Thesis (PhD)--Stellenbosch University, 2015. / ENGLISH ABSTRACT: The prevention of mother-to-child transmission (PMTCT) of HIV is a key maternal and child health intervention in the context of the HIV/AIDS pandemic in South Africa. Accordingly, the PMTCT programme has been incorporated in the District Health Management Information System (DHMIS) that collects monthly facility-based data to support the management of public health services. To date, there has not been a comprehensive evaluation of the PMTCT information system. By comparing the experiences in two health districts, using the Performance of Routine Information System Management (PRISM) framework and tools, this study seeks to evaluate the availability, quality and use of process and output indicators for monitoring PMTCT interventions. A comparative analytical and observational study was undertaken using a multi-method approach which included: a self-administered survey of health information personnel to assess confidence and competence levels for routine health information system (RHIS) tasks, an assessment of the routine PMTCT data for quality, completeness, accuracy, and data use; and a facility survey of RHIS processes and resources. In addition, in-depth interviews with 22 key informants and observations in health facilities were conducted. Data were collected from 57 health facilities in a convenience sample of two health districts, and also from 182 health information personnel in the 57 health facilities, three sub-districts, and two district offices. Descriptive statistics, χ2-test, correlation and multiple regression analyses were conducted using STATA® Version 13. A general inductive approach was also used to analyse the qualitative data, which was used for triangulation. The study revealed considerable data quality concerns for the PMTCT information with an average accuracy between the register and routine monthly report of 51% and between the routine monthly reports and DHMIS database of 84% suggesting that the primary point of departure for accurate transfer of data is during the collation process. The importance of human factors was emphasised by the observation that the average confidence level for performing RHIS-related tasks (69%) was not commensurate with the average competence levels (30%). Education was found to be associated with competence, implying that levels of education may be associated with the level at which RHIS competencies are acquired; and that three years or more of post-matriculation education is necessary. Motivation, on the other hand was not associated Stellenbosch University https://scholar.sun.ac.za iv with competence. The study observed the absence of processes such as data-quality checks and data-analysis in place in facilities. There was a general absence of a culture of information use, as a result of lack of trust in the data, and the inability of programme and facility managers to analyse, interpret and use information. We observed differences in the data accuracy by organisational authority, and multivariate analysis and qualitative information suggested that feedback may be an essential process to ensure quality. Although the PRISM framework has been developed from a multi-disciplinary evidence base, this study has been able to validate some of the internal assumptions but has also found some aspects that were not supported such as motivation and data display. Data collected from a larger number of facilities will be required to investigate this further. Institutional capacity to improve RHIS processes, ensure core competencies for RHIS-related tasks are needed, and in the longer term, measures to tackle problems associated with low pass rates in numeracy subjects among high school learners are needed. Further exploration of the possible factors that may influence data accuracy, such as supervision, training and leadership are needed as well as investigating the relationships between human and institutional agency-related aspects, in particular, how individual actions can bring about changes in institutional routines. Further study is needed to determine how decision for planning and evaluating key programmes such as PMTCT are made, and what informs such decisions if not routine data. / AFRIKAANSE OPSOMMING: In die