The media, through development communication and edutainment, plays a critical role in the transformation of societies. In line with this, this thesis discusses the extent to which commercially driven prosocial soap operas can provide a platform for public health messaging, in the context of the HIV/AIDS epidemic in South Africa, for antiretroviral treatment (ART) and for encouraging ART adherence to foster national development. Furthermore, this thesis examined the potential of celebrities as HIV/AIDS ambassadors and the potential of both fictional characters and ‘real-life’ celebrities to disseminate these health messages. Although the HIV/AIDS epidemic in South Africa is stabilising, this is not the time to relax the communication around the disease, particularly regarding adherence to ARVs, considering that South Africa has the largest ARV rollout in the world. The qualitative methodological approach taken for this thesis is a three-step approach examining the intended message, the text and the appropriated message by viewers. Firstly, a thematic content analysis of an episode of Isidingo, that illustrated Nandipha as HIV-positive and the side-effects that came with her ART adherence, and the 3Talk interview with Lesego Motsepe, where she announced that she was weaning herself off ART, was done in order to understand the intended health messaging in the soap opera and the health message disseminated by an HIV-positive actress with regards to ART. Thereafter interview responses by the production team as well as by HIV-positive viewers, using ARVs, were thematised. In addition media texts which provided commentary on the use of a celebrity as a HIV-positive role model were examined. In doing this, this thesis has offered up the meanings of how HIV-positive women taking ARVs and living in Makana experience and understand the media, particularly health messaging relating to ARVs. The findings of this study suggest that commercial soap operas are the perfect platform to address HIV/AIDS and that prosocial health messaging regarding ARV adherence is still necessary in this country. Soap operas have the potential to have an educational angle. Although, HIV-positive individuals serve as better role models as they are authentic; given human nature, fictional characters, such as Nandipha Matabane in Isidingo, may be more sustainable role models as their message can be scientifically-based and well-researched. Realistic characters serve as role models whose behaviour is to be emulated. Soap operas appeal to a wide audience and so storylines can be tailor-made according to the times and the needs in terms of health issues and messaging. Thus, soap operas are not a single platform but rather one which can be exploited to maximum advantage for public health messaging.

Text in English / The aim of the study was to explore the experiences of adult offenders living with HIV (OLWHIV) not qualifying for antiretroviral therapy (ART). Such offenders are put on the pre-antiretroviral therapy (pre-ART) program after HIV diagnosis. Follow up of OLWHIV is done every six months to ensure prompt treatment. Research objectives include exploration of experiences of OLWHIV on the pre-ART program, the accessibility of the program and the challenges thereof. An exploratory, qualitative study with face-to-face interviews was conducted. Purposive sampling of the eight participants was done to conduct the study. Seven out of eight participants accessed the pre-ART program well but had little knowledge of the pre-ART program. Furthermore, participants experienced little support from partners and health care workers. The study showed institutional constraints such as poor diet, shortage of staff and humiliation from Correctional officers. Participants portrayed commitment in the support group irrespective of the challenges experienced. The study further showed that the self-care theory could enhance the pre-ART program but that institutional constraints deterred the progress. Participants made recommendations such as strengthening of partnerships for support groups, good diet, and an increase of staff capacity. Overall study recommendations include implementation of universal test and treat and mixed methods for future studies. / Sociology / M.A. (Social Behaviour Studies in HIV/AIDS)

The aim of the study was to gain in-depth understanding of teachers ’experiences with regard to the provision of care and support to school children on antiretroviral therapy in Swaziland in order to recommend approaches for enhancing support and care offered to children on ART by teachers. The study explored the experiences of teachers providing care and support to school children on antiretroviral therapy in Swaziland. The study used interpretative phenomenological analysis design. The study population was primary schools teachers in Swaziland. Data were collected through individual semi structured interviews from 16 purposively selected teachers. Data were analysed using interpretative phenomenological analysis framework for data analysis. Three superordinate themes emerged from data analysis namely: (1) Increased responsibility, (2) inadequate support and (3) psychological impact. The increased responsibility is related to ensuring that children who are on antiretroviral therapy have eaten before taking antiretroviral treatments, are properly dressed, receive proper education and health care and protected from bullying and social exclusion. Inadequate support for teachers makes caring for the learners very challenging. The psychological impact of caring for these learners are sense of accomplishment, demotivation; helplessness and emotional pain. Recommendations are made to ensure support for teachers rendering care and support to children on antiretroviral therapy. / M.A. (Nursing Science) / Health Studies

This study sought to explore and describe the perceptions and beliefs of physicians about adherence to antiretroviral treatment by patients in the South-East district of Botswana. The Health Belief Model (Naidoo & Willis 2003:222) was adapted to suit and be used in the study. A descriptive, exploratory qualitative design was used. Unstructured interviews and unstructured observation data collection methods were applied. Informed consent was obtained prior to data collection. For triangulation purposes, observations were done following interviews, and data analysis was done by two different people. The findings of the study revealed that the perceptions and beliefs of treating physicians contributed towards adherence. Physicians perceived adherence as an important aspect in the success of antiretroviral treatment. Giving patients correct information, personal motivation, patients' understanding of treatment, traditional and religious beliefs were among other factors perceived by physicians to be impacting on adherence. / Health Studies / M.A. (Public Health)

