Electronic Theses and Dissertations (Masters)

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Browsing Electronic Theses and Dissertations (Masters) by School "Public Health"

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    Factors associated with pre-exposure prophylaxis (PrEP) uptake and continuation among adolescent girls and young women in the uMhlathuze Municipality, KwaZuluNatal South Africa
    (2024) Methazia, Jewelle Joanna Sardis
    Background Despite the notable advancements in preventing human immunodeficiency-virus (HIV) globally, South Africa (SA) continues to report the largest epidemic of HIV in the world. Furthermore, adolescent girls and young women AGYW) in SA carry the unequal burden of infection in SA. Studies have reported that AGYWs find it difficult to negotiate condom use placing them at a direct risk of contracting HIV. Pre-exposure prophylaxis (PrEP) was identified as a novel preventative intervention with uptake and continued use offering the potential to decrease HIV incidence. In SA, guidelines, and strategies to provide of PrEP to high-risk groups, which include AGYW have been developed. This study aimed to describe the characteristics of the AGYW initiating PrEP services and determine the factors associated with PrEP uptake and continued use among AGYW enrolled in an HIV prevention combination program in the uMhlathuze Municipality in KwaZulu-Natal South Africa. Methods This is a retrospective cohort study involving secondary data analysis of programmatic data from an HIV combination prevention program for AGYW in 5 Department of Health community primary health clinics the uMhlathuze Municipality in KwaZulu-Natal. We sampled participants from a population of HIV uninfected AGYW between the ages 15 -24 that initiated the program between the 1st of June 2020 and the 31st of June 2021. Our primary outcome of interest was PrEP initiation at baseline defined as the number of AGYW who were offered PrEP and initiate its use during at their first visit. Our secondary outcome of interest was PrEP continuation at follow-up visit defined as having at least 1 record of follow up after PrEP initiation. Categorical variables were expressed as frequencies and proportions. Bivariable analysis was carried out to determine associations between PrEP initiation and the categorical variables using the Chi-squared (χ2) test. Log-binomial regression was utilised to evaluate risk factors associated with our primary outcome (PrEP initiation) and our secondary outcome (PrEP continuation). Risk ratios (RRs) and their 95% CI were used as the measure of effect. Variables with p<0.1 were included in the multivariable analysis for both PrEP initiation and PrEP continuation to ascertain factors associated with each outcome. A cut off p<0.05 was used in the multivariable model to identify factors associated with both the primary (PrEP initiation) and secondary outcome (PrEP continuation). All statistical analyses were performed using Stata (V.15) statistical software and RStudio. Results Between the 1st of June 2020 and the 31st of June 2021, 3324 AGYW were enrolled in the HIV prevention combination program and were offered PrEP services. Overall, 1609 (48%) initiated PrEP services. Majority (71%) were aged 19 - 24 and 6.5% of PrEP initiates reported having an STI in the 6 months prior to initiating PrEP pills. Among those that initiated PrEP only 8% (N=125) had at least 1 record of follow-up post initiation. Factors that remained significantly associated with PrEP initiation in the multivariable analysis were had STI in the last 6 months (RR:2, CI: 1.5-2.8, p<0.001); currently on STI treatment (RR:1.6, CI: 1.2-2.3, p=0.004); used condom at last sexual encounter (RR:1.8, CI: 1.2-2.8, p=0.007). For our secondary outcome of interest PrEP continuation, factors associated with continued use of PrEP in our univariable analysis were age category 19-24 (RR:0.7, CI:0.5-1.0, p=0.036); used condom at last sex (RR: 1.7, CI:0.9-3.2, p=0.092). However, none of these factors remained statistically significant predictors of PrEP continuation in the multivariable model. Conclusion This study had moderate uptake of PrEP and poorer continuation than other studies. It is possible that lockdown restrictions implemented to curb the transmission of COVID-19 at the time of the study may have hampered the success of the PrEP intervention for AGYW enrolled in the HIV combination prevention program. This finding calls for more innovative PrEP service delivery models for programs and interventions in real clinic settings to ensure AGYW have uninterrupted access to PrEP when access to clinics is restricted. Our findings demonstrate important differences between PrEP uptake and key sexual and HIV risk behaviours. Our unadjusted analysis showed positive associations between PrEP uptake and the use of condoms at last sexual encounter, current STI diagnosis and STI diagnosis in the last 6 months, pregnancy, HIV discordant relationships, and having heterosexual anal sex. We continued to observe positive associations between the PrEP uptake and the use of condoms at last sexual encounter, current STI diagnosis and STI diagnosis in the last 6 months in our adjusted analysis. Condom use at last sexual encounter was common among PrEP initiates, and many AGYW currently taking STI treatment and those who had an STI in the last 6 months also elected to use PrEP pills. Our findings indicate programs offering PrEP should also integrate STI services with appropriate testing approaches and targeted vaccination for AGYW.
