Poor decision making among clinicians to transferring human immune deficiency virus (HIV) patients into second-line antiretroviral therapy (ART) has led to an increase in morbidity and mortality to people living with HIV (PLHIV). No clear barriers are known for clinicians not switching their patients. This is a descriptive qualitative research aimed to discover obstacles that influence clinicians' decision making to transferring patients into second-line ART despite higher level resistance to first-line ART. The researcher applied a participatory action research framework to solve the identified barriers with clinicians. Using the research questions the researcher explored reasons, perceived barriers and enabling factors for clinicians delay in making decision to transferring HIV patients into second-line ART. In-depth semistructured interviews were conducted with 30 participants. Six thematic areas (a) clinicians' capacity to diagnose treatment failure, (b) laboratory investigations, (c) availability, access, and tolerability to second-line ART, (d) clinicians' perceptions on ARV medicines, (e) clients' readiness for ARV medicines, and (f) adherence and retention to ARV medicines were analysed using STATA. Readiness, adherence and retention to ART, knowledge, competence and experience on ART , lack of viral load testing, and shortage of second-line ART were the common major barriers for clinicians in determining transferring patients into second-line ART. The government of Tanzania should acknowledge and create participation, responsibility, and commitment strategies to reduce the observed barriers. Findings of this study generates knowledge and provide actionable plans to help clinicians easily identify HIV patients who are in need of second-line ART.

The study analysed and compared data from patients' medical and pharmacy refill records to identify correlations between CD4 cell counts and adherence to antiretroviral drugs at Katutura Intermediate Hospital (KIH) in Windhoek, Namibia. The study investigated whether the pharmacy refill adherence measurement methodology could predict immunological recovery through increased CD4 cell counts. There was a positive but weak relationship between adherence and CD4 cell counts. Although the pharmacy refill records could predict immunological response it was not sensitive enough and should be used in combination with other adherence measurement tools. / Public Health / M.A. (Public Health)

This study attempted to identify personal (patient-related) factors influencing anti-retroviral therapy (ART) adherence in Addis Ababa, Ethiopia. A quantitative, descriptive, cross-sectional and analytical design was used. Structured interviews were conducted with 355 ART patients. The findings revealed that stigma, discrimination, depression and alcohol use negatively affected patients’ ART adherence levels. However, patients’ knowledge levels had no influence on their ART adherence levels, contrary to other researchers’ reports. Addressing stigma and discrimination at community levels might enhance patients’ abilities to take their medications in the presence of others. Healthcare professionals should be enabled to diagnose and treat depression among ART patients during the early stages. Non-adherent ART patients should be counseled about possible alcohol abuse. / Health Studies / M.A. (Public Health with specialisation in Medical Informatics)

The aim of this study was to assess the extent on how effective was the prevention of mother-to-child transmission of Human Immunodeficiency Virus (HIV) infection at Oshakati District Health Centre. Explanatory survey was used to conduct the research. A total of 160 nurses experienced in prevention of mother-to-child transmission and women who attended antenatal care and post natal care services participated in the study. Respondents expressed unsatisfactory with the promoting involvement of male partners, high quality voluntary counselling and testing services, couple counselling and testing, integration of Highly Active Antiretroviral Therapy services, administration of short course of Zidovudine to pregnant mothers and the provision of antiretroviral drugs to infants. Therefore, promoting involvement of male partners, couple counselling and testing, administration of short course of Zidovudine to pregnant mothers and educating women about exclusive breastfeeding prior to delivery are some of recommendations for effective prevention of mother-to-child transmission of HIV infections. / Health Studies / (M.A. (Public Health))

