Introduktion/Bakgrund: HIV/AIDS är en allmänfarlig sjukdom som angriper människan immunförsvar. År 2020 levde 37,7 miljoner människor med HIV i världen, vilket gör att vårdpersonalen påträffar denna patientgrupp i alla olika vårdformer. Stigmatisering kring HIV/AIDS finns utbrett i samhället. Att leva med HIV/AIDS innebär att dagligen bli bemött med okunskap, rädsla och distansering. Genom ett professionellt bemötande av vårdpersonal med respekt och god omvårdad ökar livskvalitén för denna patientgrupp.  Syfte: Syftet med litteraturstudien var att belysa hur patienter med HIV/AIDS upplever bemötandet från vårdpersonal.  Metod: Litteraturstudie som har följt Polit och Becks nio steg. Artiklar har sökts i databaserna Cinahl, PubMed och Psycinfo. Granskningen av artiklar har genomförts med granskningsmallar från Polit och Beck (2020).  Resultat: Resultatet består av 14 artiklar, fem mixed-method, två kvantitativa metoder och sju kvalitativa metoder. Resultatet redovisas med tre teman som identifierades: Brister i bemötande och sekretess, Diskriminerande upplevelser och Positiva upplevelser. I resultatet framkom det att patienterna med HIV/AIDS upplevde både positiva och negativa bemötanden från vårdpersonal. Slutsats: Majoriteten av patienterna har upplevt negativa bemötanden och handlingar från vårdpersonal. Kunskapen om HIV/AIDS och bemötandet mot patienterna behöver förbättras inom hälso- och sjukvården för att lindra lidandet för denna patientgrupp.

Doctor Pharmaceuticae - DPharm / Treatment of the human immunodeficiency virus (HIV) and tuberculosis (TB) infections have become very complicated due to the advent of drug resistance. Drug combinations offer an alternative approach to reducing the emergence of drug resistance. Pharmaceutical co-crystals have provided the pharmaceutical industry with the ability to optimise the physicochemical properties of active pharmaceutical ingredients (APIs) while preserving the biological activity. Pharmaceutical co-crystals are formed between APIs and suitable co-formers that are biologically safe or even a second or third API.

