Submitted by Erika Demachki (erikademachki@gmail.com) on 2014-10-08T21:42:51Z No. of bitstreams: 2 Dissertação - Bruna Lígia Ferreira de Almeida - 2013.pdf: 856377 bytes, checksum: bb3d1938f40e066ea7486b9a556bcf59 (MD5) license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) / Approved for entry into archive by Luciana Ferreira (lucgeral@gmail.com) on 2014-10-09T11:14:40Z (GMT) No. of bitstreams: 2 Dissertação - Bruna Lígia Ferreira de Almeida - 2013.pdf: 856377 bytes, checksum: bb3d1938f40e066ea7486b9a556bcf59 (MD5) license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) / Made available in DSpace on 2014-10-09T11:14:40Z (GMT). No. of bitstreams: 2 Dissertação - Bruna Lígia Ferreira de Almeida - 2013.pdf: 856377 bytes, checksum: bb3d1938f40e066ea7486b9a556bcf59 (MD5) license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) Previous issue date: 2013-04-05 / The feminization of the epidemic have many consequences, among them, the increasing number of HIV-infected children with mother to child transmission as the main route of infection. In 2010, the Ministry of Health created the recommended prophylaxis manual of mother to child HIV transmission and antiretroviral therapy in pregnant women and other behaviors related to prevention of mother to child HIV transmission. The objective of this study was to analyze if the recommendations of the Ministry of Health as control of mother to child HIV transmission are being taken by pregnant women and health professionals of a public maternity hospital in Goiânia. Research conducted between March and May 2012, divided into two stages: cross-sectional study, which consisted in the analysis of medical records of 323 HIV positive pregnant women seen at a public hospital in the State of Goiás between years 2006 to 2011, and second it is cross-sectional study involving 25 professionals working in maternity and obstetric center of this institution. Among the 323 records analyzed, 48.9% of pregnant women were included in the age group between 25 to 34 years old, 68.7% were single, 65.6% brown, 50.5% had study time between 4-7 years and 74.9% were unemployed. We checked the main risks related to mother to child HIV transmission in the 323 analyzed records. Among of the professionals surveyed, 76% have inadequate knowledge about HIV testing in pregnant women, 80% unaware the gestational age in what is realized elective caesarean, 66% do not know the dose to attack AZT and the elapsed time before child-birth, 84% do not know which method is indicated for lactation inhibition. The data observed in our study are alarming and show gaps in care for HIV positive pregnant women and newborns exposed, through information obtained that contradict this practice. / Nos últimos anos houve uma mudança do perfil da epidemia do HIV/aids, chamado por feminização da epidemia de HIV, um número crescente de mulheres em todo o mundo estão infectadas, sendo que mulheres e meninas constituem quase metade de todas as pessoas que vivem com vírus. A feminização da epidemia têm numerosas consequências, dentre elas, o aumento do número de crianças infectadas pelo HIV tendo a transmissão vertical como principal via de infecção. Em 2010, o Ministério da saúde criou o manual de Recomendações de profilaxia de transmissão vertical do HIV e terapia antirretroviral em gestantes e as demais condutas relacionadas a profilaxia da transmissão vertical do HIV. Assim, o objetivo geral deste estudo foi analisar se as medidas recomendadas pelo Ministério da Saúde como controle da transmissão vertical do HIV estão sendo adotadas por gestantes e profissionais de saúde de uma maternidade pública de Goiânia, Goiás. Pesquisa realizada entre março a maio de 2012, dividida em duas etapas: a primeira trata-se de estudo transversal, que consistiu na análise de 323 prontuários de gestantes HIV positivo atendidas em uma maternidade pública do Estado de Goiás entre os anos de 2006 a 2011, e a segunda trata-se de um estudo transversal envolvendo 25 profissionais atuantes na Maternidade e Centro Obstétrico desta Instituição. Dentre o 323 prontuários analisados, 48,9% das gestantes estavam inseridas na faixa etária entre 25 a 34 anos de idade, 68,7% eram solteiras, 65,6% pardas, 50,5% possuíam tempo de estudo entre 4 a 7 anos e 74,9% não possuíam vínculo empregatício. Foram verificados os principais riscos relacionados à transmissão vertical do HIV nos 323 prontuários analisados. Dos profissionais investigados 76% apresentam conhecimento inadequado sobre o teste anti-HIV na gestantes, 80% desconhecem com que idade gestacional realiza-se a cesárea eletiva, 66% não sabem a dose para ataque do AZT e o tempo utilizado antes do parto, 84% não conhecem qual o método indicado para inibição da lactação. Os dados observados em nosso estudo são preocupantes e evidenciam lacunas existentes na assistência prestada às gestantes HIV positivos e RN expostos, através de informações obtidas que contradizem essa prática.

