Amphiphilic block copolymers consisting of poly(ethylene oxide) and poly(lactide) have great potential for formulating drug delivery systems. Our approach was to synthesize poly(ethylene oxide-b-D,L-lactide), (PEO-b-PDLLA), block copolymers with controlled molecular weights and good functionality on the poly(ethylene oxide) end for the design of potential core-shell delivery vehicles for HIV drugs. PEO-b-PDLLA block copolymer was used as a polymeric nanocarrier to encapsulate the HIV protease inhibitor, Ritonavir, within magnetite nanoparticles. Well-defined multifunctional polymeric nanoparticles with controlled sizes and size distributions were fabricated by rapid nanoprecipitation using blends of the PEO-b-PDLLA block copolymer with poly(L-lactide), (PLLA) homopolymer. Heterobifunctional PEO oligomers were directly prepared by initiating ethylene oxide with functional alcohols bearing vinylsilane, vinylether and maleimide moieties to provide appropriate end groups for conjugating targeting ligands. The polyethers with narrow molecular weight distributions were utilized as macroinitiators for the synthesis of poly(lactide) block. Heterobifunctional diblock copolymers possessing carboxylic acids were prepared from ene-thiol addition reaction of mercaptoacetic acid across the vinyl group on the PEO end, while preserving the hydroxyl functionality on the other end. Additionally, PDLLAs bearing maleimide functionality with controlled molecular weights were synthesized using maleimide functional initiator. End group modification was performed via  Michael addition using cysteamine hydrochloride to introduce an amino group over the vinyl bond. The resulting carboxylic acid functional PEO-b-PDLLA diblock copolymers, and amino functional PDLLAs are potential biocompatible polymers that can be utilized to encapsulate an array of bioactive molecules, targeting ligands. / Master of Science

This study compare immunological and virological outcomes in antiretroviral therapy naïve patients exposed to Isoniazid prevention treatment.Medical records of antiretroviral naïve patients managed in the public sector from 1st January 2006 to 31st December 2006 were analysed.Multivariate analysis of variance showed that each treatment group achieved statistically significant increases in CD4+ cell count and viral load decay at each follow-up time point. Pairwise post hoc contrast tests showed patients in NVPipt-past group and EFVipt-past group to have superior immunological and virological outcomes respectively. / Health Studies / M.A. (Public health)

The objective of this study was to assess levels of HAART adherence and factors affecting it. An observational, analytic, cross-sectional and quantitative study using IMB model was conducted on a randomly selected 349 HIV/AIDS patients on a HAART regimen. Data collection was done by interviewing respondents using a structured questionnaire. Both descriptive and inferential statistics used in the study. Only 80.2% of the total sample population reported a HAART adherence rate of more than or equal to 95% in this study. The findings highlight the need for on-going educational, informational and other interventions to address the knowledge, motivation and adherence behavioural skills of patients in order to improve the current levels of HAART adherence behaviour. The study also suggested the need for research into objective measures of adherence as well as longitudinal studies on adherence behaviour because strict adherence to treatment is a long-term process and not a one-time activity. / Health Studies / M.A. (Public health)

Health Studies / (M.P.H. (Health Studies))