Background Being diagnosed with HIV/AIDS and commencement of lifelong antiretroviral therapy (ART) with the requirement of high adherence can exacerbate or trigger depressive disorders. Prevalence of major depression is substantially higher in people living with HIV/AIDS (PLWHA) than those in the general population. More than 50% of PLWHA are likely to meet one or more criteria for depression in their lifetime. However, access to interventions for depressive disorders remains limited in Low- and Middle-Income Countries (LMICs) where more than 90% of people with depressive disorders are not receiving formal treatment. The role of evidence-based psychological treatments has been fundamental in reducing the huge treatment gap in LMICs. Although brief, flexible and effective psychological treatments are emerging, issues in relation to their acceptability, feasibility and effectiveness in HIV populations remain unexplored. Therefore, this thesis aimed to adapt and pilot group interpersonal therapy (IPT) for treatment of depressive symptoms including its acceptability and feasibility for PLWHA. This thesis has been the first that attempted to adapt and pilot group IPT for treatment of depression in the HIV population in Ethiopia. The findings of this thesis can serve as a baseline for researchers interested in adapting or developing psychological treatments in the HIV population in Ethiopia. The findings contribute information on the process used in examining acceptability and feasibility of psychological interventions which provides indications for conducting future trials to test the effectiveness of group IPT. Methods First, a systematic review and meta-analysis of randomised controlled trials was conducted to identify the most effective psychological treatments for depressive symptoms for PLWHA in LMICs. Second, a survey of major depressive disorder (MDD) was conducted among PLWHA who were attending ART follow-up appointments at the Felege-Hiwot Referral Hospital (FHRH) in Northwest Ethiopia. The survey served as a baseline to identify cases for piloting of group IPT and helped to identify areas for intervention. Third, the intervention areas were further explored among stakeholders from the ART clinic including PLWHA and this was followed by a stepwise adaptation of the group IPT manual. Furthermore, a formative qualitative study was conducted to examine explanatory models of depression and to explore acceptable contexts for implementation of group IPT. A total of three focus groups were conducted with purposively selected case managers, adherence supporters and service users 2 at the ART clinic. The qualitative data were analysed based on a framework approach using predefined thematic concepts. Fourth, a pilot study of the group IPT intervention was conducted among PLWHA to evaluate the acceptability and feasibility of peer-administered group IPT for treatment of depressive symptoms for PLWHA in Ethiopia. A single-arm, prepost, peer-administered, group IPT interventional study was conducted with 31 consecutively recruited participants. The participants were assigned to four IPT groups for the intervention. A post-intervention evaluation of depressive symptoms, perceived social support (PSS), functional disability and quality of life (QoL) was conducted using the same instruments used at the baseline. No control group was included in this pilot study. Results The findings of the systematic review and meta-analysis revealed that trials that used IPT have shown good effectiveness in treating depressive symptoms of PLWHA in LMICs. The baseline study found 32.5% prevalence of MDD among randomly selected PLWHA (N=393). MDD was positively associated with reduced adherence to ART, functional disability and negatively associated with overall QoL. Overall findings of the baseline and the qualitative study indicated that psychosocial problems are the most important factors that need intervention for depression for PLWHA. The main findings in relation to the adaptation of the WHO group IPT were: i) an IPT group that contains five to ten people was perceived to be acceptable and mixed gender groups were recommended; ii) sessions were recommended to be conducted in private rooms for 1.5 to 2 hours, and on a weekly basis. Findings of the pilot study indicated that depression scores reduced significantly between baseline and postintervention (mean difference (MD)=9.92; t=-7.82; p<0.001). The mean PSS scores (MD=0.79; t=2.84; p=0.009) and the mean QoL scores (MD=0.39, t=4.58, p<0.001) improved significantly between baseline and post-intervention. All the IPT intervention areas (life change, disagreement, grief and loneliness) were found to be applicable to and important areas associated with depression in PLWHA in Ethiopia. Most importantly, disagreement within a family and life change due to HIV/AIDS, such as sickness and separation were faced by almost all PLWHA included in the study, followed by loneliness or social isolation as result of HIV stigma, and grief due to loss of loved ones including a spouse, a child, a mother or a father. Overall evaluation of the pilot indicated that the procedures and outcomes of group based IPT were perceived as acceptable. Participants of the intervention gained benefits in resolving psychosocial problems and reported high satisfaction with counsellors and intervention setting. The eight weekly sessions that lasted around two hours were acceptable; however, 3 additional sessions were recommended by some counsellors until everyone recovers from depression. Conclusion The overall findings of this thesis suggested that group IPT was found to be acceptable and feasible for PLWHA in Ethiopia. Future studies should focus on examining its effectiveness for treating depressive disorders among PLWHA in Ethiopia.

ackground: The changes in body composition markers (weight, fat mass, lean mass, and BMI) over time can be associated with TB treatment outcome among HIV-infected patients. The aim of this study was to investigate whether changes in fat mass and lean mass were associated with the treatment response among patients with HIV infection and pulmonary tuberculosis. Materials and Methods: This was a prospective cohort study. Data from HIV-infected patients commencing TB therapy were analyzed. This included body weight measurement using bioimpedance equipment at baseline, one month, and two months after starting TB treatment. Results: The study was conducted in 125 patients, 17 patients (13.6%) died during treatment, of which 5 died during the first month of treatment, 4 during the second month and 8 after the second month. The group of patients with good response, increased their weight by 1.3 kg (p <0.001) at the end of the first month of TB treatment and 2.6 kg in the second month (p <0.001), and body fat increase was 1.2 Kg (p <0.001) and 2.3 kg (p <0.001), the first and second month respectively. The group of patients who died had lost 2.1 kg fat mass after the first month (p <0.001) and 3.7 kg in the second month (p <0.001). Conclusions: Our results show that the weight change during TB treatment (increased fat mass) helps us predict therapeutic response. Weight loss during the first month of starting therapy should be evaluated thoroughly to identify the probable cause of treatment failure. / Revisión por pares

