The purpose of this study was to explore and describe experiences of HIV/AIDS positive patients using Sesotho traditional medicines at Scott Hospital in Morija, Lesotho. The specific objectives were to explore and describe the experiences and views of patients using Sesotho traditional medicines. The study uded an explorative qualitative design with a sample of seventeen (17) HIV positive adults aged 18-49 years who were purposively sampled. The major findings of the study were that; Sesotho traditional medicines improved the health status of the participants; and also they were of the view that Sesotho traditional medicines work as they beneficially contributed to HIV/AIDS management. The study concludes that Sesotho traditional medicines are believed and understood to play a role in the symptomatic management of HIV/AIDS even though the actual role they play is yet to be proven scientifically. / Department of Health Studies / M.A. (Public Health)

Abstract:<p>Background. This dissertation focuses on HIV-1 mother-to-child transmission (MTCT) as a major global public health issue. It consists of three papers that were published in international peer review journals. We initiated the study to answer the following research question: what was the impact of socioeconomic, clinical and biological risk factors on HIV-1 mother-to-child transmission incidence at Muhima health centre, in the specific context of Rwanda health sector reforms?<p>Methods. A prospective cohort study in Muhima health centre (Rwanda) was used to address the study objectives, with a follow up of 700 mother-infants pairs (2007-2010).<p>Results. The observed overall transmission rate was 3.2% (CI 1.9% – 4.5%) at age 6 weeks of life and 3.7% (CI 2.3% – 5.1%) at 6 months of age. Among the 679 exposed and followed-up infants, a higher risk of HIV-1 MTCT was significantly associated with the following factors: non-disclosure of HIV status to partner; high viral load (HIV-1 RNA); infant mixed feeding before 6 months of age; low mother’s CD4 count and low hemoglobin level during pregnancy.<p>Conclusions. The health sector reforms were found to have led to a conducive environment that was favorable to scaling up of maternal health services in Rwanda (2000-2010).<p>The observed overall MTCT rate of 3.2% (CI 1.9% – 4.5%) at age 6 – weeks postnatal in the Muhima cohort is a significant reduction of MTCT incidence towards achieving the elimination target of < 5% for breastfeeding populations in developing setting.<p>The most relevant factors independently associated with increased risk of mother – to – child transmission of HIV-1 included non-disclosure of HIV status to partner and high HIV-1 RNA. Members of this cohort also showed socioeconomic inequalities, with unmarried status carrying higher risk of undisclosed HIV status. <p>Integrated service delivery for PMTCT/MCH interventions, including community-based approach, task shifting and subsidized membership fees for people living with HIV, were the key national policies implemented to support optimal access to and delivery of evidence – based interventions for prevention of mother – to – child transmission of HIV in Muhima.<p><p>Résumé:<p>Contexte<p><p>Cette thèse porte sur la transmission mère-enfant du VIH-1 comme un problème majeur de santé publique au niveau mondial. Il est composé de 3 publications dans des revues internationales à comité de lecture. Nous avons initié l’étude pour pouvoir répondre à la question de recherche suivante :quel a été l’impact des facteurs de risque socio-économiques, cliniques et biologiques sur l’incidence de la transmission du VIH-1de la mère à l’enfant au centre de santé de Muhima, dans le contexte spécifique des réformes du secteur de la santé au Rwanda.<p>Cadre méthodologique<p><p>Une étude cohorte prospective a été menée au centre de santé de Muhima pour pouvoir répondre aux objectifs de l’étude, avec un suivi de 700 couples mères-enfants éligibles (2007-2010).<p>Résultats<p><p>L’incidence cumulée de transmission mère-enfant du VIH-1 a été de 3,2% (IC 1,9% – 4,5%) à 6 semaines et 3,7% (IC 2,3% – 5,1%) à 6 mois de vie. Parmi les 679 nourrissons exposés et suivis, un risque plus élevé de transmission mère-enfant du VIH-1 était significativement associé aux facteurs suivants :non divulgation du statut séropositif au VIH-1 entre partenaires ;charge virale élevée (ARN-VIH-1) ;allaitement mixte de l’enfant avant 6 mois d’âge ;CD4 bas et taux d’hémoglobine bas pendant la grossesse. <p><p><p><p><p>Conclusions<p><p>Les réformes du secteur ont pu créer un environnement favorable à l’extension des services de santé maternelle (2007-2010).<p>Le taux global 3,2% (IC 1,9 – 4,5) à 6 semaines de vie représente une réduction significative de l’incidence de transmission mère-enfant du VIH-1 pour atteindre le niveau de <5% comme indicateur relatif au plan d’élimination des nouvelles infections VIH chez l’enfant au sein des populations avec allaitement maternel comme pratique universelle.<p>Les facteurs les plus pertinents indépendamment associés à un risque élevé de transmission mère-enfant du VIH-1sont représentés par la non-divulgation du statut séropositif au VIH-1 entre partenaires et la charge virale élevée (ARN-VIH-1). Au sein de cette cohorte, l’on a également pu identifier l’existence d’inégalités socio-économiques, avec le statut de femme seule associé au risque plus élevé de non-divulgation du statut séropositif au VIH-1 entre partenaires.<p>Le service intégré de PTME / interventions de santé de la mère et de l’enfant, y compris l'approche communautaire, l’approche de délégation des tâches et la subvention des frais d'adhésion à la mutuelle de santé pour les personnes vivant avec le VIH, ont été les principales politiques nationales mises en œuvre pour favoriser l'accès optimal et la prestation des interventions basées sur les preuves pour la prévention de la transmission du VIH-1 de la mère à l’enfant au centre de santé de Muhima.<p> / Doctorat en Sciences de la santé publique / info:eu-repo/semantics/nonPublished

