xxi, 199 leaves: ill. / Introduction and purpose: This empirical study was carried out to determine the nutritional status and level of nutritional knowledge amongst orphaned children. A cycle menu will be developed after sensory evaluations of all protein enhanced dishes. Method: Anthropometric measures were used to determine the nutritional status and to measure the nutrition knowledge of 100 orphaned children aged 9 to 13 years old in Boipatong, Vaal region. A nutritional knowledge questionnaire was administered to the study group. Furthermore the anthropometric measurement was carried out and analysed with World Health Organization software (AnthoPius) using ±2 standard deviations cut off points, and data on nutritional knowledge were captured on Microsoft Excel and analysed for frequencies, mean and standard deviation (SD) using the Statistical Package for Social Science (SPSS) version 1'7. Results: The results for nutritional status revealed that 59% of the population studied were underweight, 40% were stunted and 25% were wasted. Most of the respondents (70%) scored less than 50% on the nutrition knowledge questionnaire. The mean correct answer for multiple choice questions was 29.65% and for true/false question was 50.34%. Conclusion: The orphaned children are under-nourished and wasted. Further to this, the nutrition knowledge of the orphans is poor. It is recommended that a nutrition education programme be implemented so as to address the issue of poor food choices and malnutrition. / National Research Foundation (NRF), VUT and Hubbs and Spokes Model

M.Sc. (Chemistry) / Human immunodeficiency virus (HIV) is continuously rewriting medical history as one of the diseases affecting humankind. Current treatments available for HIV, namely antiretrovirals (ARVs), do not completely eradicate the virus from the body, leading to life time commitment. Many ARVs suffer from high toxicities and unpleasant side effects; as a result many patients do not adhere to the treatment. Nanoparticles (NPs) used as drug delivery systems (DDS) hold tremendous potential, since they can easily protect the drug from external environment and enter the human cells to deliver drugs. Therefore, the main objective of this work was to load two ARVs, namely lamivudine (LAM) and efavirenz (EFV), into a biodegradable, biocompatible poly(epsilon-caprolactone) (PCL) polymer based NPs. LAM is a hydrophilic drug suffering from low half life of 5 to 7 hours and many unpleasant side effects. EFV is a hydrophobic drug suffering from low aqueous solubility (4 μg/ml), which leads to a limited oral absorption and low bioavailability (40-45%).

Degree of Masters in Public Health by coursework and research report Maternal and Child Johannesburg, March 2012 / Adolescent sexual behaviour related to low condom-use and early sexual debut has been a concern in the transmission of sexually transmitted infections (STIs) and HIV. Treatment-seeking behaviour is a problem in adolescents due to embarrassment and unfriendly health care services. The Birth to Twenty study group (Bt20) is a cohort of singletons born in 1990 with approximately 10% having tested positive for STIs at an early age. Their sexually activity and unprotected sex practices have increased their risk for HIV infection. The objectives of this study were to explore the perceptions, sexual behaviour and treatment-seeking behaviour of a sample of girls who had a previous STI, through their narratives. One-on-one narrative interviews were done on 19 girls with the aid of an interview schedule. A life history of their sexual encounters was documented. The interviews were taped and transcribed. Thematic analysis was performed. The majority of the girls had no knowledge of STIs before they were counselled by the Bt20 nurses yet 50% of the girls used condoms in their first sexual experiences. Once counselled, almost all the girls went on to seek treatment for their STI. A third of the girls reported poor service at the clinic and would prefer to be treated either privately or at Bt20 if possible. Information regarding the role of STIs in the transmission of HIV seems to be unclear. Improving the life orientation programme at schools with a focus on STIs and pregnancy would positively impact on HIV transmission. One-on-one counselling is effective but may not be feasible in under-resourced communities and the continued education of nurses in clinics, whilst increasing the number of adolescent friendly clinics, must be prioritised.

