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<p>Background and Objectives: There are some methodological and clinical challenges in conducting HIV related research. A subset of such challenges include: non-availability of a universally accepted method to quantify subclinical atherosclerosis in HIV patients; ultrasound imaging techniques aimed at quantifying atheroma burden and endothelial dysfunction have been proposed, however there is no universally accepted ultrasound protocol; conflicting inferences on the nature ofthe relationship between anti-retroviral therapy (ART) and cardiovascular disease (CVD) due to small sample sizes; and missing data from longitudinal studies and ultrasound data. The objective of this thesis is to investigate selected aspects of the afore-mentioned issues, and to provide recommendations for future research.</p> <p>Methods:</p> <p>Project 1: We compared the construct validity of carotid artery intima media thickness (IMT) and brachial artery flow mediated vasodilation (FMD); two non-invasive ultrasound techniques used in measuring the extent of sub-clinical atherosclerosis. Baseline and one-year follow-up data were obtained for a sample of 257 subjects aged 35 years or older, recruited into an ongoing study of cardiovascular risk in HIV. An ultrasound technique having statistically significantly strong association with known CVD risk factors was adjudged to have good construct validity. The relationship between baseline IMT or FMD and known CVD risk factors was studied using multiple regression analysis. We modelled the relationship between progression of IMT or FMD and risk factors using fixed-effects models.</p> <p>Project 2: To more precisely investigate the relationship between ARTs and IMT (as a surrogate for CVD), we pooled cross-sectional baseline, record-level data for 1,032 patients recruited across three cohort studies in Canada, France and USA in a metaanalysis. We investigated the association between exposure to ARTs and CVD using hierarchical linear models.</p> <p>Project 3: On missing data, we studied the impact ofan inclusive strategy for conducting multiple imputation (MI) on the efficiency ofregression parameter estimates using Monte-Carlo simulation. In an inclusive strategy, all final analysis variables are included in a multivariate normal model to impute plausible values for missing data. This issue is not well studied for longitudinal HIV data.</p> <p>Results and Conclusions:</p> <p>Project 1: Baseline IMT was significantly associated with age (p < 0.001), male gender (p = 0.034), current smoking status (p < 0.001), systolic blood pressure (p < 0.001) and total:HDL cholesterol ratio (p = 0.004). IMT progression was significantly associated with age (p < 0.001), male gender (p = 0.0051) and current smoking status (p = 0.011). Neither extent nor progression ofFMD was significantly associated with any of the examined vascular risk factors. IMT was adjudged to have better construct validity than FMD.</p> <p>Project 2: Similar to some (but not all) previous studies, AR Ts do not appear to lead to CVD independent of traditional risk factors. However, exploratory analysis of two-way interactions suggests statistically significant moderating effects between ARTs and traditional risk factors. These results warrant further investigation into potential moderating effects between ARTs and known CVD risk factors.</p> <p>Project 3: In conducting MI, simulation results show that a strategy that includes all final analysis model variables in the imputation model provides the least combined variability and bias for final regression estimates. This is important to note because final regression estimates are used in making clinically relevant inferences in practice.</p> / Thesis / Doctor of Philosophy (PhD)

This study explores how international and South African community psychology has studied HIV in the past twenty years, emphasising the methodological and theoretical aspects of research being produced. Concurrently, this study situates itself within an empowerment theory framework and has sought to comment upon marginalised groups and their presence in published community psychology-based HIV research. The research made use of data generated from a content analysis of selected journal articles from the South African Journal of Psychology, the American Journal of Community Psychology, the Journal of Community Psychology, and the Journal of Community and Applied Social Psychology over the period 1990-2009. The results reflect a dearth of community psychology research concerning HIV and a reliance on positivistic methodologies across contexts, as well as a predominant focus on epistemologies relating to risk and prevention. It was found that whilst interest in marginalised groups within community psychology based HIV research has increased particularly in the last decade, the voices of some of the most vulnerable groups remain relatively silent. It is understood that a move away from more traditional health psychology methods and understandings of HIV, to a more critical conceptualisation is imperative for the field of community psychology with regards to this prominent social problem.

Thesis (M.P.H.M. ( Primary Health Care Management))--Mahidol University, 2006. / LICL has E-Thesis 0011 ; please contact computer services.

