As transfusões sanguíneas constituem-se uma ferramenta indispensável na prática médica atual, sendo a captação e retenção de doadores uma preocupação de todo serviço hemoterápico, assim como a segurança dos doadores e receptores. Neste sentido, a educação prévia à doação de sangue exerce papel fundamental, sendo etapa obrigatória no processo de doação. Um doador bem orientado significa menor risco transfusional e maior probabilidade de retorno. Este trabalho descreve a elaboração e aplicação de um vídeo contendo informações necessárias à conscientização prévia à doação de sangue. Após o levantamento das necessidades de conteúdo, através da legislação, literatura e de grupo focal com doadores, produziu-se um vídeo que foi apresentado previamente à doação. Foram incluídos 500 doadores no grupo conscientizado com o vídeo e 500 no grupo controle, conscientizados com palestras, conforme rotina do serviço, sendo 25% de primeira vez e 75% de retorno. Após a doação, os doadores responderam a um questionário para avaliação dos conhecimentos adquiridos e os grupos foram comparados entre si. Responderam ao questionário 118 e 121 doadores de primeira vez e 375 e 345 de retorno, nos grupo do vídeo e controle, respectivamente. A distribuição dos doadores entre os grupos foi homogênea, não variando em relação a faixas etárias, gênero, escolaridade, número de comparecimentos e motivação para a doação. Quanto à nota obtida no questionário, foi significativamente superior para o grupo do vídeo em relação ao controle, marcadamente ente os doadores de primeira vez. Dentre as faixas etárias analisadas, foi inferior para a faixa etária maior de 50 anos. Os doadores de primeira vez tiveram notas inferiores em relação aos de retorno. A apresentação do vídeo não interferiu nas taxas de inaptidão clínica à doação, de situação de risco para doenças transmissíveis, de reações vasovagais, nem nos resultados sorológicos, sendo semelhantes ao grupo controle. A satisfação geral com o atendimento, medida através de instrumento padrão do serviço, foi superior no grupo do vídeo em relação ao grupo controle. Conclui-se que a ferramenta audiovisual é adequada à informação e educação dos doadores de sangue antes da efetivação da mesma, sendo de especial interesse para os doadores de primeira vez, gerando maior satisfação com o atendimento. / Blood Transfusions are an essential tool in the current medical practice, in which the capture and retention of donors is a concern of every hemotherapy service, as well as the safety of both, the donors and the receptors. Therefore, prior education to blood donation has a fundamental role for being a compulsory stage in the donation process. A well-targeted donor means less transfusion risk and more probability of return. This work describes the development and implementation of a video containing information necessary for prior awareness regarding to blood donation. After collecting data about the need of content, through the legislation, literature and focus group with donors, it was produced a video which was presented before the donation. There were 500 donors included in the group aware of the video and 500 in the control group, conscious with speeches, according to the service routine, being 25% of first time and 75% of regular donors. After the donation, the donors answered a questionnaire to evaluate the knowledge gained and the groups compared with each other. Donors from video and control group answered the questionnaire: 118 and 121 of the first time donors, and 375 and 345 regular donors, respectively. The distribution of donors among the groups was homogeneous, not varying according to age, gender, schooling, number of attendances and motivation for donation. Regarding the score of the questionnaire, it was significantly higher in the video group compared to the control group, especially for first time donors. It was lower for people over 50 years old related to the other ages, and for first time donors, related to the regular ones. The video presentation did not interfer in rates such as clinical deferral to donation, the situation of risk for communicable diseases, vasovagal reactions, not even in serological results, being similar to the control group. The general satisfaction with the attendance, which was measured through a service standard instrument, was higher in the video group compared to the control group. In conclusion, the audiovisual tool is suitable to the information and education of the blood donors before the completion of it, being of a special interest to all first time donors, generating greater satisfaction with the attendance.

