Depuis la description des premiers cas de SIDA pédiatriques en 1983, d’importants progrès ont été réalisés dans la compréhension des mécanismes de transmission, puis dans la prévention de celle-ci, et dans la connaissance de l’histoire naturelle de l’infection par le VIH chez l’enfant. Depuis 1996 les multithérapies ARV ont permis une diminution considérable de la transmission verticale et de la morbidité et mortalité des enfants infectés par le VIH.<p>Les buts de ce travail ont été :<p>• d’évaluer, dans le contexte de l’offre de soin mise en place dans un centre de référence,<p>l’impact de l’administration prophylactique des traitements ARV pendant la grossesse sur la transmission verticale du virus.<p>• de déterminer si l’instauration précoce d’un traitement ARV chez les enfants infectés à la naissance et encore asymptomatiques améliorait le devenir de l’enfant.<p>• de contribuer à l’évaluation de l’impact de l’exposition à la maladie maternelle et aux traitements ARV sur le devenir des enfants non infectés nés de mères infectées par le VIH.<p><p>Une étude rétrospective portant sur les enfants nés de mères infectées par le VIH et suivis à l’hôpital St-Pierre entre 1986 et 2002, nous a permis de comparer 3 cohortes de naissance correspondant à différents types de prise en charge. Nous avons pu montrer que le taux de transmission a diminué globalement de 10% durant la période précédant l’administration de prophylaxie ARV à 5% durant la troisième période où les multithérapies étaient recommandées en prophylaxie durant la grossesse. Nous avons montré<p>que chez les mères qui ne bénéficiaient pas de prophylaxie ARV le taux de transmission avait augmenté significativement entre 1986 et 2002; le plus souvent suite à une prise en charge trop tardive de la grossesse, à un dépistage tardif de la séropositivité maternelle, ou à une mauvaise compliance au traitement.<p>Chez le nouveau-né infecté par le VIH, la multiplication virale est beaucoup plus importante<p>et prolongée que lors de la primo-infection chez l’adulte. Parallèlement, l’évolution clinique de l’infection peut être rapide dans un quart des cas, et aboutir au SIDA ou au décès avant l’âge de 1 an, sans qu’il existe de bons facteurs prédictifs de cette évolution défavorable en début de vie. Jusqu’en 2007, les différentes recommandations internationales indiquaient de débuter un traitement chez les nourrissons infectés lors d’apparition de symptômes cliniques ou d’immunodépression. Cependant dès 1996, certains centres dans des pays industrialisés, dont l’équipe de pédiatrie du CHU St Pierre, ont décidé d’initier un traitement ARV chez tous les nourrissons infectés dès confirmation du diagnostic. En 2006, nous avons initié une étude rétrospective multicentrique incluant 13 cohortes européennes visant à étudier l’impact du traitement précoce sur l’évolution clinique et biologique de l’enfant. Les données de 210 enfants,nés entre 1996 et 2004 et infectés à la naissance ont été analysées, et ont permis de dé4<p>montrer que les enfants traités avant l’âge de 3 mois avaient un risque de développer un sida ou de décéder 5 fois inférieur aux enfants traités après cet âge. Des résultats similaires ont été observés dans une étude randomisée réalisée en Afrique du Sud et publiée simultanément. Depuis, les recommandations internationales ont été revues<p>et préconisent la mise sous traitement de tous les nourrissons infectés. L’analyse des données biologiques a permis de montrer que la réponse virologique immédiate était plus rapide avec un pic de charge virale moins élevé et que la chute des lymphocytes CD4 était moins prononcée lorsque le traitement était débuté précocement.<p>Avec la généralisation de la prophylaxie ARV pendant la grossesse, le nombre d’enfants exposés in utero au VIH mais indemnes de l’infection a considérablement augmenté.<p>Des études, menées principalement dans des pays en développement, ont révélé un risque accru de morbidité et de mortalité infectieuse ainsi que la survenue d’infections sévères inhabituelles chez ces enfants. Nous avons été frappés durant le suivi de ces enfants par la survenue d’un nombre élevé d’infections néonatales causées par le streptocoque du groupe B (GBS). La comparaison avec le taux d’infection observé dans une population contrôle (estimé sur base des naissances survenues pendant la même période dans le même hôpital) nous a permis de décrire une incidence 19 fois supérieure d’infection à GBS chez les enfants exposés au VIH et non infectés que chez les enfants contrôles. Il s’agit du premier travail publié évoquant une susceptibilité accrue aux infections des enfants exposés non infectés dans un pays industrialisé.<p>En conclusion, la prophylaxie ARV pendant la grossesse et en début de vie a permis de diminuer considérablement la transmission verticale de l’infection à VIH. Un dépistage manqué, une prise en charge tardive de la grossesse, ou la mauvaise adhérence au traitement sont encore responsables d’infection du nouveau-né. Lors de confirmation<p>d’infection du nourrisson par le VIH, il est très important de débuter un traitement le plus rapidement possible afin de contrôler rapidement la multiplication virale, de maintenir une bonne immunité et de prévenir le développement de la maladie. Enfin, en l’absence d’infection du nourrisson par le VIH, il est important de poursuivre le suivi pendant les premières années de vie puisqu’il semble que les enfants exposés au<p>VIH et non infectés soient plus susceptible aux infections sévères. Ceci a été démontré en ce qui concerne les infections néonatales à GBS. / Doctorat en Sciences médicales / info:eu-repo/semantics/nonPublished

