Submitted by (ana.araujo@ufrpe.br) on 2016-08-09T12:57:36Z No. of bitstreams: 1 Niedja Maristone Oliveira Barreto Queiroz.pdf: 2909360 bytes, checksum: 109caf21db04442310458a38ed638100 (MD5) / Made available in DSpace on 2016-08-09T12:57:36Z (GMT). No. of bitstreams: 1 Niedja Maristone Oliveira Barreto Queiroz.pdf: 2909360 bytes, checksum: 109caf21db04442310458a38ed638100 (MD5) Previous issue date: 2004-03-26 / Logistic regression has application in several fields as epidemiology, medical research, banks, market research and social research. One of its advantages is that the interpretation of the measure is possible through the " Odds Ratios” (OR), that are functions of the parameters of the model. In this study the binary regression model was used, with the objective of estimating the relationship between two variables, taking into account the presence of other factors. For his purpose a Bayesian approach was used to estimate those risk measures, and these results were compared with the corresponding classical results obtained by application of a stepwise backward process, using the maximum likelihood as criterion for exclusion of the variable of the model, and the Wald test as analysis of each parameter of the final model, both at the level of significance of 0,05. An application was performed using real data from a transverse study of 106.203 blood donor candidates, found apt by the clinical screening process performed at the blood bank Recife of the HEMOPE foundation. Measures of HIV infection association “OR” were estimated in relation with certain socio-demographic conditions, sorological markers for other Sexually Transmissible Diseases as well as the donation type. For the classical analysis thestatistical package SPSS version 10 was used, and for the bayesian analysis the Winbugs 14. The results indicated that OR obtained using the two methods are rather similar, in spite of the fact that the classical approach used Maximum likelihood and the bayesian approach used the Markov Chain Monte Carlo(MCMC), which are quite different methods. It was concluded, that the factors independently associated to the HIV infection risk among donors of blood in the observed period, for the bayesian estimate, were: age 18 to 28 years (2,45) and 29 to 39 years (2,79); illiteracy (8,17), primary school (3,31) and secundary school (3,29); positive Anti-Hbc (1,95), positive syphilis (3,14), residence in the Metropolitan Area of Recife (2,41) and type of voluntary donation (11,94). / Regressão logística tem aplicação em diversos campos como epidemiologia, pesquisa médica, bancos, pesquisa de mercado e pesquisa social. Uma de suas vantagens é que a interpretação da medida é possível através das “Odds Ratios” (OR), que são funções dos parâmetros do modelo. Neste estudo foi usado o modelo de regressão binária, com o objetivo de estimar a relação entre duas variáveis tendo em conta a presença de outros fatores. Utilizou-se para isso uma abordagem bayesiana para estimar essas medidas de risco, fazendo uma comparação com os resultados da abordagem clássica proveniente de um processo stepwise backward, utilizando o critério da razão de verossimilhança como exclusão da variável do modelo e o teste de Wald como análise de cada parâmetro do modelo final, ambos no nível de significância de 0,05. Realizou-se uma aplicação com dados reais proveniente de um estudo transversal de 106.203 doadores de sangue de 1ª doação aptos na triagem clínica no Hemocentro Recife da Fundação HEMOPE. Estimou-se medidas de associação “OR”, da infecção por HIV, com relação a algumas condições sócio-demográficas, marcadores sorológicos para outras Doenças Sexualmente Transmissíveis (DST) e tipo de doação. Para as análises no método clássico foi utilizado o pacote estatístico SPSS versão 10 e no método bayesiano o Winbugs 14. Os resultados indicaram que as OR estimadas, utilizando os dois métodos, foram bastante próximas, apesar do clássico utilizar o método de estimação por Máxima Verossimilhança, e o bayesiano utilizar os métodos de Monte Carlo Cadeia de Markov (MCMC), que são métodos diferentes. Concluiu-se, que os fatores independentemente associados ao risco de infecção por HIV entre doadores de sangue no período foram, pela estimativa bayesiana: idade 18 a 28 anos (2,45) e 29 a 39 anos (2,79); escolaridade: analfabeto (8,17), ensino fundamental (3,31) e médio (3,29); Anti-Hbc positivo (1,95); sífilis positivo (3,14); residir na Região Metropolitana do Recife (RMR) (2,41) e tipo de doação voluntária (11,94).

