WIReDSpace
Welcome to WIReDSpace(Wits Institutional Repository on DSpace)
For technical support contact Lewatle Phaladi by email: lewatle.phaladi@wits.ac.za, Tel : +27 11 717 6594.
Communities in WIReDSpace
Select a community to browse its collections.
- This community is for all faculties and schools' theses and dissertations by masters and doctoral students.
Recent Submissions
Antiretroviral therapy and aging as resources for managing and resisting HIV-related stigma in rural South Africa
(2022-12) Danielle Denardo; Sanyu A. Mojolab; Enid Schatzc; F. Xavier Gómez-Olivé
The widespread roll-out of antiretroviral therapy (ART) in Africa has contributed to a large
population of adults aging with HIV. However, little is known about how HIV-related stigma
interacts with aging in the ART era. This study uses in-depth interviews with middle-aged
and older South Africans living with HIV to explore stigma-related experiences and response
strategies. Participants describe a persistence of stigma which requires the deployment of a range
of common and age-based stigma management and resistance strategies. We find that participants
minimize their exposure to stigma through selective disclosure of their HIV status; neutralize
HIV-related stigma through comparisons to chronic illnesses common among older adults, and
deflect stigma through asserting an ART-adherent identity and othering younger non-adherent
adults. Overall, our study highlights the roles of ART and aging as resources for managing and
resisting HIV-related stigma.
SARS-CoV-2 Seroprevalence: Demographic and Behavioral Factors Associated With Seropositivity Among College Students in a University Setting
(2022-06-23) Karen Diepstra, M.P.H; Brooke W. Bullington; Lakshmanane Premkumar, Ph.D.; Bonnie E. Shook-Sa, Dr.P.H; Corbin Jones, Ph.D.; Audrey Pettifor, Ph.D.
Purpose: Examine SARS-CoV-2 seroprevalence and the association of seropositivity with demographic, geographic, and behavioral variables among University of North Carolina Chapel Hill
(UNC-CH) undergraduate students enrolled in the fall 2020 semester.
Methods: All UNC-CH undergraduate students were invited to participate in the Heelcheck study;
participants were weighted to the UNC-CH undergraduate population using raking methods. We
estimate SARS-CoV-2 seroprevalence at study entrance (11/12/2020e12/10/2020) and bivariable
associations using log-binomial regression.
Results: SARS-CoV-2 seroprevalence was 7.3% (95% confidence interval (CI): 5.4%e9.2%) at baseline. Compared to students who were living off-campus in the Chapel Hill/Carrboro area (CH) for
the Fall 2020 semester (8.6% seroprevalence), students who never returned to CH had lower
seroprevalence (1.9%, prevalence ratio (PR), 95% CI: 0.22, 0.06e0.81), whereas, students who
started the semester on-campus and moved to off-campus CH housing had 18.9% seroprevalence
(PR, 95% CI: 2.21, 1.04e4.72) and students who spent the semester living in a Sorority/Fraternity
house had 46.8% seroprevalence (PR, 95% CI: 5.47, 2.62e11.46). Those who predicted they would
join an indoor party unmasked had 3.8 times the seroprevalence of those who indicated they
would not attend (PR, 95% CI: 3.80, 1.58e9.16). Compared to students who disagreed with the
statement “.I am not going to let COVID-19 stop me from having fun.”, those who agreed had
higher seroprevalence (14.0% vs. 5.7%; (PR, 95% CI: 2.45, 1.13e5.32)).
Discussion: Increased seroprevalence was associated with congregate living and participation
(actual or endorsed) in social activities. During pandemics, universities must create safe socializing
opportunities while minimizing transmission.
The assessment of sarcopenia and the frailty phenotype in the outpatient care of older people: implementation and typical values obtained from the Newcastle SarcScreen project
(2022-03-23) R. M. Dodds; P. Heslop; Jafar; Davies; Noble; Shaw; Witham; Sayer
Purpose Sarcopenia and the frailty phenotype both indicate older adults at risk of adverse health outcomes and yet are not
widely assessed in practice. We developed the Newcastle SarcScreen to enable assessment of these two ageing syndromes
during clinical care. In the setting of our Older People’s Medicine Day Unit, our aims were to describe the implementation
of the SarcScreen and to examine the typical values obtained.
Methods The SarcScreen comprised height, weight, questions (three on the Fried frailty phenotype and fve on the SARC-F
questionnaire), grip strength and gait speed. We analysed data from 552 patients completing the SarcScreen. We expressed
grip strength as Z-scores (number of standard deviations above the mean expected for a patient’s age and sex).
