Human Immunodeficiency Virus (HIV) and Acquired Immune Deficiency Syndrome (AIDS) is a global problem. Introduction of antiretroviral therapy (ART) came as a relief to people living with HIV and AIDS as it improved their quality of life. However, maintaining high adherence levels to antiretroviral treatment is still a challenge in some settings yet strict adherence to treatment instructions is critical for successful suppression of HIV. A qualitative, descriptive phenomenological research was conducted to explore factors that influence adherence to antiretroviral therapy at Beatrice Road Infectious Disease Hospital (BRIDH). Purposive homogenous sampling was done. Data was collected from twenty patients through in-depth interviews. Study findings identified five main themes that facilitate adherence and these entail knowledge on HIV and AIDS and ART, motivation to live, adherence support networks, good service delivery and factors related to medication / Health Studies / M.A. (Public Health)

Background: IPT is an effective, safe and feasible disease prevention scheme that should be administered for all PLHIV living in areas with high latent TB prevalence. Objective: To assess the impact of isoniazid in the incidence of tuberculosis among HIV infected individuals in Addis Ababa. Methods: A case control study design was undertaken among 489 HIV and TB infected patients in Addis Ababa from January 2008 to December 2010. Results: Tuberculosis incidence rate among those who developed TB after completing 6-9 month isoniazid preventative therapy was17.14 PYO compared to 10.28 PYO among those who were not. Isonizide reduced the chance of developing tuberculosis among HIV infected patients (OR= 0.072; 95% CI 0.044, 0.12). Age (AOR= 0.14; 95% CI 0.03, 0.97) and sex (AOR= 1.86; 95% CI 1.02, 2.23) of the patient, CD4 count at HIV diagnosis (AOR= 0.21; 95% CI 0.13, 0.31), clinical stage of HIV illness (AOR= 1.22; 95% CI 1.09, 1.84) and past tuberculosis history (AOR = 1.97; 95% CI 1.24, 3.67) were major factors associated with tuberculosis incidence. Conclusions: INH prophylaxis was associated with lower incidence of tuberculosis among PLHIV. / Health Studies / M. Public Health

Purpose: The purpose of this study is to assess risk factors associated with TB co-infection in HIV/AIDS patients taking antiretroviral therapy (ART). Methodology: An observational, analytic, case-control and quantitative study was conducted on a randomly selected 367 HIV and AIDS patients of whom 92 of them were TB co-infected. Data collection was done by using self-structured questionnaire. Result: In this study, educational status, waste disposal system, monthly income, contact history with a patient of active tuberculosis or presence of a family member with active tuberculosis, drug adherence, knowledge on tuberculosis prevention and history of exposure to substance were factors independently associated with the occurrence of active tuberculosis among HIV and Aids patients taking ART. Conclusion: The findings highlight the need for on-going educational, informational and other interventions to address the risk factors of tuberculosis in HIV and Aids patients in order to decrease the rate of TB co-infection / Health Studies / M.A. Public Health

Thesis (MScMedSc)--Stellenbosch University, 2012. / Bibliography / ENGLISH ABSTRACT: Background: In the era of antiretroviral therapy (ART), the risk of acquired immune deficiency syndrome (AIDS) related deaths has decreased and people living with Human Immunodeficiency Virus (HIV) now have prolonged life spans. However, an increasing trend of non-AIDS associated deaths has been reported despite adequate control of viral loads. HIV infection is established as a chronic inflammatory condition which is associated with an increased risk for thrombosis. Thus HIV infected patients are at a higher risk of developing cardiovascular disease (CVD) and other inflammatory-associated complications. Inflammation is linked with thrombosis and promotes the formation of thrombin, which plays an important role in platelet activation. Furthermore, activated platelets have been shown to play a key role during infection and the inflammatory process, particularly by mediating interactions between cells of innate immunity. Soluble markers of platelet activation have been shown to be increased in HIV-infection. However, these have not been well documented by flow cytometry. P-selectin CD62P is stored in the alpha