Faculty of Health Sciences (ETDs)

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    A cross-sectional study investigating knowledge, attitudes and health choices in relation to diabetes mellitus among nondiabetic patients attending Chiawelo community practice, Soweto, Republic of South Africa
    (2024) Tshibeya, M. R.
    Background: The knowledge, attitudes and health choices of non-diabetic patients in resourcelimited settings to prevent the onset of diabetes mellitus (DM) are poorly understood. Aim: The aim of this study was to investigate and describe the knowledge, attitudes and health choices of non-diabetic patients in relation to DM at the Chiawelo Community Practice (CCP), Soweto, South Africa. Methods: In this cross-sectional study, a self-reported questionnaire was administered to 165 adult participants attending the CCP from 2nd March to 17th April 2020. Descriptive analysis, Chi square and univariate logistic regression were included in the analysis. Multivariate analysis was done for variables with a p-value <0.25 Results: In total, the study had 165 participants, of whom 112 (68%) were women, 35% were older than 45 years and 16% were younger than 25 years of age. Almost half (49%) of participants had good knowledge of DM, with 60% indicating good attitudes and 52% making good health choices to prevent DM. Participants who received education from clinicians were 4.31 times more likely to develop better attitudes (p=0,003) and 3.34 times more likely to adopt better health choices (p=0.004) towards DM compared to those who obtained information from media or other sources. Conclusion: The study found that poor knowledge of DM does not necessarily translate into poor attitude towards the disease, which is noteworthy. The study also highlighted the important role of healthcare workers in influencing behaviour change
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    Modelling space and time patterns of HIV interventions on HIV burden in a high priority district in South Africa
    (2024) Otwombe, Lucy Chimoyi
    Background: Ekurhuleni Metropolitan Municipality (EMM) collects monthly data from primary healthcare facilities on the HIV programmes to inform its HIV response. To study patterns of HIV burden and uptake of HIV services at a population level, the application of small area analysis offered a powerful epidemiological approach while investigating on a geographical scale, the risk, and confounding factors of certain health outcomes. This PhD thesis was aimed at highlighting and understanding the heterogeneity of HIV prevalence and selected HIV outcomes at a ward-level between 2012 and 2016. Materials and Methods: Materials and Methods: A mixed-methods approach using the HIV result chain logical framework was applied to several sources of data. Firstly, data from a National HIV Survey, the South African National Census analysed using Bayesian techniques in WINBUGS to provide an epidemiological profile of the risk factors for HIV prevalence, sub-optimal condom use and non-ART use. Secondly, a model of time and space using R-INLA applied to routinely collected HIV program data (clinical and laboratory) assessed the predictors of viral load suppression (VLS) [<1000 copies/mL (WHO) and <400 copies/mL (SA)]. Forecasting of VLS (five years post-2016) was conducted using ARIMA models. Lastly, a thematic analysis using the social cognitive theory framework on in-depth interviews with patients and healthcare staff was conducted to understand factors influencing uptake of selected HIV services in different geographical settings Results and findings: There were several clusters of high HIV infection, sub-optimal condom, non-ART use and VLS in EMM driven by different risk factors discussed in this PhD thesis. The proportion of VLS increased from 2012-2015 and decreased in 2016, and heterogeneity was observed at ward-level. As the female population and ART initiation rates increased at ward-level, VLS increased. However, this observed relationship was strong in some areas and weak in others. Lastly negative sequalae including stigma from healthcare workers and communities prevented optimum uptake of HIV services, particularly in women. Social support, availability of services and differentiated care encourage utilisation of HIV services. Conclusions: Findings highlighted the heterogenous nature of health events in EMM and are likely to inform targeted interventions to improve HIV programmes at ward-level towards achieving the 95-95-95 targets.