3. Electronic Theses and Dissertations (ETDs) - All submissions
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Item Interaction between HIV/AIDS and infective endocarditis in Africa: a retrospective case report and literature review(2009-10-29T07:14:05Z) Mvungi, Robert SostenesIn Africa, infective endocarditis (IE) is still a disease of young adults with underlying rheumatic heart disease (RHD). As of 2006, almost two-thirds of all persons infected with human immunodeficiency virus (HIV) are living in sub-Saharan Africa. Southern Africa thus remains the epicentre of the global HIV epidemic. The HIV sero-prevalence data reported in Southern Africa are as high as 20% - 30% of the adult population aged between 15 and 49 years. In South Africa, the prevalence of HIV among adults aged 15 - 49 is 18.8%. Based on a simple extrapolation, there is a higher possibility of encountering a significant number of patients infected with HIV and underlying RHD with IE in Southern Africa than in any other part of the world. In Africa because both HIV and valvular heart disease are relatively common, the co-existence of the two conditions in individual patients is not rare. Despite the major advances in diagnosis and management of this classical disease, the overall mortality rates for both native-valve and prosthetic-valve endocarditis remain as high as 20 to 25 percent after 1 year and at 50% after 10 years. However, the mortality rate varies, depending on a number of factors, such as: • the causative microorganism • the presence of complications • the development of perivalvular extension or a myocardial abscess • neurological events • the existence of conditions such as congestive heart failure • renal failure • severe immunosuppression due to HIV infection in intravenous drug abusers • the use of combined medical therapy and surgical therapy in appropriate patients. vi The clinical outcome of infective endocarditis in HIV patients is poor, severe immunodeficiency in IVDAs with IE has been reported to be associated with poor outcome. However, such an association has never been documented in non-IVDAs, particularly in Africa, where the expected majority patients with HIV and IE are non- IVDAs. The clinical profile including bacteriology of infective endocarditis in HIV patients is different from HIV uninfected patients. The clinical impact of the HIV epidemic on infective endocarditis in Africa has not been elucidated in the world literature and there is, moreover, a paucity of literature describing this clinical entity of HIV and IE in Africa. Objective The objective of this study was to highlight the co-existence of infective endocarditis in HIV positive, non-intravenous drug abuse in South Africa and Africa by: reporting three cases admitted at the researcher’s institution within a period of two months; and undertaking a literature review. Methods This was a retrospective case report and literature review study of IE in HIV infected patients. Three HIV positive patients with IE and with or without underlying chronic rheumatic heart disease were reported. The patients were admitted at the researcher’s institution within a period of two months. All three patients did not report intravenous drug abuse. However, all patients died within a short period of admission to the hospital. The systematic review of cases published in the literature was delivered from MEDLINE SEARCH from January 1985 to December 2006. The following key words were used: Human Immunodeficiency Virus, Acquired Immunodeficiency Syndrome, Rheumatic Heart Disease, Infective Endocarditis, and Intravenous Drug Abusers and Non-Intravenous Drug Abusers. Most of the articles were identified in English; where articles were identified in Spanish and French, only abstracts were used. vii Literature emanating from Africa was emphasized. In addition, the references quoted in this study were reviewed for relevance on the topic. Results Three patients with definitive IE and infected with HIV were reported: one patient was without underlying chronic rheumatic valvular heart disease and two showed underlying chronic rheumatic valvular heart disease. There are few reported studies of IE not related to intravenous drug abuse in HIV infected patients in the literature, which is probably attributable to the reported low prevalence of IE in this sub-group of patients. Most of these published studies are limited to a series of case reports and very little data or reports originate from Africa. Conclusion The clinical pattern of IE in HIV positive patients who are not IVDAs is not well described in literature. However, in this anecdotal case report, the three patients studied retrospectively had a poor outcome. Based on this anecdotal report of three cases described, if an extrapolation was done from these numbers and a prospective analysis performed, we would observed a substantial number of non-IVDU cases