Naming and labelling HIV and AIDS : responses to HIV in a rural setting in the Eastern Cape.

Master of Social Sciences in Research Psychology. University of KwaZulu-Natal, Pietermaritzburg 2016.In the next year, South Africa hopes to reduce HIV infections and stigma by 50%. With HIV stigma being a significant cause of the difficulties experienced with the management of HIV in the country, research resources have focussed on how to understand and reduce HIV. Although much attention has been given to HIV-prevention intitiatives, HIV stigma is still evident. Examining the issue of ‘talk’ around HIV and AIDS could help in gaining some insights into stigma as one of the ways HIV and AIDS stigma manifests is through language. This primary aim of this qualitative study was to explore the names and labels currently used in a rural area of the Eastern Cape to talk about HIV. Furthermore, the aim of this study was to examine whether these names are stigmatising or not. A total of 30 interviews and 11 focus groups discussions were purposively sampled from an already existing data set of 95 transcripts. Out of the 30 interviews, 16 were sampled from men and 14 from women and the participants were between the ages of 18 to 70 years. There were five focus groups with male participants and six with female participants. Focus groups had participants ranging in age between 10 to 70 years, with participants of the same age group assembled together in a group. The study used thematic analysis where six themes were identified. These were: misuse or conflation of the terms HIV and AIDS; metaphorical labels; ‘collecting death’; ‘that thing’; ‘clean blood’, as well as a discussion of attempts to describe the disease. The study then used social construction theory and a fear and blame stigma model to understand results in this study. This research shows that even though HIV/AIDS has been in our communities for over 30 years, stigma is still rife in Ematyholweni and this is reflected through the names people used to refer to the disease. This research also recognises that these names play different functions in communicating about HIV, but at the core, they are negative, stigmatising and as a result, they have led to negative responses to the disease in the research site

Barriers and facilitating factors to HIV treatment among men in a high-HIV burdened district in KwaZulu-Natal, South Africa: A qualitative study

Despite enormous increases in the proportion of people living with HIV accessing treatment in sub-Saharan Africa, major gender disparities persist, with men experiencing lower rates of testing, linkage to treatment, and retention in care. In this study, we investigated the barriers and facilitating factors to HIV treatment among men in uThukela, a high-HIV-burdened district in KwaZulu-Natal province, South Africa. We conducted a qualitative study including nine Black African male participants who were recruited from 18 health care facilities in uThukela District, KwaZulu-Natal province. In-depth interviews were conducted with participants who linked to care and those who did not link to care at 3-month post HIV diagnosis. We used Atlas.ti for thematic analysis. Data were coded and linked to broader themes emerging across interviews. The median age was 40 years (interquartile range [IQR]: 31–41). This study identified the following key themes which emerged as barriers to HIV treatment among men in uThukela District: lack of emotional readiness, perceived medication side effects, fear of treatment non-adherence, perceived stigma and confidentiality concerns, and poor socioeconomic factors

Evidence of past and current collaborations between traditional health practitioners and biomedical health practitioners: A scoping review protocol

Healthcare seekers around the globe use more than one healthcare system, with most using the traditional and the Western approaches concurrently. To date, little collaboration between the two systems has taken place within the mental health space compared with other areas of medicine. In order to inform integrating plans for traditional health practitioners and biomedical health practitioners in the South African mental health system, it is important to know which models of collaboration are used in other medical settings and contexts. This study aims to document global evidence on collaboration practices between traditional health practitioners and biomedical professionals when working with various health conditions

Healthcare provider perceptions on the implementation of the universal test-and-treat policy in South Africa: a qualitative inquiry

