Masters Degrees (African Centre for HIV/AIDS Management)

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Adherence to PMTCT antiretroviral therapy among HIV infected pregnant women in Area W Clinic, Francistown Botswana
(Stellenbosch : Stellenbosch University, 2013-03) Ochigbo, Boniface Bradford Ekwu; Munro, Greg; Stellenbosch University. Faculty of Economic and Management Sciences. Dept. of Industrial Psychology. Africa Centre for HIV/AIDS Management.
ENGLISH ABSTRACT: The purpose of this research was to determine the level of adherence among HIV infected pregnant women on prevention of mother to child transmission (PMTCT) antiretroviral therapy, and to establish the factors that contribute to poor adherence and their relative importance, in order to suggest intervention strategies that will improve treatment adherence among this population. The study was conducted in Area W Clinic, Francistown Botswana, and was a prospective cross sectional study using semi-structured questionnaire, and data collection form. In total, 61 pregnant women participated in the study and were all within three to nine months gestation, and had been enrolled into the PMTCT program at least more than one month previously. The following were their characteristics: 75% were within the ages of 26 to 42 years old, 90% were single, 81% had attained secondary school education, and 60% were unemployed. Adherence was considered optimum if greater than or equal to 95%. The participants demonstrated a good knowledge of the importance of PMTCT treatment adherence. Reported optimum adherence levels were 84% by virtual analogue assessment, and 82% by pill count. Ninety eight percent of participants reported they did not miss any dose during the last three days before the interview. The most important factors influencing adherence from the study were pregnancy related illnesses, medication side effects, and month of pregnancy of the patient as participants tended to adhere less as they got closer to delivery. It is therefore important for care-givers to carefully monitor patients for these effects, and to carry out continuous adherence counselling with special attention given to those approaching delivery in order to improve or maintain overall adherence to PMTCT therapy. In conclusion, adherence levels to PMTCT therapy among the population sampled was high but can be further enhanced with interventions designed to cover and improve the highlighted areas in the implementation of the preventive therapy.
Alcohol use among people living with HIV/AIDS (PLWHA) on Highly Active Antiretroviral Therapy (HAART) at Otjiwarongo ART Clinic and its effects on their adherence to HAART
(Stellenbosch : Stellenbosch University, 2014-04) Chikwati, Enerst Mukono; Munro, Greg; Stellenbosch University. Faculty of Economic and Management Sciences. Dept. of Industrial Psychology. Africa Centre for HIV/AIDS Management.
ENGLISH ABSTRACT: Alcohol use among PLWHA has long been recognized as a challenge in terms of HIV disease progression. However no local (Namibian) study has been done to look at prevalence of alcohol use among PLWHA on HAART and its effect on the patients’ adherence to HAART. A cross sectional survey was conducted at Otjiwarongo ART clinic to look at the proportion of PLWHA who use alcohol and the association between alcohol use and adherence to HAART. The target population was PLWHA on HAART at Otjiwarongo ART Clinic who; are 18 years and older and have been on HAART for a minimum of three months. Systematic sampling was used to select participants. A total sample size of 102 participants was obtained. Of those participants, 61(59.8%) were females and 41(40.2%) were males. Of the 102 participants, 14(13.73%) were in the age range of 18-28, 36(35.3%) in the age range of 30-39, 32(31.4%) in the age range of 40-49 and 20(19.6%) were in the age range of above or equal to 50 years. Of the total participants, 54(52.9%) used alcohol and 48(47%) were non-alcohol users. Of those who used alcohol 33(32.4%) were hazardous alcohol users (Abuse) while 21(20.6%) were non-hazardous alcohol users (Alcohol use). Of the 102 participants, 90(88.2%) were adherent to HAART in the four days prior to contact of the survey. These participants managed to take 95% or more of the total doses of their antiretroviral medicines. A total of 12(11.8%) of the participants were non adherent to HAART in the four days preceding the survey. Of the 33 participants who are hazardous alcohol users, 26(78.8%) were adherent to HAART compared to 7(21.2%) who were non adherent to HAART. The picture changes among those who did not use alcohol. Of the 48 participants who did not use alcohol, 44(91.7%) were adherent to HAART and 4(8.3%) were not adherent. What is interesting to note is the fact that of those who were non-hazardous alcohol users, adherence to HAART remained high. Adherence for this group was 95.2 %( 20 out of 21 participants). This study found that PLWHA on HAART Otjiwarongo hospital use alcohol more than the general population. This goes to show that alcohol abuse among PLWHA is indeed a problem which needs urgent attention Though the adherence is good among all the other PLWHA on HAART, adherence was particularly low in those PLWHA who were hazardous alcohol users (Alcohol Abusers). Adherence in this group was significantly low. This goes to show than hazardous alcohol use is associated with poor adherence to HAART. This re-emphasizes the need to screen all PLWHA for alcohol abuse before HAART is started so that appropriate support and advice can be provided.
