Faculty of Humanities (ETDs)
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Item Understanding the requirements and barriers to providing Post-Trial Access (PTA): A review of continued access to effective medicine(University of the Witwatersrand, Johannesburg, 2024) Mthembu, XoliswaClinical trials are essential in establishing the safety and efficacy of investigational products and are a mandatory requirement for the registration of a new medicine. Additionally, clinical studies offer access to new therapies, innovative treatments or more effective treatments which may not be readily accessible to the general population. Clinical trial participants receive investigational medicine during the study conduct phase as a study benefit and as compensation for their voluntary participation. In resource-limited countries, this may be the only option available to access new and effective medicine. Therefore, continued treatment access becomes of greater value. However, providing PTA presents ethical considerations which need to be addressed. The provision of PTA to effective medicine can be viewed as an inducement to join a study and creates inequalities between diseased patients, as it excludes other diseased patients who did not participate in the study or patients who were excluded from participation in the study. However, prior to addressing these controversies, it is necessary to establish first whether clinical trial participants have a moral claim to PTA provision. This report seeks to establish the moral requirement for PTA provision to address the ethical issues around providing continued access to effective medicines outside clinical trial settings. The first two chapters will focus on discussing the evolution of clinical trials, highlighting the ethical issues surrounding continued access to effective investigational products. The principles of bioethics will be discussed in detail in Chapter 2 to draw out the moral claims which mandate the requirement to provide PTA to efficacious medical therapy offered during the study. In Chapter 3, I will argue for the moral requirement for providing PTA using the principles of bioethics as a framework. In Chapter 4, I will discuss the challenges and PTA solutions. In my conclusion, I will reiterate my support for the mandatory requirement and implementation of PTA until the Investigational Product is commercially available and accessible to all trial participants, emphasising the importance of this stance.Item Factors associated with HIV knowledge among younger adolescents aged 12-14 years old in South Africa(University of the Witwatersrand, Johannesburg, 2024) Makgale. Tswelopele1.Background In 2019, there were 1.7 million adolescents aged 10-19 living with HIV globally, with 1.5 million in sub-Saharan Africa and 360,000 in South Africa. Early sexual debut, defined as having first intercourse at or before age 14, has significant consequences for adolescents worldwide. While sexual activity during adolescence is normal, early sexual debut is linked to risky behaviours. While efforts have been made to understand HIV/AIDS knowledge among older adolescents and young adults, research often neglects younger adolescents aged 12-14 years old. Poor HIV knowledge among this age group may increase transmission risk, delay diagnosis and treatment, and fuel stigma. It's crucial to focus on this age group to eradicate the disease, although research is limited due to the sensitive nature of discussing HIV/AIDS with younger adolescents. 2.Objective The two set objectives of this study were firstly, to examine levels of HIV knowledge among younger adolescents aged 12-14 years old in South Africa. Secondly, to identify the demographic, socioeconomic and subjective norm characteristics associated with HIV knowledge among younger adolescents aged 12-14 years old in South Africa. 3.Methodology This study utilised secondary data acquired from the fifth South African National HIV, Behaviour and Health Survey of 2017 – this was the latest survey available data was analysed using STATA version 14. The South Africa National HIV Prevalence, Incidence, Behaviour and Communication Survey (SABSSM) is a national population-based survey conducted for surveillance of the HIV epidemic in South Africa. The sample for the study was younger adolescents aged 12-14 years old. The weighted sample of 927 861 was selected and used for analyses. The dependent variable in this study was HIV knowledge, defined as having accurate knowledge of all HIV-related questions from the survey. Eight questions assessing HIV and AIDS knowledge, perceptions, and stigma were used. Adolescents were asked about the curability of AIDS, reducing HIV risk by having fewer sexual partners, whether a healthy- looking person can have HIV, mother-to-child transmission, risk reduction by monogamy with an uninfected partner, HIV transmission through shared food, condom use, and male circumcision reducing HIV risk. The original response options were 'yes', 'no', and 'don't know', with 'don't know' responses excluded to ensure that the data accurately reflected the participants knowledge on HIV