The objectives of the study were (1) to quantify adherence rate among the study participants in the ART unit and (2) to identify factors that contribute to non-adherence. This cross sectional study was carried out at Nekemete referral clinic. Data was collected using a self-developed structured questionnaire where a total of 338 participants grouped into adherent and non-adherent based on a score derived from an adherence assessment were interviewed. Data was analysed using the Statistical Package for Social Sciences (SPSS) version 17.0. By using multivariate analysis of variables identified as correlates of adherence, non-adherence was common among those; with age between 18-30 yrs, with no education, who were not married, who had no pipe water supply, those with no electricity in the house, who perceived had no access to assistance from providers, who perceived the health care providers (HCPs) did not keep information confidentially, who had a language barrier with providers, and who were treated with a psychiatric illness. The study concludes that adherence is multi-factorial and varies significantly by individual and care setting. Psychosocial factors were found to impact adherence and should be analysed in more detail by further studies. Three psychosocial factors were independently associated with poor adherence: the study found that patients perceiving poor access; those perceiving problems in information confidentiality (and possibly experiencing stigmatisation); and having psychiatric morbidity (and possibly with less social support) are more likely to be non-adherent. Furthermore, individuals without electricity and those without piped water supply, implying low income, are at risk for non-adherence / Health Studies / M.A. (Public Health)

The earlier optimism generated by the efficacy of antiretroviral drugs in human immuno-deficiency virus (HIV) patients has been dissipated in the face of the enormous chal-lenge of maintaining a nearly perfect adherence indefinitely. This study set to determine the influence of HIV adherence self-efficacy and beliefs about medicines on antiretrovi-ral therapy adherence, with the aim of developing a framework for enhancing antiretrovi-ral therapy (ART) adherence through focused intervention on modifiable factors from study variables that are strongly associated with ART adherence. A descriptive correlational design was used to assess the predictive relationships of HIV adherence Self-Efficacy, Beliefs about Medicines and ART adherence among 232 HIV-infected patients in a large public health facility in Pretoria. Participants' medication be-liefs were assessed using the Beliefs about Medicines Questionnaire, HIV adherence self-efficacy was assessed with HIV adherence self-efficacy scale (HIV-ASES) and ART adherence was assessed using the AIDS Clinical Trial Group questionnaire. Pearson correlation analysis was used to assess bivariate associations among the variables, and multiple regression analysis was used to examine the relationships among the inde-pendent variables and ART adherence. Mean adherence for the 232 participants was 95% (SD=13.2). Correlation analysis re-vealed positive bivariate associations between perceived general harm and overuse of medications, and ART adherence (p<0.05); between specific necessity and concerns about ARVs, and perceived general harm and overuse of medications (p<0.05); be-tween HIV adherence self efficacy and ART non-adherence (p<0.05). Multiple regres-sion analysis showed significance for perceived general harm and overuse of medica-tions on ART adherence (F(1;231)=11,583;p<0,001) with perceived general harmful ef-fects and overuse of medications explaining 4.8% of the variance. There was signifi-cance for HIV adherence self-efficacy on ART non-adherence (F(1;41)=4.440; p<0.041), with HIV-ASES explaining 9,8% of the variance. Based on the results, a framework for enhancing ART adherence was developed. Activities in the framework consist of baseline screening for adherence facilitators and barriers using the beliefs about medicine questionnaire and HIV ASES, this is followed by focused interventions on identified barriers of ART adherence / Health Studies / D.Litt. et Phil. (Health Studies)

The purpose of this study was to determine factors affecting non-adherence to Anti-retroviral therapy among AIDS patients. A cross sectional quantitative survey, was used. Structured interviews were conducted with 300 ART patients. Data were analysed using SPSS version 13 and presented in charts, graphs and frequency tables. Motivators of good adherence were identified as disclosure of HIV positive status to more than one person, frequent adherence counselling, self-efficacy to adhere to ART, positive interactions between patients and healthcare providers; and using an adherence partner. Barriers to adherence were forgetfulness, transportation costs to and from the clinic, time away from work and side effects. There was a strong positive correlation between adherence, CD4 counts and viral load. Adherence was closely tied to immunologic and virologic improvements. Respondents with poor adherence were likely to have unsuppressed viral loads (OR 12.98, 95%, CI 4.9-34). / Health Studies / Masters of Public Health