O HEV é um patógeno viral, transmitido principalmente pela via fecal-oral e responsável por grandes surtos de hepatite em todo o mundo. A hepatite E é considerada a hepatite com transmissão entérica mais frequente no mundo, e um importante problema de saúde pública. Por apresentar uma fase sanguínea assintomática e ser um agente emergente, cuja incidência vem aumentando ao longo da última década, o HEV é também considerado um problema para a hemoterapia, uma vez que põe em risco a segurança transfusional, devido ao risco de sua transmissão por transfusão sanguínea. No Brasil, sua ocorrência e características ainda não são compreendidas e os estudos disponíveis são limitados. Objetivo: Determinar a prevalência do HEV em doadores de sangue do Hemocentro de Ribeirão Preto no ano de 2015. Material e Métodos: Foram selecionados aleatoriamente 1.000 doadores de sangue do Hemocentro de Ribeirão Preto no período de janeiro a dezembro de 2015. Inicialmente, foi realizada a pesquisa de anticorpos da classe IgG do HEV em plasma, utilizando a metodologia de imuno-ensaio enzimático (ELISA). As amostras que se apresentaram reagentes (positivas ou inconclusivas) para IgG HEV, foram submetidas à pesquisa de antígenos virais, também por metodologia ELISA. Paralelamente aos testes sorológicos, foi realizado o teste molecular para a detecção de RNA viral, aplicando a técnica de PCR em tempo real e utilizando primers desenhados para a região mais conservada do vírus (ORF-3). Resultados: Entre as 1.000 amostras testadas, 124 foram positivas para a pesquisa de anticorpos anti-HEV IgG e 5 foram inconclusivas. A soroprevalência encontrada foi de 12,5%. A maior prevalência encontrada foi na faixa etária de 50-59 anos (21,2%, p<0,01), porém com aumento significativo entre os 40 e 69 anos de idade. A menor prevalência encontrada foi no grupo etário de 18 a 29 anos (3,9%). A soroprevalência foi proporcionalmente maior entre os indivíduos do gênero masculino (14,3%, p<0,06) em relação aos indivíduos do sexo feminino (10,4%). Nenhuma das amostras testadas foi positiva para a pesquisa de antígenos HEV e nem para a detecção de RNA viral. Conclusão: A soroprevalência do vírus da hepatite E encontrada entre os doadores de sangue de Ribeirão Preto foi alta (12,5%) e compatível com os dados nacionais de soroprevalência entre doadores. A viremia não pode ser estabelecida, pois não foram encontrados casos de HEV RNA positivos. / HEV is a viral pathogen, transmitted primarily by the fecal-oral route and responsible for large outbreaks of hepatitis worldwide. Hepatitis E is considered the most common transmissible enteric hepatitis in the world, and is currently considered a major public health problem. Because it presents an asymptomatic blood stage and is an emerging agent whose incidence has increased over the last decade, HEV is also considered a problem for hemotherapy, since it jeopardizes transfusion safety due to the risk of its transmission by transfusion. In Brazil its occurrence and characteristics are poorly understood and available studies are limited. Objective: To determine the prevalence of HEV in blood donors at the Hemocentro de Ribeirão Preto in the year 2015. Material and Methods: 1.000 blood donors were randomly selected from the Hemocentro of Ribeirão Preto from January to December 2015. Initially, a HEV IgG antibody was investigated in plasma, using ELISA (enzyme immunoassay). As samples that presented reagents (positive or inconclusive) for HEV IgG, they were submitted to the research of viral antigens, also by ELISA methodology. In parallel to the serological tests, it was carried out for molecular testing to detect viral RNA, applying a real-time PCR technique and using primers designed for a more conserved region of the virus (ORF-3). Results: Among 1,000 tested samples, 124 were positive for anti-HEV IgG antibodies and 5 were inconclusive. One seroprevalence was found to be 12.5%. A higher prevalence was found in the age range of 50-59 years (21.2%, p<0,001), but with a significant increase between 40 and 69 years of age. The lowest prevalence was found for the 18-29 age group (3.9%). Seroprevalence was proportionally higher among males (14.3%, p<0,06) than among female users (10.4%). It was not evaluated for a HEV antigen search or for viral RNA detection. Conclusion: A seroprevalence of hepatitis E virus found among blood donors from Ribeirão Preto and high (12.5%) and compatible with data from seroprevalence among donors. Viremia cannot be established because no cases of positive RNA HEV have been found

