Text in English and siSwati / The purpose of this study was to develop support guidelines to assist with disclosure of HIV status to HIV infected children by their parents and caregivers in Swaziland. The study explored parents’ and caregivers’ experiences with disclosure, and described the pattern of disclosure for HIV status to infected children. A qualitative descriptive research was conducted. Data were collected through semi-structured with thirteen (13) parents and caregivers who were purposively selected to participate in the study. Data analysis was done using qualitative content analysis. Three themes emerged which were understanding the general concept of disclosure, the pattern followed by parents and caregivers on disclosure of HIV status to infected children and the experiences of parents and caregivers on HIV status disclosure to their children. Based on the findings, support guidelines were formulated to assist parents and caregivers with disclosure of HIV status to their infected children. The outcome of this study is the description of a clear pattern of when, how and what to be disclosed to HIV infected children; as described by the parents and caregivers of the HIV positive children. / Health Studies / M.A. (Nursing Science)

Magister Psychologiae - MPsych / According to the findings of this study, childcare workers caring for HIV-positive children working in a residential care setting, have similar experiences and challenges to nurses, community-based caregivers and primary caregivers, such as coping with loss and contagion fear. Nonetheless, caring for HIV-positive children poses unique challenges for the caregiver, calling for flexibility and situation-dependent coping strategies.

Pharmacological interventions to treat Human Immunodeficiency Virus (HIV) with antiretrovirals (ARVs), have dramatically improved the survival rates of HIV positive children maturing into adulthood. However, HIV-associated neurocognitive decline still persists in the era of ARVs. Within the framework of brain plasticity, a number of researchers have begun to assess the feasibility of cognitive rehabilitation therapy as a complement to ARVs to reverse neurocognitive decline as a result of HIV (e.g., Becker et al., 2012). Only one study has been conducted in South Africa, by Zondo & Mulder (2014), assessing the efficacy of cognitive rehabilitation in a paediatric sample. The current research builds on the above mentioned study by implementing an experimental approach to examine the effect of cognitive rehabilitation in a sample of both HIV positive and HIV negative children. Five HIV positive and six HIV negative children were assigned to either an experimental or control group. The experimental group underwent two months of cognitive rehabilitation therapy remediating sustained attention, whereas the control group took part in placebo activities. Sustained attention measures were taken before and after the intervention training sessions, using a sustained attention subtest from the Test of Everyday Attention for Children (TEA-CH). A Mann Whitney U Test revealed that the experimental group (Mdn=38.50) did not differ significantly from the control group (Mdn = 37.00) after the cognitive rehabilitation intervention, U=12.00, z= -.55, p= .66, r= -.17. But a Wilcoxon Signed Rank Test found that there was a significant improvement from pretest scores (Mdn=31.00) to posttest scores (Mdn=38.00) following the rehabilitation for HIV positive participants in the sample, T=15.00, z = -2.02, p= .04, r= -.90. This raises the possibility that cognitive rehabilitation could be used as a low cost intervention in underdeveloped contexts

A quantitative, descriptive, explorative survey was conducted to explore and describe nurses’ perceptions of disclosure to children of their HIV positive status in Addis Ababa. 100 nurses working in six conveniently sampled health centres participated by completing a self-administered questionnaire. The findings revealed that the majority of participants were of the opinion that children have the right to know their HIV status, participate in their own treatment, and that disclosure contributes towards improved adherence. Forty-one of the participants said that it is nurses’ role to support caregivers in the disclosure process. But 56.3% felt they lacked the training to disclose to children that they are infected with HIV. Accordingly, it is recommended that relevant and applied training is required to equip nurses with the knowledge and skills to disclose to children their status. The importance of nurses’ proactive role in disclosure to children of their HIV status needs to be emphasised. / Health Studies / M.A. (Public Health)

