Thesis (MPhil)--Stellenbosch University, 2005. / On t.p.: HIV/AIDS Management. / ENGLISH ABSTRACT: This article describes the approach taken by a company to successfully implement prevalence testing for HIV at one of its manufacturing sites in KwaZulu-Natal. Ninety point four percent of the employees on site on the day of testing subjected themselves to voluntary anonymous testing. No rewards or incentives whatsoever were offered or given to the participants. The problem faced by the company was that there was increasing mortality amongst its employees, particularly those in the lower job grades, mainly machine operators and other lesser skilled positions. The cost of insured benefits provided by the company’s provident fund for death and disability were increasing and less money could be allocated to funding for retirement. In the absence of any empirical data the company had no idea how they would be affected by the HIV/AIDS pandemic, other than attempting to use provincial averages. The level of knowledge of HIV and AIDS in the company was judged as relatively poor. Many of the staff, more so the senior staff, had little or no exposure to the disease and what effect it had on those suffering from it or those supporting sufferers. Little had been achieved to manage HIV and AIDS until a workshop was organised by the company for representatives from all branches to attend. Various information topics about HIV were covered at the workshop, which concluded with the site representatives having to work out and table an action plan, and make a personal pledge of what they were going to do to help in the fight against HIV and AIDS. The workshop was attended by all board members, senior management, shop stewards and shop floor representatives. One of the key features of the presentations was by a senior official of the union, who then assisted throughout the rest of the workshop. Site plans were then later followed up when a central committee visited the sites and presentations on progress were made.At the workshop mention was made of the need to conduct prevalence testing and also the establishment of a HIV/AIDS committee. The site committee made the decision that prevalence testing should take place and consulted the workforce themselves and also through shop stewards. Once it was felt that sufficient support would be forthcoming a date for testing was set. The company had in the meantime contracted with a service provider to do testing where needed. A briefing session attended by the HIV/AIDS committee, shop stewards, the management team and two executive directors was arranged. A doctor employed by the service provider addressed the group and answered their concerns and demonstrated the saliva test on himself. On the day of testing senior management and the senior shop steward walked the factory floor encouraging employees to participate. This intervention has laid the foundation for a successful management campaign against HIV and AIDS in the workplace. / In hierdie artikel word die benadering wat n maatskappy gebruik om die voorkomsyfer van MIV by een van sy vervaardigingsterreine in KwaZulu-Natal to toets, beskryf. Op die dag waarop toetsing plaasgevind het, het 90,4% van die werknemers op die terrain hulleself vrywilliglik laat toets. Tydens hierdie anonieme toetsing is geen belonging of voordele van enige aard aan die deelnemers gebied nie. Die problem wat die maatskappy gehad het, was dat daar n toenemde sterftesyfer onder werknemers in die laer posvlakte soos masjienoperateurs en werknemers in posiese wat minder vaardighede vereis. Daar was stygende koste (in terme van dood en ongeskiktheid) van versekerde voordele waarvoor die maatskappy se voorsieningsfonds voorsiening maak, wat tot gevolg gehad het dat daar minder geld beskikbaar was vir pensionfondse. Omdat daar n tekort van empiriese data was, het die maatskappy geen idée gehad van die effek wat die MIV/VIGS-pandemie op hom sou uitoefen nie, behalwe deur die gebruik van provinsiale gemiddeldes. Die kennis van MIV/VIGS binne die maatskappy is as swak bestempel. ’n Groot hoeleevheid van die personeel, veral die in senior poste, het min of geen blootstelling gehad van die virus en die effek wat dit op VIGS-lyers en die ondersteuners van VIGS-lyers het nie. Min is gedoen on MIV/VIGS te bestuur, totdat n werkswinlek deur die maatskappy georganiseer is vir verteenwoordiges van al, die takke. ’n Verskeidenheid onderwerpe in verband met MIV/VIGS is deur die werkswinkel gedek. Een daarvan was dat die terreinverteenwoordiges n aksieplan moes opstel en n persoonlike eed moes afle dat hulle sou help in die stryd teen MIV/VIGS. Die werkswinkel is deur al die raadslede, senior bestuurslede, werkswinkelassistente en –verteenwoordiges bygewoon. Die hoofsaak van die voorleggings is deur n senior uniebeampte gelei, waarna hy vir die verloop van die program geassisteer het. Terreinplanne is opgestel en dit is later opgevolg deur n sentralle komitee wat die terreine besoek het en voorleggings gelewer het in verband met die vordering wat gemaak is. Tydens die werkswinkel is melding gemaak van die noodsaaklikheid van die toetsing van die voorkomsyfers van MIV en die instelling van n MIV/VIGS komitee. Die terreinkomitee het besluit dat die voorkomstoetsing moes plaasvind nadat die werkersmag en werkswinkelsttistente gekonsulteer is. Nadat besluit is dat die nodige ondersteuning uit hierdie toetsing sou voortspruit, is ’n datum vir die toetsing voorgestel. Vir die interementydperk het die maatskappy ’n diensverskaffer gekontrak om die toetsing, waar nodig, waar te neem. ’n Inligtingsessie is gereel wat deur die MIV/VIGS-komitee, werkswinkelassistente, die bestuurspan en twee uitvoerende direkteure bygewoon is. ’n Dokter, wat deur die diensverskaffer in diens geneem is, het die groep te word gestaan en antwoorde verskaf op hulle vraagstukke. Hy het ook die speekselftoets op himself gedemonstreer. Op die dag wat die toetsing plaasgevind het, het die seniorbestuur en werkswinkel-assistant deur die fabriek geloop en werknemers anngemoedig on aan die toetsing deel te neem. Hierdie intervensie het gelei tot die stigting van n suksesvolle bestuursveldtog teen MIV/VIGS in die werksplek.

