In this thesis, a mathematical model for HIV and TB co-infection with TB treatment among populations of Ethiopia is developed and analyzed. The TB model includes an age of infection. We compute the basic reproduction numbers RTB and RH for TB and HIV respectively, and the overall repro- duction number R for the system. We find that if R < 1 and R > 1; then the disease-free and the endemic equilibria are locally asymptotically stable, respectively. Otherwise these equilibria are unstable. The TB-only endemic equilibrium is locally asymptotically stable if RTB > 1, and RH < 1. How- ever, the symmetric condition, RTB < 1 and RH > 1, does not necessarily guarantee the stability of the HIV-only equilibrium, but it is possible that TB can coexist with HIV when RH > 1: As a result, we assess the impact of TB treatment on the prevalence of TB and HIV co-infection. To derive and formulate the nonlinear differential equations models for HIV and TB co-infection that accounts for treatment, we formulate and analyze the HIV only sub models, the TB-only sub models and the full models of HIV and TB combined. The TB-only sub model includes both ODEs and PDEs in order to describe the variable infectiousness and e ect of TB treatment during the infectious period. To analyse and solve the three models, we construct robust methods, namely the numerical nonstandard definite difference methods (NSFDMs). Moreover, we improve the order of convergence of these methods in their applications to solve the model of HIV and TB co-infection with TB treatment at the population level in Ethiopia. The methods developed in this thesis work and show convergence, especially for individuals with small tolerance either to the disease free or the endemic equilibria for first order mixed ODE and PDE as we observed in our models. / Mathematical Sciences / Ph. D. (Applied Mathematics)

Immunologic monitoring is part of the standard care for patients on antiretroviral treatment. Yet, little is known about the routine implementation of immunologic monitoring in Ethiopia. This study assessed the pattern of immunologic monitoring, immunologic response, level of immunologic treatment failure and factors related to it among patients on antiretroviral therapy in selected hospitals in southern Ethiopia. A retrospective longitudinal analytic study was conducted using documents of patients started on antiretroviral therapy. A total of 1,321 documents of patients reviewed revealed timely immunologic monitoring were inadequate. Despite overall adequate immunologic response, the prevalence of immunologic failure was 11.5% (n=147). Having WHO Stage III/IV of the disease and a higher CD4 (cluster differentiation 4) cell count at baseline were identified as risks for immunologic failure. These findings highlight the magnitude of the problem of immunologic failure. Prioritizing monitoring for high risk patients may help in effective utilisation of meager resources / Health Studies / M.A. (Public Health)

Background AIDS remains one of the world’s most serious health challenges affecting more females than men. The differences in the spread of Human Immunodeficiency Virus (HIV) among gender groups stem from biology, sexual behaviour and socially constructed gender differences between women and men in roles and responsibilities, access to resources and decision-making power. It could also be due to the females’ status in society which could be justified by lower economic and decision making ability. Purpose The purpose of this study was to explore and describe the role of gender in the spread of HIV among women of reproductive age in Ethiopia; with the view of developing gender sensitive HIV and AIDS prevention strategies. Methods The study used sequential mixed method with quantitative and qualitative paradigm. During first phase of the study, health facility based descriptive cross-sectional study design was used. Data was collected from 422 respondents using a structured questionnaire. Forty participants were recruited by purposive sampling from representatives working in reproductive health or related fields. Results About 83.2% of respondents reported that sexual intercourse discussion should be initiated by male partners. This showed that majority of respondents were dependent on their male partners in decision-making regarding sexual matters in their relationship. Multiple sexual partners were common among the respondents. One third of the respondents reported to have had intercourse with more than one partner during the past twelve months of the study period. Higher proportion of respondents (61.4%, n=259) had never used condom during sexual intercourse with their partner/s. As a result these risky sexual practices are a potential threat for spread of HIV and AIDS among women. Thus developed guidelines would alleviate the existing problems through implementation of strategies of HIV and AIDS prevention to enhance women’s status at household and different administrative structure level. Conclusion Gender disparities in relation to negotiating sexual relations among the study respondents were found to be still relevant. The culture that has placed men at the helm of leadership in sexual matters is strongly upheld and that includes who recommends use of preventive measures and who regulates when and how to enter into a sexual relationship. Guidelines for gender sensitive prevention strategies if applied appropriately would educate women and men to make decision about what directly affects their health / Health Studies / D. Litt. et Phil. (Health Studies)