and AIDS. The dependent variable had three categories: low HIV knowledge (1-3 out of the eight questions answered correctly), average HIV knowledge (4-5 out of the eight questions answered correctly), and comprehensive HIV knowledge (6-8 questions answered correctly). A Multinomial Logistic Regression model was employed to analyse HIV knowledge. The data analysis was done in three phases. The first phase included descriptive analyses of utilised in the study through a ranked frequency and percentage distribution table and sex ratio which was used to explore the HIV knowledge levels based on sex. The second stage included Pearson’s chi-square test which were to measure the associations between the demographic, socioeconomic and subjective norms. The third stage included an unadjusted (bivariate) and adjusted (multivariate) Multinomial Logistic Regression which was employed to examine the demographic, socioeconomic and subjective norms associated with HIV knowledge among younger adolescents aged 12-14 years old in South Africa. 4.Results Less than half of younger adolescents (47.0%) had comprehensive HIV knowledge. The relative risk ratio shown in the multivariate Multinomial Logistic Regression model showed that the respondent’s age, sex, race, place of residence, province, grade, orphanhood status and subjective norms are significant predictors of HIV knowledge among younger adolescents aged 12-14 years old in South Africa. These associations indicated that non-African female adolescents are less likely to possess HIV knowledge compared to Black male adolescents, but generally, female adolescents have a slightly higher relative risk of possessing comprehensive HIV knowledge compared to their male counterparts (1.01, P<0.05; CI=0.99-1.03). Adolescents residing in rural areas have higher relative risks of possessing average and comprehensive HIV knowledge compared to those in urban areas, with relative risks increasing by 1.52 (P<0.05; CI=1.48-1.52) and 2.18 (P<0.05; CI=2.13-2.24), respectively. Additionally, willingness to share food with someone who has HIV/AIDS shows no significant difference in the relative risk of having average or comprehensive HIV knowledge (RRR:0.641; P<0.05; CI=0.62-0.65), while willingness to play with someone who has HIV/AIDS decreases the relative risks of having average and comprehensive HIV knowledge by factors of 0.32 (P<0.05; CI=0.32-0.33) and 0.13 (P<0.05; CI=0.12-0.13), respectively. Furthermore, adolescents uncomfortable discussing HIV/AIDS with at least one family member have decreased relative risks of possessing average and comprehensive HIV knowledge by factors of 0.27 (P<0.05; CI=0.27-0.28) and 0.30 (P<0.05; CI=0.29-0.30), respectively. These results highlight the importance of demographic and social factors in understanding HIV knowledge among young adolescents in South Africa. 5.Conclusion Despite significant efforts by the South African government to integrate HIV education into the national school curriculum and collaborate with NGOs and civil society groups, adolescents aged 12-14 still lack comprehensive HIV knowledge. Understanding HIV early plays a vital role in reducing stigma and discrimination associated with HIV/AIDS, fostering a supportive and inclusive atmosphere. It also promotes critical thinking among adolescents, empowering them to question myths and misunderstandings about the disease, thereby encouraging healthier behaviours and attitudes. The hypothesis for this research was that there is no association between demographic, socioeconomic and subjective norm characteristics and HIV knowledge among younger adolescents in South Africa. The multinomial logistic regression showed significant results. Therefore, the null hypothesis was rejected. Post the completion of the National Youth HIV Prevention Strategy (2022-205), it will become mandatory for the government to evaluate and refine the policy framework to include those under 15 years. Including those aged 12-14 years old will be crucial for fostering a generation equipped to safeguard their sexual health and make informed choices, thereby perpetuating the efficacy and relevance of HIV prevention efforts within the broader national agendaItem Male Circumcision and Multiple Sexual partners in South Africa(University of the Witwatersrand, Johannesburg, 2024) Mahlangu, Theophelus Sphesihle; Frade, S.Introduction: The high prevalence of Multiple Sexual Partners (MSP) and increasing rates of HIV infection in South Africa highlight the urgent need to delve into the factors influencing risky sexual behaviour. Despite efforts to promote safe sex practices, MSP remains a significant driver of the HIV epidemic in Sub-Saharan Africa, particularly in South Africa. This study focuses to investigate the association between MC and MSP among males aged 15 years and above in South Africa, elucidating a potential relationship between MC, risky sexual behavior (RSB), and HIV prevalence. Method: This quantitative study employed a cross-sectional design using data from the 2017 South African National HIV Prevalence, Incidence, Behaviour and Communication Survey. (SABSSM), with a weighted