3. Electronic Theses and Dissertations (ETDs) - All submissions
Permanent URI for this communityhttps://wiredspace.wits.ac.za/handle/10539/45
For queries relating to content and technical issues, please contact IR specialists via this email address : openscholarship.library@wits.ac.za, Tel: 011 717 4652 or 011 717 1954
Browse
143 results
Search Results
Item Genotypic characterisation of South African human immunodefiency virus type l isolates(2003) Hunt, Gillian. M.This study was conducted to investigate the genetic diversity of human immunodeficiency virus type 1 in South African individuals. Blood was collected from 58 HIV-1 seropositive adult individuals during the period between 1996 and 1999 attending clinics across Johannesburg, South Africa. These samples were subtypedby heteroduplex mobility assay in the env and gag regions, and the sutype designations confirmed by sequencing and phylogenetic analysis.Item Investigation of the role of human parvovirus B19 in chronic anaemia of hiv infected TB patients(1994-09-30) van Niekerk, Albetus. Bernhardus. Willer.This study was undertaken to determine the role of human parvovirus B19 (B19) in chronic anaemia of HIV infected TB patients. Patients were selected from an existing databank of 307 patients included in a MRC HIV/TB study. Twenty-nine patients, 15 coinfected with HIV/TB and 14 infected with TB only, were identified for further evaluation. These patients’ sera were subjected to serological and DNA detection studies using IgG and IgM ELISA methods and a nested polymerase chain reaction (PCR) assay.Item An exploration of clinic based influences that support or hinder the retention of HIV positive clients in pre-art care at a clinic in Johannesburg, South Africa from January 2010 to July 2014(2017) Mushipe, ShelterBackground: Retaining people living with HIV in the continuum of care (CoC) is a major challenge internationally and in South Africa. However, health care providers can play a role in strengthening retention at different points in the continuum. Understanding the perceptions of health care providers regarding barriers to retention of HIV positive pre-antiretroviral therapy (pre-ART) clients can productively inform pre-ART patient retention programmes. Objective To explore health care worker perceptions on factors associated with retention of pre-ART clients at a clinic in the city of Johannesburg, South Africa. Methods: A cross sectional qualitative study was conducted using semi structured interview guides with a total of 11 health care providers who were comprised of the facility manager, six professional nurses and four lay counsellors in the ART programme. The respondents were purposively sampled. One-on-one interviews were conducted and audio recorded. Field notes were collected during the interviews and the recordings were transcribed after the interviews. Thematic content analysis was conducted using MaxQDA software. Results: The major finding of the research was that there is a lack of understanding of the scope and extent of pre-ART care and not all health care providers seem to get adequate preparation for tracing potential LTFU clients or retaining them in care. Informants in the study indicated as particularly problematic the late return for care by pre-ART clients, which usually occurs when clients are already very sick. Other factors that were identified as challenges include fear of disclosure, shortage of designated health care professional for pre-ART clients, lack of work space in the clinic, inadequate record keeping of patient information, concerns of disclosure and negative attitudes from staff. Clients not returning for their CD4 results, in part due to nonavailability of the results or infrequent health care visits, also led to a loss of care even before eligibility for pre-ART or ART could be determined. Conclusions: This study highlights some of the causes of non-engagement or loss to follow up (LTFU) in the HIV CoC among pre-ART individuals based on the health providers’ perceptions. The research thus provides an impetus for future research involving both health care providers and the pre-ART individuals to explore best practices that will enhance retention of pre-ART individuals in the continuum of care to attain optimal public health services.Item The development of a visual-motor treatment programme for pre-school HIV-infected children with visual motor integration difficulties(2017) Odejayi, RamonaThe purpose of this study is to add to current research on the impact of HIV on neurodevelopment in children and the nature of neurodevelopmental intervention needed to address the delay. The first phase of the study addressed the extent of visual motor integration delay in preschool children living with HIV. In the second phase of this study a visual motor treatment programme to address the delay specific to preschool children with HIV was proposed. Seventy-one children attending an HIV clinic were assessed to determine the extent of their visual motor integration delay on the Beery Developmental Test of Visual Motor Integration and the supplemental tests. The children’s socioeconomic status was determined based on the Household Economic and Social Status Index II. The results revealed that visual perception was the most affected component with a moderate positive correlation to the CD4 count and CD4% of the sample. The middle to low socioeconomic status of the sample had a mediating effect on the results particularly with visual motor integration in relation to the mothers’ level of education and attendance at creche. Therefore the proposed visual motor treatment programme had a large emphasis on visual perception using visual information analysis as a means of acquiring skill. The treatment programme