This study assessed healthcare providers’ knowledge, attitudes and practices towards IPT provision for people living with HIV (PLHIV) in Addis Ababa, the capital city of Ethiopia. A quantitative, descriptive, cross-sectional study design was used for the study and data was collected using a self-administered questionnaire from 104 clinicians working in ART clinics. The findings show that healthcare providers who participated in this study had a mean value of high knowledge, positive attitude and good practice towards IPT provision for PLHIV. Significant association was found between knowledge and attitude (P=0.000) but no significant associations were found between knowledge and practice, attitude and practice as well as between the type of facility (public/private) and level of practice. This implied that, the low level of IPT implementation in Addis Ababa doesn’t seem due to health care providers’ lack of knowledge and resistance to provide IPT for people living with HIV. As a result, the researcher recommends for further researches of other possible factors like; the reliability of IPT information/data management, drug supply and the leadership and governance of the health system that IPT program is a direct concern. / Health Studies / M. Public Health (with specialisation in Medical Informatics)

The purpose of the study was to describe factors contributing to mortality among HIVinfected people on Isoniazid Preventive Therapy (IPT) in Botswana. A quantitative, explorative, descriptive study was used and 80 records of deceased IPT respondents were reviewed through the use of a checklist. The demographic factors, baseline physical examination, hospitalisation and drug history were taken into consideration. Out of the deceased patients, 75% were female. The major findings showed that 100% (N=80), the most highly indicated causes of death were gastroenteritis (18.75%), cryptococcal meningitis (17.5%) andpneumonia (16.25%). Of the patients (28.75%) who died before completing the six months of IPT. The causes of death were gastroenteritis (21.7%), symptoms and signs of bacterial pneumonia (17.4%), cryptococcal meningitis (13%), Pulmonary Tuberculosis (PTB) (13%), septicaemia (13%), and murder (13%). It has been recommended that there should be reorganisation of services of care for HIV-infected persons, such as provision of Cotrimoxazole Prophylaxis Therapy (CPT) and Antiretroviral Therapy (ART) to ensure holistic approach care. The future study should include HIV-infected children on IPT using the same or modified objectives. The conclusion drawn was that disintegrated interventions of IPT, CPT and ART and lack of holistic care for PLHIV lead to opportunistic infections that caused mortality on patients on IPT. / Department of Health Studies / M.A. (Public Health)

The purpose of this study was to evaluate the antiretroviral therapy program in primary health care settings in Lesotho. Mixed methods research using a convergent parallel mixed methods design was used to collect both quantitative and qualitative data which were analysed during the same phase of the research process. Two groups of participants participated in the study, the registered nurse group was composed of registered nurses/midwives/nurse clinicians involved in ART service provision and the second group was composed of adults aged 18 years and older who were HIV/AIDS positive. Quantitative data had a compliance rate of 92% and it were analysed using SPSS (23). Qualitative data were analysed using constant comparison analysis and seven themes, fourteen categories and twenty two sub-categories emerged from the data analysis. Findings of the study revealed that the majority of PHC facilities were staffed by registered nurse midwives and nurse clinicians who were qualified, confident, knowledgeable and competent in the execution of duties. Generally there were a large number of patients that sought ART services which were offered on a weekly basis although there was variation in the actual number of days the services were provided. The time patients spent seeking ART services varied across the facilities and ARVs and other drugs were usually available. Challenges in the delivery of ART services included unsatisfactory staffing resulting in the provision of inadequate services and work overload, lack of knowledge of some patients, use of incentives by some partners and too many partners being involved in ART, inadequate documentary evidence and stigma pertaining to the HIV status of individuals. Furthermore, ARVs were reported to make patients feel hungry hence resulting in lack of satisfaction in ART services, ART services were inadequate due to dysfunctional equipment and some patients had been lost due to inability to screen for cancer and there was incomplete monitoring and evaluation of the ART program. However, participants in this study generally showed their acknowledgement of the ART services as they generally improved their health status despite the many challenges that were being faced. / Health Studies / D.Litt.et Phil. (Health Studies)