sample of 27,620,422 men in the male recode. Data analysis involved three phases: frequency and percentage distributions, Pearson’s chi-square test, and binary logistic regression. Results: The study revealed that 94.04 % of circumcised South African men reported having MSP, with higher rates in Mpumalanga (97.29%) and among white males (97.33%). MSP was associated with demographic factors like type of residence, educational background, race, paying for sex, and geographical location. Men not using condoms were also more likely to engage in MSP. However, the study did not find any significant association between male circumcision and multiple sexual partners. The study found that males who were circumcised were less likely to have multiple sexual partners compared to uncircumcised males. Specifically, the odds ratio for MSP was (AOR 0.82; p<;0.05; CI: 0.81–0.82) among circumcised males. Conclusion: The study emphasizes the importance of considering sociodemographic and behavioural factors in designing effective prevention programs targeting risky sexual behaviour in South Africa. Understanding the underlying factors driving men's engagement in multiple sexual partnerships is crucial for developing targeted interventions to address this behaviour. This study provides evidence that male circumcision does not adversely affect sexual function or lead to increased risky sexual behaviours, such as having multiple sexual partners. These findings have important implications for public health policies and individual decision-making regarding circumcision. Further research is needed to confirm these results and explore other potential factors that may influence sexual outcomes. Additionally, it is crucial to consider the individual's overall sexual health and behaviour to ensure that the benefits of circumcision are not outweighed by risky sexual practices. This is an important consideration in the context of HIV prevention and sexual health, as some studies have suggested that circumcision may lead to increased risky sexual behaviours. However, our findings suggest that circumcision alone does not necessarily influence the number of sexual partners a man has.Item 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, MamakiriThe 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.Item The Experiences of Black Female Postgraduate Students With Mental Health During The Covid-19 Pandemic, 2019-2021, The Case of Witwatersrand University(University of the Witwatersrand, Johannesburg, 2024) Mashiane, Sphiwe; Bala, SamkeloThe COVID-19 global pandemic has compelled institutions of higher education to transition to emergency remote learning, leading many postgraduate students, both nationally and internationally, to begin their studies online. Research has shown the need for universities to support the transition from undergraduate to postgraduate as this is a major transition into academia. Research has also revealed that the struggle with mental health has increased with this transition and additionally with the COVID-19 pandemic, however, there is a lack of research investigating the experiences of Black females in the academic space and their experiences with mental health. Thus, this study aims to understand the experiences of Black female postgraduate students with mental health during the spread of COVID-19, 2019-2021. The research approach used for this study was the qualitative approach as it was the most appropriate in seeking to understand the experiences of a unique group such as a Black female postgraduate. A case study design was employed, and the experiences shared were explored through the lens of the intersectionality theory and the research was grounded by the interpretivist paradigm. The sample was drawn from the population of students from Witwatersrand University and the sample consisted of eight (8) participants. The method of data collection was computer-mediated interviews which were interpreted using a five-phase thematic analysis. The participants' responses revealed that although all eight participants experienced challenges with their mental health sharing symptoms associated with anxiety, stress, depression, and loneliness, only two participants used the psychosocial services offered by the university. The reasons for not seeking help from the university psychosocial services included fear of the unknown, services feeling unreachable, stigma and fear of not being assisted immediately. The most shared reason for not seeking help however was participants not perceiving the need to seek help. Participants, therefore, opted for coping mechanisms such as sleeping, partying, and using substances and most participants turned to their spirituality. The study, therefore, made recommendations for campus psychosocial services to employ more mental health practitioners such that there is education about mental health and the services offered.Item Neurocognitive Rehabilitation for an Adolescent HIV Population: The Case of Sustained Attention(University of the Witwatersrand, Johannesburg, 2024) Zondo, SizweThe Human Immunodeficiency Virus (HIV) continues to be a significant