Magister Curationis - MCur / As early as 1993, the World Health Organisation declared Tuberculosis (TB) a global emergency and the South African Department of Health confirmed that TB was a national emergency. The primary cause of the rise in TB cases has been attributed to co-infection with HIV. TB is the leading opportunistic infection worldwide and the primary cause of mortality among people living with Human Immunodeficiency Virus (HIV). TB and HIV are two of the highest health threats globally and in South Africa. Tuberculosis and HIV combined are responsible for the deaths of over 4 million people annually. More than 65% of individuals diagnosed with TB in South Africa are co-infected with HIV. The importance of providing quality health services is a human right and non-negotiable. Better quality of health care is fundamental in improving South Africa's poor health outcomes and in restoring patient and staff confidence in the public and private health system. In 1996, the South African Department of Health introduced the topic of quality to raise its awareness and to make it an inherent part of the health care system. The South African health care consumers (patients) are increasingly becoming aware of their rights as patients and the gap between the actual and ideal health practices. They have broad knowledge and great expectations with regard to available care including effectiveness of service and treatment. Patients have desires for quality services when visiting a health care facility, and these desires are directly linked to the success of the healthcare system. If the desires are not met, they can negatively influence the outcome of healthcare processes such as treatment adherence and retention of patients on the system. This could possibly further escalate the TB/HIV co-infection rate in South Africa. The need to address TB and HIV together in the light of quality care is urgent so as to improve the provision of quality health services rendered to people co-infected with TB and HIV. The Institute of Medicine developed a framework that could guide on healthcare dimensions that need to be met for quality of care to be achieved and it is the underpinning theoretical framework for this study. The patients play a critical role in the healthcare system as they are the customers and therefore, the opinions of the patients need to be recognised to ensure that strategies and programmes that are developed are relevant. The purpose of this research was to explore and describe the perceptions of patients co-infected with TB and HIV regarding the quality of care at the Primary Health Care facilities, in the Chris Hani District. A qualitative, explorative and descriptive design was used which enabled the researcher to understand the perceptions of TB and HIV co-infected patients regarding quality of care. The population studied in this research consisted of TB and HIV co-infected patients attending the Primary Health Care facilities at the Lukhanji Sub-district within the Chris Hani District. Purposive sampling was used to select participants with the assistance of nurses working at the selected facilities. The sample size was determined by data saturation, which was reached after 18 semi-structured interviews were conducted. Data analysis was carried out simultaneously with data collection. In consensus discussions, the researcher and the co-coder reached an agreement on the main theme, sub-theme and sub-categories. From the research findings, two main themes were identified namely; satisfaction with delivered services and impediments to quality of care. These were further divided in sub themes and categories. The conclusion that could be made on the quality of care provided to the TB and HIV co-infected patients in this study is that the nurses in the facilities aim to provide four of the six IOM aims of quality of care to the TB and HIV co-infected patients namely: equitable, effective, efficient and patient-centred domains. Therefore, the quality of care provided to these patients is partial as they are not provided with all the six aims that are needed to achieve quality of care. Recommendations are made for the field of community health nursing practice and nursing research on how to improve quality of care provided to TB and HIV co-infected patients at Primary Health Care facilities.

