Thesis (MMed (Medical Microbiology))--University of Stellenbosch, 2006. / One of the major routes of transmission of human immunodeficiency virus (HIV) in the developing world is vertical transmission from mother to infant – pre-, intra-, or post-partum. In the Western Cape, HIV-1 subtype C is the predominant subtype in the heterosexual population, and this trend was expected to be seen amongst cases of mother-to-child transmission of HIV. The aim of this study was to perform genetic characterisation and phylogenetic analysis of the HIV-1 genome in positive serum/plasma samples obtained from children (age 0 to 18 months) from 2000-2002, and temporally related specimens from their mothers. We obtained 27 suitable pairs of samples taken within 6 months of delivery. From this pool, we obtained 21 infant DNA sequences and 17 maternal sequences, resulting in 16 mother-infant pairs. All patient sequences were identified as HIV-1 subtype C, and, as expected, mother and infant viral sequences clustered together. In some cases where a mother was suspected to have two dominant quasispecies based on the electropherogram, only one sequence was detectable in the infant. Single or multiple amino acid deletions were consistent between mothers and infants, and some pairs showed the same amino acid deletions seen in other pairs.

Thesis (MBA)--Stellenbosch University, 2003. / Some digitised pages may appear illegible due to the condition of the original hard copy / ENGLISH ABSTRACT: After sexual transmission of HIV, mother-to-child (MTCT) transmission is the most common cause of HIV infection in South Africa. The Western Cape government, through the Premier, has committed itself to providing access for all HIV positive women in the province attending antenatal clinics to MTCT prevention programmes by the end of 2003. The MTCT prevention programme is aimed at intervening transmission during pregnancy, during the birth of the baby and post delivery during breast-feeding of the newborn baby. The HIV virus attacks and destroys the cells of the immune system by being incorporated into the reproductive cycle of the cell. Antiretroviral drugs in the fight against HIV target two aspects of this replication cycle of the virus and as such do not halt the infection but slow it down by preventing the replication of the virus. MTCT internationally has been reduced dramatically by the use of antiretroviral drugs (AZT) antenatally, during birth and post-natally for mother and baby. However this regimen was found to be not suitable for resource-poor countries due to the complexity in administration, compliance and costs. Poor countries have developed alternative MTCT prevention programmes based on shorter course regimens and on alternative antiretroviral drugs. MTCT prevention In South Africa initially did not have the support of the national government. However, the -Western Cape Administration had developed a regional programme phasing in MTCT prevention at all state clinics within the province. The cost drivers associated with the MTCT prevention programme include costs associated with the HIV tests, costs for pre- and post-test counselling, costs for the antiretroviral drugs and costs for substitute feeding to replace breast-feeding to prevent viral transmission during breast-feeding. Depending on the option exercised, costs can be calculated per HIV positive baby averted. As regards substitute feeding, which is a substantial cost driver and a major disadvantage to the newborn baby as regards protection from common childhood diseases such as diarrhea, research from Tanzania showed that ARV therapy during childbirth could suppress HIV transmission through breast-feeding during the first few weeks after childbirth, thus enabling an optimal combination of breast-feeding in the first few crucial weeks of the newborn's life for the protective benefits of breast-milk and formula feeding thereafter to ensure protection for the infant from HIV transmission through breastfeeding. The data were subjected to a sensitivity or a "what-if' analysis usmg an Excel spreadsheet. Costs per HIV averted were calculated