lig van Suid Afrika se MIV/VIGS-pandemie kan ’n ingryping op gesondheidsvlak ’n belangrike rol speel om moeder-na-kind-oordrag (beter bekend as PMTCT) van MIV te voorkom. ’n Inligtingstelsel vir distriksgesondheidsbestuur – die DHMIS – was ontwerp vir die invordering van maandelikse fasiliteitsdata, wat gebruik kan word om die bestuur van openbare gesondheidsdienste en -programme te ondersteun. Die inligtingstelsel self was nog nie omvattend evalueer nie. Hierdie studie het die ervarings van twee gesondheidsdistrikte vergelyk met behulp van die PRISM- (Performance of Routine Information System) raamwerk en -instrumente. Derhalwe het hierdie studie die beskikbaarheid, gehalte en gebruik van proses- en uitsetaanwysers probeer bepaal om die PMTCT-ingrypings te monitor. ’n Vergelykende analitiese en waarnemingstudie is onderneem met behulp van ’n veelvuldige benadering. Die verskillende metodes het ’n selfopname onder gesondheidsinligtingspersoneel ingesluit om hul selfvertroue en bevoegdheid in roetinegesondheidsinligtingstelsel (RHIS)-take te evalueer. Daar was ook ’n assessering van die PMTCT-roetinedata om datagehalte, -volledigheid, -akkuraatheid en -gebruik te beoordeel.’n Fasiliteitsopname oor RHIS-prosesse en –hulpbronne was ook gedoen. Ander navorsingsmetodes het diepte-onderhoude met 22 sleutelpersone ingesluit, sowel as waarnemings in gesondheidsfasiliteite. Data is van 182 gesondheidsinligtingpersoneel van die 57 gesondheidsfasiliteite in ’n geriefsteekproef van twee gesondheidsdistrikte ingesamel. Deskriptiewe statistiek, χ2-toetsing, korrelasie en veelvoudige regressie is met behulp van STATA® weergawe 13 ontleed. ʼn Algemene induktiewe benadering is ook gevolg om die kwalitatiewe data te ontleed. Die studie toon dat menslike faktore ’n impak op datagehalte en -inligting kan hê, met ’n gemiddelde akkuraatheidsyfer van 51% van beide die register en roetine maandelikse verslae. Die akkuraatheid van die maandelikse verslae en RHIS databasis is 84%, wat aandui dat akkuraatheid slegs toegepas word indien inligting uit die staanspoor korrek aangeteken word. Die impak van menslike hulpbronafaktore was beklemtoon toe daar bevind was dat hoewel 69% van RHIS-dataverwerkers vertroue getoon het in die gebruik van RHIS-verwante take, slegs 30% wel bevoeg was om die werk te doen. Opvoeding was grootliks geassosieer met bevoegdheid, wat moontlik voorstel dat sekere vlakke van opvoeding benodig word vir spesifieke RHIS-bevoegdhede. Minsten drie jaar tersiêre opleiding word aanbebeel. Motivering was nie met Stellenbosch University https://scholar.sun.ac.za vi bevoegdheid geklassifeer nie. Die studie het bevind dat daar te min aandag aan datagehalte en –analise gegee word in fasiliteite. Oor die algemeen was daar nie ’n ordentlike kultuur van inligtinggebruik nie, a.g.v. die feit dat daar nie vertroue in die data was nie. Terselftertyd was program- en fasiliteitbestuurders nie bevoeg om inligting te analiseer en ontleed nie. Ons het verskille in die akkuraatheid van data opgetel wat deur organisasie-hoofde gedoen was. Meervoudige analise en kwalitatiewe informasie stel voor dat terugvoering ’n belangrike deel van die proses moet wees om kwaliteit te verseker. Hoewel die PRISM-raamwerk saamgestel was uit ’n multi-dissiplinêre bewyslewering, kon hierdie studie sommige van die interne voorneme valideer, maar daar was aspekte wat nie gestaaf kon word nie. Inligting van ’n groter aantal fasiliteite sal benodig word om verder hierna ondersoek in te stel. Institusionele kapasiteit word benodig om RHIS-prosesses te verbeter en basiese vaardighede vir RHIS-verwante take te verseker. Op langtermynvlak moet daar ook gekyk word na probleme wat lei tot laë slaagsyfers in syfervaardighede in hoërskoolleerders. Verdere ondersoek moet ingestel word om vas te stel watter faktore moontlik akkurate data teweeg kan bring. Dit sluit toesig, opleiding en leierskap, asook die verhoudings tussen menslike en agentskap-verwante aspekte in. Die feit dat optrede op individuele vlak veranderings in institusionele roetines kan aanbring, moet spesifiek na gekyk word. Verdere studies kan help om vas te stel hoe besluite vir beplanning en evaluaring vir hoofprogramme soos PMTCT gemaak word – asook hoe die besluite gemaak word indien hulle nie roetine voorafgaan nie.

