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HIV and TB care and treatment: patient utilization and provider perspectives in rural KwaZulu-NatalChimbindi, Natsayi Zanile January 2017 (has links)
Thesis submitted for the degree: Doctor of Philosophy, School of Public Health, Faculty of Health Sciences, University of Witwatersrand, Johannesburg
June 2017. / The epidemics of tuberculosis (TB) and Human Immunodeficiency Virus (HIV) in sub-Saharan Africa
are closely related and particularly persistent, proving a considerable burden for healthcare provision,
and complicating utilization of care. Concern has been expressed about patients’ experience at
healthcare facilities as this may impact on drug adherence, treatment success and willingness to return
for regular monitoring and drug pick-up. This is particularly relevant for HIV programmes, with HIV
now a chronic disease, with daily treatment necessary for life; TB treatment is limited in duration, to six
months although can be as long as two years in case of multiple drug resistant TB.
Utilization of healthcare services is an important determinant of health outcomes generally, with public
health relevance, particularly for HIV and TB services in areas of high prevalence. The main aim of
universal health coverage is to make healthcare accessible without barriers based on affordability,
availability or acceptability of services. Various factors have been shown to hinder or enable patient
utilization of healthcare services, such as organization of services, costs of transport to and from clinics,
time loss at clinics receiving care, staff attitudes, waiting times and cleanliness of facilities.
Objectives
This study aimed to determine and quantify factors associated with healthcare utilization in patients
utilizing HIV care (including those not yet initiated on antiretroviral treatment (ART) - pre-ART) or TB
treatments in a rural sub-district of Hlabisa in KwaZulu-Natal and to understand healthcare providers’
perspectives regarding patient care and provision of quality care. The study used data from patient exit
interviews, and additionally findings from interviews with healthcare providers in the local HIV treatment
and care programme, structured around the responses from the patient-exit interviews.
The study had three specific objectives: 1) to establish and quantify factors associated with healthcare
utilization, with utilization decomposed to availability, affordability and acceptability of healthcare
services, for patients in HIV or TB treatment and care; 2) to quantify ability-to-pay for healthcare and
identify associated factors for patients in pre-ART care, or on ART or TB treatment; 3) to understand the
healthcare providers’ perspectives regarding patient care and provision of quality HIV care.
Methods
In 2009 patient-exit interviews were conducted in six primary healthcare (phc) clinics in rural South
Africa with 300 patients receiving ART and 300 patients receiving TB treatment; patients were
randomly selected using a two-stage cluster random sampling approach with primary sampling units
(phc) selected with probability-proportional-to-size. In 2010 an additional 200 HIV-infected patients in
pre-ART care from the same clinics were interviewed. Patient-exit interviews were conducted in a
private room outside the facility and all data were analysed using STATA 11. In 2012, a qualitative
study was carried out with healthcare providers in eight (of 17) randomly selected phc clinics; 25 ART
healthcare providers were engaged in discussion structured around patient-exit interviews feedback to
assess possible challenges/facilitators ART healthcare providers face when providing care. Discussions
took place in the consultation rooms when no clinical sessions were ongoing and these were recorded
and transcribed; and data were managed using Nvivo 10. Thematic content analysis was conducted using
both inductive and deductive approaches and clinic or healthcare provider identifiers were removed and
replaced with pseudonyms.
Summary statistics describe patient characteristics by patient group and key availability, acceptability
and affordability factors associated with utilization of healthcare services; separate univariate and
multivariable regression models were run to assess associations between patient characteristics and these
key availability, acceptability and affordability factors. Patient socio-demographic characteristics (sex,
age, education, employment and marital status) were controlled for and adjusted for clustering at
facility-level. Factor analysis was performed to investigate underlying patient satisfaction factors.
Results
Socio-demographic characteristics of the patients
More women than men were seen in the primary care clinic, especially among pre-ART patients (79%),
followed by 62% HIV and 53% utilized TB care, with an age-sex profile comparable to previous studies
in the area. Pre-ART patients were significantly younger than ART and TB patients, with a median age of
32 years for pre-ART patients, 39 years for ART patients and 37 years for TB patients. Unemployment at
household level was high, up to 86% of ART patients’ head of households were unemployed and only 9%
of TB patients were employed. / MT2017
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Thoughts and feelings of lay HIV/AIDS peer educators, working in the field of mother to child transmission of HIV/AIDS, about their training and preparedness to perform their roleThurling, Catherine Hilary 23 February 2012 (has links)
M.Sc. (Nursing), Faculty of Health Sciences, University of the Witwatersrand, 2011
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The central role of the CD4 T-helper cell in HIV infection : analysis of cell mediated responses and CCR-5 genotypes in HIV-1 infected individuals /Leandersson, Ann-Charlotte, January 1900 (has links)
Diss. (sammanfattning) Stockholm : Karol. inst., 2001. / Härtill 7 uppsatser.