for each assumed parameter in the model that was developed. As regards prevalence, the MTCT prevention programme is most cost effective at the lower levels of the seroprevalence of HIV in the population served. If the seroprevalence is above the "cross-over" or "optimal" point for the regimen an alternative regimen should be assessed. As regards levels of identification and number accepting intervention the principle of an economy of scale applies and therefore, a level of 100 percent in both cases should be targeted. This will be dependent on wide scale advertisements and support for the programme with active efforts to destigmatise the infection. Innovative programmes such as the mothers-to-mothers-to-be (M2M2B) programme must be encouraged. / AFRIKAANSE OPSOMMING: Na seksuele oordraging van HIV is moeder tot kind (MTK) oordraging die algemeenste rede van HIV infeksie in Suid Afrika. Die Wes-Kaapse regering, deur die Premier, het hulself verbind om toegang vir alle HIV positiewe vroue in die provinsie, wat voorgeboorte klinieke bywoon, tot MTK voorkomingsprogramme voor die einde van 2003 moontlik te maak. Die MTK voorkomingsprogram is gerig op die tussenkoms van transmissie gedurende swangerskap, gedurende die geboorte en die nasorg tydens die borsvoeding periode van die pasgebore baba. Die HIV virus val die selle van die immuun sisteem aan en' vernietig dit. Die virus word geïnkorporeer tot die reproduksie siklus van die sel. Antiretrovirale wat teen die virus gerig is, is gerig teen twee aspekte van die replikasie siklus van die virus en sodoende sal die medikasie die infeksie nie staak nie, maar eerder vertraag as gevolg van die voorkoming van die replikasie. Moeder-tot-kind infeksie is internasionaal drasties verminder deur die gebruik van antiretrovirale (AZT) gedurende die tydperk voor geboorte, gedurende die geboorte en gedurende nasorg van die moeder en baba. Hierdie regimen is egter nie altyd moontlik in arm lande nie vanweë die kompleksiteit van die administratiewe toepassing en kostes. Arm lande het alternatiewe MTK voorkomingsprogramme ontwikkel, gebaseer op korter kursusse en alternatiewe antiretrovirale. Die voorkoming van MTK infeksie in Suid-Afrika het eers nie die ondersteuning van die nasionale regering geniet nie. Die Wes-Kaapse Adminstrasie het onafhanklik van die nasionale regering, streeksprogramme ontwikkel vir die infasering van MTK voorkoming in alle klinieke in die Provinsie. Die kostedrywers wat met MTK voorkomingsprogramme geassosieer word, sluit in die koste van HIV toetse, koste van voor-en-na toets berading, koste van die antiretrovirale en alternatiewe voeding om virale transmissie te voorkom gedurende die tydperk van borsvoeding. Afhangende van die opsies wat gebruik is, kan die koste van elke baba wat nie HIV opdoen nie, bereken word. Sover dit alternatiewe voeding aangaan, wat 'n belangrike kostedrywer is en 'n nadeel vir elke baba is sover dit teen beskerming van algemene kindersiekte soos diarrhea gaan het navorsing in Tanzanië bewys dat ARV terapie gedurende geboorte ook HIV transmissie deur borsvoeding gedurende die eerste paar weke na geboorte onderdruk wat 'n optimale kombinasie van borsvoeding in die eerste paar kritiese weke van die nuutgebore baba se lewe vir die beskermende voordele van moedersmelk en formulêre voeding daarna te versterk met beskerming van die baba teen HIV transmissie deur borsvoeding. Deur die gebruik van 'n Excel werkblad en 'n "wat as" metode van analiese koste van HIV opdoen in bereken word vir elke aanvaarding. Sover dit voorkoms betref is die MTK voorkomingsprogramme die mees effektief hoe laer die "seroprevalence" van HIV in die populasie gedien word. As die "seroprevalence" hoër as die optimale punt is, moet 'n ander metode bereken word. Sover dit die mate van identifisering en hoeveelheid die tussenkoms aanvaar in 'n mate van 100 persent moet in beide gevalle die mikpunt wees. Dit sal afhang van grootskaalse advertensies en ondersteuning van die programme met bedrywige pogings om die' infeksie te destigmatiseer. Nuwe programme soos die moeder tot nuwe moeder (M2M2B) program moet aangemoedig word.