emphasised naming and drawing five basic shapes. Due to the scholastic nature of this intervention, the programme was developed to be used in a preschool setting, with the preschool teacher acting as a mediator to ensure skill development and generalisation of concepts learnt to everyday living. Expert review determined content validity which assisted in developing the first draft of the programme known as the ‘My Shapes Programme’.Item Religious coping mechanism in reducing depression in PLWHA: comparison of generalized structural equation modelling and logistic regression modellin(2017) Chidumwa, GloryBackground People living with HIV/AIDS (PLWHA) are at higher risk of depression compared to HIV uninfected individuals. In addition to pharmacological treatments for depression among PLWHA, psychosocial interventions may facilitate coping with depression. Religious coping is one example of a psychosocial intervention that may help PLWHA confront both health problems and life stressors. The association between religious coping and depression among PLWHA has been examined in higher income countries using regression analyses. To my knowledge, few studies have been conducted on the African continent examining the relationship between religious coping and depression in PLWHA. Further, no study has utilized the generalized structural equation modelling (GSEM) technique to examine the above relationship. Yet literature suggests that this technique is useful in its potential to explore potential mediators and latent confounders as well to quantify each of the factors’ contribution to the covariance structure. This study contributes to the biostatistics literature and aims at addressing this gap. The study compares the GSEM approach to that of the logistic regression approach in exploring the relationship between religious coping and depression. Methods and material A secondary data analysis of a longitudinal study carried out at two specialized HIV clinics in Uganda was conducted. Data from the two sites were combined for analysis. To assess the factors associated with major depressive disorder, multivariable logistic regression and GSEM were utilized in Stata/IC version 14.1. Results Results of the logistic regression procedures suggested that stigma score (aOR = 1.08 95% CI (1.03-1.14) P = 0.002), childhood traumatic experience (aOR = 1.02 95% CI (1.00-1.05) P = 0.017), study site (aOR = 2.17 95% CI (1.48-4.98) P = 0.001), negative life events (aOR = 1.12 95% CI (0.99-1.28) P = 0.083), resilience score (aOR = 0.97 95% CI (0.95-0.99) P = 0.001), coping score (aOR = 1.04 95% CI (1.01-1.08) P = 0.003) and education (aOR = 0.69 95% CI (0.47-1.01) P = 0.054) were significantly associated with depression. However, when controlling for potential confounding factors, no significant association was found between depression and negative and positive religious coping among PLWHA (aOR = 1.12 95% CI (0.91-1.36) P = 0.282 and aOR = 1.01 95% CI (0.92-1.11) P = 0.784, respectively).On the other hand, results from fitting GSEMs showed that stigma score (aOR = 1.15 95% CI (1.10-1.20) P <0.001), childhood trauma score (aOR= 7.87 CI (3.88-15.95) P <0.001), study site, marital status, negative life events, social support score (aOR = 0.32 95% CI (0.21-0.48) P <0.001) and socio-economic status (aOR = 0.72 95% CI (0.50-1.04) P = 0.079) were significant in predicting depression. In addition, there was some evidence that negative religious coping was associated with depression among PLWHA (aOR = 1.18 95% CI (0.99-1.40) P = 0.061). Both modelling procedures thus suggest that stigma score, childhood trauma score, study site and negative life events were predictive of depression. Discussion and conclusion On comparing GSEM and logistic regression, the results obtained in this study suggest that the approaches differ only slightly. The GSEM approach found that negative religious coping was marginally significantly associated with depression. These findings, however, do not suggest superiority of either technique, but instead suggest that researchers should consider utilizing GSEM in analyzing mental health data. While some of the factors associated with depression differed between the two techniques both approaches suggested consistently that stigma score, childhood trauma score, study site, marital status and negative life events are associated with depression.Item Detecting HIV associated neurocognitive disorders (HAND) using neurocognitive assessment test in Uganda(2017) Masilela, LeeAnneBackground: HIV associated neurocognitive disorders (HAND), are a well-established consequence of HIV infection yet there is a lack of normative data required for diagnosis in Sub-Saharan Africa. Screening tools such as the International HIV dementia scale (IHDS) that are routinely used in the Sub-Saharan African region have questionable validity. This study investigates the use of the neuropsychological test battery in the detection of HAND in the absence of normative data. Further, the construct validity of the IHDS in the detection of HAND in the Ugandan context is examined. Methods Secondary data from a longitudinal Mental Health study carried out in Uganda were analysed. Information from a total of 1121 patients who underwent neuropsychological assessment in the main study qualified for the present study. A descriptive analysis of the neuropsychological performance of the study participants was conducted. To assess the relationship between demographic factors and the neurocognitive test scores of the neuropsychological test battery, multiple linear regression models were fitted. To determine how well the neuropsychological test battery predicted the IHDS score, a receiver-operating curve (ROC) analysis was conducted. The construct validity