A dissertation submitted to the Faculty of Science, University of the Witwatersrand, Johannesburg, in fulfilment of the requirements for the degree of Master of Science. Johannesburg, 2014. / Determining e ective treatment strategies for life-threatening illnesses such as HIV is a signi cant problem in clinical research. Currently, HIV treatment involves using combinations of anti-HIV drugs to inhibit the formation of drug-resistant strains. From a clinician's perspective, this usually requires careful selection of drugs on the basis of an individual's immune responses at a particular time. As the number of drugs available for treatment increases, this task becomes di cult. In a clinical trial setting, the task is even more challenging since experience using new drugs is limited. For these reasons, this research examines whether machine learning techniques, and more speci cally batch reinforcement learning, can be used for the purposes of determining the appropriate treatment for an HIV-infected patient at a particular time. To do so, we consider using tted Q-iteration with extremely randomized trees, neural tted Q-iteration and least squares policy iteration. The use of batch reinforcement learning means that samples of patient data are captured prior to learning to avoid imposing risks on a patient. Because samples are re-used, these methods are data-e cient and particularly suited to situations where large amounts of data are unavailable. We apply each of these learning methods to both numerically generated and real data sets. Results from this research highlight the advantages and disadvantages associated with each learning technique. Real data testing has revealed that these batch reinforcement learning techniques have the ability to suggest treatments that are reasonably consistent with those prescribed by clinicians. The inclusion of additional state variables describing more about an individual's health could further improve this learning process. Ultimately, the use of such reinforcement learning methods could be coupled with a clinician's knowledge for enhanced treatment design.

A RESEARCH REPORT SUBMITTED TO THE WITS SCHOOL OF GOVERNANCE IN PARTIAL FULFILMENT OF THE REQUIREMENTS FOR A MASTER OF MANAGEMENT DEGREE IN PUBLIC AND DEVELOPMENT MANAGEMENT / HIV and AIDS impact severely on the capacity of the state, its skills base and the efficient use of public funds to render high quality services to the broad populace. Public sector institutions are under immense pressure to implement policies and programmes to mitigate the impact of HIV and AIDS in the workplace (Public Service Commission, 2006). In this context, the purpose of this research is to assess the implementation of HIV and AIDS policy in the Gauteng Department of Roads and Transport to determine if employees are benefiting from this policy. To accomplish this goal, the study employed qualitative interviews and observations to obtain the necessary data from DRT managers, programme officials and employees in June 2014. An examination of the data confirmed that efforts had been made to implement the HIV/AIDS policy in the DRT, although the scope and intensity of these initiatives varied across occupational levels. It was found that an internal policy on HIV and AIDS has been developed; some employees had been informed about the risks of HIV and AIDS; some line managers had been trained on HIV/AIDS management; health screening including HIV counseling and testing takes place regularly; employees have access to 24 hour counseling services; and some units had been supplied with educative messages including pamphlets and brochures. However, the findings also revealed gaps in the current implementation strategy, including limited communications, poor participation in campaigns, lack of leadership commitment, lack of resources and time constraints. In light of this, it was concluded that the current HIV/AIDS management strategy suffers from lack of capacity and coordination

A research report submitted to the Faculty of Health Sciences, the University of the Witwatersrand, Johannesburg, in partial fulfilment of the requirements for the degree of Master of Science in Medicine in Child Health Neurodevelopment Johannesburg, 2013 / Human Immunodeficiency Virus (HIV) infection in infancy may influence the developing brain and lead to adverse neurodevelopmental consequences. We aim to describe the neurodevelopmental characteristics of a cohort of young children infected with HIV prior to antiretroviral therapy (ART) initiation and after achieving viral suppression. A retrospective analysis of data collected as part of a randomised equivalence trial between April 2005 and May 2009, at a hospital in Johannesburg, South Africa. 195 HIV-infected children under 2 years of age were assessed. A simple, inexpensive screening questionnaire (Ages and Stages Questionnaire - ASQ) was used to identify neurodevelopmental delays. The ASQ was administered prior to ART initiation, and again after viral suppression on a protease inhibitor-based regimen had been achieved. Median age pre-ART was 8.8 months (range 2.2 - 24.9), 53.9% were male. Mean time to viral suppression was 9.4 months (range 5.9 - 14.5) and the ASQ was administered to 108 caregivers at this time. Compared to pre-ART, at viral suppression, there was significant reduction in the proportion of children failing the gross motor (31.5% vs. 13%, p<0.01), fine motor (21.3% vs. 10.2%, p=0.02), problem solving (26.9% vs. 9.3%, p<0.001) and personal social (17.6% vs. 7.4%, p=0.02) domains. The proportion of children failing the communication domain was similar at each time point (14.8% vs. 12%, p=0.61). At time of viral suppression 10.2% failed at least one of the five domains. Achieving viral suppression on ART resulted in significant improvements in the neurodevelopmental function of young HIV-infected children, however, neurodevelopmental problems still persisted in a large proportion. Appropriate screening for neurodevelopmental delay and timely referral could help improve outcomes.

