Thesis submitted for the degree: Doctor of Philosophy, School of Public Health, Faculty of Health Sciences, University of Witwatersrand, Johannesburg June 2017. / The epidemics of tuberculosis (TB) and Human Immunodeficiency Virus (HIV) in sub-Saharan Africa are closely related and particularly persistent, proving a considerable burden for healthcare provision, and complicating utilization of care. Concern has been expressed about patients’ experience at healthcare facilities as this may impact on drug adherence, treatment success and willingness to return for regular monitoring and drug pick-up. This is particularly relevant for HIV programmes, with HIV now a chronic disease, with daily treatment necessary for life; TB treatment is limited in duration, to six months although can be as long as two years in case of multiple drug resistant TB. Utilization of healthcare services is an important determinant of health outcomes generally, with public health relevance, particularly for HIV and TB services in areas of high prevalence. The main aim of universal health coverage is to make healthcare accessible without barriers based on affordability, availability or acceptability of services. Various factors have been shown to hinder or enable patient utilization of healthcare services, such as organization of services, costs of transport to and from clinics, time loss at clinics receiving care, staff attitudes, waiting times and cleanliness of facilities. Objectives This study aimed to determine and quantify factors associated with healthcare utilization in patients utilizing HIV care (including those not yet initiated on antiretroviral treatment (ART) - pre-ART) or TB treatments in a rural sub-district of Hlabisa in KwaZulu-Natal and to understand healthcare providers’ perspectives regarding patient care and provision of quality care. The study used data from patient exit interviews, and additionally findings from interviews with healthcare providers in the local HIV treatment and care programme, structured around the responses from the patient-exit interviews. The study had three specific objectives: 1) to establish and quantify factors associated with healthcare utilization, with utilization decomposed to availability, affordability and acceptability of healthcare services, for patients in HIV or TB treatment and care; 2) to quantify ability-to-pay for healthcare and identify associated factors for patients in pre-ART care, or on ART or TB treatment; 3) to understand the healthcare providers’ perspectives regarding patient care and provision of quality HIV care. Methods In 2009 patient-exit interviews were conducted in six primary healthcare (phc) clinics in rural South Africa with 300 patients receiving ART and 300 patients receiving TB treatment; patients were randomly selected using a two-stage cluster random sampling approach with primary sampling units (phc) selected with probability-proportional-to-size. In 2010 an additional 200 HIV-infected patients in pre-ART care from the same clinics were interviewed. Patient-exit interviews were conducted in a private room outside the facility and all data were analysed using STATA 11. In 2012, a qualitative study was carried out with healthcare providers in eight (of 17) randomly selected phc clinics; 25 ART healthcare providers were engaged in discussion structured around patient-exit interviews feedback to assess possible challenges/facilitators ART healthcare providers face when providing care. Discussions took place in the consultation rooms when no clinical sessions were ongoing and these were recorded and transcribed; and data were managed using Nvivo 10. Thematic content analysis was conducted using both inductive and deductive approaches and clinic or healthcare provider identifiers were removed and replaced with pseudonyms. Summary statistics describe patient characteristics by patient group and key availability, acceptability and affordability factors associated with utilization of healthcare services; separate univariate and multivariable regression models were run to assess associations between patient characteristics and these key availability, acceptability and affordability factors. Patient socio-demographic characteristics (sex, age, education, employment and marital status) were controlled for and adjusted for clustering at facility-level. Factor analysis was performed to investigate underlying patient satisfaction factors. Results Socio-demographic characteristics of the patients More women than men were seen in the primary care clinic, especially among pre-ART patients (79%), followed by 62% HIV and 53% utilized TB care, with an age-sex profile comparable to previous studies in the area. Pre-ART patients were significantly younger than ART and TB patients, with a median age of 32 years for pre-ART patients, 39 years for ART patients and 37 years for TB patients. Unemployment at household level was high, up to 86% of ART patients’ head of households were unemployed and only 9% of TB patients were employed. / MT2017

M.Sc. (Nursing), Faculty of Health Sciences, University of the Witwatersrand, 2011

Includes bibliography. / xv, 257 leaves : / Title page, contents and abstract only. The complete thesis in print form is available from the University Library. / Examines the role of polymorphisms in immunoregularatory genes in conferring susceptibility to common variable immunodeficiency. / Thesis (M.D.)--University of Adelaide, Dept. of Medicine, 1998?