In this dissertation I provide an ethnographic account of the testimony of four expert witnesses who appeared before the Commission of Inquiry on the Blood System in Canada (the Krever Inquiry) as they described the production of scientific knowledge and the role that knowledge played in the struggle to protect the blood supply from being contaminated by AIDS during the early 1980's. In doing so, I bring together the experts' testimony with contemporary documents gathered by the Commission and interviews I conducted with participants in the proceedings. Using insights drawn from the disciplines of anthropology, sociology, and history, I explore what the witnesses' accounts reveal about their understandings of their professional world and its relationships with other worlds, especially that of public health policy making. The Krever Inquiry offered a valuable opportunity for carrying out such an investigation. It provided a site where science was not only used, it was talked about. The Inquiry invited those involved in the blood system in the early 1980's to reflect upon and explain the beliefs and actions which surrounded one of the worst public health disasters in Canadian history and it asked the witnesses how similar catastrophes could be avoided in the future. As a result, many of the issues addressed at the hearings reflect matters of current concern in public health and medicine. The Inquiry addressed difficult issues surrounding the nature of scientific knowledge and its application in health decision-making and policy formulation. This study, therefore, may be of interest to those dealing with the problems surrounding uncertainty and the management of public health crises. It may also be of interest to those dealing with conflicts rising out of the intersection of different worlds of experience and practice, as well as to those involved in the current initiatives to both make medical and public health institutions more proactive, and inclusive, and public health decision-making more transparent.

Abstract: Introduction: Exclusive breastfeeding for the first six months of an infant's life is recommended worldwide. In 1998 the South African Demographic and Health Survey (SADHS) showed that only 10% of mothers exclusively breastfeed at three months. As the HIV virus is transmissible via breast milk, UNAIDS (2002) recommends that women in developing countries should be given a choice of feeding method after being counselled on the risks and benefits of breast feeding versus formula feeding. As a result, the Prevention of Mother-to-Child Transmission (PMTCT) programme was launched in KwaZulu-Natal with the aim of providing interventions to prevent Mother-to-Child Transmission of the HIV virus. However, research has shown that infant feeding practices are influenced by numerous factors. Ultimately mothers will feed their infants in a manner they feel comfortable with, even if it is not always the most appropriate choice. Aim: The aim of this study was to determine and compare current infant feeding practices and some of the factors that influenced these practices among Zulu mothers with 0 - 6 month old infants attending PMTCT and non-PMTCT clinics in Central Durban, KwaZulu-Natal. Methodology: A cross-sectional, descriptive survey was conducted amongst 150 mothers sampled from three non-PMTCT clinics and 150 mothers sampled from three PMTCT clinics. Systematic random sampling of mothers attending the two types of clinics was used to ensure an equal number of mothers· with infants aged 0 - < 6 weeks, 6 - < 14 weeks and 14 weeks to 6 months. The number of mothers interviewed per clinic was determined proportionate to clinic size. Interviews were conducted in Zulu by trained fieldworkers according to a structured interview schedule consisting of 87 open- and closed-ended questions. Summary of most important findings and conclusion: Overall, one quarter of the mothers attending non-PMTCT and one third of mothers at PMTCT clinics were practising exclusive breastfeeding at the time of the survey. The general trend was that mothers attending PMTCT clinics were more inclined than those attending non-PMTCT clinics to breastfeed their infants exclusively (34% versus 24% respectively) or to formula feed (16,7% versus 12,7% respectively). Furthermore, there was a significant decline in exclusive breastfeeding and predominant breastfeeding with increasing infant age in both clinic groups. The opposite held true for mixed feeding and formula feeding in that infants were more inclined to mixed feeding or formula feeding with increasing infant age. In both clinic groups, exclusive breastfeeding was the method of choice in the 0 - < 6 week age category, while a preference for mixed feeding was shown in the 6 - < 14 week category. This trend persisted in the 14 week - < 6 month age category, especially in the non-PMTCT clinics, while there was a small but pronounced increase in formula feeding amongst