Position du problème: <p>La majorité des enfants contaminés par le VIH se retrouve dans les pays en développement. Pour prévenir la transmission verticale les femmes doivent d’abord connaître leur statut sérologique au VIH. En République Démocratique du Congo, le problème posé par la transmission mère-enfant est préoccupant. Pour lutter contre cette transmission verticale, la Prévention de la Transmission du VIH de la Mère à l’Enfant (PTME) est intégrée dans le paquet minimum d’activités de la CPN. Comme dans d’autres pays, la couverture reste toujours insuffisante.<p>Objectifs :<p>Spécifiquement ce travail visait à :(1) déterminer la proportion des femmes qui n’ont pas fait l’objet du dépistage du VIH parmi les accouchées des maternités de Lubumbashi ;(2) évaluer le niveau de connaissance du personnel travaillant dans des maternités en matière des recommandations de la PTME à Lubumbashi ;(3) déterminer l’acceptabilité du dépistage rapide du VIH en salle de travail ;(4) Mettre sur pieds une stratégie pouvant contribuer à atteindre une couverture opérationnelle optimale de la PTME dans des contextes similaires à la ville de Lubumbashi.<p>Méthodologie:<p>C’est une approche de recherche-action réalisée au niveau du système de santé, des prestataires de soins, parturientes et accouchées dans les maternités de Lubumbashi. Pour ce faire deux études transversales et une intervention ont été réalisées à partir d’avril 2010 à février 2011 :les études transversales ont permis de déterminer la proportion des accouchées avec du statut sérologique VIH inconnu et d’évaluer le niveau de Connaissances, Attitudes et Pratiques (Niveau de CAP) des prestataires de soins de salles de travail face aux recommandations de la PTME. L’intervention a consisté à faire le dépistage rapide du VIH chez les parturientes admises en salles de travail.<p>Résultats: <p>Parmi les accouchées, 52,5 % ignoraient leur statut sérologique. Parmi elles, 62,9 % accepteraient de faire le test VIH à la maternité. La proportion des femmes avec un statut sérologique inconnu au VIH était significativement plus élevée chez celles qui n’avaient pas suivi de CPN (Odds Ratio ajusté [ORa] = 5,8; Intervalle de Confiance [IC] 95 % :1,7-19,0) et chez celles qui avaient un bas niveau d’instruction (ORa = 1,5 ;IC 95% :1,1-2,1).<p>Le niveau de CAP de la PTME des prestataires des maternités à Lubumbashi etait suffisant dans seulement 8,5 % des cas. La proportion de prestataires avec un niveau CAP suffisant était significativement plus élevée chez les universitaires que chez les non universitaires (ORa = 8,6; Intervalle de Confiance [IC] 95 % :1,6-47,5) et dans les maternités où la PTME était intégrée (OR = 4,5 ;IC 95 % :1,3-18,4).<p>Sur 474 parturientes, 433 (91,4 % ;IC 95 % :88,4-93,7 %) ont bénéficié d’un dépistage du VIH en salle de travail après counseling. La prévalence du VIH chez les parturientes examinées était de 4,8 %. L’acceptabilité du dépistage rapide du VIH était significativement plus élevée lorsque la durée du counseling était inferieure ou égale à 5 minutes (ORa = 5,8 ;IC 95 % :2,6-13); chez les parturientes qui avaient déclaré ne pas avoir l’objet de dépistage aux CPN (ORa = 3,8 ;IC 95 % :2-7,8) et chez celles qui étaient en début de travail d’accouchement (ORa = 2,3 ;IC 95 % :1,2-4,7). <p>Conclusion :<p>La proportion de femmes qui accouchent sans connaître leur statut sérologique au VIH est encore importante, malgré le fait que le dépistage du VIH soit proposé lors des CPN. C’est un besoin non couvert et une deuxième opportunité manquée. Etant donné qu’il existe à Lubumbashi des structures sanitaires offrant le service de PTME, nous proposons l’approche opt out du dépistage rapide du VIH en salle de travail pour cette catégorie de femmes. Cette stratégie contribuerait à optimiser la couverture opérationnelle du service au moindre coût.