Building Semantic Causal Models to Predict Treatment Adherence for Tuberculosis Patients in Sub-Saharan Africa

Poor adherence to prescribed treatment is a major factor contributing to tuberculosis patients developing drug resistance and failing treatment. Treatment adherence behaviour is influenced by diverse personal, cultural and socio-economic factors that vary between regions and communities. Decision network models can potentially be used to predict treatment adherence behaviour. However, determining the network structure (identifying the factors and their causal relations) and the conditional probabilities is a challenging task. To resolve the former we developed an ontology supported by current scientific literature to categorise and clarify the similarity and granularity of factors

An ontology-driven approach for structuring scientific knowledge for predicting treatment adherence behaviour: a case study of tuberculosis in Sub-Saharan African communities.

Doctor of Philosophy in Mathematics, Statistics and Computer Science. University of KwaZulu-Natal, Durban 2016.Poor adherence to prescribed treatment is a complex phenomenon and has been identified as a major contributor to patients developing drug resistance and failing treatment in sub-Saharan African countries. Treatment adherence behaviour is influenced by diverse personal, cultural and socio-economic factors that may vary drastically between communities in different regions. Computer based predictive models can be used to identify individuals and communities at risk of non-adherence and aid in supporting resource allocation and intervention planning in disease control programs. However, constructing effective predictive models is challenging, and requires detailed expert knowledge to identify factors and determine their influence on treatment adherence in specific communities. While many clinical studies and abstract conceptual models exist in the literature, there is no known concrete, unambiguous and comprehensive computer based conceptual model that categorises factors that influence treatment adherence behaviour. The aim of this research was to develop an ontology-driven approach for structuring knowledge of factors that influence treatment adherence behaviour and for constructing adherence risk prediction models for specific communities. Tuberculosis treatment adherence in sub-Saharan Africa was used as a case study to explore and validate the approach. The approach provides guidance for knowledge acquisition, for building a comprehensive conceptual model, its formalisation into an OWL ontology, and generation of probabilistic risk prediction models. The ontology was evaluated for its comprehensiveness and correctness, and its effectiveness for constructing Bayesian decision networks for predicting adherence risk. The approach introduces a novel knowledge acquisition step that guides the capturing of influencing factors from peer-reviewed clinical studies and the scientific literature. Furthermore, the ontology takes an evidence based approach by explicitly relating each factor to published clinical studies, an important consideration for health practitioners. The approach was shown to be effective in constructing a flexible and extendable ontology and automatically generating the structure of a Bayesian decision network, a crucial step towards automated, computer based prediction of adherence risk for individuals in specific communities

TB STIGMA – MEASUREMENT GUIDANCE

TB is the most deadly infectious disease in the world, and stigma continues to play a significant role in worsening the epidemic. Stigma and discrimination not only stop people from seeking care but also make it more difficult for those on treatment to continue, both of which make the disease more difficult to treat in the long-term and mean those infected are more likely to transmit the disease to those around them. TB Stigma – Measurement Guidance is a manual to help generate enough information about stigma issues to design and monitor and evaluate efforts to reduce TB stigma. It can help in planning TB stigma baseline measurements and monitoring trends to capture the outcomes of TB stigma reduction efforts. This manual is designed for health workers, professional or management staff, people who advocate for those with TB, and all who need to understand and respond to TB stigma

Preventive audiology

This book is an original scholarly book that introduces the concept of preventive audiology, with a specific focus on the African context, which is in line with the South African re-engineered primary healthcare strategy as well as the World Health Organisation’s approach. The book reflects on contextually relevant and responsive evidence-based perspectives, grounded in an African context on preventive audiology, in four major ear and hearing burdens of disease within the South African context: (1) early hearing detection and intervention, (2) middle ear pathologies, (3) ototoxicity, and (4) noise-induced hearing loss. The book represents innovative research, seen from both a South African and global perspective. It offers new discourse and argues for a paradigm shift in how audiology is theorised and performed, particularly in low-and-middle-income country contexts. The goal of this book is to motivate a paradigm shift in how the ear and hearing care is approached within this low-and-middle-income country context while arguing for Afrocentric best practice evidence that leads to next practice

Preventive audiology

This book is an original scholarly book that introduces the concept of preventive audiology, with a specific focus on the African context, which is in line with the South African re-engineered primary healthcare strategy as well as the World Health Organisation’s approach. The book reflects on contextually relevant and responsive evidence-based perspectives, grounded in an African context on preventive audiology, in four major ear and hearing burdens of disease within the South African context: (1) early hearing detection and intervention, (2) middle ear pathologies, (3) ototoxicity, and (4) noise-induced hearing loss. The book represents innovative research, seen from both a South African and global perspective. It offers new discourse and argues for a paradigm shift in how audiology is theorised and performed, particularly in low-and-middle-income country contexts. The goal of this book is to motivate a paradigm shift in how the ear and hearing care is approached within this low-and-middle-income country context while arguing for Afrocentric best practice evidence that leads to next practice