Adolescent girls and young women (AGYW; aged 15-24 years) in sub-Saharan Africa, the epicenter of the global HIV epidemic, have carried the primary burden of new HIV infections in this area for almost 40 years. Research has prioritized characterizing the individual predictors of HIV infection among AGYW by creating risk assessment tools that identify high-risk sub-populations for targeted HIV prevention efforts. Despite substantial efforts, there remains a disproportionate disease burden among this vulnerable population, suggesting a need to identify and assess new intervention targets beyond the individual. The objective of this dissertation is to expand our understanding of the complex relationship between the multi-level drivers of HIV infection among AGYW using advanced data science and epidemiologic methods. This dissertation is divided into six chapters, the first of which is an introduction to the dissertation. The second chapter is a scoping review of the extant HIV-related literature that has leveraged data integration methods to combine heterogeneous, multi-level data sources. Chapters 3, 4, and 5 are empirical aims. Chapter 3 describes the development of an integrated dataset that combines information from the Population-based HIV Impact Assessment (PHIA) project, the Population and Housing Census, and the Joint United Nations Programme on HIV/AIDS (UNAIDS) Policy Indicators platform. The resulting dataset captures data at the individual, interpersonal, community, and societal levels across five sub-Saharan African countries: Cameroon, Eswatini, Malawi, Rwanda, and Uganda. Chapter 4 uses the dataset described in Chapter 3 and presents the application of causal discovery algorithms to characterize and graphically depict the pathways among individual, interpersonal, community, and societal risk factors of HIV infection among AGYW to identify the potential underlying causal mechanisms supported by the data. Chapter 5 uses the results from Chapter 4 to assess the impact of increasing the proportion of AGYW who completed secondary education on HIV prevalence using parametric g-formula. This dissertation ends with Chapter 6, which summarizes the dissertation's results and situates the findings within the broader HIV prevention literature. A brief description of the dissertation results follows. The scoping review describes the four types of data integration methods: record linkage, multiple frame methods, imputation-based methods, and modeling techniques. I identified five thematic uses of data integration in the literature that supported the included articles’ study objectives. Those themes included using data integration to 1) describe HIVrelated etiology and prognosis; 2) develop or operationalize an HIV-related databases; 3) characterize sociodemographic, behavioral, clinical, and care risk factors; 4) estimate the population size of key or hard-to-reach populations; and 5) estimate HIV prevalence for key populations or varying geographical units. Then, using one of the described integration techniques, multiple frame methods, I present the process of developing a multi-level and -country integrated dataset that combined data from the PHIA Project, the Population and Housing Census, and the UNAIDS Policy Indicators platform. Additionally, I described the population of AGYW included in this study, as well as the different interpersonal, community, and societal environments they reside in, across Cameroon, Eswatini, Malawi, Rwanda, and Uganda. I then applied the PC causal discovery algorithm to that dataset to elucidate the interconnectedness between individual, interpersonal, community, and societal level risk factors on HIV status among AGYW across each of the countries and overall. Community-level HIV prevalence and interpersonal sexual relationship factors consistently had direct paths to AGYW's HIV status for almost all country analyses. Additionally, there were multiple individual-level factors that had direct paths to AGYW's HIV status, and most of those variables were related to sexual behavior (e.g., number of sexual partners in the last 12 months, age of sexual debut). Additionally, there were multiple indirect paths to HIV status identified across all levels of organization. My last empirical study used the findings from Malawi and applied the parametric g-formula, to assess the impact of three hypothetical scenarios that model how increasing the proportion of AGYW who completed secondary education impacts HIV prevalence. I found that increasing the proportion of AGYW who completed secondary education from about 31% to 100% is associated with about a 26% decreased odds of HIV. The findings highlight the importance of improving educational attainment among AGYW, which will impact their life trajectory, economic prosperity, and overall autonomy. The findings from this dissertation improve the knowledge base informing prevention interventions, thereby advancing the development of interventions that go beyond the individual to reduce the burden of HIV among AGYW. Additionally, the methods used in this dissertation provide an illustrative example of a novel and intersectional approach to assessing the multi-level determinants of health that may expand the current epidemiologic research program.