The scourge of HIV and AIDS can no longer be underestimated. Its devastating effects have been translated into immeasurable monetary and human costs. Women and children, particularly among the rural communities, have borne most of the brunt accruing from the devastating socio-economic consequences of the disease. PURPOSE This study is intended to highlight the plight of rural communities who are constantly besieged by the demand and supply disequilibrium in the provision of primary health care and preventive interventions. OBJECTIVES To describe, compare and analyse HIV / AIDS health care services provided by fixed and mobile clinics in the Madibeng Sub-District of the North West Province. POPULATION The sampled participants were selected from a universal population among pregnant women. SAMPLING A sample of 100 pregnant women from the fixed and mobile clinics participated in answering the questionnaires during their antenatal care visits. RESEARCH SETTING The Madibeng Sub-District in the North West Province been selected as a suitable research site, as it met most of the selection criteria developed by the researcher's judgement sampling. RESEARCH DESIGN The data recorded on the questionnaires by the participants was used to compare and analyse the pregnant women's feelings about HIV / AIDS services of fixed and mobile clinics. Group discussions were also held prior self completion of questionnaires. Questionnaires were administered by the researcher and the two health promoters. FINDINGS It was found that participants in both mobile and fixed clinic have attended HIV / AIDS health care services. Fixed clinic and mobile clinic are respectively viewed as offering better health care services to pregnant women. CONCLUSIONS The research results from this study indicate that HIV / AIDS services provided at both the fixed clinic and mobile service points, including antenatal or prenatal care, are almost similar. RECOMMENDATIONS It is recommended for improving HIV / AIDS health care services that health care providers at Jericho mobile clinic and Jericho fixed clinic intervene by slowing the progression of HIV infection because it has a negative impact on the lives of women. The Jericho clinic and mobile clinic staff should be encouraged to adopt the perspective that HIV / AIDS is not a death sentence, but a preventable disease, not withstanding its deadly consequences on families and communities. The staff at these clinics is also to be motivated to adopt co-operative health care and psycho-social strategies, in which team work and the involvement and participation of all relevant stakeholders is viewed as an integral part of the struggle against HIV / AIDS and its devastating spread. / Health Studies / M.A. (Health Studies)

The aim of the study was to determine the factors that influence adherence to ART among adolescents who contracted HIV through vertical transmission. Qualitative research using descriptive phenomenology was conducted at Botswana-Baylor Children’s Clinical Centre of Excellence. Data was collected using in-depth individual semi-structured interviews. Eight (8) adolescents between 14 and 19 years who had been on ART for minimum of 4 years were interviewed. Thematic analysis of data was done and five (5) themes emerged from the participants' description of the experience of taking ART over a long period of time. The themes that emerged indicated the factors that influence adherence to ART, and they included knowledge and positive beliefs about ART, need for support, ART difficult treatment regimen, having a regular doctor and psychosocial emotional needs. The findings suggested that the adolescents who contracted HIV through vertical transmission require support while continuing on a simplified long-term ART regimen after an assessment of their psychological well beings and periodic checks. / Health Studies / M.A. (Public Health)

This study was conducted to determine retention rate and factors associated with loss to follow-up (LTFU) of adult pre-ART patients in St. Luke hospital, Ethiopia. Cross-sectional study with quantitative and qualitative data collection techniques was used. Review of patient records, focus group discussions and review of program guidelines was conducted to determine level of adherence among pre-ART patients. In addition, pre-ART service quality and perceived reasons for discontinuation was explored. The study revealed that only 38.2% of the 335 patients enrolled in the pre-ART care were retained after 12 months of follow-up in the program. More than half (55.6%), of the LTFU occurred during the first 6 months of follow-up. Fear of discrimination, high transportation cost and mistrust in the pre-ART service were perceived reasons for LTFU. Absences of clear pre-ART service package and implementation guideline were also identified as important factors that may be related to LTFU. The findings call for improved quality of care and a better pre-ART service packaging that will address the gaps identified in order to increase patient retention. / Health Studies / MA (Public Health)

The purpose of the study was to evaluate the IMB skills model for its relevance to the Ethiopian context. According to the model, adherence-related information and motivation work through adherence-related behavioural skills to affect adherence to ART. Quantitative, analytical, observational, cross-sectional, institution-based study was conducted to evaluate the model by assessing those patients who have and do not have the right information, motivation, and behavioural skills whether they have or do not have good adherence to ART. Data was collected using structured questionnaires where a total of 400 randomly selected participants provided data on adherence-related information, motivation and behavioral skills as well as adherence behavior per se. Data was analysed using the Statistical Package for Social Sciences (SPSS) version 20.0. Both descriptive and inferential statistics used in the study. Only 90.75 % of the total sample population reported ART adherence rate of more than or equal to 95% in this study. Free and restricted model tests, through bivariate and multivariate analyses, used to assess the propositions of the IMB model of ART adherence and provided support for the interrelations between the elements proposed by the model. The study has supported the applicability of the IMB model of adherence to the Ethiopian context highlighting its application in adherence-promotion intervention efforts. The findings revealed the need for on-going educational, informational and other interventions to address the knowledge, motivation and adherence behavioural skills of patients in order to improve the current levels of ART adherence behaviour. / Health Studies / D. Litt. et Phil. (Health Studies)