Introduction: Tuberculosis (TB) pericarditis is a relatively rare form of tuberculosis which has been on the decline. However, the advent of the human immunodeficiency virus (HIV) pandemic has brought about the resurgence of tuberculosis pericarditis and an even poorer prognosis for patients with HIV co-infection. Objectives: The aim is to describe the baseline characteristics of tuberculous pericarditis patients and to assess the impact of HIV on the clinical presentation of this disease. Methods: The study describes baseline data from a randomised clinical trial which explored the use of adjunctive corticosteroids in management of TB pericarditis then went on to compare HIV co-infected patients versus those without HIV co-infection using logistic regression. Results: There were 1394 patients enrolled into the study, 64% were HIV positive, 19% were HIV negative and 17% had an unknown HIV status. Forty four percent of the participants were female and age had a positively skewed distribution with median 36 years (IQR: of 29-46). HIV co-infected patients were younger with OR 0.97(95% CI: 0.96-0.98), more likely to have previously had TB with OR 2.15(95% CI: 1.25-3.72), had a more acute illness with OR 0.99(95% CI: 0.99-1.00), had lower hemoglobin with OR 0.72(95% CI: 0.67-0.78), lower White Cell Count, (WCC) with OR 0.90(95% CI: 0.86-0.96) and higher globulin with OR 1.07(95% CI: 1.05-1.09). Conclusion: HIV co-infected participants are younger, more likely to have been previously diagnosed with TB, have a more acute illness, lower haemoglobin, lower WCC and higher globulin. / Dissertation (MSc)--University of Pretoria, 2013. / School of Health Systems and Public Health (SHSPH) / unrestricted

Tuberculosis (TB) is a leading public health problem across the world. For various reasons, TB and multidrug-resistant tuberculosis (MDR-TB) have increased. Clarification on TB/HIV co-infection and homelessness as risk factors for TB and MDR-TB is required to inform policy interventions to reduce TB-related morbidity, mortality, and healthcare costs. In this quantitative study, data from the Houston Health Department (N = 341) were analyzed to explore the relationship between TB and MDR-TB outcomes and TB/HIV co-infection and type of housing/homelessness. Foreign-born persons are disproportionately affected in the United States. The socio-ecological model provided a theoretical framework for the investigation. Multiple and logistic regression analyses were conducted to investigate the relationships between variables, controlling for age and gender. Results indicate that HIV infected persons were more likely than non-infected persons to contract TB, and homeless persons were more likely than non-homeless persons to contract TB/MDR-TB, suggesting that high TB/HIV co-infection rates increase prevalence of TB and MDR-TB while improvements in housing reduce prevalence of TB and MDR-TB. However, no significant associations between variables were found. The odds ratio, Exp(B) = 0.000, p -?¥ 0.90, 95% Cl [0.000, with no upper bound values] was observed for both independent variables. Regular screening for TB/HIV co-infection among persons with high TB and MDR-TB risk profiles is recommended. Further investigation is required. Inclusion of more covariates could further elucidate more evidence of an association between variables. Study findings may support interventions to reduce TB-related morbidity, leading to positive social change.

No description available.

<p><font face="Times New Roman" size="3"><font face="Times New Roman" size="3"> <p align="left">The aim of the study is to explore the barriers associated with low VCT uptake by the TB patients attending primary health care clinics within the Buffalo City municipality. <font face="Times New Roman" size="3"><font face="Times New Roman" size="3">The study population was drawn from TB patients attending the primary health care facilities in Buffalo city municipality in the Eastern Cape Province. Eight participants were purposively selected to include those who had accepted VCT as well as those who did not.</font></font></p> </font></font></p>

<p><font face="Times New Roman" size="3"><font face="Times New Roman" size="3"> <p align="left">The aim of the study is to explore the barriers associated with low VCT uptake by the TB patients attending primary health care clinics within the Buffalo City municipality. <font face="Times New Roman" size="3"><font face="Times New Roman" size="3">The study population was drawn from TB patients attending the primary health care facilities in Buffalo city municipality in the Eastern Cape Province. Eight participants were purposively selected to include those who had accepted VCT as well as those who did not.</font></font></p> </font></font></p>

Magister Public Health - MPH (Public Health) / Over the past two decades, despite a growing tuberculosis (TB) epidemic, the South African health system and National TB Programme (NTP) have taken significant steps to ensure improved clinical awareness, early diagnosis, prompt treatment initiation and follow-up of treatment outcomes in cases of TB. The effects of these programmatic measures over time on changes in the severity of disease and presenting clinical profile of patients with pulmonary TB have not been studied. Doing so may provide another window on the impact of TB control initiatives in South Africa.