Introduction. Previous studies have established that infants born to mothers with advanced HIV disease and co-infections are smaller, premature and have rapidly progressive HIV disease and an early death. King Edward VIIIth Hospital, in Durban, admits many sick mothers and manages a large proportion of low birth weight and ill newborns. On discharge and follow-up, the mortality and morbidity of these infants are known to be high and are related to the prematurity. How much is related to being HIV exposed is still uncertain. Aim. To determine the perinatal transmission rate of HIV-1 and mortality at 12 months in HIV exposed infants that were admitted to and discharged from the Neonatal Unit, in Durban, South Africa. Methods. In this observational study, data from the outpatient charts of HIV exposed infants that required specialised neonatal care and subsequent follow up, between the period November 2007 and December 2009, were collected. Perinatal transmission rates and mortality of these infants were compared with maternal and infant risk factors. Results. Data on 463 HIV exposed, predominantly low birth weight infants are presented. The median maternal CD4 count was 309cells/mm3 with 16.8% of mothers commenced on HAART. Maternal co-infection with TB was found in 19.2% of the cohort. Early HIV transmission occurred in 11.5% of infants and was influenced by the type of ARV exposure (None, 20%; single dose NVP, 14.3%; dual therapy, 10.6%; maternal HAART, 8.5%). The dual therapy regimen for 7 days was more protective than that for 28 days (p=0.045). HIV infection was associated with higher risk of neonatal sepsis (RR 1.6; 95% CI, 1.1-2.3; p=0.015). The mortality for the cohort at 12 months was 10%. Maternal HAART was associated with a lower mortality: 2.95% vs.10.2% (RR 3.0; 95% CI, 0.4-20.5). There was a higher mortality rate in those that were low birth weight (RR 4.2; 95% CI, 1.02-18.8; p=0.037); those that were HIV infected (RR 4.8; 95% CI, 1.9-11.6; p=0.002) and those that were breastfeeding compared to formula feeding (RR 2.7; 95% CI, 1.1-6.8; p=0.038). Discussion. Rates of HIV transmission within the PMTCT programme were similar to that reported by the Department of Health. Early maternal ARVs for PMTCT prophylaxis, prevents HIV transmission. The coverage of maternal HAART was sub-optimal. Breastfeeding was associated with a higher HIV transmission rate and was most likely associated with non-exclusive breastfeeding during neonatal admission. Recommendations. Maternal HAART or ARV prophylaxis should be commenced early in the pregnancy for the best benefits. Meticulous attention should be paid to the feeding practices of high risk HIV exposed infants admitted for specialised neonatal care. / Thesis (M.Med.)-University of KwaZulu-Natal, Durban, 2012.

HIV-1 specific CD4+ T cell activity in clade C infected subjects has not been studied. CD4+ T cells play a vital role in controlling infectious diseases and there is a need to augment our knowledge of HIV immunology to aid vaccine design. We therefore embarked on a study to characterize HIV-1 specific CD4+ T cell activity in both adults and infants; assess the relationship between CD4+ and CD8+ immune responses; and the relationship between CD4+ T cell activity and markers of disease progression (viral loads and CD4 counts). Our study revealed that the magnitude of CD8+ T cell responses correlated significantly with CD4+ T cell responses, but that the percentage of CD8+ T cells directed against HIV-1 was always greater than that of CD4+ T cells. Gag was the frequently targeted HIV-1 protein by CD4+ T cells and had the highest density of epitopes targeted by CD4+ T cells. Patients with either a dominant CD4 or CD8 T cell response against Gag had significantly lower viral loads than patients in whom non-Gag proteins were the main target (p< 0.0001 for CD4 activity and p= 0.007 for CD8 responses). Single IFN- producing CD4+ T cells were present in significantly higher numbers than cells producing both IFN- and IL-2 simultaneously (p=0.009). Gag also dominated the CD4+ T cell response in acutely infected infants with IFN- production detected more frequently than IL-2 or TNF- . Longitudinal analysis of infants receiving early ARV treatment and then ceasing after 12 months revealed that early treatment conferred no protection against increasing viremia and disease progression. CD4+ T cell responses were detected sporadically in untreated infants indicating a dysfunctional immune response in the face of constant exposure to high levels of viremia. Taken together, the data reveal that a vaccine inducing Gag specific CD4+ T cell responses has the potential to confer some degree of protection, but other immunological parameters need to be investigated especially in infants. / Thesis (Ph.D.)-University of KwaZulu-Natal, Durban, 2011.