PMTCT mothers. Although these findings can be explained as a result of implementing the PMTCT programme, the positive trends observed in non-PMTCT clinics serve as an indicator that the Integrated Nutrition Programme (INP) and Baby Friendly Hospital initiative have also had an impact on the feeding choices mothers make. Despite the limited duration of the PMTCT programme at the time of the study, indicators of the impact of the intervention include that a lower percentage of PMTCT mothers introduced foods and/or liquids in addition to breast milk to their infants before six months of age compared to non-PMTCT mothers. Furthermore, more mothers attending PMTCT clinics were shown how to breastfeed and were more likely to have received information about formula feeding. Despite these indicators of a positive impact of the PMTCT programme, the mean age for introducing liquids and/or solids in addition to breast milk was about six weeks and the incidence of this practice was very high for both groups. The similar incidence of formula feeding observed between the two clinic groups suggests the presence of constraints to safe infant feeding choices among mothers attending PMTCT clinics. As observed, infant feeding practices were still not ideal in either of the two clinic groups. However, the high level of antenatal clinic attendance documented for both groups serves as evidence that, if opportunities for providing mothers with appropriate infant feeding advice are utilized optimally, the antenatal clinic could serve as an ideal medium through which infant feeding education can take place, especially as the clinic-based nursing staff were cited as the most important source of infant feeding information by both groups of mothers in the antenatal and postnatal phases. The documented infant feeding practices should be interpreted against the backdrop of factors such as socio-demographic characteristics of the mothers, availability of resources such as social support from peers and significant others and reigning infant feeding beliefs that could influence infant feeding decisions. Predictors of exclusive breastfeeding in PMTCT and non-PMTCT clinics were determined by means of multivariate logistic regression analysis. Significant values were obtained for both clinic groups in terms of the infant not having received liquids in addition to breast milk. No additional predictors were found amongst mothers attending non-PMTCT clinics, however predictors amongst mothers attending PMTCT clinics included whether the mother had not visited the clinic since the infant's birth, whether she practiced demand feeding and whether she was experiencing stress at the time of the study. The limited number of predictors of exclusive breastfeeding documented in this study, especially among non-PMTCT mothers may be explained by the fact that infant feeding behaviour is multifactorial by nature and the interaction between factors that influence feeding choice is strong. / Thesis (M.Sc.)-University of KwaZulu-Natal, Pietermaritzburg, 2005.

In July 2011, The Malawi government started implementing an innovative PMTCT policy known as Option B+ strategy that provides universal lifelong ART for all HIV-infected pregnant and breastfeeding women regardless of clinical or immunological stage. Even though Option B+ strategy is a good choice for Malawi, there is fear that the programme may be affected by poor access, utilisation, adherence and retention. Aim: The aim of this study was to explore the lived experiences of HIV-positive women on Option B+ strategy in a selected district hospital in Malawi. Methodology: A Hermeneutics phenomenological approach was used in this study to explore the lived experiences of HIV-positive women on Option B+ strategy through in-depth interviews of five purposely sampled information rich sources. Interviews were audio-taped and transcribed, then manual data analysis using Giorgi’s approach was employed to identify meaningful segments and develop categories, themes and sub-themes. Results: The lifelong commitment was described as the most challenging aspect of Option B+ strategy. Participants demonstrated lack of knowledge and understanding of Option B+ strategy and its implications which rendered them poorly prepared and unready for the task. The un optional Opt-out HIV testing resulted in participants feeling left out in their own care, as health professionals dominated the care from HIV testing throughout the process. The importance of male involvement in PMTCT was revealed in promoting partner HIV testing, disclosure, support, and prevention of further HIV spread. Barriers to participation were described in terms of attitudes of health care workers, stigma and discrimination. Despite the overemphasised need for women to be supported on Option B+ strategy participants were not willing to seek available sources of formal support. / Thesis (M.N.)-University of KwaZulu-Natal, Durban, 2013.