Background: HIV/AIDS remains a major health concern worldwide and the number of people infected in Sub-Saharan Africa continues to increase. This despite increased awareness and availability of HIV drugs in most countries. The success of current HIV-1 drugs is overshadowed by the emergence of drug resistant viral strains and the adverse side-effects they may cause. It is these limitations and many more that drives the continuous search for better HIV treatments. Research into drug discovery and development using natural products is becoming better established. With natural products, there are endless opportunities for discovering novel compounds which either ends up as final drugs or as backbones of drug leads. Methods: In this thesis, sixteen Lamiaceae (mint) plants were investigated for inhibitory properties against HIV-1 as well as for beneficial immune enhancing effects. This family of plants is commonly used in traditional medicine preparations for the treatment of various ailments including those that are virus induced. Cytotoxicity of the plant material was determined using tetrazolium dyes and the results subsequently confirmed with flow cytometry and real-time cell analysis. Direct enzyme assays were used to determine the inhibitory properties of the extracts and isolated compounds against HIV-1 protease (PR), reverse transcriptase (RT) and integrase (IN). The effect of the plant materials was also evaluated in an in vitro model of chronic and latent infection by measuring HIV-1 p24 protein secretion of an infected cell line (U1) following treatment. Most HIV-infected individuals only seek treatment during the chronic stages of disease and latent reservoirs of the virus perpetuate treatment. The immune modulating properties were determined by quantitating the effects of plant extracts/compounds on Th1/2/17 cytokine production in human mononuclear cells using the cytometric bead array technology. Finally, anti-oxidant and anti-inflammatory properties were also assessed using the 2,2-diphenyl-1-picrylhydrazyl (DPPH) and nitric oxide colorimetric assays respectively. Results and discussion: The 50% cytotoxic concentration (CC50) of the extracts was between 4.2 and 100 μg/ml. Of the sixteen, extracts from six plants (Ocimum labiatum, Ocimum serratum, Plectranthus barbatus, Plectranthus neochilus, Salvia apiana and Stachys byzantina) were active against HIV-1. Four plants (P. neochilus, O. serratum, S. apiana and S. byzantina) demonstrated moderate inhibitory properties against HIV-1 PR, RT and IN (40-49%) and three of these plants (O. serratum, S. apiana and S. byzantina) significantly (p<0.05) suppressed HIV-1 replication in U1 cells. The most exciting data was obtained from extracts of P. barbatus and O. labiatum which demonstrated inhibition classified as good (>50%) against HIV-1 PR (IC50s 62 ±0.2 and 49.8 ±0.4 μg/ml), reduced the production of pro-inflammatory cytokines at non-cytotoxic concentrations and demonstrated strong antioxidant properties (IC50 values 13 ±0.8 and 15.8 ±0.3 μg/ml). O. labiatum extract also suppressed HIV-1 expression in U1 cells, significantly (p<0.05). In addition, one of the extracts (P. ciliatus) had anti-cancer potential with CC50 values <10 μg/ml. O. labiatum extract was purified to yield a chlorophyll derivative, pheophytin-a (phy-a); triterpene isomers (3-hydroxy-4,6a,6b,11,12,14b-hexamethyl- 1,2,3,4,6,6a,6b,7,8,8a,9,10,11,12,12a,14,14a,14b-octadecahydropicene-4,8adicarboxylic acid), amyrin and a labdane diterpenoid (labda-8(17),12E,14-triene-2R,18- diol). Phy-a inhibited HIV-1 PR with an IC50 value of 44.4 ±1.5 μg/ml. The triterpenes activated latent HIV-1 (a serious obstacle in the eradication of the virus) while the diterpenoid reduced the production of pro-inflammatory cytokines. These activities were observed at non-toxic concentrations of these compounds. There is an ongoing search for novel compounds that are able to activate latent HIV-1 to use in conjunction with HAART. If the triterpenes were to progress to clinical use, their use would be in activating latent virus for eradication by existing treatments. Conclusion: The findings presented in this thesis provide some scientific explanation for the anecdotal success of some Lamiaceae plants used traditionally to manage HIV/AIDS. The findings also conform to recommendations by the scientific community regarding the validation of the beneficial effects of plant products used traditionally. / Thesis (PhD)--University of Pretoria, 2013. / gm2014 / Biochemistry / unrestricted