Orientador: Marta Helena Krieger / Dissertação (mestrado) - Universidade Estadual de Campinas, Instituto de Biologia / Made available in DSpace on 2018-08-25T08:07:57Z (GMT). No. of bitstreams: 1 Negreti_AmandaAlvim_M.pdf: 4855920 bytes, checksum: 587474864a97f3d14df8bf3c945ee76b (MD5) Previous issue date: 2014 / Resumo: O óxido nítrico (NO) é um agente biológico multifuncional que vem sendo alvo de diversos estudos. A sua capacidade de promover a reendotelização ou inibir a formação da neointima após injúria vascular é reconhecida nos últimos anos devido a sua eficácia em atuar na proliferação e na migração de células endoteliais, bem como na sua capacidade de inibir a adesão e agregação plaquetária. A neointima intra-stent pode ser combatida com o desenvolvimento de stents eluidores de drogas (SED). Os nitrosilos complexos de rutênio se destacam dentre os doadores de NO, devido a sua capacidade de liberar o NO de forma controlada e incorporados a veículos. Este estudo se propôs padronizar as condições de cultivo das células endoteliais umbilicais humana (HUVEC) "saudáveis", verificar a margem de segurança do composto trans-[Ru(NO)Cl(cyclam)](PF6)2, nomeado Ru(cyclam)NO, em células HUVEC por meio de ensaios de citotoxicidade, verificar sua capacidade de promover proliferação/migração celular e a inibição da adesão de plaquetas humanas, e, também verificar a biocompatibilidade deste composto quando incorporados em plataformas de aço. Expressão de proteínas fenotípicas da célula endotelial foi utilizada para padronização de cultivo de HUVEC. A concentração de 0,5mM foi definida como ótima nas condições experimentais. A ação do composto foi caracterizada pelas respostas de manutenção da proliferação (incorporação de timidina triciada - 3HT) e no aumento da migração celular (ensaio transwell), entretanto foi capaz de reduzir as ações estimulatórias do fator de crescimento epidermal (EGF). A citotoxicidade do complexo e das plataformas de incorporação foi determinada por ensaio de redução do 3-brometo de 4,5-dimetil-2-tiazolil-2,5-difenil-tetrazólio (MTT). Em relação ao nitroprussiato de sódio (SNP) a toxicidade induzida pelo composto nas concentrações de 0,5mM a 2,0mM foi reduzida, mesmo na maior concentração após 24 horas de exposição (MTT: 59% ± 4,42). O complexo mostrou ser capaz de reduzir a adesão ao fibrinogênio de plaquetas humanas ativadas ou não. A biocompatibilidade total das plataformas de inox, matriz de siloxano e matriz de siloxano incorporado com Ru(cyclam) foram demonstradas pelo ensaio de redução de MTT e a funcionalidade pelo ensaio de migração transwell. A margem de segurança do Ru(cyclam)NO e de suas respectivas plataformas de imobilização foram caracterizadas como baixa e ausente citotoxicidade. As avaliações funcionais evidenciaram que o Ru(cyclam)NO manteve a proliferação celular, estimulou a migração das HUVEC e inibiu a adesão de plaquetas humanas. Estas evidências constituem-se de pontos fundamentais para se obter a reendotelização / Abstract: Nitric oxide (NO) is a multifunctional biological agent that has been the subject of several studies. In recent years, its ability to promote re-endothelialization or inhibit neointimal formation after vascular injury is recognized due to its efficacy in stimulates proliferation and migration of endothelial cells, as well as its ability to inhibit platelet adhesion and aggregation. The in-stent neointimal can be prevented with the development of drug-eluting stents (DES). Nitrosyl ruthenium complexes highlighted from the NO donors, due to their ability to release NO in a controlled manner and incorporated into vehicles. This study aimed to: 1) standardize the cultivation conditions of " healthy " human umbilical endothelial cells (HUVEC); 2) verify the safety margin of the compound trans - [Ru(NO)Cl(cyclam)](PF6)2, named Ru(cyclam) O, in HUVEC cells by cytotoxicity assay; 3) determine its ability to promote proliferation/migration cell and inhibition adhesion of human platelets; and also 4) verify biocompatibility of this compound when incorporated in slides. Phenotypic expression of the endothelial cell protein was used to standardize cultured HUVEC. A concentration of 0.5 mM was set to the optimal experimental conditions. The Ru(cyclam)NO action was characterized by responses of the proliferation maintenance (tritiated thymidine incorporation - 3HT ) and migration cell increased (transwell assay), however was able to reduce the stimulatory actions of epidermal growth factor (EGF). The cytotoxicity of the compound and its incorporation slides was determined by reduction of 3- bromide, 4,5-dimethyl -2-thiazolyl -2 ,5 -diphenyl tetrazolium bromide (MTT). In relation to sodium nitroprusside (SNP), Ru(cyclam)NO showed reduced toxicity from 0.5 mM to 2.0 mM, even at the highest concentration that was 59% ± 4.42 of the cell viability. The Ru(cyclam)NO was shown to reduce adhesion to fibrinogen of human platelets activated or not. The total biocompatibility of stainless slide with siloxane matrix and siloxane matrix incorporated with Ru(cyclam)NO were demonstrated by MTT reduction assay and their functionality by transwell migration assay. The safety margin of Ru(cyclam)NO and their respective slide incorporated were characterized as low or absent cytotoxicity, respectively. Functional evaluations showed that the Ru(cyclam)NO maintained cell proliferation and stimulated the migration of HUVEC, well as well, inhibited adhesion of human platelets. These obtained evidences are key points to get the re-endothelialization / Mestrado / Fisiologia / Mestra em Biologia Funcional e Molecular