Thesis (MNutr (Interdisciplinary Health Sciences. Human Nutrition))--Stellenbosch University, 2008. / Objective: Primary: To investigate the effect of pasteurisation on the composition of expressed breast milk from HIV positive mothers and its adequacy in relation to the growth of their VLBW premature infants. Methods: A descriptive, prospective case-controlled pilot study was performed in 3 regional state hospitals in the Western Cape, South Africa. The control and study groups consisted of 12 HIV negative and 11 HIV positive mothers, with their VLBW premature infants, respectively. All mothers (19 - 35 years old) belonged to the Xhosa ethnic group. All infants were born <34 weeks gestation and birth weight <1500g. Eight breast milk samples were collected on days 6, 7, 13, 14, 20, 21, 27 and 28 from all mothers during the first 28 days after birth. Breast milk was expressed by hand or pump from either the right or left breast. Half of each breast milk sample was kept raw. The remaining sample was Pretoria pasteurised, after which both samples were subdivided into 3 or 4 aliquots to determine energy, protein, carbohydrate, fat, folate, calcium, phosphorus, magnesium, sodium, otassium, iron, copper, zinc content and HI viral load (study group only). The mothers’ dietary intake during pregnancy and lactation was obtained by means of a quantitative food frequency questionnaire and repeated 24-hour recall respectively. The infants’ dietary intake was recorded daily. Mothers’ anthropometric measurements taken at study entry and exit were weight, height and mid-upper arm circumference. All infants’ daily weight, as well as length and head circumference at birth and on day 28 postpartum was obtained. Biochemical analysis was performed on the blood samples obtained at study entry and exit from all mothers and infants. For statistical analysis, Statistica® (release no 7, 2006) was used for repeated measures analysis of variance (ANOVA) to determine the effect of HIV, pasteurisation, milk expression and time on the composition of the breast milk. Results: There was no significant difference in the studied macro- and micronutrient composition between raw or pasteurised expressed breast milk from HIV positive and HIV negative mothers with premature infants. A significant decline in breast milk protein (p<0.01), magnesium (p=0.045), potassium (p=0.002), zinc (p<0.01) and copper (p=0.03) content was observed for the whole study population over time, while folic acid content increased significantly (p=0.012) over time. The sodium/potassium ratio of both groups remained strongly indicative of the presence of sub-clinical mastitis. A significant (p=0.03) greater mean volume of milk was obtained with pump [42.5 Standard Deviation (SD) 18.1 ml], compared to hand expression [36.7 (16.7) ml]. Method of expression did not result in a significant difference in breast milk composition for any of the nutrients studied. Eight (35%) infants were born SGA while 21 (91%) infants were SGA on day 28. The infants gained a mean of 16.37 (4.5) g/kg/day (i.e. 91% of the recommended growth rate of >18g/kg/day) from the day on which birth weight was regained. The control and study group infants respectively consumed a mean of 3.27 (1.36) and 3.21 (1.36) g protein/kg/day and 138.1 (33.8) and 142.3 (33.8) kcal total energy/kg/day. This corresponds to a PER of 2.6 (control group) and 2.5 (study group) respectively, which cannot provide for the increased growth needs of the SGA infant in need of catch-up growth. Six infants experienced an incident of Grade 1 NEC which resolved and all completed the study. Two (18%) HIV-exposed infants were found to be HIV positive at 28 days post delivery. Four participating infants died. No adverse event or mortality was related to the study protocol as no intervention was undertaken. Conclusion: HIV positive Xhosa mothers provide as nutritious breast milk to their VLBW premature infants as HIV negative Xhosa mothers. Maternal nutrient intake during pregnancy and lactation did not have a significant effect on the nutritional composition of breast milk, except for folate content.