A research report submitted to the faculty of Health Sciences, University of the Witwatersrand in partial fulfillment of the requirements for the Master of Science Degree in Epidemiology. / Antiretroviral therapy (ART) recommendations among HIV – infected pregnant women have been revised several times by the World Health Organization (WHO). Option B+, which is the latest recommendation continues to be rolled out in several countries across the globe but mostly in sub-Saharan Africa. Retention in care and adherence to antiretroviral (ARV) drugs taken by these women remains unclear in this new program. We assessed ability to stay in care (retention) and adherence to ART among HIV – infected women starting life-long treatment during pregnancy and after, at an HIV care and treatment clinic in Ifakara Tanzania. Our study provided an opportunity to understand the trends in adherence to ART and retention in care for this population. Methods We analyzed data of HIV-infected pregnant women registered and starting ART for the first time in the Kilombero and Ulanga Antiretroviral Cohort in 2009 and 2010 with a follow up period of up to two years to 2011 and 2012 respectively. Adherence was by patient self-report (PSR) and was sufficient (good) if the woman took all the prescribed pills of the issued batch or insufficient (poor) if she missed two or more pills. Women that missed two or more consecutive scheduled visits to the clinic were not retained while those that honored their scheduled visits were retained in care. Two sample t test and Wilcoxon rank sum test were used to test predictor outcome associations for continuous variables while Pearson’s and Fisher’s exact tests were used for categorical ones. Hazard ratios of each predictor variable were calculated using Cox regression. Student No: 737395 Page v Results A total of 1,282 HIV – infected women were registered in KIULARCO between 2009 and 2010. Fifty (50) were pregnant and started life-long ART upon registration in this period. Of these, 25 (50%) were registered in 2009 and the other 25 (50%) in 2010. Slightly more than half, 52.2% had CD4 cell counts above 350cells/mm3. Almost half, 49% of the women were registered in their final (third) pregnancy trimester. About 82% were in WHO stage one and 60% of all the 50 women were initiated on AZT/3TC/EFV regimen. Only 5.7% had secondary education while the rest had primary or no education at all. Of the women that reported their partners HIV state, 54.5% had partners that had never tested for HIV. Adherence for all participants was reported as sufficient (good) for the entire period the women were in care. No one had insufficient (poor) adherence. Retention in care was higher during pregnancy than after delivery. Generally, loss to follow up was 40%. About 30% were lost during pregnancy and the majority, 70% lost after they had delivered their babies. There was no evidence to prove that any of the factors studied independently predicted non retention. The most likely time to non retention was six months after delivery. Conclusions Our study, despite small sample size, shows that among women diagnosed HIV – infected and starting life-long ART during pregnancy (Option B+), adherence to ART is sufficient and retention in care similar during and after pregnancy. Counseling on the importance of staying in care especially around the first few months after delivery should be emphasized at ANC.

With increasing rates of HIV prevalence in South Africa, research focus is on examining factors that may affect HIV-related sexual risk behaviour, especially in adolescents. Two such factors, parenting styles and socio-economic status (SES) have been highlighted. Despite remarkable consistence in parenting style research, with the authoritative parenting style reliably associated with positive outcomes, the applicability of this model in diverse contexts is questioned given that the majority of this research was conducted in White, middle-class populations. Both parenting practices and SES have produced some inconsistent results in relation to sexual risk behaviours; where results have been dependable, they have failed to account for the mechanisms influencing such relationships. The current study aimed to determine if the documented parenting styles – and SES - sexual risk behaviour relationships could be found in 366 South African adolescents. The study also explored parenting style as a moderator and/or a mediator in the SES – sexual risk behaviour relationship, and SES as a moderator on the parenting style – sexual risk behaviour model. The participants completed adapted self report questionnaires (Parenting Style Index (PSI) and Adolescent Sexual Risk Behaviour Questionnaire) and a self-developed biographical questionnaire. Both the parenting styles – sexual risk behaviour and the SES – sexual risk behaviour relationships were found (r =-.21 and -.24 respectively, p <.0001). While the mediation model was disproven, SES and parenting style were both found to act as moderators (F6, 363=2.15, p=.0469). These results are valuable in terms of providing knowledge that may help to develop relevant and effective sexual risk behaviour intervention programmes, as well as adding richness to the current fields of parenting style, and sexual risk behaviour research.