<p> <p>Background:<p>The majority of children infected with HIV are found in developing countries. To prevent vertical transmission women must first know their HIV status. In the Democratic Republic of Congo, the problem of mother to child transmission is a concern. To fight against vertical transmission, national policy has included the Prevention of HIV Transmission from Mother to Child Transmission (PMTCT) in the package of activities of the Antenatal care. As in other countries, coverage is still insufficient.<p>Objective:<p>Specifically this study aims to: (1) determine the proportion of women who did not receive HIV testing among women who gave birth in maternity units in Lubumbashi, (2) assess the level of knowledge of staff working in maternity units in the recommendations of PMTCT in Lubumbashi, (3) determine the acceptability of rapid HIV testing in the labor room, (4) develop a strategy to improve the operational coverage of PMTCT in similar contexts to the city of Lubumbashi.<p>Methods:<p>This is an approach to action research conducted at the health system, care providers and parturients and women gave birth in maternity birth in the maternity Lubumbashi. To get two successive cross-sectional studies and intervention was conducted from April 2010 to the end of February 2011: cross-sectional studies have determined the proportion and determinants of birth with unknown HIV status and to evaluate the Level of Knowledge, Attitudes and Practices (KAP level) providers care delivery room in the PMTCT recommendations.<p>The intervention consisted in the rapid HIV testing in parturient admitted to labor wards.<p><p>Results:<p>The analyses of our results showed that among mothers, 52.5% were unaware of their HIV status. Among them, 62.9 % would be tested for HIV to motherhood. The proportion of women with unknown HIV status to HIV was significantly higher in those who had not attended ANC (adjusted odds ratio [aOR] = 5.8, Confidence Interval [CI] 95%: 1.7 - 19) and among those with a low education (aOR 1.5, 95% CI: 1.1 to 2.1).<p>The level of CAP PMTCT providers of maternity was sufficient to Lubumbashi in only 8.5% of cases. The proportion of claimants with a sufficient level CAP was significantly higher among academics than among non-academic (aOR = 8.6, confidence interval [CI] 95%: 1.6 to 47.5) and in maternity wards where PMTCT was integrated (OR = 4.5, 95% CI: 1.3 to 18.4).<p>Among 474 parturients, 433 (91.4% confidence interval [CI] 95%: 88.4 to 93.7%) were voluntary testing for HIV in the labor ward after counseling. HIV prevalence among parturients examined was 4.8%.The acceptability of rapid HIV testing was significantly higher when the duration of counseling was less than or equal to 5 minutes (aOR = 5.8, 95% CI: 2.6 to 13) in parturients who reported not doing this testing for EIC (aOR = 3.8, 95% CI: 2 to 7.8) and among those who were in early labor delivery (aOR = 2.3, 95% CI: 1.2 - 4.7). By cons, it was lower among adolescents than among adults (aOR = 0.1; [CI] 95%: 0.0-0.7).<p>Conclusion:<p>The proportion of women who give birth without knowing their HIV status is still important, despite the fact that HIV testing be made available when the antenatal care. This is an unmet need and would be a missed opportunity. Since there Lubumbashi health facilities offering PMTCT service, we offer the opt-out approach of rapid HIV testing in the labor ward for such women, to optimize coverage of operational service at the lowest cost.<p> <p> <p><p> / Doctorat en Santé Publique / info:eu-repo/semantics/nonPublished

