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Item Acceptability and effectiveness of rapid ART initiation: patients’ and healthcare workers’ perspectives.(2022) Govere, Sabina May.; Chimbari, Moses John.The Joint United Nations Programme on HIV/AIDS is leading the global effort to end AIDS as a public health threat by 2030. In achieving these goals, emphasis has been on the 95–95–95 targets that by 2030, 95% of people living with HIV know their HIV status. However, the focus is on achieving the second 95 and third 95; having 95% of people diagnosed with HIV initiating on treatment within the expected timeframe and 95% of those on treatment obtaining a suppressed viral load. Commendable efforts have been made in increasing HIV testing numbers however, same day initiation on treatment and achieving viral load suppression remains a challenge. According to the WHO recommendations; same day (ART) initiation should be offered to all people living with HIV following a confirmed diagnosis. This study determined the factors influencing the acceptability and implementation of Universal Test and Treat by both patients and healthcare workers. Universal Test and Treat is a prevention strategy encourages that if a person tests HIV positive, irrespective of the persons CD4 count and clinical staging at the time of testing they will have to begin treatment immediately. Furthermore, patient’s clinical outcomes following test and treat in eThekwini municipality in KwaZulu-Natal were determined. This study was cross-sectional and used prospective - mixed methodology to collect data from 403 patients who either accepted or deferred same day ART initiation from June 2020 to May 2021. A structured questionnaire was used to collect demographic information, sexual behaviour, acceptance of same day ART initiation and knowledge of Universal Test and Treat on the day of HIV diagnosis. Key informant in-depth interviews were conducted with healthcare workers and patients were followed up at 6 months after HIV diagnosis to determine clinical outcomes for both groups, rapid and deferred ART initiators using medical charts and electronic databases. Two different analysis univariate and multivariate logistic regression were performed to examine associations between same day ART initiation and several explanatory factors. Logistic regression was performed to examine associations between same day ART initiation and several explanatory factors, retention in care, clinical outcomes and facility related factors. Thematic analysis was used to assess experiences, knowledge and observations of healthcare workers in implementing the Universal Test and Treat policy. Among the 403 participants same-day initiation was 69.2% (n=279). In an adjusted analysis (age, gender, level of education were adjusted at 0.5 significance level in univariate level) number of sexual partners (aOR: 0.35; 95% CI: 0.15-0.81), HIV status of the partner (aOR: 5.03; 95% CI: 2.74-9.26), knowledge of universal test and treat (aOR: 1.97; 95% CI: 1.34-2.90), support from non-governmental organizations (chi-square = 10.18; p-value= 0.015 and provision of clinic staff (chi-square = 7.51; p value = 0.006) were identified as major factors influencing uptake of same-day ART initiation. In the bivariate analysis; gender (OR: 1.672; 95% CI: 1.002–2.791), number of sexual partners (OR: 2.092; 95% CI: 1.07–4.061), age (OR: 0.941; 95% CI: 0.734–2.791), ART start date (OR: 0.078; 95% CI: 0.042–0.141) and partner HIV status (OR: 0.621; 95% CI: 0.387–0.995) were significantly associated with viral load detection and retention in care. (All variables that were significant at e.g. 0.5 level in univariate). Our results suggest a steady increase in uptake of same day ART initiation with poor retention in care. The results also emphasise a vital need to not only streamline processes to increase immediate ART uptake further but also ensure retention in care in order to meet the 95-95-95 targets. The findings of the study contribute to knowledge useful for strengthening rapid ART initiation implementation by considering individual patient factors, healthcare workers’ perspectives and facility level factors. The qualitative findings revealed variations in UTT knowledge, experiences and observations among diverse healthcare workers from the four clinics in different geographical settings. While training on UTT and SDI of ART initiation was conducted at the inception of the implementation phase, the understanding and interpretation varied especially between clinicians and non-clinical healthcare providers. Denial, feeling healthy, fear of disclosure, limited knowledge about ART, fear of ART side effects, fear of stigma and discrimination were some of the factors HCW observed as hindering uptake of SDI. These findings relate to some of the reasons given by patients with fear of disclosure frequently mentioned by those who deferred SDI of ART.Item Experience of forgiving in Indian marriages: a qualitative inquiry.(2022) Essop, Karshila.; Hlengwa, Wellington Mthokozisi.This research study concentrated on understanding the experience of forgiving in Indian marriages in Durban, KwaZulu Natal. The qualitative research study involved eight participants who were interviewed using a semi-structured interview schedule. With the consent of each participant, every interview was recorded utilising an audio recorder and then later transcribed by the researcher. The ecological systems theory was utilised as a framework for the study. The data that was obtained during the data collection period was evaluated, analysed and organised through thematic analysis. This assisted the researcher to organise data into themes, sub-themes and sub-sub-themes. The five themes that were discovered and discussed are: Understanding forgiveness, the experience of forgiving, the psycho-social influences of forgiving, dominant cultural influence and improvement of forgiveness in Indian marriages. The research study found that the participants experienced forgiving more positively than negatively. Forgiveness allowed for trust to be rebuilt in marriages and paved the way for harmony in both spousal and/or family systems. The research study found that reconciliation in Indian marriages plays a vital role and affects every participant’s family system, spousal system, psychological health and well-being. A strong correlation between forgiveness and personality was drawn indicating that personality is one of the more significant influences on forgiving. More so, social, cultural and theological influences were seen as strong motivators of forgiving in Indian marriages. Participants recommended marital counselling and face-to-face conversations about transgressions created between spouses to assist marital forgiveness in Indian marriages. Through the limitations of the research study discussed in chapter six, it is proposed that further research on the experience of forgiving in Indian marriages should be conducted.Item Mapping the integration of the fields of mental health and psychosocial support with peacebuilding through co-creation.(2022) Dlamini, Noxolo Zanele.; Sliep, Yvonne.; Makhakhe, Nosipho Faith.Protracted conflict, combined with the resultant psychological scarring have been a part of present life for many societies. Historically Peace Building and MHPSS (Mental Health and Psychosocial Support) have been used to address the effects of conflict separately, yet they offer different yet complementary solutions to the problem. The purpose of this research was to explore the integration of MHPSS and PB from the viewpoint of the participants of cocreation workshops conducted in 2019 and 2021 on the same topic. A qualitative descriptive design was utilised in this study as it allowed the researcher to explore how the participants responded to the co-creation methodology used in the workshops while gaining insight into their opinions on integration. The study was conducted using documented reports and transcripts of the co-creation workshops, followed by in-depth online interviews. A thematic analysis was used, and findings show that changing funding mandates were necessary as these impact on what humanitarian work is done. Through advocacy, information sharing, and policy change, the way in which donors approach this work could be changed. Much needs to be done to capacitate those working in the field and to raise awareness of the value of linking these disciplines. Greater understanding between the two fields and knowledge of the language, theories and tools used will need to be shared. The co-creation method that was used for the present study seems to have benefitted the process of integration in the participating organisations, through reflection, information sharing, research and writing.