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Towards ribozyme-mediated gene therapy of HIV-1 infections /Hotchkiss, Graham, January 1900 (has links)
Diss. (sammanfattning) Stockholm : Karol. inst. / Härtill 4 uppsatser.
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Knowledge and concerns about HIV/AIDS among childbearing women in Mahalapye, BotswanaLebodi, Pamela 19 May 2014 (has links)
The aim o f the study w as to determ ine the know ledge and concerns about HIV/AIDS
among childbearing w om en in M ahalapye, Botswana.
A descriptive study design using an inri-view schedule was used. The sam ple o f 166
respondents (aged 18-29 years) w as draw n from a population o f w om en w ho attended
M ahalapye clinics. D ata w ere analysed by use o f a com puter and descriptive statistics
including frequencies and percentages.
The dem ographic data showed that the m ajority (85.5%) o f the respondents w ere not
m arried, o f w hom 78% had partners and 9% w ere cohabiting. Seventy percent had
secondary education and 70.4% w ere unem ployed, hence their dependence on their
partners and relatives for econom ic support.
The results show ed that the respondents had a high level o f know ledge about HIV/AIDS
including risk factors, m ode o f transm ission and prevention. A ll respondents (100%)
seem to be aware that a person can contract H IV through having m ultiple sexual partners.
The m ajority (98%) stated that H IV can be transm itted sexually and 97% said that infected
pregnant w om en can transm it H IV to their babies. N inety seven percent o f w om en said
that the spread o f H IV can be prevented by \ h g condom s, 21.1 % said by having sex less
frequently and 98.8% said people can protect them selves from contracting H IV by
through sharing utensils and food w ith an infected person, 38% believed that mosquitoes
and insects can transm it H IV and 41.6% did not believe that a person infected with HIV
m ight look healthy. Thirty six (21.7% ) w om en perceived them selves not to be at risk o f
H IV ow ing to current m onogam ous relationships and their trust in their partners. Radio
and health personnel w ere m entioned as the m ain sources o f inform ation about HIV/AIDS.
All (100% ) respondents revealed that they w ere afraid o f becom ing infected w ith the virus
and 98.2% said that they w ere concerned that m en do not like using condom s. Even
though 93.4% said that they w ere free to discuss sexual activities w ith their partners,
83.7% said that they w ould not find it easy to reveal their H IV status to their partner for
fear o f rejection and stigm atisation. The results show ed that know ledge was related to
education level. A ll w om en w ho had post secondary education indicated that AIDS
cannot be cured by consulting traditional doctors ( 9 -0 0v'7) and W estern doctors
(p=0.046) as com pared w ith those w ho did /iOf hav-'-post secondary education. A ge and
m arital status seem not to be related to know ledge (p>0.05).
Educational program m es targeted at these w om en should address the m isconceptions
about the m ode o f transm ission. W om en should be equipped w ith effective
com m unication and decision m aking skills that w ill em power them to adopt behaviours
that will protect them from becom ing infected or infecting others. Further research is
needed to determ ine the extent to w hich concerns expressed by w om en in this study are
expressed by other groups o f women.
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Knowledge of HIV/AIDS, related attitudes and participation in risky sexual behaviour among first and fourth year female students at the University of Botswana.Cavric, Gordana 16 February 2012 (has links)
M.P.H., Faculty of Health Sciences, University of the Witwatersrand, 2011 / Introduction
Botswana still has the second highest HIV prevalence in the world with little indication of any significant decline. In
Botswana, women are disproportionately affected: young women account for more than half (58 %) of the adults
living with HIV thus indicating a significant gender disparity in HIV infection. University educated, urban young
women aged 19-39 have been identified as group at particularly high risk of HIV infection.
Aim
This study aimed to assess knowledge and attitudes regarding HIV and AIDS and how such knowledge and
attitudes have implications for participation in risky sexual behavior among female University of Botswana
students in their first and fourth years of study.
