Electronic Theses and Dissertations (Masters)

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    Understanding the requirements and barriers to providing Post-Trial Access (PTA): A review of continued access to effective medicine
    (University of the Witwatersrand, Johannesburg, 2024) Mthembu, Xoliswa
    Clinical trials are essential in establishing the safety and efficacy of investigational products and are a mandatory requirement for the registration of a new medicine. Additionally, clinical studies offer access to new therapies, innovative treatments or more effective treatments which may not be readily accessible to the general population. Clinical trial participants receive investigational medicine during the study conduct phase as a study benefit and as compensation for their voluntary participation. In resource-limited countries, this may be the only option available to access new and effective medicine. Therefore, continued treatment access becomes of greater value. However, providing PTA presents ethical considerations which need to be addressed. The provision of PTA to effective medicine can be viewed as an inducement to join a study and creates inequalities between diseased patients, as it excludes other diseased patients who did not participate in the study or patients who were excluded from participation in the study. However, prior to addressing these controversies, it is necessary to establish first whether clinical trial participants have a moral claim to PTA provision. This report seeks to establish the moral requirement for PTA provision to address the ethical issues around providing continued access to effective medicines outside clinical trial settings. The first two chapters will focus on discussing the evolution of clinical trials, highlighting the ethical issues surrounding continued access to effective investigational products. The principles of bioethics will be discussed in detail in Chapter 2 to draw out the moral claims which mandate the requirement to provide PTA to efficacious medical therapy offered during the study. In Chapter 3, I will argue for the moral requirement for providing PTA using the principles of bioethics as a framework. In Chapter 4, I will discuss the challenges and PTA solutions. In my conclusion, I will reiterate my support for the mandatory requirement and implementation of PTA until the Investigational Product is commercially available and accessible to all trial participants, emphasising the importance of this stance.
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    Factors associated with HIV knowledge among younger adolescents aged 12-14 years old in South Africa
    (University of the Witwatersrand, Johannesburg, 2024) Makgale. Tswelopele
    1.Background In 2019, there were 1.7 million adolescents aged 10-19 living with HIV globally, with 1.5 million in sub-Saharan Africa and 360,000 in South Africa. Early sexual debut, defined as having first intercourse at or before age 14, has significant consequences for adolescents worldwide. While sexual activity during adolescence is normal, early sexual debut is linked to risky behaviours. While efforts have been made to understand HIV/AIDS knowledge among older adolescents and young adults, research often neglects younger adolescents aged 12-14 years old. Poor HIV knowledge among this age group may increase transmission risk, delay diagnosis and treatment, and fuel stigma. It's crucial to focus on this age group to eradicate the disease, although research is limited due to the sensitive nature of discussing HIV/AIDS with younger adolescents. 2.Objective The two set objectives of this study were firstly, to examine levels of HIV knowledge among younger adolescents aged 12-14 years old in South Africa. Secondly, to identify the demographic, socioeconomic and subjective norm characteristics associated with HIV knowledge among younger adolescents aged 12-14 years old in South Africa. 3.Methodology This study utilised secondary data acquired from the fifth South African National HIV, Behaviour and Health Survey of 2017 – this was the latest survey available data was analysed using STATA version 14. The South Africa National HIV Prevalence, Incidence, Behaviour and Communication Survey (SABSSM) is a national population-based survey conducted for surveillance of the HIV epidemic in South Africa. The sample for the study was younger adolescents aged 12-14 years old. The weighted sample of 927 861 was selected and used for analyses. The dependent variable in this study was HIV knowledge, defined as having accurate knowledge of all HIV-related questions from the survey. Eight questions assessing HIV and AIDS knowledge, perceptions, and stigma were used. Adolescents were asked about the curability of AIDS, reducing HIV risk by having fewer sexual partners, whether