with infective endocarditis and HIV/AIDS in Africa. The literature review in its current form may shed some light on HIV and IE in non-IVDU patients, but doesn’t specifically address the issue of the potential co-existence of HIV and IE in Africa. Given the high prevalence both HIV/AIDS and rheumatic valvular heart disease in Africa, in future, we are more likely to see a significant proportion of patients with IE and underlying rheumatic valvular heart disease who are coincidentally HIV infected. There is a useful need for prospective studies describing the prevalence and outcome and for subsequently defining the management of this condition in Africa.Item Mainstreaming HIV/AIDS in physiotherapy education and practice(2009-09-01T11:47:12Z) Myezwa, HellenThis thesis centres around the issues concerning HIV/AIDS and physiotherapy education, curriculum and practice. In particular, this thesis examines which HIV specific content should be included in a physiotherapy curriculum and ultimately presents a conceptual framework for HIV input into the curriculum. There is a vast body of literature available on HIV. For physiotherapists, however, apart from a brief review given by Nixon and Cott (2000) using the ICIDH, no comprehensive literature is available that places information on HIV into a framework that speaks to physiotherapists as part of the rehabilitation fraternity. The literature on impairments is descriptive and buried in the medical model as symptoms. Section one of the literature review placed the literature in such a framework and provided a comprehensive description using the ICF and related aspects that concern physiotherapists. The ICF captures all the elements of current rehabilitation theory and practice and the literature is presented in an ICF framework. In addition, important background information on prevalence, its determinants, treatment approaches and subsequent impacts were reviewed. As most of the literature available still remains in the medical model, the conditions that manifest and from which patients develop impairments, were reviewed. The effects of HIV on body systems are extensive and pervasive. In each body system HIV has direct effects on mature and maturing cells e.g. progenitor cells and mature muscle cells. In the musculoskeletal system HIV impacts on functional systems and organs resulting in pathophysiological changes that manifest as impairments such as muscle wasting. Conditions manifesting in all body systems were reviewed and outlined. Impairments such as pain, breathlessness and proximal muscle weakness were reported in the literature. In addition to impairments, analysis of the literature revealed studies that had found high levels of functional and activity limitations as well as impacts on Health-related Quality of Life in HIV. The literature also presents the current status of physiotherapy interventions. Many studies have reported that exercises are a safe and effective mode of intervention not-withstanding the limitations encountered. The second part of the literature review focussed on aspects concerned with curriculum. Previous studies have focused on establishing baseline knowledge, attitudes and practices (KAP) to HIV and the impact of training programmes on KAP. What the actual content was for health workers, in particular physiotherapists and the approach to incorporating HIV into curricula is a gap in the literature. To inform the overall aim, with context-appropriate HIV content, this study undertook a number of studies in order to obtain the necessary information on HIV, specific to physiotherapy. Therefore the overall approach was a mixed methods one employing both a quantitative and qualitative study mix. The first and second studies informed the clinical picture and were both cross-sectional and descriptive. In both studies descriptive statistics were used to analyse data, especially in determining the absence or presence of conditions. Study 1 sought to establish the level of referral to physiotherapy by retrospectively examining the patient records of patients admitted with HIVrelated conditions over a period of one year. Of the 732 patient records reviewed, 139 (19%) had diagnoses considered suitable for physiotherapy and 3% were referred to physiotherapy. Study 2 aimed to establish a relevant overview of the functional and participation limitations of people living with HIV. Two groups of patients were studied i.e. an in-patient group and an outpatient group. The out-patient group was from a well resourced mining out-patient setting. The ICF checklist was utilised to collect the data and statistical analysis was performed to indicate the presence or absence of impairments, activity limitations and participation restrictions. A logistic regression was done to determine the odds of activity, limitation or participation restriction given certain levels of domains. Both groups