Immunologic monitoring is part of the standard care for patients on antiretroviral treatment. Yet, little is known about the routine implementation of immunologic monitoring in Ethiopia. This study assessed the pattern of immunologic monitoring, immunologic response, level of immunologic treatment failure and factors related to it among patients on antiretroviral therapy in selected hospitals in southern Ethiopia. A retrospective longitudinal analytic study was conducted using documents of patients started on antiretroviral therapy. A total of 1,321 documents of patients reviewed revealed timely immunologic monitoring were inadequate. Despite overall adequate immunologic response, the prevalence of immunologic failure was 11.5% (n=147). Having WHO Stage III/IV of the disease and a higher CD4 (cluster differentiation 4) cell count at baseline were identified as risks for immunologic failure. These findings highlight the magnitude of the problem of immunologic failure. Prioritizing monitoring for high risk patients may help in effective utilisation of meager resources / Health Studies / M. A. (Public Health)

Background AIDS remains one of the world’s most serious health challenges affecting more females than men. The differences in the spread of Human Immunodeficiency Virus (HIV) among gender groups stem from biology, sexual behaviour and socially constructed gender differences between women and men in roles and responsibilities, access to resources and decision-making power. It could also be due to the females’ status in society which could be justified by lower economic and decision making ability. Purpose The purpose of this study was to explore and describe the role of gender in the spread of HIV among women of reproductive age in Ethiopia; with the view of developing gender sensitive HIV and AIDS prevention strategies. Methods The study used sequential mixed method with quantitative and qualitative paradigm. During first phase of the study, health facility based descriptive cross-sectional study design was used. Data was collected from 422 respondents using a structured questionnaire. Forty participants were recruited by purposive sampling from representatives working in reproductive health or related fields. Results About 83.2% of respondents reported that sexual intercourse discussion should be initiated by male partners. This showed that majority of respondents were dependent on their male partners in decision-making regarding sexual matters in their relationship. Multiple sexual partners were common among the respondents. One third of the respondents reported to have had intercourse with more than one partner during the past twelve months of the study period. Higher proportion of respondents (61.4%, n=259) had never used condom during sexual intercourse with their partner/s. As a result these risky sexual practices are a potential threat for spread of HIV and AIDS among women. Thus developed guidelines would alleviate the existing problems through implementation of strategies of HIV and AIDS prevention to enhance women’s status at household and different administrative structure level. Conclusion Gender disparities in relation to negotiating sexual relations among the study respondents were found to be still relevant. The culture that has placed men at the helm of leadership in sexual matters is strongly upheld and that includes who recommends use of preventive measures and who regulates when and how to enter into a sexual relationship. Guidelines for gender sensitive prevention strategies if applied appropriately would educate women and men to make decision about what directly affects their health / Health Studies / D. Litt. et Phil. (Health Studies)

