<p>HIV counselling and testing (HCT) is an essential element in the response to the HIV epidemic. There are still major gaps in research about the best ways to provide HCT, especially to young people. School-based HCT is a model which has been suggested for providing HCT to young people in a youth friendly manner. This study was aimed at producing recommendations for providing a youth friendly school-based HCT service using the World Health Organisation (WHO) framework for youth friendly health services. It was conducted in six secondary schools in Cape Town, where a mobile HCT service is provided by a nongovernmental organisation (NGO). It was an exploratory descriptive study, using a mixed-methods approach. Twelve focus group discussions (FGDs) were held with learners to explore their needs with regards to school-based HCT. An evaluation (which consisted of observation of the HCT site, service provider interviews and direct observation of the HCT counselling process) was done to determine whether the mobile school-based HCT service was youth friendly. A learner survey was conducted with 529 learners to investigate the factors that influence the uptake of HCT and to explore learners&rsquo / behaviours and experiences under test conditions. In the FGDs, learners said that they wanted HCT to be provided in schools on condition that their fears and expressed needs were taken into account. They wanted their concerns regarding privacy and<br /> confidentiality addressed / they wanted to be provided with information regarding the benefits and procedure of HCT before testing took place / they wanted service providers to be competent to work with young people, and they wanted to be assured that those who tested positive were followed up and supported. On evaluation of the mobile school-based HCT service, it was evident that the service did not meet all the needs of the learners nor did it have all the characteristics of a youth friendly health service. The model of &lsquo / mass testing&rsquo / used by the NGO did not fulfil learners&rsquo / expressed need for privacy with regards to HCT. Service providers were friendly and non-judgemental but had not been trained to work with young people (especially marginalised groups e.g. young men who have sex with men). The information needs of learners were not addressed, and learners were not involved in the provision of the HCT service. Learners who tested positive were not assisted in accessing care and support. The learner survey revealed a high uptake of HCT (71% of learners) at schools with learners who do not identify themselves as Black, with female learners and older learners being more likely to have had an HIV test. Factors that influenced uptake of HCT were complex, with learners reporting many different motivators and barriers to testing. Of concern was the low risk perception of leaners with regards to HIV infection and the fact that learners who tested HIV positive were not being linked up with treatment and care. Based on the findings of the study, recommendations were made for providing youth friendly schoolbased HCT. A multisectoral approach, with learner and community involvement, was suggested in order to provide a service which is equitable, accessible, acceptable, appropriate and effective.</p>

<p>HIV counselling and testing (HCT) is an essential element in the response to the HIV epidemic. There are still major gaps in research about the best ways to provide HCT, especially to young people. School-based HCT is a model which has been suggested for providing HCT to young people in a youth friendly manner. This study was aimed at producing recommendations for providing a youth friendly school-based HCT service using the World Health Organisation (WHO) framework for youth friendly health services. It was conducted in six secondary schools in Cape Town, where a mobile HCT service is provided by a nongovernmental organisation (NGO). It was an exploratory descriptive study, using a mixed-methods approach. Twelve focus group discussions (FGDs) were held with learners to explore their needs with regards to school-based HCT. An evaluation (which consisted of observation of the HCT site, service provider interviews and direct observation of the HCT counselling process) was done to determine whether the mobile school-based HCT service was youth friendly. A learner survey was conducted with 529 learners to investigate the factors that influence the uptake of HCT and to explore learners&rsquo / behaviours and experiences under test conditions. In the FGDs, learners said that they wanted HCT to be provided in schools on condition that their fears and expressed needs were taken into account. They wanted their concerns regarding privacy and<br /> confidentiality addressed / they wanted to be provided with information