showed high levels of impairment. For the in-patient group loss of muscle power 75%(n=60) energy and drive 75%(n=60), disturbed sleep 71%(n=56), emotional problems 62%(49), mild-severe pain 80%(66), weight maintenance difficulties and diarrhoea were apparent. In the out-patient mining group memory problems, energy and drive functions 36%(n=18), sleep 24% (n=12) and emotional functions 28% (n=14), seeing 32% (n=17), hearing, vestibularproblems 28%(n=14) and pain 55%(n=28), blood pressure and respiratory problems 24%(n=12), weight maintenance 63%(n=32), sexual functions 22%(n=11) and reduced proximal muscular power 24%(n=12) were encountered. The in-patient group had high levels of activity limitations and participation restrictions, while the out-patient mining group did not. There was association between the different domains and in the in-patient group gender (p=0.02) and marital status (p=0.01) were likely to influence the activity and participation levels and the experience of the environment. The remaining three studies involved aspects related to informing the curriculum component of this thesis. Study 3 audited the universities’ curricular documents to establish what the current curriculum included. Seven of the eight universities that offer physiotherapy training were reviewed and their curricula were generally scanty on information regarding HIV/AIDS. When compared to the areas outlined as a result of the literature review, the study of the patients and focus groups with clinicians and academic staff, revealed some gaps, in particular; the types of conditionsand the influence of HIV on other body systems which are pertinent to the clinical reasoning process for the physiotherapist: The philosophy of care and approach to management and the physiotherapists’ role in HIV prevention, treatment and care were evident gaps. Study 4 sought to develop a framework of HIV content for a physiotherapy curriculum. This was done by integrating the results found so far and verifying and enriching this data by gaining clinicians’ and academics’ insights and perceptions around HIV, based on their clinical and educational experience. Focus group discussions were conducted and a qualitative approach was undertaken for data analysis. A framework for curricula content emerged from this exercise. In study 5 the framework of HIV content was used to develop a questionnaire that was sent out in the Delphi survey to academic staff with the aim to test the level of consensus. Eighty three components of the curriculum under four outcome areas (Appendix 7.2) were sent to 68 academic staff who were identified. Of the 68 academic staff, 58 were available and 47 responded and consented to participate. All but two topics obtained consensus set at 80% and the remaining two obtained consensus in the second round. The final chapter discusses the results of these studies and illustrates how these results on HIV affect and can be applied to the physiotherapy curriculum, when applied to the UNAIDS mainstreaming criteria. Applying the mainstreaming principles to the process of including HIV content into the curriculum, ensures that the process is not done in a piece meal fashion but encompasses all important facets which were identified. The programme, if systematically implemented, could result in a coordinated outcome accounting for all the important facets. A conceptual framework is drawn from the results of this thesis illustrating the three levels of curriculum taxonomy: At the micro level, through the body systems, the meso level through the role of physiotherapy, dealing with internal and external domains and teaching approaches. The macro level is accounted for by the facilitatory activities such as advocacy among clinicians and academics and forming strategic partnerships at all levels.Item Evaluation of a theatre performance for adolescents promoting safer sex behaviour using AIDS risk reduction theories.(2009-06-19T06:58:14Z) Scott, Michelle MoniqueThere are repeated calls in the literature for the implementation and evaluation of evidence based HIV prevention programmes. This study aimed to evaluate a life-skills theatre performance for adolescents promoting safer sex behaviour against aspects of an established AIDS risk reduction theory. The study used a quasi-experimental research design, and was operationalised through the use of a questionnaire measuring knowledge, attitudes and perceptions conducive to HIV/AIDS risk reduction. Bandura’s (1990) Social Cognitive Theory (SCT) provided a conceptual framework for the development of the instrument. A further aim of the study was to establish whether the instrument would yield a factor structure that could be linked to Social Cognitive Theory using a principal components factor analysis. A sample of 392 adolescent high school learners in Grades 10 and 11 at two high schools in Naledi, Soweto completed the evaluation