KwaZulu-Natal is the province worst affected by the disease burden of HIV and AIDS with 38.7% of pregnant women attending antenatal clinics (ANC) testing positive for HIV in 2008 (South Africa National Department of Health, 2008; Horwood et al, 2010). The lack of male partner involvement has been recognized as a contributing factor to poor programme adherence by women initiated into the prevention of mother-to-child-transmission (PMTCT) programme in South Africa (Peltzer et al, 2011a). Increasing male partner involvement in the services, therefore, has been acknowledged as one of the strategies that may have an impact in the success of the programme (DOH, 2008; Peltzer et al., 2011a; Reece et al, 2010; Vika et al, 2010) This study aimed to explore and describe male partner involvement in PMTCT services in a selected primary health care facility in KwaZulu-Natal. Five areas were investigated: demographic factors; knowledge; socio-cultural factors; programmatic factors; and the interrelationship between demographic factors, knowledge, socio-cultural factors and programmatic factors on male involvement in PMTCT. A quantitative exploratory descriptive design was conducted in November 2012 at a selected primary health care facility in KwaZulu-Natal. Questionnaires were issued to 90 men. The study revealed some association between certain variables of interest and male involvement. The study recommended that PMTCT programmes need to boost their awareness strategies as a means of increasing male involvement in the services. / Theses (M.N.)-University of KwaZulu-Natal, Durban, 2013.

South Africa has one of the highest prevalence of HIV infections in the world. Sexual transmission is the primary mode of transmission across the country’s population. Misinformation about AIDS, negative attitudes to HIV testing and AIDS’ stigmatizing beliefs represent potential barriers to seeking HIV testing. Youth between 15-24 years have the greatest risk of HIV infection but only 37% of students at the University of KwaZulu-Natal (UKZN) had undertaken HIV counselling and testing (HCT) according to the HEAIDS (2008) report. Prevention of HIV and behaviour change includes knowledge about, and adequacy of, HIV counselling and testing (HCT) resources on campuses. The aim of this study was to investigate students’ perceptions about HCT at UKZN and make recommendations regarding improvements. An observational, analytical, cross-sectional study of UKZN undergraduate students on the five campuses was conducted. Participants completed anonymous self-administered questionnaires. Of 965 surveyed students, 663 (71%) had tested for HIV among whom 545 (58%) were females and 501(52%) were 20-25 years. Fear of positive results, perceived low risk of acquiring the infection and having confidence in his/her partner influenced student HIV testing behaviour (p<0.001). A significant difference was also found in positive attitudes towards HCT on campus between people who had tested (median score 20) and people who had not tested (median score 18) (p < 0.05). Since one third of students at UKZN had not tested for HIV, HCT at UKZN needs to be advertised more effectively so as to increase HIV testing by students on campuses. / Thesis (M.Med.Sc.)-University of KwaZulu-Natal, Durban, 2013.

