Summaries in English and Shona / Introduction Despite wide spread information and knowledge of HIV and AIDS transmission, High school teenage girls continued to engage in risky sexual behaviour in Tshwane, a District of Gauteng Province of South Africa. Age-parity relationships between High school teenage girls and older men known as “Sugar Daddies” or “Blessers”, who showered High school teenage girls with money and expensive gifts, were believed to be spreading HIV. High school teenage girls failed to negotiate condom use due to lack of autonomy, coupled with sexual violence, resulting in HIV transmission. Consequently, Tshwane became one of the highest HIV burdened cities in South Africa. Purpose of the study This study explored and described the High school teenage girls’ knowledge and perceptions of the risks of human immunodeficiency virus and acquired immune deficiency syndrome in Tshwane, a District of Gauteng Province of South Africa. Method The study used a quantitative approach. The data were collected using questionnaires. The population comprised of all girls aged 15 to 19 at a selected High school. The sample consisted of 109 girls. Systematic sampling was used. The study was conducted in the school hall of a selected High school. Data were analysed using SPSS version 23 program. Results Generally, the High school teenage girls’ HIV knowledge was very high (84.4%) as compared to their knowledge on AIDS (3.7%). Only 10.1% of the High school teenage girls knew what the window period entailed. They were aware of HIV preventive measures evidenced by abstinence ranking first (1) and had the highest score of five (5). 17.4% of the High school teenage girls doubted the usefulness of the condom in combating HIV infection. Health care workers were easily accessible (30.3%). The television was the most available mass media (92%). The radio was most preferred (31%). High school teenage girls preferred to discuss HIV related information with their peers and friends (50%). 42% of the High school teenage girls preferred to discuss sex related topics with parents or guardians. Those who were below 18-years were 7.2 times less likely to have sex. 90% of the 19-year-old girls had had sex. Therefore, High school teenage girls’ perception of HIV risk was low because they continued to be involved in concurrent multiple relationships although 90% of those involved were using condoms. Conclusion Although High school teenage girls proved that they had knowledge of HIV and AIDS, they still had a low perception of HIV risk because they were involved in concurrent multiple sexual relationships with older men. / Habedi, Debbie Kgomotso / Kunyangwe vane ruzivo rwechirwere cheshura matongo, vasikana vane makore ari pakati pegumi nematatu negumi nemapfumbamwe vari kuenderera mberi nekuita unhu unoita kuti vabatwe nechirwere cheshuramatongo (AIDS). Vasikana ava vari kudanana nevarume vakuru kuvadarika vamwe masadzimba zvinoita kuti vatapurirwe utachiona hweHIV zvinoita kuti vasikana vane hutachiona uhwu vawandise muguta reTshwane, mudunhu reGauteng munyika yeSouth Africa. Vanasikana ava vanopuwa mari nekutengerwa mbozhanhre nenguvo zvinodhura nekudya tunonaka. Nekuda kwekuti varume vanesimba rehudzvinyiriri nekuvarwisa, muAfrica, vasikana ava havakwanisi kushandisa makondomu kuzvidzivirira kubva kuhutachiona hweHIV. Ndosaka guta reTshwane raita mukurumbira munyika yeSouth Africa nekuti vanasikana vane hutachiona hweHIV vari kuwandisa. Gwaro iri rinoongorora nekutsanangura ruzivo uye maonero evanasikana huipi hwechirwe cheshuramatongo muguta guru reTShwane, mudunhu reGauteng. Munyika yeSouth Africa. Mafambiro Egwaro Gwaro iri riri kuongorora nekutsanangura ruzivo nemaonerwo anoitwa hutachiona hweHIV nechirwere cheshuramatongo nevasikana vari pakati pemakore gumi nemakore matatu nevanegumi nemakore mapfumbamwe