Results It was possible to implement the SarcScreen. In 552 patients (65.9% females) with mean age 80.1 (7.7) years, grip strength
was feasible in 98.2% and gait speed in 82.1%. Gait speed was typically not assessed due to mobility impairment. Most patients
had weak grip strength (present in 83.8%), slow gait speed (88.8%) and the frailty phenotype (66.2%). We found a high prevalence
of probable sarcopenia and the frailty phenotype across all age groups studied. This was refected by low grip strength Z-scores,
especially at younger ages: those aged 60–69 had grip strength 2.7 standard deviations (95% CI 2.5–2.9) below that expected.
Conclusion It is possible to implement an assessment of sarcopenia and the frailty phenotype as part of the routine outpatient
care of older people.
Improving the communication skills of medical students ——A survey of simulated patient-based learning in Chinese medical universities
(2022)
Background: It is useful to advance simulated patient (SP) participation in teaching to improve the communication
skills of medical students, so this study aims to explore the current state of Chinese mainland SP education.
Methods: A cross sectional survey was designed utilizing well defned quantitative research methods and descriptive statistics. The questionnaire sought information which elucidated the current status of SP-based education, the
origin of SP-based learning, SP training, challenges of this learning strategy and future developments. Questionnaires
were distributed to 79 medical colleges in mainland China, and 68 were returned. Of these, 64 constituted valid
responses (81%).
Results: The number of SP-based education activities in medical colleges ofering 5-year、7-year and 8-year clinical
medicine programs was signifcantly higher than that in medical colleges which ofered only a single 5-year program
(p<0.01). Communication skills training accounted for 73% of the content of SP-based learning activities, and was
expected to rise in the future to 90%, in response to a need to improve doctor-patient relationships. Persons recruited
as ‘simulated patients’ included students (21% of the total), residents (49%), medical staf (15%) and teaching staf
(14%).
Colleges, planning a SP-based education program, preferred teachers (80%) and students (55%) to assume ‘simulated
patient’ roles. In objective structured clinical education (OSCE) scenarios, co-scoring by both SPs and teachers featured more highly in the ‘consultation’ station and ‘doctor-patient communication’ station. A number of factors were
identifed as hindering future development and implementation of SP-based learning including budget restraints, SP
selection and training.
Conclusions: SP-based learning programs ofer clear benefts for improving the clinical education of medical students and their communication skills. The main obstacles to achieving more widespread and higher quality SP-based
education are insufcient funding and the lack of standardized training and performance evaluation processes for
simulated patients. Medical colleges should consider reducing the proportion of students and teachers acting as SPs,and attract more citizens to participate in SP-based learning activities. Formalised training and evaluation of SPs performance are necessary to establish a ‘standard simulated patient’ for a particular medical discipline, thus improving
SP-based activities and student learning
Predictors of migration in an HIV hyper-endemic rural South African community: evidence from a population-based cohort (2005–2017)
(2022) Armstrong Dzomba; Hae‑Young Kim; Andrew Tomita; Alain Vandormael; Kaymarlin Govender; Frank Tanser
Globally, South Africa hosts the highest number of people living with HIV (PLHIV) and the unique legacy of inter‑
nal labour migration continues to be a major driver of the regional epidemic, interrupting treatment-as-prevention
eforts. The study examined levels, trends, and predictors of migration in rural KwaZulu-Natal Province, South Africa,
using population-based surveillance data from 2005 through 2017. We followed 69 604 adult participants aged
15–49 years and recorded their migration events (i.e., out-migration from the surveillance area) in 423 038 personyears over 525 397 observations. Multiple failure Cox-regression models were used to measure the risk of migration
by socio-demographic factors: age, sex, educational status, marital status, HIV, and community antiretroviral therapy
(ART) coverage. Overall, 69% of the population cohort experienced at least one migration event during the follow-up
period. The average incidence rate of migration was 9.96 events and 13.23 events per 100 person-years in women
and men, respectively. Migration rates declined from 2005 to 2008 then peaked in 2012 for both women and men.
Adjusting for other covariates, the risk of migration was 3.4-times higher among young women aged 20–24 years
compared to those aged≥40 years (adjusted Hazard Ratio [aHR]=3.37, 95% Confdence Interval [CI]: 3:19–3.57), and
2.9-times higher among young men aged 20–24 years compared to those aged≥40 years (aHR=2.86, 95% CI:2.69–
3.04). There was a 9% and 27% decrease in risk of migration among both women (aHR=0.91, 95% CI: 0.83 – 0.99) and
men (aHR=0.73, 95% CI 0.66 – 0.82) respectively per every 1% increase in community ART coverage. Young unmar‑
ried women including those living with HIV, migrated at a magnitude similar to that of their male counterparts, and
lowered as ART coverage increased over time, refecting the role of improved HIV services across space in reducing
out-migration. A deeper understanding of the characteristics of a migrating population provides critical information
towards identifying and addressing gaps in the HIV prevention and care continuum in an era of high mobility