Since early 1983, the incidence and prevalence of heterosexually transmitted AIDS among women have increased at an alarming rate. However, due to the conceptualization of AIDS as a "gay male" disease, little research attention has been devoted to the prevention of HIV infection among women. The purpose of the current intervention was to test the utility of extending a behavioral social influence/diffusion of innovation approach to a group of heterosexual women. A randomized experimental field design was used to compare a community intervention (AIDS education materials plus the training of individuals identified as key opinion leaders to serve as peer behavior change agents) with a comparison intervention (AIDS education materials alone). The study was conducted at a small liberal arts college for women. Two dormitories were randomly assigned to either an intervention or comparison condition. Twenty-four women, living in the intervention dormitory, were identified as key opinion leaders among their female peers. These key opinion leaders then received information concerning the basic epidemiology of AIDS and other STDs, misconceptions about the transmission of AIDS/STDs among heterosexual women, gender constraints that impact health behavior change among women, and practical risk reduction strategies. Opinion leaders also received training in specific conversation skills to endorse HIV-protective behavior and to convey a change in normative sexual behavior to women living in the intervention dormitory. At pre- and post-intervention, 580 surveys were collected from both the intervention and comparison dormitories. Using an anonymous identification code, survey data were matched for 192 comparison and intervention participants. The major dependent variables included (a) AIDS/STD risk behavior knowledge, (b) perceived risk, (c) perception of peer norms for HIV-risky and HIV-protective behaviors, (d) stage of health behavior change, (e) intentions to practice safer sex, (f) socially and sexually assertive behavior, (g) HIV-risky sexual behavior, and (h) alcohol and drug use. Condom-taking behavior provided a nonreactive measure of behavioral intentions. A number of direct training effects were found for the key opinion leaders, including an increase in AIDS/STD risk behavior knowledge, conversation skills, and empathic assertion. However, there was no change in behavioral intentions, stage of change, perceptions of peer norms for HIV-protective behavior, or reported HIV-risky behavior. Analysis of covariance on posttest scores, using pretest scores as covariates, showed that, relative to the comparison participants, the intervention participants increased their AIDS/STD risk behavior knowledge and the number of AIDS/STD related peer conversations. No other treatment effects due to diffusion of innovation were found. The rate of risky sexual behavior for the intervention period was relatively low. However, descriptive statistics revealed a pattern of HIV-risky behavior in the current sample suggesting that HIV/STD risk may increase over time as a function of unprotected vaginal and oral intercourse and serial monogamy. The implication of these findings are discussed in terms of future interventions targeting heterosexual women. / Ph. D.

Animal behavior has important impacts on animal populations and the ecosystem at large, but the impact of such behavior on many ecological phenomena is understudied. For example, behavior drives transmission between wildlife disease hosts. Space use and resource selection determines where hosts will make contact, movement determines how pathogens may spread over the landscape, and other fine-scale behaviors determine the rate of contact and transmission. Spatial and movement data from GPS telemetry are useful for studying the causes and consequences of many behavioral processes. One particular focus of such spatial analyses is the behavioral responses of prey to predation risk. While many studies have highlighted the broad impacts of these antipredator behaviors, few studies have emphasized how predation risk may impact the behavioral drivers of disease transmission. White-tailed deer (Odocoileus virginianus) are an excellent system to study these questions for three reasons. First, deer exhibit a fission-fusion social structure, so contacts are dependent on numerous interacting factors. Second, deer face varying predation risks and respond to these risks with varying strategies including spatial avoidance, foraging, and grouping behavior. Third, deer are host to many important diseases with differing transmission mechanisms. In this dissertation, I had three main objectives; 1) to evaluate the factors that produced variation in deer-to-deer contact, 2) to evaluate multiple behavioral responses of deer to predation risk and, 3) to use these behavioral patterns to make predictions of the relative risk of deer-to-deer contact.In chapter