of the IHDS in detecting HAND in the Ugandan population was then assessed using ROC analysis and published normative data. Results The total study population was 1,121 participants, with the majority being female (66.3%) while almost 62% had only primary school education. The mean age of the study participants was 35.0±9.3 years. Using the IHDS, 73.3% of the HIV infected patients were identified to be at risk of developing HIV associated dementia (HAD). Using the Frascati criteria and published normative data, only 9.1% of the HIV infected patients had HAND. Ageing, being female, having a lower socio-economic score and having lower levels of education were identified as predictors for poor neurocognitive performance. Poor performance in the neurocognitive measures to assess gross and fine motor function was directly proportional to poor performance in the IHDS (score ≥10 points). Better performance in the neurocognitive measures to assess verbal leaning/working memory and attention/working memory was directly proportional to poor performance in the IHDS (score ≥10 points). The neurocognitive tests discriminated modestly between patients at risk of developing HAD and those that were not at risk of developing HAD (sensitivity=64.62%; specificity=66.67%). At the recommended cut-off score of 10 points, the IHDS had poor ability to identify patients with HAND (sensitivity=34.54%) and a high ability to identify patients without HAND (specificity=90.74%). At a cut-off point of 7 points, the IHDS discriminated modestly between patients with HAND and those without (sensitivity=65.66%; specificity=58.52%). Conclusion The neuropsychological test battery used in the present study discriminated modestly among HIV patients at risk of developing HIV associated dementia and those that were not at risk of developing dementia. In the Ugandan population, the construct validity of the IHDS in the diagnosis of HAND was poor. Further work is required to produce an algorithm to detect HAND in the absence of normative data. This includes an inclusion of important clinical biomarkers, exploration of further demographic confounders as well strengthening of the HAND diagnostic criteria using the neuropsychological test battery.Item Retrospective outcomes and cost analysis of antimalarial treatment in HIV-infected patients in a tertiary hospital setting in Soweto, South Africa(2017) Dandare, Murtala MuhammadMalaria is the most lethal parasitic infection globally, with a high mortality rate in sub-Saharan Africa. Imported malaria continues to cause life-threatening illness among non-immune antimalarial treatment and outcomes and performed a costs analysis among HIV-infected patients with malaria at Chris Hani Baragwanath Academi. [Abbreviated Abstract. Open document to view full version]Item Postnatal experiences, perceptions and practices of the Prevention of Mother to Child Transmission of HIV Programme among women enrolled at a Johannesburg Community Health Centre, South Africa(2017) Ngyende, BenonIntroduction: South Africa has made great strides to reduce the national rate of mother to child transmission of HIV (MTCT) since the implementation of Prevention of Mother to Child transmission (PMTCT) programme in 2002. However, the programme still faces a number of challenges including the increasing rate of post-natal MTCT. Although many studies have been done on PMTCT in South Africa, there is a scarcity of information on postnatal PMTCT. In particular, there is a dearth of information regarding postnatal experiences, perceptions and, practices among women attending postnatal PMTCT services. Similarly, there is a paucity of data on enablers and barriers to postnatal PMTCT from the users’ perspective. The aim of the study was to explore the postnatal PMTCT experiences, perceptions and practices among women enrolled on the programme as well as to identify the key reported enablers and barriers to their attendance of the programme at a Johannesburg community health centre (CHC), during April-May, 2016. Methodology: Fifteen women enrolled on a PMTCT programme at the CHC participated in the study. A purposive sampling strategy was used to recruit women who have been enrolled on the postnatal PMTCT programme for at least a period of six weeks. A qualitative research design was employed and data were collected through in-depth individual interviews using a standard interview guide. The data was analysed thematically to understand women’s experiences, perceptions and practices in the postnatal PMTCT services. Using both deductive and inductive analysis, various themes emerged from the voices of the women themselves. The analysis of results was guided by the conceptual framing of the study, which drew on Ferguson’s (2013) literature review of women’s experiences in PMTCT services. This literature review presents PMTCT experiences as comprised health services, individual and societal levels. Health services include counselling, confidentiality and health facility factors, individual level includes attitude and beliefs, perception of need and competing obligations while the societal level comprises stigma, gender and legal and policy environment. Results: With respect to postnatal PMTCT women’s experiences, the study identified confidentiality and health facility factors (availability of drugs and easy access to CHC) as key enablers to the postnatal PMTCT services. However, inadequate postnatal PMTCT counselling, sub-optimal health worker-client interactions (uncaring, rude, judgemental, disrespectful and discriminatory attitudes) and health facility factors (long waiting times, queuing at different departments within the CHC and shortage of the postnatal PMTCT staff) were identified as key barriers to these services. The study