BACKGROUND: Human Papillomavirus (HPV) is the most common sexually-transmitted infection in the U.S. and is associated with a number of cancers. A vaccine that can prevent 90% of HPV-associated cancers has been available since 2006, yet millions of young adults remain unvaccinated. Low vaccination uptake has been observed in cisgender sexual minority communities and less is known about HPV vaccination among transgender and gender nonbinary (TGNB) people. The aims of this dissertation were: (a) to identify facilitators for and barriers to HPV vaccination among gender minority people; (b) to compare HPV vaccination rates, HPV risk and situational factors like barriers to care, access to care, preventive care, HPV knowledge and Internet use in a sample of TGNB people and cisgender sexual minority people; and (c) to explore the association of online health information and HPV vaccination receipt among TGNB people compared to cisgender sexual minority people and determine if eHealth Literacy or general health literacy moderate this relationship. METHODS: The dissertation comprised three studies. First, an integrative review of the literature included searches of three electronic databases to identify and appraise studies that explore patient-, provider- and system-level HPV vaccination barriers among gender minority people. Second, guided by the Integrative Model of eHealth Use, a cross-sectional secondary analysis of The Population Research in Identities and Disparities for Equality (PRIDE) Study Annual Questionnaire 2018-19, compared the rate of HPV vaccination among TGNB and cisgender sexual minority people and described situation factors (e.g., barriers to care, access to care, preventive care), Internet use, HPV knowledge, HPV risk, and HPV vaccination among these communities. Third, a novel cross-sectional online survey of TGNB and cisgender sexual minority participants recruited from The PRIDE Study, also guided by the Integrative Model of eHealth Use, explored the association between online health information seeking and receipt of HPV vaccine, and whether eHealth literacy and/or general health literacy moderate this relationship. Statistical methods for the cross-sectional studies included prevalence ratios (PR) using robust Poisson statistics and multivariable logistic regression with post hoc Bonferroni-Holm correction. RESULTS: The integrative review identified six cross-sectional studies and one qualitative study that explored HPV vaccine barriers and facilitators among gender minority people. The majority of the studies included <10% gender minority participants. Key barriers to vaccination identified were misperceptions of risk at patient-level, bias towards vaccinating female assigned individuals at the provider-level and population effects of recommendations for girls-only at the policy-level. The cross-sectional secondary analysis of The PRIDE Study 2018-19 Annual Questionnaire and included N = 5,500 responses and found that: (a) the prevalence of ever receiving HPV vaccine was 1.2 times greater among TGNB participants than cisgender participants (PR 1.2; 95% CI, 1.1-1.3); (b) the prevalence of ever receiving HPV vaccine was 2.4 times greater among transgender men who were assigned female at birth compared to transgender women who were assigned male at birth (PR 2.4; 95% CI, 2.0-2.8); and (c) no differences in vaccination initiation and vaccination completion based on gender identity, sex assigned at birth, sex organs born with, or current sex organs. The cross-sectional novel online survey of PRIDE participants yielded N = 3,258 responses (response rate 19.6%). After controlling for covariates including age, race/ethnicity and educational attainment, we found that TGNB as compared to cisgender participants had increased odds (aOR=1.5=; 95% CI, 1.1-2.2) of reporting receipt of HPV vaccine ever and decreased odds (aOR=0.7; 95% CI, 0.5-0.9) of ever receiving of HPV vaccine when they looked for info on vaccines in the past year. Conversely, TGNB participants had over twice the odds (aOR=2.4; 95% CI, 1.1-5.6) of ever receiving HPV vaccine if they visited a social networking site like Facebook or Instagram in the past year. There were no moderating effects observed from eHealth or general health literacy. CONCLUSIONS: TGNB communities are understudied in terms of HPV vaccination and the existing literature shows misperceptions about the need of HPV vaccination among TGNB communities at both the patient and provider level. TGNB participants were more likely to have ever received HPV vaccine compared to cisgender sexual minority participants in the cross-sectional secondary analysis of The PRIDE Study 2018-19 Annual Questionnaire which may be attributed to high primary engagement in the cohort. Finally, online health information seeking about vaccines was associated with decreased receipt of HPV vaccine (ever) whereas social media use increased HPV vaccine receipt (ever) among TGNB participants compared to cisgender sexual minority participants. These conflicting findings suggest that the quality of online health information relating HPV vaccines, how, when and why TGNB people search for health information online may affect health behaviors like HPV vaccination. More research is warranted to explore how online health information seeking may influence personal health decision-making among TGNB communities.

All six plants studied (Senna petersiana, Terminalia sericea, Cassine transvaalensis, Elephantorrhiza burkei, Rauvolfia caffra and Anredera cordifolia) proved to have considerable antibacterial activity. The water extracts of five of the six plants tested, showed activity against Bacillus pumilis, B. subtilis and Staphylococcus aureus respectively. Water extracts from S. petersiana showed a significant antibacterial activity by inhibiting all Gram-positive and two Gram-negative bacteria. A cytotoxicity assay of three plants (S. petersiana, T. sericea and A. cordifolia) on primary vervet monkey kidney ceelsl showed that A. cordifolia was the least cytotoxic extract with an ID50 value of 1.560 mg/ml. Both S. petersian and T. sericea showed an ID50 value of 0.024 mg/ml. Cytotoxicity as determined in this study does not necessarily mean that the active compound which can be isolated from these plants will also be toxic. Antiviral activity of S. petersiana, T. sericea and A. cordifoli crude extracts were investigated against herpes simplex virus type I at the non-toxic concentrations. Both T. sericea and A. cordifoli extracts showed to be non-active against HSV -I, but S. petersiana showed a 20 % reduction in replication of the virus after the sixth day of the experiment. Because of the sensitivity and instability of compounds in the root extract of S. petersiana, it was very difficult to isolate any pure compound. Bioassay-guided fractionation of the seeds of S. petersiana resulted in the isolation luteolin. Its structure was identified and confirmed through spectroscopic methods including IH, BC, UV, HMBC and HMBQ. An antibacterial assay of luteolin isolated from the seeds of S. petersiana showed activity against Baccilus cereus, B. pumilis, Streptococcus aureus and Staphylococcus areus at the concentration of I mg/ml. In the assay to assess the possible antiviral activity of luteolin against herpes simplex type I virus, 50% of the virus was inactivated at the concentration of 250 μg/ml. The results of this study have shown that it is possibl4e that the extracts studied, can provide humankind with valuable agents of potential use in the treatment of herpes and some bacterial species. / Dissertation (MSc ( Plant Physiology))--University of Pretoria, 2006. / Plant Science / unrestricted

The overall aim of this study was to evaluate quality of STI services in Umjindi local municipality. A concrete objective was to investigate the health system issues that may have a negative impact in the provision of quality STI service in the local municipality. These include accessibility of the STI services to the community, training of health workers in syndromic management, availability of necessary equipment and supplies for STI management, turn-around time for blood results and infrastructure of the facilities.

The overall aim of this study was to evaluate quality of STI services in Umjindi local municipality. A concrete objective was to investigate the health system issues that may have a negative impact in the provision of quality STI service in the local municipality. These include accessibility of the STI services to the community, training of health workers in syndromic management, availability of necessary equipment and supplies for STI management, turn-around time for blood results and infrastructure of the facilities.