Methodology
This study was conducted at the University of Botswana (UB) in Gaborone. Data was collected using a selfadministered
questionnaire on Knowledge of HIV/AIDS and participation in Risky Sexual Behavior among female
students in first and fourth year of studies at University of Botswana.
Results
The knowledge regarding the “window period” and infectivity during the window period was significantly lower for
first year students compared to fourth years. Attitudes towards people with HIV were positive in both groups,
while affirmative attitudes towards premarital sex are increasing as the students progress academically.
The analyses highlight that the percentage of women who reported having been sexually active the proceeding
year was significantly higher among fourth year students (82.6%) than their first year counterparts (56.9 %),
(p<0.01), with the number of partners significantly higher among women in their fourth year.
Significantly, 3% of first year female students stated that their partners did not want to use a condom while 7
percent of the participants themselves said that that was the case. Amongst fourth year UB female students
responding, 4% said that their partners did not want to use a condom, yet 14% participant said that they
themselves did not want to use one.
Overall, the prevalence of self-reported STI’s was significantly higher among fourth year students when compared
with first year students 19 of 155 [12.26% ]vs. 4 of 144 [2.78 %] p<0.01 .
Conclusion
This study explored the knowledge of HIV/AIDS and participation in risky sexual behavior amongst female students
in their first and fourth years at the University of Botswana. The study supported the findings that higher levels of
formal education are associated with better knowledge of how to protect oneself from HIV/AIDS transmission.
Although many HIV/AIDS prevention campaigns might have contributed to educated women being knowledgeable
about how to protect themselves from HIV/AIDS transmission and the importance from abstaining from risky
sexual behavior, a small but significant proportion of women still do not use condoms consistently
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Sexually transmitted infection (STI) and HIV / AIDS related knowledge, attitudes, perceptions and behaviour among San learners in a combined school in Platfontein, Northern CapeFredericks, Mercedes Beryl 05 February 2014 (has links)
Prevention of Human immunodeficiency virus (HIV) in South Africa includes early detection and
treatment of sexually transmitted infections (STIs), as well as health promotion activities. The latter
include health education programmes and the promotion of screening activities such as voluntary
counselling and testing (VCT). The South African government recognises the need for creating
equity for access to health care services. The 1997 White Paper for the Transformation of the Health
System, stipulates one of the aims of health Policy in the new South Africa as ‘promoting equity by
developing a single, unified health system’. This commitment is inclusive of the Platfontein
community which comprises the two largest San-groups in South Africa: the !Xun and the Khwe
who were settled on the Platfontein farm at the end of 2004. There are 3500 !Xun and 1100 Khwe
currently living in the Platfontein community. A health facility, compliant with the principles of
Primary Health Care (PHC), was built on the farm to render services to the Khwe and !Xun
communities who were not recognised as a distinct cultural group during the Apartheid era in South
Africa. For the young people in the community it was the first time they could access the formal
schooling and health system in South Africa.
The objective of this study was to assess the perceptions, attitudes, behaviour and knowledge levels
among the school-going youth of the Platfontein community, about STIs, HIV/AIDS and the health
care services that are available to them.
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Diagnosis and monitoring of HIV in infants: investigating the first fourth generation rapid test and two viral load technologies for use in the South African settingBhowan, Kapila 17 November 2014 (has links)
Thesis (M.Sc. (Med.))--University of the Witwatersrand, Faculty of Health Sciences, 2013. / Human immune deficiency virus (HIV) infection contributes to child mortality rates in South Africa.
Investigations of newer technologies for improving early infant diagnosis of HIV in the South
African setting could reduce child mortality as life saving treatment can be accessed early in life.
This study investigated three technologies: a fourth generation rapid HIV test and two viral load
(VL) platforms.
Determine Combo (DC) is a qualitative fourth generation rapid test that is able to detect HIV
antibodies and p24 antigen simultaneously. The performance of DC was evaluated in the field on
samples from pregnant and postpartum women; in the laboratory, on stored samples from children
and with the addition of heat denaturation.