pachikoro chesekonari chakasarudzwa mugutu guru reTshwane, mudunhu reGauteng, munyika yeSouth Africa. Vasikana vaka pindura mibvunzo pamusoro peruzivo rwavaiva narwo uye zvakanyangara zvinoita kuti vabatwe nehutachiona hweHIV. Vasikana zana nevapfumbamwe ndivo vakapindura mibvunzo. Vasikana vakapindura mibvunza yaiva pamapepa muhoro yepachikoro pavo. Zvakabuda Muchidzidzo Zvakaonekwa kuti vasikana vane ruzivo rwechirwere cheshuramatongo asi vane zvimwe zvinhu zvavasinga nzwisisi pamusoro pechirwere ichi zvekuzvidzivirira. Vasikana havakwanisi kupa mutsauko wehutachiona (HIV) nechirwere cheshuramatongo (AIDS). Vanasikana vazhinji vanofunga kuti hutachiona hweHIV hunotapurirwana pakutsvodana uye pakushandisa zvimbuzi. Vasikana vazhinji havakwanisi kutsanangura nguva inogara hutachina hweHIV mumuviri hwusati hwaonekwa kuti hurimo. Vasikana havana chokwadi chekuti makondomu anogona kudzivirira hutachiona hweHIV kuti hwusapinda mumuviri nguva dzebonde. Vadzidzisi vechikoro ndivo vakasarudzwa kuti vane ruzivo rwechirwere cheshuramatongo. Vasikana havafariri kudzidziswa nezve chirwere cheshuramatongo nevabereki vavo. Vanofarira kukurukura nezvechirwere ichi nevanhu vezera ravo. Vasikana vasingagari nevabereki vavo vanoita bonde kudarika vanogara nevabereki vavo uye vanoita bonde nevadiwa vazhinji vamwe vacho varume vakuru madzisaimba. Vasikana vanotaridza kusatya kubatwa nechirwere chishuramatongo nemhaka yehunhu wawo hwakashata hweku danana nevarume vazhinji uye kusashandisa makondomu nguva dzebonde. Mhendero Zvidzidzo zvinopiwa vasikana zvinechekuita nezvepabonde zvinofanira kuongororwa zvipamhidzirwe kuti vasikana vagone kuzvidzivirira kuchirwere cheshuramatongo. Madzimudzangara netelevhizhoni zvino kurudzirwa kudzidzisa mitambo nedzimbo dzinodzidzisa pamusoro pekudzivirira chirwere cheshuramatongo. Vabereki vanofanira kudzidziswawo kuti vagone kudzidzisa vana vavo kuti vagone kuzvidzivirira kuti vasabatwa nechirwere ichi. Vanasikana vanofanirwa kudzidziswa kushandisa makondomu pese pavanoita bonde. Makondomu anofanira kuiswa pachena paano kwanisa kuwonekwa nevasikana. / Health Studies / M.P.H. (Health Studies)

The effects of HIV/AIDS and subsequent opportunistic infections and/or associated conditions on the development of infected children are substantial. Considerable delays and/or disorders in communication development have been noted in the HIV/AIDS infected child, as well as the need for Early Communication Intervention (ECI) services for this population. A dearth of locally relevant data regarding the speech, language and hearing development of HIV/AIDS infected children within the South African context currently exists. The objective of this study was to describe the characteristics of a group of HIV/AIDS infected children being managed at an outreach clinic of regional hospital in Gauteng. A cross-sectional, retrospective, non-experimental, descriptive, quantitative research design was used in this study. The main objective was achieved by analysing the clinic records of 203 children infected with HIV/AIDS between the ages of 0 – 5 years 11months through the use of a pre-designed checklist. A questionnaire completed by four medical doctors practicing at the HIV/AIDS clinic within the hospital was also used. This allowed for the perceptions and practices of the medical doctors to be described. Results revealed that the majority HIV/AIDS infected children being managed at the outreach clinic were significantly immunocompromised and diagnosed with Stage III or Stage IV HIV/AIDS infection. Furthermore, results indicated the presence of several opportunistic infections and HIV/AIDS associated conditions (such as Tuberculosis, Candidiasis and Encephalopathy). A positive finding was that 76% of the HIV/AIDS infected children (n=153) were receiving Highly Active Antiretroviral Therapy (HAART) at the