4. Electronic Theses and Dissertations (ETDs) - Faculties submissions

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    An outcomes evaluation of the ‘differentiated care’ antiretroviral therapy delivery in South African urban township
    (University of the Witwatersrand, Johannesburg, 2022) Tebeila, Tebogo
    With the high prevalence and massive expansion of antiretroviral therapy (ART), alternative ART delivery models are needed in scaling up, delivering ART, and maintaining high-quality services to people living with HIV. Various differentiated care ART delivery models were implemented in health facilities across South Africa, notable results from the literature suggest that differentiated care ART delivery models were piloted and implemented at scale, nevertheless, there is little evidence on the scale-up of these models on patients’ outcomes in South African urban townships. Ultimately, the research seeks to assess the outcomes of the differentiated care ART delivery models in a South African urban township called Tembisa in the Ekurhuleni Metropolitan Municipality. The research is a quantitative, retrospective cohort analysis. Logistic regression and Chi- square tests were used to determine rates of retention and factors associated with loss to follow-up. Behavioural theories were used to interpret the research findings. The research findings revealed that rates of retention were at 91.8 per cent and loss to follow-up was at 8.2 per cent. Furthermore, health facility, age at enrollment and duration on ART were associated with the probability of being lost to follow-up, nonetheless, there was no difference in sex and no association with modality. The finding from the study confirms that alternative ART care models are important in scaling up and delivering ART within an urban township setting, although there was poor viral load specimen collection at the scheduled clinic appointment good rates of retention in care and viral load suppression were achieved. Overall, the implementation of the intervention in a similar setting should be customized to patients aged between 18-24 years or younger, and those with a duration on ART of fewer than 24 months at enrollment differentiated care ART delivery models to reduce the probability of being lost to follow up after enrollment
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    HIV/AIDS and Educational Attainment Among South African Children and Adolescents
    (University of the Witwatersrand, Johannesburg, 2023-06) Havley, Simon; Booysen, Frikkie
    This study examines the effects of HIV-infection, antiretroviral treatment exposure and viral load suppression on indicators of educational attainment among children and adolescents of school-going age in South Africa using data from a nationally representative survey and linked biomedical information. This study employs propensity score matching-based approaches to examine the effects of HIV-related indicators on educational attainment overall and within each gender. This study also uses decomposition analyses to examine the contribution of HIV- related indicators to gender gaps in educational attainment, and to identify factors contributing to differences in the impacts of HIV-related factors on educational attainment of females specifically. It is found that HIV-positive status has a significant impact on the likelihood of school attendance, absenteeism, and being old for one’s grade. This is the case for all children and adolescents of school-going age. These effects are statistically significant for girls but not for boys. The study also finds that HIV-related factors contribute to gender gaps in school attendance, and that these gaps are observed in all tiers of the HIV treatment cascade. These results indicate that HIV-related factors impact disproportionately and negatively on educational attainment for girls. Further research on the gendered nature of the impact of HIV on education in South Africa is encouraged, as is the design of health and education policies that specifically target improved education outcomes among HIV-positive girls.
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    Off-label evaluation of alternative specimen types: Cobas® plasma separation card for HIV viral load and dried blood spots for COVID-19 serology testing
    (2024) Mampa, Thabiso Mmammitsi
    Plasma is the preferred specimen for HIV viral load (VL) monitoring and COVID-19 serology testing but poses a challenge in resource-limited settings due to the need for venous blood, skilled phlebotomy, and cold storage for specimen integrity. In this study dried blood spots and novel plasma separation devices (PSC, HSSE, and VLPlasma) versus plasma were investigated as alternative specimen types. The plasma separation devices (PSD) were compared to DBS to determine if eliminating cellassociated nucleic acids could improve HIV VL performance. Paired PSD (n=72), DBS (n=72) and plasma (n=72) were prepared from HIV positive residual whole blood. Similarly, paired PSC, DBS (n=91) and plasma (n=91) were prepared from HIV positive prospective whole blood to assess PSC as an alternative specimen for use on the Abbott m2000. The eluates were processed on the GeneXpert (residual blood), Abbott m2000 (residual and prospective blood) and Roche cobas® 68/8800 (prospective blood). Using plasma as reference, residual blood: DBS outperformed PSC, HSSE and VLPlasma in terms of accuracy 91.8%, compared to 87.8%, 79.1% and 75%. Prospective blood: PSC had improved performance over DBS in terms of sensitivity (92.2% and 87.1%), specificity (65% and 61.9%), and accuracy (86.9% and 80.7%). Additionally, the performance of DBS was evaluated for COVID-19 serology testing in 45 PCR-confirmed, COVID-19 positive individuals by preparing laboratory paired DBS-plasma samples. DBS were eluted using two diluents followed by manual ELISA and results compared to reference plasma testing. DBS-PBS and DBS-manufacturer’s diluent showed the same accuracy (93.6%). Kappa values (0.817 and 0.845) and sensitivity (100% and 91.4%) were similar, but DBS-PBS showed low specificity (75%) compared to DBS-diluent (100%). Off-Label use of the cobas® PSC for HIV VL and DBS for COVID-19 serology testing provides expanded options for testing in resource-limited settings. Further evaluation on capillary blood and automated laboratory workflow optimisation would still be required prior to scaled implementation.