In the maternal DC study 90 (8 .8%) of 1019 women tested HIV positive of whom 59 (17.1%
prevalence) were pregnant and 31 % (4.6% prevalence) were postpartum. The sensitivity and
specificity of the antibody component of DC on plasma was 100%(Confidence Interval (CI): 95.9-
100%) and 99.8%(CI: 99.2-99.9%) respectively. Three postpartum patients tested false positive for
HIV antibodies (n=2) and p24 antigen (n=1). No true positive p24 antigen was detected
DC was performed on stored samples from 182 (90%) HIV-exposed and 20 (10%) HIV-unexposed
children aged from birth to six years. The DC HIV antibody component returned false negative
results in 2 HIV-infected children; one clinically symptomatic and one asymptomatic aged 7 and 23
months respectively. The sensitivity of DC HIV antibody was 100% (CI :94.3-100%) in infants aged
6 months and younger with a specificity of 100% (CI:81.6-100%) for all ages. Of the 61 HIV infected
infants tested , the DC p24 antigen was reactive in only one clinically symptomatic infant
resulting in a sensitivity for detection of HIV infection of 1.7% (CI 0.3-8.9%).
A heat denaturation technique designed to improve p24 antigen detection was applied to HIVinfected
samples but failed to enhance p24 antigen detection on DC.
HIV viral load (VL) molecular assays are used to confirm an HIV-infected diagnosis and for VL
monitoring. In South Africa, plasma is the gold standard sample for VL monitoring in infants even
though dried blood spots (OBS) are the preferred specimen type in resource-constrained settings
and for early infant diagnosis. The use of OBS specimens for HIV VL monitoring would
convenience resource limited settings. The OBS matrix therefore requires validation to determine
accuracy (for establishing diagnosis) and precision (for VL monitoring) compared to plasma VL.
This study investigated the accuracy and precision limits of OBS VL on the Roche Cobas
AmpliPrep-Cobas TaqMan HIV-1 v2.0 assay (CAP/CTM) and the Abbott RealTime HIV-1 assay
(m2000) platforms on samples from HIV-infected adults and children. The CAP/CTM was
investigated on OBS containing 751J1 blood and the m2000 was investigated using one (50IJI) and
two (2x501J1) OBS.
Compared to plasma VL, OBS VL from adults and children were higher in the lower range
«310g,<1000copies/ml) and lower values in the higher range (>510g, >185,000copies/ml) on the
CAP/CTM in the study of OBS VL accuracy. Additionally, OBS VL values were >log1.0 higher in
42/100 (42%) of adult and 16/49 (33%) of measurements from children, which will have clinical
significance. On the m2000 platform, the differences between plasma and OBS VL were lower in
the range >5 log and higher in the range 2 log copies/ml (100 copies/ml) to 4 log copies/ml (10000
copies/ml). Compared to plasma VL, OBS VL values were >log1.0 higher in 20/82 (24%) adult and
7/43 (16%) of measurements from children.
Both platforms demonstrated 100% specificity in testing stored OBS from HIV-uninfected infants
who were diagnosed negative on HIV DNA PCR.
Acceptable limits for plasma VL precision is a coefficient of variation (CV) <35% and standard
deviation (SO) :50.19 log. Where plasma VL :5510g, OBS VL demonstrated poor precision with
CV>40% in 8/10 patients and total SO>0.30 log in 4/10 patients on the CAP/CTM. The m2000
total SO was >210g between adult plasma and OBS VLs under the 4 log copies/ml cut-off,
irrespective of the number of DBS used. DBS VLs were unreliable when using precision limits
used on plasma VLs on both platforms.
In conclusion the DC test does not offer any advantage over currently available rapid tests in
diagnosing new infection in women and children. The two VL platforms can be used to establish
an HIV status in treatment naive patients in view of the 100% specificity. HIV-infected patients on
treatment with undetectable plasma VL will always have detectable DBS VL on CAP/CTM, but
equally undetectable DBS VL on the m2000. With DBS, the CAP/CTM assay generates higher VL
values in the lower VL range than on plasma likely due to amplification of proviral DNA. Both
platforms display poor intra- and inter- assay precision, using plasma VL based criteria and the
variances would potentially affect clinical decision making. The acceptable limits for plasma VL
precision cannot be applied to DBS VL on either platform.
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The health literacy needs of women living with human immunodeficiency virus or acquired immuno deficiency syndrome who attend the wellness clinic at the Jubilee Hospital in HammanskraalThompson, Judy January 2011 (has links)
Thesis (M.Cur.) --University of Limpopo, 2011
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HIV-1 and HIV-2 infections in Guinea-Bissau, West Africa : studies of immune responses, prevailing viruses and epidemiological trends /Andersson, Sören, January 1900 (has links)
Diss. (sammanfattning) Stockholm : Karol. inst. / Härtill 7 uppsatser.
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