This qualitative exploratory and descriptive study explored and described the experiences of HIV sero-discordant couples post diagnosis at the Perinatal HIV Research Unit in Soweto, Gauteng Province. Data was collected using in-depth interviews with each individual from seven HIV sero-discordant couples. Following thematic analysis, four themes emerged: immediate response to HIV sero-discordant results; challenges in relation to disclosure of HIV sero-status; limited information on HIV sero-discordant; and the impact of HIV sero-discordant on the couples. All these were mainly linked to poor counselling and inadequate support to HIV sero-discordant couples. The findings of this study have both clinical and policy development implications. Recommendations have been put forward for development of contextual relevant HIV Sero-discordant Couple Counselling and support guidelines focusing of enhancing knowledge and skills of health care professionals responsible for counselling and supporting HIV sero-discordant couples. / Health Studies / MA (Public Health)

Thesis (MBA (Business Management))--Stellenbosch University, 2008. / The government has identified the need to transform the South African economy from one that is primarily resource based to one that is knowledge-based and has formulated a 10 year plan in order to accomplish this objective. The plan involves the creation and funding of five theme-specific consortium-based centres of competence that focus on the five top national health priorities, linked to the growth of the local pharmaceutical industry. This research study proposed that if collaboration and communication between academic researchers and the biotechnology industry in South Africa was improved it would lead to an increase in the development of innovative products for HIV/AIDS prevention and treatment. The objective of the study was the development of a strategy for a centre of competence for HIV research and development that brings together academic researchers and industry in a public private partnership and that will enable the proposal to be tested. Centre of competence programmes in both developed and developing countries, including Sweden, Austria and Estonia, were reviewed. The success factors for the various programmes were discussed. The strategic planning analysis began by considering the mandate of the CoC for HIV R&D. The requirements and expectations of the DST in establishment of the centres of competence were examined. An analysis of the external environment relevant to the South African biotechnology industry was then performed. This involved a detailed macro-environmental analysis in which political, economic, social, technological and environmental factors were considered. It was followed by an analysis of the current biotechnology industry in South Africa. The industry’s dominant economic features were identified as were its future driving forces. In a competitive environment analysis the South African biotechnology industry was found to be extremely competitive. Two industry issues, price controls and access to capital, were identified and discussed. The industry key success factors identified included access to large and sustained capital, attracting and retaining talented employees, an efficient and high quality regulatory authority, continued government support, productive and appropriate partnerships and skilled intellectual property management. An internal environment analysis was performed which identified competencies and resource strengths of the CoC for HIV R&D, including the high level of academic research in the HIV/AIDS field and expertise in clinical trials of HIV/AIDS products. Competitive deficiencies and resource weaknesses identified included shortages of skills and talent and the lack of co-ordination for funding of HIV/AIDS research. The analysis of the internal environment continued with the examination of the internal value chain of the CoC for HIV R&D. This consisted of discovery, pre-clinical development and clinical development stages. Gaps in the value chain were identified, including the lack of facilities for high-throughput screening of compounds for anti-HIV activity, lack of pre-clinical testing facilities and lack of manufacturing plants capable of producing products for use in clinical trials. The results of the external and internal environment analysis were used in a SWOC analysis and a number of strategies were identified to capitalise on opportunities and to address challenges. A subsequent competitive strength assessment identified a competitive advantage in the formation of the CoC for HIV R&D. In addition a number of strategic issues facing the centre were identified and ways to address or manage the issues were proposed. The strategic planning process was completed by the selection of a strategic approach for the CoC for HIV R&D. The study concluded that a PPP of public and private organisations operating under a corporate strategy of related diversification developed and implemented by the CoC for HIV R&D, would be suitable for testing the Proposal. The study’s conclusion also highlighted the need to ensure that the CoC for HIV R&D receives a long term commitment of funding from public sources, and that is managed by an experienced team with strong leadership skills. Important strategies emerging from the study and specifically from the SWOC analysis were development of a national HIV research plan and funding of the highest priority projects; focusing research funding on research with greatest potential for generation of HIV/AIDS products; and establishment of new technology platforms to fill gaps in the value chain. Finally, a number of recommendations were made for implementation of the results of this study or as the basis for further study.

This qualitative exploratory and descriptive study explored and described the experiences of HIV sero-discordant couples post diagnosis at the Perinatal HIV Research Unit in Soweto, Gauteng Province. Data was collected using in-depth interviews with each individual from seven HIV sero-discordant couples. Following thematic analysis, four themes emerged: immediate response to HIV sero-discordant results; challenges in relation to disclosure of HIV sero-status; limited information on HIV sero-discordant; and the impact of HIV sero-discordant on the couples. All these were mainly linked to poor counselling and inadequate support to HIV sero-discordant couples. The findings of this study have both clinical and policy development implications. Recommendations have been put forward for development of contextual relevant HIV Sero-discordant Couple Counselling and support guidelines focusing of enhancing knowledge and skills of health care professionals responsible for counselling and supporting HIV sero-discordant couples. / Health Studies / M. A. (Public Health)