In this dissertation I provide an ethnographic account of the testimony of four expert witnesses who appeared before the Commission of Inquiry on the Blood System in Canada (the Krever Inquiry) as they described the production of scientific knowledge and the role that knowledge played in the struggle to protect the blood supply from being contaminated by AIDS during the early 1980's. In doing so, I bring together the experts' testimony with contemporary documents gathered by the Commission and interviews I conducted with participants in the proceedings. Using insights drawn from the disciplines of anthropology, sociology, and history, I explore what the witnesses' accounts reveal about their understandings of their professional world and its relationships with other worlds, especially that of public health policy making. The Krever Inquiry offered a valuable opportunity for carrying out such an investigation. It provided a site where science was not only used, it was talked about. The Inquiry invited those involved in the blood system in the early 1980's to reflect upon and explain the beliefs and actions which surrounded one of the worst public health disasters in Canadian history and it asked the witnesses how similar catastrophes could be avoided in the future. As a result, many of the issues addressed at the hearings reflect matters of current concern in public health and medicine. The Inquiry addressed difficult issues surrounding the nature of scientific knowledge and its application in health decision-making and policy formulation. This study, therefore, may be of interest to those dealing with the problems surrounding uncertainty and the management of public health crises. It may also be of interest to those dealing with conflicts rising out of the intersection of different worlds of experience and practice, as well as to those involved in the current initiatives to both make medical and public health institutions more proactive, and inclusive, and public health decision-making more transparent. / Arts, Faculty of / Anthropology, Department of / Graduate

MSc (Mathematcs) / Department of Mathematics and Applied Mathematics / Infectious diseases remain a major public health concern. Well-known for causing sickness and death, enormous pain and suffering, increased time spent on patient care and huge economic losses due to lost production. Infectious diseases continue to be a scourge without equal. In this work, we address the following research question: Can we use a multiscale model of HIV/AIDS transmission dynamics to assess the comparative effectiveness of health interventions that are implemented at different scale domains? To achieve the set objectives of the study, we use multiscale modelling approach, a new and emerging computational high-throughput technique for mathematically studying problems that have many characteristics across several scales. To be more specific, we perform three tasks in addressing the research question. First, we develop a within-host submodel and use it to show it’s associated limitations which only a multiscale model can resolve. Second, we develop a between-host submodel and use it to motivate the need for multiscale modelling of the HIV/AIDS disease system. Finally, we link the two submodels to produce a nested HIV/AIDS multiscale model that affords us the opportunity to compare effectiveness of five preventive and treatment HIV/AIDS health interventions. Analysis of the multiscale model shows that it is possible to jointly study two key aspects (immunology and epidemiology) of infectious diseases. The multiscale model provides the means for making meaningful comparative effectiveness on available preventive and treatment health interventions. Consequently, we employ the multiscale model to show that impact of HIV/AIDS packages increases as more interventions are integrated into the packages. Specifically, the study shows that combined HAART and male circumcision is more effective than an intervention involving HAART alone. Overall, our study successfully illustrates the utility of multiscale modelling methodology as a tool for assessing the comparative effectiveness of HIV/AIDS preventive and treatment interventions. For purposes of informing public health policy, we use the study results to infer that condom use, male circumcision and pre-exposure prophylaxis are more effective in controlling the transmission dynamics of HIV/AIDS at the start of the epidemic as compared to when the disease is endemic in the community while the converse is also true for HAART. / NRF

The purpose of this study was to investigate and compare knowledge and attitudes of directors of athletics and head trainers in the Southwest (Division 1A) and the Southland (Division 1AA) Conferences concerning HIV/AIDS issues related to transmission, prevention, and protection within college athletics programs. The results of this qualitative study provided descriptive data from university administrators within the athletics setting who are responsible for providing adequate student athlete health care services from developed and implemented administrative policies that directly or indirectly affect a student athlete's physiological and psychological well-being.

This study aimed at exploring the influence of the home environment of women that were on the prevention of mother-to-child transmission (PMTCT) programme for HIV/AIDS. A qualitative descriptive study was conducted to explore the home environment for the psycho-social support that was available for women on the PMTCT programme and the influence this had on compliance to the programme. Data collection was done using a semi-structured interview guide, with a sample size of 14 participants (n=14). The data was then coded and grouped into categories and major themes. The findings revealed that the common barriers that prevented full disclosure of an HIV positive status included stigma and discrimination, fear of social isolation and financial dependence. A major constraint that affected the women’s full utilisation of the PMTCT preventative strategies and their adherence to treatment was the poor acceptance of people living with HIV in the family and community / Health Studies / M.A. (Health Studies)