M.Cur. (Maternal and Child Nursing Science) / The implementation of the PMTCT programme was conceptualised in 2000. The aim of this study was to determine the views of midwives regarding the implementation of the PMTCT programmes in the public health centres in Soweto. Data was collected from midwives involved in the implementation of PMTCT in antenatal clinics by means of semi-structural interviews. Of the 20 midwives (N=20) interviewed, only five (5) midwives attended formal training. The discussion of the views of midwives regarding the implementation of PMTCT centered around the lack of formal training, lack of resources, lack of infrastructure, negative attitude of the community, lack of budgeting, lack of support by colleagues and poor management support, language barriers in communication and religious beliefs. This study found that midwives need to go for formal training on PMTCT programmes and that more research need to be done in this field. Moreover, the findings from this study have implications for clinical practice. In addition, guidelines were formulated to help midwives and other health care practitioners to implement the PMTCT programmes in antenatal care.

The study aimed at assessing the factors influencing the low involvement of men in prevention of mother-to-child transmission (PMTCT) of HIV programmes in the Mambwe district, Zambia. The factors studied were grouped as knowledge and awareness, socio-cultural, programmatic and demographic characteristics. A quantitative, exploratory study was used and 127 men were interviewed. The major findings were: Knowledge of PMTCT was the strongest factor which was positively associated with the level of men's involvement in PMTCT. Socio-cultural and programmatic factors were found to negatively influence men's involvement (although weakly); and among the demographic characteristics, age and level of education were positively associated with an increase in the level of involvement, while the duration of the relationship with the female partner was negatively associated with the level of men involvement. / Health Studies / M.A. (Public Health)

The purpose of the study is to investigate and identify the factors that affect utilisation of prevention mother to child transmission of HIV services and propose measures to promote utilisation of services by HIV positive pregnant women in Onitsha, Anambra State, Nigeria. Mother-to-child transmission of HIV accounts for over 90% of infections in children under 15 years. Infected pregnant women can pass on the infection to their babies during pregnancy, delivery or through breastfeeding. There are effective interventions now reduce of the infection to the baby. However some infected women still do not avail themselves of these services due to several reasons. A quantitative descriptive study, using the Health Belief Model as the conceptual framework was used to conduct the research. A structured interview schedule was used to interview 102 pregnant women at two health facilities in Onitsha, Anambra state, Nigeria. The findings from the study reveal that majority of the respondents knew about HIV transmission but not about ways the infection can be transmitted from mother-to-child. The respondents recognise that HIV/AIDS is a very serious threat in Nigeria and the study site and were of the opinion that all pregnant women should know their HIV status. The attitude of health care workers and fears about disclosure of HIV status to others was a setback. Revealing their status to the spouse was feared.