Thesis (MPhil)--Stellenbosch University, 2005. / ENGLISH ABSTRACT: Mineworkers in South Africa are in abundance as mining is the main occupation especially in the former black homeland. These mineworkers retrenched or retire, and returned to their homeland. Transkei is a former black homeland where abundant retired mineworkers reside to their destiny. Migrancy, which for century has been such a conspicuous feature of the South African labour system, and thought to be a significant contributor to the spread of HIV/AIDS (Lurie M, 2000). The migrant labour system in Transkei region was attributed very extensively to contagious disease especially related with sexually transmitted diseases (STI) like HIV/AIDS. It is estimated that 2 million of the 5 million black mineworkers in South Africa at the time were migrant labourers. Majority of them are from the Transkei region. The ex-mineworkers in this study group are between 41 and 78 years of age (mean 55 years). They have serviced in the mines from 5 to 48 years (mean 20 years). All are married, and having children between 1 and 10 ((mean 6). Fifty seven percent ex-mineworkers did not answer about their number of sexpartners. Only 43% mentioned that they have one partner. Only 31% mineworkers were consuming alcohol. Of them 9% were consuming everyday, and 18% twice in a week. In this study, HIV/AIDS related knowledge, attitudes and behaviour of exmineworkers, living in the remote rural areas of Transkei region of Eastern Cape, were elicited by sending questionnaires to them. Only 19.9% have replied back. There is absolute lack of knowledge in 13.6%, and negative attitude in 27% of the ex-mineworkers. Risks of unsafe sex have been observed among 69%. Of them, 48% have mentioned that they have trust in their wives. Urinary tract symptoms were indicated by 18%, and HIV positivity was reported by 4.5% of mineworkers. There is suicidal tendency (life is not worth living) was found in 22.7% of ex-mineworkers, and a majority (16%) mentioned that it is related with their sickness. Majority of ex-mineworkers have good knowledge about HIV/AIDS, and positive attitude for the survivals. They have also been practicing sex without condoms, but they have provided reasoning to be a faithful to their partners. There is a high level of awareness and a positive attitude towards HIV/AIDS individuals. It was observed that there is less risk taking sexual behaviour among exmineworkers. / AFRIKAANSE OPSOMMING: 'n Groot gedeelte van Suid-Afrikaanse mynwerkers is uit die Transkei gebied afkomstig. Daar word konserwatief beraam dat tussen twee en vyf miljoen mynwerkers jaarliks tussen hulle werkplek en die myne migreer en dat hierdie migrasie ingrypende inplikasies vir die verspreiding van die MI-virus het. Die doel van hierdie studie is om die kennis, houding en gedrag van mynwerkers ten opsigte van MIV/Vigs by 'n steekproef van 198 voormalige mynwerkers in die Transkei te toets. Die inligting is deur middel van 'n vraelys en onderhoude gedoen en daar word tot die gevolgtrekking gekom dat die kennis van Vigs en die voorkoming daarvan besonder goed is by hierdie steekproef. Die implikasies van die bevindinge van die studie word uitgespel en voorstelle vir verdere studies word aan die hand gedoen.