An analysis of factors affecting health-workers application of the routine HIV testing and counseling (RHT) protocol
(Stellenbosch : Stellenbosch University, 2014-04) Theu, Joe; Munro, Greg; Stellenbosch University. Faculty of Economic and Management Sciences. Dept. of Industrial Psychology. Africa Centre for HIV/AIDS Management.
ENGLISH ABSTRACT: Not all patients who come to the hospital are offered Routine HIV Testing and Counseling (RHT) as is expected by the Ministry of Health of Botswana’s Routine HIV Testing and Counseling Protocol. This study sought to unearth in detail, factors that affect health-workers in Thamaga Primary Hospital in their application of RHT. A qualitative study was used to get lived experiences of health-workers working at Thamaga Primary Hospital. Semi-structured in-depth interviews were conducted with 4 groups of health workers and with 6 individual health-workers. Content analysis was done on the data collected selecting emerging themes deductively. Relational analysis was conducted to gain the meaning of the findings. The findings of the deductive analysis were also compared inductively with The Porter-Lawler Theory of Motivation to see if theory was applicable in HIV work or applicable to health-worker motivation. Seven main factors that affect RHT either positively or negatively emerged: accountability, health-worker knowledge, human rights, workload, resources, patients’ age and patients’ knowledge. Accountability (36.8%) was by far, the dominant factor that influenced RHT positively when it was present and negatively when it was absent. The other two factors which had sizable portions were knowledge of RHT (21.2%) and human rights issues (20.2%). When concept mapping was done to find meaning, lack of knowledge of RHT was found to lead to poor understanding of human rights which led to poor accountability that led to the many other factors that were inter-related and ultimately directly or indirectly influenced performance levels of RHT. When tested against the findings, The Porter-Lawler Theory of Motivation was congruently applied to factors that arose with minor discrepancies on intrinsic factors making it largely relevant to HIV work or health-worker motivation. The findings call for training of health-workers on RHT and human rights issues accompanied by concurrent application of performance monitoring and appraising tools like Performance Based Reward Systems/ Performance Development Plans (PBRS/PDPs) that enhance accountability. Use of The Porter-Lawler Theory in HIV work or health-worker motivation is still applicable and is recommended where underlying factors are less well understood or not yet researched.
Assessing the current practice of tuberculosis (TB) screening in HIV-infected persons
(Stellenbosch : University of Stellenbosch, 2011-03) Ganesh, Rochelle Aneeta; Munro, Greg; University of Stellenbosch. Faculty of Economic and Management Sciences. Dept. of Industrial Psychology. Africa Centre for HIV/AIDS Management.
ENGLISH ABSTRACT: The delayed diagnosis of a curable disease such as TB contributes to the morbidity and mortality of HIV-infected persons in South Africa. The life-time risk for active TB in an HIV-negative person is 5–10%, while the annual risk in HIV-infected persons is up to 15%. The risk of developing TB in HIV-infected persons can be reduced by as much as 60% with an integrative approach to HIV/AIDS and TB. The health care environment can pose a risk with regard to TB transmission. TB infection control aims to provide a safe health care environment for both patients and HCPs. The aim of the study was to establish the current practice of TB screening in HIV-infected persons in Mount Ayliff Hospital in order to provide guidelines for the clinical management of TB in HIV-infected persons. The research study focussed on TB transmission and risk; infection control and practice and integrated HIV/AIDS and TB services in the area of work. The current practice of TB screening in HIV-infected persons in Mount Ayliff Hospital is poorly aligned to the National TB Infection Control policy. The integration of HIV/AIDS and TB services has not been fully implemented. Formulation of an institutional TB infection control plan that includes regular occupational audits may assist in the development of guidelines for the management of TB.
Barriers to antiretroviral adherence of HIV/AIDS patients under the Wellness programme in Mogwase health centre
(Stellenbosch : Stellenbosch University, 2012-03) Moremi, Georgina Shadi; Munro, Greg; Stellenbosch University. Faculty of Economic and Management Science. Dept. of Industrial Psychology. Africa Centre for HIV/AIDS Management.