time of data collection. The most outstanding finding was that very few of the children with HIV/AIDS being managed at the outreach clinic were recorded as having speech, language and/or hearing delays and/or disorders. Similarly, referrals to other professionals as recorded in the children’s hospital records seemed to be limited to Social Workers and Dietitians, with only one child recorded as being referred to a Speech-Language Therapist and Audiologist for further management. It was unclear whether more children were in fact referred for additional intervention by other professionals and this was simply not recorded in the children’s records, or whether these referrals were in fact not made. Results from the questionnaires completed by the medical doctors working with the pediatric HIV/AIDS population within the outreach clinic were significant. Findings indicated that the majority of the respondents believed that HIV/AIDS infected infants were more at risk for developmental and communicative delays and/or disorders than the general population, and that this population would likely benefit from Speech-Language Therapy and/or Audiology intervention services. Respondents indicated that medical doctors working with the pediatric HIV/AIDS population were often not adequately informed regarding the effects of HIV/AIDS on communication development and that they would benefit from further training in this regard. The need for further research regarding the characteristics of the pediatric HIV/AIDS population, particularly on a larger sample, was described. This would assist in the development of a guideline for ECI service delivery for children infected with HIV/AIDS. The need for further training of other professionals regarding the effects that HIV/AIDS has on the communication development of the infected child, to assist with necessary referrals and teamwork, was also highlighted. AFRIKAANS : Suid-Afrika is een van die lande ter wêreld, wat die hoogste voorkoms van Menslike Immuniteitsgebrekvirus/ Verworwe Immuniteitsgebreksindroom (MIV/VIGS), toon - met die pediatriese populasie op die voorfront van hierdie epidemie. Die effek wat MIV/VIGS en opeenvolgende opportunistiese infeksies en/of ander geassosieerde toestande op die ontwikkeling van kinders het, is verreikend. Internasionale literatuur beskryf agterstande en/of akwykings in die kommunikasie ontwikkeling van kinders wat met MIV/VIGS geinfekteer is. Die behoefte vir Vroeë Kommunikasie Intervensie (VKI) vir hierdie populasie word ook gemeld. Daar bestaan egter slegs ‘n beperkte hoeveelheid relevante, plaaslike literatuur met betrekking tot die spraak-, taal- en gehoorontwikkeling van kinders met MIV/VIGS binne die Suid-Afrikaanse konteks. Die doelwit van hierdie studie was om die kenmerke van ‘n groep kinders, wat met MIV/VIGS besmet is en by ‘n streekshospitaal in Gauteng behandel word, te beskryf. ‘n Kwantitatiewe, nie-eksperimentele, terugwerkende, dwarsdeurige, beskrywende navorsingsontwerp is gebruik. Die hoofdoelwit was bereik deur die kliniekrekords van kinders wat met MIV/VIGS besmet is, te analiseer deur van ‘n vooraf-ontwerpte merklys gebruik te maak. Data is ook ingesamel deur middel van vraelyste wat deur mediese dokters, wat by MIV/VIGS klinieke binne die hospitale werk, voltooi is. Dit het toegelaat dat die persepsies en praktyke van die mediese dokters ook beskryf kon word. Resultate het getoon dat die meerderheid kinders met MIV/VIGS, wat by klinieke behandel word, se immuunsisteme ernstig onderdruk was en dat hulle met stadium III of stadium IV van MIV/VIGS gediagnoseer was. Die resultate het verder ook die voorkoms van verskeie opportunistiese infeksies en MIV/VIGS geassosieerde toestande aangedui. ‘n Positiewe bevinding was dat 76% van die kinders (n=153), wat met MIV/VIGS geinfekteer was, tydens die proses van data-insameling