instrument. A sample of 165 learners were exposed to the play prior to completion of the evaluation instrument. A sample of 227 learners completed the questionnaire before the play was scheduled to be performed and were thus considered a control group. The effects of exposure to the play, gender, age, grade and whether the learners reported that they were sexually active formed the independent variables in the analysis, which were examined for their influences on the theoretical constructs measured by the instrument through analysis of variance (ANOVA). The results indicated that learners at both schools had a reasonably high level of knowledge, attitudes and perceptions conducive to HIV/AIDS risk reduction. However, learners at the control school scored significantly higher on the factors tapped by the questionnaire than learners attending the school exposed to the play. Possible reasons for these differences are discussed in the report. The results also highlighted significant differences between Grade 11 and Grade 10 learners in knowledge, attitudes and perceptions conducive to HIV/AIDS risk reduction. The physical age of the learner did not appear to be as important as educational level and/or possible social peer group norms on responses to the instrument.Item Adolescent females, coercive practices and sexual choice in the era of HIV/AIDS(2009-05-29T10:03:35Z) Noorbhai, Najeebah YousufOne of the population groups most acutely infected and affected by HIV/AIDS are adolescent females. Coercive practices and gender inequalities have been cited as important determinants of women’s HIV risk. This research aims to explore adolescent girls’ understanding of their identity and heterosexual sexuality. In addition, this study intends to assess the implications that gendered powered relations held for understanding the risks and dilemmas that young women are confronted with in relation to HIV/AIDS contraction. This research presents the findings of a qualitative and quantitative study conducted using a self-constructed questionnaire that was administered to a purposive sample of adolescent girls aged 13-18. Content analysis is used to analyse the data, the aim being to extract themes as they emerged from the data. Some of the following themes were identified as significant in the girls’ responses: The physical changes that occur during adolescence were highlighted alongside the viewpoint that adolescence is a time of inconsistency and turmoil. Self-worth was closely linked and related to socially desirable characteristics, and in addition gendered behaviour was widely endorsed amongst these girls. Romantic relationships were an important component of these girls’ lives. However, many described their relationships as being less sexual and more emotional in nature. The awareness of sexual readiness and choice hold positive implications for HIV/AIDS. A common consensus existed regarding practicing safe sex and almost all respondents agreed that the onset of sexual intercourse should be postponed until the age of 18 years or older. It appeared that although adhering to feminine stereotyped behaviour could be protective in the sense that it may result in less risky sexual engagement, it however, was also apparent that it could render females less powerful within their heterosexual relationships, thereby increasing their vulnerability to HIV infection. Although only a small proportion of the respondents experienced being forced into a sexual encounter against their will, an underlying fear of sexual coercion or threat nevertheless, emerged. It is concluded that sex education should engage with gender-stereotyped behaviour especially during early and middle adolescence when identities are being formed and developed.Item Uptake of the prevention of mother-to-child-transmission programme at a primary care level in Sedibeng District(2009-04-29T09:54:51Z) Berthet, EmilieIntroduction: Prevention of mother-to-child-transmission of HIV is a priority public health problem in Africa as pregnant women and their children are the most vulnerable. In South Africa, a prevention of mother to child transmission of HIV (PMTCT) programme has been implemented in antenatal clinics to reduce paediatric HIV/AIDS. It is necessary to assess the uptake of this programme by pregnant women. Objectives The purpose of this study was to determine the uptake of the PMTCT programme in the antenatal clinics of Sedibeng district. Using data coming from all the antenatal clinics (ANC) at a primary health care levelin Sedibeng for 2005 and 2006, we determined the proportion of ANC attendees who accepted to be counselled, the proportion of these who accepted to be tested for HIV, the proportion of these who came back for results and the proportion who were HIV positive. Nevirapine (NVP)uptake was determined as well among HIV positive women and babies born to HIV positive women. Methods Data