granules of platelets and is expressed on the surface only upon platelet activation. This facilitates interaction with other blood cells and the endothelium. Activated platelets may play a role in HIV-induced atherosclerosis through the expression and release of mediators that induce endothelial activation and support the adhesion of leukocytes to the inflamed vessel wall. Fibrinogen is a precursor of the blood coagulatory protein fibrin and the degradation of fibrin to D-dimer is a measure of the formation and the subsequent dissolution of blood clots. In HIV infected patients, chronic inflammation induces the up-regulated expression of tissue factor (TF) on monocytes which triggers the activation of the clotting cascade and increases the level of D-dimers. Methods: This pilot study consisted of ART naïve patients and all platelet flow analyses were carried out on whole blood. In this study, a total of 57 adult South Africans were recruited from a clinic in the Western Cape. These included 32 HIV positive patients and 25 HIV negative individuals. The levels of platelet activation and platelet function were investigated using a novel platelet cytometry assay. The method was optimized to ensure minimal platelet activation: no centrifugation or red blood cell (RBC) lysis steps were performed. The platelet-specific markers CD41a and CD42b were used to ensure gating on platelets only. CD62P expression was used to evaluate platelet activation and these levels were correlated with Fibrinogen, hsCRP, Ddimer, CD4 counts and viral load. Furthermore, platelet function was evaluated by investigating the response of platelets to endogenous agonists which included adenosine diphosphate(ADP) and arachidonic acid (AA) at varying concentrations. Results:This study demonstrated higher baseline levels of CD62P expression in treatment naïve HIV positive patients as compared to uninfected controls (mean %CD62P 71.74 ± 2.18 vs control 54.52 ± 2.42; p=<0.0001). In addition it was shown that %CD62P expression correlated directly with platelet counts (r=0.374, p=0.042). Platelet counts showed an inverse correlation with viral loads (give values) Fibrinogen levels correlated with the absolute WCC (r=0.659, p=0.0021); absolute neutrophil count (r=0.619, p=0.0105); absolute monocyte count (0.562, p=0.0235) and hsCRP (r=0.688 p=0.0011). In addition, fibrinogen showed a strong negative correlation with CD4 counts (r=-0.594, p=0.0014) and therefore, may be a valuable marker of both disease progression and risk of thrombosis in treatment naïve HIV positive patients. HsCRP levels correlated with the absolute neutrophil counts (r=0.392, p=0.0005). The HIV Group showed an overall hyper-response to ADP at a concentration 0.025 μM as compared to uninfected controls (62.34 ± 9.7 vs control 36.90 ± 5.7, p=0.0433). Conclusions: In this study we describe a novel Flow Cytometry technique that may be used to evaluate the levels of platelet activation and platelet function in HIV infected patients. In addition we report a cost-effective panel in the form of fibrinogen, WCC and platelets that may be valuable in predicting the progression of HIV infection to AIDS or other inflammatory- associated complications in treatment naïve HIV infected patients. Platelet counts showed an inverse correlation with viral loads and a direct correlation with the level of activated platelets. These findings taken together suggest the potential prognostic value of platelet activation and platelet counts in the context of asymptomatic HIV infected patients. Our findings suggest WCC and Fibrinogen may be used to evaluate the inflammatory profile of individual HIV infected patients. This may have a direct impact on HIV patient management prior to initiation of antiretroviral therapy and valuable in monitoring responses to treatment. Further, we present a novel flow cytometry based platelet functional assay and suggest the use of ADP at a concentration of 0.025 μM to evaluate platelet function optimally in HIV infected patients. The utilization of the novel Flow Cytometry technique as described in this study would add significant value in the assessment of thrombotic risk and disease progression in HIV infected patients and may additionally prove to be of value in other chronic inflammatory conditions. / AFRIKAANSE OPSOMMING: Voorkennis: In die era van antiretrovirale terapie (ART), het die risiko van vigs-verwante sterftes verminder en mense wat nou met volle naam (MIV) leef, het ‘n verlengde lewensduur. Nogtans, word 'n toenemende neiging van nie-vigs geassosieer sterftes berig wat hoofsaaklik toegeskryf word aan trombotiese toestande. MIV-infeksie word as 'n chroniese inflammatoriese toestand beskou met ʼn verhoogde trombose risiko geassosieer word. Dus, MIV-besmette pasiënte het 'n hoër risiko om kardiovaskulêre siekte (CVD) te ontwikkel ongeag of hulle ARV naïef is of op behandeling is nie. Inflammasie word geassosieer met trombose en bevorder die vorming van trombien, wat 'n belangrike rol in plaatjie aktivering speel. Verder, word daar bewys dat geaktiveerde bloedplaatjies 'n belangrike rol speel tydens infeksie en die inflammatoriese proses.Hulle bemiddel interaksies tussen die selle van ingebore immuniteit. Daar word bewys dat oplosbare merkers van plaatjie aktivering verhoog is in MIV-infeksie, maar die bewyse is nie so goed gedokumenteer deur vloeisitometrie nie. P-selectin (CD62P) word gestoor in die alfa korrels van plaatjies en word uitgedruk op die oppervlak slegs wanneer plaatjies geaktivering word; daardeur fasilitering dit die interaksie met ander bloedselle en die endoteel. Geaktiveerde plaatjies kan ook 'n rol in MIV-geïnduseerde aterosklerose speel deur middel van die uitdrukking en vrylating van bemiddelaars wat endoteel aktivering induseer asook die adhesie van leukosiete aan die ontsteekte vat wand ondersteun.. Fibrinogeen, 'n voorloper van die bloed koagulatories proteïen fibrin en die degradasie van fibrin na D-dimeer is' n maatstaf van die vorming en die daaropvolgende ontbinding van bloedklonte. Kroniese inflammasie in MIVbesmette pasiënte, induseer die op-gereguleerde uitdrukking van weefsel faktor (TF) op monosiete wat die aktivering van die stolling kaskade inisieer en die D-dimere vlakke verhoog. Metodes: Hierdie loodsstudie bestaan uit ART naïewe pasiënte en al die plaatjie vloei ontleding was op vol bloed uitgevoer. In hierdie studie, 'n totaal van 57 volwasse Suid-Afrikaners was van' n kliniek in die Wes-Kaap gewerf. Dit sluit 32 MIV-positiewe pasiënte en 25 MIV negatiewe individue in. Die vlakke van plaatjie aktivering en plaatjie funksie was ge ondersoek deur middel van 'n nuwe plaatjie sitometrie toets. Die metode was geoptimaliseer om minimale plaatjie aktivering te verseker: dus geen sentrifugering of volle naam (RBS) liseer stappe was gebruik nie. Die plaatjie-spesifieke merkers, CD41a en CD42b was gebruik om te verseker dat slegs bloedplaatjes gekies word. Die uitdrukking van CD62P was gebruik vir die evaluering van plaatjie aktivering en hierdie vlakke was gekorreleer met fibrinogeen, hsCRP, D-dimeer, CD4- tellings en virale lading. Verder, was plaatjie funksie geëvalueer deur die reaksie van plaatjies aan endogene agoniste wat ADP en AA by wisselende konsentrasies insluit te ondersoek. Results: Hierdie studie het getoon hoër basislyn vlakke van CD62P uitdrukking in behandeling naïewe MIV-positiewe pasiënte in vergelyking met onbesmette beheermaatreëls (beteken% CD62P 71,74 ± 2,18 vs beheer 54,52 ± 2,42, p <0.0001). Daar is ook getoon dat% CD62P uitdrukking direk gekorreleer met plaatjie tellings (r = 0,374, p = 0,042). Plaatjie tellings het 'n omgekeerde korrelasie met virale ladings (gee waardes) fibrinogeen vlakke korreleer met die absolute WCC (r = 0,659, p = 0,0021), absolute neutrofiel telling (r = 0,619, p = 0,0105); absolute monosiet telling (0,562, p = 0,0235) en hsCRP (r = 0,688 p = 0,0011). Daarbenewens, fibrinogeen het 'n sterk negatiewe korrelasie met 'n CD4-tellings (r = -0,594, p = 0,0014) en daarom kan 'n waardevolle merker van beide die siekte en die risiko van trombose in behandeling naïewe MIV-positiewe pasiënte. HsCRP vlakke gekorreleer met die absolute neutrofiel tellings (r = 0,392, p = 0,0005). Die MIV-groep het 'n algehele hiper-reaksie op die ADP by 'n konsentrasie 0,025 μM in vergelyking met onbesmette beheermaatreëls (62,34 ± 9,7 vs beheer 36,90 ± 5.7, p = 0,0433). Gevolgtrekkings: In hierdie studie beskryf ons 'n roman vloeisitometrie tegniek wat gebruik kan word om die vlakke van Plaatjie aktivering en plaatjie funksie in die MIV-besmette pasiënte te evalueer. Verder het ons 'n verslag van 'n koste-effektiewe paneel in die vorm van fibrinogeen, WCC en plaatjies wat waardevol kan wees in die voorspelling van die vordering van MIVinfeksie tot VIGS of ander inflammatoriese-verwante komplikasies in die behandeling naïewe MIV-besmette pasiënte. Plaatjie tellings het 'n omgekeerde korrelasie met