Faculty of Humanities (ETDs)

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    Developing a management framework for predicting adherence to HIV care and treatment in Eswatini
    (University of the Witwatersrand, Johannesburg, 2024) Mango, Thabiso; Kasese-Hara, Mambwe; Mulaudzi, Mamakiri
    The primary objective of this research was to develop a management framework for predicting adherence to HIV care and treatment in Eswatini. To achieve this goal, the study delved into the comprehension of adherence to HIV care and treatment among people living with HIV/AIDS (PLHIV); identified psychological factors influencing adherence to HIV care and treatment; evaluated Theory of Planned Behavior (TPB)- based indicators to assess their effectiveness in predicting adherence behaviour to HIV care and treatment before commencing antiretroviral therapy (ART); and validated the applicability of the TPB in predicting adherence to HIV care and treatment. The study employed a sequential exploratory mixed methods approach in its research methodology. An initial qualitative study was conducted to explore the adherence beliefs of newly diagnosed PLHIV towards HIV care and treatment. The process involved gathering qualitative data on the beliefs of 19 recently diagnosed HIV-positive patients from a local HIV Clinic in Manzini, Eswatini. A thematic analysis revealed 226 beliefs, which were then condensed into 45 themes to establish the final set of significant beliefs categorised under TPB precursors: behavioural outcomes, subjective standards, and perceived behavioural control. The results of this qualitative study played a crucial role when constructing the TPB questionnaire, as the data gathered from the study were used as variables in creating the questionnaire. The TPB questionnaire, derived from the qualitative research, was distributed to 152 participants as part of the main quantitative study. This investigation unveiled the complex interplay between individuals' perceptions of social norms, attitudes, and perceived behavioural control in shaping their adherence to HIV care and treatment. While the opinions of influential figures in participants' lives were significant, the study found that participants' personal beliefs and attitudes towards adherence had a more substantial influence. During a span of 12 months, the 152 participants were closely observed, and their adherence to HIV care and treatment was assessed at baseline and endline points to evaluate the predictive validity of the TPB measure. The analysis of the collected data revealed that, despite participants appearing to adhere to their medication regimen iv based on clinic visits and self-reported pill usage, their viral loads remained detectable. This study underscored the drawbacks of solely relying on self-reported data and emphasized the necessity of employing alternative approaches to accurately assess levels of adherence. The study revealed limitations in the application of the TPB in addressing adherence to HIV care and treatment in developing nations with socioeconomic challenges. The original TPB model mainly concentrates on predicting and explaining behavioural intentions but overlooks the objective evaluation of the observed behaviour. When assessing adherence to HIV treatment, it is crucial to analyse the effectiveness of the behaviour being observed to identify the elements that lead to good adherence. This research suggests expanding the existing TPB model to overcome its limitations by including factors other than observable behaviour. A conceptual management framework for HIV care and treatment based on the TPB was developed to overcome the shortcomings of the TPB in predicting adherence to HIV care and treatment in underdeveloped countries. Four crucial additions were incorporated: (1) an enhanced behavioural intention (2) developmental challenges driven by socio-economic factors (3) subjective confirmation regarding the behavioural action, and (4) behavioural validation of the behavioural action. In addition to various aspects, it recommended that the conceptual framework developed by this study to manage HIV/AIDS care and treatment based on the TPB should undergo a validation process before its implementation with the aim of validating its effectiveness.