Submitted by Luciana Ferreira (lucgeral@gmail.com) on 2014-10-29T14:55:41Z No. of bitstreams: 2 Dissertação - Marina Pedroso de Oliveira - 2013.pdf: 1546029 bytes, checksum: 047574069d3a0ee543cf485aa4e61edd (MD5) license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) / Approved for entry into archive by Luciana Ferreira (lucgeral@gmail.com) on 2014-10-30T10:52:04Z (GMT) No. of bitstreams: 2 Dissertação - Marina Pedroso de Oliveira - 2013.pdf: 1546029 bytes, checksum: 047574069d3a0ee543cf485aa4e61edd (MD5) license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) / Made available in DSpace on 2014-10-30T10:52:04Z (GMT). No. of bitstreams: 2 Dissertação - Marina Pedroso de Oliveira - 2013.pdf: 1546029 bytes, checksum: 047574069d3a0ee543cf485aa4e61edd (MD5) license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) Previous issue date: 2013-02-28 / Fundação de Amparo à Pesquisa do Estado de Goiás - FAPEG / It is estimated that about 10% of individuals infected with human immunodeficiency virus (HIV) throughout the world have chronic infection with hepatitis B virus (HBV). The HIV-HBV co-infection increases the risk for developing cirrhosis and hepatocellular carcinoma. Also, co-infected individuals have atypical serological profiles more often than monoinfected patients, many of whom may have occult hepatitis B (presence of HBV-DNA in serum and/or liver in the absence of HBsAg) in addition to mutations in the viral genome that may have implications for the prognosis and therapeutics of hepatitis B. This study aimed to estimate the prevalence of occult HBV infection in HIV-infected treatment-naive patients, in Goiânia, Goiás, to determine the viral load of HBV-DNA positive samples, to identify circulating genotypes/subgenotypes and to investigate the occurrence of mutations in P and S regions of the HBV genome. This is a cross-sectional study conducted in HIV-infected treatment-naive patients attended at a reference hospital for infectious diseases in the Goiania city. After serological screening of the population (n = 505), two groups of patients were selected for this study: (i) 99 anti-HBc positive/HBsAg negative and (ii) 29 HBsAg reactive individuals. HBV-DNA was detected by semi-nested PCR and quantified by real time PCR. The amplicons were genotyped by RFLP and nucleotide sequencing. The identification of mutations in the viral genome was made by deduction of the amino acid sequences from the nucleotides sequences. The search for occult HBV infection performed in 99 anti-HBc positive/HBsAg negative samples (Group 1) showed a prevalence of 16.2% (16/99, 95% CI: 9.8-25.2). Of 29 HBsAg positive patients (Group 2), HBV-DNA was detected in 69% (20/29). As expected, DNA levels in the HBsAg reactive patients were significantly higher than those found in patients with occult infection (mean 2.89 x 108 copies/ml vs 6.59 x 102 copies/ml, p < 0.01). The genotypes (subgenotypes) A (A1 and A2), D (D2 and D3) and F (F2) were identified, being A/A1 the most frequently found. Mutations in the S region of HBV were found in both groups of patients, whereas mutations in the P region were observed only in patients HBsAg positive. These results revealed a high prevalence of occult HBV infection, the predominance of genotype A (A1), and the presence of mutations in the viral genome of HBV-HIV co-infected treatment-naive patients in Goiânia, Goiás. / Estima-se que cerca de 10% dos indivíduos infectados pelo vírus da imunodeficiência humana (HIV) em todo o mundo apresentam infecção crônica pelo vírus da hepatite B (HBV). A coinfecção HIV-HBV aumenta o risco para desenvolvimento de cirrose e hepatocarcinoma. Ainda, indivíduos coinfectados apresentam perfis sorológicos atípicos mais frequentemente do que os monoinfectados, sendo que muitos deles podem apresentar hepatite B oculta (presença do HBV-DNA no soro e/ou fígado na ausência do HBsAg), além de mutações no genoma viral que podem ter implicações no prognóstico da hepatite B e na terapêutica. Este estudo teve como objetivos estimar a prevalência de infecção oculta pelo HBV em indivíduos infectados pelo HIV, virgens de tratamento, em Goiânia-Goiás, determinar a carga viral das amostras HBV-DNA positivas, identificar os genótipos/subgenótipos circulantes e investigar a ocorrência de mutações nas regiões S e P do genoma do HBV. Este é um estudo transversal conduzido em pacientes infectados pelo HIV, virgens de tratamento, atendidos em um hospital de referência para doenças infecciosas na cidade de Goiânia. Após triagem sorológica da população (n=505), dois grupos de pacientes foram selecionados para o presente estudo: (i) 99 anti-HBc positivos/HBsAg negativos e (ii) 29 indivíduos HBsAg reagentes. O HBV-DNA foi detectado por semi-nested PCR e quantificado por PCR em tempo real. Os amplicons foram genotipados por RFLP e sequenciamento de nucleotídeos. A identificação de mutações no genoma viral foi feita pela dedução de aminoácidos a partir de sequências de nucleotídeos. Ao pesquisar a infecção oculta para o HBV nas 99 amostras anti-HBc positivas/HBsAg negativas (Grupo 1), estimou-se uma prevalência de 16,2% (16/99; IC 95%: 9,8-25,2). Dos 29 pacientes HBsAg positivos (Grupo 2), o HBV-DNA foi detectado em 69% (20/29). Como esperado, os níveis de HBV-DNA nos pacientes HBsAg reagentes foram significativamente maiores do que os encontrados nos pacientes com infecção oculta (média: 2,89 x 108 cópias/mL vs 6,59 x 102 cópias/mL; p < 0,01). Os genótipos (subgenótipos) A (A1 e A2), D (D2 e D3) e F (F2) foram identificados, sendo A/A1 os mais frequentes. Mutações na região S do HBV foram encontradas nos dois grupos de pacientes, enquanto que as mutações na região P foram evidenciadas somente nos pacientes HBsAg positivos. Estes resultados revelaram uma prevalência alta de infecção oculta pelo HBV, a predominância do genótipo A (A1), bem como a presença de mutações no genoma viral dos pacientes HBV-HIV coinfectados, virgens de tratamento, em Goiânia-Goiás.