reeds Hoogsaktiewe Antiretrovirale Terapie (HAART) ontvang het. Die mees uitstaande bevinding was dat slegs ‘n geringe hoeveelheid kinders met MIV/VIGS by die kliniek, as met ‘n agterstand en/of afwyking in spraak, taal en/of gehoor, aangeteken is. Beperkte verwysings na ander professionele persone is ook in die kliniekrekords opgemerk. Verwysings was beperk tot Maatskaplike Werkers en Dieëtkundiges. Daar was slegs een aantekening van ‘n kind wat vir behandeling na ‘n Spraak- en Taalterapeut en Oudioloog verwys is. Dit is egter onduidelik of daar werklik meer verwysings na ander professionele persone gemaak is, maar net nie in die kinders se kliniekrekords aangedui is nie, of dat daar werklik min verwysings na ander professionele dissiplines gemaak is. Bykomend, was die resultate van voltooide vraelyste deur mediese dokters, wat met die pediatriese MIV/VIGS populasie in die kliniek werk, insiggewend. Bevindings dui aan dat die meerderheid proefpersone, wat aan die studie deelgeneem het, van mening is dat kinders wat met MIV/VIGS besmet is wel ‘n hoër risiko toon vir ontwikkelings- en kommunikasie agterstande en/of afwykings in vergeleke met die algemene populasie. Die proefpersone is verder ook van mening dat hierdie populasie wel van spraak- en taalterapie en/of oudiologiese intervensie sal baatvind. Proefpersone het verder aangedui dat mediese dokters, wat met die pediatriese MIV/VIGS populasie werk, nie ten volle ingelig is omtrent die effek van MIV/VIGS op kommunikasie ontwikkeling en dat hulle van verdere opleiding sal baatvind. Die behoefte vir verdere navorsing in die veld van pediatriese MIV/VIGS en kommunikasie ontwikkeling, binne die Suid-Afrikaanse konteks, word in hierdie studie beskryf. Dit sal as riglyn vir VKI dienslewering aan hierdie populasie dien. Daar is ook ‘n groot behoefte vir verdere opleiding van ander mediese professionele persone met betrekking tot pediatriese MIV/VIGS en die effek wat die op die kind se kommunikasie ontwikkeling het. / Dissertation (MCommunication Pathology)--University of Pretoria, 2010. / Speech-Language Pathology and Audiology / unrestricted

M. Tech. (Department of Biotechnology, Faculty of Applied and Computer Sciences), Vaal University of Technology. / Background: Currently, the South African National Blood Services are not testing for HTLV and HTLV screening is not mandated by the WHO or by regulatory standards in South Africa. Looking at the uniquely high prevalence of HIV and HIV / HBV co-infections in the South African population and taking into account the literature that suggests that most of these infected patients will be receiving blood, exposing these patients to an additional burden like HTLV can result in an increased disease progression of HIV to AIDS and a poor prognosis in these infected patients. Study design and methods: A blinded cross-sectional study was performed. 7015 specimens were collected from all blood transfusion laboratories across South Africa excluding the Western Cape Blood Transfusion Service laboratories. The specimens collected were tested using the ABBOTT Alinity S® Immunochemiluminescent autoanalyser. All test results were confirmed with the Roche Cobas® E801 and E411 auto analyser. Results: Over all prevalence for HIV was 39.39% (N=2763), HBV 7.57% (n=531) and HTLV 0.70% (N=49). Concurrent infection for HIV/HBV 4.92% (N=345), HIV/HTLV 0.36% (N=25), HBV/HTLV 0.09% (N=6) and HIV/HBV/HTLV 0.07% (N=5). Conclusion: This study confirmed an overall high prevalence of HIV and HBV infections among patients receiving blood products from the SANBS. Compared to the general population, the HIV prevalence in blood recipients was two-fold higher. Patients receiving a blood transfusion from the SANBS have high rates of HIV, HBV and HTLV which should be taken into consideration when determining donor screening strategies.