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    Factors and Levels Associated with HIV Knowledge among Non- Heteronormative Youth in South Africa
    (University of the Witwatersrand, Johannesburg, 2024) Peter, Andrea Nathania; Wet- Billings,Nicole De
    Introduction Within the South African context, non-heteronormative individuals, those who do not relate to heterosexuality and mainly differ from heterosexual practices regarding their sexual orientation such as the Lesbian, Gay, Bisexual, Queer and other (LGBTQ+) communities, face great levels of social exclusion due to their sexual orientation. Much of the LGBTQ+ community remains hidden and in fear of the potentially harsh – and sometimes lethal – consequences that follow ‘coming out’. Furthermore, those who identify as non-heteronormative face several sexual and reproductive health challenges. Individuals in same-sex relationships find it difficult to access safe sex measures in health clinics. In many cases, non-heteronormative individuals are unaware of the needed measures to practice safe sex to avoid health detrimental implications such as HIV. Methodology This study aimed to determine the demographic, socioeconomic and sexual behaviour factors that are associated with HIV knowledge among non-heteronormative youth (15-34 years old) in South Africa. The study used data from the 2017 Fifth South African National, HIV, Behaviour and Health Survey (SABSSM). The survey interviewed people 15 years and older who reside in South Africa. The study focused on non-heteronormative youth (15-34 years old) with a weighted national sample size of 365,237 individuals who indicated they had been in a same-sex relationship. Various demographic, socioeconomic and risky sexual health behaviour factors were used as independent variables to test for any association with HIV knowledge, the dependent variable. To test for association chi-square, proportion calculations and a probit regression were used to assess the level of HIV knowledge among non-heteronormative youth and the level of association with the independent variables. Results More than 50% of non-heteronormative youth indicated high levels of HIV knowledge, with females aged 25-29 years old having the highest level of knowledge. When running the adjusted and unadjusted probit regression, the variables sex, marital status and multiple sexual partners were shown to influence HIV knowledge. With these factors indicating a relationship with HIV knowledge among non-heteronormative youth, there is an association with the demographic, socioeconomic and risky sexual behaviour factors with HIV knowledge. Conclusion Although an association was found between the variables and HIV knowledge among non- heteronormative youth, it did not provide indicate a full view of the various factors that could 9 influence HIV knowledge among non-heteronormative population in South Africa. This study contributed data and research regarding the non-heteronormative, which has limited information available. Results indicated that there are high levels of HIV knowledge among non-heteronormative youth but further insight is required to assess where this information is from and how accessible it i
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    Investigation of Middle Ear Function Through Wideband Absorbance Measure in Adults Living with Human Immunodeficiency Virus in Gauteng Province, South Africa
    (University of the Witwatersrand, Johannesburg, 2022-06) Sebothoma, Ben; Khoza-Shangase, Katjah
    Background: The association between the human immunodeficiency virus (HIV) and auditory pathologies, including middle ear pathologies, has been extensively researched. However, most of this research has documented the middle ear pathologies of people living with HIV using conventional tympanometry with single probe tone, which has been shown to have poor sensitivity and specificity. Consequently, middle ear function and pathologies of people living with HIV may not have been accurately represented. While wideband acoustic immittance (WAI) such as wideband reflectance or/and absorbance measures emerged as a potential measure that can accurately identify early signs of middle ear pathologies and provide an accurate picture of the middle ear function, little is known about middle ear function and pathologies of adults living with HIV using wideband acoustic immittance. The value of preventive audiology in this population that comprises a big component of South Africa’s quadruple burden of disease cannot be overemphasized. Purpose: The primary purpose of this study was to investigate middle ear function through WAI in adults living with HIV. Specific objectives included to: review evidence on trends of middle ear pathologies in adults living with HIV; determine current practices employed by South African audiologists in identifying middle ear pathologies; determine the usefulness of using tele-practice to identify middle ear pathologies in adults living with HIV; determine the usefulness of wideband absorbance measures in identifying middle ear pathologies in adults living with HIV; determine the sensitivity, specificity, and characteristics of wideband absorbance measures in adults with and without HIV; determine the combined effects of HIV and comorbidities on hearing function; and explore risk factors that influence the development of middle ear pathologies in adults living with HIV. Participants: A non-probability purposive sampling was used to recruit and select participants. South African adults aged 18 years and above who were diagnosed and living with HIV in the Gauteng Province and attending an HIV clinic, as well as adults who are HIV negative as a control group were recruited and included in the study. Design: While the general methodology for this research comprised of a quantitative, cross-sectional design, each research article that forms part of this study has its own specific research design and methodology, and this is presented in each article. Data analysis: Data were analysed using the STATA version 1.5. For each paper (presented as chapters in this thesis), specific statistical analysis procedures were adopted, and are reflected in each of the chapters. Results: Findings in this study revealed that middle ear pathologies are common and highly prevalent in adults living with HIV, reaching approximately 60% in the current sample. These pathologies vary