a healthy- looking person can have HIV, mother-to-child transmission, risk reduction by monogamy with an uninfected partner, HIV transmission through shared food, condom use, and male circumcision reducing HIV risk. The original response options were 'yes', 'no', and 'don't know', with 'don't know' responses excluded to ensure that the data accurately reflected the participants knowledge on HIV and AIDS. The dependent variable had three categories: low HIV knowledge (1-3 out of the eight questions answered correctly), average HIV knowledge (4-5 out of the eight questions answered correctly), and comprehensive HIV knowledge (6-8 questions answered correctly). A Multinomial Logistic Regression model was employed to analyse HIV knowledge. The data analysis was done in three phases. The first phase included descriptive analyses of utilised in the study through a ranked frequency and percentage distribution table and sex ratio which was used to explore the HIV knowledge levels based on sex. The second stage included Pearson’s chi-square test which were to measure the associations between the demographic, socioeconomic and subjective norms. The third stage included an unadjusted (bivariate) and adjusted (multivariate) Multinomial Logistic Regression which was employed to examine the demographic, socioeconomic and subjective norms associated with HIV knowledge among younger adolescents aged 12-14 years old in South Africa. 4.Results Less than half of younger adolescents (47.0%) had comprehensive HIV knowledge. The relative risk ratio shown in the multivariate Multinomial Logistic Regression model showed that the respondent’s age, sex, race, place of residence, province, grade, orphanhood status and subjective norms are significant predictors of HIV knowledge among younger adolescents aged 12-14 years old in South Africa. These associations indicated that non-African female adolescents are less likely to possess HIV knowledge compared to Black male adolescents, but generally, female adolescents have a slightly higher relative risk of possessing comprehensive HIV knowledge compared to their male counterparts (1.01, P<0.05; CI=0.99-1.03). Adolescents residing in rural areas have higher relative risks of possessing average and comprehensive HIV knowledge compared to those in urban areas, with relative risks increasing by 1.52 (P<0.05; CI=1.48-1.52) and 2.18 (P<0.05; CI=2.13-2.24), respectively. Additionally, willingness to share food with someone who has HIV/AIDS shows no significant difference in the relative risk of having average or comprehensive HIV knowledge (RRR:0.641; P<0.05; CI=0.62-0.65), while willingness to play with someone who has HIV/AIDS decreases the relative risks of having average and comprehensive HIV knowledge by factors of 0.32 (P<0.05; CI=0.32-0.33) and 0.13 (P<0.05; CI=0.12-0.13), respectively. Furthermore, adolescents uncomfortable discussing HIV/AIDS with at least one family member have decreased relative risks of possessing average and comprehensive HIV knowledge by factors of 0.27 (P<0.05; CI=0.27-0.28) and 0.30 (P<0.05; CI=0.29-0.30), respectively. These results highlight the importance of demographic and social factors in understanding HIV knowledge among young adolescents in South Africa. 5.Conclusion Despite significant efforts by the South African government to integrate HIV education into the national school curriculum and collaborate with NGOs and civil society groups, adolescents aged 12-14 still lack comprehensive HIV knowledge. Understanding HIV early plays a vital role in reducing stigma and discrimination associated with HIV/AIDS, fostering a supportive and inclusive atmosphere. It also promotes critical thinking among adolescents, empowering them to question myths and misunderstandings about the disease, thereby encouraging healthier behaviours and attitudes. The hypothesis for this research was that there is no association between demographic, socioeconomic and subjective norm characteristics and HIV knowledge among younger adolescents in South Africa. The multinomial logistic regression showed significant results. Therefore, the null hypothesis was rejected. Post the completion of the National Youth HIV Prevention Strategy (2022-205), it will become mandatory for the government to evaluate and refine the policy framework to include those under 15 years. Including those aged 12-14 years old will be crucial for fostering a generation equipped to safeguard their sexual health and make informed choices, thereby perpetuating the efficacy and relevance of HIV prevention efforts within the broader national agenda
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    Male Circumcision and Multiple Sexual partners in South Africa
    (University of the Witwatersrand, Johannesburg, 2024) Mahlangu, Theophelus Sphesihle; Frade, S.