Le présent travail repose sur l’hypothèse que l’infection par le VIH provoque et/ou aggrave les déficits nutritionnels de l’enfant. Ces déficits nutritionnels aggravent le déficit immunitaire et ont un impact négatif sur la survie de l’enfant infecté par le VIH/SIDA. Mais cette malnutrition même grave peut être améliorée et l’amélioration de l’état nutritionnel peut améliorer la santé d’enfants infectés par le VIH, en stade avancé de la maladie, afin de rendre possible leur prise en charge par les antirétroviraux.<p>Les travaux ont été réalisés au Burkina Faso. Le contexte géographique est favorable au développement des maladies infectieuses et parasitaires. La mortalité infanto juvénile y est élevée et ainsi que la proportion d’enfant malnutris. Bien que la courbe de la prévalence du VIH montre un début de ralentissement, l’infection continue de progresser chez les enfants.<p>Principales conclusions et implications de nos travaux :<p>& / Doctorat en Sciences de la santé publique / info:eu-repo/semantics/nonPublished

Tuberculosis (TB) has become a serious South African health problem because it is the most common opportunistic disease that leads to death in people with HIV/AIDS. Due to the airborne nature of the disease it can easily be spread to anyone including healthy people. A lack of compliance to treatment by TB patients explains why prevalence rates of the disease are high and why there is an emergence of drug resistant strains such as XDR-TB and MDR-TB. Information on existing knowledge, attitudes and perceptions regarding TB can provide a crucial foundation for the development of educational programmes and interventions aimed at reducing the further spread of the disease. This study aimed at understanding the knowledge, attitudes and perceptions towards TB and relating these to the current prevalence of HIV/AIDS. A face-to-face interview survey was conducted among adult Grahamstown East residents (n=1020). The Health Belief Model (Rosenstock et al., 1994) and Bandura’s (1986) Social Cognitive Theory formed the theoretical framework of the data collection and analysis. The data generated from the field work was first descriptively analysed providing frequency tables. Thereafter cross tabulations were calculated for relevant items using independent variables, namely gender, level of education, and experience of dealing with TB. The results of the study show that, in general, knowledge concerning TB was sufficient to provide a foundation for the adoption of healthier behaviours in the female respondents. Few of the respondents reported feeling personally susceptible although the majority of the respondents acknowledged the severity of the disease. The cues to action lacked the influence to persuade people to adopt positive health related behaviours. The perceived benefits of adopting preventative behaviour were not very influential in the adoption of healthier behavioural changes in the respondents. Disease stigma regarding the dual association of TB and HIV/AIDS was the main barrier for the adoption of healthier behavioural attitudes. Perceived self-efficacy in preventative behaviours was generally low in the less educated respondents. Recommendations regarding areas for future research and change interventions are provided.

MPH / Department of Public Health / The main entry point for the HIV/AIDS prevention, care and treatment is through HIV Testing Services (HTS). Despite undeniable benefits and increased availability of HIV Testing Services, uptake remains low among students. The aim of this study was to investigate factors contributing to low HIV Testing Services (HTS) among Health Sciences students. Quantitative research method was used to conduct this study. Descriptive quantitative research design was employed. 306 respondents determined by the sample formula were selected through Probability, Systematic sampling technique. Structured questionnaires were used to collect data from respondents. Validity was ensured through content and face validity. Reliability in the form of test-retest reliability were ensured through pre-testing the instrument using 31 respondents from the target population. Data collected was analysed using SPSS version 24. Ethical considerations were ensured throughout the study. The findings of the study showed that out of 306 respondents, 44,1% (n=135) of respondents, comprising 30,7% (n=94) of females and 13,4% (n=41) of males had gone for HIV testing. Respondents had adequate knowledge about HIV Testing Services (HTS) and their attitude towards HIV Testing Services (HTS) was favourable. HIV/AIDS-related stigma, fear of potential HIV positive diagnosis, low perception of HIV infection risk and negative attitude of healthcare service providers were attributed to low uptake of HIV Testing Services (HTS) among respondents. There were recommendations for HIV Testing Services (HTS) workshops, education and awareness campaigns emphasizing the benefits and importance of HIV Testing Services (HTS). The use of various forms of media including campus radio and newsletters to promote the uptake of HIV Testing Services (HTS) among university students was also recommended. / NRF