The overall aim of this study was to understand the determinants of VCT uptake in the general population of Nigeria’s federal capital territory of Abuja. Uptake of VCT still remains low despite increased availability of VCT information and services in Abuja, Nigeria. A quantitative cross-sectional study was undertaken with 180 respondents from Abuja, using an adaptation of the Health Belief Model as conceptual framework, to elucidate the social demographics of respondents, their HIV/VCT knowledge, their perceptions of VCT facility design, societal support for VCT, and how HIV stigma shapes the phenomenon of VCT uptake in Abuja, Nigeria. The key findings were that a better understanding of HIV prevention, a perception of support from community and religious leaders, and access to HIV test services in government facilities are positive predictors of higher VCT uptake. Poor personal risk assessment and the cost of HIV testing were identified as the key barriers to VCT access. / Health Studies / M.P.H.

The purpose of this study was to explore and identify factors that either facilitate or inhibit individuals volunteering for HIV-testing. The target group was comprised of Xhosa first-language construction workers in a company with an HIV/AIDS workplace policy and programme. This programme provides basic education and awareness about HIV/AIDS. This education includes information about where to access voluntary counselling and testing (VCT) services. Interpretive qualitative research was undertaken in order to explore the beliefs, perceptions and intentions of the target group in regard to the utilisation VCT services. Data was collected using an unstructured interview guide. The data was analysed using Tesch’s approach to content analysis. Concerns about validity and reliability were engaged throughout the research process and supported further by using researcher reflexivity and an independent researcher. The independent researcher analysed data separately and only after discussion and consensus being found between the two researchers were final categories and codes agreed upon and data analysis considered complete. Findings revealed that an HIV/AIDS workplace programme has a positive impact on the health-seeking behaviour of workers in the construction company used in this research. Respondents knew how HIV/AIDS is transmitted, how to prevent transmission and where to find HIV-testing treatment and support. In this case HIV-testing services can easily be accessed further facilitating respondents volunteering for HIV-testing. It was also found that family, friends and churches support HIV-testing behaviour by providing education, guidance and support to respondents encouraging behaviour change. On the other hand, respondents held that community members who had not benefited from an HIV/AIDS workplace programme such as theirs are exposed daily to the devastating effects of HIV leading to AIDS deaths and live in fear of the disease. Debilitating illness and eventual death is equated with an HIV-positive diagnosis which causes community members to believe it is better not to volunteer for HIV-testing than to ascertain one’s HIV-status. The HIV/AIDS workplace policy and xv programme on the other hand is seen to have provided respondents with HIV/AIDS knowledge enabling them to overcome their fear of an HIV-positive diagnosis and to volunteer for regular HIV-testing.

Indiana University-Purdue University Indianapolis (IUPUI) / In this study we compared the distribution of HPV types in cervical cancer specimens from women living in either Indiana or Botswana. Paraffin-embedded blocks of formalin-fixed cervical cancer specimens were identified from women living in Indiana (n=51) or Botswana (n=171)