Highly active antiretroviral therapy (HAART) adherence rates of 70 ? 80% often appear in the literature. However, it is estimated that 95% adherence must be achieved to cause virologic failure. Furthermore, if viral replication is not suppressed by HAART, the virus can mutate and become resistant to the patient?s current regimen and render it ineffective. Previous work has indicated that psychosocial factors like mood and personality may be related to outcomes such as adherence and disease progression. Interventions may improve adherence through modification of mood. Moreover, personality may impact the extent to which interventions can effectively impact adherence. The present study evaluated the role of personality in a 10-week Cognitive-Behavioral Stress Management (CBSM) intervention designed to improve HAART adherence. Analyses were performed on 93 ethnically diverse men who have sex with men (MSM) living with HIV/AIDS who were on high-active antiretroviral therapy, had completed the NEO Personality Inventory ? Revised, and were enrolled in an ongoing group-based CBSM intervention study. Repeated measures ANCOVAs, with income and number of HIV symptoms as covariates, showed (1) the intervention had no effect on HIV viral load; (2) high Conscientiousness was related to better HAART adherence; (3) CBSM buffered a drop in HAART adherence, as well as an increase in depressed mood in those low in Conscientiousness across the intervention period; (4) low Conscientiousness, as well as high Neuroticism was related to higher levels of depressed mood through 15-months post randomization. However, while allowing for the further analysis of ethnic group interactions, the utilization of multiple imputation to account for missing data due to attrition changed several relationships between variables of interest, HAART adherence, and depressed mood. Linear regression, controlling for relevant variables, showed that (5) neither Conscientiousness nor Neuroticism were related to CBSM session or medication adherence training session attendance. These findings show that personality factors such as Conscientiousness and Neuroticism and ethnic group membership are related to changes in mood and behaviors (i.e., HAART adherence) relevant to the treatment of MSM living with HIV/AIDS.

Thesis (Ph. D.)--University of Washington, 2001. / Vita. Includes bibliographical references (leaves 76-91).

Includes bibliography. / xv, 257 leaves : / Title page, contents and abstract only. The complete thesis in print form is available from the University Library. / Examines the role of polymorphisms in immunoregularatory genes in conferring susceptibility to common variable immunodeficiency. / Thesis (M.D.)--University of Adelaide, Dept. of Medicine, 1998?

Includes bibliography. / xv, 257 leaves : / Title page, contents and abstract only. The complete thesis in print form is available from the University Library. / Examines the role of polymorphisms in immunoregularatory genes in conferring susceptibility to common variable immunodeficiency. / Thesis (M.D.)--University of Adelaide, Dept. of Medicine, 1998?

Diss. (sammanfattning) Stockholm : Karol. inst., 2001. / Härtill 7 uppsatser.

Diss. (sammanfattning) Stockholm : Karol. inst. / Härtill 4 uppsatser.

>Magister Scientiae - MSc / Determination of CXCR4-usage patterns is essential in establishing suitability of CCR5 antagonist prescription in HIV-1 infected individuals to prevent treatment failure. Previous studies have suggested a switch to CXCR4-usage to be far less common in subtype C, yet recent studies have reported between 30 - 50% CXCR4-usage in this subtype. However, CXCR4-usage in subtype C is poorly characterised. Furthermore, the reliability of available genotypic algorithms is unknown for subtype C sequences. In this study, a comparative analysis of the predictive ability of several subtype B-modeled genotyping algorithms in subtype C tropism determination was undertaken. A total of 731 HIV-1 subtype C V3 sequences with phenotypically determined coreceptor tropism were collated from several sources. Datasets of 349 CCR5, 25 CXCR4 exclusive and 31 R5X4 (Dual) sequences were submitted to 11 various tropism prediction tools. The best performing tool was used to determine the tropism of 12,121 subtype C V3 sequences with unknown phenotypes, in order to characterise the prevalence and method of CXCR4 usage in HIV-1 subtype C. We determined that geno2pheno with a false positive rate of 5% is the best approach for predicting CXCR4-usage in subtype C sequences with an accuracy of 94% (89% sensitivity and 99% specificity). Contrary to what has been reported for subtype B, the optimal approaches for prediction of CXCR4-usage in sequence from viruses that use CXCR4 exclusively, also perform best at predicting CXCR4-use in dual-tropic viral variants. Furthermore, we find that a switch to CXCR4 usage is seen in subtype C for well over 20 years and has occurred consistently over time. At 5%, the frequency of CXCR4-usage in subtype C database records is lower than previous reports for both subtype C and B. The Geno2pheno coreceptor tool may be used as a reliable genotypic predictor in clinical settings to establish the viability of CCR5-antagonist therapies using drugs such as Maraviroc and provides a rapid and cost effective alternative to phenotypic testing in resource limited areas. A switch to CXCR4-usage in subtype C is constant but lower when compared to subtype B, a finding which may have broad implications for the design of intervention and treatment strategies for HIV-1 subtype C.