DCur / Departmet of Public Health / See the attached abstract below

Text in English with abstracts and keywords in English, Tswana and Sepedi / Providing support to employees living with HIV to adhere with treatment at home and at work is the key to prolong life and wellbeing of those who are infected and affected by HIV/AIDS pandemic. This study was qualitative explorative research. The study used qualitative method of collecting data which allowed the researcher to conduct interviews at the natural settings where it was convenient for participants to take interview calls. The purpose of this study was to explore how implementation of ART programmes support employees living with HIV (ELWHIV) to adhere with treatment at home and work so that gaps and areas of improvement are identified. The study took place at SWHAP companies that are based in Ekurhuleni, Gauteng. The study used purposive sampling to identify key informants who were directly involved in the implementation of the ART programmes. Data was largely analysed using content, thematic and triangulation analysis. Theory of social ecology and empowerment theory were applied as companies are seen using workplaces as safe space to provide counselling and psychosocial support to ELWHIV through Reality Wellness. Findings: The findings of the study revealed that ART programmes are in place in SWHAP companies and are also ongoing. The study also reveals that Reality Wellness provided counselling and psychosocial support to ELWHIV to adhere with treatment at home and at work. The study further reveals that ELWHIV fear to disclose their HIV status because of stigma and discrimination. Recommendations: More dialogue and further studies on ART programmes particularly on ART adherence at home and at work need to be done. Management should take ownership and get involved directly with ART programmes and enhance support to ELWHIV to adhere with treatment at home and at work. / Go tshegetsa badiri ba ba tshelang ka mogare wa HIV gore ba obamele tiriso ya kalafi kwa gae le kwa tirong go botlhokwa go tshegetsa botshelo le itekanelo ya ba ba tshwaeditsweng le ba ba amilweng ke leroborobo la AIDS. Thutopatlisiso eno e ne e lebelela mabaka mme e tlhotlhomisa. Mokgwa wa go lebelela mabaka go kokoanya data o letlile mmatlisisi go dira dipotsolotso mo mafelong a tlwaelo a banni-le-seabe moo go neng go le bonolo mo go bone go araba megala ya dipotsolotso. Maikemisetso a thutopatlisiso eno, e ne e le go tlhotlhomisa ka moo go tsenngwa tirisong ga mananeo a ART go tshegetsang badiri ba ba tshelang ka HIV (ELWHIV) ka go na go obamela tiriso ya kalafi kwa gae le kwa tirong gore go kgone go supiwa diphatlha le dikarolo tse di ka tokafadiwang. Thutopatlisiso e dirilwe kwa ditlamong tsa SWHAP tse di kwa Ekurhuleni, Gauteng. Go diragaditswe mokgwa wa go tlhopha sampole go ya ka maikaelelo a thutopatlisiso go supa basedimosetsi ba botlhokwa ba ba neng ba na le seabe ka tlhamalalo mo go tsenngweng tirisong ga mananeo a ART. Go lokolotswe data go dirisiwa molokololo wa diteng, morero le tiriso ya melebo e e farologaneng go lokolola. Go dirisitswe tiori ya ikholoji ya loago le tiori ya maatlafatso ka ntlha ya fa ditlamo di bonwa di dirisa mafelo a tiro jaaka dibaka tse di bolokesegileng tsa go tlamela tshegetso ya maikutlo le tshegetso ya tlhaloganyoloago go badiri ba ba tshelang ka HIV ka itekanelo ya nnete. Diphitlhelelo: Diphitlhelelo tsa thutopatlisiso di bontsha gore mananeo a ART a gona mo ditlamong tsa SWHAP mme a tswelela pele. Itekanelo ya nnete e tlamela ka tshegetso ya maikutlo le ya tlhaloganyoloago go badiri ba ba tshelang ka HIV gore ba obamele tiriso ya kalafi kwa gae le kwa tirong. Gape thutopatlisiso e bontsha gore badiri ba ba tshelang ka HIV ba tshaba go senola seemo sa bona sa HIV ka ntlha ya sekgobo le go tlhaolwa. Dikatlenegiso: Go tshwanetse ga nna le dipuisano le dithutopatlisiso tse dingwe tsa manaeo a ART, bogolo segolo kobamelo ya tiriso ya ART kwa gae le kwa tirong. Botsamaisi bo tshwanetse go nna beng ba, e bile bo nne le seabe ka tlhamalalo mo mananeong a ART le go tshegetsa badiri ba ba tshelang ka HIV gore ba obamele tiriso ya kalafi kwa gae le kwa tirong. / Go fa bašomi bao ba phelago ka HIV gore ba obamele go nwa dihlare ka gae le mošomong ke selo se bohlokwa go dira gore ba phele lebaka le letelele le gore bao ba fetetšwego le