Navigating multiple sources of healing in the context of HIV/AIDS and wide availability of antiretroviral treatment: a qualitative study of community participants’ perceptions and experiences in rural South Africa

Background: South Africa introduced the world’s largest antiretroviral treatment (ART) program in 2004 and since 2016 the Department of Health implemented a universal Treatment as Prevention (TasP) strategy. However, some studies have shown that increasing the availability of ART is insufficient for the comprehensive treatment of HIV, since many people still use traditional health practitioners (THPs) to avoid being identified as HIV positive, and for reasons unrelated to HIV/AIDS. This qualitative study explored the factors influencing how both HIV-negative and HIV-positive people choose amongst multiple sources of healing and how they engage with them, in the context of HIV/AIDS and wide availability of ART. Methods: Data were collected as part of a larger TasP trial at the Africa Health Research Institute, KwaZulu-Natal. Repeat in-depth individual interviews were conducted with 10 participants. Repeat group discussions were conducted with 42 participants. Group discussion data were triangulated using community walks and photo-voice techniques to give more insight into the perceptions of community members. All data were collected over 18 months. Thematic analysis was used to analyze participants’ narratives from both individual interviews and group discussions. Findings: In the context of HIV/AIDS and wide availability of ART, use of biomedical and traditional healing systems seemed to be common in this locality. People used THPs to meet family expectations, particularly those of authoritative heads of households such as parents or grandparents. Most participants believed that THPs could address specific types of illnesses, especially those understood to be spiritually caused and which could not be addressed or cured by biomedical practitioners. However, it was not easy for participants to separate some spiritually caused illnesses from biological illnesses in the context of HIV/AIDS. These data demonstrate that in this context, the use of THPs continues regardless of the wide availability of ART. To meet the health care needs of those patients requiring a health care system which combines biomedical and traditional approaches, collaboration and integration of biomedical and traditional health care should be considered

Traditional health practitioners’ management of HIV/AIDS in rural South Africa in the era of widespread antiretroviral therapy

Background: Traditional health practitioners (THPs) have been identified as a key local resource in the fight against HIV/AIDS in South Africa. However, their approaches to the treatment of people living with HIV (PLHIV) have been met with skepticism by some biomedical practitioners amidst increasing access to antiretroviral treatment (ART). In light of this ambivalence, this study aims to document and identify treatment approaches of THPs to the management of illness among PLHIV in the current era of widespread access to ART. Methods: The study was conducted as part of a larger trial of treatment as prevention (TasP) in rural northern Kwa-Zulu Natal, intended to treat PLHIV regardless of CD4 count. Nine THPs were enrolled using purposive and snowballing techniques. Repeat group discussions, triangulated with community walks and photo-voice techniques were conducted. A thematic analysis approach was used to analyse the data. Results: Eight of the nine THPs had received training in biomedical aspects of HIV. THPs showed a multilayered decision-making process in managing illness among PLHIV, influenced by attributes and choices of the THPs. THPs assessed and managed illness among PLHIV based on THP training in HIV/AIDS, THP type, as well as knowledge and experience in the traditional healing practice. Management of illness depended on the patients’ report of their HIV status or willingness to test for HIV. Conclusions: THPs’ approaches to illness in PLHIV appear to be shifting in light of increasing exposure to HIV/AIDS-related information. Importantly, disclosure of HIV status plays a major role in THPs’ management of illness among PLHIV, as well as linkage to HIV testing and care for their patients. Therefore, THPs can potentially enhance further success of antiretroviral therapy for PLHIV when HIV status is known

An outcome evaluation of Living Through Learning's Coronation Reading Adventure Room Programme

This dissertation was an outcome evaluation of the Living Through Learning's Coronation Reading Adventure Room Programme. LTL's reading programme objectives include aspects of improving and developing English literacy in disadvantaged schools, teaching learners how to read and write and equipping teachers with the necessary skills to teach effectively. LTL also provides facilitators to offer assistance to the teachers in order to teach effectively in overcrowded classes. The main programme beneficiaries are teachers and grade one learners. This dissertation focuses on 18 schools in disadvantaged communities in Cape Town who received the literacy programme in 2015. Two evaluation questions were formulated, for the literacy programme. The first evaluation question focused on the learners and assessed whether or not the learners who were part of the CRAR programme were better off regarding literacy performance than they were before the programme. For the teacher characteristics, the evaluation question asked if the teachers' language teaching experience, English language proficiency, teaching self-efficacy, perceptions of usefulness of the LTL materials, and usage of the reading room had any influence on the learner's performance. Secondary data provided by LTL was utilised to answer the literacy programme evaluation question. The data included test scores of grade 1 learners from 18 different schools. Primary data was used for teacher's characteristics and this was done through a questionnaire sent out to the different teachers. Data analysis methods included descriptive statistics for the learners' assessments and inferential statistics for teacher characteristics. The results showed that learners who were part of the LTL programme showed improvement in assessment scores. All schools, except one, attained the realistic NGO (60%) standard in their reading assessments. Three schools attained the high standard (85%). Furthermore, all schools attained the 50% Curriculum Assessment Policy Statements standard in the CAPS based-assessments. Therefore, it can be concluded that the LTL programme successfully aided improvement of literacy skills of the learners who were part of the programme. In an analysis of teacher's characteristics, teacher experience in literacy was the only variable that significantly predicted learner performance in literacy. However, the results must be interpreted with caution; the absence of a comparison group makes it difficult to give all credit to the LTL programme alone. At this point I simply do not know whether it was only the programme that led to the improvement in literacy scores or whether other factors had an influence, or a joint influence in combination with the literacy programme (e.g. learners started reading more in their own time as a result of the programme)