Magister Public Health - MPH / BACKGROUND: Namibia has generalised Human Immunodeficiency Virus (HIV) and tuberculosis (TB) epidemics. In response to the TB/HIV co-epidemics in Namibia, the Ministry of Health and Social Services approved a policy of TB/HIV collaborative activities at national level and the integration of TB/HIV services at the point of service delivery. The present study explored barriers and facilitators of integration of TB and HIV service delivery in Tsandi District Hospital, which lies in rural northern Namibia. It focused on understanding the perspectives of healthcare workers and service users on integration of TB and HIV services at the health facility. AIMS & OBJECTIVES: The study aimed to describe the barriers, facilitators, and opportunities of integrated TB/HIV service delivery in Tsandi District Hospital. The specific objectives were: to describe the staffing and support systems in place for the integration of TB/HIV care; to describe the perceptions and experiences of integrated TB/HIV care by the health care workers, management and co-infected clients; and to describe the factors that facilitate or hinder the integration of TB/HIV services in the district from the point of view of district hospital managers, health care workers and co-infected clients. METHODS: The study used a descriptive qualitative study design with semistructured key-informant interviews conducted with five healthcare managers and senior clinicians and focus group discussions with 14 healthcare workers and five TB/HIV co-infected patients, supplemented by non-participant observation in Tsandi district hospital over two weeks between May – June 2011. Sessions were audiorecorded, transcribed, and thematically analysed. RESULTS: Several factors influenced whether and to what degree Tsandi district hospital was able to achieve integration of TB and HIV services. These are: (1) model of care and nature of referral links; (2) the availability and use of human resources and workspace; (3) the system of rotating staff among departments in the hospital; (4) the supply and mode of providing medicines to patients; (5) information systems, recording and reporting arrangements; (6) and the amount of follow-up and supervision of the integrated services. The main suggested barrier factors are: (1) poor communication and weak referrals links between services; (2) inadequate infrastructure to encourage and deliver TB and HIV care; (3) staff shortages and high workload; (4) lack of training and skills among healthcare workers; (5) financial constraints and other socioeconomic challenges; and (6) fragmented recording and reporting systems with limited data use to improve service delivery. The four main facilitating factors are: (1) positive staff attitudes towards TB/HIV integration; (2) common pool of staff managing different programmes; (3) joint planning and review of TB and HIV activities at the ARV Committee; and (4) informal task sharing to alleviate healthcare worker shortages. CONCLUSIONS: This study recommends that the district build on the current facilitators of integration, while the inhibitors should be worked on in order to improve the delivery of TB/HIV services in the district. Simple and practical recommendations have been made to address the some of the barriers at district level. It is hoped that these will inform future planning and review of the current model of care by the District nagement Team.