ENGLISH ABSTRACT: This study determines barriers affecting Antiretroviral Adherence to patients on the wellness programme .It was undertaken at Moses Kotane Health Sub-District in Mogwase Health Centre. A qualitative study was done using a structured questionnaire which included open and closed –ended questions. A total of 20 people (6 male and 14 female) who are HIV positive and on ART participated in the study. Participants were aged 21 years and above. Data was analyzed using qualitative methods. Frequencies were used for analysis of closed ended questions. Themes were identified in open-ended questions. The responses given by the patients gave an insight on barriers affecting ART of HIV/AIDS adherence under the wellness programme in Mogwase Health Centre although the study population was too small to make conclusions of a generalized nature to all those on ART. In this study, it was revealed that the following barriers may play a role in poor adherence: Transport issues, financial burden, food insecurity, forgetfulness and lack of social support. The main finding in this research was that many barriers thought to be contributing to poor adherence do not seem to have influence on ART adherence in this setting although general ART adherence of patients at Mogwase Health Centre is low. To enhance good adherence, it is of paramount importance that ART be rolled out to the lowest level health centres, and mobile point should reach patients in order to avoid transport cost, more nurses should be trained on prescribing and dispensing of ART, and patients should be given at least 3 months supply of ART. Lastly.it would be of importance to conduct a similar type of study in the future on a larger scale to verify the results of this study.
Determination of factors affecting adherence to anti-retroviral therapy in Mitford and Philani clinics
(Stellenbosch : Stellenbosch University, 2013-03) Khewu, Vintwembi Lawrence; Munro, Greg; Stellenbosch University. Faculty of Economic and Management Sciences. Dept. of Industrial Psychology. Africa Centre for HIV/AIDS Management.
ENGLISH ABSTRACT: The aim of this quantitative study was to determine factors affecting adherence to anti – retroviral therapy in two medical health centres, Mitford and Philani clinics in the magisterial district of Queenstown and Ntabethemba Administrative area with the aim of making some recommendations to improving adherence to anti – retroviral therapy. The researcher distributed twenty self completion questionnaires per clinic. All questionnaires at Mitford clinic were returned completed as required whereas only seventeen were returned from the Philani clinic. The research study included HIV positive patients receiving anti – retroviral therapy in the respective clinics that are on ART already for 3 – 4 months. Respondents were between the ages of 18 – 55. The study was conducted for a period of 4 months with data collection and analysis conducted within a month. The researcher realises that the numbers were generally very small, more participants could have possibly changed the results of the study. Established results were however significant. The study was able to identify what could be presented as reasons for non – adherence to anti – retroviral therapy. Support to PLWHA and socio – economic issues were determined as primary reasons for non – adherence to ART. A study with more participants (larger samples) in the future could possibly cover the weakness of this particular research study. Participants in the research study could be seen as adherent in the main with only a few cases that did not adhere at times as a result of reasons cited here. The study took long to take off because of the ethical clearance that took long to be issued by the REC. The period that it was meant to take was interfered with as a result of this delay by the REC. The REC clearance had to be followed by clearances from the EC Provincial DOH (Epidemiological Research & Surveillance Unit – Bisho) and the two managements of the two districts had to issue their clearances thereafter. These clearances also took time to be secured. These delays further impacted on the time frame of the study as planned. The study however, managed to achieve the purpose for which it was set to achieve.
The effect of poor adherence to treatment of people living with HIV/AIDS
(Stellenbosch : University of Stellenbosch, 2011-03) Jeneke, Johannes Marthinus; Munro, Greg; University of Stellenbosch. Faculty of Economic and Management Sciences. Dept. of Industrial Psychology. Africa Centre for HIV/AIDS Management.
ENGLISH ABSTRACT: The purpose of this research was to identify the effect of poor adherence to treatment of people living with HIV/AIDS. Due to the rise in HIV/AIDS related deaths this study tried to establish whether the support systems of People living with HIV/AIDS (PLWA) are in line with the actual needs of PLWA to adhere to effective treatment therapy. The researcher made use of a semi-structured interview to collect the required information. The findings of this study shows that certain obstacles prevent PLWA to adhere effectively to treatment and that these patients should be assisted in whatever way to overcome these obstacles to adhere effectively. Effective adherence to treatment therapy should further be enhanced through the implementation of good HIV/AIDS care practice that encourages patient involvement.
The effectiveness of routine nutrition assessment in the treatment and care of people living with HIV and AIDS in the Eastern Cape Province of South Africa : a case study of Lukhanji Sub District
(Stellenbosch : Stellenbosch University, 2013-03) Chapfunga, Merlyn Tapuwa; Munro, Greg; Stellenbosch University. Faculty of Economic and Management Sciences. Dept. of Industrial Psychology. Africa Centre for HIV/AIDS Management.