In all types of debates - regardless of topic - research findings, investigations, evaluations and media reports regarding aid will find one prominent question, namely whether there is any clear connection between aid and economic growth in countries that have received high amounts of foreign aid. One argument has been that the connection between a high amount of foreign aid and economic growth is none existing. However, this assumption has been questioned by reports that claims the opposite: that aid, with the right conditions, could have a positive effect on a country’s economic growth. This study makes an effort to examining the effects of foreign aid in Bolivia by looking at the country’s development process in terms of economic growth. Questions like - who were the main donors that contributed with foreign aid in Bolivia? In what way were this foreign aid applied? How do development agencies asses the macro economic impact of aid? - will be discussed and answered throughout the thesis. The findings of the study demonstrate the complexity of measuring development within a certain case. It depends on what one chose to include in the term as well as which area is being investigated. Furthermore, the results seems to vary between the different programs evaluated that has been shaped and implemented by foreign donors. However, drawing from the findings presented in this study, the result indicates that foreign aid in general has had a positive effect on Bolivia’s economic growth.

Since the discovery in 1989 of hepatitis C virus (HCV) as the infectious agent responsible for the vast majority of post-transfusion non-A non-B hepatitis, blood transfusions are no longer a source for HCV transmission in Sweden. Anti-HCV testing was implemented for all blood donations in 1992. Since then intravenous drug use (IDU) has become the major route of transmission in the western world. Six genotypes and more than 80 subtypes of HCV have now been identified world-wide. These genotypes and subtypes are determined by genetic divergences between the HCV strains. Subtypes 1a, 1b, 2b, 2c, and 3a have global spread, while the other subtypes have a more limited geographical distribution. Little was known on the prevalence of HCV among blood donors and on which genotypes and subtypes of HCV were circulating in Sweden before the testing of all blood donations was implemented. The prevalence of anti-HCV was therefore investigated in sera sent to the Swedish Institute for Infectious Disease Control (SMI) from 412 patients; 241 were sampled between 1970 and 1991 before the universal screening in 1992, while 171 were sampled between 1992 and 2002. The samples derived from 193 (47%) blood donors, (104 sampled before, and 89 after 1992), and from seven other groups of patients. Two groups had suspected known routes of infection, intravenous drug use (IDU) 33 patients and hemodialysis, 16 patients, while it was unknown for the other patients. Anti-HCV was detected in 120 (29%) samples. The highest frequency was found among IDUs, (91%). Before general screening was implemented, 2.8% of the blood donors were positive for hepatitis C, whereas 28% of those sampled after 1992 were anti-HCV positive. Those latter samples were sent to SMI due to anti-HCV reactivity in a primary test at the blood centre. HCV RNA could be detected by PCR in 56 (47%) of the anti-HCV positive samples, the subtype could be determined by sequencing in 45 (80%) of those. The subtypes found were 1a in 31 %, 1b in 18%, 2b in 22%, and 3a in 27%. One sample was of subtype 2c. There was a tendency of increase of genotype 2 and a decrease in subtype 1a with time. 1a was found in 38% of the samples collected before 1992, while it was only found in 19% of the samples from 1992 or later. On the other hand genotype 2 was found in 17% sera sampled before 1992 and in 37% of the samples collected 1992 or later. It is not known if this genotype has recently been introduced into Sweden. Further analysis on larger series of samples is needed to confirm these preliminary results. / AcknowledgmentsI would like to express my gratitude to several people who have been supportive in different ways throughout this project.First of all, I want to thank my supervisor Helene Norder, for giving me the possibility to do my diploma thesis at the Department of Virology, Swedish Institute for Infectious Disease control (SMI) and for helping me during this study and for the many insightful conversations during the design and development stages of the application, and also for the many helpful comments and suggestions on the text of the thesis.I want to express my appreciation to my laboratory supervisor Regina Wallin, Camilla Jern and Josefine Ederth for helping me during the procedure for this study. Then, I want to thank my examiner Magnus Johansson from the Södertörns university collegefor his advice on writing this paper. Finally, I would like to thank my family and specially my mother Bahar Hamid for always supporting me during my whole life.Last, but not least, I would like to thank my friends Annika Andersson and Yourdons Yemane for being encouraging, understanding and always supportive.