die virale laste en 'n direkte verband met die vlak van geaktiveerde bloedplaatjies. Hierdie bevindinge saam, dui op die moontlike prognostiese waarde van Plaatjie aktivering en die plaatjie tel in die konteks van die asimptomatiese MIV-geïnfekteerde pasiënte. Ons bevindinge dui daarop WCC en fibrinogeen kan gebruik word om die inflammatoriese profiel van individuele MIV-geïnfekteerde pasiënte te evalueer. Dit kan 'n direkte impak op MIV pasiënt vooraf aan die inisiasie van antiretrovirale terapie en waardevolle in die monitering van die reaksie op behandeling. Verder bied ons 'n roman vloeisitometrie gebaseer plaatjie funksionele toets en dui op die gebruik van die ADP teen 'n konsentrasie van 0,025 μM plaatjie funksie optimaal te evalueer in MIVgeïnfekteerde pasiënte. Die benutting van die roman vloeisitometrie tegniek soos beskryf in hierdie studie sal 'n beduidende waarde toevoeg in die beoordeling van die die trombotiese risiko en die siekte in MIV-geïnfekteerde pasiënte en kan addisioneel bewys van waarde te wees in 'n ander chroniese inflammatoriese toestande. / National Reserach Foundation

Introdução: Pacientes com infecção pelo HIV têm risco aumentado para o desenvolvimento de linfomas não-Hodgkin de células B comparado à população geral. Dentre os mecanismos que podem estar relacionados a esta patologia, encontra-se a reativação do vírus de Epstein-Barr secundária a imunossupressão. O papel do sistema imune para desenvolvimento de tumores é citado há longa data, e seu equilíbrio é mantido pelos linfócitos T regulatórios, cujo principal regulador e marcador é o fator de transcrição FOXP3. Neste estudo, avaliamos a presença de EBER e FOXP3 em amostras diagnósticas, além da carga viral para o vírus de Epstein-Barr em pacientes com linfomas relacionados à Aids a fim de avaliar e correlacionar os resultados como marcadores prognósticos nesta população. Métodos: Análise prospectiva da carga viral para Epstein-Barr no plasma e em células mononucleares do sangue periférico em 15 pacientes com linfomas relacionados à Aids acompanhados no Serviço de Hematologia do Instituto de Infectologia Emílio Ribas e do Hospital das Clínicas/Instituto do Câncer do Estado de São Paulo da Faculdade de Medicina da Universidade de São Paulo. As mensurações foram realizadas para cada paciente por reação da cadeia de polimerase em tempo real ao diagnóstico, término do tratamento e três meses após o término do tratamento. Dois grupos controles constituídos de 26 pacientes infectados pelo HIV em uso de anti-retroviral e sem diagnóstico de linfoma ou infecção oportunista e 30 indivíduos saudáveis também foram analisados para comparação da carga viral para o vírus de Epstein-Barr. Amostras coletadas por biópsia para o diagnóstico de linfoma foram submetidas a análise imuno-histoquímica para FOXP3 e para EBER por hibridização in situ. Resultados: 13 pacientes eram do sexo masculino e dois do sexo feminino, dos quais 14 foram tratados com quimioterapia e um com radioterapia de sistema nervoso central. Nove de 15 pacientes (60%) completaram o tratamento proposto e obtiveram remissão completa. A mediana da carga viral para o vírus de Epstein-Barr antes do tratamento foi 13 cópias/106 nas células mononucleares do sangue periférico (1-1472 cópias/106) e 70 cópias/mL (0-24900 cópias/mL) no plasma. Após o tratamento foi de 0,5/106 (0-109,5) e indetectável no plasma, com diminuição significativa da carga viral em células mononucleares do sangue periférico (p=0,022) e no plasma (p=0,003) ao término do tratamento em comparação ao diagnóstico. Nos pacientes em remissão completa, a carga viral para o vírus de Epstein-Barr diminuiu tanto no plasma como em células mononucleares do sangue periférico na maioria dos casos. A hibridização in situ para EBER resultou positiva em 7/15 (46,7%) casos, sendo significativamente superior no grupo de pacientes com linfomas relacionados a AIDS com mais de um sítio extralinfonodal comprometido (p=0,041) e com linfócitos T CD4 <100 células/L (p=0,026). A expressão de FOXP3 foi negativa em 15/15 (100%) dos pacientes com ARL. Conclusões: A expressão de EBER foi positiva em 7/15 (46,7%) dos pacientes com linfomas relacionados à Aids e superior de forma significativa nos pacientes com estádio mais avançado do linfoma e maior grau de imunossupressão. Observou-se diminuição estatisticamente significativa da mediana de carga viral para o vírus de Epstein-Barr em células mononucleares do sangue periférico (p=0,022) e plasma (p=0,003) após o tratamento do linfoma em comparação aos valores do diagnóstico em pacientes que atingiram remissão completa, o que poderia ser considerado um marcador prognóstico de resposta a terapia / Introduction: Patients with HIV infection have increased risk for development of non-Hodgkins lymphoma compared to general population. Among mechanisms that could be related to this disease is the reactivation of Epstein-Barr virus infection secondary to immunosuppression. The role of immune system in development of tumors was reported a long time ago, and balance of this system is maintained by regulatory T cells; FOXP3 transcription factor is the main regulator and marker of these cells. In this study we evaluated the presence of EBER and FOXP3 in diagnostic samples, and also viral load of Epstein-Barr virus in patients with Aids-related lymphoma to evaluate and correlate the results as prognostic markers in this population. Methods: Prospective analysis of viral load of Epstein-Barr virus in plasma and peripheral blood mononuclear cells from 15 patients with Aids-related lymphoma treated at Instituto de Infectologia Emílio Ribas and Hospital das Clínicas/Instituto do Câncer do Estado de São Paulo da Faculdade de Medicina da Universidade de São Paulo. Viral load measures were performed by real time polymerase chain reaction at diagnosis of lymphoma, completion of treatment and three months afterwards. Two control groups composed by 26 HIV-positive patients in use of HAART and without diagnosis of lymphoma or opportunistic infection and 30 healthy persons were also analyzed for viral load comparison. Biopsy samples performed to lymphoma diagnosis were submitted to immunohistochemistry for FOXP3 and in situ hybridization to EBER. Results: 13 patients were male and two females, 14 were treated with chemotherapy and one with radiotherapy of central nervous system. Nine of 15 patients (60%) completed treatment achieving complete remission. Median viral load of Epstein-Barr virus before treatment was 13 copies/106 in peripheral blood mononuclear cells (1-1472 copies/106) and 70 copies/mL (0-24900 copies/mL) in plasma. After treatment it was 0,5/106 (0-109,5) and not detectable in plasma, with significant decrease of viral load in peripheral blood mononuclear cells (p=0,022) and in plasma (p=0,003) after treatment compared to diagnosis. In patients with complete remission, viral load decreased in the majority of cases. In situ hybridization for EBER was positive in 7/15 (46,7%), and significant higher in the group of patients with Aids-related lymphoma with more than one extra nodal site (p=0,041) and CD4 T-cells <100 cells/L (p=0,026). FOXP3 expression was negative in 15/15 (100%) of patients with ARL. Conclusions: EBER expression was positive in 7/15 (46,7%) of patients with Aids-related lymphoma and significantly higher in patients with advanced stages of lymphoma and higher degree of immunosuppression. Significant decrease in median viral load of Epstein-Barr virus was observed in peripheral blood mononuclear cells (p=0,022) and plasma (p=0,003) after lymphoma treatment compared to diagnosis in patients that achieved complete remission, what could be considered a prognostic marker of response to therapy

Introdução: O emprego da terapia antirretroviral (TARV) proporcionou dramático impacto na mortalidade por aids e aumento na sobrevida. Entretanto, esse panorama depende da manutenção de altas taxas de adesão ao tratamento medicamentoso. A relevância da adesão tem sido reconhecida pelo Programa Nacional de DST e Aids desde o final dos anos 1990. Em que pese o destaque que o plano propositivo do Programa tem dado para a questão, ainda não dispõe de estudo atualizado sobre o número e tipo das atividades que estão em curso nos serviços. Este estudo teve por objetivo descrever as atividades de adesão em curso nos serviços de HIV/aids do Estado de São Paulo. Métodos: Foi enviado um questionário semi-estruturado para todos os 179 ambulatórios de HIV/aids do Estado, com perguntas sobre o tipo de serviço, pessoas sob TARV, formas e frequências de avaliação de adesão, atividades desenvolvidas (individuais, coletivas e para grupos específicos) e parcerias com organizações não governamentais. Para testar associação entre variáveis categóricas utilizou-se o teste Qui-quadrado de Pearson ou os testes exato de Fisher ou teste da razão de verossimilhanças, no nível de significância de p<0,05. A análise