ENGLISH ABSTRACT: With the knowledge that HIV and malnutrition are interlinked, a great need for on-going nutritional assessment becomes critical in the treatment and care of people living with HIV and AIDS. In the absences of ARV treatment , people living with HIV and AIDS tend to lose weight and eventually become undernourished whilst ARV treatment is associated with longer life span hence they tend to gain weight becoming overweight or obese. This study attempted to determine the effectiveness of routine nutritional assessment offered to improve the nutrition status, well-being and quality of life of people living with HIV and AIDS attending HIV treatment and care facilities in Lukhanji Sub District of the Eastern Cape Province, South Africa. The thesis reports on the findings collected from an interview guide with semi structured interviews from twenty (20) non pregnant adults that consisted of fourteen (14) females and six (6) males living with HIV and AIDS and not hospitalised. To determine the effectiveness of nutritional assessment the study used descriptive methods and convenience sampling. The study results demonstrated that the routine nutritional assessments being provided to the HIV clients are useful to detect and track body changes and trends to determine the effectiveness of nutrition therapy in slowing the progression of the disease. Furthermore the study showed that the nutrition interventions currently provided at facility site focuses mainly on under nutrition and very little to address over nutrition. In conclusion this study highlighted to some extent the effectiveness of nutrition assessment in treatment and care of PLHIVs with the limited time and the sample size. Hence, recommendations can be made to improve on this study to determine the effectiveness of nutrition assessment further.
The effectiveness of TB & HIV collaboration programme at wellness centre, Kimberley
(Stellenbosch : Stellenbosch University, 2012-12) Enwerem, Martin Ogbonnia; Munro, Greg; Stellenbosch University. Faculty of Economic and Management Sciences. Dept. of Industrial Psychology. Africa Centre for HIV/AIDS Management.
ENGLISH ABSTRACT: This study sought to determine the effectiveness of a TB/HIV collaboration programme in an infectious disease clinic in Frances Baard District, Kimberley, and assess the underlying challenges that clients face while accessing TB and HIV treatment, care and support services from the health care facility. South Africa is facing one of the worst dual epidemics of TB and HIV in the world. It is also described as one of the countries with the highest TB burden in the world. HIV has been shown to fuel the TB epidemic by promoting progression to active disease, both in people with recently acquired and latent disease. Given that a large proportion of TB patients are HIV infected and experience considerable morbidity and mortality, integration of both services at the same service point becomes unavoidable. Data was collection through focus group discussions and self-administered questionnaires. It was clear that TB/HIV programme collaboration has not been optimized. Clients travel from one service point to another to access TB and HIV care. Service delivery sometimes is delayed due to several factors and therefore clients miss the appointments at the other service point. This has led to adherence challenge, treatment default, treatment failure and increasing burden of TB/HIV disease. The research determined that the key to optimize TB/HIV collaboration is to provide both services from the same service point as well as to improve the level of care to the clients. Shared responsibility should be encouraged among service providers/caregivers and clients in an infectious disease unit. Timely interventions to clients will reduce the morbidity rates associated with TB/HIV co-infection and more deaths will be averted especially if full integration is implemented. It is increasingly evident that TB and HIV programmes must collaborate fully to counteract the impact of HIV on TB.
An evaluation of the level of awareness about biomedical intervention for HIV prevention among the post secondary school youth in Richards Bay
(Stellenbosch : Stellenbosch University, 2014-04) Adekola, Ayobami Precious; Munro, Greg; Stellenbosch University. Faculty of Economic and Management Science. Dept. of Industrial Psychology. Africa Centre for HIV/AIDS Management.
ENGLISH ABSTRACT: Despite various strategies such as biomedical, behavioural and political strategies to stop the spread of HIV epidemic among the youth, the risky sexual behaviour among the youth and the resultant increase in unwanted pregnancies is driving the spread of HIV transmission among the youth of Kwazulu-Natal. This study sought to evaluate the level of awareness of post secondary school youth who are living in Richards Bay in Kwazulu-Natal. The researcher conducted the study within a quantitave paradigm. The population for this study are the post secondary school youth in Richards Bay. The data sources for this study will come from survey conducted using semi-structured questionnaire and from the focus group session. The data collection tool was distributed by referral using snowball sampling technique. This study found that the level of general knowledge about biomedical strategies for HIV prevention is low among the youth in Richards Bay since most participants knew only about condoms as a strategy for HIV prevention. The study also found that a significant number of the study participants did not know about the role of circumcision in HIV prevention. In addition, the study found that level of knowledge about biomedical intervention for HIV prevention is higher in female participants than male participants. This study ascertained that the youth have good attitude towards biomedical intervention for HIV prevention though much mobilisation and education will still have to be done with regards to circumcision. The study also identified practices that may impede the use of biomedical strategies such as a lack of availability and accessibility to female condoms The study recommends the need to educate and mobilise the community about biomedical strategies for HIV prevention such as condoms, circumcision, PMTCT, PEP, PrEP, HAART and VCT. The Umhlatuze municipality needs to create a massive awareness within Richards Bay about its available facilities and services like free circumcision and condom distribution outlets that can increase the uptake of biomedical strategies for HIV prevention. Also, the government needs to engage the faith based organisations and other NGOs to integrate biomedical strategies for HIV prevention in their awareness campaign. The study also recommends provision of female condoms in appropriate quantities like male condoms and that multimedia campaign against HIV-related stigma and discrimination should be intensified in Richards Bay.