one, I evaluated population variation in contact and tested the impact of variation in contact-related behavior on inferences from social network analysis. I used camera trap recordings of visits and behaviors by deer to scrapes throughout DeSoto National Wildlife Refuge, Nebraska from 2005 and 2006. Based on 2,013 interactions by 169 unique identifiable males and 75 females, I produced social networks based on indirect contact among deer at scrapes, with edges weighted based on the frequency, duration, and types of behaviors. Social networks based on scrape-related behavior were highly connected and dependent upon the frequency, duration, and type of behavior exhibited at scrapes (e.g., scraping, interacting with a scrape or overhanging branch, rub-urinating, grazing) as well as the age of the deer. Including behavior when defining edges did not preserve the network properties of simpler measures (i.e., unweighted networks) confirming that heterogeneity in behaviors that affect transmission probability are important for inferring transmission networks from contact networks. In chapters two through five, I evaluated the behavior of deer using movement data from GPS collars. I captured and collared white-tailed deer (Odocoileus virginianus) at two sites: Shelbyville, IL, and Carbondale, IL from January 2020 to March 2022. I collared a total of 156 deer across both sites, 71 in Shelbyville and 85 in Carbondale. Of these deer, 45 in the Shelbyville sample were female and 26 male, and in Carbondale, 54 deer were female and 31 male. Deer were tracked with remotely-sensed GPS telemetry collars for periods of roughly one year on average, resulting in a total of 1,933,465 GPS locations. In chapter two, I used this GPS data to develop a method to relate resources to the relative probability of encounter based on a scale-integrated habitat selection framework. This framework integrates habitat selection estimates at multiple scales to obtain an appropriate estimate of availability for encounters. Using this approach, I related encounter probabilities to landscape resources and predicted the relative probability of encounter. Additionally, I further tested the usefulness of this approach by applying this framework to two other systems representing social contact and predator-prey contact respectively. This predicted distribution of encounters was more accurate when predicting novel encounters than a naïve approach or any individual scale alone. In chapter three, I improved estimates of the drivers of movement by developing novel methods for step selection analysis (SSA). To determine the impact of long-term behavior on local selection from SSA, I simulated movement trajectories including bias toward locations simulating different types of long-term behavior. Based on these simulated trajectories, I evaluated the impact of long-term behavior by identifying frequently reused locations based on a three-dimensional kernel density estimate including latitude, longitude, and time of day. Following this, I developed two approaches to account for spatial and temporal patterns of long-term behavior. I then compared estimates of known values of selection from models using these correction methods to previously established methods based on factors such as spatial memory. In chapter four, I applied this method to estimate local-scale step selection of deer in response to sources of risk. Additionally, I evaluated the impact of risk variables on behavioral states using hidden Markov models (HMMs) and determined state-specific estimates of selection. I found that deer avoided human modification but were more likely to change behavioral state in response to mesopredators. Since different sources of risk induce different behavioral responses, it is likely necessary to account for all of these behavioral responses when estimating the impacts of predation risk and its potential consequences. In chapter five, I used inferences from the preceding three chapters to build a mechanistic model of home range selection and movement that can be used to infer contact distributions. This approach could include varying levels of complexity including local-scale step selection, behavioral state transitions, and antipredator response. I ran models with varying levels of complexity and compared the performance of those models to the approach in chapter 2 for predicting contacts. I found that this method could predict contacts accurately even with limited data, but still had difficulty when transferring predictions to new locations.