de agrupamento foi utilizada para investigar cada uma das associações de cada resposta com as variáveis: tamanho do município, tipo e tamanho das clínicas. Resultados: 136 dos ambulatório (76%) responderam à pesquisa. Quase todos (96,3%) relataram incentivar a adesão na prática clínica, predominantemente nas consultas de médicos (94,1%) e enfermeiros (67,6%). A maioria (78,7%) relatou avaliar a adesão através de registros da farmácia. Grupos (38,2%) e palestras (28,7%) foram as atividades de grupo mais conduzidas. A análise de agrupamento identificou três grupos de ambulatórios, dois deles muito distintos. Grupo 1 (27 ambulatórios) foi composto predominantemente por unidades de saúde básica, com menos de 100 pacientes, apresentaram a menor freqüência de avaliação da adesão e menos atividades individuais e em grupo. Grupo 2 (51 ambulatórios) foi constituído principalmente por ambulatórios especializados em HIV/aids, com mais de 500 pacientes, com maior freqüência de avaliação da adesão, maior participação de psicólogos, assistentes sociais e farmacêuticos e mais atividades individuais e em grupo. Grupo 3 (56 ambulatórios) foi composto em sua maioria por ambulatórios de especialidades e de médio porte, com a maioria das atividades semelhantes ao Grupo 2, exceto pela ausência de atividades para grupos específicos e menos envolvimento multidisciplinar. Conclusão: Dado o amplo reconhecimento da importância da adesão por parte das clínicas, ainda há poucas atividades específicas de adesão no Estado. As clínicas maiores e mais especializadas tendem a oferecer mais atividades individuais e em grupo, utilizando abordagens multidisciplinares. Maior atenção deve ser dada para a descentralização do atendimento às pessoas vivendo com HIV para assegurar cuidados de qualidade mais homogêneos em toda a rede ambulatorial. / Introduction: The use of antiretroviral therapy (HAART) has provided dramatic impact on AIDS mortality and improved survival. However, this scenario depends on maintaining high rates of adherence to HAART. The relevance of adherence has been recognized by the National STD/AIDS Program since the late 1990s. Despite the emphasis that the Program has given to the issue, there have been no study to date on the number and type of activities that are underway in the services. This study aimed to describe the HAART adherence support activities in Sao Paulo State HIV/AIDS clinics. Methods: We sent a semi structured questionnaire to all 179 HIV/AIDS clinics with questions about type of clinic, people on HAART, adherence assessment, activities (individual, group and for specific groups). To test association between categorical variables used the chi-square test or Fisher exact test or likelihood ratio test at a significance level of p <0.05. Cluster analysis was used to investigate each association of each answer with the variables: municipality size, type and size of the clinics. Results: 136 clinics (76%) answered the survey. Almost all (96.3%) reported encouraging adherence in clinical practice, particularly in the medical (94.1%) and nurse (67.6%) visits. Most (78,7%), reported assessing adherence by pharmaceutical records. Groups (38.2%) and lectures (28.7%) were the group activities most developed. Cluster analysis identified three groups of clinics; two of them were too different. Group 1 (27 clinics) was predominately composed by primary care clinics, with less than 100 patients, the lowest frequency of assessing adherence and fewer individual and group activities. Group 2 (51 clinics) predominately composed by HIV specialized clinics specializing, HIV/AIDS, with more than 500 patients, assessing adherence more frequently, with greater involvement of psychologists, social workers and pharmacists developing more individual and group activities. Group 3 (56 clinics) was predominately composed by medium size specialized clinics, with majority of activities similar to Group 2, except by the absence of activities to specific groups and less multidisciplinary involvement. Conclusion: Given the broad recognition of the adherence importance by the clinics, there are still few specific adherence activities. The larger and more specialized clinics tend to provide more individual and group activities, using multidisciplinary approaches. Greater attention should be given to the decentralization of care offered to people living with HIV to ensure more homogeneous quality care across the ambulatory network.