L’infection par le VHB est endémique en Thaïlande. Malgré l’introduction des programmes de vaccination contre le VHB, la transmission périnatale reste une cause majeure d’infection chronique. Les objectifs de ce travail étaient d’identifier les mutants du VHB pouvant être associés à des échecs de vaccination, de diagnostic et de thérapeutique. Le travail présenté ici est divisé en trois parties. Dans une première partie, nous avons analysé la prévalence de la transmission périnatale du VHB dans une cohorte issue d’un protocole thérapeutique de prévention de la transmission materno-fœtale du VIH. Nous avons cherché à caractériser les mutants d’échappement à la vaccination contre le VHB. Parmi 3349 femmes enceintes séropositives pour le VIH, l’antigène (Ag) HBs était positif dans 7% des cas. L’Ag HBs était détectable à l’âge de 2 et 18 mois chez 11 enfants nés de mères porteuses chroniques. Les variants du VHB présents au sein de 9 de ces paires mère-enfant ont pu être étudiés après séquençage et clonage. Trois types de transmission du VHB ont pu être décrites ; i) transmission de variants non mutés par les mères présentant une charge virale VHB élevée ii) transmission d’un virus mutant minoritaire isolé chez la mère, et iii) transmission de mutants déjà présents à plus de 20% chez la mère. La capacité in vitro de ces mutants à échapper à la réponse neutralisante anti-HBs sera étudiée en utilisant un modèle de pseudo-particules portant les mutations identifiées. / Thailand is an endemic area for chronic HBV infection. Despite implementation of HBV vaccination, perinatal HBV transmission remains a major cause of chronic infection. This study aimed at identifying HBV mutants that may be associated with vaccine failure, misdiagnosis of chronic HBV infection and antiviral treatment failure. The dissertation is divided in three parts. In the first part, we analyzed the prevalence of perinatal HBV transmission in a large HIV prevention cohort in Thailand and characterized the HBV vaccine escape mutants. Among 3,349 HIV-infected pregnant women, 7% were found HBsAg positive. Eleven children born to HBsAg-positive mother were found HBsAg-positive at 2–18 months of age. Complete series of samples were available for 9 mother-child pairs. Based on direct sequencing and cloning analysis, 3 patterns of transmission were observed : i) transmission of wild-type variants from mothers with high HBV DNA level, ii) transmission of maternal minor variant and iii) transmission of variants already present in maternal blood samples. The capacity of HBV variants to escape from anti-HBs neutralization in vitro will be further studied using HBV-pseudoviral particles harboring the characterized mutations.