Thesis (Ph. D.)--University of Washington, 2000. / Vita. Includes bibliographical references (leaves 33-40).

Thesis (Ph. D.)--Rutgers University, 2009. / "Graduate Program in Anthropology." Includes bibliographical references (p. 269-275).

Thesis (Ph. D.)--UCLA, 2009. / Vita. Description based on print version record. Includes bibliographical references (leaves 100-109).

Thesis (Ph. D.)--University of Washington, 2003. / Vita. Includes bibliographical references (leaves 109-140).

Thesis (M.A. (Psychology))--Rhodes University, 2003. / Submitted in partial fulfillment of the requirements for the degree of Master of Arts.

A systematic review and meta-analysis was conducted to evaluate the efficacy of different infant antiretroviral (ARV) prophylaxis regimens for prevention of mother to child transmission (MTCT) of human immunodeficiency virus (HIV) infection in breastfeeding infants who were born to HIV positive mothers but were HIV uninfected at birth. The systematic review of the literature published during January 2000 to April 2012 resulted in ten randomized and controlled clinical studies which met the study inclusion criteria. Two datasets were identified from the ten selected clinical trials. One dataset contains six studies evaluating short-course ARV prophylaxis regimens, and the second dataset contains four studies evaluating short-course versus extended ARV prophylaxis regimens. The odds ratio was used as the effect size to measure the efficacy between two comparative infant ARV prophylaxis regimens. Meta-analyses were conducted to assess the overall (pooled) treatment effect of the two comparative infant ARV prophylaxis regimens of the two datasets. The pooled ARV treatment effect was calculated as a weighted average of the effect estimated in the individual studies. If no heterogeneity was identified, a fixed-effect meta-analysis by the Mantel-Haenszel method was used. The random-effects method was used when there was heterogeneity in the meta-analysis. The inverse-variance method was used in the random-effects method of meta-analysis. Heterogeneity in the meta-analysis was accessed by the Chi-squared (χ2) test and I2 test. The combined sample size of all ten clinical trials was a total of 10,316 breastfeeding infants, and the overall postnatal HIV transmission rate regardless of ARV regimens and the timing of HIV infection status was approximately 8.7%. The overall HIV transmission rates of the short-course ARV prophylaxis regimen groups were 10.3% at 4-8 weeks and 9.0% at 6-9 months, respectively. The overall late postnatal HIV transmission rate (at 6-9 months after birth) was 5.5% in the extended ARV prophylaxis regimen group. The first dataset contains six randomized and controlled studies to evaluate the efficacy outcome (defined as the unadjusted HIV infection status at 4-8 weeks after birth) of two short-course infant ARV prophylaxis regimens, the nevirapine (NVP) regimen and the zidovudine (ZDV) with or without combination of lamivudine (3TC) or NVP regimen. Due to the existence of substantial heterogeneity, a random-effects method was used to test for the overall treatment effect. The results show that there was no significant difference between the two short-course infant ARV prophylaxis regimens (odds ratio:1.07; 95% CI: 0.69-1.66; Z=0.31, p=0.76). The results of the meta-analysis of five comparative short-course versus extended infant ARV prophylaxis regimens from four randomized and controlled clinical trials, demonstrate a favorable efficacy outcome (defined as the unadjusted HIV infection status at 6-9 months after birth), of the extended ARV regimens. There was no heterogeneity found in this dataset. There was a highly significant difference in the overall effect between the two ARV prophylaxis regimens by a fixed-effect model (odds ratio: 1.72; 95% CI:1.45-2.04; Z=0.68, p<0.00001). In summary, there was no significant difference in the overall treatment effect in reducing the early postnatal MTCT of HIV infection by infant short-course regimens of ARV prophylaxis, which include NVP, ZDV and their combination regimens. In comparison with the short-course ARV regimens, the extended ARV prophylaxis further reduced the risk of the late postnatal MTCT of HIV infection in breastfeeding infants. / published_or_final_version / Public Health / Master / Master of Public Health