Women and children are often the most affected by pandemics which have swept through the world, and in this regard the HIV/AIDS pandemics is not an exception. The most common route of HIV infection in HIV positive children under 5 years of age is through Mother-To-Child Transmission (MTCT). In spite of the seriousness of this pandemic, the Constitutional Court has found that the measures taken by the South African government with regard to the Prevention of Mother-To-Child Transmission (PMTCT) has fallen short of what the Constitution requires. This dissertation critically reviews the management of the South African PMTCT programme, and discusses the relevant Court decisions. The study finally clarifies the obligations of the South Africa government in the context of PMTCT under the 1996 Constitution and in terms of international law. / Constitutional,International & Indigenous Law / LL.M. (Legal aspects of HIV/AIDS)

This study sought to determine if ANC and PMTCT services are utilized within the first trimester of pregnancy by the women in East Ekurhuleni sub-district. Quantitative descriptive research was conducted on 390 eligible pregnant women and data collection was done using structured questionnaires. The results indicated that women start ANC late despite their knowledge of first trimester as the best time to start ANC. Actions that would motivate them to start ANC early were explored and barriers were identified. / Health Studies / MA (Public Health)

Thesis in English, Annexure E: Consent form (leaf 81) as well as KABP Survey Questionnaire (leaves 87-91) in English and SiSwati. / The purpose of the study was to assess knowledge, explore attitudes and determine practices of breastfeeding mothers living with HIV regarding post-natal PMTCT interventions and services. The study was quantitative and descriptive in nature, utilising a retrospective cohort design. The study sample included breastfeeding mothers living with HIV, who attended the King Sobhuza II public health unit in the Manzini region of Swaziland. A written questionnaire was administered to a non-random sample of 90 consecutively selected mothers living with HIV attending the above-cited public health unit for post-natal health purposes. The overall study results revealed that the majority of breastfeeding mothers living with HIV in the afore-mentioned region (77.8%) presented high levels of knowledge on PMTCT, and 90% demonstrated a positive attitude; while a further 90% also demonstrated positive behaviour towards PMTCT. However, stigma and discrimination among family members, non-disclosure of HIV status to sexual partners; as well as poverty and fear of future drug-resistance are the cause of non-adherence to ARV prophylaxis. Furthermore, inconsistent condom use, mixed-feeding methods and wet-nursing also emerged as other contributing factors to the increase of post-natal mother-to-child transmission of HIV among breastfeeding mothers living with HIV. / Health Studies / M.A. (Nursing Science)

The purpose of the study is to investigate and identify the factors that affect utilisation of prevention mother to child transmission of HIV services and propose measures to promote utilisation of services by HIV positive pregnant women in Onitsha, Anambra State, Nigeria. Mother-to-child transmission of HIV accounts for over 90% of infections in children under 15 years. Infected pregnant women can pass on the infection to their babies during pregnancy, delivery or through breastfeeding. There are effective interventions now reduce of the infection to the baby. However some infected women still do not avail themselves of these services due to several reasons. A quantitative descriptive study, using the Health Belief Model as the conceptual framework was used to conduct the research. A structured interview schedule was used to interview 102 pregnant women at two health facilities in Onitsha, Anambra state, Nigeria. The findings from the study reveal that majority of the respondents knew about HIV transmission but not about ways the infection can be transmitted from mother-to-child. The respondents recognise that HIV/AIDS is a very serious threat in Nigeria and the study site and were of the opinion that all pregnant women should know their HIV status. The attitude of health care workers and fears about disclosure of HIV status to others was a setback. Revealing their status to the spouse was feared.

Women and children are often the most affected by pandemics which have swept through the world, and in this regard the HIV/AIDS pandemics is not an exception. The most common route of HIV infection in HIV positive children under 5 years of age is through Mother-To-Child Transmission (MTCT). In spite of the seriousness of this pandemic, the Constitutional Court has found that the measures taken by the South African government with regard to the Prevention of Mother-To-Child Transmission (PMTCT) has fallen short of what the Constitution requires. This dissertation critically reviews the management of the South African PMTCT programme, and discusses the relevant Court decisions. The study finally clarifies the obligations of the South Africa government in the context of PMTCT under the 1996 Constitution and in terms of international law. / Constitutional,International and Indigenous Law / LL.M. (Legal aspects of HIV/AIDS)