FundaÃÃo Cearense de Apoio ao Desenvolvimento Cientifico e TecnolÃgico / A Escala de AvaliaÃÃo da Capacidade para Cuidar de CrianÃas Expostas ao HIV (EACCC-HIV) à um instrumento que estima o cuidado de mÃes Ãs crianÃas nascidas na vigÃncia do HIV. Objetivou-se avaliar a capacidade de mÃes para cuidar de crianÃas expostas ao HIV mediante a EACCC-HIV e verificar a associaÃÃo entre as dimensÃes da escala e as caracterÃsticas maternas. Estudo transversal desenvolvido em 2010 em Fortaleza-CE. Participaram 62 cuidadoras (mÃes) HIV+ com 64 filhos (dois gemelares) nascidos expostos ao HIV menores de 1 ano. Apreciaram-se as caracterÃsticas das mÃes e das crianÃas; as estratÃgias para reduÃÃo da transmissÃo vertical do HIV; Apgar familiar e a EACCC-HIV. A escala possui 52 itens e cinco fatores que sÃo utilizados para determinadas idades entre zero e 1 ano: Fator 1: capacidade para administrar o AZT xarope (crianÃas atà 42 dias de vida); Fator 2: capacidade para preparar e administrar o leite em pà (crianÃas atà 1 ano); Fator 3: capacidade para preparar e administrar alimentaÃÃo complementar (crianÃas > de 4 meses); Fator 4: capacidade para administrar a profilaxia com sulfametoxazol e trimetoprim (crianÃas > 42 dias); Fator 5: capacidade para garantir a adesÃo ao acompanhamento clÃnico e vacinaÃÃo (todas as crianÃas). As respostas sÃo mediadas por fator ou pela somatÃria de todos os itens, indicando-se o grau de cuidado desenvolvido pela mÃe. Para anÃlise utilizou-se o STATA 11.0, empregando-se nÃvel de significÃncia de 5%. A idade materna oscilou entre 18 e 42 anos, 33,9% com aids, 61,3% integrantes das classes D e E. Das crianÃas uma tinha aids (1,6%), 98,4% iniciaram o AZT nas primeiras horas de vida, 3,1% foram amamentadas, 61,3% tiveram consumo inadequado de leite artificial e 36,2% consumo inadequado de alimentaÃÃo complementar. O Apgar familiar indicou 34,4% severamente funcional. Enquanto o fator 1 da EACCC-HIV avaliou 11 crianÃas, das quais 72,7% recebiam cuidados considerados adequados, o fator 2 avaliou 64 crianÃas e indicou que 86,0% das mÃes possuÃam alta capacidade de cuidar. Pelo fator 3, o cuidado concentrou-se entre moderado (44,4%) e alto (50%). O fator 4 estimou o cuidado oferecido para 51 crianÃas, indicando que 76,5% tiveram alta capacidade para o cuidado, e o fator 5 avaliou respostas das 62 mÃes sobre as 64 crianÃas. Destas, 95,3% possuÃam alta capacidade para adesÃo ao acompanhamento clÃnico e vacinaÃÃo. Pela avaliaÃÃo global, 29,7% dos cuidados foram considerados como adequados (alta capacidade para o cuidado). A associaÃÃo de variÃveis indicou significÃncia entre Apgar da famÃlia e capacidade para administrar o leite em pà (fator 2); paridade e capacidade para administrar a profilaxia com sulfametoxazol e trimetropim; paridade e escolaridade e capacidade para garantir adesÃo ao acompanhamento clÃnico e vacinaÃÃo; e estÃdio evolutivo e tempo de diagnÃstico com avaliaÃÃo global da escala. Com a EACCC-HIV favoreceu-se avaliar o cuidado materno dispensado Ãs crianÃas e realizar intervenÃÃes em prol da saÃde infantil para a manutenÃÃo da qualidade de vida na vigÃncia da exposiÃÃo ao HIV ou para aquelas infectadas pelo vÃrus. / A Escala de AvaliaÃÃo da Capacidade para Cuidar de CrianÃas Expostas ao HIV (EACCC-HIV) à um instrumento que estima o cuidado de mÃes Ãs crianÃas nascidas na vigÃncia do HIV. Objetivou-se avaliar a capacidade de mÃes para cuidar de crianÃas expostas ao HIV mediante a EACCC-HIV e verificar a associaÃÃo entre as dimensÃes da escala e as caracterÃsticas maternas. Estudo transversal desenvolvido em 2010 em Fortaleza-CE. Participaram 62 cuidadoras (mÃes) HIV+ com 64 filhos (dois gemelares) nascidos expostos ao HIV menores de 1 ano. Apreciaram-se as caracterÃsticas das mÃes e das crianÃas; as estratÃgias para reduÃÃo da transmissÃo vertical do HIV; Apgar familiar e a EACCC-HIV. A escala possui 52 itens e cinco fatores que sÃo utilizados para determinadas idades entre zero e 1 ano: Fator 1: capacidade para administrar o AZT xarope (crianÃas atà 42 dias de vida); Fator 2: capacidade para preparar e administrar o leite em pà (crianÃas atà 1 ano); Fator 3: capacidade para preparar e administrar alimentaÃÃo complementar (crianÃas > de 4 meses); Fator 4: capacidade para administrar a profilaxia com sulfametoxazol e trimetoprim (crianÃas > 42 dias); Fator 5: capacidade para garantir a adesÃo ao acompanhamento clÃnico e vacinaÃÃo (todas as crianÃas). As respostas sÃo mediadas por fator ou pela somatÃria de todos os itens, indicando-se o grau de cuidado desenvolvido pela mÃe. Para anÃlise utilizou-se o STATA 11.0, empregando-se nÃvel de significÃncia de 5%. A idade materna oscilou entre 18 e 42 anos, 33,9% com aids, 61,3% integrantes das classes D e E. Das crianÃas uma tinha aids (1,6%), 98,4% iniciaram o AZT nas primeiras horas de vida, 3,1% foram amamentadas, 61,3% tiveram consumo inadequado de leite artificial e 36,2% consumo inadequado de alimentaÃÃo complementar. O Apgar familiar indicou 34,4% severamente funcional. Enquanto o fator 1 da EACCC-HIV avaliou 11 crianÃas, das quais 72,7% recebiam cuidados considerados adequados, o fator 2 avaliou 64 crianÃas e indicou que 86,0% das mÃes possuÃam alta capacidade de cuidar. Pelo fator 3, o cuidado concentrou-se entre moderado (44,4%) e alto (50%). O fator 4 estimou o cuidado