    Introduction: The high prevalence of Multiple Sexual Partners (MSP) and increasing rates of HIV infection in South Africa highlight the urgent need to delve into the factors influencing risky sexual behaviour. Despite efforts to promote safe sex practices, MSP remains a significant driver of the HIV epidemic in Sub-Saharan Africa, particularly in South Africa. This study focuses to investigate the association between MC and MSP among males aged 15 years and above in South Africa, elucidating a potential relationship between MC, risky sexual behavior (RSB), and HIV prevalence. Method: This quantitative study employed a cross-sectional design using data from the 2017 South African National HIV Prevalence, Incidence, Behaviour and Communication Survey. (SABSSM), with a weighted sample of 27,620,422 men in the male recode. Data analysis involved three phases: frequency and percentage distributions, Pearson’s chi-square test, and binary logistic regression. Results: The study revealed that 94.04 % of circumcised South African men reported having MSP, with higher rates in Mpumalanga (97.29%) and among white males (97.33%). MSP was associated with demographic factors like type of residence, educational background, race, paying for sex, and geographical location. Men not using condoms were also more likely to engage in MSP. However, the study did not find any significant association between male circumcision and multiple sexual partners. The study found that males who were circumcised were less likely to have multiple sexual partners compared to uncircumcised males. Specifically, the odds ratio for MSP was (AOR 0.82; p<;0.05; CI: 0.81–0.82) among circumcised males. Conclusion: The study emphasizes the importance of considering sociodemographic and behavioural factors in designing effective prevention programs targeting risky sexual behaviour in South Africa. Understanding the underlying factors driving men's engagement in multiple sexual partnerships is crucial for developing targeted interventions to address this behaviour. This study provides evidence that male circumcision does not adversely affect sexual function or lead to increased risky sexual behaviours, such as having multiple sexual partners. These findings have important implications for public health policies and individual decision-making regarding circumcision. Further research is needed to confirm these results and explore other potential factors that may influence sexual outcomes. Additionally, it is crucial to consider the individual's overall sexual health and behaviour to ensure that the benefits of circumcision are not outweighed by risky sexual practices. This is an important consideration in the context of HIV prevention and sexual health, as some studies have suggested that circumcision may lead to increased risky sexual behaviours. However, our findings suggest that circumcision alone does not necessarily influence the number of sexual partners a man has.
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    People’s Dignity is at stake: The Ambulance Availability Crisis in Lusikisiki, Ingquza Hill Local Municipality
    (University of the Witwatersrand, Johannesburg, 2024) Bolitina, Sinovuyo
    Access to healthcare is and remains a challenge globally. In South Africa, the limited ambulance availability crisis is an example of this. The people affected the most rely on public healthcare in remote and rural areas, such as the small town of Lusikisiki in the Eastern Cape Province. This study sought to investigate the research question, “How does the limited ambulance availability impact access to public healthcare for the people of Lusikisiki in the Ingquza Hill Local Municipality?”. I adopted a qualitative research approach and interviewed twenty participants identified through purposive and snowball sampling techniques. Limited ambulance availability inhibits the people of Lusikisiki from accessing healthcare. This crisis exists and impacts clusters of communities already facing socioeconomic, political, and geographical issues. These factors are at play and impact people’s day-to-day lives. Recommendations entail implementing more strategies and policies, looking at a more holistic approach, and examining this crisis from a social and health context perspective to overcome healthcare access barriers; thereby ensuring access and the health and well-being of everyone.