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

South Africa has an estimated 920 000 patients on antiretrovirals (ARVs), the largest number of patients in any country. ARV therapy demands adherence levels in excess of 95% to avoid development of drug resistance, but adherence to ARV therapy is estimated to be only between 50% and 70%. Poor medication adherence is acknowledged as a major public health problem, reducing the effectiveness of therapy and promoting resistance to ARVs. More than two thirds of the South African population have marginal reading skills and this significantly influences a patient’s ability to read and understand health-related information. Patient education materials tailored for the South African population could be a useful aid in facilitating communication with patients and perhaps impact positively on their medicine-taking behaviour. This behaviour is influenced by patient knowledge, beliefs, attitudes and expectations and includes self-management, self-efficacy and adherence. Self-efficacy, which refers to patient confidence in the ability to self-manage medicine taking, is a key factor influencing adherence. This study aimed to develop illustrated patient information leaflets (PILs) and medicine labels for all first-line ARV regimens used in the public health sector in South Africa and, using a randomised control study design, to investigate the impact of these illustrated information materials on knowledge, medication-taking behaviours and health outcomes in HIV/AIDS patients taking ARVs. To achieve this aim, the objectives were to assess HIV/AIDS and ARV-related knowledge, as well as self-efficacy and adherence to ARV therapy; to assess the influence of demographic variables on knowledge, adherence and self-efficacy; to assess the influence of the information materials on knowledge, self-efficacy and adherence and to assess the association of knowledge with health outcomes. Medicine labels and PILs, both English and isiXhosa, were developed for ARV regimens 1a, 1b, 1c and 1d. The 8-item Morisky Medication Adherence Scale (MMAS-8) and HIV Treatment Adherence Self Efficacy Scale (HIV-ASES) instruments for measuring respectively adherence and self-efficacy, were modified to optimize clarity, simplicity and cultural acceptability and were translated into isiXhosa using a multi-stage translation-back translation. The questions and the rating scales, for both the MMAS and HIV-ASES, underwent preliminary qualitative evaluation in focus group discussions. Patients were recruited from local Grahamstown clinics. A pilot study to evaluate applicability of the instruments was conducted in 16 isiXhosa AIDS patients on ARVs and the results from this study informed further modifications to the instruments. One hundred and seventeen patients were recruited for the randomised control trial and were randomly allocated to either control group (who received standard care) or experimental group (who received standard care as well as pictogram medicine labels and the illustrated PIL). Interviews were conducted at baseline and at one, three and six months. Data were analysed statistically using the t-test, chi-squared test and ANOVA (Analysis of Variance) at a 5% level of significance. Correlations were determined using Pearson and Spearman rho correlations. Approval was obtained from Rhodes University Ethical Standards Committee, Settlers Hospital Ethics Committee and the Eastern Cape Department of Health. The results of this research showed that illustrated PILs and medicine labels enhanced understanding of HIV/AIDS and ARV information, resulting in a mean overall knowledge score in the experimental group of 96%, which was significantly higher than the 75% measured in the control group. Variable knowledge scores were measured in three areas: baseline knowledge of general HIV/AIDS-related information was good at 87%, whereas knowledge scores relating to ARV-related information (60%) and side-effects (52%) were lower. These scores improved significantly in the experimental group over the 4 interviews during the 6 month trial duration, whereas in the control group, they fluctuated only slightly around the original baseline score. There was no significant influence of gender on knowledge score, whereas health literacy, education level and age tested (at one and three months) had a significant influence on knowledge. Self-efficacy and adherence results were high, indicating that the patients have confidence in their ability to adhere to the ARV therapy and to practice optimal self-care. Age, gender and education, in most cases, significantly influenced self-efficacy, but were found to have no effect on adherence. The CD4 count improved over the trial duration which may have been influenced by a number of factors, including better knowledge of ARVs and improved adherence. No significant parametric correlation was found between knowledge score and change in CD4 count, however, Spearman's rho showed significance (rs=0.498; p=0.022). Both patients and healthcare providers were highly enthusiastic about the illustrated labels and PILs, and indicated their desire for such materials to be routinely available to public sector HIV/AIDS patients. The isiXhosa version of the PIL was preferred by all the patients. These simple, easy-to-read leaflets and illustrated medication labels were shown to increase understanding and knowledge of ARVs and HIV/AIDS in low-literate patients, and their availability in the first-language of the patients was central to making them a highly useful information source.