go angwa ke leuba la AIDS ba phele gabotse. Dinyakišišo tše di bile tša boleng le tša go utolla. Mokgwa wa go kgoboketša tshedimošo wa boleng o kgontšhitše monyakišiši go dira dipoledišano ka seemong sa tlhago sa mokgathatema fao go bilego bonolo go yena go araba megala ya dipoledišano. Maikemišetšo a dinyakišišo tše e bile go utolla ka fao go tsenya tirišong ga mananeo a ART go thekgago bašomi bao ba phelago ka HIV (ELWHIV) go obamela go nwa dihlare ka gae le mošomong gore dikgoba le dibaka tša kaonafalo di tsebje. Dinyakišišo tše di dirilwe ka dikhamphaning tša SWHAP tšeo di lego ka Ekurhuleni, Gauteng. Go dira sampole ka maikemišetšo go phethagaditšwe ka nepo ya go tseba baseboši ba bohlokwa bao ba bego ba kgatha tema thwii ka mananeong a ART. Tshedimošo e sekasekilwe ka go šomiša tshekatsheko ya diteng, ya morero le ya seemokhutlotharo. Teori ya ekholotši ya leago le theori ya maatlafatšo di dirišitšwe ka ge dikhamphani di bonwa e le tšeo di šomišago mafelo a mošomong bjalo ka mafelo ao a bolokegilego a go fana ka keletšo le thekgo ya tša menagano go ELWHIV ka go diriša temogo ya seemo sa makgonthe. Dikutollo: Dikutollo tša dinyakišišo di utolla gore mananeo a ART a tsentšwe tirišong ka dikhamphaning tša SWHAP ebile a tšwela pele. Temogo ya seemo sa makgonthe e fana ka keletšo le thekgo ya menagano go ELWHIV ka nepo ya gore ba omabele go nwa dihlare ka gae le mošomong. Dinyakišišo di tšwela pele go utolla gore ELWHIV ba tšhoga go tsebagatša maemo a bona a HIV ka lebaka la kgobošo le kgethologanyo. Ditšhišinyo: Dingangišano tše dingwe le dinyakišišo go tšwela pele ka go mananeo a ART, kudukudu mabapi le go obamela go nwa dihlare tša ART ka gae le mošomong, di swanetše go dirwa. Ba taolo ba swanetše go tšea maikarabelo a mananeo a ART le go kgatha tema ka go ona thwii le go maatlafatša thekgo go ELWHIV ka nepo ya go obamela go nwa dihlare ka gae le mošomong. / Health Studies / M.A. (Social Behaviour Studies in HIV/AIDS)

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)

Recognizing that a parent is a key role player in fighting HIV/AIDS, the researcher conducted a study to examine and describe the knowledge parents have of this disease and its virus. The study was conducted among a sample of 100 parents/guardians, using a questionnaire to examine the respondents' conceptual, episodic, descriptive, procedural and declarative knowledge of HIV/AIDS. The study found that the respondents lacked especially conceptual and declarative knowledge and that the main factor contributing to knowledge is the level of education. / Health Studies / M.A. (Health Studies)

This study explores the multiple ways in which Acquired Immune Deficiency Syndrome (AIDS) functioned through concrete biomedical institutions, namely, the Centres for Disease Control (CDC), the National Institutes of Health (NIH), and the World Health Organization (WHO). AIDS is viewed as a product of the full range of institutional practices in which it became embedded and in which it was set within the boundaries of Louis Pasteur's germ theory of disease (see the Preface section). This biomedical model of disease was materialized through journalistic practices and sold as news. Within these operative terms can be understood another analytical strategy that also designates the main domain of my study of this contemporary social form: I argue in this thesis that knowledge about AIDS was by no means dependent solely on the objective, scientifically determined, "received narrative" of biomedicine; what is today known as AIDS is also a product of a wide range of social practices produced and reproduced over time and space. AIDS is also an outcome of the resolutions, judgements and decisions that working journalists made over time in terms of what they generated or covered as news; the disease is also product of a large assortment of representational mirrors that I call `authentic voices', to take as good examples, the "narrative of moral protest", the narrative of a "homosexual disease", the narrative of a "heterosexual disease," and the narrative of a "modern-day Black Death" (plague). The story of AIDS in the media can also be seen to be defined by the proliferation of these authentic voices. From this reading, the distinctive trait of AIDS in the media lies in the fact that it is a constructed object, a disease framed through a specific structure of meanings. When we look at these structure of meanings we find that their moral and cultural assumptions and stereotypical connotations embody certain aspects of the organism of the society within which they were created and nourished over a much longer history. / Sociology / D.Litt. et Phil. (Sociology)