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    Knowledge, attitudes, and referral practices regarding animal bites and prevention of human rabies among traditional health practitioners in Ethekwini district in Kwazulu-Natal province, South Africa, 2022
    (2024) Mabona, Maxwell Musa
    Background: Despite the availability of effective post-exposure prophylaxis (PEP), South Africa records about 10 human rabies deaths each year. Many animal bite victims initially seek help from Traditional Health Practitioners (THPs) before considering conventional healthcare facilities. Prompt referral of animal bite victims for PEP initiation by THPs can be lifesaving. Our study aimed to assess the knowledge, attitudes, and referral practices regarding human rabies and the associated factors among THPs in eThekwini District, KwaZulu-Natal. Methods: We conducted a cross-sectional study among registered THPs consulting patients in the eThekwini District. We used a structured standardized questionnaire to collect data. The questionnaire was administered through physical and telephonic interviews. We described socio-demographic characteristics using summary statistics. Multivariable logistic regression was used to analyze factors associated with knowledge, attitudes, and referral practices of human rabies. Odds ratios (OR) were used with a 95% confidence interval, and a probability (p)-value of ≤0.05 was considered statistically significant. Results: We interviewed 204 THPs, and 74% (150/204) were female. The median age was 43 years (inter-quartile range: 22-75 years) and 31% (64/204) had over 10 years of experience. The majority of THPs had inadequate knowledge (80%, 163/204), and poor referral practices (73%, 149/204). However, 91% (186/204) had positive attitudes toward human rabies prevention. Having more experience was associated with adequate knowledge (p<0.01), and positive attitudes (p=0.02). THPs who had adequate knowledge (aOR:2.30 95% CI: 1.12-4.75) and positive attitudes (aOR:1.21 95% CI: 0.37-3.89), had higher odds of having good referral practices. Conclusion: Despite THPs in eThekwini District having positive attitudes towards rabies prevention, gaps exist in their knowledge and referral practices. The study highlights that improving their knowledge and attitudes might lead to better referral practices of animal bite victims for PEP initiation. A multidisciplinary approach that includes THPs is recommended to decrease human rabies deaths in eThekwini District.