The aim of this study was to investigate the perceptions, attitudes, opinions and fears of the adolescent high school learners towards HIV counseling and testing at school.Quantitative, descriptive, exploratory research was conducted to determine if high school learners would like to be tested for HIV at school. Data collection was done using structured questionnaires. The respondents in the study were daytime high school learners (n=120) who were in grade 8 to 12, between ages of 12 to 18 years of age. The study highlighted that adolescents engage in sexual activities at an early age. The results revealed that there is lack of knowledge, unavailability of HCT services for adolescents and the resources to keep a girl child school. This behavior may result in adolescents contracting sexually transmitted infections and HIV, falling pregnant at an early age, which may force adolescent high school learners to drop out of school. However, the study shows that government has more to educate adolescent high school learners about HIV/AIDS to modify their perceptions and attitudes towards HIV counseling and testing. / Health Studies / M.A. (Health studies)

AIM The purpose of this study was to explore and describe factors that contribute to the non-initiation of Antiretroviral Therapy (ART) amongst Pre-Antiretroviral Therapy eligible patients and to make recommendations for health care workers to enhance early initiation of pre-ART-eligible patients for primary health care facilities in Swaziland. METHOD A qualitative design was applied in rural primary health care (PHC) facilities in the Hhohho region of Swaziland. The target population for this study included nurses who have successfully completed the National Nurse Led Antiretroviral Therapy Initiation in Swaziland (NARTIS) training, and who actively initiated ART to eligible patients in rural PHC facilities. Data was collected through semi-structured interviews and field notes. Purposive, convenient sampling was applied. Eleven respondents were interviewed for the study, and data was collected until data saturation was reached. Data from transcripts and field notes was analysed and categorised with thematic analysis through Tesch’s open coding process. RESULTS The study identified the following three predominant themes: 1) systematic enablers of prompt ART initiation, 2) barriers to prompt ART initiation, 3) sources of support. Categories included public health care (PHC) factors, community level factors, the interdependence of the health care system, patient centred barriers, individual patient agency, and NARTIS nurse support. CONCLUSION The recommendations for health care workers that emerged from the study included continued HIV treatment scale-up and decentralisation to grass roots levels, aggressive treatment prioritisation among pre-ART patients, building the capacity of the local health care system and continued research initiatives. It is hoped that recommendations emerging from the findings of this study will have positive implications for programming and practice regarding the initiation of ART for eligible pre-ART patients in Swaziland. / Health Studies / M. PH.

Des progrès importants ont été réalisés dans la thérapie des personnes vivant avec le VIH (PVVIH) avec le développement d’antirétroviraux (ARV) de plus en plus efficaces, sûrs avec une bonne innocuité et tolérance. Cependant, des défis thérapeutiques demeurent chez les PVVIH dont le VIH pourrait être porteur de mutations génétiques conférant de la résistance aux traitements soit en raison d’une histoire d’échec thérapeutique antérieur soit en raison d’une exposition antérieure à une mono/bithérapie aux inhibiteurs nucléosidiques de la transcriptase inverse (INTI) (thérapie sous-optimale qui se faisait avant l’ère des trithérapies). Chez ces patients, les cliniciens peuvent tenter des combinaisons peu étudiées dans l’espoir de mieux contrôler la charge virale ou de réduire les effets secondaires. Ainsi, cette thèse par articles avait trois objectifs qui visaient à étudier des thérapies utilisées chez ces patients mais pour lesquelles il y a peu ou pas de données. Le premier objectif (article 1) consistait à déterminer si l'efficacité du régime ARV avec dolutégravir chez les patients stables (dont la charge virale est supprimée) variait en présence d'une histoire d’échec virologique ou d’exposition antérieure à la thérapie sous-optimale. Le deuxième objectif (article 2) visait à