The health care industry in Nigeria is increasingly grappling with challenges of meeting end users’ requirements and expectations for quality antiretroviral therapy (ART) service provision. This study sought to explore and describe the quality of antiretroviral therapy in public health facilities in Nigeria and the perceptions of the end users. A descriptive qualitative research design was used in the study in order to generate ideas from end users for improving quality of ART service provision, and prompt additional research activities. Unstructured focus group discussions were conducted with end users (n=64) in 6 locations across the 6 geopolitical zones of Nigeria. Data was analysed using the framework approach because it reflects the original accounts and observations of the end users and the Weft QDA version 1.0.1 software to validate the results. Findings revealed that end users were satisfied with uninterrupted antiretroviral drug supplies, courtesy treatment, volunteerism of support group members and quality counselling services. End users expect public health facilities to accept diagnostic results from collaborating facilities, implement continuous quality improvement (CQI), maintain clean and adequate health infrastructure, reduce end user waiting time, reduce stigma, comprehensively assess end users during each clinic visit and ensure uninterrupted ART services. They also expect effective collaboration between healthcare providers and support group members, to enhance the quality of life of people living with HIV (PLHIV). End users identified the following as quality gaps in ART service provision: weak health facility leadership, non-attractive ART service infrastructure, frequently interrupted laboratory services, demotivated and inadequate health care workers, long waiting time, interrupted medicine supplies and inadequate procedure for complaints management. In conclusion, the following recommendations were proffered: deploy and train additional health care workers, integrate ART into regular health services, improve supply chain management of health commodities, and reduce end user overload in clinics. Finally, a best practice guideline for the provision of end user focused ART service provision was developed. / Health Studies / D.Litt. et Phil. (Health Studies)

Submitted in fulfillment of the requirements for the Degree of Master of Technology: Biomedical Technology, Durban University of Technology, 2012. / Antiretroviral therapy (ART) was introduced because it has shown to reverse the Acquired Immunodeficiency syndrome (AIDS), by reducing the HIV replication, allowing the regeneration of the patient’s immune system. ART is given to patients for the rest of their lives as part of HIV clinical care, but the use of ART has shown evidence of metabolic side effects which range from manageable to life threatening complications. Aims and objectives of the study The aim of the study was to investigate whether patients on ART developed metabolic side effects such as pancreatitis, dyslipidaemia and hepatotoxicity. These metabolic side effects were determined by laboratory testing of blood levels of specific biomarkers at stipulated intervals. Any significant change in the blood levels of these specific biomarkers was identified. Methodology : The study included 92 patients who were already selected for the ART programme which is in accordance to the South African National Antiretroviral Therapy Guidelines of 2003 Laboratory blood analysis was conducted. The repeated measures analysis of variance (ANOVA) was used to compare changes in biomarkers over time. The severity of each side effect was assessed by grading each biomarker laboratory result through the use of an established toxicity grading table. Results : It was found that the biomarker blood levels were not significantly altered within 12 months of ART, however, there was a gradual increase of most biomarker values, indicating that abnormalities may be detected after a longer period of treatment. Conclusion : Within 12 months of treatment, life-threatening toxicities were not detected. It may be speculated that if ART is monitored correctly, life-threatening toxicities may be avoided in many patients.

