Major advances have been made in preventing mother to child transmission of HIV (PMTCT), as well as in decreasing morbidity and mortality amongst HIV-infected infants and children. However, maintenance of excellent adherence to combination antiretroviral therapy (cART) lifelong is required to achieve optimal benefits. In addition, treatment options for children are limited by potential drug-resistance following PMTCT exposure, availability of appropriate and palatable formulations, long-term toxicity concerns and drug-interactions - notably with co-treatment for tuberculosis. Given these challenges, drug simplification strategies for children remains an important area of research. The World Health Organisation (WHO) recommends lopinavir/ritonavir-based (LPV/r) cART as first-line for children <36 months old with the option to substitute LPV/r with a non-nucleoside reverse transcriptase inhibitor if virologic suppression is maintained. This simplification strategy is potentially cost-saving, regimen-sparing and more tolerable, with a better long-term side-effect profile. Consequently, benefits should also exist in terms of adherence. The main evidence in support of this strategy has come from trials conducted by the Nevirapine Resistance Studies (NEVEREST) group. In particular, the NEVEREST 3 trial showed that substituting LPV/r for efavirenz (EFV) in children aged 36-60 months virologically suppressed on LPV/r-based cART was protective against viral rebound and had no effect on virological failure compared with remaining on LPV/r. To our knowledge, no studies to date have examined the virologic outcomes of children changed to an EFV-based regimen after initiating a LPV/r based regimen in routine, resource-constrained settings where selection of patients as eligible for EFV substitution and subsequent monitoring practices may be less rigorous than in a trial setting. At the International Epidemiologic Database to Evaluate AIDS - Southern Africa collaboration's (IeDEA-SA) South African sites LPV/r has been used for first-line cART in children <36 months of age irrespective of PMTCT antiretroviral exposure. At many of these sites clinicians have, at their discretion, elected to substitute LPV/r with EFV when children reach 36 months of age. This has provided the opportunity to conduct an observational study to investigate this practice in a routine-care setting – comparing outcomes in children virologically suppressed and ≥36 months old who underwent a substitution of LPV/r to EFV (substitution group) to those who remained on their initial LPV/r-based regimen (stay group).

Background: The prevalence of global abortion rates coupled with the lack of systematic assessment tools for monitoring women's abortion experiences has necessitated the creation of a core outcome set (COS) outlining key outcomes of women's abortion experiences. Objectives: Utilizing a woman-centered lens, this project attempts to establish this core outcome set through a qualitative systematic review of key abortion outcomes as espoused by women's perspectives across the globe. Methods: A qualitative review was performed to determine outcomes that are meaningful to women experiencing abortion. Findings: After analyzing the qualitative data produced by the 32 included studies, nine core outcomes were established. These outcomes include continuity of care, the capacity to cope effectively with the psychological dimensions of abortion, and the capacity for self-care/self management during their abortion processes. Women also discussed the importance of feeling a sense of autonomy, choice and control during their abortion experiences as well as feeling that healthcare providers met their information needs. Feeling emotionally supported by healthcare providers as well as having felt treated respectfully by healthcare providers, the capacity to control/management of pain, side effects and complications and the social repercussions of abortion were identified as core outcomes. Conclusion: Incorporating these findings into relevant surgical and medical abortion trials has the potential to increase the impact of women's perspectives and experiences on the study of abortion.

The World Health Organization (WHO) Constitution defines health as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity”, and further states “the highest standards of health should be within reach of all, without distinction of race, religion, political belief, economic or social condition” (WHO, 2006). “This definition applies equally to migrants as health is a basic human right and an essential component of sustainable development. Health is a fundamental precondition for migrants to contribute to the social and economic development of their communities of origin and destination” (Migration Data Portal, 2021). However, migrants often experience legal, social, cultural, economic, behavioral and communication dissimilarities from their own country. These differences and conditions often lead to health inequity between migrants and locals. Nevertheless, there is little research on the determinants of health inequity between migrants and locals. This paper intends to reveal, through empirical analysis, factors determining health inequity between migrants and locals. Based on the International Organization of Migration’s (IOM) applied Dahlgren-Whitehead (2007) model, health equity determinants were examined based on three areas: (1) the effect of social and community influences on health equity, (2) the effect of living and working conditions on health equity, and (3) the effects of general socioeconomic, cultural, and environmental conditions on health equity. From the analysis: countries that have less discrimination against minorities (the higher GAI), fewer language spoken (the lower LDI), higher acceptance of migrants (the higher MAI), better assessment of 'basic human needs' and 'welfare-based' opportunities (the higher SPI), more specialized quality body and enforcement mechanisms for discrimination (the higher MDISC), more equitable laws addressing individual and property right (the higher RLI), and fairer distribution of income and benefits (the higher IHDI) indicated fewer health inequities between migrants and locals. / 2024-03-09T00:00:00Z