regarding the benefits and procedure of HCT before testing took place / they wanted service providers to be competent to work with young people, and they wanted to be assured that those who tested positive were followed up and supported. On evaluation of the mobile school-based HCT service, it was evident that the service did not meet all the needs of the learners nor did it have all the characteristics of a youth friendly health service. The model of &lsquo / mass testing&rsquo / used by the NGO did not fulfil learners&rsquo / expressed need for privacy with regards to HCT. Service providers were friendly and non-judgemental but had not been trained to work with young people (especially marginalised groups e.g. young men who have sex with men). The information needs of learners were not addressed, and learners were not involved in the provision of the HCT service. Learners who tested positive were not assisted in accessing care and support. The learner survey revealed a high uptake of HCT (71% of learners) at schools with learners who do not identify themselves as Black, with female learners and older learners being more likely to have had an HIV test. Factors that influenced uptake of HCT were complex, with learners reporting many different motivators and barriers to testing. Of concern was the low risk perception of leaners with regards to HIV infection and the fact that learners who tested HIV positive were not being linked up with treatment and care. Based on the findings of the study, recommendations were made for providing youth friendly schoolbased HCT. A multisectoral approach, with learner and community involvement, was suggested in order to provide a service which is equitable, accessible, acceptable, appropriate and effective.</p>

Introduction. Des traitements efficaces permettent la prise en charge des personnes vivant avec le VIH (PVVIH) et la prévention. Cependant, seulement 55% des PVVIH connaissent leur statut et ce taux est encore plus faible pour les pays de l’Afrique de l’Ouest et du Centre (35%). Afin d’accroître l’offre de Conseil et Test pour le VIH (CTV), l’OMS a publié en juillet 2015 un guide consolidé basé sur des études, dont certaines ont été réalisées en Afrique Subsaharienne. Et très peu d’entre elles concernent les pays à faible prévalence du VIH, notamment l’Afrique de l’Ouest francophone. Cette thèse a pour objectif général d’analyser les enjeux et les limites des politiques et programmes de CTV dans les pays africains de basse prévalence VIH, à partir de la situation du Burkina Faso, et de proposer de nouvelles mesures pour développer l’offre de CTV.Méthodes. Deux études ont été conduites. La première portait sur les motivations et les obstacles à la pratique du test VIH. Elle a été menée dans le cadre du projet « Multi-country African Testing and Counselling for HIV » (MATCH) portant sur quatre pays (Burkina Faso, Kenya, Malawi, Ouganda). Au Burkina Faso, l’étude a été conduite en 2008-2009 en milieu urbain (Ouagadougou) et rural (Dédougou) dans des sites sélectionnés selon leur niveau de fréquentation. Des approches quantitatives et qualitatives ont été utilisées.La deuxième étude a été conduite en 2015 auprès des acteurs et des décideurs du CTV au niveau national, et visait à analyser leurs perceptions des directives publiées par l’OMS en 2015. Un outil de collecte des données expliquant les changements a diffusé par voie électronique. Les réponses ont été analysées de manière quantitative et qualitative.Résultats. L’offre du CTV est basée au Burkina Faso sur des documents validés en 2008.L’analyse de l’utilisation du test à l’initiative du client a montré que les femmes étaient les plus nombreuses (58,5%). Cependant les hommes (p=0,02), les 18-34 ans (p=0,01), et les plus scolarisés (p=0,001) semblaient utiliser plus précocement les services.. En analyse multivariée, ces catégories utilisaient plus les campagnes. Les signes ou symptômes liés au VIH motivaient le test chez les femmes (p=0,008), les 35 ans et plus (p<0,001) et les non scolarisés (p<0,001) qui sollicitaient plus le test en sites fixes. L’utilisation du CTV pendant la campagne était associée au désir de connaître le statut (p<0,001), tandis qu’en dehors des campagnes, l'état de santé de l’utilisateur, la maladie ou le décès du partenaire était le principal motif (p=0,001). Aussi 61% des utilisateurs avaient réalisé 2 tests et plus. Dans une analyse multivariée, l’utilisation répétée du CTV par les personnes séronégatives était associée à la scolarisation (au moins le secondaire), au jeune âge et pour les PVVIH à la résidence en milieu urbain.Les prestataires déclaraient être confrontés à des difficultés logistiques et matérielles pour offrir adéquatement le CTV. Il en résultait une faible qualité des services, notamment un conseil post test dispensé partiellement, et