Given the lack of effective vaccine or medicine, changing an individual's risk behaviours has been crucial in preventing the spread of HIV. Consistent and correct condom use has been considered as the most effective form of HIV prevention among female sex workers. Despite coordinated national level interventions over the last decade, a consistent decline in condom use among female sex workers has been evidenced in the Ethiopian context, particularly with non-paying partners. Thus far, no study has been produced that has illustrated major determinants of consistent condom use among female sex workers which would help in developing effective intervention strategies for the prevention of HIV spread in the country. In other countries, the Information, Motivation and Behaviour (IMB) model has been used to identify individual level determents of condom use. However, the researcher postulated that behaviour emanating from the personality structure of individuals could be the fundamental individual level determents of adherence to condom use and chose to investigate this using the Enneagram theory of personality, which was acknowledged for its heuristic value in explaining and enhancing self-development of at-risk individuals. This cross-sectional study was conducted in Addis Ababa. With the Without Finite Population Correction of the Sample Size Estimation Formula, the sample size of 350 was set and participants were recruited using Respondent-Driven Sampling (RDS). Using trained female sex workers, the Essential Enneagram Test (EET) and an Information-Motivation-Behaviour (IMB) questionnaire were administered to collect data. General Linear Modeling (GLM) Multivariate analysis was carried out to assess the correlation between personality style and consistent condom use among participants in the last seven days before the interview. The finding of this study revealed that personality type, measured by the Essential Enneagram Test (EET), is able to predict adherence to condom use among female sex workers and provided a new dimension for policy makers and practitioners in behavioural intervention programmes, such as Information-Education-Communication, peer-to-peer approaches, as well as health and rehabilitation services by using the Enneagram principles and universal growth process. / Psychology / D. Litt. et Phil. (Psychology)

BACKGROUND: Studies done in both developed and developing countries have reported the tendencies of adolescents to engage in risky behaviours. Such behaviours include indulging in early and unsafe sexual activities, having multiple sexual partners, alcohol and drug use and dropping out of school among others. PURPOSE: The main aim of the study was to develop intervention strategies for reducing sexual risk practices among adolescents in Ethiopia. METHODS: A mixed method approach using quantitative and qualitative approaches was employed in order to investigate the risks of sexual practices among urban and rural adolescents in the selected area. A cross-sectional survey was used to gather data quantitatively and focus group discussions were used for the qualitative part of data collection. A total of 449 students and 72 FGD participants were selected for quantitative and qualitative study respectively using systematic random sampling technique. Logistic regression was done to identify possible factors associated with knowledge on emergency contraceptive, condom utilisation, pre-marital sex practices and perception of risky sexual practices. RESULTS: One hundred and seventy (37.9%) respondents had experienced sexual intercourse at the time of the study. The higher proportion (42.6%) of those who had engaged in sexual relationships was from the rural school compared to 33.1% in the urban schools. The proportion of sexually active respondents was higher among males (44.8%) compared to (29%) females. Multiple partners were higher in rural adolescents (44.7%) compared to 31.8% among urban adolescents. Sexually Transmitted Diseases were reported by 28.6% of the sexually active adolescents and the prevalence was higher among males (73.5%) compared to 27% females. 87% of the sexually active adolescents rarely used a condom. CONCLUSION: The study identified a knowledge gap on ASRH which limited adolescents to access reproductive services. Social, cultural and economic factors contributed to adolescent engagement in risky sexual behaviours. Based on the major findings of this study, intervention strategies targeting behavioural, biomedical and structural interventions were proposed. / Health Studies / D. Litt. et Phil. (Health Studies)

Given the lack of effective vaccine or medicine, changing an individual's risk behaviours has been crucial in preventing the spread of HIV. Consistent and correct condom use has been considered as the most effective form of HIV prevention among female sex workers. Despite coordinated national level interventions over the last decade, a consistent decline in condom use among female sex workers has been evidenced in the Ethiopian context, particularly with non-paying partners. Thus far, no study has been produced that has illustrated major determinants of consistent condom use among female sex workers which would help in developing effective intervention strategies for the prevention of HIV spread in the country. In other countries, the Information, Motivation and Behaviour (IMB) model has been used to identify individual level determents of condom use. However, the researcher postulated that behaviour emanating from the personality structure of individuals could be the fundamental individual level determents of adherence to condom use and chose to investigate this using the Enneagram theory of personality, which was acknowledged for its heuristic value in explaining and enhancing self-development of at-risk individuals. This cross-sectional study was conducted in Addis Ababa. With the Without Finite Population Correction of the Sample Size Estimation Formula, the sample size of 350 was set and participants were recruited using Respondent-Driven Sampling (RDS). Using trained female sex workers, the Essential Enneagram Test (EET) and an Information-Motivation-Behaviour (IMB) questionnaire were administered to collect data. General Linear Modeling (GLM) Multivariate analysis was carried out to assess the correlation between personality style and consistent condom use among participants in the last seven days before the interview. The finding of this study revealed that personality type, measured by the Essential Enneagram Test (EET), is able to predict adherence to condom use among female sex workers and provided a new dimension for policy makers and practitioners in behavioural intervention programmes, such as Information-Education-Communication, peer-to-peer approaches, as well as health and rehabilitation services by using the Enneagram principles and universal growth process. / Psychology / D. Litt. et Phil. (Psychology)