disease burden. In terms of neurocognitive health, HIV crosses the blood-brain barrier, resulting in neuronal dysregulation and compromised neurocognition. Of further import, antiretroviral drugs are indicated to have limited permeability in the central nervous system and do not reverse compromised neurocognition, sequent HIV neuroinvasion. The objectives of the study were to investigate the efficacy of HIV cognitive rehabilitation therapy (HIV-CRT) in adolescent HIV. The first aim was to investigate the evidence for the cognitive rehabilitation of HIV in adolescent and geriatric samples, sequent neuroHIV. This investigation resulted in the publication of a meta-analysis detailing the efficacy of attention remediation in neuroHIV. The second aim was to examine the efficacy of fNIRS neuroimaging in measuring hemodynamic responses in the prefrontal cortex in adolescents neuroHIV. This investigation resulted in the publication of an article detailing the efficacy of fNIRS in detailing changes in oxygenated haemoglobin in adolescents living with neuroHIV. The third aim was to pair fNIRS optical neuroimaging with behavioural data to investigate changes associated with brain training at a cortical and behavioural level. The execution of the above aim resulted in the publication of an article detailing the procedures and methods to achieve the enquiry. The fourth article, under review, details findings related to neural efficiency and attention training. The final manuscript, under preparation, details functional connectivity outcomes related to attention training. To enable the analysis of the published articles, an initial cohort of 42 adolescents (mean age = 17.28) living with HIV participated in the study. Following attrition, the sample was reduced to 26 participants. Thirteen participants were assigned to the treatment group (n = 13; mean age = 16; SD = 1.2), which received cognitive rehabilitation to remediate attention. Thirteen children acted as controls (mean age = 17; SD = 1.3). Pre- and post-intervention data were analysed using behavioural and optical imaging data. 5 Findings indicated that HIV-CRT (attention) is associated with decreased oxygenated haemoglobin (HbO) and increased functional connectivity in the Central Executive Network (CEN). Contrary to expectation, HIV-CRT was associated with minimal behavioural gains, as indicated by neuropsychological assessments. Taken together, findings seem to suggest that in adolescent neuroHIV, customised HIV-CRT promotes cortical efficiency. However, brain training does not translate to immediate behavioural improvements at post-assessment. Summarily, findings suggest that cortical plasticity may precede near-and-far cognitive transfer gain in adolescents neuroHIV.Item Career adaptability, occupational identity, and psychologica well-being after a career change during the covid-19 pandemic(University of the Witwatersrand, Johannesburg, 2024) Kutu, Siyamthanda; Donald, FionaOBJECTIVE: This study aims to explore the relationship between career adaptability, occupational identity, and Psychological Well-being at Work in South African employees who experienced career change during the COVID-19 pandemic. The study is framed within the Career Construction Theory where the pandemic is contextualised as a career shock. METHODS: Employing a quantitative approach, this study adopts a correlational, non-experimental, cross-sectional research design. Purposive sampling, including criterion-based and snowball sampling techniques, was utilized to recruit participants. The sample comprised 62 South African employees who experienced career changes between 2020 and 2022 due to the pandemic's impact on the labour market. Data w as collected through structured online questionnaires, incorporating validated scales. Ethical considerations were addressed, ensuring informed consent, confidentiality, and minimal harm to participants. RESULTS: Regression analysis revealed significant positive relationships between career adaptability, occupational identity, and Psychological Well-being at Work. Specifically, both career adaptability and occupational identity emerged as strong predictors of Psychological Well-being at Work among the participants. Descriptive statistics provided insights into the sample characteristics, indicating a diverse range of career change experiences during the pandemic. The study under scores the importance of fostering adaptability and building a robust occupational identity to enhance employees' psychological well-being amidst career transitions, particularly in times of crisis like COVID-19.Item The perceptions of social workers on the implementation of the Occupation Specific Dispensation policy (OSD) within the Department of Social Development in the Johannesburg Region(University of the Witwatersrand, Johannesburg, 2020) Mathebula, Sipho Sol; Masinga, PoppyThe Occupation Specific Dispensation (0SD) policy was introduced in the public service for social workers in 2009 as a strategy to recruit and retain social workers with the introduction of new salary scales, career pathing, pay and grade progression and