The applicant's research has led to a substantial body of published work and 17 pieces from this work are submitted here. Of these, eight are in peer refereed journals testifying to the importance of the body of work submitted. The work has attracted external funding of £73,000 from North West Thames Regional Health Authority which attests further to the quality of the work undertaken. In addition the applicant's expertise in the area has been recognised internationally by her appointments as World Health Organisation Advisor (Guidelines on Counselling of HIV Infected and AIDS Patients; Intravenous Drug Use and Risk of HIV Infection) and as UK representative to the Commission of the European Communities (Prevention of AIDS for Intravenous Drug Users) and she has presented evidence to a Home Office Working Party (Advisory Council on the Misuse of Drugs) and acted as academic referee for several academic journals including AIDS, AIDS Care, and Addiction. The submitted research publications are based upon five studies drawing upon 623 injecting drug users (idus) surveyed between 1985 and October 1992. The demographic characteristics of the clients included in each of the studies did not vary substantially between studies. Three of the studies involved evaluation of interventions for harm minimisation and two of those included designs of innovative interventions. The remaining two were aimed at identifying trends in risk - related behaviours and risk reduction. The body of work with its regular data collection over a seven year period from one location in the UK charts the behavioural changes and service responses from a point in time when AIDS awareness among idus was virtually non-existent through the response to the awareness of risks of sharing injecting equipment, followed by the introduction of needle exchange schemes and their evaluation, awareness of sexual transmission risks and need for sexual counselling, provides a unique perspective. The first and the final study had longitudinal components but the over all behavioural and attitudinal trends are identified from cross-sectional data. The approach taken by the research was to place risk-related behaviours within a context of the idus' social lifestyles rather than isolating behaviours from the contexts in which they occur. This approach contrasts with the individualistic social-cognitive models that have been used by others rather unsuccessfully to try to account for health related risk behaviours. The aims of the research were to obtain accurate information about the behaviours of idus with specific reference to HIV transmission related behaviours especially injecting practices and sexual behaviours by (1) identifying the characteristics of idus attending a drug dependency unit and/or syringe exchange unit in Central London (2) examining the sexual and drug-related behaviours of clients attending those services and their risks for HIV infections.

ABSTRACT Pulmonary Tuberculosis (PTB) rates in Kwa Zulu Natal (KZN) is amongst the highest in the South Africa and is often associated with Human Immunodeficiency Virus (HIV) co-infection. Bronchial Artery Embolisation (BAE) is an expensive, time consuming procedure requiring operator skill and is accompanied by risk to both patient and operator. Aim: To investigate the impact of HIV infection when superimposed on PTB (active or sequelae) on the success of BAE. Method: A retrospective cross sectional study with descriptive and analytical components of the BAE procedure between January 2006 and December 2007 was performed on sequential BAE studies. These were analyzed for procedural and clinical outcome and reasons for procedural failure were investigated. The impact of CD4 level on procedural and clinical failure was investigated for a subset of cases. Cases were included if they presented with massive or life threatening haemoptysis with a diagnosis of previous or active PTB (made clinically, radiologically or microbiologically) in whom HIV status is known and where the clinician assessed a need for BAE, but excluded any third or more attempt at the procedure for that patient. Results: The final sample size after exclusion of 91 cases is 107. Each attempt at BAE was viewed as an individual case. The study population is made up of 74 HIV positive and 33 HIV negative cases. The median CD4 level is 176 cells / microlitre. Statistically, procedural success does not imply clinically successful outcome.HIV status does not correlate significantly with clinical or procedural results of BAE.CD4 level does not correlate significantly with clinical or procedural results of BAE. There is no technical reason of statistical significance that impacts on the success of the procedure when correlated with HIV status. These include being unable to select, unable to subselect, unable to engage securely, reflux, presence of fistulae and the presence of spinal feeder arteries. The complication rate is not statistically significant when correlated with HIV status. The differences in follow up of clinically unsuccessful cases were not significant when correlated with HIV status. On imaging, all cases demonstrated pathology. No particular zone is significant when correlated with HIV status. The most common finding is parenchymal architectural distortion followed closely by features of active tuberculous infection and no statistical significance is attributed to either when correlated with HIV status. The detection of lymphadenopathy is noted in 19.1% of HIV positive cases and 42.4% of HIV negative cases, and is the only feature of significance when correlated with HIV status. Interpretation: Coinfection with HIV does not have an impact on the success of BAE in patients with active or sequelae PTB who present with massive or life threatening haemoptysis. The rate of technical failure of the procedure suggests that this needs to be performed by persons that are adequately trained. Technical success does not imply clinical success but this finding was not statistically significant when correlated with HIV status. Re-evaluation of the procedure technique and improvements in local practice may produce results that correlate better with international standards. / Thesis (M.Med.)-University of KwaZulu-Natal, Durban, 2011.