BACKGROUND: Studies done in both developed and developing countries have reported the tendencies of adolescents to engage in risky behaviours. Such behaviours include indulging in early and unsafe sexual activities, having multiple sexual partners, alcohol and drug use and dropping out of school among others. PURPOSE: The main aim of the study was to develop intervention strategies for reducing sexual risk practices among adolescents in Ethiopia. METHODS: A mixed method approach using quantitative and qualitative approaches was employed in order to investigate the risks of sexual practices among urban and rural adolescents in the selected area. A cross-sectional survey was used to gather data quantitatively and focus group discussions were used for the qualitative part of data collection. A total of 449 students and 72 FGD participants were selected for quantitative and qualitative study respectively using systematic random sampling technique. Logistic regression was done to identify possible factors associated with knowledge on emergency contraceptive, condom utilisation, pre-marital sex practices and perception of risky sexual practices. RESULTS: One hundred and seventy (37.9%) respondents had experienced sexual intercourse at the time of the study. The higher proportion (42.6%) of those who had engaged in sexual relationships was from the rural school compared to 33.1% in the urban schools. The proportion of sexually active respondents was higher among males (44.8%) compared to (29%) females. Multiple partners were higher in rural adolescents (44.7%) compared to 31.8% among urban adolescents. Sexually Transmitted Diseases were reported by 28.6% of the sexually active adolescents and the prevalence was higher among males (73.5%) compared to 27% females. 87% of the sexually active adolescents rarely used a condom. CONCLUSION: The study identified a knowledge gap on ASRH which limited adolescents to access reproductive services. Social, cultural and economic factors contributed to adolescent engagement in risky sexual behaviours. Based on the major findings of this study, intervention strategies targeting behavioural, biomedical and structural interventions were proposed. / Health Studies / D. Litt. et Phil. (Health Studies)

This study aimed to identify factors affecting women’s utilisation of the prevention of mother-to-child transmission (PMTCT) of HIV, evaluate the quality of PMTCT services, describe health outcomes of mothers and infants and to identify factors that influence mother-to-child transmission (MTCT) of HIV. Structured interviews were conducted with 384 women who had utilised PMTCT services. Information was also obtained from the health records of these women and of their infants. Better educated women, who had male partners and were self-employed were more likely to use PMTCT services. Being unmarried, poor and feeling stigmatised made it difficult for women to use these services. Respondents were satisfied with PMTCT services except that clinics sometimes had no medications. The health care workers followed the Ethiopian guidelines during HIV testing and counseling but not when prescribing treatment. Although the respondents’ CD4 cell counts improved, their clinical conditions did not improve. The MTCT rate was significantly higher if infants did not receive ARVs, had APGAR scores below seven, weighed less than 2.5kg at birth, were born prematurely, and if their mothers had nipple fissures. PMTCT services could be improved if more women used these services, health care workers followed the national guidelines when prescribing ARVs, clinics had adequate supplies of medicines, all infants received ARVs, and mothers’ nipple fissures could be prevented. Antenatal care should help to avoid premature births of infants weighing less than 2.5kg and having APGAR scores below 7. Future research should compare formula feeding versus breastfeeding of infants with HIV-positive mothers / Health Studies / D. Litt. et Phil. (Health Studies)