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    Perceptions of community care workers on their roles and responsibilities: Soshanguve, Pretoria
    (2020) Mawadzwa, Tronny
    Care workers play a pivotal role in the community affected by HIV/AIDS through regular home visits. The purpose of this research was to understand better the perceptions of care workers who provide services to HIV/AIDS home visits in the community of Soshanguve. The researcher used the qualitative research strategy because the study was concerned with collecting data about the care workers’ perceptions and opinions about the services offered to HIV/AIDS-affected individuals and their families. The researcher selected a phenomenology research design for this research to help understand the perceptions and experiences of care workers, and it allowed for an in-depth analysis of the information from a single group of care workers. The researcher used semi-structured interview guides to ask questions in a focus group set up and on individuals as Key Informants’ Interviews (KIIs). A sample of 9 care workers took part in the study, broken down into one focus group with 7 participants and 2 KIIs were conducted as well. The findings from the study indicate that care workers have fragmented roles and responsibilities that are always changing. The working conditions are not safe for their health and safety. Care workers reported that they are not recognized by higher superiors and are forced to work under harsh weather conditions with tight targets to accomplish every month. Findings indicate that care workers require adequate training and psychosocial support to help them cope with emotional stress. Lastly, the remuneration of care workers has to be revised as data collected showed that the stipend they receive does not sustain their basic living conditions. Care workers have a passion for assisting the government meet their sustainable development goals on HIV/AIDS. For care workers to effectively perform at work, roles and responsibilities have to be fixed, their working conditions improved, provide training and psychosocial support and revise their stipend.
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    Perceptions of community care workers on their roles and responsibilities: Soshanguve, Pretoria
    (2021) Mawadzwa, Tronny
    Care workers play a pivotal role in the community affected by HIV/AIDS through regular home visits. The purpose of this research was to understand better the perceptions of care workers who provide services to HIV/AIDS home visits in the community of Soshanguve. The researcher used research strategy because the study was concerned with collecting data about the care workers’ perceptions and opinions about the services offered to HIV/AIDS-affected individuals and their families. The researcher selected a phenomenology research design for this research to help understand the perceptions and experiences of care workers, and it allowed for an in-depth analysis of the information from a single group of care workers. The researcher used semi-structured interview guides to ask questions in a focus group set up and on individuals as Key Informants’ Interviews (KIIs). A sample of 9 care workers took part in the study, broken down into one focus group with 7 participants and 2 KIIs were conducted as well. The findings from the study indicate that care workers have fragmented roles and responsibilities that are always changing. The working conditions are not safe for their health and safety. Care workers reported that they recognized by higher superiors and are forced to work under harsh weather conditions with tight targets to accomplish every month. Findings indicate that care workers require adequate training and psychosocial support to help them cope with emotional stress. Lastly, the remuneration of care workers has to be revised as data collected showed that the stipend they receive does not sustain their basic living conditions. Care workers have a passion for assisting the government meet their sustainable development goals on HIV/AIDS. For care workers to effectively perform at work, roles and responsibilities have to be fixed, their working conditions improved, provide training and psychosocial support and revise their stipend