study was the lack of research concerning skills needed by counsellors in counselling HIV/AIDS patients who are on antiretroviral treatment (ART) or are about to commence antiretroviral treatment. To add to the knowledge that is lacking, the study was approached by means of both quantitative and qualitative research methods. The purpose of the research was explorative and descriptive. The discussion on the literature that was studied provides an overview of the implications of HIV/AIDS for the individual and the family, and of the psychosocial implications, in addition to describing antiretroviral treatment and the nature of HIV and adherence counselling processes and skills. A sample of 16 adherence counsellors who were between the ages of 27 and 57 years was interviewed. These adherence counsellors were employed by Sothemba Aids Action, placed at the different ART sites, trained at the Aids, Training, Information and Counselling Centre (ATTIC) and have gained one or more years’ experience in HIV/AIDS counselling. A semi-structured questionnaire was used as research instrument. It contained both open- and closed-ended questions. All the interviews took place at the clinics where the counsellors were employed or worked. The results of the study showed that an equal number of respondents from two different ethnic groups were interviewed; all the participants had received high school education; and a few obtained tertiary level qualifications. They all received training in basic counselling skills and adherence counselling skills. A few indicated additional training in Voluntary Counselling and Testing (VCT), as well as Prevention of Mother-to-child Transmission Counselling (PMTC). A minority of counsellors indicated making use of a translator and that their experience was that the message was always misinterpreted. All the adherence counsellors indicated a need for further training involving social problems and counselling of children at different ages and stages of development. It was also found that the adherence counsellors lack skills in counselling intervention processes and in intervention. All the adherence counsellors raised concerns regarding their working conditions and salaries. In light of the above it is recommended that patients be counselled in their preferred language, that all counsellors receive the same training in counselling and in the additional areas where they experience a shortcoming. Data on HIV/AIDS and adherence counselling, including the views of counsellors and patients are limited. It is recommended that more research be done on HIV/AIDS and adherence counselling, including the different disciplines that are involved and the views of patients about services rendered to them by those in the different disciplines, and counsellors.

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.

Thesis (MBA)--Stellenbosch University, 2004. / ENGLISH ABSTRACT: HIV infection has increased sharply in SA over the past decade, from almost zero to a level where between 4-6 million citizens are estimated to be HIV positive (i.e. around Il percent of the total population). Given the considerable lag and link between the HIV and AIDS epidemic, the mortality consequences of this exponential increase in HIV infection over the 1990s are more or less matter-of-fact over the coming decade; even drastic interventions can do little to avoid this reality, albeit possibly impactingfurther beyond. The health care industry, and more specifically the pharmaceutical industry, is the only industry that can have a direct impact on the outcome of the epidemic in terms of provision of antiretroviral drugs. More importantly, the decision by multinational companies to provide voluntary licensing to local SA pharmaceutical manufacturers for the manufacturing of generic ARVs has gone a long way into achieving the World Health Organisations' objective of providing an ARV cocktail for less than $1,00 per day. The mam aim of the study is to establish and study the micro-economic effect of HIV/AIDS on a South African pharmaceutical manufacturer and to evaluate their HIV/AIDS Policy with the framework of the mV/AIDS & SID Strategie Plan for South Africa 2000-2005. Both qualitative and quantitative methods were used to obtain data from various key informants, manufacturers and market survey companies. The analysis of quantitative data was done using Excel software and a descriptive analysis method was used to interpret the data. The key findings from the study are that Aspen Pharmacare will experience a 20,8 % HIV prevalence rate in 2005, which will progressively increase to a 25,6 % level in 2015. This