The vast majority of paediatric HIV occurs in sub-Saharan Africa and could be averted through implementation of effective Prevention of Mother to Child Transmission (PMTCT) strategies. At the United Nations General Assembly Special Session on HIV/AIDS in 2001, members committed themselves to the goal of reducing paediatric HIV by 20% by 2005 and by 50% by 2010. In South Africa, rates of HIV infection range between 28% in KwaZulu-Natal and 16% in the Western Cape. The South African National Department of Health has, over the past few years, phased in a comprehensive package for PMTCT of HIV. KwaZulu-Natal implemented its programme in 2002. The South African private healthcare sector follows guidelines of those of developed countries for PMTCT. Not much data is available of the outcome of infants born to HIV positive mothers managed in private practice. In view of this, the present study aimed to assess success or otherwise of PMTCT in private paediatric practice in South Africa. Eight of the 20 private paediatricians, in the central region of Ethekweni Metro of KwaZulu-Natal (Durban Central Area), agreed to participate in a retrospective study. Data for all their HIV exposed infants between January 2004 and June 2005 were reviewed. One hundred and one Black African infants were born to 100 HIV positive women aged 29.85 years (SD 5.38; range 18-44 years). The median CD4 count was 426 (IQR 244-613). The median viral load at first presentation was 3.97 logs (IQR 1.6-5.8) or 11 391 copies/ml (IQR 2 013-41 502). Eighty six women had HAART, nine had other antiretroviral therapy and five had no prophylaxis. Treatment started before 34 weeks in 72 women. There were 93 caesarean sections. There were 20 low birth weight neonates, 18 were preterm and all had been formula fed and received AZT for six weeks. Of the 92 tested, two (one preterm) were positive. Although caesarean deliveries, both these mothers had not adhered to the optimal treatment protocol. Of the rest, eight did not return for HIV testing and one died (the only neonatal death). This death was unlikely to have been HIV related. The transmission rate of less than one percent in those women who followed the protocol optimally is much better than that in the SA public sector, and is consistent with transmission rates in the developed world. / Thesis (M. Med.)-University of KwaZulu-Natal, Durban, 2009.

This thesis reports on a formative evaluation study conducted, firstly, to inform an adaptation of the Collaborative HIV Prevention and Adolescent Mental Health Program (CHAMP) so as to strengthen the adult protective shield in order to prevent high risk behaviour and HIV among children in the targeted community in Embo, Kwadedangendlale, KwaZulu-Natal (Study 1); and secondly, after a pilot intervention, to evaluate the adapted programme in order to understand the processes involved in strengthening the adult protective shield (Study 2). The research design for both Study 1 and Study 2 was qualitative in nature. More specifically, the two studies used a focused ethnographic case study approach. Thematic content analysis was used to analyse the data from both studies and three theoretical approaches facilitated the understanding of the data: Joffe’s psychoanalytic extension of social representation theory, Carpiano’s integrative theory of social capital, and Campbell and Murray’s critical approach to community health psychology. The participants in the first study were a volunteer convenience sample of parents of children aged 9-12 years from a school in the targeted community. Focus groups and in depth follow up interviews were conducted with the parents. Interviews were also conducted with key members of the community. At the community level, lack of containment emerged as an overarching theme, with splitting and lack of trust as subthemes interpreted as emerging to deal with anxiety. Anxiety was also linked to stigmatization of people suspected of being HIV positive or having AIDS. Coping mechanisms used to deal with stigmatization were silence and denial. Linked to the issue of stigmatization was that of death and bereavement. At the family level, disempowerment of caregivers emerged as an overarching theme creating anxiety for parents, one of the sources of which was the generational knowledge gap, with parents being generally less educated than their children. This was linked to two issues: that of children’s rights; and parents’ attempts to resort to severe forms of authoritarian parenting. In the second study, in-depth semi-structured interviews, based on the themes that had emerged from the pre-intervention focused ethnographic study, were conducted with a volunteer convenience sample of nine mothers who had been part of the CHAMPSA intervention. Two broad themes emerged: Individual empowerment, including the subthemes parental empowerment, women empowerment, and social support and social leverage; and collective empowerment, including the subthemes informal social control and community organisation, and HIV/AIDS stigma. The findings of the second study contributed to the development of a model showing how improved parent child communication and parental HIV knowledge at the individual level as well as renegotiated, empowered parental identities facilitated through the group process restored parental authority at the individual level as well as collectively, strengthening social capital and restoring the adult and community protective shields. / Theses (Ph.D.)-University of KwaZulu-Natal, Durban, 2011.