Thesis (M. A. (Sociology)) --University of Limpopo, 2017. / Refer to document

This thesis assesses the effectiveness of the National Prevention of Mother to Child Transmission of HIV (PMTCT) programme in 3 sites in South Africa, and the quality of infant feeding counselling across four countries, Botswana, Kenya, Malawi and Uganda . Implementation and outcome of PMTCT services were very different across the 3 sites. The Paarl site is achieving results comparable to clinical trial studies with a HIV-free survival rate of 85% at 36 weeks, while Umlazi is somewhat lower (74%) and Rietvlei, with HIV-free survival of 64%. Maternal viral load, prematurity and site were independent risk factors for infection and/or death. The regression analysis suggests that some of this difference is explained by the differences in quality of health systems across the sites. Traditional risk factors (e.g. viral load, prematurity) do not seem to explain the substantial differences in HIV-free survival between the Paarl and Rietvlei sites. The overall mortality rate for HIV exposed infants in this cohort was 155 per 1000 live births at 36 weeks, a level higher than most other HIV exposed cohorts. The excess mortality is occurring almost completely amongst HIV infected infants who had a nine fold increased risk of mortality compared with HIV exposed but HIV negative infants. There was no significant difference in 36 week survival rates between those HIV exposed but uninfected infants and those who were not HIV exposed, Hazard ratio 0.7 (95% CI 0.3-1.5). With respect to HIV and infant feeding most health workers across the four countries (234/334, 70%) were unable to correctly estimate the transmission risks of breastfeeding. Exposure to PMTCT training made little difference to this. Infant feeding options were mentioned in 307 out of 640 (48%) observations of PMTCT counselling session and in only 35 (5.5%) were infant feeding issues discussed in any depth; of these 19 (54.3%) were rated as poor. South Africa was similar with only two out of thirty four HIV positive mothers being asked about essential conditions for safe formula feeding before a decision was made. This body of work has demonstrated that the gap between efficacy and effectiveness can be significant.

<p>Disclosure of HIV positive status to male partners is well established as a key element in the success of prevention of mother to child transmission of HIV programmes, as it helps improve adherence to ARVs by the women within these programme. However, partner notification rates remain low in the urban areas of Lusaka, Zambia against a high HIV prevalence of 25%. The purpose of this study was to explore the timing of disclosure as part of the process of disclosure amongst women who were part of the PMTCT services at Kaulu health centre in Lusaka. An exploratory descriptive study using qualitative research methods was conducted. 15 women, who were attending the Kaulu health centre PMTCT programme, were requested to participate in a semi-structured interview. The women, who were purposively selected with the aid of the health centre‟s PMTCT focal point nurse, had to have disclosed their HIV positive status to their partner, either before or during the course of their pregnancy or after delivery. To increase rigour,&nbsp / individual interviews were conducted with 5 health workers associated with the PMTCT programme so as to obtain their perspective and experiences on the issue of HIV disclosure amongst their PMTCT patients. Participation in the study was voluntary and all information obtained during the course of the interviews remained confidential and secure. Potential participants were each provided with an explanation of the purpose and process of the study and their informed written consent obtained before the researcher embarked on the interviews. Content analysis of the transcripts was done so as to develop coding categories and identify emerging themes. Disclosure to male partners is an important step in PMTCT and facilitates adherence to HIV care for the family and should be done as early as possible after the woman receives her HIV test result, though there exists a range of alternative times when it can be done. The relationship existing between a couple is very important in determining the timing of when a woman chooses to disclose. PMTCT services need to provide ongoing counselling for HIV positive women during pregnancy and after giving birth that supports, informs and equips them with the necessary skills to make an informed and timely decision about disclosure to a partner. In addition, the PMTCT service providers need to be encouraged to implement couple counselling as a strategy to facilitate disclosure as well as establishment of a peer support network for HIV positive pregnant women. The study findings will be used to contribute to health workers‟ capacity to support women manage the disclosure process to their male partners, thus helping to increase the disclosure rate and also contributing to improving the positive effect of the PMTCT services, in Lusaka, Zambia</p>

ABSTRACT Background: Worldwide HIV is going through a feminization and rejuvenation as more women are living with HIV/AIDS, increasing the risk of vertical transmission. Despite the efforts in Latin America and the Caribbean (LAC) by 2010, Panama was the third most affected country in the region with HIV/AIDS, with females aged 15-24 twice as affected as men. Methods: This descriptive epidemiological study of HIV vertical transmission in Panama reviewed clinical charts to identify health care personnel's practices during pregnancies in 2008. This study also examines the impact of interventions comparing the HIV outcome of the children at the end of the 18-month follow-up period (March 2011). Results: This study found 290 clinical charts; 116 from women and girls living with HIV who were pregnant in 2008 and 174 clinical charts of prenatally exposed children to HIV in 2008. During pregnancy, 58.05% of the mothers received HAART, and 68.39% received intravenous zidovudine during labor. The 81.03% of the children received oral zidovudine six weeks after birth, and 54.02% were fed with infant-adapted formula. During the follow-up period 12.64% of children studied were diagnosed as HIV positive and 36.36% of those children had an older seropositive sibling. Discussion: The Republic of Panama has made efforts to prevent vertical HIV transmission. The current study shows early interventions such as receiving HAART during pregnancy, intravenous zidovudine during labor, caesarean section birth, receiving oral zidovudine six weeks after birth, and feeding with infant-adapted formula that show statistical significance when compared to final diagnosis of the prenatally exposed children to HIV.