Nos últimos anos o tratamento da infecção crônica pelo HCV passou por importantes mudanças. Recentes avanços em biologia molecular proporcionaram o melhor conhecimento sobre a estrutura molecular do HCV e permitiram o desenvolvimento de moléculas que tem como alvo proteínas específicas integrantes do ciclo replicativo do vírus, denominados agentes antivirais de ação direta (DAAs). No Brasil, atualmente, os DAAs aprovados para o tratamento da Hepatite C são: Simeprevir (2ª geração de inibidor de protease), Daclatasvir (inibidor de NS5A) e o Sofosbuvir (inibidor análogo nucleotídeo de polimerase). A combinação dessas diferentes classes de DAAs permite maior eficácia no tratamento do HCV, reduz a duração do tratamento e o risco da emergência de resistência. Ao mesmo tempo em que o desenvolvimento de DAAs promete melhorar a chance de sucesso do tratamento dos pacientes crônicos infectados pelo HCV, a emergência de variantes associadas à resistência representa um grande desafio ao sucesso da terapia antiviral atualmente proposta e informações sobre a presença dessas mutações ainda são escassas. Este estudo tem como objetivo o mapeamento de variantes associadas à resistência (RAVs) primárias aos inibidores da polimerase (NS5B) do HCV em pacientes monoinfectados (HCV) e em pacientes coinfectados (HCV/HIV). Para tal, o rastreamento de substituições de aminoácidos foi realizado entre as posições 159 e 495 da proteína NS5B do HCV nas sequências de 244 pacientes infectados pelo HCV-1: 133 monoinfectados [1b (n=93); 1a (n=40)] e 111 coinfectados [1a (n=93); 1b (n=18)]. A ocorrência natural de RAVs nos resíduos S282, L320 e P495 não foi observada nas sequências analisadas neste estudo. As RAVs encontradas no grupo de monoinfectados foram: L159F (16,1% - 1b), C316N (16,3% - 1b) e A421V (21,4% - 1a; 3,2 - 1b) ; e no grupo de coinfectados foram: C316N (7,1% - 1b), V321A (1,6% - 1a), M414V (1,3% - 1a); A421V (23,7% - 1a; 6,3% - 1b), A421G (1,3% - 1a); Y448H (1,3% - 1a). Entre os pacientes monoinfectados, a região NS5B do HCV-1a apresentou menor número de variantes associadas à resistência (RAVs) quando comparada ao subtipo 1b, ao contrário do observado nos coinfectados. A variante C316N foi a única que ocorreu em combinação com outras variantes. Houve a ocorrência concomitante das variantes L159F e C316N em 8 pacientes monoinfectados pelo HCV-1b (8/56; 14,3%). Entre os coinfectados, foi observada a ocorrência concomitante das variantes C316N e A421V em apenas 1 paciente infectado pelo HCV-1b (1/14; 7,1%). A presença de RAVs foi detectada nas duas populações estudadas neste estudo. Contudo, outros estudos são necessários para que se possa avaliar o real impacto dessas mutacões na resposta ao tratamento / The treatment of chronic HCV infection has undergone important changes recently. Advances in molecular biology provided a better knowledge of the HCV molecular structure and allowed the development of molecules which target specific proteins that have important roles in the viral replicative cycle, known as direct action antiviral agents (DAAs). In Brazil, DAAs approved for treating hepatitis C are Simeprevir (2nd generation protease inhibitor), Daclatasvir (NS5A inhibitor) and sofosbuvir (nucleotide analogue NS5B polymerase inhibitor). The combination of these different DAAs classes leads to a greater efficacy in the treatment of HCV, reducing its duration and the risk of resistance associated variants (RAVs) emergence. DAAs increase the chance of successful treatment of HCV chronic infected patients. RAVs emergence represents a major challenge to the success of antiviral therapy. Nevertheless, data about the presence of these mutations are still scarce. The aim of this study was to verify the presence of primary RAVs associated to HCV polymerase inhibitors primary resistance in monoinfected (HCV) and coinfected (HCV / HIV) patients. For this purpose, amino acid substitutions identification was conducted between positions 159 and 495 of the HCV NS5B protein in the sequences of 244 patients with HCV-1: 133 monoinfected [1a (n=40); 1b (n=93)] and 111 coinfected [1a (n=93); 1b (n=18)]. Naturally occurring RAV in S282, L320 and P495 residues were not observed among the sequences analyzed in this study. RAVs found in monoinfected patients were L159F (16.1% - 1b), C316N (16.3% - 1b) and A421V (21.4% - 1a; 3.2% - 1b); while in co-infected group, the following RAVs were identified: C316N (7.1% - 1b), V321A (1.6% - 1a), M414V (1.3% - 1a); A421V (23.7% - 1a; 6.3% - 1b), A421G (1.3% - 1a); Y448H (1.3% - 1a). Among monoinfected patients, HCV-1a NS5B region showed fewer RAVs when compared to HCV-1b, conversely to what was observed in HIV coinfected patients. Variant C316N occurred in combination with other ones: there was the simultaneous occurrence of L159F and C316N variants 8/56 (14.3%) 8 HCV-1b monoinfected patients Among the coinfected patients, it was observed concomitant occurrence of C316N and A421V variant in only 1/14 (7.1%) HCV-1b infected patient. RAVs were detected in both HCV and HCV/HIV infected populations in this study. Further studies are required to assess the real impact of these changes in response to treatment