The aim of this study was to investigate the relationship between parent’s socioeconomic status including age, income, marital status, parent’s education level, and whether they stay at home and the influence of these factors on their children’s dietary habits and oral health. A total of 60 parents of children aged 1-5-years were included in this questionnaire-based study. Parents were asked to complete a self-administered paper–pencil questionnaire that included 53 items assessing different factors such as their demographic information and their children’s dietary and oral health factors. Demographic information included the parent’s age, income level, marital status, parents’ education level, and if the parents are stay at home parents. Although parents’ age, marital status, income and employment status showed no significant relationship with children’s eating schedule (p>0.05), parents’ education level and whether they stay at home significantly impacted children’s eating schedule (p<0.001 and p=0.02 respectively). Most of the parental characteristics did not significantly impact the consumption of juice and sugar except for parents’ education level. Sugar consumption was inversely related to parents’ education level (p=0.02). When comparing the prevalence of dental caries in the three categories of parents’ education level, children of parents with a bachelor’s degree or higher reported significantly lower prevalence of dental caries among their children than parents from other educational levels(p=0.005). The parental demographical factors showed no influence on whether the child drank from a bottle or sippy cup for children older than 1-year-old. Also, parents’ income did not have a significantly impact on children’s eating habits and the level of caries. In conclusion, our results suggest a possible association between dental caries and selected parental sociodemographic characteristics. Parent’s education level had a significantly positive impact on the eating schedule of their children as well as children’s sugar consumption. Having stay at home parents can positively and significantly impact on adopting a healthy eating schedule among children.

This study tested the effectiveness of a substance abuse and substance-related HIV prevention programme designed for use within a South African workplace setting. The overarching study design used in this study was a clustered RCT which employed seven distinct phases. Phase 1 of the study required determining the effectiveness of programmes to prevent substance abuse and substance-related HIV risks at the workplace through a systematic review. This was followed by the selection of a substance abuse and substance related HIV prevention programme for implementation within a service industry in Cape Town, South Africa. Phase 2 employed a cross-sectional study design for collecting baseline data on substance abuse and substance-related HIV risks. Phase 3 of the study required the effective adaptation of the selected evidence-based substance abuse and substance-related HIV risks prevention programme for application in the workplace. This phase was followed by an outcomes evaluation on the implemented programme. Qualitative in-depth interviews with 8 participants, all senior management in the organization where study was conducted, concluded the study. For the clustered RCT, data were gathered from 325 employees who were employed in two divisions within a local municipality. The Team Awareness (TA) intervention, an eight hour evidence-based programme addressing behavioural risk among employees, was administered to 168 employees in the intervention arm. The 157 employees in the control arm received a one hour wellness talk. Self-report questionnaires were used to gather data on demographic variables, the work environment, policy and EAP service utilisation, substance abuse behaviours, co-worker substance abuse and substance-related HIV risks. Data was analysed using a random effects model accounting for clustering. This study found that alcohol is the more commonly substance abused by persons in this sample. Of the sample surveyed, more than three quarters indicated abuse of alcohol, with only a small proportion of employees reporting drug abuse. Close to a quarter had a positive CAGE score greater than the cut-off :!:2, suggesting hazardous drinking patterns. A third of employees in our sample, who use alcohol, reported engaging in risky sexual practices. The results suggest that employees who received TA showed significant reductions in the risky use of alcohol from baseline to three month follow-up. TA was also found to increase willingness to use the EAP service and improve employee knowledge in relation to workplace substance abuse polices. These findings highlight the need for evidence-based prevention programmes in workplace settings. It further highlights that application of one intervention programme, Team Awareness since TA was found to contribute to reductions in problem drinking and increases help-seeking behaviours. Additionally such prevention programmes create positive attitudes towards policies that regulate substance abuse within the workplace environment. The study makes useful recommendations for research practice and policy to help organisations address the burden of substance abuse.