"Contingent organisation" on the East Rand : new labour formations organising outside of trade unions, CWAO and the workers' Solidarity Committee.

Research report for the degree of Master of Arts in Industrial Sociology, submitted to the Faculty of Humanities, University of the Witwatersrand, JohannesburgThis research paper studied the recent labour unrest in the East Rand as there has been a rise in the number of marches and demonstrations led by the precarious workers to several workplaces. [No abstract provided. Information taken from introduction]201

HR Governance for Sustainable Human Resource Development: Evidence from Private Sector of Bangladesh

HR governance is the practice of making effective decisions regarding the human resources of the organization and the efficient controlling of them. It is interrelated with establishing HR policies, continuous monitoring of their proper implementation and governing the body of an organization. This study explores the HR governance practice of the private sector in Bangladesh and its impact on organization’s sustainable human resource development. To investigate this scenario, sample size of 200 from five manufacturing industries and three service industries both sectors were selected to conduct a survey through floating a structured questionnaire on target employees. Here, six independent variables talent management, consolidated HR policy, HR risk management, employee development, compensation benefits, employee welfare and one dependent variable sustainable human resource development have been identified to conduct the regression analysis. The result shows that the f-test value = 34.400 which implies that the model is statistically significant and valid. The significance level of the employee development and compensation benefits at (0.000) which have positive impact on sustainable human resource development. On the contrary, the talent management is insignificant at (0.006) and consecutively consolidated HR policy (0.019), HR risk management (0.063) and employee welfare (0.106). The regression model illustrates that the private sector of Bangladesh is going to be comparatively more concern about the employee development and compensation management but others variables have insignificant but positive relationship for the increasing of sustainable human resource development. Moreover, this study attempts to provide the conceptual and pragmatic insight of the HR governance practices in the private sector of Bangladesh; this might help to emerge new corridors for future research. Keywords: HR governance, talent management, consolidated HR policy, HR risk management and sustainable human resource development

Industrial development in a high tech sector of a developing country: the unfinished technological transition in the Brazilian vaccine industry

This thesis investigates the development of the Brazilian vaccine industry. This industry has experienced a sharp growth in the last decades supported by public policies and a protected and fast-growing public market. In addition, this development is apparently characterized by continuous processes of technology acquisition, rather than indigenous R&D, as the main source of its technological knowledge, and by other specificities in the vaccine context. The research draws on studies of the dynamics of technological capability building in catching-up industries of latecomer contexts, especially during the transition period when they are approaching the innovation frontier. It also draws on those studies focusing on new directions/paths as an alternative strategy adopted to overcome barriers and disadvantages to develop. It has been argued that the specificities of the Brazilian context and, of the vaccine sector, may be determining a particular pattern of technological accumulation to this industry, and that interpreting its pattern of development may be useful to understand how and if this industry has overcome its constraints to develop. A framework based on linear approaches of catching-up, and that integrates the innovation transition approach was built as a benchmark model for the search for similarities and differences in the pattern of development of this industry. The findings show similarities and new directions in the process of technological accumulation of the industry, suggesting that, more recently, it has actually developed through a distinct pattern. They also show the strong role of the government and its public market as one of the drivers of this new path. Distinct roles of the technology acquisition strategy and a high level of technological capabilities currently developed are also revealed. Finally, they show that the technology acquisition strategy has effectively contributed to the development of this industry and that the constraints to the completion of the transition phase is linked less to technical and scientific issues and more to managerial and policy ones

Relevansi Pemikiran Pendidikan Ki Hajar Dewantara dengan Layanan Bimbingan Konseling dalam Konteks Kurikulum Merdeka