Introduction: Compassion fatigue is an extreme state of tension and preoccupation with the suffering of those being helped and affects those who work in caring professions. Helping people in distress can traumatise the helper because of their empathetic ability. Nurses who work in ARV clinics witness the suffering of their patients when they listen to their patients' descriptions of the trauma that they have to cope with. The patients get the chance to let go of the trauma and to share their concerns. Unfortunately the nurses often absorb some of the emotional pain of their patients and not all nurses are equipped to handle the situations in such a way that they do not become secondarily affected by the trauma of their patients and therefore, become vulnerable to develop compassion fatigue. If compassion fatigue is not identified in time and addressed adequately, the affected nurses may develop feelings of hopelessness in their ability to take care of their patients with detrimental effect on the quality of nursing care to these patients. Aims: Firstly, to explore and describe the extent of the manifestation of compassion fatigue amongst nurses working in antiretroviral clinics; and secondly, to develop a wellness programme to aid in the identification and management of episodes of compassion fatigue as well as the prevention of future occurrences of such episodes of compassion fatigue amongst nurses working in antiretroviral clinics. Methodology: The researcher conducted the study in two phases. In Phase one, a single embedded case study design, with three sub-units situated within the case, namely nurses who work in the adult, ante-natal and paediatric ARV clinics in a tertiary public hospital, was used. Purposive sampling was used to select seven nurses. Data was collected using semi-structured interviews. The researcher used content analysis as described by Elo and Kyngäs (2008) to analyse the transcribed interviews. The themes identified include the risk to develop compassion fatigue, manifestation of compassion fatigue and strategies to prevent and manage compassion fatigue. For document analysis the researcher used professional and enrolled nurses' job description and the employee health and wellness programme for public service. In Phase two, the researcher developed the wellness programme to aid in the identification, prevention and management of compassion fatigue amongst nurses who work in antiretroviral clinics and the Delphi Method was used to refine the wellness programme. Findings: Nurses working in the ARV clinics are at risk of developing compassion fatigue due to work environment issues such as challenges created by the health care system, lack of support from management, and their overwhelming work load. The cost of the nurse-patient relationship also contributed to nurses being at risk of compassion fatigue. Aspects that were identified that relate to the cost of a relationship with patients who are HIV positive include caring for traumatised patients, vicarious exposure to traumatic experiences of patients, and the influence caring for patients who are HIV positive has had on nurses' personal lives and their families. Nurses can traumatise their family members by continually not being available for them through emotional withdrawal. Nurses presented with physical, psychological, spiritual symptoms and changes in their behaviour that are indicative of compassion fatigue. Various strategies to prevent and manage compassion fatigue were identified: both what nurses can do, and what they expected from management. Nurses' job description is generic and does not spell out their role and function within antiretroviral clinics. The implementation of the health and wellness programme is lacking. The findings of Phase one and related literatures formed the bases from which the researcher developed the wellness programme to aid with the identification, prevention and management of compassion fatigue. Conclusion: Nurses are at risk of developing compassion fatigue due to the cost of the nurse-patient relationship with patients who are HIV positive. The key to prevention of compassion fatigue is awareness and a number of strategies that can aid in the identification, prevention and management of compassion fatigue have been identified and included in the wellness programme. Managerial support and practicing of self-care is important to maintain the health and well-being of nurses who work in antiretroviral clinic. / Thesis (PhD)--University of Pretoria, 2016. / Nursing Science / PhD / Unrestricted

See the attached abstract below

Thesis (Ph. D. (Clinical Psychology)) -- Univesity of Limpopo, 2019 / The aim of the study was to determine the experience of ambiguous loss and grief reactions in adolescents affected by parental diagnosis of HIV/AIDS, and the identification of potential resilience factors that moderate the grieving symptoms. A convenient sample of 159 adolescents ninety-five (95) from families with a parental diagnosis of HIV/AIDS and a control group of sixty-four (64) adolescents whose parent(s) were diagnosed with cancer, participated in the study. The age of the participants from both families fell in the following ranges: 11-14 (n=45), 14-17 (n=65), 17-18 (n=45), 18 and above (n=2). Eighty-nine (89) were females whereas seventy (70) were males. A triangulation method of data collection was used wherein a biographical questionnaire designed by the researcher, a TRIG questionnaire to assess the level of grief in the participants and resilience scales were used in the quantitative phase. The family resilience scales included Family attachment and changeability Index 8 (FACI-8), Family Crisis Orientated Personal Evaluation Scale (F-COPES), Family Hardiness Index (FHI), and Relative and Friend Support Index (RFS). The Pearson correlation was used to identify the significance of potential resilience factors present in the affected families. Regression analysis was used to determine the predictability of variables to show moderating effect of resilience factors on the impact of experience of an ailing member of the family. Interviews were held with the adolescents in the qualitative phase using semistructured interview schedule. The questions elicited qualitative responses on the participants’ feelings towards the illness of the parents, the role they are playing and feelings towards the role, experience of feelings of loss, disclosure and the family qualities perceived to be helping them adapt to the stress of having a sick parent. The results showed that the two groups experienced ambiguous loss in the form of boundary ambiguity marked by enforced role changes following indisposed parent due to ill-health. Both groups of adolescents experienced forms of grief during the ailment of the parent(s). HIV/AIDS affected group experienced delayed grief whilst the control group of cancer affected individuals experienced acute and prolonged grief. Parental disclosure following diagnosis was higher among cancer affected families (75%) than those affected by HIV/AIDS (55%). There was, however, no significant difference between disclosure of disease status and the experience of grief, p=0.0120. Potential resilience factors in both families were F-COPES, FHI, and FACI-8. These factors were also found to have a moderating effect on the experience of grief in the HIV/AIDS affected families, but showed the opposite effect on the experience of grief in the cancer affected families. This shows the uniqueness of the study in the way the HIV/AIDs and Cancer affected families responded differently to the moderation of the resilience factors. The difference in the impact is in line with the shift in the status of HIV/AIDS from being a terminal condition to being manageable and considered chronic in contrast to cancer. The shift was seen occurring also in this study where previously high grief was associated with HIV/AIDS as its diagnosis was regarded as a death sentence. There was high stigma associated with HIV/AIDS diagnosis until recently when it was found to be controllable and also positively impacting on the life expectancy in South Africa that increased from 53 to 64 years post utilization of ARV’s.