Ce travail est réparti en deux parties différentes issues de deux études différentes.<p>La première partie décrit l’étude AMATA conçue en 2005 au Rwanda, étude prospective basée sur le suivi d’une cohorte répartie en deux groupes d’intervention postnatale. Cette étude avait pour objectif de tester l’hypothèse que l’allaitement maternel (AM) sous trithérapie antirétrovirale maternelle (HAART) pouvait être une prévention aussi efficace que le lait artificiel (LA) afin de réduire drastiquement la transmission du virus VIH de la mère à l’enfant avec une moindre mortalité infantile. Cette intervention permettait de préserver les avantages de l’AM, connue pour offrir une prévention naturelle minimisant les infections graves, en particulier les gastro-entérites et diminuant le taux de malnutrition protéino-énergétique (MPE). Dans la cohorte « AMATA », un groupe d’enfants était allaité exclusivement durant six mois, les mères étant sous trithérapie antirétrovirale systématique et un autre groupe d’enfants était nourri au LA durant les six premiers mois de vie. L’intervention débutait durant la grossesse à partir de la 28ème semaine d’âge gestationnel, une trithérapie antirétrovirale étaient donnée à toutes ces femmes enceintes infectées par le VIH participant à l’étude, quel que soit leur stade immunitaire ou clinique. Cette trithérapie était poursuivie à vie pour les femmes nécessitant cette combinaison de traitements antirétroviraux pour des raisons cliniques et/ou immunitaires et non poursuivie pour les autres femmes, avec un schéma d’interruption minimisant les résistances aux ARVs. <p>Les critères d’évaluation de comparaison des deux interventions postnatales étaient la survie à 9 mois des enfants non infectés, le taux d’infection par le VIH et la mortalité des enfants dans chaque groupe. La présence de facteurs confondants a été recherchée en effectuant une analyse de variance car la randomisation était impossible pour des raisons éthiques. <p> Dans l’étude AMATA, parmi les 532 enfants inclus, 227 (43%) étaient allaités et 305 (57%) recevaient du LA, 7 enfants furent infectés par le VIH (1,3%) dont 6 in utero (3 enfants par groupe). Un enfant fut infecté par l’AM correspondant à un risque cumulatif postnatal de 0,5% [IC95% 0,1–3,4%; P 0,24]. Ce taux de transmission reste parmi les plus bas dans un pays à ressources limitées même en comparant avec d’autres études où la trithérapie fut aussi utilisée durant l’AM. Ces études furent publiées après le début de l’enrôlement des patientes dans l’étude rwandaise AMATA en 2005. <p>La différence de mortalité à 9 mois n’était pas statistiquement différente dans les 2 groupes avec 3,3% (95% IC 1,6–6,9%) pour les enfants allaités et 5,7% (95% IC 3,6–9,2%) pour les enfants recevant du LA (P= 0,20). <p>Cette étude renforce la notion que l’AM sous trithérapie antirétrovirale (HAART) reste une approche à recommander dans les contextes où la mortalité infantile est élevée. Cette prévention postnatale permet non seulement de réduire très efficacement la transmission du VIH de la mère à l’enfant en préservant les avantages de l’AM et en évitant les risques du LA distribué dans des contextes d’hygiène précaire où un accès à l’eau potable est difficile. <p>Dans cette étude, l’efficacité de ces 2 interventions postnatales était comparable avec des taux de transmission et de mortalité semblables statistiquement.<p> <p> <p> La deuxième partie de ce travail, basée sur les résultats d’une cohorte d’enfants âgés de moins de 18 mois nés de mères infectées par le VIH permettait d’évaluer les signes cliniques présomptifs proposés par l’OMS en 2005. Ces signes <p>étaient créés afin de pouvoir effectuer le diagnostic clinique d’infection par le VIH chez les enfants exposés au virus VIH <p>dans les pays où les techniques moléculaires de PCR n’étaient pas accessibles. Les enfants nés de mères infectées par le <p>VIH gardent parfois des anticorps anti-VIH maternels jusqu’à l’âge de 18 mois sans être pourtant contaminés par le VIH/SIDA. Avant cet âge, la confirmation de l’infection par le VIH repose sur la démonstration de la présence d’ADN proviral ou ARN par la technique PCR. La mortalité précoce des nourrissons infectés par le VIH est élevée, il est important de pouvoir bénéficier d’ARVs dès le diagnostic précoce de l’infection.<p>Les signes cliniques de présomption d’infection par le VIH chez l’enfant exposé (sérologie VIH +) de moins de 18 mois ont été proposés en 2005 par l’OMS et modifiés en 2006 mais ne furent jamais évalués. <p>Cette étude transversale comprenant 236 enfants de moins de 18 mois ayant une sérologie VIH positive consistait à évaluer la sensibilité (76,6%) et la spécificité (52,7%) de ces signes cliniques en confirmant leur statut infectieux réel par le test PCR pour le VIH, test de référence. <p>Cette spécificité basse inquiétante était liée aux enfants présentant des signes cliniques similaires bien que non infectés par le VIH mais souvent carencés par manque d’apport calorique et/ou souffrant d’une forme avancée de tuberculose extra pulmonaire ou d’autres affections chroniques. Ces enfants cachectiques pouvaient présenter les mêmes signes cliniques que les enfants infectés par le VIH car ils avaient une baisse de leur immunité cellulaire due à la MPE. <p><p> Dans la première partie de ce travail, l’étude AMATA a montré 2 façons efficaces de diminuer la transmission du VIH de la mère à l’enfant.<p> Dans la deuxième partie, on a évalué une méthode de diagnostic clinique précoce proposé par l’OMS afin de détecter les enfants infectés par le VIH en l’absence de test virologique PCR mais la basse spécificité indique la nécessité d’améliorer cette méthode diagnostique.<p> / Doctorat en Sciences médicales / info:eu-repo/semantics/nonPublished

