Thesis (M.Med. (Internal Medicine))--University of the Witwatersrand, Faculty of Health Sciences, 2013. / Background Cryptococcus is a life-threatening opportunistic infection; data is limited regarding early infection. Treatment of cryptococcal antigenaemia may impact on disease progression. Screening those most at risk for cryptococcal antigenaemia is necessary to be cost effective. The prevalence of cryptococcal antigenaemia in patients hospitalised with community acquired pneumonia (CAP) at Chris Hani Baragwanath Academic Hospital (CHBAH) was evaluated. Methods 200 patients admitted to CHBAH with presumed CAP were enrolled. Clinical and laboratory data were collected and a Cryptococcal Lateral Flow Immunoassay was done on whole blood. Results Of the 200 patients, 185 (92.5%) were HIV-infected. Amongst the HIV-infected group, the median CD4 cell count was 47 cells/mm3 and 111 subjects (60%) had a CD4 cell count < 100 cells/mm3. The prevalence of cryptococcal antigenaemia was 0.5% (CI 0.01-2.75). Conclusion The prevalence of cryptococcal antigenaemia amongst inpatients with CAP was low. Routine screening of this group would not be cost-effective.

DSc (Med), Faculty of Health Sciences, University of the Witwatersrand, 2009.

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

M.Sc. (Nursing), Faculty of Health Sciences, University of the Witwatersrand, 2011

Diss. (sammanfattning) Stockholm : Karol. inst., 2001. / Härtill 7 uppsatser.

Diss. (sammanfattning) Stockholm : Karol. inst. / Härtill 4 uppsatser.

No description available.

No description available.

In 2008, 1.8 million children under the age of 15 were living with HIV/AIDS in sub-Saharan Africa. The same report estimates that in 2008, there were 390 000 new infections in children below the age of 15 in Sub- Saharan Africa. Children appear to be the generation most affected by the HIV/AIDS epidemic. With the introduction of Highly Active Antiretroviral therapy (HAART) more perinatally infected children are living into adolescence and beyond. They will have to learn to live with a stigmatising, potentially fatal chronic illness. Health care workers can no longer rely solely on traditionally used outcome measures, such as viral loads and CD4+ percentages, to monitor effectiveness of interventions and treatments. Quality of Life (QoL) has been suggested as an additional essential outcome measure in clinical practice and research involving children living with a chronic illness. In this research the concept of Health Related Quality of Life (HRQoL) is evaluated in HIV-infected children using the PedsQL 4.0 Generic Core Scale (child self-reports, ages five-seven). The PedsQL 4.0 Generic Core Scales has been found to be a valid and reliable HRQoL measurement tool in children with chronic diseases, school-going children and children infected with HIV. Domains of Physical, Emotional, Social and School Functioning were evaluated. The children in the comparison group scored significantly higher (p<0.01) indicating a better quality of life. The HIV-infected children scored significantly lower in all four domains, with Physical Functioning being most affected (p<0.01). The children with HIV were found to be shorter (p<0.01) and lighter (p<0.01) than those in the comparison group. This could be a contributing factor to the physical difficulties experienced by the HIV-infected children. No relationship could be established between total scores of HRQoL and CD4+ percentages, viral load and duration of HAART treatment. Demographic data collected indicate that the HIV-infected children were more likely to have a primary caregiver with a lower level of education (p=0.01) and more likely to be receiving a Dependency Care Grant (p=0.05). The HRQoL results of this study are similar to those conducted in other parts of the world. The results stress the need for a multi-disciplinary approach when treating HIV-infected children. It has become essential to focus on the medical, physical and psychosocial functioning of the HIV-infected child thereby promoting participation in the family, school and the broader community.

Hospital acquired pneumonia (HAP) causes significant mortality and morbidity and is now no longer reimbursed by Centers for Medicare and Medicaid (CMS). For all of these reasons, hospitals want to minimize their HAP rates. Aggressive oral care (tooth brushing 3 times a day) has been shown to reduce the incidence of HAP in the intensive care unit setting, but this has not been tested in the acute care setting, in which patients are more stable, less sick, and more ambulatory. In an attempt to address HAP rates in acute care settings, this clinical trial entailed providing all patients in four wards with a 3 times per day tooth-brushing oral care protocol, which was implemented or supervised by the nurses on each ward. Six matched wards on a separate campus that received normal standard of care served as controls. The goal of this clinical trial was to cut the pneumonia rate in half, from 2% to 1%. This clinical trial was conducted to determine whether an oral care regimen would reduce the incidence of aspiration pneumonia over the three months of intervention in the experimental group (HAC) versus the control group (ENC) from Nov 5, 2012 to Feb 15, 2013.