oferecido para 51 crianÃas, indicando que 76,5% tiveram alta capacidade para o cuidado, e o fator 5 avaliou respostas das 62 mÃes sobre as 64 crianÃas. Destas, 95,3% possuÃam alta capacidade para adesÃo ao acompanhamento clÃnico e vacinaÃÃo. Pela avaliaÃÃo global, 29,7% dos cuidados foram considerados como adequados (alta capacidade para o cuidado). A associaÃÃo de variÃveis indicou significÃncia entre Apgar da famÃlia e capacidade para administrar o leite em pà (fator 2); paridade e capacidade para administrar a profilaxia com sulfametoxazol e trimetropim; paridade e escolaridade e capacidade para garantir adesÃo ao acompanhamento clÃnico e vacinaÃÃo; e estÃdio evolutivo e tempo de diagnÃstico com avaliaÃÃo global da escala. Com a EACCC-HIV favoreceu-se avaliar o cuidado materno dispensado Ãs crianÃas e realizar intervenÃÃes em prol da saÃde infantil para a manutenÃÃo da qualidade de vida na vigÃncia da exposiÃÃo ao HIV ou para aquelas infectadas pelo vÃrus. / The Assessment Scale of the Ability to take Care of Children Exposed to HIV (EACCC-HIV) estimates mothersâ care delivery to children born in conditions of HIV. The goal was to assess mothersâ ability to take care of children exposed to HIV through the EACCC-HIV and to verify the association between scale dimensions and maternal characteristics. This cross-sectional study was carried out in Fortaleza-CE in 2010. Participants were 62 HIV+ caregivers (mothers) with 64 children (two twins) exposed to HIV at birth and younger than one year. The mothers and childrenâs characteristics were evaluated; strategies to reduce vertical HIV transmission: Family Apgar and EACCC-HIV. The scale contains 52 items and five factors, used for certain ages between zero and 1 year: Factor 1: ability to administer AZT syrup (children up to 42 days of life); Factor 2: ability to prepare and administer powder milk (children up to 1 year); Factor 3: ability to prepare and administer complementary feeding (children > 4 months); Factor 4: ability to administer prophylaxis with sulfamethoxazole and trimethoprim (children > 42 days); Factor 5: ability to guarantee adherence to clinical monitoring and vaccination (all children). Answers are mediated by a factor or by the sum of all items, indicating the degree of care the mother develops. STATA 11.0 software was used for analysis, with significance set at 5%. Maternal age ranged between 18 and 42 years, 33.9% suffering from aids, 61.3% in lower socioeconomic classes. One of the children had aids (1.6%), 98.4% had starting AZT in the first hours of life, 3.1% was breastfed, 61.3% showed inadequate artificial milk consumption and 36.2% inadequate complementary feeding consumption. The Family Apgar indicated 34.4% severely functional. While factor 1 of the EACCC-HIV assessed 11 children, 72.7% of whom received adequate care, factor 2 assessed 64 children and indicated high ability for care delivery in 86.0% of the mothers. According to factor 3, care was concentrated between moderate (44.4%) and high (50%). Factor 4 estimated the care offered to 53 children, indicating high ability for care delivery in 76.5%, and factor 5 assessed the 62 mothersâ answers on the 64 children. In total, 95.3% showed high ability for adherence to clinical monitoring and vaccination. According to the global assessment, 29.7% of care was considered adequate (high ability for care delivery). The association between variables indicated significance between family Apgar and ability to administer powder milk (factor 2); parity and ability to administer prophylaxis with sulfamethoxazole and trimethropim; parity and education level and ability to guarantee adherence to clinical monitoring and vaccination: and staging and diagnosis time with global assessment of the scale. Through the EACCC-HIV, maternal care for the children could be assessed and interventions could be made to enhance child health, with a view to maintaining quality of life in cases of exposure to or contamination by HIV. / The Assessment Scale of the Ability to take Care of Children Exposed to HIV (EACCC-HIV) estimates mothersâ care delivery to children born in conditions of HIV. The goal was to assess mothersâ ability to take care of children exposed to HIV through the EACCC-HIV and to verify the association between scale dimensions and maternal characteristics. This cross-sectional study was carried out in Fortaleza-CE in 2010. Participants were 62 HIV+ caregivers (mothers) with 64 children (two twins) exposed to HIV at birth and younger than one year. The mothers and childrenâs characteristics were evaluated; strategies to reduce vertical HIV transmission: Family Apgar and EACCC-HIV. The scale contains 52 items and five factors, used for certain ages between zero and 1 year: Factor 1: ability to administer AZT syrup (children up to 42 days of life); Factor 2: ability to prepare and administer powder milk (children up to 1 year); Factor 3: ability to