Thesis (MA)--University of Stellenbosch, 2011. / ENGLISH ABSTRACT: The topic of antiretroviral adherence remains a subject of continued importance, as it is associated with positive health outcomes amongst patients attending public healthcare facilities. Available literature on adherence behaviour mainly focuses on the psychological and behavioural barriers, while overlooking the multitude of structural barriers within the patient’s environment affecting the patient’s adherence to antiretroviral treatment and care. The present study provides a unique perspective on adherence behaviour amongst persons living with HIV and receiving antiretroviral treatment, as it identifies important structural barriers to clinical attendance and pill-taking. The sample for this study were selected from patients attending an infectious diseases clinic at a major peri-urban secondary hospital and receiving antiretroviral therapy, nurses and doctors providing health services to patients, and patient advocates providing psychosocial support to patients under the auspices of a local non-governmental organisation. The participants included in this study were selected by means of convenience sampling to participate either in semi structured interviews or focus group discussions. Participants were assured of the confidentiality of the process and their anonymity in both cases. Both semi structured interviews and focus groups were digitally recorded and transcribed after which transcriptions were entered into Atlas.ti for textual analysis. Transcriptions were thematically analysed according to the perceptions of various participants. The main themes that emerged from the present study included individual barriers, poverty-related barriers, institutionrelated barriers, and social and community-related barriers. The results of the present study were triangulated by considering the concurrences and discrepancies between the patients, clinicians and patient advocates on the main, and subthemes. These themes were then discussed according to Bronfenbrenner’s (1972) Ecological Systems Theory, which divided the main themes identified according to the different systems operating within the patient’s environment, i.e. the micro-, exo-, and macrosystem. The microsystem included both individual psychological and behavioural barriers and poverty-related barriers. Institutional barriers were considered within the exosystem of the patient’s ecological environment. And the social and community-related barriers were considered within the macrosystem of the patient’s ecological environment. The significance of this study lies in the identification of adherence behaviour as the product of the patient’s environment through the examination of triangulated data. Future research may include effective ways in which patients can be assisted in developing the necessary skills to cope with their environment and to enhance social support. The development of strategies to support newly-enrolled patients also still needs investigation. / AFRIKAANSE OPSOMMING: Volgehoue antiretrovirale behandeling bly ‘n onderwerp van voortdurende belang omdat dit geassosieer word met positiewe gesondheidsuitkomste onder pasiënte wat van openbare gesondheidsfasiliteite gebruik maak. Beskikbare literatuur oor volhoudings gedrag fokus grootliks op sielkundige en gedragshindernisse, terwyl veelvuldige strukturelehindernisse binne die pasiënt se omgewing steeds misgekyk word. Dié studie bied ‘n unieke perspektief op volhoudingsgedrag onder MIV-positiewe pasiënte wat tans antiretrovirale terapie ontvang, aangesien dit belangrike strukturele hindernisse tot kliniek bywoning en die neem van medikasie identifiseer. Dié steekproef sluit pasiënte in wat tans antiretrovirale terapie by ‘n aansteeklike siektes-kliniek by ‘n peri-stedelike sekondêre hospitaal ontvang. Dit sluit ook dokters en verpleegsters in wat gesondheidsdienste aan dié pasiënte verskaf, en pasiënt- advokate wat psigo-sosiale ondersteuning aan pasiënte verskaf onder die vaandel van ‘n plaaslike nieregerings organisasie. Dié deelnemers is deur middel van gerieflikheidssteekproef geselekteer om aan semi-gestruktureerde onderhoude of fokusgroepbesprekings deel te neem. Deelnemers van albei groepe is van hul anonimiteit en die vertroulikheid van die proses verseker. Beide die semi-gestruktureerde onderhoude en die fokusgroepbesprekings is digitaal opgeneem en transkripsies is daarvan gemaak, waarna die transkripsies in Atlas.ti gelaai is vir tekstuele analise. Transkripsies is tematies geanaliseer volgens die persepsies van die verskeie deelnemers. Die hooftemas wat na vore gekom het, sluit in individuele hindernisse, armoedeverwante hindernisse, institusieverwante hindernisse asook sosiale en gemeenskapsverwante hindernisse. Resultate van dié studie is getrianguleer deur die verskille en ooreenkomste te vind tussen pasiënte, klinici en pasiënt-advokate oor die hoof- en subtemas. Die hooftemas is toe volgens Bronfenbrenner (1972) se Ekologiese Sistemeteorie verdeel in die verskillende sisteme teenwoording in die pasiënt se omgewing, naamlik die mikro-, ekso-, en makrosisteem. Die mikrosisteem het individuele sielkundige en gedragshindernisse asook die armoedeverwante hindernisse ingesluit. Institusieverwante hindernisse is binne die eksosisteem van die pasiënt se ekologiese omgewing beskou en sosiale en gemeenskapsverwante hindernisse is beskou binne die makrosisteem van die pasiënt se ekologiese omgewing. Die belang van dié studie lê in die identifisering van volhoudingsgedrag as produk van die pasiënt se omgewing, soos beskou deur die Ekologiese Sistemeteorie. Toekomstige navorsing kan fokus op effektiewe maniere waarop pasiënte bygestaan kan word om die nodige vaardighede te ontwikkel om hul omgewing beter te kan hanteer en beskikbare sosiale ondersteuning te kan verbeter. Die ontwikkeling van strategieë om nuwe pasiënte by te staan, benodig ook verdere navorsing.