Predicting adherence to antiretroviral therapy and retention to HIV care : effects of baseline biopsychosocial status and neuropsychological functioning

These drugs have demonstrated efficacy in improving immune function and reducing HIV-related morbidity and mortality, and while a cure is not available, patients on treatment may live longer, healthier lives. However, early optimism has been tempered by the growing recognition that meticulous adherence is a prerequisite for optimal clinical response and prevention of drug resistance

Developing predictive models for depression and risktaking behavior among people living with HIV and AIDS (PLWHA): A focus on the construction of the Self and Implicative Dilemmas

Philosophiae Doctor - PhD (Psychology)Due to the chronicity of the HIV infection, substantial changes may occur in the life of people living with HIV and AIDS (PLWHAs), emerging new needs must be understood and dealt with, enhancing the already existing ones. Understanding the self-concept of PLWHAS is essential and was situated within Kellys Personal Construct Theory. Increased self-concept makes the individual living with HIV perceive him/herself in a positive way; on the other hand, those with affected self-concept and implicative dilemmas may see themselves as more limited and discouraged, with great implications for mental health. Given the circumstances, the present study aims were to evaluate the sociodemographic, disease, psychosocial factors, as well as cognitive factors such as self-concept and implicative dilemmas and to relate it to depression and risk-taking behaviours in PLWHAs. This quantitative study administered a battery of questionnaires namely, the 1.) Personal and Demographic Questionnaire, 2.) Beck's Depression Inventory (BDI-II), 3.) Hospital Anxiety and Depression Scale (HADS), and the Repertory Grid to 142 adults living with HIV and AIDS who were attending a public health clinic in a resource-constrained area in the Cape Metropole Region

Planned Behavior and Congolese Physicians’ Practice: Predicting Advanced Preventive Health Services Provision

The provision of preventive services, health promotion, and health maintenance has become the cornerstone of primary care practice in the United States and other Western countries to prevent morbidity and premature mortality and to increase the quality and years of a healthy life. Unfortunately, the delivery of these advanced preventive health services (APHS) has been sporadic in the Democratic Republic of Congo, a country with poor health indicators. The purpose of this cross-sectional mixed-method study was to apply Ajzen’s theory of planned behavior (TPB) to predict the intention of Congolese primary care physicians (PCPs) in the provision of APHS. Using a self-administered 24-item survey from the Francis’ instrument, primary data were collected from May to November 2019 from a purposive sample of 173 consenting PCPs aged 24–69 years old practicing in Kinshasa, Kongo Central, and Kwilu provinces. Multiple regression was used to analyze the data. The findings revealed that Congolese PCPs’ intention to provide APHS was statistically significantly predicted by their attitudes (β = .183 at p \u3c 0.05), subjective norms (β = .209 at p \u3c 0.01), and perceived behavioral control (β = .198 at p \u3c 0.01). After controlling for age and gender, all 3 predictor variables explained 10.9% variance on the dependent variable intention at the significance level of \u3c 0.01. Despite the low variance, these findings suggested that TPB was a suitable theory model for predicting the intention of Congolese PCPs to provide the APHS. However, a countrywide randomized study is recommended to generalize the results. This study may provide positive social change by standardizing and enhancing the quality of primary care in Congo, by preventing morbidity and premature death, decreasing healthcare costs, and promoting a healthy lifestyle and long productive life of Congolese people

Tuberculosis: A disease of poverty; a question of control? A case study of TB in Malawi.

Tuberculosis (TB) has re-emerged as a major threat in the developing world and is one of the leading infectious disease killers globally (UN 1999; WHO 2005). In Malawi, one of the poorest countries in sub-Saharan Africa, the National TB Control Programme (NTP) is struggling in a setting where an HIV pandemic combined with extreme poverty is undermining its efforts. There has been an upsurge in TB case rates and falling cure rates. Despite such deteriorating statistics, this programme is nevertheless regarded as a 'model' by the World Health Organisation (WHO 1995; WHO 2001), which applauds the early and sustained implementation of the DOTS strategy - seen as the most effective strategy for TB control. This apparent 'disconnect' between WHO praise for DOTS implementation and the deteriorating TB outcomes suggests that further investigation should examine why this is the case, and what can be done to improve it. This thesis, therefore, investigates tuberculosis and its control in the Malawian setting, and aims to understand it from the point of view of ordinary people who are most at risk, from the perspective of policy making and implementation, and from the experience of care providers. Using a qualitative case study approach in a severely affected country, it shows that the failure of TB programmes to understand in-depth the environment in which they operate will limit their ability to recognise and respond to the particular needs of their public with practical service provision options, thus contributing to continued poor TB outcomes. One of the overarching policy implications concerns the common reluctance of TB control experts to allow systematic social science research to uncover the complexities of the context in which they are situated. Biomedical control is instead promoted as a means to contain and avoid complexity, yet in doing so, ultimately precludes what may bring positive change