prepare and administer complementary feeding (children > 4 months); Factor 4: ability to administer prophylaxis with sulfamethoxazole and trimethoprim (children > 42 days); Factor 5: ability to guarantee adherence to clinical monitoring and vaccination (all children). Answers are mediated by a factor or by the sum of all items, indicating the degree of care the mother develops. STATA 11.0 software was used for analysis, with significance set at 5%. Maternal age ranged between 18 and 42 years, 33.9% suffering from aids, 61.3% in lower socioeconomic classes. One of the children had aids (1.6%), 98.4% had starting AZT in the first hours of life, 3.1% was breastfed, 61.3% showed inadequate artificial milk consumption and 36.2% inadequate complementary feeding consumption. The Family Apgar indicated 34.4% severely functional. While factor 1 of the EACCC-HIV assessed 11 children, 72.7% of whom received adequate care, factor 2 assessed 64 children and indicated high ability for care delivery in 86.0% of the mothers. According to factor 3, care was concentrated between moderate (44.4%) and high (50%). Factor 4 estimated the care offered to 53 children, indicating high ability for care delivery in 76.5%, and factor 5 assessed the 62 mothersâ answers on the 64 children. In total, 95.3% showed high ability for adherence to clinical monitoring and vaccination. According to the global assessment, 29.7% of care was considered adequate (high ability for care delivery). The association between variables indicated significance between family Apgar and ability to administer powder milk (factor 2); parity and ability to administer prophylaxis with sulfamethoxazole and trimethropim; parity and education level and ability to guarantee adherence to clinical monitoring and vaccination: and staging and diagnosis time with global assessment of the scale. Through the EACCC-HIV, maternal care for the children could be assessed and interventions could be made to enhance child health, with a view to maintaining quality of life in cases of exposure to or contamination by HIV.

Health Studies / M.A. (Health Studies)

Thesis (MBA)--Stellenbosch University, 2006. / ENGLISH ABSTRACT: HIV/AIDS is one of the most devastating pandemics the world has ever faced. SubSaharan Africa remains the region most affected where more two thirds of the total HIV positive population resides. Despite this region trying to grapple with many negative factors like political unrest, draughts, armed conflict, it now also have to content with HIV/AIDS. HIV/AIDS has already killed ten times more Africans than all of the armed conflicts on the African continent combined (The Washington Quarterly, 2001:191-196). Many of the Sub-Saharan countries are renowned for unemployment and poverty which can be partly be alleviated by economic growth. Studies by Bonnel (2000) concluded that a typical Sub-Saharan country with a 20% HIV/AIDS prevalence rate, would suffer a 2.6% reduction in GDP growth per annum. This indicates that South Africa, where an estimated S.5 million HIV positive people resides (the most in globe) and ever increasing HIV prevalence, is in a serious predicament. There are many interacting variables causing the negative socioeconomic decline. At organisational level direct and indirect costs attributable to HIV, results in a severe decline of profitability and jeopardises sustainable economic activity. Direct costs include costs for medical treatment, health insurance, funeral expenses, retirement and disability and costs to manage HIV in the workplace. Indirect costs include absenteeism and loss of productivity, retraining and recruiting of employees to fill deceased employees' places etc. Although South African organisations acknowledge and predict that HIV/AIDS will have an ever-increasing negative impact on their business, the response to dealing with this issue has been insufficient. The deficient response could be partly ascribed to a lack of guidance, deficient proof of cost effectiveness with no real measurement for the outcomes of intervention programs. This study will critically evaluate a KAPB (knowledge, attitude, perception and behaviour) survey as a second-generation HIV surveillance tool that could address these organisational concerns. KAPB surveys have advantages like providing guidance and increasing cost effectiveness of HIV programs, benchmarking interventions and providing a platform for communication design and feedback to stakeholders. These benefits should motivate organisations to initiate programs that address HIV at an organisational level. KAPB surveys evaluate four employee factors related to HIV - knowledge, attitudes, perception and sexual behaviour. This report will critically evaluate the appropriateness of measuring these factors and some tools used to measure these factors. Further elaboration of the methodology during the execution of a KAPB survey will highlight the current best