Thesis (MNutr (Interdisciplinary Health Sciences. Human Nutrition))--Stellenbosch University, 2008. / Introduction: More than half a million children worldwide die from the Human Immunodeficiency Virus (HIV) and Acquired Immunodeficiency Syndrome (AIDS) each year. In Uganda, HIV/AIDS is a major cause of infant and childhood mortality. Although the government of Uganda, through various strategies, has increased access to antiretroviral drugs (ARVs), resulting in national scaling up of accessibility to antiretroviral therapy (ART), initiation of ART in resource-limited areas remains a challenge due to constraints such as the absence of or limited number of CD4 machines and related laboratory constraints. Further scaling up of ART for children would be greatly strengthened by increased access to laboratory services for CD4 counts or the introduction of alternative indicators or guidelines for the initiation of ART. Aim: This study therefore set out to investigate, through the analysis of retrospectively collected data, whether anthropometric indices (wasting - weight for height; underweight - weight for age; and stunting - height for age) could provide a useful alternative guide when deciding about initiation of ART in children aged 2-12 years in the absence of sophisticated clinical and laboratory support. Methods: The study was conducted at the Mildmay Centre, an HIV/AIDS specialist centre located in Kampala, Uganda. Parameters such as the age at which children had been initiated onto ART, duration on ART, World Health Organisation (WHO) and Centre for Disease Control (CDC) disease stages at time of initiation, anthropometry at time of initiation, CD4% staging at time of initiation, support received from food aid programmes, referral to other health centres as a result of malnutrition and care-giver nutrition education/counselling were all determined retrospectively from clinical records. Results: It was found, based on CDC (2000) growth reference charts, that of the total number of children who took part in this study (N=125), 98.4% were mildly wasted, 52.8% mildly underweight and 75.2% mildly stunted when they were initiated onto ART. Of the children, who had WHO disease staging documented - 40% (N=50), the majority - 86% (N=43) were in WHO disease staging II and III during initiation of ART. and 96% (N=48) were mildly wasted. However, the relationship between WHO disease staging and wasting, underweight, and stunting at initiation of ART in children at the Mildmay centre was not significant. The relationship between CD4% and underweight or stunted children was also not significant. It was established however, that in the absence of CD4 laboratory parameters (since CD4% is vital in the initiation of ART in children) as is the case in resource limited areas, anthropometric indices (moderate to severe wasting, weight for height -W/H) could be used concurrently with CDC and WHO disease staging to initiate ART in children. However, it is important to note that anthropometric indices on their own cannot be used as a guide for initiating ART in children. Conclusion: Anthropometric status alone cannot be used to accurately determine when to initiate ART in children 2-12 years.

This study compare immunological and virological outcomes in antiretroviral therapy naïve patients exposed to Isoniazid prevention treatment.Medical records of antiretroviral naïve patients managed in the public sector from 1st January 2006 to 31st December 2006 were analysed.Multivariate analysis of variance showed that each treatment group achieved statistically significant increases in CD4+ cell count and viral load decay at each follow-up time point. Pairwise post hoc contrast tests showed patients in NVPipt-past group and EFVipt-past group to have superior immunological and virological outcomes respectively. / Health Studies / M.A. (Public health)

The objective of this study was to assess levels of HAART adherence and factors affecting it. An observational, analytic, cross-sectional and quantitative study using IMB model was conducted on a randomly selected 349 HIV/AIDS patients on a HAART regimen. Data collection was done by interviewing respondents using a structured questionnaire. Both descriptive and inferential statistics used in the study. Only 80.2% of the total sample population reported a HAART adherence rate of more than or equal to 95% in this study. The findings highlight the need for on-going educational, informational and other interventions to address the knowledge, motivation and adherence behavioural skills of patients in order to improve the current levels of HAART adherence behaviour. The study also suggested the need for research into objective measures of adherence as well as longitudinal studies on adherence behaviour because strict adherence to treatment is a long-term process and not a one-time activity. / Health Studies / M.A. (Public health)