<p>Disclosure of HIV positive status to male partners is well established as a key element in the success of prevention of mother to child transmission of HIV programmes, as it helps improve adherence to ARVs by the women within these programme. However, partner notification rates remain low in the urban areas of Lusaka, Zambia against a high HIV prevalence of 25%. The purpose of this study was to explore the timing of disclosure as part of the process of disclosure amongst women who were part of the PMTCT services at Kaulu health centre in Lusaka. An exploratory descriptive study using qualitative research methods was conducted. 15 women, who were attending the Kaulu health centre PMTCT programme, were requested to participate in a semi-structured interview. The women, who were purposively selected with the aid of the health centre‟s PMTCT focal point nurse, had to have disclosed their HIV positive status to their partner, either before or during the course of their pregnancy or after delivery. To increase rigour,&nbsp / individual interviews were conducted with 5 health workers associated with the PMTCT programme so as to obtain their perspective and experiences on the issue of HIV disclosure amongst their PMTCT patients. Participation in the study was voluntary and all information obtained during the course of the interviews remained confidential and secure. Potential participants were each provided with an explanation of the purpose and process of the study and their informed written consent obtained before the researcher embarked on the interviews. Content analysis of the transcripts was done so as to develop coding categories and identify emerging themes. Disclosure to male partners is an important step in PMTCT and facilitates adherence to HIV care for the family and should be done as early as possible after the woman receives her HIV test result, though there exists a range of alternative times when it can be done. The relationship existing between a couple is very important in determining the timing of when a woman chooses to disclose. PMTCT services need to provide ongoing counselling for HIV positive women during pregnancy and after giving birth that supports, informs and equips them with the necessary skills to make an informed and timely decision about disclosure to a partner. In addition, the PMTCT service providers need to be encouraged to implement couple counselling as a strategy to facilitate disclosure as well as establishment of a peer support network for HIV positive pregnant women. The study findings will be used to contribute to health workers‟ capacity to support women manage the disclosure process to their male partners, thus helping to increase the disclosure rate and also contributing to improving the positive effect of the PMTCT services, in Lusaka, Zambia</p>

Magister Public Health - MPH / Since the introduction in 2005 of prevention of mother-to-child transmission of HIV (PMTCT) services in Akwa Ibom State in Nigeria the PMTCT programme has faced several challenges including that of poor male participation in the PMTCT programme. To date no research has focused on the issue of male participation in PMTCT programmes in Akwa Ibom State, and there is thus a limited understanding of why so few male partners of HIVpositive pregnant women participate in the State's PMTCT programme. It is therefore important to explore the factors affecting male involvement in PMTCT programmes in Akwa Ibom State, so that strategies can be put in place to help improve the overall health of their families and themselves. The overall aim of the study was thus to explore the factors affecting male participation in the PMTCT programme at a primary health care center in West Itam, Akwa Ibom State, in Nigeria. This explorative study was conducted using a descriptive qualitative research approach. The research study approach helped to understand the perspectives of the male partners of HIV positive pregnant women who received the PMTCT intervention, as well as key informants in the Primary Health Care (PHC) facility where these PMTCT services are offered. The study population consisted of all males living within the catchment area of the West Itam PHC, Akwa Ibom State, Nigeria. In the research study, 11 men were purposively sampled: five of whom were the partners of HIV-positive women who had attended, or were currently attending the PMTCT services at the West Itam PHC with their partner. The other six interviewees were local male community members – who would be eligible to potentially accompany their partner to PMTCT services at the facility. The data was collected through individual, in-depth interviews with the male partners and community members using a semi-structured interview guide. One focus group discussion (FGD) was conducted with key personnel working in the West Itam PHC using a semistructured interview guide. All interviews and the FGD were tape-recorded and transcribed. Thematic analysis was used to analyse the data. Ethical approval was first obtained from the UWC Research Ethics Committee and the Ethics Committee of the Akwa Ibom State Ministry of Health before proceeding with the study. From this study, it is suggested that most of the respondents knew that PMTCT services are offered at the PHC West Itam. They knew their partner's next antenatal appointment, but only very few accompany their pregnant partners to the antenatal clinic. The striking reason being a lack of time/being busy. The key means of support of the partners' antenatal visits was giving their pregnant partners money for transport, and money for food/snacks (at the clinic). Inter-spousal communication was found to be good, and there appeared to be a perception by the men that antenatal clinic (ANC)/PMTCT is not only for women, with most of the men agreeing that it is useful for men to participate in PMTCT. The barriers to male participation in the PMTCT programme that were elicited in this study include lack of belief about HIV/AIDS and lack of awareness about PMTCT and the perception of PMTCT as a "women's affair". Another barrier to male participation in the PMTCT programme was the men being busy with their jobs/lack of time, and fear. Facility-based barriers include delays/time wasting at the clinic, and the nurses, who were identified as having an unaccommodating attitude towards the clients. Finally, the fact that the nurses and counsellors at the PHC West Itam were all female was a problem for men. It is recommended that there is need for advocacy and education to raise awareness about HIV/AIDS, and encourage male participation in PMTCT. It is also important to encourage the disclosure of HIV status by the women to their male partners. Furthermore, a separate male counselling unit needs to be created, as well as ensuring the employment of male nurses and counsellors. Additionally, the female nurses at the facility need to be trained/re-trained on proper attitude and confidentiality, and efforts must be made to avoid delays at the clinic.