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    An analysis of the relationship between HIV-testing and cervical cancer screening uptake among females of reproductive age (15-49 years old) in South Africa
    (University of the Witwatersrand, Johannesburg, 2024) Madubye, Koketšo Tholo; Wet-Billings, Nicole De
    Background: Higher income countries (HIC) have threefold testing coverage over lower to middle income countries (LMIC). Cervical cancer is the 4th most prevalent cancer among females globally, and a key contributor to mortality in Southern Africa. In LMIC, including South Africa, only 9% of the eligible screening cohort had ever undergone cervical cancer screening. This study examined the gap in understanding the relationship between HIV testing behaviours and the uptake of cervical cancer screening. Methods: The study was conducted in South Africa, utilising the 2016 South African Demographic and Health Survey (SADHS), as a secondary data source. The sample size of this study was a weighted (n) distribution of 4,199 females. The study design is cross-sectional, the outcome variable of interest in this study was the uptake of cervical cancer screening and the predictor variable is HIV Testing. The data by SADHS (2016) was analysed through the three phases: univariate, bivariate and multivariate. At the bivariate level, contingency tables were employed, using the Pearson chi-square test of association which examined the strength of crude relationships between cervical cancer screening and the study of independent variables. In addition, a multivariate analysis through the employment of a binary logistic regression as the outcome of the study was categorised with ‘yes’ and ‘no’ binary responses. Results: The findings of this study indicated that 33% of females of reproductive age had ever undergone cervical cancer screening, while 62.5% responded affirmatively to having tested for HIV. Females who tested for HIV displayed a higher propensity to having undergone cervical cancer screening, 37.43% female respondents who tested for HIV had undergone screened for cervical cancer, as opposed to those who didn’t test, which only 10.19 % screened for cervical cancer. Conclusions: 37.43% female respondents who tested for HIV had undergone screened for cervical cancer. Among those who did not test for HIV, 10.19 % screened for cervical cancer. There is still much to be done to improve cervical cancer screening among females, while HIV testing remains high, cervical cancer screening is alarmingly low. The 2017 Cervical Cancer Prevention and Control Policy functions as a mediating apparatus, additional supplementations targeting females below the age of 30 remain a necessity
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    Exploring the involvement of HIV patients in person-centred care: The case of Nancholi Youth Organization (NAYO) in Blantyre, Malawi
    (University of the Witwatersrand, Johannesburg, 2024) Magola, Delipher; Dickinson, David; Lewins, Kezia
    This research report explored the involvement of HIV patients in person-centred care (PCC). PCC is the collaboration between healthcare providers, patients, and their support system to achieve the desired goals of quality treatment and care. PCC has been implemented in high- income countries where definitions, theories, and frameworks have been made. The literature review focuses on six major concepts namely PCC, expert patient, Greater Involvement of People with HIV/AIDS (GIPA), community-based care, patient support system, and stigma. PCC, expert patient and GIPA are core to understanding community-based initiatives and the need to implement PCC and community-based care. Community care, patient support systems and stigma drive person-centred care implementation, especially in low-income countries. The main research question was: What is the involvement of HIV patients in the Malawian Nancholi Youth Organization (NAYO) Programmes in Blantyre? In its methodological considerations, the study used the following research approaches: (1) A qualitative design to explore the involvement of HIV patients in NAYO Programmes; (2) A purposive sampling technique in the identification of seven respondents from NAYO staff and five community volunteers; (3) A stratified sampling technique in recruiting 11 HIV patients on the first line of HIV treatment; (4) Semi-structured interviews to gather information from NAYO staff members, HIV patients, and community volunteers; (5) Adopted the participant observation method in observing interactions between patients and healthcare providers; (6) Thematic analysis was adopted to draw themes based on research-specific questions and NAYO programmes. Findings reveal that NAYO uses a community-based approach for the implementation of its services and much of the involvement of patients is on a community level. NAYO Community volunteers facilitate and coordinate the collaboration between patients and healthcare providers. NAYO relies on community volunteers to implement its programmes. Finally, the research revealed that patients’ support system includes family relations, friends, church members and community leaders who provide psychosocial-moral support. Felt and enacted stigma are barriers to the implementation of community-centred care. Financing programmes and services is a major challenge for NAYO in the implementation of its activities.
