published_or_final_version / Community Medicine / Master / Master of Public Health

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.

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

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.

M.Sc.(Med.), Faculty of Health Sciences, University of the Witwatersrand, 2009 / Community-acquired pneumonia (CAP) is a major cause of morbidity and mortality worldwide. Knowledge of the predominant agents associated with CAP locally is essential, as it represents the basis for empiric antibiotic treatment. The objective of this study was to establish polymerase chain reaction (PCR)-based methods that could be used to identify CAP pathogens. Real-time PCR assays were developed to detect 10 viral and 5 non-viral pathogens as well as 2 internal controls using SYBR Green I and TaqMan probes, in singleplex and multiplex reactions. Six multiplex assays, with sensitivities of 1-10 copies/μl, were successfully developed to simultaneously detect 12 organisms. These reactions were used to test a limited number of patient and simulated samples. Data from the real-time PCR methods compared favourably to those from commercially available conventional PCR kits. These detection methods could be used to complement each other in prevalence studies and in selected diagnostic applications.

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.

DSc (Medicine), Faculty of Health Sciences, University of the Witwatersrand / No abstract present

We are grateful to Centro de Investigacion del Envejecimiento (CIEN) of Universidad San Martin de Porres (USMP) for providing us with the database for the study. To the faculty team of research of the medical school of Universidad de Ciencias Aplicadas (UPC) for their appreciations and comments. Jorge L. Maguiña is a doctoral candidate studying Epidemiological Research at Universidad Peruana Cayetano Heredia under FONDECYT/CIENCIACTIVA scholarship EF033-235-2015 and supported by training grant D43 TW007393 awarded by the Fogarty International Center of the US National Institutes of Health . / El texto completo de este trabajo no está disponible en el Repositorio Académico UPC por restricciones de la casa editorial donde ha sido publicado. / Introduction: Sarcopenia is a geriatric syndrome characterized by loss of muscle mass and strength. The prevalence in people between 60–70 years is about 5–13% and in adults over 80 years, between 11–50% in the USA. Sarcopenia increases the risk of mortality and nosocomial infections. Community-acquired pneumonia is the first infectious-related cause of death in elderly people. However, there is lack of evidence about the association between sarcopenia and pneumonia. The aim of our study was to determine the incidence and risk factors of community-acquired pneumonia in older adults with sarcopenia in a Peruvian hospital. Methods: A retrospective cohort study was conducted in the geriatrics service of Centro Medico Naval “Cirujano Mayor Santiago Tavara”. Sarcopenia was defined by “European Consensus of Sarcopenia” criteria. MultivariatePoisson regression model was conducted to estimate the effect of the independent association between sarcopenia and pneumonia. Results: A total of 1598 subjects were enrolled, 59.0% were male; with a mean age of 78.3 ± 8.6 years. The prevalence of sarcopenia was 15.1% (95% CI: 13.3–16.8) and the incidence of community-acquired pneumonia was 15.14% (95%CI 13.4–16.9). In the multivariate model, we found a higher incidence of pneumonia in sarcopenic compared to non-sarcopenic, RR(a) 3.88 (95% CI: 2.82–5.33). Discussion: Our study showed a higher incidence of community-acquired pneumonia in sarcopenic subject. Results provide information on the importance of detecting this syndrome because it gives us scientific evidence of the interest of a correct comprehensive geriatric assessment in older patients with a high risk of pneumonia. / We are grateful to Centro de Investigacion del Envejecimiento (CIEN) of Universidad San Martin de Porres (USMP) for providing us with the database for the study. To the faculty team of research of the medical school of Universidad de Ciencias Aplicadas (UPC) for their appreciations and comments. Jorge L. Maguiña is a doctoral candidate studying Epidemiological Research at Universidad Peruana Cayetano Heredia under FONDECYT/CIENCIACTIVA scholarship EF033-235-2015 and supported by training grant D43 TW007393 awarded by the Fogarty International Center of the US National Institutes of Health . / Revisión por pares / Revisión por pares

The purpose of this research was to determine the relationship of the slime layer antigen(s) to the "101" or LPS antigens and to attempt to evaluate the role of antibodies against the latter in protection against experimental infections in mice with the homologous strain of Pseudomonas aeruginosa. Results from agglutination tests, chromatographic separations, passive protection tests, and characterizations of the antigens by gel double diffusion do not support the concept that LPS is a necessary portion of the immunogenic material. The immunogenicity of LPS can be attributed to co-purification of residual amounts of slime layer antigens on the washed cells from which LPS was extracted.

Thesis (M.Cur.) --University of Limpopo, 2011