A sociological analysis of Southern African AIDS Trust's capacity-development model in responding to HIV and AIDS
- Authors: Mushonga, Allan
- Date: 2014
- Subjects: Southern African AIDS Trust , AIDS (Disease) -- Social aspects -- South Africa , HIV (Viruses) -- Social aspects -- South Africa , HIV-positive persons -- South Africa , Community development -- South Africa
- Language: English
- Type: Thesis , Masters , MA
- Identifier: vital:3379 , http://hdl.handle.net/10962/d1013261
- Description: The issues of capacity and capacity development in the response to HIV and AIDS is a topic of intense academic interest and is on the agenda of development practitioners, particularly as these issues are linked to community HIV and AIDS competence and sustainability of civil society organisations and community capacity. The capacity development model of the Southern African AIDS Trust is one of the more illuminating examples of capacity development of civil society organisations for the enhancement of community HIV and AIDS competence in southern Africa. The thesis examines the conceptualisation and implementation of the Southern African AIDS Trust's capacity development model in order to identify and understand the multi-dimensional factors that influence the success and sustainability of HIV and AIDS responses. It argues that, even though the conceptualisation, formulation and implementation of the model were appropriate and yielded acceptable benefits to communities in relation to HIV and AIDS, the sustainability of the model depended fundamentally on the availability of requisite resources. The dependence on external resources, the availability of which is in large part beyond the control of the Southern African AIDS Trust and its community-based beneficiaries, undercuts the sustainability of the model and the programmes delivered through it. Community capacities and community-based HIV and AIDS responses are sustainable only to the extent that communities have sufficient resources to build capacities and develop responses, or can leverage and negotiate external inputs. The degeneration of capacity in intermediary organisations (such as Southern African AIDS Trust) that support community competence undermines models that at first sight seem suitable for effective capacity enhancement with regard to HIV and AIDS programmes. In this regard, the thesis also focuses on the organisational crisis within Southern African AIDS Trust and the ramifications this had for community HIV and AIDS competence.
- Full Text:
- Date Issued: 2014
- Authors: Mushonga, Allan
- Date: 2014
- Subjects: Southern African AIDS Trust , AIDS (Disease) -- Social aspects -- South Africa , HIV (Viruses) -- Social aspects -- South Africa , HIV-positive persons -- South Africa , Community development -- South Africa
- Language: English
- Type: Thesis , Masters , MA
- Identifier: vital:3379 , http://hdl.handle.net/10962/d1013261
- Description: The issues of capacity and capacity development in the response to HIV and AIDS is a topic of intense academic interest and is on the agenda of development practitioners, particularly as these issues are linked to community HIV and AIDS competence and sustainability of civil society organisations and community capacity. The capacity development model of the Southern African AIDS Trust is one of the more illuminating examples of capacity development of civil society organisations for the enhancement of community HIV and AIDS competence in southern Africa. The thesis examines the conceptualisation and implementation of the Southern African AIDS Trust's capacity development model in order to identify and understand the multi-dimensional factors that influence the success and sustainability of HIV and AIDS responses. It argues that, even though the conceptualisation, formulation and implementation of the model were appropriate and yielded acceptable benefits to communities in relation to HIV and AIDS, the sustainability of the model depended fundamentally on the availability of requisite resources. The dependence on external resources, the availability of which is in large part beyond the control of the Southern African AIDS Trust and its community-based beneficiaries, undercuts the sustainability of the model and the programmes delivered through it. Community capacities and community-based HIV and AIDS responses are sustainable only to the extent that communities have sufficient resources to build capacities and develop responses, or can leverage and negotiate external inputs. The degeneration of capacity in intermediary organisations (such as Southern African AIDS Trust) that support community competence undermines models that at first sight seem suitable for effective capacity enhancement with regard to HIV and AIDS programmes. In this regard, the thesis also focuses on the organisational crisis within Southern African AIDS Trust and the ramifications this had for community HIV and AIDS competence.