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    The Relationship Between Sensory Disability Status and Contraceptive Use Among Women Aged 15- 49 Years Old In South Africa
    (University of the Witwatersrand, Johannesburg, 2024) Sifora, Kutlwano Katlego Kimberly; De Wet-Billings, Nicole
    Background: Studies suggest that disability significantly hinders access to reproductive health services, particularly family planning, in low- and middle-income countries. Women with disabilities have a low contraceptive use rate, leading to increased risks of unintended pregnancies and health complications. This study examined the relationship between sensory disability status and contraceptive use in South Africa. A sensory disability is a condition that affects one or more of the body's sensory functions like sight, hearing, touch, taste, or smell. In this study, sensory disabilities focused on hearing and visual impairments. Methods: The study employed a cross-sectional design using the 2016 South Africa Demographic and Health Survey. The study focused on women of reproductive age (15–49 years old) in South Africa, who were sexually active and provided information on both their contraceptive use and sensory disability status. The outcome variable of this study was contraceptive use, and the main independent variable was sensory disability status. The control variables included demographic characteristics namely age, race, marital status, province, and place of residence, as well as socioeconomic characteristics such as employment status, wealth status, education, family planning messages, and contraceptive knowledge. The analysis was conducted using Stata 17.0 on a weighted sample of 6 683 sexually active women aged 15–49 years old who answered questions on contraceptive use. The data analysis was done in three phases. For the first phase, cross-tabulations and chi-square analysis were used to demonstrate the levels of contraceptive use as well as all characteristics of women. For the second phase, bivariate binary logistic regression models were used to determine the relationship between each of the independent variables and the outcome variable of contraceptive use. Lastly, for the third phase, a stepwise multivariate binary logistic regression was utilised to determine the relationship between sensory disability status and contraceptive use among women aged 15– 49 years old in South Africa. Results: Among South African women of reproductive age, 55.4% were using contraceptives. Women with sensory disabilities were shown to have lower odds of using contraceptives than those without sensory disabilities, even after adjusting for all other variables [OR: 0.78, CI: 0.63873 - 0.95227]. Significant associations with contraceptive use were observed for factors xi including age, race, marital status, education and province. Compared to women aged 15–24, women aged 35–39 had a much lower likelihood of using contraceptives. [OR: 0.46, CI: 0.38150 - 0.55364]. Women from races other than black were also observed to have lower odds for contraceptive use compared to black women [OR: 0.75, CI: 0.61098 - 0.92237]. Conversely, married women were significantly more likely to use contraceptives than women who were never married [OR: 1.23, CI: 1.05328 - 1.42899]. Additionally, women with secondary [OR: 1.98, CI: 1.28089 - 3.07512] or higher education [OR: 2.40, CI: 1.49931 - 3.83750] exhibited a significantly higher likelihood of contraceptive usage compared to those lacking formal education. Women residing in Western Cape [OR: 1.83, CI: 1.29743 - 2.57637], Eastern Cape [OR: 1.66, CI: 1.27747 - 2.15886], Northern Cape [OR: 1.61, CI: 1.18574 - 2.19087], KwaZulu Natal [OR: 1.51, CI: 1.17797 - 1.92456], North West [OR: 1.43, CI: 1.01266 - 2.01228], and Mpumalanga [OR: 1.50, CI: .15808 - 1.93439] were found to have a higher likelihood of using contraceptives compared to women residing in Limpopo. Conclusions: Low contraceptive use among women with sensory disabilities in South Africa highlights the need for inclusive reproductive health services, addressing communication, information access, and societal attitudes to ensure informed decisions.