South Africa has not escaped the rising prevalence and severe impact of HIV/AIDS in relation women. From an economic and social vantage point, the HIV/AIDS epidemic hits women the hardest, with underprivileged black women the most susceptible to the virus. The theoretical framework of this research focuses on the intersection between HIV/AIDS, gender inequality and gender violence, and more specifically, on certain cultural practices and customs that contribute towards and exacerbate women’s subordination and inequality, which in turn, increase women’s exposure to become infected with HIV. Relevant to this focus is inevitably an investigation of perceived threats to specific fundamental human rights as a result of some entrenched practices that continue to reinforce women’s subordinate position in society, aggravated by the high incidence of gender violence. / Constitutional, International & Indigenous Law / LL.M.

A quantitative, explorative, descriptive research approach was used to investigate why HIV positive people have a problem with disclosing their status. The HIV infection spread is increasing globally, nationally and locally and disclosing would help reduce the spread of infection through preventive measures. Interviews were conducted with 106 respondents at Kagiso primary health care clinics in the West Rand Health Region. Reasons given by the respondents for non-disclosure of the HIV status were: discrimination, stigma to the HIV positive person and the family by the community, isolation and rejection by the family members, discrimination and possible dismissal at the workplace, fear of losing a partner. The findings illustrate that a large percentage of the population know about HIV and its spread and know that by disclosing, one can get support from health resources and family, but people will not make their status public unless stigmatisation is addressed / Health Studies

Submitted in fulfillment of the requirements for the degree of Master of Technology, Information Technology, Durban University of Technology, Durban, South Africa, 2013. / This study reports on the application of decision making core technology adoption theory to empirically examine youth preferences for Human Immunodeficiency Virus (HIV) preventive actions. In order to contribute to the open discourse on whether technology adoption rate is higher for male or female, goal desire, goal intention, action desire and action intention elements of decision making core theory were tested. A mobile health information system was implemented as an HIV information disseminating tool and used for experimentation to determine adoption by youths. A dataset of 118 pupils from two high schools was used for pilot investigation. A dataset of 292 undergraduate youths aged 10-24 years from two universities in South Africa was generated to validate the research model. The Partial Least Square (PLS) analytic modelling technique was used to determine the predictive power of decision making core model from the input dataset. Results of experimentation show that regardless of the gender youth accepts to use mobile information system to access HIV information. The predictive power of the decision making core model was found to be independent of gender factor, which was also not found to moderate the relationship between Perceived Behavioural Control (PBC) and action intention. In addition, gender was not found to moderate the order of importance in factors that predict youth preferences for HIV preventive action. PBC, action desire and goal desire were selected as the most important predictors of HIV preventive actions. The factor of action desire was found to mediate the relationship between PBC and action intention such that the mediation effect was stronger for male youth (68%) than for female youth (19%). Finally, the decision making core model better predicted youth preferences for HIV preventive actions as compared to two models based on Theory of Reason Action (TRA) and Theory of Planned Behaviour (TPB).