3. Electronic Theses and Dissertations (ETDs) - All submissions

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    "Factors associated with HIV testing among residents of Johannesburg : does migration status matter?"
    (2014-01-15) Mkwanazi, Nobantu Urbania Ann
    Background: The HIV epidemic is a serious public health concern globally. There are 1,692,242 million known non-citizens in South Africa; this is equivalent to 3.3% of the total South African population (Statistics South Africa [STATS SA], 2011) this reflects global trends relating to number of non-citizens living in foreign countries (Vearey, 2008). Migration is an important demographic process to consider when studying HIV transmission as it increases migrants’ susceptibility to HIV (International Organisation for Migration [IOM], 2010). International migration, which is the movement of people across international borders, can result in migrants finding themselves in spaces of vulnerability which may lead to risky sexual behaviour (IOM, 2010). Furthermore, access to healthcare may be limited due to the dynamics of living in a foreign country. Internal migration, defined as the movement of people within the borders of a country (IOM, 2010) may result in ‘intra-urban’ inequalities that inhibit access to basic services such as housing and healthcare (Nunez et al, 2011). Despite it being the smallest province in the country, Gauteng has the highest level of in-migration, with an estimated net inflow of 367 100 internal migrants as for the period 2006–2011 (STATS SA, 2011). Globally, international migrants are more seriously considered as a concern for HIV transmission. However, in South Africa, internal migrants are equally as concerning particularly due to their circular migratory patterns. Knowledge of one’s status is a crucial first step in management of HIV. Voluntary HIV testing remains a challenging aspect of public health interventions, especially amongst key populations such as migrants (WHO, 2010). Although numerous studies have been conducted around migration and HIV, there remained a need for an investigation into the factors that influence HIV testing among Johannesburg residents. This is particularly significant, given the rapidly increasing levels of migration into the city, as well as the high urban HIV prevalence, which has been found to be twice high as that in rural areas and highest within urban informal settlements (Vearey, 2010). Therefore, this study set out to examine factors associated with HIV testing among residents of Johannesburg, in an attempt to determine whether migration status matters or not. Methods: This is a quantitative study with a sample size of 487 Johannesburg residents. International (n=150) and internal migrants (n=293) were examined in relation to each other and a comparative group of Johannesburg natives (n=44). STATA version 11 was utilised to conduct secondary data analysis of the RENEWAL survey (2008). This data, which was collected using a cross-sectional study design, was acquired from the African Centre for Migration and Society (ACMS) at the University of the Witwatersrand. Univariate descriptive analysis, bivariate chi-squared test and multivariate, logistic regression models were employed. Results: Levels of HIV testing were found to be higher amongst internal migrants (56%) when compared to international migrants (42%), (x2(1) =0.62; Pr=0.004). There was only a slight difference between Johannesburg natives and internal migrants who reported a 55% chance of HIV testing (x2(2) =8.32; Pr=0.016).These findings were only significant at the bivariate level. Overall, factors that were significantly associated with HIV testing amongst residents are: sex (95% CI 2.01 to 4.88; p=0.000); type of residence (95% CI 0.29 to 0.76; p=0.003); knows where to locate a testing facility (95% CI 1.41 to 3.50; p=0.001) and knows that anti-retroviral treatment (ART) is free (95% CI 1.93 to 4.83; p=0.000). Income was significantly associated with HIV testing amongst migrants (95% CI 0.40 to 0.90, p=0.016). Females were three times more likely (3.14) to test for HIV when compared to males. The odds of getting an HIV test by those who resided in informal settlements were less (0.48) when comparing with those who stay in formal housing. Residents who knew where to locate a HIV testing facility were twice (2.22) as likely to get tested for HIV as compared to those who did not know where to find one. Residents who knew that ART is free were three times as likely (3.05) to get tested for HIV as compared to those who did not. Those who were not earning a salary were less likely (0.61) to get tested for HIV compared to those who were earning a salary. Conclusion: The fact that migrant status, that is -internal versus international migration as a variable is not significant against HIV testing at the multivariate level indicates that there are far more important mediating factors that determine HIV testing than migration. More importantly, a more detailed and focused exploration into the length of stay of migrants in the city as well as the effect of urban inequalities on health, is needed.
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    The management of HIV positive patients using a CD8/38 flow cytometry assay as an alternative to viral load testing
    (2011-09-19) Moodley, Keshendree
    BACKGROUND: Human Immunodeficiency Virus (HIV) is a global epidemic with growing numbers of people on highly active anti‐retroviral therapy (HAART) programmes. Effectiveness of treatment needs to be monitored to ensure the uncompromised well being of patients. This is currently done using both Viral Load (VL) and CD4 cell counts for HAART initiation and follow‐up. Although VL is the best predictor of disease progression it is often too expensive for monitoring patients in resource‐limited settings. There is thus a need for a cheaper, more accessible alternative to monitor long term patient response to therapy. METHODS: This study evaluated the use of a recently described flow cytometric assay of CD38 expression (previously developed at the Johannesburg Flow Cytometry Reference Laboratory) in a cohort of HIV+ patients failing 1st line therapy, who were subsequently enrolled onto 2nd line HAART. CD38 and CD8 were “piggy ‐backed” onto the PLG/CD4 protocol and mean fluorescence intensity (MFI) of the CD8/38 expression was monitored longitudinally. Patterns of CD38 expression were compared to 1st line treatment observations to establish equivalence in the predictive power of CD38 expression of fluctuation in viral load on 2nd line treatment patients. In addition, the effect of sample age on assay accuracy was tested before implementation of the CD38 assay at a secondary testing site. RESULTS: The patterns observed in the cohort of 2nd line therapy patients mirrored patterns previously seen in 1st line therapy with 55% of patients showing a continuous decline in CD38 MFI that mimicked changes in VL. The remaining 33% of patients had non‐specific increases in CD38 MFI without concurrent increases in VL and one patient showed irregular VL and CD38 MFI (non‐responder). The CD38 assay showed acceptable accuracy and reproducibility up to 48 hours after venesection (%CV<5%). Implementation at the secondary testing site was successful with 98% similarity (%CV<5%) compared to the reference laboratory. CONCLUSION: CD38 monitoring of 2nd line therapy patients showed comparable patterns to observations in 1st line therapy patients. The assay proved stable over time and easy to implement at another PLG/CD4 testing facility. As such, the CD38 assay offers a cost‐effective, reliable real time supplementary test to long‐term VL monitoring of HIV infected patients on the national ART programme.