Between 1847 and 1903, spanning the first three episcopates of the newly-created Diocese of Manchester, 228 churches were built, or significantly extended, in the largest by far of its five deaneries, the Deanery of Manchester. Exploration of diocesan, Mancunian, and parochial archival and other sources revealed that sixty-one of those 228 building-projects – over a quarter – had each been funded by a single donor or single family. The fifty 'singular' donors (eight financing more than one project) represented a wide swathe of the middle and upper echelons of society, comprising six MPs; thirty-one industrialists, including twenty-two (predominantly textile-) mill-owners, three engineers, and two colliery- and canal-owners; and thirteen non-industrialists, including five bankers, two landed gentry and three clerics. The scale of this aspect of industrial city philanthropy, and its lack of study are striking. Singular funding by donors of specific buildings provides a fresh angle from which to approach the reasons for philanthropy at an individual level. In each case, what role did self-interest play; what role such impulses as Established-Church-allegiance, evangelism, paternalism, territorialism, and dynasticism? Could a master driving-force, composed of a combination of some or all of those and other possible impulses, have been a donor's desire for worth: self-worth; worth in the eyes of contemporary society; and worth for remembrance in posterity? Were donors essentially creating churches in their own image? The Introduction covers identification of the churches and the ecclesiastical, industrial and historical context of their building and of nineteenth-century Mancunian philanthropy. Chapter One, exploring the donors' biographies, includes, as potential drivers in church-creation, timing of public preferment – providing scant support for its previously identified role in other charitable giving – and alternative donor-self-image-related impulses. Chapter Two considers, as a measure of donor-church-identity, possible linkage of donor to church through dedication, proximity, iconography, memorials, armorials, dedicated space, and burial arrangements. Chapter Three uses choice of architect, their north-western oeuvre, and the balance of architects' and donors' roles, to further assess reflection of donor-self-image in the church. Finally, Chapter Four scrutinises each donor-church-architect nexus for signs of churchmanship; a quality – where present in strength and definable as donor-led – considered strongly indicative of donor-self-image. Donor, church, architect, and churchmanship – key components of the donated church and to assessing in each their interconnections – disclose great diversity. Donor-self-image was indeed present, in its various aspects, in most if not all the churches. Its presence ranged from almost negligible or inconclusive to what amounts to its passionate expression. Archive Note: Research for this project resulted in far more material of relevance to its substance than could be included in the text. The University of Manchester has kindly consented to hold this material, comprising textual and photographic data, as an archive freely accessible on request.