practices identified in literature. The report will also highlight the obstacles and ways of negotiating them when conducting a KPAB survey. The study will conclude that a well -executed KAPB survey through its many benefits should motivate and assist organisations in designing and implementing HIV/AIDS programs. / AFRIKAANSE OPSOMMING: HIV is een van die ernstigste pandemies wat die wereld al ooit beleef het. Die state in die Sub-Sahara streek is die ergste geaffekteer en meer as twee derdes van die totale HIV positiewe populasie kom in die gebied voor. Die streek wat deurgaans geteister word deur politieke onrus, droogte, oorlog, moet nou ook probeer tred hou met MIV /VIGS. MIV/VIGS het tot op hede alreeds tien keer meer mense gedood as al die oorloë op die Afrika continent saam (The Washington Quarterly, 2001: 191-196). Die meeste van die state in Sub-Sahara word gekenmerk deur werkloosheid en armoede wat deels verlig kan word deur ekonomiese groei. Studies deur Bonnel (2000) het getoon dat die tipiese staat in Sub-Sahara, met 'n 20% MIV insidensie 'n vermindering van tot 2.6% groei in die GDP kan ondervind. Dit voorspel dat Suid-Afrika met 'n voorspelde 5.5 miljoen HIV positiewe inwoners (die meeste in die wereld) ekonomiese noodlot in die oog staar. Daar is verskeie faktore wat saamwerk om die negatiewe ekonomiese 'effek van MIV/VIGS te bewerkstellig. Organisasies se ekonomiese vooruitgang en oorlewing word bedreig deur direkte en indirect kostes van MIV. Direkte kostes wat organisasies moet aangaan sluit in mediese behandeling, mediese fonds bydraes, begrafnis onkostes, aftrede en ongeskiktheidspensioenbetalings. Indirekte kostes sluit in afwesighede, verlies aan produktiwiteit en die heropleiding en werwing van werknemers wat afgestorwe werknemers se plek moet neem. Ten spyte van die feit dat organisasies erken en voorspel dat MIV/VIGS 'n negatiewe impak op die ekonomies welvaart van organisasies sal hê, het weining van die organisasies aksie geneem om die probleem aan te spreek. 'n Moontlike rede vir die onvoldoende aksie kan toegeskryf word aan die tekort aan leiding, bewyse vir kostedoeltreffendheid en geen werklike maatstaf om die programme se resultate te evalueer. Hierdie studie sal KGPG (kennis, gevoelens, persepsie ' en gedrag) studies as 'n tweede generasie MIV opname, krities evalueer. KGPG studies bied verskeie voordele soos om leiding vir HIV programme te bied en verbeterde koste effetiwiteit van MIV programme te bewerkstellig. KGPG studies voorsien ook 'n maatstaf om MIV programme te evalueer en 'n kommunikaise platvorm tussen aandeelhouers. Hierdie voordele sal moontlik organisasies motiveer om aksie te neem en MIV in die organisasie aan te spreek. KGPG studies evalueer vier werknemer faktore met betrekking to MIV /VIGS. Die vier faktore is kennis, gevoelens, persepsie en seksuale gedrag. Die verslag sal die vier faktore krities evalueer vir toepaslikheid en ook fokus op die instrumente wat die faktore evalueer. Aanbevelings sal ook gemaak word ten opsigte van die korrekte en beste metodes wat gevold moet work tydens 'n KGPG studie. Die struikelblokke wat ondervind kan word tydens 'n KGPG studie asook hoe om dit te oorkom sal bespreek word. Die verslag sal bewys dat 'n KGPG studie wat uitgevoer word in Iyn met die beste praktyk baie waarde kan toevoeg tot organisasies ten opsigte van die beplanning en uitvoering van programme om MIV/VIGS te bekamp.

Background: In times of limited organs for transplantation, anti-HBc positive organs can be accepted for lung transplantation to increase the number of donors. Transplant recipients should be vaccinated against hepatitis B to prevent HBV infection. However, response after HBV vaccination has only been poorly evaluated in patients with end-stage pulmonary disease. Material/Methods: Anti-HBs titers of 40 anti-HBc negative patients with end-stage pulmonary disease evaluated for lung transplantation were analyzed with the Architect® system (Abbott, Germany). Responders, partial responders, or non-responders after HBV vaccination were defined by anti-HBs titers >100 IU/L, 10–100 IU/L, and <10 IU/L, respectively. Results: There were 34/40 individuals (85%) vaccinated against hepatitis B, and 6 were not vaccinated. Response, partial response, and non-response after vaccination were observed in 10/34 (29.4%), 11/34 (32.4%), and 13/34 (38.2%) of patients, respectively. Response to vaccination did not correlate with sex, pulmonary disease, comorbidities, immunosuppressive therapy, or smoking status. Conclusions: Although 85% of patients evaluated for lung transplantation were vaccinated against hepatitis B, 38.2% did not show an anti-HBs titer >10 IU/L. Thus, anti-HBs titers should be regularly monitored. Nonresponders should be considered for booster vaccinations, alternative vaccination schedules, or prophylactic treatment with a nucleos(t)ide analogue in case of transplantation of an anti-HBc–positive organ.

