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This thesis is concerned with providing an overview of mathematical and computational techniques used to investigate the spread of sexually transmitted infections throughout heterogeneous populations. These techniques are then applied to issues arising in healthcare provision for a major UK city.

Variations in the incidence and prevalence of diagnosed sexually transmitted infections (STIs) across racial and ethnic groups have been described in many western industrialised settings. The reasons for these variations are unclear. However, an understanding of their determinants is required in order to develop and refine targeted HIV/STI prevention interventions. This thesis brings together a collection of studies exploring the relationship between ethnicity and the epidemiology of STIs (including HIV infection). It is divided into three main sections. Section one outlines the aims and objectives of the thesis explores concepts of race and ethnicity provides an historical and demographic overview of Black and ethnic minority communities in Britain and critically reviews and summarises the research evidence in this field. Section two outlines the rationale, methodology and outcomes of four studies developed to explore and quantify the nature and range of ethnic variations in sexual health outcomes in Britain. The concluding section summarises key themes arising from this work and relates findings back to set objectives. This thesis confirms the existence of variations in the prevalence of diagnosed STIs among Britain's main ethnic groups. The inequalities are found across a variety of settings, for both reported and prevalent diagnosed infections. Compared with the ethnic majority, adverse sexual health outcomes are more prevalent among Black British ethnic groups, and less so among Indians and Pakistanis. The collated studies confirm that ethnic differences in the prevalence and distribution of high-risk behaviours exist (particularly among men) and may, to a large extent, explain the variations in adverse outcomes. However, behaviour alone cannot account for the observed differences. Other factors, including patterns of health-seeking behaviour, genetic susceptibility, patterns of sexual mixing and background prevalence of disease also contribute, to the observed variations in incidence. Recommendations for future studies and interventions in this field are made.