une faible référence des PVVIH. Celles-ci avaient un vécu de stigmatisation élevé, soit 46% de stigmatisation interne, 40% dans les relations interpersonnelles et 11% dans les services de santé. Les décideurs et acteurs ont trouvé la plupart des directives de 2015 pertinentes, mais sont pessimistes sur leur faisabilité.Conclusion. Ce travail a identifié les limites du CTV au Burkina Faso et donne des éléments significatifs pour les pays africains de basse prévalence. Dans un contexte de raréfaction des ressources, l’accès équitable au CTV nécessite l’identification de stratégies innovantes. Le renforcement des capacités des prestataires pour une offre globale de services de qualité est nécessaire. La lutte contre la stigmatisation devrait être intensifiée. La prise en compte des avis des experts permettra la révision des documents nationaux et leur adaptation selon les directives OMS. / Background. Treatments are effective for people living with HIVAIDS (PLWHA) care and prevention. However, only 55% of PLWHA are aware of their status. This rate is lower in Central and West Africa (35%). In July 2015, WHO published new guidelines on HIV testing. In Sub-Saharan Africa, there are many studies which results are used to define policies and guidelines on HIV testing at the international level. Few of them are implemented in low HIV prevalence countries, notably French-Speaking West Africa. The overall objective of this thesis is to analyze the challenges and limitations of HIV testing and counselling (HTC) policies and programs in low prevalence countries, over the situation in Burkina Faso and propose new measures to increase the access to HTC services.Methods. Two studies have been conducted. The first one was carried out in the « Multi-country African Testing and Counselling for HIV » (MATCH) project which was implemented in four countries (Burkina Faso, Kenya, Malawi, Uganda). It aimed to analyze the motivations and barriers to HTC services practices by users, non-users and providers. In Burkina Faso, the study was carried out in Urban (Ouagadougou) and rural (Dédougou) areas in 2008-2009. In each locality, study sites (client initiated testing and provider initiated testing sites) were chosen, given the level of utilization. Quantitative and qualitative methods were used. The second study was conducted in 2015, with HTC providers and decision makers at national level. The objective was to analyze their perceptions on WHO 2015 guidelines. A data collection tool explaining the changes introduced in the guidelines has been designed and transmitted via electronic means. Their opinions were analyzed.Results. Guidelines for HTC in Burkina Faso were from 2008. In client initiated testing sites, there were more women (58.5%). However, men (p=0.02), 18-34 years old (p=0.01), and the more educated ones (p=0.001) appeared to have used early services. In multivariate analysis, those categories used often campaigns. Women (p=0.008), 35 years of age and over (p<0.001) and less educated people (p<0.001) sought more often the test in fixed sites. The use of HTC services during campaigns is associated with the desire to know one's HIV status (p<0.01), while outside of campaigns, the health status of the user, the illness or the partner's death was the main concern (p=0.001). Campaigns are associated with the hope of knowing one’s HIV status (p<0.001). There were 61% of users who were repeat testers (2 or more tests). In a multivariate analysis, repeat testing for HIV negative people was associated with higher education, young age and for PLWHA living in urban areas. HTC Providers declared that they faced logistic and material challenges. It resulted in a low quality of services, in particular post-test counselling sessions that were partially done and a low effective reference of PLWHA towards care services. HIV stigma was found to be very high (46% of PLWHA faced internal stigma, 40% of interpersonal stigma, and 11% in health services). Decision-makers and providers have found most of the 2015 guidelines relevant, but were pessimist about their feasibility.Conclusion. This work has identified limitations of HTC at the individual, community, health services and institutional levels in Burkina Faso, and provides significant elements for African low prevalence countries. Given the scarcity of resources, there is a need for innovative strategies for equitable access to HTC, in order to attract more men, and test earlier women, less educated and 34 years or older. Strengthening the capacity of service providers to include a comprehensive range of quality services is necessary. All the aforementioned should be supplemented by the fight against stigma. Paying attention to national HTC experts’ opinion will help for national guidelines review and adapt them to WHO guidelines.