The dissertation takes the form of an impact study. It is based on a ten month period of research involving a literature review, interviews with headmasters of secondary schools who gave permission to survey their students, educational talks to secondary school learners and a survey of 500 learners from different schools in the Mthatha region. Purpose: The research endeavour addressed the problem of investigating the effectiveness of blood donor education in secondary schools in Mthatha region. Design/methodology/approach: This study employed a questionnaire-based survey. Five schools namely Mthatha High School, Holy Cross High School, Strategic High School; St Johns’ College and Zamukulungisa High School participated in this study. The Statistical Analysis System was employed to assess the association between the awareness strategies and general donor response. A chi–square test of association, based on the p –value approach, was used to achieve the results. Findings: This study finds that a blood donor education programme can increase blood donation awareness; benefit the schools and community, thus increasing the blood donor base. Receiving information as to the criteria for blood donation and how each individual donation is used to save a life is seen as a powerful means of reinforcement. Research limitations/implications: Further research is recommended on a large scale, involving all schools in Mthatha region. The research was delayed because it employed a new approach and a team had to be appointed before the blood donor centre can be opened. It is further recommended a once–off educational programme is not ideal because learners may not have received blood donation education before and should be repeated in follow-up sessions. Originality: This is the first research study looking at the effectiveness of a blood donor education programme in Mthatha secondary schools.

La République du Congo (RC) ou nos travaux ont eu lieu, est un pays d’Afrique Centrale, il partage ses frontières avec la République démocratique du Congo, la République centrafricaine, le Gabon, le Cameroun, et l’Angola (Cabinda). Dans ces pays la circulation des arboviroses est documentée. En RC, il y avait peu ou pas de documentation sur les arboviroses avant nos travaux. Nous avons réalisé des études de séroprévalence des arboviroses de différentes familles chez des donneurs de sang Congolais. Nous avons aussi étudié l’épidémie de chikungunya ayant sévit en RC en 2011. Nos travaux ont permis de mettre en évidence des taux de séroprévalence élevés pour les pathogènes principaux incriminés: 47,2% pour Dengue, 27,8% pour Yellow fever, 24,4% pour West Nile, 38,8% pour Chikungunya et 7,9% pour Rift Valley fever. Ces taux de séroprévalence élevés prouvent la circulation de ces virus au Congo, bien qu’aucune épidémie n’ait été encore déclarée pour certains. Nous avons également isolé et caractérisé génétiquement une souche nommée "Brazza_MRS1", appartenant au lignage East Central and Southern African, issue de l’épidémie due au virus chikungunya de 2011. La RC a connu plusieurs épidémies dues au virus Ebola. Nous avons tenté de mieux caractériser la circulation des filovirus chez les donneurs de sang asymptomatiques par une étude de séroprévalence. Les taux de séroprévalence IgG anti Ebola virus, observés étaient de 2,5% en général (1,6% à Brazzaville, 4% à Pointe-Noire et 4% en milieux ruraux). Les facteurs de risques identifiés étaient l’exposition aux chauves-souris (p<0.001) et aux oiseaux (p = 0.04). Le taux de séroprévalence IgG anti Marburg virus était de 0,5%. / The Republic of Congo (RC) where our work took place is a Central African country, sharing borders with the Democratic Republic of Congo, Central African Republic, Gabon, Cameroon, and Angola (Cabinda). In these countries the circulation of arboviruses is documented. In RC, there was little or no documentation on arboviruses prior to our work. We conducted studies of arbovirus seroprevalence in Congolese blood donors for different virus families. We also studied the epidemic caused by the chikungunya virus that prevailed in RC in 2011.Our work have highlighted the high rate of seroprevalence for incriminated major pathogens: 47.2% for Dengue, 27.8% for Yellow Fever, 24.4% for West Nile, 38.8% for Chikungunya and 7.9% for Rift Valley fever. These high seroprevalence rates indicate that these viruses actively circulate in Congo, although no epidemic has yet been reported for some viruses. We have also isolated and genetically characterized a strain named "Brazza_MRS1", belonging to the East Central and Southern African lineage, after the chikungunya epidemic in 2011. The RC has experienced several outbreaks caused by the Ebola virus. We have performed a filovirus seroprevalence study to attempt to better characterize the circulation of filoviruses in asymptomatic Congolese blood donors. The observed rate of seroprevalence of anti Ebola IgG was 2.5% overall (1.6% in Brazzaville, 4% in Pointe-Noire and 4% in rural areas). Identified epidemiological risk factors were the exposure to bats (p <0.001) and birds (p = 0.04). The seroprevalence rate of Marburg virus IgG was low (0.5%).