- Full Text:
- Date Issued: 2014
Illustrated medicines information for HIV/AIDS patients: influence on adherence,self-efficacy and health outcomes
- Authors: Barford, Kirsty-Lee
- Date: 2012
- Subjects: AIDS (Disease) -- Treatment -- South Africa , HIV infections -- Treatment -- South Africa , AIDS (Disease) -- Patients -- South Africa , HIV-positive persons -- South Africa , AIDS (Disease) -- Study and teaching -- South Africa , Antiretroviral agents -- South Africa , Communication in medicine -- South Africa , Communication in public health -- South Africa
- Language: English
- Type: Thesis , Masters , MPharm
- Identifier: vital:3863 , http://hdl.handle.net/10962/d1015678
- Description: South Africa has an estimated 920 000 patients on antiretrovirals (ARVs), the largest number of patients in any country. ARV therapy demands adherence levels in excess of 95% to avoid development of drug resistance, but adherence to ARV therapy is estimated to be only between 50% and 70%. Poor medication adherence is acknowledged as a major public health problem, reducing the effectiveness of therapy and promoting resistance to ARVs. More than two thirds of the South African population have marginal reading skills and this significantly influences a patient’s ability to read and understand health-related information. Patient education materials tailored for the South African population could be a useful aid in facilitating communication with patients and perhaps impact positively on their medicine-taking behaviour. This behaviour is influenced by patient knowledge, beliefs, attitudes and expectations and includes self-management, self-efficacy and adherence. Self-efficacy, which refers to patient confidence in the ability to self-manage medicine taking, is a key factor influencing adherence. This study aimed to develop illustrated patient information leaflets (PILs) and medicine labels for all first-line ARV regimens used in the public health sector in South Africa and, using a randomised control study design, to investigate the impact of these illustrated information materials on knowledge, medication-taking behaviours and health outcomes in HIV/AIDS patients taking ARVs. To achieve this aim, the objectives were to assess HIV/AIDS and ARV-related knowledge, as well as self-efficacy and adherence to ARV therapy; to assess the influence of demographic variables on knowledge, adherence and self-efficacy; to assess the influence of the information materials on knowledge, self-efficacy and adherence and to assess the association of knowledge with health outcomes. Medicine labels and PILs, both English and isiXhosa, were developed for ARV regimens 1a, 1b, 1c and 1d. The 8-item Morisky Medication Adherence Scale (MMAS-8) and HIV Treatment Adherence Self Efficacy Scale (HIV-ASES) instruments for measuring respectively adherence and self-efficacy, were modified to optimize clarity, simplicity and cultural acceptability and were translated into isiXhosa using a multi-stage translation-back translation. The questions and the rating scales, for both the MMAS and HIV-ASES, underwent preliminary qualitative evaluation in focus group discussions. Patients were recruited from local Grahamstown clinics. A pilot study to evaluate applicability of the instruments was conducted in 16 isiXhosa AIDS patients on ARVs and the results from this study informed further modifications to the instruments. One hundred and seventeen patients were recruited for the randomised control trial and were randomly allocated to either control group (who received standard care) or experimental group (who received standard care as well as pictogram medicine labels and the illustrated PIL). Interviews were conducted at baseline and at one, three and six months. Data were analysed statistically using the t-test, chi-squared test and ANOVA (Analysis of Variance) at a 5% level of significance. Correlations were determined using Pearson and Spearman rho correlations. Approval was obtained from Rhodes University Ethical Standards Committee, Settlers Hospital Ethics Committee and the Eastern Cape Department of Health. The results of this research showed that illustrated PILs and medicine labels enhanced understanding of HIV/AIDS and ARV information, resulting in a mean overall knowledge score in the experimental group of 96%, which was significantly higher than the 75% measured in the control group. Variable knowledge scores were measured in three areas: baseline knowledge of general HIV/AIDS-related information was good at 87%, whereas knowledge scores relating to ARV-related information (60%) and side-effects (52%) were lower. These scores improved significantly in the experimental group over the 4 interviews during the 6 month trial duration, whereas in the control group, they fluctuated only slightly around the original baseline score. There was no significant influence of gender on knowledge score, whereas health literacy, education level and age tested (at one and three months) had a significant influence on knowledge. Self-efficacy and adherence results were high, indicating that the patients have confidence in their ability to adhere to the ARV therapy and to practice optimal self-care. Age, gender and education, in most cases, significantly influenced self-efficacy, but were found to have no effect on adherence. The CD4 count improved over the trial duration which may have been influenced by a number of factors, including better knowledge of ARVs and improved adherence. No significant parametric correlation was found between knowledge score and change in CD4 count, however, Spearman's rho showed significance (rs=0.498; p=0.022). Both patients and healthcare providers were highly enthusiastic about the illustrated labels and PILs, and indicated their desire for such materials to be routinely available to public sector HIV/AIDS patients. The isiXhosa version of the PIL was preferred by all the patients. These simple, easy-to-read leaflets and illustrated medication labels were shown to increase understanding and knowledge of ARVs and HIV/AIDS in low-literate patients, and their availability in the first-language of the patients was central to making them a highly useful information source.