Philosophiae Doctor - PhD / The HIV/AIDS epidemic remains an unbeaten challenge that affects all parts of the global population. Since the identification of the epidemic in the early 1980s, nearly 58 million people have become infected with the virus and 25 million people have died of HIV-related complications. This study aimed to elucidate individual and community level factors associated with the uptake of antenatal care (ANC), health facility delivery, HIV Counselling and Testing (HCT), and Prevention of Mother-to-Child Transmission of HIV (PMTCT) services by implementing a hierarchical (multilevel) methodological approach. This study used a cross-sectional, multistage sampling design in which health facilities were first selected (stage 1), followed by recruitment of post-partum women who came for child immunization from each health facility (stage 2), in Tigray region. Structured interview guides were developed for interviews. Four-fifths (80.0%) of mothers used antenatal services at least once during their most recent pregnancy and of these 74.6% of women accessed HCT. Sixty nine percent of women had delivered at a health facility, 79% of mothers and 55.7% of their children had received PMTCT services. Place of residence was significantly associated with ANC attendance and place of delivery, with women living in urban areas almost 2 times (OR=1.75, 95% CI 1.06, 2.92) more likely to deliver at a health facility. With the addition of one health facility per 25000 people, the likelihood of delivering at a health facility increased by 2.45 fold (OR=2.45, 95% CI 1.04, 5.78). Attending ANC (OR=4.54; 95%CI 2.82,7.33) and getting support from husband (OR=1.97; 95%CI 1.25,3.10) were significantly associated with HCT, at the individual level. At the community-level, for the addition iii of one health facility and HCT site for every 25000 people increase the likelihood of HCT utilization by 2.1 and 2.4 fold respectively. Mothers who delivered at a health facility were 18 times (OR=18.21; 95%CI 4.37,75.91) and children born at a health facility were 5 times (OR=4.77; 95%CI 1.21,18.83) more likely to receive PMTCT services, compared to mothers delivering at home. With the addition of one nurse per 1500 people, the likelihood of getting PMTCT services for a mother increases by 7.22 fold (OR=7.22; 95% CI 1.02,51.26). Community-level random-effects were also significant and there was confirmation of nesting at the community-level even after controlling for individual and communitylevel variables. Findings also showed that HCT utilization was nested according to district of residence, contributing 11.3% of the variance. In addition, the variation of mothers getting PMTCT services between districts was only 0.6%, but was 27.2% for children. Conclusion: Factors influencing utilization of maternal health services work at different levels, individual and community. Hierarchical models reveal these differences in ways that single-level (individual or community) models do not. Interventions are needed to increase spouse involvement in ANC utilization, and explore effective ways of increasing health facility delivery among poor women with little formal education in rural areas and increasing the number of health facility per people are important. The government should focus on increasing ANC access, educating couples on the importance of health services utilization, increasing the number of health facilities and HCT sites per population to improve HCT utilization. In addition to these, programmes should focus on increasing health facility delivery, training traditional birth attendants to understand the need for PMTCT and increasing iv HCT coverage to advance getting PMTCT services for mothers at the individual level and for children at both individual and community level. Permission to conduct the study was granted from the Ethics Committee of the University of the Western Cape and from Tigray Region Health Bureau. Verbal informed consent was obtained from each participant in the health facility based interview.

Magister Public Health - MPH / The study had an observational, descriptive, cross sectional design. The sample consisted of 205 participants selected through convenience sampling. All students who presented for HIV testing during the colleges’ HIV Counselling and Testing campaign in December 2011 were asked to complete a self-administered closed-ended questionnaire voluntarily. The data was analysed with EPI Info versions 3.5.1. A frequency analysis was conducted for all the variables such as demographics, risk perception to HIV, knowledge of HIV, HIV testing behaviour. The association between HIV knowledge, risk perception and risk behaviours were assessed for gender differences. Chi-square analysis was conducted to determine the association between the main variable of interest HIV risk behaviour and each other explanatory variable (demographics, HIV knowledge, risk perception etc). Results were discussed using the theory of planned behaviour.