comparer l’issue virologique des PVVIH stables ayant un échec virologique documenté ou une exposition antérieure à la thérapie sous-optimale et qui ont maintenu leur régime inhibiteur de la protéase/ritonavir (IP/r) par rapport à ceux qui sont passés au dolutégravir. Finalement, le troisième objectif (article 3) était de comparer le risque d’échec virologique chez les PVVIH avec une histoire d’échec virologique ou de thérapie sous-optimale prenant un traitement non standard d’ARV composé d’abacavir/ténofovir disoproxil (ABC/TDF) avec un 3e ARV d’une classe différente par rapport à un régime composé d’un traitement de fond standard. Nous avons utilisé les données de la cohorte VIH du Québec qui regroupe 10 219 PVVIH suivies au niveau de quatre centres à Montréal incluant la Clinique de médecine urbaine du Quartier Latin (CMUQL), la Clinique médicale l’Actuel (CMA), le Centre hospitalier universitaire de Montréal (CHUM) et le Centre universitaire de santé McGill (CUSM). Une restriction à certains patients a été réalisée pour chacun des objectifs. Les patients avec une charge virale indétectable qui avaient reçu une thérapie avec dolutégravir + 2 INTI à partir de 2013 ont été retenus pour l’objectif 1. Le modèle de risque proportionnel de Cox avec score de propension a été utilisé afin de comparer l’issue virologique des patients sous dolutégravir en fonction de l’exposition étudiée. Pour l’objectif 2, les patients stables avec une histoire d’échec virologique documenté ou d’exposition à une thérapie sous-optimale qui étaient sous IP/r + 2 INTI à partir de 2014 ont été sélectionnés. Le modèle de Cox structurel marginal a permis de voir l’effet du changement de traitement vers le dolutégravir + 2 INTI en comparaison avec ceux qui sont restés sur IP/r + 2 INTI. Pour l’objectif 3, les patients avec une histoire d’échec virologique documenté ou d’exposition à une thérapie sous-optimale qui étaient sous traitements de fond standards (abacavir/lamivudine, ténofovir disoproxil/emtricitabine, ténofovir disoproxil/lamivudine) avec un agent autre qu’un INTI à partir du 1er janvier 2006 ont été retenus. Le modèle multivarié proportionnel de Cox a été utilisé afin de comparer l’issue virologique des patients passés à un régime de thérapie inhabituelle à base d’ABC/TDF par rapport à ceux qui sont restés sur traitement de fond standard. L’article 1 a montré une efficacité similaire du dolutégravir chez les patients stables avec ou sans histoire d’échec virologique documenté ou d’exposition à une thérapie sous-optimale (Hazard ratio ajusté (HRa)=0,84 (IC95% : 0,35 - 2,01)). Dans l’article 2, aucune preuve d'un risque accru d'échec virologique n’a été trouvée chez les patients stables ayant déjà eu un échec virologique antérieur ou une exposition à une thérapie sous-optimale qui ont eu un changement de régime vers le dolutégravir en comparaison avec ceux qui ont maintenu leur régime IP/r (HRa=0,57 (IC95% : 0,21 - 1,52)). Dans l’article 3, une réduction non significative du risque d’échec virologique avec le traitement de fond non standard à base d’ABC/TDF a été trouvée par rapport au traitement de fond standard (HRa=0,45 (IC95% : 0,06 - 3,36)). En conclusion, les résultats de cette thèse n’ont pas montré un effet de la présence d’échec virologique antérieur ou d’exposition à une thérapie sous-optimale sur l’efficacité du dolutégravir. Par ailleurs, les résultats ont permis de constater que le changement vers le dolutégravir + 2 INTI pour des patients stables sur un régime IP/r + 2 INTI peut être envisagé malgré la présence ou la suspicion de mutation de résistance aux INTI. Ces résultats sont importants puisqu’ils devraient permettre de faire changer les guides cliniques concernant le dolutégravir chez les patients stables. Par contre, nos résultats n’ont pas réussi à montrer un avantage significatif à utiliser le traitement de fond à base d’ABC/TDF en comparaison au traitement de fond standard chez des patients présentant une histoire d’échec virologique ou d’exposition à la thérapie sous-optimale. / Significant progress has been made in treatment for people living with HIV (PLHIV) with the development of increasingly effective antiretroviral (ARV) therapy, safe with good tolerability. However, clinicians can sometimes face treatment challenges related to the monitoring of PLHIV whose HIV could carry genetic mutations conferring resistance to treatments either because of a history of virologic failure or because