MPH / Department of Public Health / See the attached abstract below

PhD (Health) / Department of Public Health / The Government of South Africa in response to a prevalent human immunodeficiency virus (HIV) has adopted an approach of integrating HIV/AIDS service into primary health care, as a key to achieving universal access to antiretroviral treatment (ART). Despite the government’s efforts of integrating HIV service into Primary Health Care (PHC), insufficient numbers of PHC staff and inadequate infrastructure is challenging when integrating HIV/AIDS service into PHC. This study explored the extent of HIV service integration into PHC and whether the clinic/health centre’s environment is enabling to integrate HIV service into PHC. Barriers to HIV/AIDS services integration as well as attitudes of PHC nurses were assessed. The overall purpose of this study was to develop guidelines to facilitate the integration of HIV/AIDS services into PHC in Vhembe district of Limpopo province, South Africa. An exploratory sequential mixed methods design was used. The qualitative data was collected and analysed before and results for qualitative approach used to build a subsequent quantitative phase. The current study revealed that HIV/AIDS services are integrated into every existing programme at the PHC clinic and health centres; these include: Immunisation programme, Family planning, PMTCT and ANC programmes, STIs, minor ailments and chronic illness and TB. The study further revealed that the environments at PHC clinics and health centres are not enabling the integration of HIV/AIDS services into PHC due to insufficient staff and inadequate infrastructure. Guidelines to facilitate the integration of HIV/AIDS services based on the findings was developed. The study recommendations comprise; increasing knowledge of HIV serostatus, accelerating HIV prevention, accelerating the scale-up of HIV treatment and care, creating of enabling environment for the integration of HIV/AIDS services into PHC, nursing education and training and nursing education and training.

MPH / Department of Public Health / See the attached abstract below

MA (Psychology) / Department of Psychology / Background: An estimated 70% of people in Sub-Saharan Africa out of 25 million are living with HIV. HIV is a debilitating disease, however, antiretroviral treatment helps promote effective viral suppression, reduces the risk of transmission and prevents death (WHO, 2013). To ensure positive treatment outcomes, high levels of Anti-Retroviral Therapy (ART) adherence, 95%, is necessary, however, research indicates that 23% of Africans are achieving less than 80% adherence, potentially impacting negatively on prognosis. Aim: The aim of this study was to determine adherence, explore perceptions and behaviour of patients on Antiretroviral Therapy attending Thohoyandou Health Centre, in Vhembe District, Limpopo, South Africa. Methodology: This was a mixed method which employed both quantitative and qualitative research approaches. In quantitative, triangulation was utilised through a questionnaire and patients’ file, simple random sampling was used to select 105 male and female patients aged 18-60 who are on ART at Thohoyandou Health Centre; data were collected and SPSSversion 25 was used to analyse the data through descriptive, cross tabulation and inferential statistics using Chi-square.Qualitative phase – phenomelogical research design was utilised, twenty participants were purposively sampled and individually interviewed, ATLAS. ti program was used to analyse the data collected. Results: 67% of respondents were females, 34% of the respondents’ age range was 50-60 years, 44.8% were single, 48.6% had tertiary education and 69.5% were unemployed. The self-report of ART adherence of 87.6% among patients was indicated, with 19.6% who reported defaulting ART, 14.3% admitted to missing medical appointments. The reasons for missing medical appointments were: forgetfulness, not a convenient time, patient feeling better, transportation challenges and being too sick to attend. The objective evaluation of patients’ CD4 count at baseline revealed that 40.9% of patients had a CD4 count of <200c/mm3, out of 40.9% respondents (15.2%) were those aged between 41-50 years, 31.4% of respondents did not know their CD4 count for various reasons (defaulted on treatment, missed appointments). CD4 count follow-up data after six months revealed that 33% of patients had a CD4 count <200c/mm3 and 39% accounted for unknown CD4 count. vi Three themes emerged from the data, namely: Knowledge of HIV were respondents presented a negaitive and positive perception of ths diagnosis; barriers to ART adherence where sub-themes included discrimination, strigma, rejection, inadequate knowledge about the diagnosis and treatment, side effects; coping strategies where acceptance, religion and social support serve as corner stones for patients. Association was examined and findings did not reveal any significant association between gender, marital status, education, occupation; however, age was significantly associated with non-adherence to ART with X2 = 3.69, df = 1, p = < .002. Recommendations: The study recommends intensification of health education campaign against stigma, discrimination, rejection and other barriers to enhance positive attitude towards HIV patients that wil consequently stimulate adherence and alleviate the burden associated with taking treatment unswervingly. Given the high percentage of infected older respondents, government must also focus its resources to educate illiterate and older people about HIV, adherence and management in order to achieve the golden standardrate of 95% adherence. Strategies to facilitate and normalise adherence among males is indicated. / NRF