according to type and severity, and this is influenced by the middle ear measure used for assessment. The common middle ear pathologies in this study were otitis media with effusion, chronic suppurative otitis media, with conductive hearing loss. Despite the existence and occurrence of middle ear pathologies, some audiologists do not regularly incorporate tympanometry into their clinical practice. Asynchronous tele practice, through video-otoscopy, was found to be useful and feasible in the identification of middle ear pathologies in adults living with HIV, with substantial agreement (K=0.5801 to 0.6047) between otorhinolaryngologists. The wideband absorbance measure was found to be more accurate in identifying middle ear pathologies than the tympanometry with 226Hz probe tone and pure tone audiometry using air/bone gap. The sensitivity of wideband absorbance reached 88%, while that for tympanometry with 226Hz probe and pure tone audiometry was below 20%. In addition, the wideband absorbance patterns, measured at ambient pressure and tympanometric peak pressure, were also established for participants with normal middle ear function and middle ear pathology. While there was a difference between the wideband absorbance pattern of participants with normal middle ear function and middle ear pathologies, with middle ear pathologies being lower in the low to mid frequencies (226Hz to approximately 3000) for both ambient pressure and tympanometry peak pressure, this difference was not statistically significant between and within groups. Finally, findings of this study indicated that adults living with HIV, with comorbidities such as hypertension and hypercholesterolemia, and risk factors such as advancing age and an extended use of ART, have an increased the risk of developing various types of hearing loss. Conclusion: Current findings highlight the importance of preventive tailored care for adults living with HIV. The study indicated that middle ear pathologies and hearing loss are high in adults living with HIV. The development of these pathologies is associated with comorbidities and other risk factors. Wideband absorbance measures appear to offer promise as a diagnostic measure for middle ear pathologies in this population. However, wideband absorbance must be used in conjunction with other middle ear measures such as video otoscopy to improve early identification and intervention of middle ear pathologies. While this study indicates that middle ear pathologies are common in adults living with HIV, the patterns of wideband absorbance suggest that middle ear function in this population may not be different to HIV negative control group. Findings of this study also highlighted the importance of training facilitators to capture quality video otoscopic images that can be used for tele practice in a South African context where demand versus capacity challenges exist in as far as ear and hearing care healthcare practitioners are concerned. Finally, this study raises implication for resource distribution, ensuring that accurate measures such as wideband absorbance measures are available in clinical setting, which will improve early identification and intervention in adults living with HIV.
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    The Socio-Demographic Factors Associated with Condom Consensus among Adolescents in South Africa
    (University of the Witwatersrand, Johannesburg, 2022-07) Guambe, Malesedi Pokello; Frade, Sasha
    Background: Evidence highlights that heterosexual condomless sex among adolescents aged 15 to 24 years is argued by the literature to be a contributor to the high HIV prevalence, STIs, and adolescent pregnancies. As South Africa seeks to reduce new HIV infections by approximately 80%, condom use is of paramount importance. This is due to the fact that condoms are a preventative method that can protect against HIV transmission, STIs and unwanted pregnancies. Previous studies have shown that mutual agreement about using a condom improves consistent condom use among sexual partners. This study therefore investigates the socio-demographic factors associated with condom consensus among adolescents in South Africa. Methodology: This is a cross-sectional study, conducted using secondary data from the South African National HIV Prevalence, HIV Incidence, Behavior and Communication Survey (SABSSM) collected from January to December 2017. The study sampled 2 995 adolescents aged 15 to 24 years in South Africa. The software STATA 14 has been used to manage and analyze data. Descriptive statistics were computed to describe the characteristics of the study population. Cross-tabulation and Pearson Chi2 test were computed to test for association between socio-demographic factors and condom consensus. In order to examine the relationship between socio-demographic factors and condom consensus, binary logistic regression was used. Key Results: The study found condom accessibility and frequency of condom use to be significantly associated with condom consensus. Findings show that condom consensus was 0.457 less likely for adolescents who reported that condoms were not easily accessible, compared to adolescent with easier access. Statistical significance for condom accessibility is p=0.031. Furthermore, the likelihood of condom consensus for frequency of condom use was more likely (AOR,1.931; CI, 1.185-3.145) for adolescents who reported using condoms almost every-time and less likely (AOR, 0.563, CI, 0.379-0.798) for adolescents who used condoms sometimes. Main conclusion: This study found association for condom accessibility and condom consensus, as well as for frequency of condom use and condom consensus. For other socio-demographic factors there was no statistical significance with condom consensus. This study suggests that exposure of Social and Behavioral Change Communication programs needs to be increased among adolescents in South Africa. Central to reducing HIV infections, STIs, and adolescent pregnancy are programs that will influence behavior change among adolescents. At the core of such programs, there is a need for counselling on condom consensus and encouragement about not consuming alcohol before sexual intercourse. Additionally, these programs should make condom accessibility adolescent friendly, so as to encourage using condoms all the time as this is central to reducing new HIV infections, STIs, and adolescent pregnancy.