of previous exposure to mono/bitherapy to nucleoside reverse transcriptase inhibitors (NRTIs) (suboptimal therapy that was provided before the era of triple therapy). In these patients, clinicians can sometimes try less studied combinations in the hopes to better control viral load or reduce side effects in these patients. Therefore, this thesis by articles had three objectives aiming to evaluate less studied therapies that are used in these patients. The first objective (Paper 1) was to determine whether the efficacy of ARV regimen with dolutegravir in stable patients (whose viral load is controlled) varied in the presence of a history of virologic failure or with a previous exposure to suboptimal therapy regimen. The second objective (Paper 2) was to study virologic outcome after switching to dolutegravir compared to remaining on a boosted protease inhibitor (PI/r) regimen in stables PLHIV with prior documented virologic failure or exposure to mono/dual NRTI. Finally, the third objective (Paper 3) was to compare the risk of virologic failure for PLHIV who have previous documented virologic failure or prior exposure to suboptimal therapy taking an ARV therapy composed of abacavir/tenofovor (ABC/TDF) with a third agent of a different class, versus an ARV regimen composed of a standard backbone also with a non-NRTI third agent. We used data from the Quebec HIV cohort which brings together clinical information from 10,219 PLHIV followed in four clinical care centers in Montreal including the “Clinique de médecine urbaine du Quartier Latin (CMUQL)”, “Clinique médicale l’Actuel (CMA)”, the “Centre hospitalier de l'Université de Montréal (CHUM)” and the “McGill University Health Center (MUHC)”. A restriction to some patients in the cohort was made with regards to each objective of this thesis. Patients with an undetectable viral load who had received therapy with dolutegravir +2 NRTI from 2013 were selected for the objective 1. A Cox proportional hazard model with propensity score was used to compare the virologic outcome of patients on dolutegravir according to the exposure. For objective 2, patients with an undetectable viral load with an history of documented virologic failure or exposure to suboptimal therapy who were on PI/r + 2 NRTI from 2014 were selected. A marginal structural Cox model was used to measure the effect of switching to dolutegravir +2 NRTI compared to those who remained on PI/r + 2 NRTI therapy. For objective 3, patients with a documented virologic failure or exposure to suboptimal therapy in standard backbone (abacavir/lamivudine, tenofovir disoproxil/emtricitabine, tenofovir disoproxil/lamivudine) with another agent from January 01, 2006 were selected. A Cox proportional multivariate model was used to compare the virologic outcome of patients who switched to a non-standard regimen including ABC/TDF therapy versus those who remained on standard backbone. The article 1 suggested similar virologic efficacy of dolutegravir in stables patients with or without an history of documented virologic failure or exposure to suboptimal therapy (adjusted Hazard Ratio (aHR)=0,84 (95%CI: 0,35 - 2,01)). In article 2, no evidence of an increased risk of virologic failure was found in stables patients who had a regimen switched to dolutegravir compared to those who maintained their regimen with PI/r in patients who have had previous virologic failure or exposure to suboptimal therapy (aHR=0,57 (95%CI: 0,21 - 1,52)). In article 3, a non-significant reduction in the risk of virologic failure with the non-standard backbone including ABC/TDF was found compared to standard backbone (aHR=0,45 (95%CI: 0,06 - 3,36)). In conclusion, the results of this thesis first suggested no effect of the presence of previous virologic failure or exposure to suboptimal therapy on the efficacy of dolutegravir in stables patients. In addition, the results showed that the switch to dolutegravir +2 NRTI for patients with an undetectable viral load on PI/r +2NRTI regimen can be considered despite the presence of proved or suspected NRTI resistance mutation. These results are of great importance as they should lead to changes the clinical guidelines for the use of dolutegravir in stable patients. On the other hand, our results failed to show a significant advantage to the use of the backbone ABC/TDF instead of standard backbones in patients with prior documented virologic failure or previous exposure to suboptimal therapy.