M.A. (Counselling Psychology) / This study is an examination of the context of the gay male individual with HIV illness. A psychosocial model is used to investigate the effects of HIV disease on the individual, his partner and the relationship. The model includes a discussion of variables which are related to adjustment to the disease." These include the special characteristics of HIV disease such as the stigma and the progressive nature of the disease. Furthermore the personality characteristics of the individual and the characteristics of his situation are examined. These factors together contribute to making HIV positive diagnosis a crisis for the individual in his context. A case study approach was used to research the subjective experiences of an HIV infected gay man and his partner. In depth interviews were conducted in order to obtain qualitative data on the individuals within the context of their relationship. The data obtained from the interviews supports the literature in many respects. Of special importance is the impact of an HIV positive diagnosis on intimacy in the relationship. Also important are the changes which occur in the sexual relationship as a result of fear of transmission of the HIV virus. Other important changes include adapting to the uncertainty of living with HIV disease and coping with the emotional reactions, which follow HIV diagnosis. The study highlights the importance of emotional support within the primary relationship as well as the role of friends and family in adjusting to HIV disease. The study also demonstrates the importance of effective communication in dealing with the various stresses associated with HIV disease. Lastly therapeutic interventions have been suggested for counselling the gay infected person and his partner in order to help them to cope with the crisis of HIV disease.

Magister Public Health - MPH / Aim: To establish whether a family centered approach to HIV care in which HIV positive adults are counseled on the importance of having their children tested results in the adults bringing their children under the age of five years for testing and or accessing HIV care, and to explore challenges faced by caregivers in bringing children for testing and care. / South Africa

Magister Public Health - MPH / Aim: This study sought to investigate service-related factors that affect uptake of HIV testing among children enrolled in CMAM. This was a descriptive study that used mixed quantitative and qualitative methods. To assess uptake of HIV testing records were reviewed of number of children tested as a percentage of number of children enrolled in CMAM over 12-month period in a sample of health facilities. Face to face in-depth interviews were conducted of CMAM and HTC focal persons to investigate factors affecting uptake. Information from interviews was analyzed using a thematic approach.