recognition of appropriate experience. The perceptions of social workers on the implementation of the OSD policy have not been established and this lack of knowledge leaves a gap in understanding the perceived impact this policy has had on social workers. The aim of the study was to explore the perceptions of social workers on the implementation of the Occupation Specific Dispensation policy within the Department of Social Development in the Johannesburg Region. Since implementation of the policy, there has been research studies conducted on the outcomes of the OSD policy within the public health sector yet no studies have been conduct that focus on the challenges encountered by social workers in the implementation of the policy. The study utilised the qualitative research approach which was exploratory and descriptive in nature. The collective case study design was adopted. A sample of ten social workers and three key informants were selected using purposive sampling. Data was collected using semi-structured interviews and analysed using thematic content analysis. The key finding was that the OSD policy was not effective in recruitment since it is rigid and inflexible. Another concern raised was the long period it took to move from one occupational level to the next resulting in a demotivated and demoralised workforce. The study also found that there was management bias in the implementation of the performance management and development system. The study contributes to our understanding of the perceptions about the unintended consequences of the OSD policy and how these are perceived to have impacted negatively on the recruitment and retention of social workers.Item People’s Dignity is at stake: The Ambulance Availability Crisis in Lusikisiki, Ingquza Hill Local Municipality(University of the Witwatersrand, Johannesburg, 2024) Bolitina, SinovuyoAccess to healthcare is and remains a challenge globally. In South Africa, the limited ambulance availability crisis is an example of this. The people affected the most rely on public healthcare in remote and rural areas, such as the small town of Lusikisiki in the Eastern Cape Province. This study sought to investigate the research question, “How does the limited ambulance availability impact access to public healthcare for the people of Lusikisiki in the Ingquza Hill Local Municipality?”. I adopted a qualitative research approach and interviewed twenty participants identified through purposive and snowball sampling techniques. Limited ambulance availability inhibits the people of Lusikisiki from accessing healthcare. This crisis exists and impacts clusters of communities already facing socioeconomic, political, and geographical issues. These factors are at play and impact people’s day-to-day lives. Recommendations entail implementing more strategies and policies, looking at a more holistic approach, and examining this crisis from a social and health context perspective to overcome healthcare access barriers; thereby ensuring access and the health and well-being of everyone.Item Psychological Well-Being and South African Socio- Economic Stressors: The moderating role of Leaders creating Hope(University of the Witwatersrand, Johannesburg, 2024) Aysen, Savannah; Milner, KarenThe current research study explored whether leaders creating hope in their employees moderates the relationship between South African socio-economic stressors and employee psychological well-being. Existing literature indicates that stressors have dire implications for the well-being of employees and that psychological capital is a meaningful resource to elevate deteriorating well-being (Slone et al., 1999; Charles et al., 2013). Moreover, research reveals the potential of leaders to create hope within their organisations which may aid in elevating deteriorating well-being levels (Yukl, 1998; Helland and Winston, 2005). Accordingly, this research aimed to explore whether leaders creating hope would moderate the relationship between South African socio-economic stressors and psychological well-being. This study utilised a quantitative non-experimental cross-sectional research design to explore the statistical relationships between South African socio-economic stressors, psychological well-being and leaders creating hope. Data was collected through an online self-report questionnaire (N=130). The questionnaire contained a self-developed demographic questionnaire, an adapted South African socio-economic stressors scale, the Psychological General Well-Being Index, and the adapted Leaders Creating Hope scale. Results of the study indicated that both South African socio-economic stressors and leaders creating hope were correlated with psychological well-being, and a multiple regression analysis revealed that both South African socio-economic stressors and leaders creating hope are predictors of psychological well-being within the sample. However, even though leaders creating hope was found to have a positive effect on psychological well-being it did not have a moderating effect on the relationship between South African socio-economic stressors and psychological well-being.