HIV (Human Immunodeficiency Virus) has been shown to have significant effects on the development of a child. Currently there is limited South African research regarding HIV and specific characteristics of communication development, and the treatment thereof, in the child infected with HIV. The objective of the research was to describe the communication characteristics of a group of children between the ages of 0 – 5 years infected with HIV at a hospital in Gauteng, South Africa. Clinic records of 203 children infected with HIV between the ages of 0-5 years were reviewed by using a pre-designed checklist within the outreach clinic of a large regional hospital. A questionnaire was completed by 4 medical practitioners working with this population within the outreach clinic. A total of 91.62% of the infected children were diagnosed as being either in Stage III or IV of the disease (according to the WHO classification system of 2005), with all infants presenting with a CD4 count of ≤ 60. The majority (75.37% of the total sample) were receiving HAART (Highly Active Antiretroviral Therapy) at the time the data was collected. According to their medical, social, communication and general development, almost all the children qualified for Early Communication Intervention (ECI) but were not recorded as being referred for such services. A large proportion of the target population presented with opportunistic infections and/or HIV associated conditions. The results highlight the developmental characteristics of children living with HIV, and identify the need for medical doctors and allied health professionals to be provided with relevant literature or training regarding the communication development of children infected with HIV. This will facilitate appropriate referrals for ECI services.

In July 2011, The Malawi government started implementing an innovative PMTCT policy known as Option B+ strategy that provides universal lifelong ART for all HIV-infected pregnant and breastfeeding women regardless of clinical or immunological stage. Even though Option B+ strategy is a good choice for Malawi, there is fear that the programme may be affected by poor access, utilisation, adherence and retention. Aim: The aim of this study was to explore the lived experiences of HIV-positive women on Option B+ strategy in a selected district hospital in Malawi. Methodology: A Hermeneutics phenomenological approach was used in this study to explore the lived experiences of HIV-positive women on Option B+ strategy through in-depth interviews of five purposely sampled information rich sources. Interviews were audio-taped and transcribed, then manual data analysis using Giorgi’s approach was employed to identify meaningful segments and develop categories, themes and sub-themes. Results: The lifelong commitment was described as the most challenging aspect of Option B+ strategy. Participants demonstrated lack of knowledge and understanding of Option B+ strategy and its implications which rendered them poorly prepared and unready for the task. The un optional Opt-out HIV testing resulted in participants feeling left out in their own care, as health professionals dominated the care from HIV testing throughout the process. The importance of male involvement in PMTCT was revealed in promoting partner HIV testing, disclosure, support, and prevention of further HIV spread. Barriers to participation were described in terms of attitudes of health care workers, stigma and discrimination. Despite the overemphasised need for women to be supported on Option B+ strategy participants were not willing to seek available sources of formal support. / Thesis (M.N.)-University of KwaZulu-Natal, Durban, 2013.

Health communication is a vital part of health care and treatment. For patients living with HIV, effective health communication is crucial. This study aimed at describing health communication from the perspective of HIV-positive patients by uncovering their experiences as they interacted with various medical staff members at Stanger Hospital. Guided by a review of various health communication models, data were collected via individual interviews and non-participant observation. The findings showed that interactive communication was favoured by all the respondents, especially communication that was patient-centred. Such communication encompassed education on how to live and cope with HIV. Obstacles to effective communication such as power differentials, lack of time and privacy at public health care clinics were identified. The study found that the different medical staff members at the clinic to various degrees addressed distinctive communication needs of HIV-positive patients. This study contributed to effectively understating the communication process as a whole. / Sociology / M.A. (Social Behaviour Studies in HIV/AIDS)

Human Immunodeficiency Virus (HIV) and Acquired Immune Deficiency Syndrome (AIDS) is a global problem. Introduction of antiretroviral therapy (ART) came as a relief to people living with HIV and AIDS as it improved their quality of life. However, maintaining high adherence levels to antiretroviral treatment is still a challenge in some settings yet strict adherence to treatment instructions is critical for successful suppression of HIV. A qualitative, descriptive phenomenological research was conducted to explore factors that influence adherence to antiretroviral therapy at Beatrice Road Infectious Disease Hospital (BRIDH). Purposive homogenous sampling was done. Data was collected from twenty patients through in-depth interviews. Study findings identified five main themes that facilitate adherence and these entail knowledge on HIV and AIDS and ART, motivation to live, adherence support networks, good service delivery and factors related to medication / Health Studies / M.A. (Public Health)