MPH / Department of Public Health

In English / The purpose of this study was to establish factors affecting the participation of men working in the informal sector economy of South Africa in HIV counselling and testing (HCT) or voluntary counselling and testing (VCT). This includes the exploration of reasons for acceptance and non-acceptance of HIV testing, knowledge and perceptions about HIV testing and behaviours and attitudes towards HIV testing. Data was collected through a structured questionnaire and a sample of fifty (50) men was purposively selected. It was found that the reasons for acceptance of HIV testing are satisfactory and reasons for non-acceptance are still a concern, and that several issues such as education about HIV testing and HIV in general still need to be addressed. Most of the respondents had undergone testing for HIV, but there is still a stigma attached to HIV testing. / Sociology / M. A. (Social Behaviour Studies in HIV/AIDS)

In English / The purpose of this study was to establish factors affecting the participation of men working in the informal sector economy of South Africa in HIV counselling and testing (HCT) or voluntary counselling and testing (VCT). This includes the exploration of reasons for acceptance and non-acceptance of HIV testing, knowledge and perceptions about HIV testing and behaviours and attitudes towards HIV testing. Data was collected through a structured questionnaire and a sample of fifty (50) men was purposively selected. It was found that the reasons for acceptance of HIV testing are satisfactory and reasons for non-acceptance are still a concern, and that several issues such as education about HIV testing and HIV in general still need to be addressed. Most of the respondents had undergone testing for HIV, but there is still a stigma attached to HIV testing. / Sociology / M. A. (Social Behaviour Studies in HIV/AIDS)

Summaries in English, Afrikaans and Zulu / South Africa is facing an ongoing public health crisis with increasing and alarming human immunodeficiency virus (HIV) statistics. Farmworkers in South Africa are highly vulnerable and susceptible to HIV. This study involved the farmworker community on a farm in the North West province of South Africa. The purpose of this study was to explore the perceptions and acceptance of home-based HIV counselling and testing (HBHCT) in a rural farming community, using an interactive World Café method to stimulate creative discussions around questions that matter. Thirty-one farmworkers participated in the World Café. This study had an explorative approach and qualitative design. The study did not investigate the number of HIV infections or sexual practices on the farm, and did not offer an HIV test or any other medical treatment to any participant. Data were collaboratively analysed by the researchers and the participants. Content analysis of data was conducted. The findings indicated that majority of the farmworkers had a positive perception of HBHCT, and that there was a serious need for HIV prevention and intervention in this community. Some concerns were raised among the participants regarding the confidentiality of HBHCT, attention should therefore be paid to these concerns. More research is needed to establish linkage to care after HBHCT. It remains unclear whether the migrant farmworker population would be effectively linked to HIV care and treatment without legal identification documentation. The acceptance of HBHCT in the farming community by farmers, should be explored. The study found that there would be a high level of acceptability if HBHCT were to be offered to farmworkers in this region. This study created insight into the HIV care and prevention needs