Factors associated with delay in seeking antiretroviral therapy in Zimbabwe : cross-sectional study
(Stellenbosch : Stellenbosch University, 2013-03) Makurumidze, Richard; Munro, Greg; Stellenbosch University. Faculty of Economic and Management Sciences. Dept. of Industrial Psychology. Africa Centre for HIV/AIDS Management.
ENGLISH ABSTRACT: Access to antiretroviral therapy has been gradually increasing in resource limited settings, Zimbabwe included. Despite the increasing access to antiretroviral therapy quite a number of patients are still delaying to seek antiretroviral therapy. The purpose of the study was to examine factors associated with delay in seeking antiretroviral therapy. A survey was conducted at Parirenyatwa Hospital Opportunistic Infections/Antiretroviral Therapy Clinic from September and November 2012. A total of 80 participants starting antiretroviral therapy who met the criteria were included in the study. The inclusion criteria included patients 18 years above but less than 65 years, no prior history of antiretroviral therapy and eligibility for antiretroviral therapy based on CD4 count or World Health Organisation clinical staging. An interviewer administered questionnaire containing demographic, socio-economic and health-facility factors were used to collect data. Four weeks was used as a cut off point for delay in seeking antiretroviral therapy. The majority of participants (60%) delayed seeking antiretroviral therapy and the factors which were associated with delay in seeking antiretroviral therapy included female gender; lack of a partner; low level of education; low socio-economic status; treatment of opportunistic infections; extra laboratory tests on top of the CD4 count tests; not being on Cotrimoxazole Prophylaxis; not being referred for antiretroviral therapy by the testing site; stigma and discrimination. However disclosure was not associated with early seeking of antiretroviral therapy. Health system factors such as attitude of health care workers, shortage of staff and long waiting times were also identified as bottlenecks to patients seeking antiretroviral therapy early. Efforts to increase early starting of antiretroviral therapy should focus on addressing the referral system from testing sites to antiretroviral therapy initiating sites, improving efficiency of antiretroviral initiating sites, increasing point of care HIV & AIDS diagnostics tools and addressing patient‟s concerns such as stigma & discrimination.
Factors contributing to the delay in distribution of ARV and other related treatments for HIV positive patients during follow up at the ARV clinic of the Rundu State Hospital
(Stellenbosch : Stellenbosch University, 2012-12) Shipapo, Mathilde Makena; Munro, Greg; Stellenbosch University. Faculty of Economic and Management Sciences. Dept. of Industrial Psychology. Africa Centre for HIV/AIDS Management.
ENGLISH ABSTRACT: It is believed and observed by many that the clinics or hospitals that administer ARV are congested and patients wait for a long time for services thus the study undertook to de-termine the factors contributing to the delay in distribution of ARV and other related treatments for people living with HIV during follow up at the ARV clinic of the Rundu State Hospital. The researcher conducted a mixed approach whereby qualitative and quantitative data was collected, the researcher conducted two qualitative methods, a document analysis of the National Guidelines for Antiretroviral Therapy for the Republic of Namibia (Ministry of Health and Social Services) and unpublished government documents of the clinic and a semi structured interview with the immediate supervisors of the clinic. This was fi-nished with questionnaires for CDC health workers and patients that have been using the centre for at least 4 months and more. It was found that the CDC clinic is truly congested with patients and all the participants acknowledged the long waiting time and long queues of the patients at the clinic. This issue has been highlighted as the main challenge within the clinic, along with few health workers and no enough counseling and consulting rooms. Recommendations are pro-vided for both the clinic and the nation at large or the line ministry to assist collectively in finding a way forward in reducing the long queues and long waiting time of the pa-tients at the CDC clinics in Namibia.
Factors impacting on adherence to antiretroviral treatment at False Bay Hospital
(Stellenbosch : Stellenbosch University, 2013-03) Vanqa, Nosivuyile; Munro, Greg; Stellenbosch University. Faculty of Economic and Management Sciences. Dept. of Industrial Psychology. Africa Centre for HIV/AIDS Management.