It is now widely accepted that surface contamination plays an important role in the transmission of both respiratory and gastrointestinal infections in the domestic environment and community setting. The efficiency of transfer of a pathogen to the hand from a fomite is important in modeling transmission in microbial risk assessment models. The objective of this study was to use published literature to assess the role of fomites and hands in disease transmission, and to conduct fomite-to-finger transfer studies from various porous and nonporous fomites under different relative humidity condition using non-pathogenic strains of Escherichia coli, Staphylococcus aureus, MS2 coliphage, Bacillus thuringiensis spores, and poliovirus 1; to evaluate the persistence of bacteria and viruses on surfaces; to examine bacteria and virus transfer from treated surfaces; and to conduct a foodborne quantitative microbial risk assessment using Campylobacter jejuni from the data obtained in these studies. It was found that numerous factors influence the transfer efficiency of microorganisms, with moisture being the most important, with greater transfer under humid conditions. Other factors influencing transfer include drying time, contact time, pressure, friction, type of material, and porosity of the fomite. Percent transfer was greater under high relative humidity for both porous and nonporous surfaces. Most organisms on average had greater transfer under high relative humidity (40 - 65%) compared to low relative humidity (15 - 32%). Relative humidity and fomite type influenced the survival of all studied organisms; survival was greater on nonporous surfaces than those for porous surfaces. Test organisms were reduced up to 99.997% on the fomites after the surfaces were wiped with a disinfectant wipe. Microbial fomite-to-finger transfer from disinfectant wipe-treated surfaces were, lower than from non-treated surfaces. The disinfectant-wipe intervention reduced the risk of Campylobacter infection, illness, and death by 2 to 3 orders on all fomites. The disinfectant-wipe intervention reduced the annual risk of illness below the reported national average of diagnosed Campylobacteriosis cases 1.3E-04. This risk assessment demonstrates that the use of disinfectant wipes to decontaminate surface areas after chicken preparation reduces the risk of C. jejuni infections up to 99.2%.

A dissertation submitted to the Faculty of Health Sciences, University of Witwatersrand, Johannesburg in fulfillment of the requirements for the degree of Master of Science in Medicine, Johannesburg , 2013 / South Africa’s Prevention of Mother-to-Child Transmission (PMTCT) programme is critical for eliminating vertical HIV transmission and reducing infant mortality. Early treatment of HIV-infection to curb infant deaths requires earlier diagnostic testing than the currently recommended six-week test. This study describes the continuum of PMTCT care at a Johannesburg hospital to identify interventions for improvement and investigates birth HIV testing for infants. Data from a cohort study at the hospital evaluating diagnostic assays in HIV-exposed infants were collated with routine clinical data, validated and analysed. Among 838 mother-infant pairs, 38% of mothers attended antenatal clinics early enough to receive optimal antenatal prophylaxis. Only 72% of infants accessed six-week testing at the hospital; a further 10% underwent testing elsewhere. Of 38 HIV-infected infants, 29 were infected in-utero and could have been identified at birth (sensitivity of 76.3% for birth testing), compared to only 26 (68%) diagnosed by six-week testing at the hospital. Majority (88%) of these 26 infants accessed antiretroviral therapy, but treatment was only initiated at a median age of 16.0 weeks and 43% of HIV-infected infants who initiated treatment had defaulted or died before the end of the study. Mathematical modelling demonstrated that birth testing would be superior to a six-week test to maximise infants diagnosed and life years saved, with the ideal algorithm being a birth and ten-week test. The PMTCT programme can be enhanced by earlier antenatal care for women and earlier infant diagnosis. Birth testing would diagnose HIV-infection before infants die or default from the PMTCT programme, thereby enabling effective monitoring of MTCT, and would allow earlier treatment initiation to reduce early infant mortality.

A transmissão vertical do HIV-1 da mãe para criança foi significativamente reduzida com o uso de terapias antirretrovirais, resultando um aumento do número de crianças que foram expostas ao vírus. Estudos evidenciam a expressão de receptores Toll-like (TLR) em células trofoblásticas que pode ser uma ferramenta importante para regular a diferenciação e ativação de células do sistema imunológico, orquestrando um ambiente imunorregulador, contribuindo para o sucesso gravidez e proteção do feto. Considerando que as consequências da infecção por HIV-1 no microambiente placentário, na mãe e no recém-nascido (RN) não são bem entendidos, salienta-se a necessidade de investigar estratégias que possam potencializar a resposta imune inata, neste contexto. Com isso, no presente trabalho, foram avaliados as células mononucleares (CMN) do sangue periférico e cordão umbilical (RN) de parturientes infectadas por HIV-1 e parturientes-RN não infectados, a secreção de TNF-a, IL-10 e IFN-a induzida por agonistas de