prevalence level will be severely experienced in the skilled, semi-skilled and unskilled employment of the company during the 2010 period and will start to stabilise in the latter part of 2015. The AIDS prevalence in the company will increase from a 2,0 % level in 2005 to a 4,4 % level in 2015. This increase is largely due to the increase in the prevalence rates in the semi-skilled and unskilled employees. At a senior management level the forecasted number of employees that will have clinical AIDS after 2010 is between 6 and 8. This clearly indicates that mv/AIDS prevalence at this level is independent of race and is lifestyle dependent. If the company were to have the full responsibility for the provision of benefits, based on the current expected employee benefit structures, the direct cost to company would add 10 % to salary and wages by 2005 and around 20 % by 2010. Indirect costs to company, such as recruitment and training, increased labour turnover, lost skills and intellectual property, etc. are estimated to be 2,5 % by 2005 and 5 % by 2010. With the high HIV/AIDS prevalence rates, especially amongst the unemployed, companies will have to carry the costs of their mv/AIDS patients for longer and register then with Aid for AIDS when it becomes too costly. More importantly employers will have to investigate the cost implication of assisting employee dependents, as this will have a direct impact on the morale of the employees. Aspen Pharmacares' mv/AIDS Policy goes beyond the requirements of the mv/AIDS Strategic Plan for SA in terms of the legal and social requirements. The company also has a Corporate Social Investment division that assists many NGOs, clinics, hospitals and communities. Based on the intellectual property, the pharmaceutical competencies and the continuous dialogue that exists between the pharmaceutical industry and the department of health, the researcher concludes, that pharmaceutical companies have an advantage over nonpharmaceutical companies in dealing with the mv/AIDS issues. The paper concludes by suggesting recommendations that companies can adopt to ensure that their mv/AIDS policy can form a significant component of their skills retention strategy. / AFRIKAANSE OPSOMMING: MIV infeksie het skerp gestyg in SA oor die laaste dekade, vanaf amper geen tot 'n vlak waar tussen 4-6 miljoen inwoners beraam word om MIV positiefte wees (minstens 11% van die totale bevolking). Gegee die aansienlike vertraging en skakel tussen die MIV en VIGS epidemie, word die eksponensiële toename in die sterfte syfer as gevolg van MIV infeksies gedurende die jare negentig as vanselfsprekend aanvaar in die komende dekade. Selfs ingrypende veranderinge kan min doen om hierdie katastrofe te keer. Die gesondheidsorg industrie, en meer spesifiek die farmaseutiese industrie is die enigste industrie wat 'n direkte slag kan slaan om die uitkoms van die epidemie te beinvloed, in terme van voorsiening van antiretrovirale medisyne. Die besluit van die multinasionale maatskappye om vrywillige lisensiëring aan plaaslike farmaseutiese maatskappye te bied, vir die vervaardiging van generiese antiretrovirale medisyne, is een stap vorentoe om by die doelwit van die Wereld Gesondheidsorg Organisasie se doelwit van die voorsiening van 'n daaglikse toediening van antiretrovirale medisyne van minder as $1.00 per dag. Die primêre doelwit van hierdie projek is om te bepaal wat die mikro-ekonomiese effek van MIV/VIGS op 'n Suid Afriakaanse farmaseutiese vervaardiger is en hul MIV/VIGS beleid te evalueer binne die raamwerk van die MIV/VIGS en SOS Strategiese Plan vir SA 2000-2005. Beide kwalitatiewe en kwantitatiewe metodes is gebruik om data te verkry vanaf verskeie bronne, vervaardigers en marknavorsings maatskappye. Die kwantitatiewe inligting was geanaliseer deur gebruik te maak van "Excel" sagteware en 'n beskrywende analitiese metode was gebruik om die data te interpreteer. Die hoof bevindinge van die studie is dat Aspen Pharmacare 'n MIV infeksie vlak van 20.8 % in 2005 sal ondervind, wat progressief sal toeneem tot 25,6 % in 2015. Hierdie infeksie vlak sal in die geskoolde, semi-geskoolde en ongeskoolde arbeid die ergste voorkom gedurende die 2010 periode en sal dan stabiliseer in die latere gedeelte van 2015. Die VIGS infeksie vlak in die maatskappy sal toeneem vanaf 2,0 % in 2005 tot 'n 4,4 % in 2015. Hierdie toename kan toegeskryf word aan die toename in die infeksie vlakke van die semi-geskoolde and ongeskoolde arbeid. Op die senior bestuurs vlak word beraam dat tussen 6 en 8 werknemers VIGS onder lede sal hê na 2010. Hierdie beraming toon duidelik aan dat MIV/VIGS op hierdie vlak onafhankilik van kleurgroup is en direk leefstyl verwant is. Gebaseer op die huidige verwagte werknemer voordele struktuur, en die feit dat die maatskappy volle verantwoordelikheid sou aanvaar vir die voorsiening van voordele, word beraam dat die direkte koste as gevolg van MIV/VIGS 'n toename van 10 % in 2005 en 20 % in 2010 by salarisse en lone sal voeg. 