Globally HIV and AIDS are considered to be a major health and developmental challenge facing humanity. The HIV infection of children is not only an area of great concern for families but for the future of humankind. Caring and nurturing of children generally is considered as a challenging responsibility. Caregivers of HIV infected children are faced with the added responsibility of ensuring that these children have access to life saving health care at all times. Caregivers who are responsible for the health and well being of HIV infected children face constant challenges in their care giving role and this has implications for the quality of care of the child. The needs of HIV infected children are complex and vital to their basic needs is the administration of antiretroviral therapy (ART). This study aimed to explore, describe and interpret the experiences of caregivers, caring for HIV infected children and accessing services from a public hospital in Durban. Using the ecosystems theory, this qualitative study explored the experiences of thirty caregivers caring for HIV infected children. The data was collected using semi structured interviews with the caregivers. Four main themes emerged from the data analysis; namely: The caregivers’ intrapersonal experiences, their perspectives on HIV and ART, their access to health and social services and their coping strategies. This study concludes that caregivers of HIV infected children within the public hospital setting, experience numerous psycho-social and economic challenges on a daily basis. Subsequently, these challenges impacted on the quality of care to the HIV infected child. It was evident that respondents dealt with challenges differently, as the older respondents were more equipped emotionally and psychologically than the younger respondents. Generally, all respondents were negatively affected by poor psychological and socio-economic circumstances that prevented them from ensuring the wellbeing of the child. The challenges that they faced on the micro level (economic and psycho-social experiences), the mezzo (stigma, community and family support) and exo levels (health and welfare services) together with the macro level (DOH strategic plans and childcare legislations) determined how they provided for the care of the HIV infected child. Despite these challenges respondents’ resilience and commitment to providing for the health and wellbeing of the HIV infected child was consistent and remained a priority. Multi-level intervention programmes are required to help caregivers cope with their challenges. As such social work practitioners need to take cognizance of the psycho-social, emotional and material support required by caregivers of HIV infected children. / Thesis (M.A.)-University of KwaZulu-Natal, Durban, 2013.

HIV-positive adolescents are an increasingly numerous and challenging population in the South African HIV/AIDS epidemic. Their access to, and retention in, ART care has become a pressing public health concern. Comprised of four journal articles, this thesis explores the practice of antiretroviral treatment (ART) among a cohort of HIV-positive adolescents (age 10-19) in South Africa's Eastern Cape. By 'practice', I mean the volatile, situated and relational 'work' that goes into young people's everyday achievement of ART - into consuming daily medication, regularly attending health appointments, and participating in HIV programmes. Through an exploration of the ways in which some HIV-positive adolescents use, appropriate, or reject ART care; this thesis contributes to a much-needed evidence-base on the needs and survival strategies of adolescent ART users. Data for this study was gathered through eight months of multi-method ethnographic fieldwork with 23 HIV-positive youth, their families, and local health workers. The findings elucidate adolescent ART as a complex (and often volatile) form of social incorporation, through which young people negotiate survival, care and moral connection in contemporary South Africa. Enrolling in ART meant being encompassed into a (often hierarchical) set of social relationships, through which adolescents sought belonging, recognition and protection, amid profound insecurity. Through ART and its associated programmes, adolescents and their families attempted to strengthen familial ties, appeal to powerful patrons, petition for care, and access basic resources. Yet these pursuits were often deeply ambivalent, as discipline, blame, and resentment often came encased in the terms of care. At the crux of each article is an attempt to understand how adolescents, often alongside their families, negotiated both the social stakes and possibilities of ART. Through these discussions, we might better be able to grasp the fragility and complexity of young people's retention in ART.