The study explored, described and explained the current models of voluntary counselling and testing services delivery and analysed the extent to which a given VCT model had influenced uptake of VCT services in the fishing communities along the shores of Lake Victoria, in Wakiso District, with an aim of designing optimal VCT service delivery strategies. The study was therefore exploratory, descriptive and explanatory, and collected both qualitative and quantitative data in a three-phased approach. Phase I involved the Kasenyi fishing community respondents, while phases II and III involved VCT managers and VCT counsellors at the Entebbe and Kisubi Hospitals. The findings indicated that VCT services are generally available onsite at health facilities, and in the field through mobile VCT outreach or home-based VCT services provided at clients’ homes. Both client-initiated and health provider-initiated VCT services are available and services are integrated with other health services. Despite the availability of VCT, only about half of the respondents in phase I had accessed VCT services although almost all indicated a willingness to undergo HIV testing in the near future. The main challenges to service delivery and utilisation included limited funding and staffing as well as limited awareness in target communities. The strategies drawn are based on the need to increase availability, accessibility, acceptability and utilisation of VCT services. / Health Studies / D. Litt. et Phil. (Health Studies)

The study explored, described and explained the current models of voluntary counselling and testing services delivery and analysed the extent to which a given VCT model had influenced uptake of VCT services in the fishing communities along the shores of Lake Victoria, in Wakiso District, with an aim of designing optimal VCT service delivery strategies. The study was therefore exploratory, descriptive and explanatory, and collected both qualitative and quantitative data in a three-phased approach. Phase I involved the Kasenyi fishing community respondents, while phases II and III involved VCT managers and VCT counsellors at the Entebbe and Kisubi Hospitals. The findings indicated that VCT services are generally available onsite at health facilities, and in the field through mobile VCT outreach or home-based VCT services provided at clients’ homes. Both client-initiated and health provider-initiated VCT services are available and services are integrated with other health services. Despite the availability of VCT, only about half of the respondents in phase I had accessed VCT services although almost all indicated a willingness to undergo HIV testing in the near future. The main challenges to service delivery and utilisation included limited funding and staffing as well as limited awareness in target communities. The strategies drawn are based on the need to increase availability, accessibility, acceptability and utilisation of VCT services. / Health Studies / D. Litt. et Phil. (Health Studies)

Appendix B (leaves 217-218), Appendix M (leaves 239-247) and Appendix O (leaves 253-259) in English and Amharic / The purpose of this research was to develop HIV testing Health Belief Scale (HTBS) that contains the constructs of Health Belief Model (HBM), and also to analyse HIV testing intention and behaviour among university students. The mixed method approach was used in phases. First, Literature review and in-depth interviews were conducted to develop item pool for HTBS, which was followed by content validity assessment by experts. In the second phase, a pilot survey was conducted on randomly selected 318 university students to refine the HTBS using item analysis and Exploratory Factor Analysis (EFA). Lastly, cross-sectional survey was conducted on representative sample of 612 students in order to further refine the HTBS using Confirmatory Factor Analysis (CFA) and also analyse predictors of HIV testing intention and behaviour. A total of 61 items was written for the HTBS and 23 of these were generated from the in-depth interviews. Content validity assessment by three experts indicated that the average content validity index (CVI) for the 61 items was 91.2% which was more than the recommended cut off point of 90%. The HTBS, after experts review, contained 64 items. EFA indicated that a five factor model which was roughly consistent with HBM was identified and 44 items were retained based on factor loading and reliability analysis. The Cronbach’s alpha for all the six constructs of HBM and HIV testing intention in the HTBS were >0,70. (susceptibility, benefit, self-efficacy and HIV testing intention) fitted the sample data based on chi-square test. However, all the seven constructs demonstrated RMSEA value of less than 0.08 and GFI value of >0.90 indicating acceptable fit. The final HTBS was reduced to 39 items based on factor loading and reliability assessment. All the constructs demonstrated a Cronbach’s alpha value >0.70 except for perceived susceptibility and cues to action. Analysis of multiple linear regression indicated that class year, perceived benefit, perceived self-efficacy and cues to action were significant predictors of HIV testing intention. However, only marital status and cues to action were significant predictors of recent history of HIV testing through analysis of binary logistic regression. / Health Studies / D.Litt. et Phil. (Health Studies)