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Thesis (M.Pharm.(Pharmacology)) --University of Limpopo, 2014. / Management of Sexually Transmitted Infections (STIs) in Private Pharmacies in Limpopo Province: Practice and Knowledge of Pharmacists Background: In 2001, the South African Pharmacy Council (SAPC) developed a strategic plan, which recognised the crucial role that pharmacists could play in controlling sexually transmitted infections (STIs) and the spread of HIV infection. In South Africa, patients seek and receive treatment for STIs from pharmacies despite a legal restriction (Ward, Pharm, Butler, Mugao, Klausner, Mcfarland, Chen & Schwarcz, 2003). Current legislation bars people to seek treatment from the pharmacists for certain acute illnesses, thus significantly influencing the spread of some infections with the view that the longer infections remain untreated, the more opportunities for transmissions to occur. The perceived lack of treatment options in private pharmacies may even prevent patients from accessing advice or preventative measures at the pharmacy level (Gupta, Sane, Gurbani, Bollinger, Mehendale & Godbole, 2010). It is against this background that the study was carried out with the aim of assessing the knowledge and practice of private pharmacists in management of sexually transmitted infections (STIs) in the Limpopo Province and ultimately assist in the reduction of the spread of HIV infections. Objectives: The objectives of the study were; to identify areas of weakness in services provided by pharmacists in management of STIs in private pharmacies; to identify possible pharmaceutical care of HIV; to determine the level of use of Department of Health Standard Treatment Guidelines of sexually transmitted infections by private pharmacy; to determine the availability of sexually transmitted infection drugs for treatment of STIs; and to identify the type of information given to clients with STI. Method: A cross-sectional design was used in this study. The study was carried out in the Limpopo Province, South Africa. Out of the population of 130 pharmacies registered with the SAPC in Limpopo, a sample of 23 was selected. The pharmacies were stratified according to where they were located. This study used a questionnaire designed as an instrument of data collection. The data was collected through a face-to-face interview with the responsible pharmacist in each pharmacy outlet. This study used Simulated Client Method to evaluate the practice. In this method, simulated male and female clients visited randomly selected Pharmacies. Two scenarios were developed for a male patient with urethral discharge and a female patient with vaginal discharge. The simulated clients on a standardised reporting form, outside the pharmacy, carefully recorded all observations made during the simulated scenario. Data analysis: The data were analysed using cross-tabulation techniques and chi-square test was used to check existence of association. Compliance with Standard Treatment Guidelines in terms of treating STI syndrome was used as dependent variable. Location (Rural and urban) of private pharmacies, the gender of the client in the simulated client method, treating genital ulcer syndrome (GUS), treating male urethritis syndrome (MUS) and treating female vaginal discharge syndrome were used as independent variables. The existence of association between the dependent and variable was tested using the Chi-square test of independence. Result: The results showed that 27% of private pharmacies in Limpopo treated and managed STIs clients in accordance with Standard Treatment Guidelines. The structured interviews results showed that 78% of private pharmacists in Limpopo knew the linkage between HIV and STIs. Only 39% of the private pharmacists knew about the existence of Standard Treatment Guidelines and used them in daily client consultations. Cross tabulation of data on compliance with Standard Treatment Guidelines in terms of treating STI syndrome (the dependent variable) and the location of private pharmacies (the independent variable) produced a Chi-square value of 1.31. This showed that the dependent variable had no association with location of independent private pharmacies. The study found that the treatment and management of GUS, MUS and female discharge varied according to location of the private pharmacies. The medicines stocked were in line with the Standard Treatment Guidelines in both rural and urban pharmacies in the Limpopo Province. There was very high demand for STI medication without a prescription averaging of 150 clients per week. Private pharmacies in both areas gave the necessary information to their clients focused on use condom with 54%, partner notification with 38% and only 27% of pharmacists advised client to consult the physician. The simulated client visits showed the discrepancy between knowledge and actual practice of the private pharmacists. Conclusion: The majority of private pharmacies operating in the Limpopo Province do not comply with the Standard Treatment Guidelines for treatment and management of STIs due to inadequate knowledge. While there is a need to train some pharmacists in the provision of primary health care for syndromic STI treatment in order to reduce STIs and HIV transmission, the lifting of current legal restriction in South Africa that prevents pharmacists from prescribing STI medication may be necessary. The knowledge and practice of incidence of specific infections in communities served by the specific pharmacy should be part of the pharmaceutical care provision.

This study is about evaluating the effectiveness of training in syndromic management ofSTDs. The purpose of this study was to fmd out to what extent the STD training programme had been implemented. A stratified sample of twenty-two primary health care clinics in the Port Shepstone region was used. Twenty-two professional nurses rendering STD management in the clinics were observed. Data-gathering was done through a clinic inventory obtained by interviewing the sister-incharge, observation of professional nurses providing treatment to STD patients, interviews with professional nurses to assess their knowledge of the syndromic approach, and exit interviews with patients treated at the clinic. The fmdings suggest that certain areas in the STD training need to be emphasized, such as vaginal speculum and bi-manual examinations. It is recommended that certain negative aspects which hinder effective STD management, like staff shortages and lack of equipment be given attention. / Health Studies / M.A. (Health Studies)

This study is about evaluating the effectiveness of training in syndromic management ofSTDs. The purpose of this study was to fmd out to what extent the STD training programme had been implemented. A stratified sample of twenty-two primary health care clinics in the Port Shepstone region was used. Twenty-two professional nurses rendering STD management in the clinics were observed. Data-gathering was done through a clinic inventory obtained by interviewing the sister-incharge, observation of professional nurses providing treatment to STD patients, interviews with professional nurses to assess their knowledge of the syndromic approach, and exit interviews with patients treated at the clinic. The fmdings suggest that certain areas in the STD training need to be emphasized, such as vaginal speculum and bi-manual examinations. It is recommended that certain negative aspects which hinder effective STD management, like staff shortages and lack of equipment be given attention. / Health Studies / M.A. (Health Studies)