L’infection par le VIH est caractérisée en l’absence d’intervention par une évolution progressive vers un état d’immunodépression favorisant la survenue d’affections opportunistes et entrainant le décès. La connaissance de l’évolution spontanée de l’infection par le VIH repose sur les données observationnelles issues des cohortes. La meilleure façon d’aborder l’histoire naturelle de cette infection est de l’étudier à partir de la date de séroconversion, ce qui ne peut se faire que dans les cohortes dites incidentes. Ces cohortes incidentes font appel à des structures parfois lourdes et des procédures rigoureuses que l’on peut plus aisément mettre en place dans les pays à ressources élevées. Les cohortes de personnes à date estimée de séroconversion permettent d’identifier les facteurs de risque de la transmission, d’étudier l’évolution de l’infection, d’étudier l’évolution de ses marqueurs et ses déterminants en minimisant le biais de sélection inhérent aux études prévalentes. L’évolution naturelle concerne la période qui s’écoule entre la date d’infection et le décès pour les patients qui n’ont pas bénéficié de prescription du traitement antirétroviral. Cette période s’arrête à la date de prescription des antirétroviraux pour ceux qui en bénéficient.La cohorte ANRS 1220 Primo-CI de personnes à date estimée de séroconversion pour le VIH-1 a été mise en place en juin 1997 sur le site de l'ANRS d'Abidjan en Côte d'Ivoire, au Centre national de transfusion sanguine (CNTS), avec la coordination de l'INSERM U330/593/897-ISPED de Bordeaux. C’est l’une des rares cohortes de séroconverteurs pour le VIH-1 dans le contexte des pays à faibles ressources et l’unique en Afrique de l’ouest. Dans cette cohorte de patients dépistés parmi les donneurs de sang effectuant plus de deux dons de sang par an, les données cliniques et biologiques ont été recueillies régulièrement pour tous les patients, tous les six mois depuis leur inclusion dans la cohorte.Les principaux apports de la cohorte Primo-CI dans la lutte contre le VIH en Côte d’Ivoire, ont consisté à recueillir des informations sur les facteurs de risque d’infection par le VIH pour aider à améliorer la sélection des donneurs de sang. La cohorte Primo-CI a permis d’améliorer également les capacités de la structure de prise en charge qui a servi de centre de recrutement et de prise en charge des patients de la cohorte. Cette cohorte a contribué à la mise en place d’un cadre d’échanges réguliers entre les médecins chargés de la sélection des dons de sang et l’équipe de la cohorte Primo-CI.Nos données ont fourni des estimations de la probabilité d'atteindre les critères d'initiation des antirétroviraux depuis le premier contact dans une population de séroconverteurs récents pour le VIH en Afrique de l’ouest et de la probabilité de survenue des événements morbides au cours du temps.L'ADN intracellulaire du VIH-1 était la variable la plus fortement associée à la progression de la maladie, indépendamment des autres variables explicatives. Il était suivi des lymphocytes CD4 avec une association plus faible. La charge virale plasmatique VIH-1 était faiblement associée à la progression de la maladie et ce après la prise en compte de l'ADN.La cohorte ANRS 1220 Primo-CI a participé à plusieurs travaux de collaborations portant sur les seuils d’éligibilité aux antirétroviraux, la comparaison de la baisse des lymphocytes CD4 avec des patients européens, la morbidité et la mortalité liées au SIDA et le rôle prédictif de l'ADN intracellulaire du VIH-1. Elle a également contribué à la réalisation de travaux scientifiques en virologie et immunologie qui ne portent pas sur l’objectif principal de ce travail. / In the absence of any intervention, HIV infection is characterized by a gradual evolution towards a state of immunosuppression favoring the occurrence of opportunistic infections and causing death. The natural history of HIV infection is usually documented based on data from observational cohorts. But the best way to address the natural history of this infection is to observe subjects from the date of their seroconversion (within an “incident” cohort). However these incident cohorts often involve heavy structures and complex procedures that are more easily set-up in high-resources countries.Cohorts of individuals with estimated date of seroconversion can identify risk factors for HIV transmission, study the evolution of the infection, and study the evolution of its markers and determinants by minimizing the selection bias inherent in prevalent studies. The natural history of HIV is defined by the period between the date of infection and either the date of death for patients who were not prescribed antiretroviral therapy or the date of antiretroviral therapy prescription for others.The ANRS 1220 Primo-CI Cohort of people with a known date of HIV-1 seroconversion was launched in June 1997 in the site of the ANRS Abidjan in Côte d'Ivoire, National Blood Transfusion Centre (CNTS), with the coordination of U330/593/897-ISPED INSERM Bordeaux. This is one of the few adult cohorts of HIV-1 seroconverters in the context of low-resource countries and