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    Association between perinatal behaviors and hypertensive disorders among pregnant and postpartum women in Southern Africa
    (University of the Witwatersrand, Johannesburg, 2024) Mhlanga, Lesley; Wet-Billings, Nicole De
    Background: Hypertensive Disorders of Pregnancy (HDP) are among the primary causes of maternal and newborn infant deaths and morbidity globally. It affects between 5 to 10% of pregnancies, and 14% of pregnant women worldwide die due to HDP related complications. There are several known HDP risk factors, both those that can be changed and those that cannot. However, there are conflicting reports on the impacts of dietary and behavioral habits on HDP. As a result, the role of perinatal behaviors on HDP outcomes remains unclear. Objective: This study aims to determine the prevalence of HDP and examine the association between perinatal behaviors and HDP among pregnant and postpartum women in three Southern African countries (South Africa, Namibia, and Lesotho). Methodology: This investigation employed a cross-sectional study design utilizing secondary data from the most recent population-based DHS programs for South Africa (2016), Lesotho (2014), and Namibia (2013). The study population comprised 1273 pregnant and postpartum women with complete blood pressure measurements. Chi-square statistical tests were conducted to describe the prevalence of HDP. Adjusted and unadjusted binary logistic regression analyses assessed the relationship between perinatal behaviors and HDP. Stata statistical software (v.14) was used for data management and analysis. Results: Of the 1273 participants enrolled in the study, about 221 (17.36%) HDP cases were identified, while the majority, 1052 (82.6%), had no HDP in all three Southern African countries. The prevalence of HDP was higher in Namibia (23.78%) and South Africa (23.75%) than Lesotho (11.54%). After accounting for confounders, only iron supplement intake, was confirmed to be a significant predictor of HDP. Iron supplement intake increased the odds of HDP by three fold among study participants (AOR: 2.99; CI: 2.00 to 3.72; p < 0.05). Conclusion This study concluded that of the five main predictor variables analyzed in this study, routine iron supplementation was the only significant predictor of HDP among pregnant and postpartum women in these three Southern African countries. HDP prevalence was notably higher in these three countries compared to global and regional estimates, with Namibia and South Africa showing higher rates than Lesotho, despite their upper middle-income status
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    Phenomena in the therapeutic setting when treating clients with gender-related Body dysphoria
    (University of the Witwatersrand, Johannesburg, 2023) Bain, Katherine
    This study explored psychotherapists’ experiences of somatic phenomena, in relation to their own bodies, when treating clients with significant gender-related body dysphoria within the treatment setting. It also examined their experiences and deeper understandings of somatic transference and countertransference within the analytic frame when working with this particular client profile. The various resistance mechanisms deployed by such clients were also explored as well as the ways in which psychotherapists may be resistant to working more closely with their own somatic countertransference. A qualitative approach to research was in order to generate meaning and understanding through rich material. An interpretivist paradigm was employed whose ontology examines the perceptions and experiences of therapists who have treated clients with significant gender-related body dysphoria. Therapists’ experiences of somatic countertransference phenomena were varied and inconsistent. More than half of the therapists reported the experiencing of sensations including nausea, headaches, restriction of the chest and experiences of drowsiness. Some therapists could not recall any experiences of somatic countertransference and demonstrated a tendency to minimize, deny or disavow somatic phenomena.
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    A study of the psychometric properties of the Personality and Values Questionnaire in a sample of the South African Population
    (University of the Witwatersrand, Johannesburg, 2024-03) Clack, Crystal; Laher, Sumaya
    Personality assessment plays a crucial role in various domains in South Africa. Both personality traits and values dimensions have been shown to be reliable predictors of performance and behaviour. Research on personality in South Africa is lacking, as is research on values. Assessment use in South Africa is governed by legislation, requiring evidence of reliability, validity, fairness, and a lack of bias. Most objective, self-report personality assessments are based on the Five Factor Model (FFM), which is widely accepted in personality as being universal. However, evidence on personality in South Africa suggests that there are additional elements to these factors. This study explored the applicability of the Personality and Values Questionnaire (PVQ) for use in the South African context. This was done by investigating internal consistency reliability, construct validity, and aspects of construct bias as they pertain to the potential for adverse impact. A non probability convenience sample of 288 participants completed the PVQ. The study took the form of a non-experimental, cross-sectional design. From the results, it was evident that the scales of the PVQ demonstrated adequate internal consistency reliability. In assessing construct validity, the five factor structure replicated similarly with regards to the Extraversion and Neuroticism domains, but the domains of Agreeableness, Openness, and Conscientiousness loaded differently to that proposed by the FFM and the test developers and more in line with other research on personality in South Africa. Evidence for construct bias was found. Women were likely to be more considerate of others, and concerned with how they appear to others. Black participants appeared more inclined towards harmony in interpersonal relationships and traditionalism. The differences for the language subgroups were small. The results suggest that the PVQ would have some suitability for use in South Africa depending on the context and sample. More research with larger and more diverse samples is needed.