- Full Text:
- Date Issued: 2012
- Authors: Barford, Kirsty-Lee
- Date: 2012
- Subjects: AIDS (Disease) -- Treatment -- South Africa , HIV infections -- Treatment -- South Africa , AIDS (Disease) -- Patients -- South Africa , HIV-positive persons -- South Africa , AIDS (Disease) -- Study and teaching -- South Africa , Antiretroviral agents -- South Africa , Communication in medicine -- South Africa , Communication in public health -- South Africa
- Language: English
- Type: Thesis , Masters , MPharm
- Identifier: vital:3863 , http://hdl.handle.net/10962/d1015678
- Description: South Africa has an estimated 920 000 patients on antiretrovirals (ARVs), the largest number of patients in any country. ARV therapy demands adherence levels in excess of 95% to avoid development of drug resistance, but adherence to ARV therapy is estimated to be only between 50% and 70%. Poor medication adherence is acknowledged as a major public health problem, reducing the effectiveness of therapy and promoting resistance to ARVs. More than two thirds of the South African population have marginal reading skills and this significantly influences a patient’s ability to read and understand health-related information. Patient education materials tailored for the South African population could be a useful aid in facilitating communication with patients and perhaps impact positively on their medicine-taking behaviour. This behaviour is influenced by patient knowledge, beliefs, attitudes and expectations and includes self-management, self-efficacy and adherence. Self-efficacy, which refers to patient confidence in the ability to self-manage medicine taking, is a key factor influencing adherence. This study aimed to develop illustrated patient information leaflets (PILs) and medicine labels for all first-line ARV regimens used in the public health sector in South Africa and, using a randomised control study design, to investigate the impact of these illustrated information materials on knowledge, medication-taking behaviours and health outcomes in HIV/AIDS patients taking ARVs. To achieve this aim, the objectives were to assess HIV/AIDS and ARV-related knowledge, as well as self-efficacy and adherence to ARV therapy; to assess the influence of demographic variables on knowledge, adherence and self-efficacy; to assess the influence of the information materials on knowledge, self-efficacy and adherence and to assess the association of knowledge with health outcomes. Medicine labels and PILs, both English and isiXhosa, were developed for ARV regimens 1a, 1b, 1c and 1d. The 8-item Morisky Medication Adherence Scale (MMAS-8) and HIV Treatment Adherence Self Efficacy Scale (HIV-ASES) instruments for measuring respectively adherence and self-efficacy, were modified to optimize clarity, simplicity and cultural acceptability and were translated into isiXhosa using a multi-stage translation-back translation. The questions and the rating scales, for both the MMAS and HIV-ASES, underwent preliminary qualitative evaluation in focus group discussions. Patients were recruited from local Grahamstown clinics. A pilot study to evaluate applicability of the instruments was conducted in 16 isiXhosa AIDS patients on ARVs and the results from this study informed further modifications to the instruments. One hundred and seventeen patients were recruited for the randomised control trial and were randomly allocated to either control group (who received standard care) or experimental group (who received standard care as well as pictogram medicine labels and the illustrated PIL). Interviews were conducted at baseline and at one, three and six months. Data were analysed statistically using the t-test, chi-squared test and ANOVA (Analysis of Variance) at a 5% level of significance. Correlations were determined using Pearson and Spearman rho correlations. Approval was obtained from Rhodes University Ethical Standards Committee, Settlers Hospital Ethics Committee and the Eastern Cape Department of Health. The results of this research showed that illustrated PILs and medicine labels enhanced understanding of HIV/AIDS and ARV information, resulting in a mean overall knowledge score in the experimental group of 96%, which was significantly higher than the 75% measured in the control group. Variable knowledge scores were measured in three areas: baseline knowledge of general HIV/AIDS-related information was good at 87%, whereas knowledge scores relating to ARV-related information (60%) and side-effects (52%) were lower. These scores improved significantly in the experimental group over the 4 