A dissertation submitted to the Faculty of Science, University of the Witwatersrand, Johannesburg, in fulfillment of the requirements for the degree of Master of Science in Genetics. Johannesburg, South Africa 2017 / Background: Stavudine (d4T) use is associated with the development of sensory neuropathy (SN), several mechanisms may underlie d4T-induced toxicity, including: (1) Inter-patient genetic variability in the genes modulating the deoxynucleotide triphosphate (dNTP) pool sizes. (2) Variation in intracellular ARV drug concentrations due to genetic variation in drug transporters. In our study we examined the genetic variation in four stavudine transporter genes and seven genes regulating the deoxythymidine triphosphate (dTTP) synthesis and their associations with d4T-induced SN or CD4+ T cell count or mtDNA copy number. Methods: We examined a cohort of HIV-positive South African (SA) adults exposed to d4T, including 143 cases with SN and 120 controls without SN. 26 single nucleotide polymorphisms (SNPs) from the literature were chosen, prioritised on being tagSNPs with minor allele frequency >5% in Kenyan Luhya (a proxy population for the SA Black population); SNP functional effects and suitability for multiplex analysis on the genotyping platform. Genotyping was performed using Sequenom mass spectrometry. A qPCR assay was used to measure the mtDNA copy number. Association of sensory neuropathy, CD4+ T cell count and mtDNA copy number with genetic variants was evaluated using PLINK. Results: All 26 SNPs were in Hardy-Weinberg equilibrium (HWE) in both the cases and controls. SNP rs8187758 of the SLC28A1 transporter gene and a 3-SNP haplotype ABCG2 were significantly associated with CD4+ T cell count after correction for multiple testing (p = 0.043 and p=0.042 respectively), but were not significant in multivariate testing. No SNP remained significantly associated with SN or mtDNA copy number, after correction for multiple testing. Conclusion: Variation in genes encoding molecular transporters of d4T may influence CD4+ T cell counts after ART. This study presents a positive step towards achieving personalized medicine in SA. / MT 2018

A research report submitted to the Faculty of Health Sciences, University of Witwatersrand, Johannesburg, in partial fulfilment of the requirements for the degree of Master of Medicine in the branch of Diagnostic Radiology Johannesburg, 2013 / INTRODUCTION: There is limited information on the radiographic presentation of children eligible to start HAART in resource-limited settings. OBJECTIVES: Determine radiographic patterns on pre-HAART chest X-rays (CXRs) in children, compare findings in immune-suppressed vs. non immune-suppressed children, compare the percentage of children with radiographic features of pulmonary TB to the percentage of children on TB treatment and assess inter-observer agreement between 3 radiologists. METHODS: Children (0-8 years) participating in a cohort study of TB and BCG-IRIS who had an acceptable routine pre-HAART CXR were included. CXRs were independently assessed by 3 radiologists, blinded from clinical data, using a standardised assessment form. All 3 readings were used to create a majority consensus finding during the data analysis phase. RESULTS: Amongst 161 children, the median age at enrolment was 2.3 years (25% (41/161) were <1year), 54% (87/161) were on TB treatment and 65% (100/154) were immune-suppressed. The majority (71%) had an abnormal CXR finding, predominantly air space disease (42%) and parenchymal interstitial disease (21%). Of the sub-group of 112 (70%) CXRs that could be assessed for lymphadenopathy, 75(67%) had one or more features suggestive of TB (74 lymphadenopathy, 2 cavities, 18 miliary infiltration) and 65% (70/107) were immune-suppressed. Statistically significant differences between immune-suppressed and non-immune-suppressed children were noted for features of lymphadenopathy and radiographic pulmonary TB. Amongst the sub-group of 112 CXRs a high percentage 49/75 (65%) were on TB treatment, with 26/75 (35%) not on TB treatment. Inter-observer agreement between all 3 readers was fair for overall abnormal CXR findings (K=0.23), airspace disease (K=0.22), moderate for parenchymal interstitial disease (K=0.54) and slight for lymphadenopathy (K=0.05). CONCLUSION: Among children eligible to start HAART, most (71%) presented with abnormal CXR findings and the majority (67%) had one or more CXR signs suggestive of TB. Of concern was the high proportion of CXRs (30%) that were of insufficient quality to be assessed for lymphadenopathy and the poor inter-observer agreement for lymphadenopathy.