Pemikiran Ki Hajar Dewantara juga yang menjadi pokok di cetuskannya kurikulum merdeka. Kurikulum merdeka menjadi alternatif solusi bagi pendidikan di Indonesia, sebab Indonesia yang memiliki beragam adat istiadat, sumber daya alam yang berbeda di tiap daerah, serta keberagaman agama dan ekonomi. Adanya kurikulum merdeka di harapkan pendidikan dapat berjalan sesuai dengan ciri khas masing-masing daerah dan tentunya mengikuti perkembangan zaman yang ada di masing-masing daerah. Sehingga kegiatan belajar mengajar di rasa nyaman dan menyenangkan bagi guru maupun peserta didik. Tulisan ini di tulis untuk menguraikan dan sebagai sumber referensi pelaksanaan layanan bimbingan konseling di sekolah dalam konteks kurikulum merdeka, serta menguraikan relevansinya dengan pemikiran Ki Hajar Dewantara. Penelitian ini menggunakan pendekatan kualitatif dengan jenis penelitian adalah deskriptif. Studi deskriptif bertujuan untuk menjelaskan populasi, situasi, atau fenomena secara akurat dan sistematis. Sumber data pada penelitian ini adalah sumber data primer dan sekunder. Dalam penelitian ini terdapat tiga informan yang merupakan guru BK di salah satu sekolah di Sidoarjo yang menerapkan kurikulum merdeka. Hasil penelitian ini adalah relevansi pemikiran Ki Hajar Dewantara dengan layanan bimbingan konseling di sekolah dan penerapan layanan bimbingan konseling dalam kurikulum merdeka

Equity in maternal health in South Africa: analysis of health service access and health status in a national household survey

Background: South Africa is increasingly focused on reducing maternal mortality. Documenting variation in access to maternal health services across one of the most inequitable nations could assist in re-direction of resources. Methods: Analysis draws on a population-based household survey that used multistage-stratified sampling. Women, who in the past two years were pregnant (1113) or had a child (1304), completed questionnaires and HIV testing. Distribution of access to maternal health services and health status across socio-economic, education and other population groups was assessed using weighted data. Findings: Poorest women had near universal antenatal care coverage (ANC), but only 39.6% attended before 20 weeks gestation; this figure was 2.7-fold higher in the wealthiest quartile (95%CI adjusted odds ratio = 1.2-6.1). Women in rural-formal areas had lowest ANC coverage (89.7%), percentage completing four ANC visits (79.7%) and only 84.0% were offered HIV testing. Testing levels were highest among the poorest quartile (90.1% in past two years), but 10% of women above 40 or with low education had never tested. Skilled birth attendant coverage (overall 95.3%) was lowest in the poorest quartile (91.4%) and rural formal areas (85.6%). Around two thirds of the wealthiest quartile, of white and of formally-employed women had a doctor at childbirth, 11-fold higher than the poorest quartile. Overall, only 44.4% of pregnancies were planned, 31.7% of HIV-infected women and 68.1% of the wealthiest quartile. Self-reported health status also declined considerably with each drop in quartile, education level or age group. Conclusions: Aside from early ANC attendance and deficiencies in care in rural-formal areas, inequalities in utilisation of services were mostly small, with some measures even highest among the poorest. Considerably larger differences were noted in maternal health status across population groups. This may reflect differences between these groups in quality of care received, HIV infection and in social determinants of health

Adjusting the effect of integrating antiretroviral therapy and tuberculosis treatment on mortality for non-compliance : an instrumental variables analysis using a time-varying exposure.

Doctoral Degree. University of KwaZulu-Natal, Pietermaritzburg.In South Africa and elsewhere, research has shown that the integration of antiretroviral therapy (ART) and tuberculosis (TB) treatment saves lives. The randomised controlled trials (RCTs) which provided this compelling evidence used intent-to-treat (ITT) strategy as part of their primary analysis. As much as ITT is protected against selection bias caused by both measured and unmeasured confounders, but it is capable of drawing results towards the null and underestimate the e ectiveness of treatment if there is too much non-compliance. To adjust for non-compliance, \as-treated"and \per-protocol"comparisons are commonly made. These contrast study participants according to their received treatment, regardless of the treatment arm to which they were assigned, or limit the analysis to participants who followed the protocol. Such analyses are generally biased because the subgroups which they compare often lack comparability. In view of the shortcomings of the \as-treated"and \per-protocol"analyses, our objective was to account for non-compliance by using instrumental variables (IV) analysis to estimate the e ect of ART initiation during TB treatment on mortality. Furthermore, to capture the full complexity of compliance behaviour outside the TB treatment duration, we developed a novel IV-methodology for a time-varying measure of compliance to ART. This is an important contribution to the IV literature since IV-methodology for the e ect of a time-varying exposure on a time-to-event endpoint is currently lacking. In RCTs, IV analysis enable us to make use of the comparability o ered by randomisation and thereby have the capability of adjusting for unmeasured and measured confounders; they have the further advantage of yielding results that are less sensitive to random measurement error in the exposure. In order to carry out IV analysis, one needs to identify a variable called an instrument, which needs to satisfy three important assumptions. To apply the IV methodology, we used data from Starting Antiretroviral Therapy at Three Points in Tuberculosis (SAPiT) trial which was conducted by the Centre for the AIDS Programme of Research in South Africa. This trial enrolled HIV and TB co-infected patients who were assigned to start ART either early or late during TB treatment or after TB treatment completion. The results from IV analysis demonstrate that survival bene t of fully integrating TB treatment and ART is even higher than what has been reported in the ITT analysis since non-compliance has been accounted for