'n Toename van 2,5 % in 2005 en 5 % in 2010 word beraam vir indirekte koste (werwing van personeel, opleiding, ens.)as gevolg van MIV/VIGS. Met die hoë MIV/VIGS infeksievlakke, veral onder werkloses, sal maatskappye die kostes vebonde aan hul MIV/VIGS werknemers vir langer moet verduur en dan later sulke werknemers registreer by "Aid for AIDS" indien dit onbekostigbaar word. Belangriker is die feit dat werknemers die koste implikasie bepaal in die verband, omdat dit 'n direkte invloed sal hê op werknemer selfvertroue. Aspen Pharmacare se MIV/VIGS beleid bied meer as die wettige en sosiale vereistes soos uiteengesit in die MIV/VIGS en SOS Strategiese Plan vir SA 2000-2005. Die maatskappy het ook 'n Korporatiewe Maatskaplike Beleggings afdeling wat 'n bydra lewer by NGOs, klinieke,hospitale en gemeenskappe. Gebaseer op die intelligensie eiendom, die farmaseutiese bekwaamheid en die aanhoudende gesprekvoering wat bestaan tussen die farmaseutiese bedryf en die department van gesondheid, oortuig die navorser dat farmaseutiese maatskappye 'n voordeel het bo nie-farmaseutiese maatskappye in die hantering van die MIV/VIGS strydvraag. Hierdie studie sluit af met aanbevelings wat maatskappye kan toepas om te verseker dat hul MIV/VIGS beleid 'n betekenisvolle komponent van hul bekwaanheids retensie strategie is.

INTRODUÇÃO: O sucesso da terapia antirretroviral de alta potência depende da manutenção de altas taxas de adesão do paciente ao tratamento, o que provocou a implementação de intervenções para melhorar a adesão nos programas de Aids em todo o mundo. No Brasil há poucos estudos sobre a efetividade destas intervenções e apenas um foi aleatório e controlado. Este estudo objetiva avaliar a efetividade de uma intervenção psicossocial para melhorar a adesão de pessoas vivendo com HIV e Aids à terapia antirretroviral. MÉTODOS: Consentiram em participar do estudo 121 dos 363 pacientes com carga viral >50 cópias/ml e com mesmo esquema antirretroviral por no mínimo seis meses, em acompanhamento no Centro de Referência e Treinamento em DST e Aids - São Paulo/Brasil. Todos os participantes utilizaram monitoramento eletrônico de medicação por 60 dias sendo então aleatorizados na proporção de 1:1 para os grupos de intervenção (GI) e controle (GC). O GI recebeu o cuidado usual do serviço e participou de quatro encontros individuais de uma hora com profissional de saúde previamente capacitado a intervalos de 15 dias. O GC recebeu apenas o cuidado usual. O desfecho primário foi a adesão medida pelo monitoramento eletrônico no momento da alocação nos grupos (início da intervenção), após 30, 60, 90 e 120 dias. A medida secundária foi a carga viral no início e no final do estudo. A análise foi feita por intenção de tratamento. RESULTADOS: Não houve diferença estatística significativa nas medidas de adesão segundo percentual de doses tomadas, de doses tomadas no horário e proporção de pacientes com adesão >= 95%, entre os grupos GI e GC durante o período da intervenção (medidas de 30 e 60 dias). Entretanto, a evolução da proporção de pacientes com adesão >= 95% entre o início da intervenção e o primeiro seguimento pós intervenção (medida de 90 dias) mostrou aumento no GI e declínio no GC, embora sem significado estatístico. O GI mostrou queda significativa em todas as medidas de adesão de 60 dias (final da intervenção) e 120 dias (final do seguimento). A carga viral média diminuiu significativamente entre o início e o final do estudo em ambos os grupos, sem diferença estatística significativa entre o GI e o GC. CONCLUSÕES: A intervenção não provocou aumento na adesão dos participantes do estudo. O discreto aumento na proporção de aderentes no grupo da intervenção em relação ao controle durante o período da intervenção sugere, contudo, que o número de participantes - bem menor do que a estimativa amostral - possa ter comprometido os resultados pela falta de poder estatístico suficiente para mostrar diferenças entre os grupos. A redução nos níveis de carga viral foi benéfica, pois se associa com a diminuição da mortalidade e da progressão para Aids. Registro do Ensaio: National Institute of Healthy - Clinical Trials: NCTOO716040 / INTRODUCTION: The success of the antiretroviral therapy depends on high patient adherence to treatment, which has led to the implementation of interventions