Rapid urbanisation in many low- and middle-income countries in Africa has led to substantial changes in both built and food environments, with resultant changes to housing and diet, respectively. These changes interact with factors that influence risk of disease and healthcare access, and may contribute to, and exacerbate, inequities in health outcomes. Increasing global attention is given to the link between characteristics of built and food environments and health. In addition, international health agendas are calling for intersectoral action, which may be guided by the World Health Organization's Health-in-All-Policies approach, to address the social determinants of health that largely lie outside the reach of the health sector. The thesis uses two lenses to investigate the intersectoral determinants of health exploring: i) non-communicable diseases through a food environment lens in the African region, and ii) infectious diseases through a human settlement built environment lens in South Africa. Firstly, this research investigates the landscape of global, regional (African) and national (South African) policies to identify opportunities to integrate health considerations into diet-related and human settlements policies. Secondly, focusing on the built environment context of Cape Town, South Africa, this thesis provides a practical demonstration of a transdisciplinary research approach to gathering evidence, integrating data from health and non-health sectors, and building support for a future implementation of a Health-in-All-Policies approach within a sub-national government setting. In addition, an improved transdisciplinary research approach was developed to support future efforts to address health inequities through urban planning interventions.

Background: In 2019, the World Health Organisation called for the elimination of cervical cancer as a public health concern. In South Africa, despite having a national screening policy in place since 2000, diagnosed cervical cancer incidence has shown no signs of decline. Since 2014, girls aged 9 have been vaccinated against HPV infection using the bivalent vaccine, with high coverage. However, due to the long delay between HPV infection and progression to cancer, the impact that vaccination will have on cervical cancer incidence will be unobservable in the near future. This thesis sets out to quantify this impact using a mathematical model, and will estimate the impact of scaling up current cancer prevention strategies, as well as proposed alternative strategies. Methods: This research extends a previously developed individual-based model for HIV to include infection with 13 high-risk HPV types and progression to cervical cancer. HPV infection and cervical disease parameters were calibrated to a wide range of South African data sources using a likelihood based approach. In the process of developing an appropriate model for cervical cancer incidence in South Africa, important aspects related to HIV/HPV co-infection dynamics, the natural history of HPV and the current and historic levels of cervical cancer prevention in the Western Cape were investigated. The calibrated and validated model was used to estimate the impact of current and proposed alternative prevention strategies on cervical cancer incidence in the next century. Findings: Using a model structure that does not include a biological transmission co-factor, we show that simulated associations between HIV and HPV transmission are similar to corresponding empirical estimates and therefore these associations may result from residual confounding by sexual behavioural factors and network-level effects. Using simulated vaccine trials, we show that viral latency and reactivation of latent infections is necessary in the natural history of HPV to match results from empirical trials. The model's screening algorithm reflects findings from the Western Cape's public health sector – low levels of screening coverage and linkage to treatment facilities, and poor adherence to screening schedules. The model matches stable trends in diagnosed cervical cancer incidence in South Africa, but it estimates increases in cervical cancer incidence over the last number of years (due to increased life expectancy of women on ART), which will result in sharp increases in diagnoses. While decreasing HIV prevalence and HPV vaccination will substantially reduce cervical cancer incidence in the long term, improvements in South Africa's current screening strategy, as well as switching to new screening technologies, will have significant impact in the short term. Conclusions: This thesis presents an epidemiological model of cervical cancer in South Africa – the first to dynamically simulate infection with both HIV and HPV at national level. It allows for estimation of the impact of both HIV and cervical cancer prevention on cancer incidence, and provides the opportunity to identify the vaccination and screening strategies with the greatest public health significance.

While rates of uninsured have dropped in the United States, The Latinx population continues to suffer from the highest proportion of the uninsured (KFF 2016). Obstacles persist for Latinos/Latinas, even though health coverage appears to be at its peak. The purpose of this paper is to investigate the experiences of Latinx in the Greater Boston Area, who are eligible under the Affordable Care Act and/or state-subsidized health care. The focus of this investigation is the subsidized health plan enrollment process and health care experiences of those who are eligible and interested in enrolling. This includes obstacles to signing up for health plans offered on the state health care exchange, Latinx perceptions of and their experiences with the ACA and the HealthConnector, and how subsidized health care influences their perceptions surrounding access to care. To capture a more accurate image of the Latinx experiences with state-subsidized healthcare, this paper also explores the 2017 political climate, the proposal of Trumpcare, and the effects of the proposed healthcare reform on a vulnerable population.

Includes bibliographical references (leaves 47-51). / The aim of this thesis is to characterise the profile of infant, childhood and adolescent mortality in three adjancent district municipalities in the Boland region of the Western Cape Province of South Africa.

Includes bibliographical references. / The aim of our study was to identify areas for quality improvement in regards to preventable trauma deaths at Groote Schuur Hospital Trauma Centre (GSHTC).