The aim of this study was to investigate the perceptions, attitudes, opinions and fears of the adolescent high school learners towards HIV counseling and testing at school.Quantitative, descriptive, exploratory research was conducted to determine if high school learners would like to be tested for HIV at school. Data collection was done using structured questionnaires. The respondents in the study were daytime high school learners (n=120) who were in grade 8 to 12, between ages of 12 to 18 years of age. The study highlighted that adolescents engage in sexual activities at an early age. The results revealed that there is lack of knowledge, unavailability of HCT services for adolescents and the resources to keep a girl child school. This behavior may result in adolescents contracting sexually transmitted infections and HIV, falling pregnant at an early age, which may force adolescent high school learners to drop out of school. However, the study shows that government has more to educate adolescent high school learners about HIV/AIDS to modify their perceptions and attitudes towards HIV counseling and testing. / Health Studies / M.A. (Health studies)

Since the earliest reported cases of HIV/AIDS probably in 1959 in Africa, there has been a consistent progression in the new HIV/AIDS infection cases. In South Africa, Gauteng, records one of the highest HIV/AIDS prevalence rates in the country. The Department of Health (DOH) South Africa conducts ongoing studies on HIV/AIDS at provincial levels; these studies monitor the prevalence of HIV/AIDS amongst pregnant women attending antenatal clinics, as a tool for determining and monitoring the prevalence, trends, patterns and spread of the disease in the general population. This study analyses sentinel and spatial data collected from the (DOH) and Statistics South Africa (StatsSA) respectively, and depicts them in the form of spatial maps, and then critically analyses the spatial patterns that occur. The research findings would hopefully contribute to the overall knowledge of HIV/AIDS and provide framework and relevant literature for further investigation. / Geography / M.Sc. (Geography)

The research objectives were to describe the age and gender of adult HIV positive clients on ART who received IPT; the incidence of tuberculosis among clients that received IPT and the defaulter rate among those that were commenced on IPT. Quantitative non-experimental descriptive retrospective cohort study was undertaken to ascertain the incidence of tuberculosis among adult HIV positive clients who received IPT. 104 clinic records of HIV positive adult clients accessing care at Isithebe Clinic, iLembe-South Africa who were commenced on IPT between 01 July 2010 and 30 November 2011 were analysed. The study found that 66 of 104 (63.5%) study respondents completed the course of IPT and the majority of those that defaulted were due to poor quality of care. Gender was statistically found to have played a role on whether a patient completes IPT. None of the study respondents that completed IPT was diagnosed with TB disease. / Health Studies / M.A. (Public Health)

L’Organització Mundial de la Salut (OMS) estima que fins a un 3% de la població mundial ha estat infectada pel virus de l’hepatitis C i és la causa més important d’hepatitis crònica, cirrosi i de malaltia hepàtica terminal, que finalment acaba conduint a un transplantament de fetge. La relació entre la variabilitat en la seqüència del virus de l’hepatitis C i el desenvolupament de la malaltia hepàtica és de tipus multifactorial. La infecció crònica causa fibrosi hepàtica, fet que es veu accelerat per mecanismes desconeguts en el cas de pacients coinfectats amb VIH. La progressió de la malaltia produïda pel VHC en pacients coinfectats, està influenciada no només per factors demogràfics, epidemiològics o pels antecedents clínics dels pacients, si no també per diferències genètiques entre els diferents virus i els hostes.