ENGLISH ABSTRACT: The purpose of this research was to investigate factors impacting on adherence to antiretroviral treatment on people living with HIV and to further explore challenges they come across with adherence. The primary focus of this investigation relates to the following four themes. (i)To evaluate demographic factors such as age, gender and socio-economic factors and the influence they have or contribution to adherence, in correlation with the effects of cultural and health beliefs in this context. (ii) To establish the significance of counselling and review critical challenging issues that needs consideration. (iii) To investigate the nature of reception (negative or ( positive) that patient receives in this local health facility, including the nature of perceived youth friendliness as it may act as a deterrent for confidentiality with regard to referrals. (iv) To determine perceived relationship between health care providers and patients, by patients in terms of support system, referral systems and the prevention of stigma and discrimination. This study comprises of the literature analysis on adherence globally and in the South African context, reviewing the challenges experienced by many South Africans and people living in this country. The study was implemented at a Government’s facility in a health care sector “False Bay Hospital” in the Western Cape, through one focus group and ten semi-structured interviews with patients. The findings of the study reveal that stigma and discrimination is one of the leading causes to poor adherence on antiretroviral treatment including social problems experienced by PLWA. Support and counselling programmes provided at False Bay Hospital were significant but did not necessarily help PLWA in other challenges they came across with. This study also demonstrated the importance of health education and good relationship with patience has a positive effect towards adherence and improves chances of better health.
Factors that affect adherence to antiretroviral therapy among adolescent patients at selected Palapye clinics
(Stellenbosch : Stellenbosch University, 2013-03) Kambale, Herve Nzereka; Munro, Greg; Stellenbosch University. Faculty of Economic and Management Sciences. Dept. of Industrial Psychology. Africa Centre for HIV/AIDS Management.
ENGLISH ABSTRACT: This study, which was conducted from 1 to 31 October 2012, was aimed at describing the main factors that influence adolescent adherence to antiretroviral treatment in three selected health facilities of Palapye Health District. During the one-month data collection period, 30 adolescents were interviewed using semi-structured interview tools. Different factors influencing adolescent adherence to antiretroviral treatment were highlighted and adherence to such treatment was measured using the method of calculating the percentage of returned pills. The mean adherence level for the entire sample was 76.96%, with common factors contributing to poor adherence among adolescents being found to be the poor processing of disclosure, stigma, the accessibility of health facilities, due distance and waiting time, the nature of social support, and feelings toward taking antiretroviral. Thus, by addressing adolescent adherence to antiretroviral treatment, adolescent-adherence counselling before and during treatment is to be shaped, insisting on the preparation of young patient caregivers for the process of disclosure; the reinforcement of positive messages during consultations; insistence on the importance of disclosing HIV status to others; the implementation of the antiretroviral dispensing outreach at health posts; and exerting effort to reduce the waiting time at health facilities prioritising young patients and adolescents.
An investigation of the utilisation of condoms among patients on antiretroviral therapy at Aliwal North Hospital as a prevention method against HIV re-infection
(Stellenbosch : University of Stellenbosch, 2011-03) Sandlana, Simphiwe Dennis; Munro, Greg; University of Stellenbosch. Faculty of Economic and Management Sciences. Dept. of Industrial Psychology. Africa Centre for HIV/AIDS Management.
ENGLISH ABSTRACT: The main objective during the study was to determine the extent to which patients that are on antiretroviral therapy use condoms during sexual engagement as a prevention tool against HIV re-infection, factors associated with non use of condoms and perceptions towards the use thereof. This quantitative study was carried out at Aliwal North Hospital, in the Joe Gqabi District Municipality of the Eastern Cape Province, South Africa. Data was collected using a structured questionnaire with open and closed type questions where a total of 57 participants were given a survey questionnaire to complete. Data was analysed using the tallying method. Results show that the adherence to condom use at last sexual experience by patients on ART was 70%. Based on these findings, recommendations are made that to enhance condom use for patients on ART, the government and other stakeholders should craft programmes that reinforce and promote public confidence in the effectiveness of condoms, intensify health education campaigns against stigma and promote communication and disclosure among sexual partners. Condom supply and distribution should be changed so that condoms are more easily accessible to high-risk groups. Recognising the pivotal role played by Lay Counsellors, it is important to ensure that the counselling skills of Lay Counsellors in all public health facilities are enhanced so that they can offer a quality service.
Non-adherence to ART medication regimens among people living with HIV, who are registered with Leratong hospital in Gauteng province, South Africa
(Stellenbosch : Stellenbosch University, 2012-03) Moiloa, Edwin Mohlalefi; Munro, Greg; Stellenbosch University. Faculty of Economic and Management Sciences. Dept. of Industrial Psychology. Africa Centre for HIV/AIDS Management.