collection was by a record review of PMTCT records from all antenatal clinics in the district. To determine maternal uptake of PMTCT, data were extracted from antenatal clinics monthly collation sheets for 2005 and 2006. Nevirapine uptake for the babies born to HIV positive mothers was determined in one facility: data were v - collected in the midwife obstetric unit of the community health centre from both the Nevirapine register and the mothers’ delivery records. Results A total of 8010 women attended in Sedibeng antenatal clinics in 2005 and 10217 in 2006. In 2005 95 % of attendee women accepted to be counselled among whom 91% accepted to be tested for HIV. In 2006 93% women accepted to be counselled among whom 91% accepted to be tested. Almost all tested women came back for results: 99% came back for results in 2005 and 98% in 2006. The proportion of HIV positive women in the attendees population was 23% in 2005 and 24% in 2006. Nevirapine was dispensed to only 600 per 1000 HIV positive women in 2005 and 539 per 1000 HIV positive women in 2006. From June 2005 to May 2006 only 59% of babies born to an HIV positive mother received NVP. Discussion and conclusion The study showed a good uptake of voluntary counselling and HIV testing in Sedibeng district antenatal clinics. But a low proportion of HIV positive women and HIV-exposed babies received NVP. There was probably a loss of follow up of women between ANC visits and delivery. Nevirapine uptake must be improved in Sedibeng antenatal clinics and further investigations need to be done to understand the factors influencing uptake.Item Privacy, surveillance and HIV/AIDS in the workplace : a South African case study.(2009-03-19T08:05:37Z) Muskat-Gorska, ZuzannaThe study focus on socio-legal dimension of medical data surveillance in the workplace on the example of the South African workplace response to HIV/AIDS. The strating point is the problem of growing data gathering and monitoring as an institutional feature of the information/surveillance society. Studying the problem in the context of workplace aims at indicating possibilities for social partners to respond to the new developments in the area of workplace surveillance and HIV/AIDS management in particular. The empirical data has been drawn from document analysis and interviews with trade union and business representatives from South Africa, involved in developing workplace response to HIV/AIDS. Particularly, the study is interested in identifying ways in which trade unions can make personal data treatment a trade union issue.Item A critical inquiry into sexual networks in Marange District, a case study of Johane Marange Apostolic Church community in Marange, Zimbabwe.(2009-03-06T06:40:41Z) Mavunganidze, Talent CeliaThe study is an inquiry of sexual networks in the Johanne Marange apostolic community. The study is a conceptual shift in the study of HIV transmission, with focus moving beyond the individual and beyond the principles of desire, pleasure and procreation to a study of sexual networks which are social structures. The study identifies the type of sexual networks and further investigates the determinants of sexual networks in Marange community. Sexual networks are simply webs of sexual relations in a community or society and these webs of relations act as transmission highways for HIV. The study discusses all the complex interactions between the domain of society that is religion, culture, history and environment of the Marange community and uncovers how these aspects of society have influenced the shape and structure of sexual networks in the community. The study also emphasizes the importance of understanding sexual network structure as it influences the efficiency of HIV transmission and aims to contribute to a better understanding of sexual networks and HIV transmission.Item Institutionalised children's understanding of HIV/AIDS.(2009-03-05T08:43:00Z) Mahlobo, BongiweLimited research has been conducted on children’s understanding of HIV/AIDS despite its widespread practice in South Africa today. This study aimed to explore this area, specifically investigating institutionalised children’s understanding of HIV/AIDS Increased mortality rates have been seen as a result of the pandemic. In addition, children are seen as vulnerable to the impact of HIV/AIDS. While some children are directly affected by HIV/AIDS, having lost their parents to the epidemic, other children are infected with the virus. Taking this into account, it was deemed useful to explore how children have made sense of HIV/AIDS. The participants for the current study were between the ages of 8 and 14 years, and they were drawn from a children’s institution in a black community within South Africa. The participants engaged in story telling and drawing as means of communicating their understanding of HIV/AIDS. They participated in the following activities: Draw