Background South Africa had an estimated 7.5 million people living with HIV (PLHIV), accounting for approximately 20% of the 38.4 million PLHIV globally in 2021. In 2015, the World Health Organization recommended the universal test and treat (UTT) intervention which was implemented in South Africa in September 2016. Evidence shows that UTT implementation faces challenges in terms of human resources capacity or infrastructure. We aim to explore healthcare providers (HCPs)’ perspectives on the implementation of the UTT strategy in uThukela District Municipality in KwaZulu-Natal province. Methods A qualitative study was conducted with one hundred and sixty-one (161) healthcare providers (HCPs) within 18 healthcare facilities in three subdistricts, comprising of Managers, Nurses, and Lay workers. HCPs were interviewed using an open ended-survey questions to explore their perceptions providing HIV care under the UTT strategy. All interviews were thematically analysed using both inductive and deductive approaches. Results Of the 161 participants (142 female and 19 male), 158 (98%) worked at the facility level, of which 82 (51%) were nurses, and 20 (12.5%) were managers (facility managers and PHC manager/supervisors). Despite a general acceptance of the UTT policy implementation, HCPs expressed challenges such as increased patient defaulter rates, increased work overload, caused by the increased number of service users, and physiological and psychological impacts. The surge in the workload under conditions of inadequate systems’ capacity and human resources, gave rise to a greater burden on HCPs in this study. However, increased life expectancy, good quality of life, and immediate treatment initiation were identified as perceived positive outcomes of UTT on service users. Perceived influence of UTT on the health system included, increased number of patients initiated, decreased burden on the system, meeting the 90-90-90 targets, and financial aspects. Conclusion Health system strengthening such as providing more systems’ capacity for expected increase in workload, proper training and retraining of HCPs with new policies in the management of patient readiness for lifelong ART journey, and ensuring availability of medicines, may reduce strain on HCPs, thus improving the delivery of the comprehensive UTT services to PLH

Telegestão de rede de rega em aproveitamentos hidroagrícolas

Dissertação de mestrado, Engenharia Eléctrica e Electrónica, Instituto Superior de Engenharia, Universidade do Algarve, 2016O apoio ao desenvolvimento da agroindústria está na génese do Grupo Hubel, quer na vertente agronómica quer nas vertentes tecnológicas, como por exemplo telecomunicações, tecnologias de informação e automação. A agroindústria carece de tecnologias fiáveis, eficientes, inovadoras e competitivas de modo a dar resposta às crescentes necessidades desta indústria para possibilitar um aumento de eficiência e rentabilidade. Dentro da agroindústria, a agricultura está a assistir a uma revolução tecnologia denominada “Agricultura de Precisão”, esta agricultura assenta na premissa que é possível medir, prever e actuar em todos os factores que interfiram com o bom desenvolvimento das culturas de modo a minimizar os riscos de perdas de capitais e racionalização dos recursos naturais disponíveis. Para melhor gerir, armazenar, contabilizar e racionalizar a água para a rega, foram criados em Portugal diversos aproveitamentos hidroagrícolas, com especial incidência na zona de influência da barragem do Alqueva. Enquanto colaborador do Grupo Hubel, tive o privilégio de participar no projecto e na construção de vários destes aproveitamentos, ao nível da automatização das redes de rega e no desenvolvimento de sistemas de informação para o seu controlo e gestão. No presente relatório descrevo essencialmente as actividades, enquanto profissional de engenharia, que desenvolvi na concepção e instalação dos sistemas de automatização acima referidos. Dando especial enfoque ao projecto, à análise de soluções e de arquiteturas de comunicação e de automação, realçando os aspectos de aquisição e comunicação de dados. Por último, efectuo uma pequena abordagem às redes LPWAN em que assentam a maioria das soluções IoT

Evidence of past and current collaborations between traditional health practitioners and biomedical health practitioners: a scoping review protocol

Introduction Healthcare seekers around the globe use more than one healthcare system, with most using the traditional and the Western approaches concurrently. To date, little collaboration between the two systems has taken place within the mental health space compared with other areas of medicine. In order to inform integrating plans for traditional health practitioners and biomedical health practitioners in the South African mental health system, it is important to know which models of collaboration are used in other medical settings and contexts. This study aims to document global evidence on collaboration practices between traditional health practitioners and biomedical professionals when working with various health conditions.Methods and analysis This scoping review will be guided by an improved Arksey and O’Malley framework, the 2010 Levac et al methodological framework and the 2017 Joanna Briggs Institute guidelines. A systematic literature search will be carried out using seven different databases, EMBASE, PubMed, LILACS MEDLINE, APA PsycArticles, CINAHL Plus, Academic Search Complete and Scopus, in addition to the WHO repository, bibliographical search engines, and Open Access Theses and Dissertations. Moreover, the references of relevant publications between January 1978 and March 2020 will be scanned. Two reviewers will independently screen articles for eligibility based on the predetermined inclusion and exclusion criteria. Thematic analysis and descriptive numerical analysis will be performed using ATLAS.ti V.8 and Excel software, respectively. The results for this review will be presented using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis: Extension for Scoping Review.Ethics and dissemination This study will not require ethics approval because publicly available material will be used. Study findings will be published in an open-access journal and be presented to other key health system stakeholders and academic research gatherings