ENGLISH ABSTRACT: The study sought to establish the causes of non-adherence to ART medication regimens among people living with HIV. The research was conducted at Leratong Hospital in Johannesburg, Gauteng province, South Africa. The researcher selected a qualitative design in which 24 patients on ART and six healthcare providers in the field of HIV/AIDS, who fulfilled inclusion criteria of 18 and above years, were interviewed. Tape-recorded interviews as an instrument of data collection was used and patient-participants were approached and requested to participate in one to one interview as they came to collect their medication. Health personnel were approached in their respective offices and asked to be interviewed. Thematic Content Analysis (TCA) was later used to generate themes. The results indicated that adherence levels among the patients were sub optimal (less than 95%). Social economic related factors such as poverty, stigma and fear of disclosure; and medication side effects profoundly influenced adherence. Patient-related factors such as lack of social support, preference of traditional medicines, feeling better, substance abuse; and one health system-related factor being staff shortages, had a little contribution to poor medication adherence. According to the study findings, the process of ART delivery at the clinic had no contribution to patients‟ non-compliance. In fact it was found to have been intended at providing extrinsic motivation to, and raising the levels of adherence among the patients. When the patients stated their views concerning the programme, the major problem lay with strict time rules and that gave birth to forgetfulness. Their suggestion directed not to the health centers, but sorely to the government and all stakeholders including the ARV drugs-manufacturers, was that ART be provided in the form of three to six months injection. The findings revealed that stigma exacerbates non-adherence, so, there is a need to intensify health education campaigns against stigma in communities, workplaces and households. The findings from this study showed a significant relationship between treatment adherence and gender, in which women are generally more compliant than men to ART, so it was recommended that men be given extra pre-ARV counseling and compliance checking.
Non-occupational HIV exposure and post exposure prophylaxis : knowledge and practice among police and prison service personnel in Blantyre, Malawi
(Stellenbosch : Stellenbosch University, 2013-12) Soko, Douglas; Munro, Greg; Stellenbosch University. Faculty of Economic and Management Sciences. Dept. of Industrial Psychology. Africa Centre for HIV/AIDS Management.
ENGLISH ABSTRACT: A cross sectional descriptive study aimed at determining the knowledge and practices of non-occupational exposure and Post Exposure Prophylaxis (PEP) of HIV among police and prison service personnel in Blantyre, Malawi was conducted as part of prevention and management of HIV/AIDS in the workplace. Police and prison service personnel at four police stations of Ndirande, Blantyre, Chilobwe and Limbe in Blantyre and the Chichiri maximum prison respectively and later on Thyolo, Bvumbwe, Bangwe, Chileka were added and surveyed. In total 150 personnel were surveyed using quantitative and qualitative methods. The sampling method was convenient and purposive. A structured questionnaire was self-administered by all participants. Interviews and focus group discussions were also conducted. A total of five interviews targeting HIV/AIDS officers as key informants were conducted; these are officers responsible for HIV/AIDS issues in police stations and prison respectively. On the other hand, four focus group discussions were held targeting middle to low ranking personnel. This segregation of respondents based on choice of qualitative data collection methods was done because mixing low and high ranking police and prison personnel in a focus group discussion would not have created homogeneous, dynamic groups which would have adequately explored issues under investigation. The main findings were that percutaneus and mucotaneus exposures seldom happen among the Police and Prison personnel. Most exposures that happen are not serious to warrant PEP, however the knowledge of HIV exposure and PEP is very low among both groups.
Psychosocial characteristics of AIDS patients with unsuppressed viral load after six months of antiretroviral therapy
(Stellenbosch : Stellenbosch University, 2013-03) Okoli, Emmanuel Ikechukwu; Munro, Greg; Stellenbosch University. Faculty of Economic and Management Sciences. Dept. of Industrial Psychology. Africa Centre for HIV/AIDS Management.
ENGLISH ABSTRACT: STUDY AIM The aim of the study is to explore the psychosocial characteristics of HIV positive clients who are yet to achieve viral load suppression after six months of commencing ARV at Sundumbili CHC in order to plan positive intervention strategies. RESEARCH DESIGN Non-experimental quantitative design was used in carrying out the study. The data was collected through retrieval of information from clinic records and completion of questionnaires to clients on ARV who met the inclusion criteria and consented to participating in the study. A total of 51 adults aged more than 18 years that were initiated in 2010/2011 and still access their treatment at Sundumbili CHC were enrolled into the study. They were selected through convenience sampling. FINDINGS Psychosocial challenges still exist among research participants whose viral load results were not suppressed after six months on ARV. This affected the adherence of some of them to their antiretroviral treatment. CONCLUSION Given the rural nature of Sundumbili and surroundings where the bulk of the patients reside, there are several psychosocial challenges affecting the patients. No known previous study has been undertaken to ascertain the psychosocial characteristics of this group of patients and the impact they may have on viral load suppression after six months of treatment. The study is therefore significant as the findings have provided more insight into the plight of the patients. It is envisaged that the recommendations from the study will assist the relevant management staff in the department in planning and subsequently implementing more positive intervention strategies. The strategies should be targeted at improving the quality of care of the HIV positive clients and attending to their psychosocial needs.