A Person (DAP), Kinetic Family Drawing (KFD), Draw a picture of a person infected with HIV/AIDS, Drawing a picture of HIV/AIDS, and completing Incomplete Sentences in relation to their understandings of HIV/AIDS. They also answered relevant questions in relation to all their drawings. Thematic content analysis was used to analyse data, together with methods adopted from a study conducted by Wiener and Figueroa (1998). It was found that children have a basic understanding of HIV/AIDS, based on information they obtained from their educators, guardians, peers, and the media. Prominent themes arising from the findings are as follows: the visibility of HIV infection, the impact of HIV on relationships, HIV changing lives, preoccupation with death and dying, confusion about HIV/AIDS, and HIV and Morality. Generally, respondents were found to have a negative perception of HIV/AIDS. It was also found that although respondents seem to have some understanding of HIV/AIDS regarding modes of transmission, and ways of preventing transmission, confusion about HIV/AIDS was dominant.Item Pills of wisdom: an investigation of pharmacist-patient interactions in a South African antiretroviral clinic(2009-02-19T12:11:43Z) Watermeyer, Jennifer MaryABSTRACT Successful communication with patients in a multicultural, multilinguistic environment is a challenge to health professionals, particularly in the context of HIV/Aids and antiretroviral (ARV) treatment. Although the introduction of ARVs has brought hope, high levels of adherence are required to ensure treatment success and numerous barriers to adherence exist. Pharmacists play an important role in encouraging adherence to ARV treatment regimens by providing education and counselling. However, previous research indicates that interactions are often dominated by the pharmacist. Also, verification of patients’ understanding of information is infrequent and that patients are often passive recipients of instructions. This study aims to identify and describe interactive processes in pharmacy interactions while considering the impact of the disease and macro context on communication. Twenty-six cross-cultural, cross-linguistic pharmacist-patient interactions from a South African HIV/Aids pharmacy are described. Data collection included video recordings, interviews with participants and ethnographic observations in the pharmacy. A hybrid analytical approach incorporated aspects of Conversation Analysis (CA) and Discourse Analysis (DA). The results of this study are particularly encouraging. They demonstrate that despite the presence of cultural, linguistic and other contextual barriers, pharmacist-patient interactions can be efficient. The use of facilitative verbal and non-verbal communication strategies ensures that dosage instructions are successfully communicated by the pharmacist to the patient. In line with prior research, collaboration is promoted when pharmacists create rapport and focus on the lifeworld of the patient. The study shows that intuition and sensitivity to atmosphere in interactions is essential for achieving concordance. The disease context of HIV/Aids has a profound influence on the pharmacistpatient interaction and this study demonstrates the significant impact of the macro ii context on micro aspects of communication. The evidence suggests that the nature of humanity and the daily interface between culture and language in South Africa enables pharmacists and patients to transcend some of the barriers to communication and collaboration that have been identified in previous studies. The findings imply that the diversity of South Africa provides both hope and a resource which can inform policy and future practice.Item An investigation and monitoring of the auditory status in a group of adults with AIDS receiving anti-retroviral and other therapies attending a provincial hospital HIV/AIDS clinic in Johannesburg, South Africa.(2009-01-30T11:52:40Z) Khoza, KatijahPurpose: The main objective of the current study was to investigate and monitor the auditory status in a group of adult patients with AIDS receiving antiretroviral therapy (ART) and other therapies in a hospital outpatient clinic in Gauteng, South Africa. Specific objectives included estimating the prevalence of hearing loss and the presence of other otologic effects over and above hearing impairment (tinnitus, aural fullness, disequilibrium, and so forth); assessing the type, degree and configuration of the hearing loss; exploring the type of hearing symptom onset; documenting case history data such as signs and symptoms of each participant and identifying any associations between obtained signs and symptoms and hearing loss; documenting the names of all medications used and their possible impact on hearing function (specifically ototoxicity monitoring of ART); and comparing the results of the experimental group to those of a control group.