the only one in West Africa. Within this cohort of patients recruited among blood donors performing more than two blood donations per year, the clinical and laboratory data were collected routinely every six months from their inclusion.One of the main contributions of the Primo-CI cohort in the fight against HIV in Côte d’Ivoire was the collection of information on the risk factors for HIV infection. It helped to improve the selection of blood donors. It also helped to improve the capacity of the health structure where the cohort patients were recruited and followed-up.This cohort has contributed to establish a system for regular exchanges between physicians responsible for the selection of blood donations and the team of the Primo-CI cohort. Our data have provided estimates of the probability of reaching the criteria for initiating antiretroviral drugs from the first contact and the probability of occurrence of morbid events over time, in a population of recent HIV seroconverters in West Africa.The HIV-1 intracellular DNA was the variable most strongly associated with disease progression, independently of other variables. It was followed by lower CD4. Plasma viral load HIV-1 was poorly associated with disease progression after taking into account the HIV-1 intracellular DNA.Finally, the ANRS 1220 Primo-CI cohort participated in several collaborative studies regarding the threshold of eligibility for antiretroviral drugs, the comparison of the decrease in CD4 lymphocytes with European patients, morbidity and mortality related to AIDS and the predictive role of HIV-1 intracellular DNA. It also contributed to scientific studies in virology and immunology that do not concern the main objective of this work.

This study explores Security Sector Reform as a concept to address peace building or post-conflict reconstruction in a country attaining independence or emerging from a major conflict as in the case of South Sudan. Although various descriptions for a security sector exist, it is a common term applied to refer to structures, institutions, and personnel who are responsible for managing, providing, and overseeing security within a state. In general it refers to the armed forces, law enforcement agencies, national intelligence agencies, border control agencies, and civil protection entities. SSR refers to actions aimed at strengthening legitimate institutions and governance to provide citizens security, justice, and jobs which is crucial to break the cycle of violence. SSR is also conceptualised within the enlarged definition of security which includes human security. This emphasises the approach that SSR is not only restricted to defence and the role of law and order, but is also included in wider political, economic, and social issues. Within the concept of SSR, various prerequisites are stated for the effective execution of SSR within a state. For an analysis of effective SSR in South Sudan, the following aspects were identified to apply as a theoretical model to analyse the execution of SSR in South Sudan. These aspects were the necessity of a formalised peace agreement; the execution of a clear and effective DDR programme; the importance of foreign involvement and international military involvement; the importance of the institutionalisation of security sector structures, and civil oversight. The study concludes that certain aspects of the SSR plan contributed to peace building and post-conflict reconstruction such as certain provisions of the peace agreement, the involvement of the international community, and financial support. However, SSR in South Sudan mainly failed due to a failure of the DDR process, the inability of the international involvement to address outstanding security issues, a failure to address border demarcations, and a total failure to install effective security sectors and civil oversight mechanisms over the military. The study on the other hand suggests SSR as a concept for post-conflict reconstruction, specifically within a state acquiring independence such as South Sudan, should be viewed as a workable concept. As a model to address peace building or post-conflict reconstruction, SSR can indeed be effective. It provides for a wide spectrum of measures to address security, political, and economic disparities within a state emerging from a conflict and aspiring to democratise as a new state such as in the case of South Sudan. The failure of the SSR concept in South Sudan is not ascribed to an insufficient SSR process or plan, but due to the non-adherence of the provisions of the plan by the signatories of the plan and the socioeconomic, ethnic, and security challenges in independent South Sudan that would have complicated any SSR attempt. SSR as a concept can be applied for peacebuilding if certain conditions such as enforced DDR, commitment by international role players, the enforcement of provisions of the peace agreement, and effective measures to institute the de-politisation of the military are provided. / Mini-dissertation (MSecurity Studies)--University of Pretoria, 2015. / tm2015 / Political Sciences / MSecurity Studies / Unrestricted