Self-reported strategies for maintaining adherence to antiretroviral therapy in men aged 21 - 49
(Stellenbosch : University of Stellenbosch, 2010-03) Voget, Jacqueline Olivia; Munro, Greg; University of Stellenbosch. Faculty of Economic and Management Sciences. Dept. of Industrial Psychology. Africa Centre for HIV/AIDS Management.
ENGLISH ABSTRACT:Adherence to antiretroviral therapy (ART) is essential to maintain long term health benefits and avoid development of drug resistance. It is not possible for health care providers to reliably predict which individuals will ultimately be adherent to their treatment plan. The reason being that adherence does not correlate with gender, cultural background, socio-economic status or level of education. Studies showed that adherence in resource-limited settings are equal or superior to that in resource-rich settings. HIV positive patients‟ adherence to ART is relatively high in African nations compared to developed world countries. Adherence is a multidimensional phenomenon determined by five sets of factors as set out by the World Health Organisation (WHO). The predictors of adherence are related to factors pertaining to the patient, their condition, socio-economic status, the health care system and the ART they receive. Semi-structured interviews were conducted with twelve men at a government clinic that provides ART services. The ages range from 25 to 44 years. The mean CD4 count was 294 (range 68 – 622) and all the participants had undetectable viral loads within the last six months. They were on ART for a mean 27.8 months (range 9 – 41 months). Some self-strategies emerged from this study to explain the good virological response that is linked to good adherence. Participants experienced remarkable improvement in their health and physical condition and maintained good health whilst taking ART. This led to increased confidence in the ART and motivated them to stay adherent. Participants were fearful of falling ill again and of dying. Feedback regarding their CD4 counts recovering and viral loads decreasing provided them with positive reinforcement. Monthly pill counts are a strategy that gave them a sense of achievement and motivated them to maintain adherence. The participants developed specific strategies to remember to take ART. They made use of watches and cell phone alarms. Pill-taking was incorporated into their daily activities such as mealtimes, listening to radio and watching television. All the participants had an open relationship with the clinic staff. Patients at this particular clinic were well prepared by the clinic staff before starting ART. They trust the advice and instructions from the doctor and other clinic staff. The findings support the recommendations made by the National Antiretroviral Treatment Guidelines pertaining to adherence. This study emphasises the fact that patients devise their own strategies to stay adherent to ART. Each community is different and each clinic should further investigate the unique strategies that patients employ to stay adherent and build it into their treatment plan.
Sociodemographic factors associated with adherence to Antiretroviral Therapy among HIV patients receiving free Antiretrovirals at Bapong Community Health Centre.
(Stellenbosch : Stellenbosch University, 2012-03) Phiri, Almakio; Munro, Greg; Stellenbosch University. Faculty of Economic and Management Sciences. Dept. of Industrial Psychology. Africa Centre for HIV/AIDS Management.
ENGLISH ABSTRACT: The aim of this quantitative study was to establish the sociodemographic factors associated with adherence among HIV/AIDS patients at Bapong Community Health Centre (CHC) in order to make recommendations to improve adherence to ART. The researcher distributed 37 self-completion questionnaires to all the 37 patients at the ART clinic at Bapong CHC, all of which were completed. The research population included all the HIV-positive patients attending the Bapong CHC aged eighteen years old and above and were on ART for more than thirty days. Thirty-seven (37) patients were included in the study out of the 1200 patients attending the Bapong CHC by randomly sampling five patient file numbers of the patients attending the ART clinic at the Bapong CHC on a particular day. The study was conducted over a period of four months with data collection and analysis conducted in less than a month, in January 2012. The researcher found that the numbers in this research study were generally too small with only one statistically significant result, of all the sociodemographic factors that were investigated - that of those whose CD counts were less than 50ml/uL at the start of treatment were more likely to default than those who had higher CD levels (Odds ratio 8.33, p value 0.03 - Fisher exact). Although the other findings were not significant, the study showed findings that were very important to Bapong CHC. Recommendations were made to improve ART adherence, and to conduct another study with larger samples to achieve statistical significant findings.

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