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    Workplace peer educators and HIV testing: understanding the challenges faced in a South African mining company
    (2011-08-04) Sibanda, Ochard
    South Africa has a high number of people living with HIV as UNAIDS (2009) projected the population of people living with HIV to be 5.7 million of which 20% of this population is said to be in employment. As a corrective measure, various strategies at national and company levels are being employed to get people to test for HIV. HIV testing helps people to know their status which is a gateway to informed prevention behavior and treatment. In workplaces, peer educators play an important role in getting workers to take up HIV test. As workplace peer educators mobilize workers to take up HIV test, they continue to face challenges. This precedes the broad objective of this study, which is to understand challenges faced by workplace peer educators in getting workers to take up HIV test. This report is a product of in-depth interviews, with fourteen peer educators, two wellness officers and the wellness coordinator. Participant observations and document analysis were also employed in gathering data. The data collection process extended from July to December 2010 in a mining company in the North West province in South Africa. Findings of the research revealled that despite the company’s HIV testing programme being a success as evidenced by a recorded cumulative annual uptake rate of 82% (2009), peer educators still face challenges emanating from environmental, programmatic and socio-interactional and perceptional factors. Environmental factors include skepticism based on precarious employment contracts while programmatic factors include certification of test results, speculation of test results based on time spent in the testing cubicle, consent procedures and incentivisation of testing. Lastly socio-interactional and perceptional factors that include stigma and discrimination, cultural beliefs, poor disclosure strategies, perceived racialisation of workplace testing centers and male workers relying on results from partner’s antenatal test were identified as another set of challenges faced by peer educators. The study suggests that in order to improve the HIV test uptake rate, in this context referring to the attainment of an absolute uptake rate, mitigation measure which include the use of trade unions in mobilizing workers for HIV testing, training on disclosure, re-negotiation and design of testing programmes and education must be considered. The adoption and administration of these measures into the case study company’s HIV test programme and other institutions facing the same challenges will help improve the HIV test uptake.
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    The Socio-demographic characteristics of employees who had HIV testing in 2005 within selected companies on the Direct AIDS Intervention Programme.
    (2009-05-06T09:45:04Z) Xulu, Thembisile Lynette
    Background and Objectives: South African businesses are feeling the brunt of HIV & AIDS and experiencing losses in productivity and profitability due to high levels employee absenteeism, sick leave and disability as well as the added costs of recruiting and retraining. These losses have had a negative impact on the national economy and in response some employers have agreed to recognize that HIV is a business issue and introduced HIV workplace programmes. It is not really known whether the employees that are most at risk are actually testing through these employer funded programmes in order for them as well as the employer to gain maximum benefit. There is a need to identify barriers to HIV testing so that workplace programmes can design better targeting strategies. Methods: This study was a retrospective review and analysis of the 2005 records of tested and untested employees in 8 companies registered on the Direct AIDS Intervention (DAI) Programme. Results: Overall there was very poor utilization of Voluntary Counselling and Testing (VCT) services with an average uptake of 13%. Multivariate logistic regression analyses showed that race, sex, period of employment and sector were significantly associated with HIV testing while there was no association with age and marital status. In general, Blacks were more likely to be tested for HIV (OR(95%CI)1.47(1.24 – 1.74);p<0.0001) and so were Coloureds (OR(95%CI) 1.79;(1.48 – 2.18); p<0.0001) and Indians(OR(95%CI)1.35(1.04 – 1.76);p=0.03) when compared to Whites. Males were less likely to have an HIV test (OR 0.69;p<0.0001) compared to female employees. Those who had been employed for more than one year were more likely to test (OR(95%CI); 1.83(1.37 – 2.43);p<0.0001) than newer employees. Employees who worked within a manufacturing company were more likely to have an HIV test (OR(95%CI) 2.39(1.96 – 2.92);p<0.0001) and so were those employed by a health/research companies (OR(95%CI) 2.83(2.11 – 3.81);p<0.0001) compared to those that were employed by a services sector company. Conclusions: The low uptake of VCT in this study is attributed to stigma which if not addressed will to continue to have a negative impact on the success of workplace programmes. Employers need to develop specific education activities in order to protect employees from discrimination and thus build confidence in the independence of the programmes thereby encouraging utilization.
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