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    Revalence and factors associated with virological nonsuppression amongst HIV positive pregnant and lactating adult women in the Kingdom of Eswatini in 2016-2017
    (2024) Ndlangamandla, Mpumelelo
    Antiretroviral treatment (ART) is the primary intervention for preventing mother to child transmission of HIV service package. The likelihood of vertical transmission of HIV can be drastically reduced by using ART. The World Health Organization (WHO) recommends ART initiation in pregnant and lactating women living with HIV regardless of WHO clinical staging and thereafter to continue combination Antiretroviral Therapy (cART) for life. There are some challenges in implementing the WHO recommendations in settings where many women cannot attend antenatal care services due to social or economic barriers or structural barriers and even fewer women attend postnatal care services. The objectives of this study are to determine the prevalence of virological non-suppression among pregnant and lactating women living with HIV, to quantify the association between self-reported ART use and virological non-suppression and determine socio-demographic, clinical and behavioural characteristics associated with virological non-suppression among pregnant and lactating women living with HIV. This is a cross-sectional study using secondary data from the Swaziland HIV Incidence Survey. The primary study was a population-based survey which was nationally representative, using a cross-sectional study design conducted in 2016-2017 in the Kingdom of Eswatini employing a two-stage stratified cluster sample design. This study sample included adult women living with HIV who were either pregnant or lactating at the time of the survey. Data analysis was conducted using Stata 17. The data analysis made use of sampling weights and clustering of individuals within each enumeration area using weighted clustered logistic regression survey analysis commands in Stata. A total of 195 adult women living with HIV were included in the survey with a median age of 28 years old. Among the women, 104 (54.4%) were either married or cohabiting with someone, and 151 (71.9%) were living in a rural setting. Only 77 (38.8%) had attained primary education as their highest level of education while 122 (63.8%) were lactating. A total of 120 (62%) reported being on ARVs and 158 (81.8%) being virally suppressed. The overall virological non-suppression prevalence of 36.8% was higher than the UNAIDS target of 10% by 2020 to speed up HIV elimination. In a multivariable analysis, two risk factors remained statistically significant. Women who were aged 17 to 24 years old were almost five times more likely to be virologically non-suppressed (aOR=4.7, 95% CI 1.8 - 11.8, p=0.001) while women who did not report ARV use during pregnancy were eight times more likely to have virological non- RESEARCH REPORT (COMH7060) 320775 IV suppression (aOR=8.1, 95% CI 3.0 - 21.8, p<0.001). Maternal age was dichotomised with the younger group compared to the older group (17-24 years, vs 25+ years). An additional analysis excluding self-reported ARV use at pregnancy found that virological non-suppression was associated with maternal age (OR=5.5, 95% CI 2.3 – 13.7, p<0.001) and number of sexual partners in the previous 12 months (OR=7.9, 95% CI 1.6 – 40.5, p=0.013). Maternal age was dichotomised with the younger group compared to the older group (17-24 years, vs 25+ years) The study found that virological non-suppression was associated with maternal age and ARV use at pregnancy. The additional analysis also found a strong association with maternal age and number of sexual partners the women reported having in the previoustwelve months. However, the primary study was not powered to detect differences in virological non-suppression among our population of interest. The sample size was also small, which limited the ability to investigate other possible risk factors. To help the country address the identified gaps, I would recommend the scale up of the DREAMS program and strict following of HIV guidelines to actively monitor viral load and ART uptake during pregnancy and lactation. In addition, messaging around avoidance of multiple sexual partners should be strengthened
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    The use of machine learning techniques in identifying gender differentials in COVID-19 hospitalizations, probabilities of hospitalization outcomes and hidden correlations with demographic and clinical factors
    (2024) Malaatjie, Meghan Abigail
    Background: Sex-differentiated data on hospitalisation frequency, case severity, pre-existing medical conditions, and mortality outcomes amongst Covid-19 hospitalised patients is needed but limited in Gauteng province, the epicentre of the Covid-19 pandemic in South Africa. This study aims to investigate whether Machine Learning techniques can provide insight into gender differentials in COVID-19 hospitalizations throughout the four waves of the pandemic, in the Gauteng province of South Africa. Method: A weak supervision learning algorithm was used to perform binary classification. The training of a DNN was performed on 14 features of patient characteristics (Demographic variables, presence of comorbidity, care received upon admission and setting of care), to separate the two classes of data sets: a) severe disease class (a proxy measure of higher severity, which included those who died during admission or were admitted into an intensive care (ICU) or high care unit (HCU)), and b) less severe disease class. Results: The number of Covid-19 hospitalisations was highest in wave 3 for both males and females, and higher in females than males across all 4 waves. The observed difference in COVID-19 hospitalization frequency between men and women was the highest in the 20 - 40-year age group with a ratio of 1:3. There was a higher frequency of COVID-19 hospitalization for hypertension, diabetes, and HIV frequencies across all age groups. Conclusion: This study demonstrated the utility of machine learning for analysing multidimensional sexdisaggregated data to provide accurate, real-time information for public health monitoring of sexdifferences in the Gauteng province.