identified adequate knowledge on the postnatal PMTCT as enabler, while competing obligations and ART side effects were identified as key barriers to the postnatal PMTCT from individual-level perspective. Furthermore, stigma was identified as the key barrier to the postnatal PMTCT from societal-level perspective. With regard to postnatal PMTCT women’s perceptions, the perceived importance of postnatal PMTCT counselling, the effectiveness of the postnatal PMTCT programme and the convenience as well as cost-effectiveness of exclusive breastfeeding were identified as enablers to postnatal PMTCT. However, negative perceptions of adherence to ART and exclusive breastfeeding were identified as barriers to the postnatal PMTCT from individual-level perspective. With respect to postnatal PMTCT women’s practices, compliance with the follow up clinic visits and adherence to ART were identified as enablers while inadequate practicing of exclusive breast feeding was identified as a barrier to the postnatal PMTCT from individual-level perspective. Conclusion: The South African PMTCT programme has made great progress to curb the rate of MTCT since its implementation. However, many challenges still remain including increasing MTCT among HIV exposed infants during the postnatal period. In order to meet the national goal to eliminate the postnatal MTCT, researchers, health policy makers, individual users and community need to be aware of postnatal PMTCT enablers and barriers at different levels: health services, individual and societal levels. Furthermore, it is critical to improve women participation and ensure optimal outcomes for women and their infants by strengthening the programme enablers as well as addressing the bottlenecks. Key words: Postnatal PMTCT, experiences, perceptions, practices, enablers, barriersItem The acute clinical presentation of older patients admitted to the medical wards of Chris Hani Baragwanath Academic Hospital(2017) Mohapi, Makgotso PatienceIn South Africa, very little is known regarding the spectrum of clinical illnesses for which older patients are admitted to hospital. Within this group who are admitted, even less is known of the burden of HIV disease. This study investigated the clinical indications for acute medical admission in adults over the age of 50 years at Chris Hani Baragwanath Academic Hospital. The study also determined the prevalence of HIV infection of those with HIV, their access and adherence to treatment. Methods: This was a prospective, observational study of patients over 50 years of age who were acutely admitted to the medical wards of Chris Hani Baragwanath Academic Hospital (CHBAH) between August 2014 to March 2015. Results: A total of 200 participants 50 years and older were enrolled, 34% HIV-positive, 37% HIV-negative and 29% whose HIV status was unknown. The HIV-positive group was younger (p <0.0001), had poorer access to pension funds (p<0.0001) and higher burdens of acute infectious illness when compared to their HIV-negative counterparts (p<0.0068). HIV-negative patients had higher rates of acute cardiovascular and haematological conditions (p<0.0001) and higher rates of chronic non-communicable disease (p<0.0004), predominantly diabetes mellitus (p<0.0095) and hypertension (p<0.0024). Conclusion: In older patients hospitalised for acute illness, both infectious and non-communicable disease play a significant role however, in those with HIV, the infectious burden of disease is more prominent while non-communicable chronic disease predominated in those without HIV.Item Deep vein thrombosis in the era of high HIV and TB prevalence: a prospective review of its diagnosis and treatment in a quaternary care centre(2017) Hodkinson, Katherine ElizabethBackground Venous thromboembolic disease (VTE) is a leading cause of morbidity and mortality worldwide. Human immunodeficiency virus (HIV) and tuberculosis (TB) infections have an aetiological association with VTE. Implementation of national HIV and TB programs in South Africa have changed the burden of these two conditions with resultant effects on VTE prevalence. Furthermore, with the increased use of direct oral anticoagulants (DOACs), baseline thrombosis data is needed in order to evaluate the impact of these new agents. Objectives To determine the real-life baseline VTE characteristics in a pre-DOAC era and to document the association of HIV and TB infections with VTE. Methods This is a single centre prospective cohort study performed in a quaternary care centre at the Charlotte Maxeke Johannesburg Academic Hospital (CMAJH), Gauteng, South Africa. Key inclusion criteria included a signed informed consent by adults (≥ 18 years) with a new episode of thrombosis. Procedures included physical examination, thrombosis risk factor assessment, duplex doppler examination, thrombotic screen tests, inpatient treatment and outpatient followup. Results Ninety-nine participants with confirmed thrombosis met the inclusion criteria. Participants were predominantly black (80%) and female (65%) with a median age of 46 (38-57) years. The HIV and TB prevalence were 53% and 21% respectively. The most common thrombosis risk factors were TB infection (17%) and malignancies (14%). The thrombotic screen assays had a low diagnostic yield. The median time to target international normalized ratio (INR) during hospitalization was 5.5 (4.0-7.0) days and the median duration of hospitalization was 9 (7-11) days. The overall mortality in the cohort at three months post hospitalization was 12%. Conclusion This prospective study provides real-life data of thrombosis diagnosis and management at a quaternary public healthcare facility. This data provides a valuable baseline against which the impact of new DOAC anticoagulants can be assessed.