ENGLISH : The purpose of this study was to determine the role of fear for HIV/AIDs in adolescents’ sexual choices. Theories which informed the study included developmental theory, decisionmaking theory, as well as emotion theory. In this survey study a mixed-method questionnaire was designed, piloted and then implemented with 252 purposefully selected Grade 11, Afrikaans learners (127 boys and 125 girls), aged 16 to 17 years in one high school in Gauteng. Data was analysed quantitatively and qualitatively. It was found that adolescents link several emotions with HIV&AIDS: fear, concern and caution. Another finding was that adolescents reportedly made safe sexual choices. Therefore, it was concluded that adolescents fear for HIV&AIDS positively impacted on their safe sexual choices. AFRIKAANS : Die doel van hierdie studie was om te bepaal welke rol vrees vir MIV&VIGS speel in adolessente se seksuele keuses. Teorieë wat die studie ingelig het was ontwikkelingsteorie, besluitnemingsteorie en emosie-begronde teorieë. Die navorsingsontwerp van hierdie studie was ‘n opname studie. ‘n Gemengde metode vraelys is ontwerp, geloods, aangepas en geïmplementeer met. 252 graad 11, Afrikaanse leerders (127 seuns en 125 dogters), tussen die ouderdom van 16 en 17 jaar, wat doelgerig geselekteer is vanuit een hoërskool in Gauteng. Vraelysdata is kwantitatiewe en kwalitatiewe geanaliseer. Daar is bevind dat adolessente MIV/VIGS verbind met die emosies: vrees, bekommernis en versigtigheid. Verder blyk dit dat adolessente veilige seksuele keuses maak. Die gevolgtrekking is gemaak dat adolessente se vrees vir MIV&VIGS positief korreleer met hul veilige seksuele keuses. / Dissertation (MEd)--University of Pretoria, 2009. / Educational Psychology / unrestricted

MAAS / M.E.R. Mathivha Centre for Languages Arts and Culture

See the attached abstract below

Abstract in English / The overall aim of this study was to construct and describe a conceptual framework that can serve as a frame of reference for organisational stakeholders to sustain a community coalition to manage alcohol misuse as a risk factor of HIV infection in a specific community in the North West Province, South Africa. A Participatory Action Research (PAR) design that was qualitative and theory generative in nature was followed in this study. A phased approach with specific objectives aligned to the PAR cycle, namely observe (Phase One), reflect (Phase Two), plan (Phase Three) and act (Phase Four), was followed. These phases were actualised through an exploratory, descriptive and contextual research design, guided and theoretically influenced by critical theory. Data in Phase One were collected through 10 key informant interviews. Data were collected in Phases Two to Four through 10 dialogue meetings. Data collected in the four phases were used to construct and describe the conceptual framework that was evaluated by five experts in the field of mental health and substance misuse for refinement (Phase Five). Thematic data analyses was done to identify emerging themes. Key issues identified were that the community is characterised by fragile community coalitions that hamper the management of alcohol misuse as a risk factor of HIV infection. Factors to be considered to sustain the coalition were identified as sharing a common vision, promoting a trusting relationship, formalising the coalition, transformational leadership, strengthening organisational unity, and access to financial resources. This research adds knowledge in the field of mental health and substance misuse by providing a sustainable community coalition conceptual framework for organisational stakeholders to manage alcohol misuse as a risk factor of HIV infection. The conceptual framework could be used to inform policy, further research, education and improve practice in the field of mental health and substance misuse. Although the study was limited to a specific geographical area of a community in the North West Province, South Africa, the findings can be adapted to fit a specific setting. / Health Studies / D Litt et Phil. (Health Studies)

The purpose of this study was to explore and describe the determinant factors affecting adherence to antiretroviral therapy among HIV infected patients in Addis Ababa, Ethiopia. A cross-sectional study design was used and data were collected by interviewing 290 study participants from two health facilities using structured questionnaire. The research finding revealed 80.0% of the study participants had optimal combined adherence to dose, schedule and dietary instructions in the past three days. And, the non adherence rate was 20.0%. In multivariate analysis only WHO clinical stage, change of ARV medication, knowledge about HIV disease and ART, and use of reminders were found to be independently associated with adherence to antiretroviral therapy. The most common reasons for missing HIV medications in the past one month were forgetfulness (35.1%), being busy with other things (17.5%), and running out of pills (10.5%). Adherence improving interventions should be emphasized to address multi-faceted problems. This study recommends setting of convenient appointment schedule, disclosure of one's HIV status, maintaining confidentiality of patient-related information, enhancing patient-provider relationship, use of reminders including SMS text messages, and engagement of PLHIV in adherence improving interventions through peer support, and providing regular health education to the PLHIV to improve adherence of patients to ART / Health Studies / M.A. (Public Health)