TLRs extracelular (TLR2, TLR4 e TLR5) e agonistas de TLRs intracelulares (TLR3, TLR7, TLR7/8, TLR9). Além disso, como sensor da resposta imune inata foi avaliado o perfil de resposta de células dendríticas mielóides (mDC) e plasmocitóides (pDC), após ativação com ligantes relacionados com resposta antiviral (TLR7, TLR7/8 e TLR9). No microambiente placentário foi verificada a expressão de CD123, TLR8, CD14/CD16 e HLA-G de amostras da decídua e vilo de mães infectadas por HIV-1 e grupo controle. Os resultados mostraram que as CMNs de mães infetadas por HIV-1 e de seus RNs têm um déficit na secreção TNF-a após ativação pelas vias de TLR2, TLR5, TLR3, TLR7, contudo, preservada para estimulação TLR7/TLR8 (composto CL097), principalmente pelas células de recém-nascidos. Além disso, apenas a ativação com CL097 foi eficaz para induzir a secreção IL-10 e IFN-a pelo grupo infectado, tanto na mãe quanto no RN. O CL097 também foi capaz de induzir a expressão de RNAm para o fator regulador de interferon-7 (IRF-7), IFN-a e TNF-a em níveis similares entre os grupos, confirmando o potencial de ativação TLR7/8. A ativação via TLR7/TLR8 foi capaz de controlar o déficit na da produção de TNF-a pelas mDC, mas não reverteu a resposta funcional de IFN-a por pDCs nas mães e RN infectados por HIV-1. No tecido placentário infectado por HIV-1, houve aumento da expressão de TLR8, CD123, e HLA-G. Os achados mostraram a importância da via TLR8 tanto na resposta sistêmica como no microambiente placentário, ressaltando a importância dos ligantes naturais e/ou sintético no papel adjuvante para melhorar a resposta antiviral na interação materno-fetal. / Mother-to-child transmission of HIV-1 has been significantly reduced with the use of antiretroviral therapies, resulting an increased number of HIV1-exposed uninfected infants. Studies have been evidenced that expression of Toll-like receptors (TLR) in trophoblast cells may be a relevant tool to regulate the differentiation and activation of immune cells, orchestrating an immunoregulatory environment, contributing to successful pregnancy and fetal protection. Since the consequences of HIV-infection in the immune innate system from placental microenvironment, mother, and newborn are not well understood, emphasize to investigate the strategies to potentiate the innate immune immune response. We evaluated in mononuclear cells (CMN) of peripheral blood and cord blood from HIV-1-infected pregnant and uninfected mother-cord blood the TNF-a, IL-10 and IFN-a secretion induced by agonists of extracellular Toll-like receptor (TLRs) (TLR2, TLR4 and TLR5) and agonists for intracellular TLRs (TLR7, TLR7/8, TLR9). Moreover, as checkpoint of innate immune response we evaluate the myeloid dendritic cells (mDC) and plasmacytoid DC (pDC) responsinevess to TLRs related to antiviral response (TLR7, TLR7/8 e TLR9). Were also evaluated expression of CD123, TLR8, CD14/CD16 and HLA-G of maternal samples of decidua and villi both infected by HIV-1.The results showed that HIV-1 infected mother-cord blood have a deficit in the TNF-a response induced by TLR2, TLR5, TLR3, TLR7 PBMC activation, but preserved for TLR7/8 (CL097) stimulation, mainly by the newborn cells. Moreover, only CL097 activation was efficacious to induce IL-10 and IFN-a secretion by the infected group, in both mother and cord blood cells. Up-regulation of IFN-a secretion level was achieved with CL097 by cord blood from HIV-infected mother compared to control mothers. CL097 stimulation was also able to induce Interferon-regulator factor-7, IFN-a and TNF-a mRNA expression in PBMC at similar levels between groups, confirming the potential of TLR7/8 activation. TLR7/TLR8 activation overcomes the impairment of TNF-a production by mDC, but maintained the dysfunctional type I IFN response by pDCs in HIV-infected pairs. Expression of TLR8, CD123 and HLA-G was increased in placental tissue from infected-mother compare to uninfected control. Our findings highlight the dysfunction of innate immune response in HIV-treated mother-newborn. Adjuvant potential of TLR8, in the systemic response as well as in the placental microenvironment, emphasizes the use of natural and /or synthetic TLR agonists to improve antiviral response at the maternal-fetal interface.

It has been a widely accepted belief in scientific and public discourse at the end of the twentieth century that cannibalism was the principal means of transmission of the disease call 'Kuru'.The study argues that other explanations might have been excluded from consideration, in particular, iatrogenic transmission.Circumstantial evidence in support of this proposition is examined.The work begins with an examination of the relationship between a number of diseases including, X disease, poliomyelitis, louping ill, scrapie and kuru through the first half of the twentieth century. Major themes of the work revolve around the boundary between research on animal and human disease, the complexities of research in this area, and the different messages that exist simultaneously in three domains: scientific research and publications, government and institutional archives, and the public domain. The thesis argues that the circumstantial evidence presented needs to be considered seriously and that further research in the area is required before we can come to a reliable understanding of the factors involved in the transmission of kuru / Doctor of Philosophy (PhD)