interviews during the 6 month trial duration, whereas in the control group, they fluctuated only slightly around the original baseline score. There was no significant influence of gender on knowledge score, whereas health literacy, education level and age tested (at one and three months) had a significant influence on knowledge. Self-efficacy and adherence results were high, indicating that the patients have confidence in their ability to adhere to the ARV therapy and to practice optimal self-care. Age, gender and education, in most cases, significantly influenced self-efficacy, but were found to have no effect on adherence. The CD4 count improved over the trial duration which may have been influenced by a number of factors, including better knowledge of ARVs and improved adherence. No significant parametric correlation was found between knowledge score and change in CD4 count, however, Spearman's rho showed significance (rs=0.498; p=0.022). Both patients and healthcare providers were highly enthusiastic about the illustrated labels and PILs, and indicated their desire for such materials to be routinely available to public sector HIV/AIDS patients. The isiXhosa version of the PIL was preferred by all the patients. These simple, easy-to-read leaflets and illustrated medication labels were shown to increase understanding and knowledge of ARVs and HIV/AIDS in low-literate patients, and their availability in the first-language of the patients was central to making them a highly useful information source.
- Full Text:
- Date Issued: 2012
Condom influence strategies among university students
- Authors: Majara, Tsepang David
- Date: 2009
- Subjects: Condom use -- South Africa , Seduction -- South Africa , Birth control -- South Africa , Risk communication -- South Africa , College students -- Sexual behavior , Sexually transmitted diseases , HIV-positive persons -- South Africa , AIDS (Disease) in adolescence -- South Africa
- Language: English
- Type: Thesis , Masters , M Soc Sc (C Psy)
- Identifier: vital:11857 , http://hdl.handle.net/10353/235 , Condom use -- South Africa , Seduction -- South Africa , Birth control -- South Africa , Risk communication -- South Africa , College students -- Sexual behavior , Sexually transmitted diseases , HIV-positive persons -- South Africa , AIDS (Disease) in adolescence -- South Africa
- Description: This study investigated influence strategies used by university students to negotiate condom use. The study examined the seven condom influence strategies (CISs) -withholding sex, direct request, seduction, relationship conceptualizing, risk information, deception, and pregnancy prevention- used by heterosexually active male and female students. The sample comprised of 156 first year students (male=44 and female=112). Statistically significant correlations were found among all the condom influence strategies subscales. Results suggest that the university students influence their partners in all identified condom influence strategies and the risk information strategy holds the most promise of all the strategies.
- Full Text:
- Date Issued: 2009
- Authors: Majara, Tsepang David
- Date: 2009
- Subjects: Condom use -- South Africa , Seduction -- South Africa , Birth control -- South Africa , Risk communication -- South Africa , College students -- Sexual behavior , Sexually transmitted diseases , HIV-positive persons -- South Africa , AIDS (Disease) in adolescence -- South Africa
- Language: English
- Type: Thesis , Masters , M Soc Sc (C Psy)
- Identifier: vital:11857 , http://hdl.handle.net/10353/235 , Condom use -- South Africa , Seduction -- South Africa , Birth control -- South Africa , Risk communication -- South Africa , College students -- Sexual behavior , Sexually transmitted diseases , HIV-positive persons -- South Africa , AIDS (Disease) in adolescence -- South Africa
- Description: This study investigated influence strategies used by university students to negotiate condom use. The study examined the seven condom influence strategies (CISs) -withholding sex, direct request, seduction, relationship conceptualizing, risk information, deception, and pregnancy prevention- used by heterosexually active male and female students. The sample comprised of 156 first year students (male=44 and female=112). Statistically significant correlations were found among all the condom influence strategies subscales. Results suggest that the university students influence their partners in all identified condom influence strategies and the risk information strategy holds the most promise of all the strategies.