Made available in DSpace on 2014-12-17T14:14:03Z (GMT). No. of bitstreams: 1 RichardsonARS.pdf: 244790 bytes, checksum: 7ec9324fdc574c3d106b56b638713650 (MD5) Previous issue date: 2006-05-19 / This study had as objective to identify to the perception of mothers and professionals of health on the attention to the health of HIV-Positive children/adolescents in the city of Natal-RN. It is a descriptive-exploratory study with quantitative and qualitative approach, carried through in the Giselda Trigueiro Hospital and in the State and Municipal Health Councils in Natal - RN, from march to december of 2005. The sample was composed by 56 participants, 33 mothers of children who use specialized assistance and 23 professionals. Data collection occurred with the application of a half-structuralized interview. Quantitative data were analyzed through descriptive statistics and qualitative data were submitted to content analysis. Prevailing categories in relation to the cartography of the attention to seropositive children and adolescents in Natal were: Organization and dynamics of the attention; Institutional management and human development; Control and prevention; other contexts of attention; relationship/communication team-patient and organization and functioning of the services. The profile epidemiologist of the children, adolescents and of the people/mothers, who take care of them with HIV/Aids, followed the evolution of the epidemic in the country and the world. It was verified that mothers need care and information; however they make a positive evaluation of the attendance they receive. It was also observed many gaps in the services of assistance, in which the researched group was attended, beyond imperfections in the communication between health professionals and users. The professionals recognize the advances that the politics represent for the assistance of people with Aids; however feel themselves limited by the precariousness of the system and the partner-economic conditions of the people. According to these data, it can be verified great challenges to go through in the context of integrality of the assistance to HIV positive children and adolescents in the city of Natal and in the improvement of the communication in the institution of reference / Este estudo teve como objetivo Identificar a percep??o de m?es e profissionais de sa?de sobre a aten??o ? sa?de de crian?as/adolescentes soropositivos no munic?pio de Natal-RN. Tratou-se de um estudo descritivo-explorat?rio com abordagem quantiqualitativa, realizado no Hospital Giselda Trigueiro e nas Secretarias Estaduais e Municipais de Sa?de situados em Natal RN, no per?odo de mar?o a Dezembro de 2005. A amostra foi formada por 56 participantes, sendo 33 m?es de crian?as usu?rias da assist?ncia especializada e 23 profissionais. A coleta de dados ocorreu com a aplica??o de uma entrevista estruturada. Os dados quantitativos foram analisados atrav?s da estat?stica descritiva e os dados qualitativos foram submetidos ? an?lise de conte?do. As categorias prevalentes em rela??o ? cartografia da aten??o as crian?as e adolescentes soropositivos em Natal foram: Organiza??o e din?mica da aten??o; Gest?o Institucional e desenvolvimento humano; Controle e preven??o; Outros Entornos de aten??o; relacionamento/comunica??o equipe-paciente e organiza??o e funcionamento do servi?o. O perfil epidemiol?gico das crian?as, adolescentes e seus respectivos cuidadores/m?es com HIV/Aids, foi semelhante ? evolu??o da epidemia no pa?s e no mundo. Observou-se que essas m?es s?o carentes de cuidados e informa??es, por?m fazem uma avalia??o positiva do atendimento que recebem. Foram verificadas diversas lacunas nos servi?os de assist?ncia, no qual o grupo pesquisado foi atendido, al?m de falhas na comunica??o entre equipe de sa?de e usu?rios. Os profissionais reconhecem os avan?os que as pol?ticas representam para a assist?ncia de pessoas com Aids, por?m sentem-se limitados pela precariedade do sistema e das condi??es s?cioecon?micas das pessoas. Diante desses dados, constatam-se os grandes desafios a serem percorridos no contexto da integralidade da assist?ncia a crian?as e adolescentes portadores de HIV no munic?pio de Natal e na melhoria da comunica??o na institui??o de refer?ncia