aimed at enhancing adherence in AIDS programs worldwide. Few studies have been performed in Brazil investigating the effectiveness of these interventions, and only one randomized controlled study is available. The aim of this study is to assess the effectiveness of a psychosocial intervention in improving adherence to antiretroviral treatment among individuals living with HIV and AIDS. METHOD: A total of 121 out of 363 patients with viral load > 50 copies/ml and in use of the same antiretroviral scheme for at least six months were recruited from the Reference and Training Center for STD and AIDS - São Paulo/Brazil. All participants used electronic monitoring of medication for 60 days and were randomized in a 1:1 ratio for the intervention group (IG) and control (CG) The IG, in addition to receiving standard care, took part in four 1-hour meetings, held every fortnight by a trained-health professional. The CG received standard care only. The study was run for six month. The primary outcome was adherence measured by electronic monitoring at the time of allocation groups (commencement of intervention), after 30, 60, 90 and 120 days. The secondary measure was the viral load at baseline and end-point of the study. The analysis was done by intention to treat. RESULTS: Comparison between IG and CG during the intervention period revealed no statistically significant difference in adherence in terms of percentage of doses taken, percentage of doses taken on time, or proportion of patients with adherence >= 95%. However, the evolution of the proportion of patients with adherence >= 95% between the commencement of intervention and follow-up after first intervention (as of 90 days) showed increased adherence in the GI and a tendency for reduced adherence in the CG, although this did not reach statistical significance. A significant decrease in all measures of adherence was observed between 60 days (end of intervention) and 120 days (study end-point). Viral load was found to decrease between baseline and study end-point in both groups (p<0.0001), but presented no statistically significant difference between the IG and CG. CONCLUSIONS: The intervention did not lead to increased adherence among study participants The slight increase in the proportion of adherent participants in the intervention group compared to control during the intervention period suggests, however, that the number of participants - far less than the estimated sample-may have affected the results by the lack of sufficient statistical power to show differences between the groups. Reduced viral load can be beneficial to patients since it is associated with lower mortality and disease progression. National Institute of Healthy - Clinical Trials: NCTOO716040

In July 2011, The Malawi government started implementing an innovative PMTCT policy known as Option B+ strategy that provides universal lifelong ART for all HIV-infected pregnant and breastfeeding women regardless of clinical or immunological stage. Even though Option B+ strategy is a good choice for Malawi, there is fear that the programme may be affected by poor access, utilisation, adherence and retention. Aim: The aim of this study was to explore the lived experiences of HIV-positive women on Option B+ strategy in a selected district hospital in Malawi. Methodology: A Hermeneutics phenomenological approach was used in this study to explore the lived experiences of HIV-positive women on Option B+ strategy through in-depth interviews of five purposely sampled information rich sources. Interviews were audio-taped and transcribed, then manual data analysis using Giorgi’s approach was employed to identify meaningful segments and develop categories, themes and sub-themes. Results: The lifelong commitment was described as the most challenging aspect of Option B+ strategy. Participants demonstrated lack of knowledge and understanding of Option B+ strategy and its implications which rendered them poorly prepared and unready for the task. The un optional Opt-out HIV testing resulted in participants feeling left out in their own care, as health professionals dominated the care from HIV testing throughout the process. The importance of male involvement in PMTCT was revealed in promoting partner HIV testing, disclosure, support, and prevention of further HIV spread. Barriers to participation were described in terms of attitudes of health care workers, stigma and discrimination. Despite the overemphasised need for women to be supported on Option B+ strategy participants were not willing to seek available sources of formal support. / Thesis (M.N.)-University of KwaZulu-Natal, Durban, 2013.