Thesis (MPhil)--Stellenbosch University, 2005. / ENGLISH ABSTRACT: This research provides some insight into some of the socio-cultural barriers hindering the implementation of MTCT programmes in Eastern Cape. In most parts of the world today, HIV infection is increasing faster among women more than men. The resulting infection of women is that many babies born to HIV mother become automatically infected. Mother-to-Child transmission (MTCT) of HIV is most significant source of HIV infection in children. Of the estimated 36 million people living with HIV/AIDS, 1.4 million are children (UNAIDS, 2002). The devastating effect of MTCT, prompted the South African government to initiate an urgent programme. In 2000, the SA government set up 18 pilot sites, including 2 sites in Eastern-Cape; the East London Complex, to curb children HIV infection. However, four years after the inception of the programme its success still depends largely on many factors, one of which is the socio-cultural barrier. This research therefore set out to explore some aspect of these socio-cultural barriers that is hindering the PMTCT programme in Eastern Cape. The research report consists of five chapters. Chapter 1. Deals with the introduction into the topic. Chapter 2. Summarises the literature on PMTCT associated with the research, as well as risk factors associated with PMTCT and possible interventions that were identified in various literature that attempts to reduce MTCT. Chapter 3. Focus on the research methodology. It explains the study design, the research aim and objectives, the study population and data analysis resulting from the research. Chapter 4. The results of the research findings is discussed in-dept in this chapter. An overarching theme of high level of societal stigma emerged as the key socio-cultural barrier. Chapter 5. This chapter discusses the identified socio-cultural barrier as well as possible recommendations as to how to address some of these barriers and also suggestion for further research. / AFRIKAANSE OPSOMMING: Hierdie navorsing bied ‘n mate van insig tot sommige van die sosiokulturele beperkinge wat die implementering van sogenaamde MTCT-programme in die Ooskaap kortwiek. In die meeste wêrelddele styg die voorkoms van die HIV-virus onder vroue tans vinniger as onder mans. Die resultaat daarvan is dat die babas van geïnfekteerde vroue outomaties ook geïnfekteer word. Moeder-tot-kind-oordrag MTKO (Mother-to-child transmission –MTCT) van MIV is die hoofsaaklike bron van infeksie in kinders. Van die geskatte 36 miljoen mense wat tans met MIV/VIGS lewe, is 1, 4 miljoen kinders (UNAIDS, 2002). Die vernietigende effek van MTKO het die Suidafrikaanse regering daartoe genoop om ‘n dringende program van stapel te stuur. Gedurende die jaar 2000, het die SA regering beslag gegee aan 18 loodsterreine, waarvan 2 in die Ooskaap-Oos-Londen-kompleks, om MIV-infeksies onder kinders te begin beperk. Vier jaar na die aanvang van die program, egter, is die sukses daarvan steeds afhanklik van ‘n veeltal faktore, een waarvan die sosio-kulturele grens is. Om hierdie rede was hierdie navorsing daarop ingestel om sommige aspekte van hierdie sosio-kulturele grense wat die VMTKO-programme (Voorkomig van MTKO) in die Ooskaap bemoeilik, van nader te ondersoek. Die navorsingsverslag bestaan uit vyf hoofstukke. Hoofstuk 1. Handel oor die inleiding tot die onderwerp. Hoofstuk 2. Som die bestaande literatuur oor VMTKO op sover dit op die navorsing van toepassing is; insluitende risikofaktore wat met VMTKO geassosieer word asook moontlike intervensies met die oog op pogings om MTKO te verlaag, soos geïdentifiseer in verskeie bronne in die literatuur. Hoofstuk 3. Fokus op die navorsings metodologie. Dit verduidelik die ontwerpbeginsels van die studie, die navorsingsdoelstellings en oogmerke, die teikengroep van die studie en die data-analise voortspruitend uit die navorsing. Hoofstuk 4. Die navorsingsresultate word hierin in diepte bespreek. ‘n Oorheersende tema van stigma binne gemeenskapsverband tree as sentrale sosiokulturele grens na vore. Hoofstuk 5. Die geïdentifiseerde sosiokulturele grense word bespreek en moontlike aanbevelings gemaak ten opsigte van hoe sulke grense aangespreek kan word, asook voorstelle vir verdere navorsing.