Master of Public Health - MPH / Background: Zimbabwe has one of the highest HIV prevalence rates in sub-Saharan Africa, with the adult prevalence rate at 15%. The HIV prevalence is highest among adult women, at 18%. Mother-to-child transmission is the second leading cause of HIV in Zimbabwe. Therefore, provision of anti-retroviral therapy to pregnant women is important in reducing mother-to-child transmission. In 2012, the World Health Organisation formally adopted ART guidelines known as "Option B Plus", where triple therapy is provided to pregnant women for life, regardless of CD4 count. Zimbabwe subsequently adopted Option B Plus in September 2013. However, the success of ART depends on adherence to treatment. Lack of adherence to treatment leads to an increased risk of opportunistic infections and drug resistance, which is costly to treat. The aim of the study was to explore pre-and post-partum barriers to anti-retroviral therapy for HIV-positive women initiated onto Option B Plus in Harare, Zimbabwe. Methodology: Descriptive qualitative methods were used to explore the barriers to ART adherence for pre-and post-partum HIV-positive women initiated onto Option B Plus in Harare, Zimbabwe. In-depth, semi-structured interviews were conducted in Shona with 20 non-adherent pre-and post-partum HIV-positive women and four key informants who are health workers from two identified health facilities (Edith Opperman Polyclinic and Kuwadzana Polyclinic). The interviews were recorded, transcribed and translated into English. The data was analysed using inductive thematic analysis. Results: Health facility and individual factors emerged as barriers to adherence. Heavy workload and staff shortages, negative health worker attitude, cost of accessing health facilities, medicine shortages and detrimental health facility policies were all health facility related barriers identified by both key informants and the women. Individual barriers were related to difficulty in navigating the early days after diagnosis and treatment, stigma, intimate partner dynamics and religion. Conclusion: Despite free, decentralised provision of ART, barriers to adherence still exist. Many of the barriers have been articulated in previous research that focused on prevention of- mother-to-child transmission regimens, as well as ART regimens for the general population. The fact that the barriers remain suggests that the barriers are complex and addressing them will require tackling social constraints such as stigma and gender roles that pose a significant barrier to adherence.

Magister Public Health - MPH / The study aimed to assess the level of adherence and to identify the barriers to adherence and the motivations for good adherence to antiretroviral therapy, amongst women who commenced treatment while pregnant at research clinics in Molepolole, Mochudi, Lobatse and Gaborone. / South Africa

Magister Public Health - MPH / Introduction Mother to Child Transmission is a significant route of HIV infection in children and in South Africa (SA) the median HIV prevalence rate among pregnant women is 30, 2% and in the Western Cape Province (WCP) it is 18, 2%. lthough Prevention of Mother to Child Transmission (PMTCT) programmes are now available at 100% of all health care facilities and 95% of women attend antenatal care, these programmes are complex and outcome data reveals fluctuations in transmission rates as well as pockets of high transmission within well performing sub-districts. The careful management of programme processes thus requires more than coverage and outcome data. It also requires a clear picture of process indicators related to access to PMTCT services, the quality and continuity of care within the PMTCT programme and integration of PMTCT service into the comprehensive package of health care services. Aims and objectives To develop a tool that will measure the quality of care of HIV exposed infants in the PMTCT programme at primary care setting in Cape Town, by engaging local programme managers in a participatory process to develop a tool that is locally applicable and relevant, and captures local management expertise. To identify the evaluation omains, to develop a set of indicators for each domain and to pilot the tool to assess its feasibility and usefulness of the data generated.