A qualitative study following a phenomenological approach was undertaken to explore voluntary counselling and testing nurses' perception of educating HIV+ people about ARVs. Non-probability convenience sampling was used and in-depth semi-structured face-to-face interviews were conducted to collect data from 12 participants. The most important results were: &#61623; The need for extensive education on ARVs since it is a new technology used to curb the infection therefore clients need the information in order to use them effectively. &#61623; Stumbling blocks encountered when educating HIV+ people about the drugs. The problems are mainly due to the nurses lack of current knowledge about the drugs; patients' low economic status; severe side effects; difficulties in behaviour change; poor quality of life on ARVs and medical terminology. &#61623; Inability of clients to comply to the regimen because of severe side effects, complex regimen, lack of support from family and friends, lack of motivation, depression, cultural beliefs, lack of knowledge on how to use them and financial constraints. &#61623; Challenges for continuous education because of current nursing shortage, negative attitudes of some nurses, demotivation and inadequate funding for such activity. Recommendations include provision of continuing education and the incorporation of ARV therapy knowledge in the basic nursing curriculum in nursing education. / Health Studies / MA (HEALTH STUDIES)

The HIV/AIDS epidemic is described as a crisis by the Global Report (UNAIDS 2004:13). Swaziland¡¦s King Mswati III also declared the HIV/AIDS epidemic as a disaster when the HIV/AIDS prevalence rate increased from 3.9% in 1992 to 42.6% in 2004 (MOHSW 2004:3). In responding to the increasing numbers, the Government of Swaziland established various programmes; one of them being the Voluntary Counselling and Testing (VCT) services to meet societal needs. The MOHSW designed guidelines to be utilized when training nurses to be pre and post HIV test counselors (TASC 2003:2). The period of training ranges between 1 to 2 weeks, after which they are deployed to the VCT centres where nurses provide counseling and testing, treatment of opportunistic infections and distributing antiretroviral drugs. Much research has been done in Swaziland on HIV/AIDS however; there is insufficient knowledge on the impact of HIV/AIDS on nurses working at the VCT services. The objectives of the study were to: ,,« Explore and describe the experiences of nurses working in the VCT services. ,,« Explore and describe the experiences of clients receiving VCT services. ,,« Design and develop an empowerment programme for nurses working in the VCT services in Swaziland. ,,« Formulate and describe guidelines for the implementation of the programme. In this qualitative study, the exploratory descriptive and contextual methodology was utilized to look into lived experiences of nurses and clients. This was done within the adaptation of the intervention Design and Development genre proposed by Rothman and Thomas (1994). Data was collected through purposive sampling and analysed according to Tesch¡¦s methods (Tesch 1990:890) The study revealed one major theme; constant experience of stress that was related to psychological and physical factors (categories). Nurses identified the complexity of HIV/AIDS, shortage of staff, lack of social support, lack of a supportive working environment, and a need for staff development under psychological factors. Clients identified stigma and discrimination. Constant exhaustion and development of medical conditions were identified as physical factors that led to constant experience of stress. Conclusions drawn from the data analysis revealed that nurses were stressed and felt disempowered at working in the VCT services. An empowerment programme was designed and developed to enable these nurses to deal with issues and VCT services for rendering quality care and enjoy the work they do. Guidelines were formulated to implement the empowerment programme. The study concluded with the identification of limitations and recommendations for future endeavours. / Health Studies / D.Litt. et Phil.

The aim of this study was to explore the knowledge of HIV transmission and prevention among adolescents aged between 14 and 16 years at the Tshwane West District. A qualitative exploratory descriptive contextual study was conducted. The World Café approach was used to obtain data from participants in this research. A questionnaire served as the data collection tool to extract data from participants. The study consisted of 37 participants and content analysis was done to analyse data gathered from participants during the World Café. Conclusions were drawn from the study and the findings revealed that the knowledge of HIV transmission and prevention among adolescents in the Tshwane West District is poor. / Health Studies / M.P.H.