Submitted in accordance with the requirements for the degree of DOCTOR OF LITERATURE and PHILOSOPHY In the subject of Communication Science at the University of Zululand, 2007. / This dissertation presents the results of an analysis of corporate social investment and HIV/Aids programmes in South African corporations. The study measures the growing debate over the responsibilities of business and the examination of Corporate Social Investment (CSI) programmes and communication strategies used in HIV/Aids awareness programmes by the top 100 listed companies on the Johannesburg Stock Exchange (JSE). The first part of the study reviews theories and literature relevant to defining the understanding and the impact of HIV/Aids on businesses, the idea of corporate social investment/responsibility and the business response to AIDS. Subsequent chapters describe the construction of a survey instrument employed to measure and evaluate the extent of CSI and HIV/Aids in South African corporations and the findings of the survey. Penultimate chapters blend the insights gained from this literature review to interpret the results, obtained through the quantitative research methodology, to describe a set of conclusions and recommendations in the context of applying corporate social investment -and HIV/Aids to the South African business environment. / National Research Foundation (NRF)

Bakgrund: Idag lever cirka 109 miljoner individer med HCV eller HIV/AIDS i världen. Respektive sjukdom är en blodsjukdom och smittan överförs via blod eller kroppsvätskor. De fördomar och okunskap som följer av att diagnostiseras och leva med HCV eller HIV kan leda till ett ytterligare försämrat hälsotillstånd. En individ diagnostiserad med HCV kan bli frisk med rätt behandling medan en individ diagnostiserad med HIV aldrig kan bli botad. Under vårdtiden är det viktigt med personcentrerad vård och föreliggande kunskap medan stöd från närstående har en betydande roll under hela sjukdomstiden.   Syfte: Syftet är att undersöka upplevelsen av att leva med HCV respektive HIV-smitta.   Metod: Litteraturöversikt vilken baseras på 11 artiklar med kvalitativ metod.    Resultat: Det framgick en tydlig förekomst av stigmatisering av individer med HCV eller HIV, där stigmatiseringen grundades i okunskap hos vårdpersonal och närstående. Att vårdpersonal ansågs oroliga för att smittas och de negativa stereotyper individerna blev tilldelade resulterade i ett sämre välmående. Relaterat till den befintliga stigmatiseringen blir individer diagnostiserade med HCV eller HIV nekad vård samt undviker att söka vård av rädslan att inte bli accepterad. Detta ökar även risken att drabbas psykosocialt, såsom depression, ångest och lägre självkänsla. Dessa är tre återkommande besvär vilka i sin tur leder till isolering och ensamhet.    Slutsats: Det är av stor vikt att forska i hur individer diagnostiserade med HCV eller HIV upplever att leva med en smittsam sjukdom och vad de anser att god omvårdnad bör innehålla. Detta för att ändra eventuella beteenden och attityder, därmed kan god omvårdnad erbjudas. Därmed är det av stor vikt att öka kunskapen om respektive sjukdom hos såväl vårdpersonal som närstående.