- Full Text:
- Date Issued: 2009
Disclosure of HIV status and adherence to antiretroviral therapy
- Kubashe, Nomachina Theopatra
- Authors: Kubashe, Nomachina Theopatra
- Date: 2009
- Subjects: HIV-positive persons -- South Africa , Self-disclosure -- South Africa , Antiretroviral agents -- South Africa
- Language: English
- Type: Thesis , Masters , MPharm
- Identifier: vital:10142 , http://hdl.handle.net/10948/1174 , HIV-positive persons -- South Africa , Self-disclosure -- South Africa , Antiretroviral agents -- South Africa
- Description: The Human Immunodeficiency Virus (HIV)/Acquired Immune Deficiency Syndrome (AIDS) is one of the leading chronic diseases affecting people in South Africa and throughout the world. This study aimed to investigate the effect disclosure of HIV status had on antiretroviral therapy (ART) adherence. A convenience sample of 65 HIV positive adult patients currently taking ART at a public Primary Health Care (PHC) clinic in the Nelson Mandela Metropole was selected. Participation was voluntary and confidentiality was maintained at all times. Data was collected using three tools/techniques: (1) a Patient Questionnaire (PQ) to extract information on patient's demographics, HIV disclosure status, regimen the patient was on and self-reported adherence to ART; (2) an audit of a Patient Medical Record (PMR) for information on the regimen the patient was on, the period during which the patient had been on ART medication, the adherence to ART care and the level of the patient‟s biological markers; and (3) Pill Counts (PC) performed on the patient's medical supply to validate the self-reported adherence to ART. There was no significant relationship between the disclosure of HIV status and adherence to ART (p= 0.59; Chi²). However, the relationship between the adherence to ART and increase in the CD4 count levels of patients on ART in this population was significant (p=0.03; Chi²). It can be concluded that no direct relationship was found between the disclosure of HIV status and adherence to ART in this population. However, several factors affected the reasons and decisions of individuals to disclose their HIV status and this influenced their daily taking of medication.
- Full Text:
- Date Issued: 2009
- Authors: Kubashe, Nomachina Theopatra
- Date: 2009
- Subjects: HIV-positive persons -- South Africa , Self-disclosure -- South Africa , Antiretroviral agents -- South Africa
- Language: English
- Type: Thesis , Masters , MPharm
- Identifier: vital:10142 , http://hdl.handle.net/10948/1174 , HIV-positive persons -- South Africa , Self-disclosure -- South Africa , Antiretroviral agents -- South Africa
- Description: The Human Immunodeficiency Virus (HIV)/Acquired Immune Deficiency Syndrome (AIDS) is one of the leading chronic diseases affecting people in South Africa and throughout the world. This study aimed to investigate the effect disclosure of HIV status had on antiretroviral therapy (ART) adherence. A convenience sample of 65 HIV positive adult patients currently taking ART at a public Primary Health Care (PHC) clinic in the Nelson Mandela Metropole was selected. Participation was voluntary and confidentiality was maintained at all times. Data was collected using three tools/techniques: (1) a Patient Questionnaire (PQ) to extract information on patient's demographics, HIV disclosure status, regimen the patient was on and self-reported adherence to ART; (2) an audit of a Patient Medical Record (PMR) for information on the regimen the patient was on, the period during which the patient had been on ART medication, the adherence to ART care and the level of the patient‟s biological markers; and (3) Pill Counts (PC) performed on the patient's medical supply to validate the self-reported adherence to ART. There was no significant relationship between the disclosure of HIV status and adherence to ART (p= 0.59; Chi²). However, the relationship between the adherence to ART and increase in the CD4 count levels of patients on ART in this population was significant (p=0.03; Chi²). It can be concluded that no direct relationship was found between the disclosure of HIV status and adherence to ART in this population. However, several factors affected the reasons and decisions of individuals to disclose their HIV status and this influenced their daily taking of medication.
- Full Text:
- Date Issued: 2009
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