of the local farmworker community, as well as highlighted the barriers the farmworkers face in attending primary healthcare (PHCs) clinics for HIV testing. / Suid-Afrika staar ’n voortdurende openbare gesondheidskrisis in die gesig met toenemende en onrusbarende menslike immuungebrekkige virus (MIV)-statistieke. Plaaswerkers in Suid-Afrika is uiters kwesbaar en vatbaar vir MIV. Hierdie studie het die plaaswerkergemeenskap van ’n plaas in die Noordwes-provinsie van Suid-Afrika geteiken. Die doel van hierdie studie was om die sieninge en aanvaardingsvlakke van tuis-gebaseerde MIV-berading en -toetsing (TSMBT) te ondersoek, deur gebruik te maak van die “World Café”-metode om kreatiewe bespreking rondom belangrike vrae te stimuleer. Een-en-dertig plaaswerkers het deelgeneem aan die “World Café”. Hierdie studie het nie die aantal MIV-infeksies of seksuele praktyke op die plaas ondersoek nie, en ook nie ’n MIV toets of enige ander mediese behandeling vir enige deelnemer aangebied nie. Die studie het gevind dat die meerderheid van die plaaswerkers ’n positiewe persepsie van TSMBT gehad het, en dat daar ’n dringende behoefte aan MIV-voorkoming en - ingryping in hierdie gemeenskap is. Bekommernis is uitgespreek deur die deelnemers rakende die konfidensialiteit van TSMBT, dus moet aandag hieraan geskenk word. Die studie het gevind dat daar ’n hoë vlak van aanvaarding van TSMBT sal wees as dit aan die plaaswerkers in hierdie streek gebied word. Hierdie studie skep insig in die MIVsorg- en -voorkomingsbehoeftes van die plaaslike plaaswerkergemeenskap, en beklemtoon die hindernisse vir plaaswerkers om die primêre gesondheidsorgkliniek te besoek vir MIV-toetsing. / INingizimu-Afrika ibhekene nokuqhubeka kokukhula kwenkinga yezempilo, kanye nokudlondlobala okushaqisayo kwezibalo zegciwane lesandulela ngculazi (HIV). Abasebenzi basemapulazini eNingizimu-Afrika ibona abasengozini enkulu yokutheleleka ngegciwane lesandulela ngculazi. Lolucwaningo lwenziwe emphakathini wabasebenzi basemapulazini esifundazweni sase-North West eNingizimu-Afrika. Inhloso yalolucwaningo bekuwukubona imibono kanye nezinga lokwamukela ukululekwa nokuhlolela igciwane lesandulela ngculazi emakhaya(i-HBHCT) emphakathini wasemapulazini kusetshenziswa Isizinda sokucobelelana ngolwazi (i- World Cafe) ukukhuthaza izingxoxo ezakhayo nokubuza imibuzo esemqoka. Bangama- 31 abasebenzi basepulazini ababambe iqhaza esizindeni sokucobelelana ulwazi (i- World Cafe). Lolucwaningo aluzange luphenye izibalo zabantu abatheleleke ngegciwane lesandulela ngculazi kanye nezinga labo lokuzibandakanya ocansini, futhi aluzange lunike abebebambe iqhaza ithuba lokuhlolela igciwane lesandulela ngculazi(HIV) kanye nokulashwa kwanoma iluphi uhlobo. Imiphumela iveze ukuthi iningi labasebenzi basemapulazini babe nemibono emihle mayelana nosizo lokululekwa nokuhlolela igciwane lesandulela nngculazi (HIV) emakhaya (HBHTC), futhi kunesidingo esikhulu sokuthi kungenelelwe kulomphakathi ukuze kuvikelwe igciwane lesandulela ngculazi (HIV). Kube nokukhathazeka kwababebambe iqhaza mayelana nezimfihlo zokulekelelwa ngokwelulekwa kanye nokuhlolela igciwane lesandulela ngculazi emakhaya(HBHCT),ngalokhoke kufanele kubhekelelwe lokho kukhathazeka. Ucwaningo luveza ukuthi kuzokwamukelwa ukuqala usizo lokwalulekwa nokuhlolela igciwane lesandulela ngculazi (HBHCT) kubasebenzi basemapulazini kulesisifundazwe. Lolucwaningo luveze ngokujulile izidingo zokunakekela kanye nokuvikela igciwane lesandulela ngculazi (HIV) emphakathini wabasebenzi basemapulazini kulendawo, laphinde lwaveza nezithiyo (Barriers) abasebenzi basemapulazini abahlangana nazo mabevakasha emitholampilo (PHCs) ukuyohlola igciwane lesandulela ngculazi. / Health Studies / M.P.H. (Public Health)