BACKGROUND: Rapid advances in the treatment of the hepatitis C virus (HCV) have been witnessed in clinical practice over the last five years. Pharmacological developments have ended the reliance on the drug interferon-α as a component of successful therapy, heralding the dawn of a new era in the fight against the disease. How this new era is being understood and experienced by those individuals living with the virus is currently unknown. METHODS: A purposive sample of 20 individuals participated in face-to-face semi-structured interviews exploring their experience of living with HCV. Eight of these participants were interviewed again following a period of interferon-free treatment. All interviews were conducted between June 2015 and March 2016. The interviews were transcribed verbatim and explored using thematic analysis, underpinned by social phenomenological theory. RESULTS: Analysis of the corpus of data resulted in three overarching themes entitled ‘positioning HCV', ‘beyond a physical burden' and ‘reconstructing uncertainty'. These themes offer original insight into how this new era of therapy is being realised by those living with the virus. The experience of interferon-free treatment was also explored through the narratives of those individuals who participated in a further post-treatment interview. Three further themes entitled ‘expectations and realisations', ‘an honour and a pleasure' and ‘treatment needs' encapsulate their experience. DISCUSSION: The findings from this study recontextualise the lived experience of HCV within a new era of treatment. In doing so, they expose social and emotional spheres of illness, and a perception of illness chronicity, which remain untouched by the treatment revolution. Further, this work emphasises how treatment inequalities fundamentally underpin multiple aspects of the daily lived experience, and are integral to how those living with HCV articulate the disease. The implications of this work challenge current HCV policy and clinical practice.

TB care and prevention is led by the public sector, but many TB symptomatics first seek care in the private sector, highlighting the importance of engaging these facilities. This report examines basic TB epidemiology (such as the gap in case finding that could be addressed in part via private sector activities), health-seeking behaviors (HSB) and diagnostic delays, the size of the private sector, activities of professional societies, and financing. It examines the potential utility of integrating Voronoi tessellations as a GIS-based method for informing and improving Public-Private Mix (PPM) efforts throughout six states in Nigeria. Further, it explores a potential methodology for quantifying the theoretical number of individuals served by each private facility in order to better guide funding allocation to private providers who need it most. Standardized searches of academic papers obtained from PubMed, Google, and of key planning documents from National Tuberculosis Programs (NTPs) were conducted. In Nigeria, PPM is quickly becoming entrenched in healthcare, and Voronoi tessellations supplement these efforts by dividing private provider location data into meaningful and clear partitions. These tessellations were deficient in areas with high levels of clustering (dense urban sprawl), but are suited for examining private provider distribution in rural locations. The methodology of estimating populations through the polygons was too inaccurate to yield meaningful conclusions. Themes for PPM implementation include effective consolidation and representation of private sector providers, structured leadership from the NTP, and an understanding of HSBs.

Thesis (MScConsEcol (Conservation Ecology and Entomology))--Stellenbosch University, 2008. / Medicinal plants represent an important asset to the livelihoods of many people in developing countries. This is the case for South Africa where most of the rural and also urban communities rely on medicinal plants for their primary healthcare needs and income generation. Harvesting for domestic usage is not generally detrimental to the wild populations of medicinal plants. However, the shift from subsistence to commercial harvesting is posing unprecedented extinction threat to the wild populations of medicinal plants. The purpose of this investigation was to: (1) document the most traded/used species of medicinal plants in the Cape Peninsula, including parts used, sourcing regions, harvesting frequencies and seasons as well as the conservation status of these species; (2) to profile and investigate the rationales for the involvement of stakeholders in medicinal plants related-activities; and to (3) assess constraints and opportunities for sustainable management of medicinal plants in the Cape Peninsula. Triangulation techniques such as semi-structured questionnaires, formal and informal interactions with key informants from the Cape Peninsula and surroundings, personal observations and field visits were used to gather relevant data for this investigation. Accordingly, about 170 medicinal plant species were found to be actively traded or used in the study area. These species were mostly traded/used for their underground parts; shoot, barks and in many cases the whole plant is uprooted. The bulk of traded/used species were from the wild populations, harvested on monthly basis and the Western and Eastern Cape provinces acted as the main source regions. Some of the traded/used species are rare, vulnerable, endangered, critically endangered and are declining from the wild. Nonetheless, there are subtitutes for some of these medicinal plant species. Traders and collectors were mainly men in the Cape Peninsula. Cultural considerations, economic conditions and the burden imposed by the number of dependents were the factors influencing local communities to engage in medicinal plants related-activities. Despite the fact that the majority of the informants acknowledged the decline of medicinal plants from wild stocks, an overwhelming number of them expected an upsurge in the future demand for natural remedy due to its popularity among South Africans. Similarly, the majority of the respondents were aware of the conservation status of the plants that they were using, but this did not prevent them from trading/using some protected species. Encouragingly, an overwhelming number of the informants were willing to use cultivated species and cultivate some of the most used medicinal plant species if seeds and land were freely provided. It is noteworthy that these results were influenced by the gender, age, category and time of involvement in medicinal plants, ethnicity and residence status of the respondents as well as the source of supply of medicinal plants. It is recommended that species that have been identified of concern should be prevented from further commercial harvesting. Competent conservation organizations like CapeNature should focus on practical skills development of people who have expressed willingness to cultivate medicinal plants or are already doing so, especially in plant propagation and basic gardening techniques.

Le Massif central est un ensemble de territoires aux dynamiques variées. Il réunit toutefois des caractéristiques qui, ajoutées aux enjeux nationaux, induisent des difficultés dans la présence, l’organisation et l’accès aux soins, en particulier pour les territoires éloignés des zones urbaines et des structures hospitalières, peu peuplés, peu attractifs et dont la population vieillit. Ce travail de thèse a pour objectif de rendre compte des questionnements qui s’expriment dans ces territoires, des acteurs qui s’y investissent et des actions qui s’y déroulent, selon un angle d’approche territoriale et en particulier à travers les discours et les actions des institutions sanitaires, des collectivités territoriales et des professionnels de santé locaux. Prendre en compte ce qui fait les spécificités des territoires ruraux du Massif doit mieux aider à concevoir des solutions. La proximité des relations entre les professionnels de santé et la population, le faible nombre de professionnels, la place des élus locaux et les configurations des collectivités rurales, sont autant d’éléments à considérer. A partir des préoccupations et des postures de chacun et des exemples de projets innovants tels que les réseaux de santé de proximité, ce travail permet de mieux comprendre qu’au-delà des faibles dessertes de l’offre de soins et des situations d’éloignement aux services, c’est la capacité des acteurs à travailler ensemble et leurs modalités d’organisation et de collaboration qui contribuent au maintien, à l’accès et à la qualité de l’offre de soins. / The Massif Central is made up of several areas with specific dynamics. However, a number of common characteristics (rural and mountain areas, low population density) added to the national issues related to the health system make the organization of health care and its access difficult. Following a territorial approach and based on speeches and actions made by health care services, local authorities and health professionals, our research effort was focused on collecting and analyzing raised issues, actors involved in the field and actions that were taken. Evaluating the distinctive features of the rural areas in the Massif could allow new solutions to be developed. The close relationship between the populations and health actors, the low number of professionals, the role of the elected members and of the rural local authorities are key elements to take into account in Massif Central. We analyzed the interests and positions of each actor and explore new ongoing projects such as the healthcare centres with primary care teams or the local health care network developed in rural areas. This work contributes to the understanding of the pivotal role of the dialogue and cooperation among the main local actors (health professionals, political representatives and health institutions) on the success of the present and future projects to maintain and develop the supply of health care.