Autonomy and infant feeding decision-making among teenage mothers in a rural and urban setting in KwaZulu-Natal, South Africa

Abstract Background The nutritional status of infants born to teenage mothers can be sub-optimal compared to those born to older mothers. One contributing factor is inappropriate feeding practices adopted by teenage mothers. Little is known about how infant feeding decisions are made among teenage mothers, particularly in under resourced settings. In this study we prospectively explored autonomy and infant feeding decision-making among teenage mothers in a rural and urban setting in KwaZulu-Natal, South Africa. Methods This study adopted a qualitative longitudinal design. Thirty pregnant participants were recruited to the study cohort, from the catchment area of two hospitals (one urban and one rural). Participants were purposively selected to include teenagers, HIV positive, and working pregnant women. We report findings from ten teenage mothers, aged between 15 and 19 years, who participated in the larger cohort (n = 5 rural; n = 5 urban). Monthly in-depth interviews were conducted with participating mothers for 6 months starting 2 weeks after delivery. All interviews were conducted in the local language, transcribed verbatim and translated into English. Data was coded using NVivo v10 and framework analysis was used. Results Findings from this study showed that teenage mothers had knowledge about recommended feeding practices. However, our findings suggest that these mothers were not involved in infant feeding decisions once they were at home, because infant feeding decision-making was a role largely assumed by older mothers in the family. Further, the age of the mother and financial dependency diminished her autonomy and ability to influence feeding practices or challenge incorrect advice given at home. Most feeding advice shared by family members was inappropriate, leading to poor infant feeding practices among teenage mothers. Returning to school and fear of breastfeeding in public were also barriers to exclusive breastfeeding. Conclusion Teenage mothers had a limited role in the infant feeding decision-making process. Health workers have an important role to play in ensuring that knowledge about infant feeding is shared with the mother’s family where infant feeding choices are made. This will improve support for teenage mothers, and may also positively impact on the nutritional status of children

Enhancing linkage to HIV care in the “Universal Test and Treat” era: Barriers and enablers to HIV care among adults in a high HIV burdened district in KwaZulu-Natal, South Africa

Abstract Ending AIDS by 2030 would depend on how successful health systems are in linking people living with HIV (PLHIV) into care. The World Health Organization recommended the ‘Universal Test and Treat’ (UTT) strategy – initiating all individuals testing positive on antiretroviral therapy (ART) irrespective of their CD4 count and clinical staging. This study aimed to explore the enablers and barriers to linkage to HIV care among adults with a new HIV diagnosis in a high-HIV prevalent rural district in South Africa. A qualitative study was undertaken to explore patients’ perceptions of enablers and barriers of linkage-to-care, using a life-story narration and dialogue approach. In-depth interviews were conducted with 38 HIV-positive participants sampled from a cohort of 1194 HIV-positive patients recruited from December 2017 to June 2018. Participants were selected based on whether they had been linked to care or not within 3 months of positive HIV diagnosis. Interviews were thematically analysed using a general inductive approach. Of the 38 participants, 22 (58%) linked to care within three months of HIV-positive diagnosis. Factors that facilitated or inhibited linkage-to-care were found at individual, family, community, as well as health systems levels. Enablers included a positive HIV testing experience, and assistance from the fieldwork team. Support from family, and friends, as well as prior community-based education about HIV and ART were also noted. Individual factors such as acceptance of HIV status, previous exposure to PLHIV, and fear of HIV progressing, were identified. Barriers to linkage included, denial of HIV status, dislike of taking pills, and preference for alternative medicine. Negative experiences with counselling and health systems inefficiency were also noted as barriers. Perceived stigma and socio-economic factors, such as lack of food or money to visit the clinic were other barriers. Community-based and health system-level interventions would need to focus on clinic readiness in providing patients with necessary and effective health services such as proper and adequate counselling. This could increase the number of patients who link to care. Finally, interventions to improve linkage-to-care should consider a holistic approach, including training healthcare providers, community outreach and the provision of psychological, social, and financial support