O objetivo do estudo foi avaliar a influência da implantação do projeto Pré-natal do parceiro (PNP) no município de Ribeirão Preto sobre: 1) as taxas das infecções pelo vírus da imunodeficiência humana (HIV), vírus das hepatites B e C (VHB, VHC) e pelo Treponema pallidum (TP) entre gestantes; 2) as taxas de transmissão vertical (TV) dos VHB, VHC, do HIV e do TP; 3) os indicadores de qualidade do pré-natal (número de consultas; idade gestacional (IG) na primeira consulta; desfecho gestacional); 4) os indicadores perinatais (peso ao nascer; prematuridade; índice de Apgar no 1º e 5º minutos) e 5) as taxas das infecções pelos VHB, VHC, do HIV e do TP nos parceiros que aderiram ao projeto. Estudo transversal do grupo de gestantes (G) e nascidos vivos (NV) que tiveram seus parceiros participantes do projeto PNP (denominados G1 e NV1) e do grupo de gestantes e NV que não tiveram seus parceiros participantes do projeto PNP (denominados G2 e NV2). Os grupos de gestantes e parceiros foram incluídos no estudo no período de 1º de Julho de 2013 a 30 de Junho de 2014 e os grupos de NV, entre 1º de Julho de 2013 a 31 de Dezembro de 2014. Foram selecionadas 5391 gestantes (1781 do G1 e 3610 do G2), 1781 parceiros e 4044 NV (1376 do NV1 e 2668 do NV2). Utilizado o teste Quiquadrado de Pearson com um nível de significância de 5%. Os resultados demonstraram prognósticos estatisticamente mais favoráveis no grupo onde houve a participação do parceiro no pré-natal (G1 e NV1). Encontraram-se menores taxas de TV (0,7% no NV1 e 1,5% no NV2 com p= 0,04); início mais precoce do PN (com até 120 dias de gestação 88,3% no G1 e 84,5% no G2 com p< 0,01); mais de sete consultas no PN (80,8% no G1 e 74,3% no G2 com p< 0,01); desfecho gestacional favorável (95,9% no G1 e 94,2% no G2 com p= 0,01); menores taxas de prematuridade (10,3% no NV1 e 12,9% no NV2 com p= 0,01), menor ocorrência de baixo peso ao nascer (8,7% no NV1 e 11,4% no NV2 com p< 0,01) e melhores índices de Apgar no 5º minuto (2,5% de Apgar <= 7 no NV1 e 3,8% no NV2 com p= 0,03). Frente a estes dados foi possível concluir que a estratégia de inclusão do parceiro no PN foi importante na identificação e tratamento da sífilis reduzindo significativamente a taxa de TV do TP. A adesão do parceiro ao PNP foi fundamental para a adesão da gestante ao PN associando-se também à melhora significativa dos indicadores de saúde perinatal / The goal of these study was to evaluate of the influence of the implementation of the project \"Male Partner in the Prenatal Care (MPPC)\" in Ribeirao Preto city on: 1) the rates of infection by the human immunodeficiency virus (HIV), hepatitis virus B and C (HBV, HCV), and Treponema pallidum (TP) among pregnant women; 2) the vertical transmission (VT) rates of HBV, HCV, HIV and TP; 3) the prenatal care quality indicators (number of visits, gestational age (GA) at the first visit, gestational outcome); 4) the perinatal indicators (birth weight, prematurity, Apgar score at 1 and 5 minutes) and 5) the rates of infection with HIV, HBV, HCV and TP in partners that have joined the project. It is a cross-sectional study of group of the pregnant women (G) and born alive (BA) who had their partners participating MPPC project (called G1 and NV1) and the group of pregnant women and BA who have not had their partners participants (called G2 and NV2). The pregnant women groups and the male partners group were surveyed in the period from July 1, 2013 to June 30, 2014 and the BA groups, between July 1, 2013 to December 31, 2014. Were selected 5391 pregnant women (1781 of the G1 and 3610 of the G2), 1781 partners and 4044 BA (1376 of the NV1 and 2668 of the NV2). Used the Chi-square test of Pearson with a 5% significance level. The results showed statistically more favorable prognosis in the group where there was the partner\'s participation in prenatal care (G1 and NV1). The lower VT rate was found (0.7% in NV 1 and 1.5% in NV2 p= 0.04); earlier initiation of PN (up to 120 days of gestation 88.3% in G1 and 74.3% in G2 with p< 0.01); more than seven consultations in PNC (80.8% in G1 and 74.3% in G2 with p< 0.01); favorable pregnancy outcome (95.9% in G1 and 94.2% in G2 with p= 0.01); lower prematurity rates (10.3% in the NV1 and 12.9% in the NV2 with p= 0.01); lower incidence of low birth weight (8.7% in NV1 and 11.4% in NV2 with p< 0.01) and better Apgar scores at five minutes (2.5% Apgar <= 7 in NV1 and 3.8% in NV2 with p= 0.03). Considering these data it was concluded that the male partner\'s inclusion strategy in prenatal care was important in the identification and treatment of syphilis reducing significantly the VT rate of the TP. The partner\'s adherence to MPPC project was essential to the mother\'s adherence to PNC and it was also associated with significant improvement in perinatal health indicators.

Submitted by Fabiana Gonçalves Pinto (benf@ndc.uff.br) on 2016-05-11T18:37:15Z No. of bitstreams: 1 Lauanna Malafaia da Silva Alves.pdf: 83952060 bytes, checksum: 65e2587e0f40c942aea429d572a70c5a (MD5) / Made available in DSpace on 2016-05-11T18:37:15Z (GMT). No. of bitstreams: 1 Lauanna Malafaia da Silva Alves.pdf: 83952060 bytes, checksum: 65e2587e0f40c942aea429d572a70c5a (MD5) Previous issue date: 2015 / Mestrado Profissional Ensino na Saúde / O presente estudo tem por objetivos identificar as dúvidas dos alunos do Instituto Federal Fluminense (IFF) Campus Campos Guarus sobre Infecção Sexualmente Transmissível (IST) e propor uma abordagem ou metodologia educacional mais apropriada para os mesmos; programar e realizar a Educação Permanente, no Instituto Federal Fluminense, tendo como ponto de partida a temática IST; elaborar uma Fan Page para disponibilizar oficinas de educação permanente para profissionais de saúde e educação sobre IST. A problemática que levou ao desenvolvimento desta pesquisa surgiu a partir da percepção pelos autores que, em sala de aula, sabem que a quantidade de assuntos para serem retratados é grandiosa, pois, tendo que desenvolver o conteúdo pedagógico, os professores acabam não dialogando sobre assuntos pessoais e íntimos com os alunos, e os servidores, muitas das vezes não sabem como lidar com a sexualidade dos adolescentes. Do outro lado, a família e os pais modernos têm cada vez menos tempo para dialogar com os seus filhos. Deste modo, cabe perguntar: quem poderá contribuir para a prevenção de IST dos adolescentes e outros problemas relativos ao autocuidado? Seria importante que os servidores da escola participassem de um projeto de educação permanente? Desta forma, esta pesquisa é um estudo descritivo e exploratório, com abordagem metodológica qualitativa, pesquisa de campo, participativa, do tipo pesquisa-ação, realizada no IFF Guarus. Por ser uma pesquisa que envolve seres humanos, a mesma foi submetida ao comitê de ética e aprovada em 08/08/2014 com o parecer número 741.076. Como sujeitos desta pesquisa têm-se os alunos do primeiro ano do Ensino Médio dos cursos de Meio Ambiente e Eletrônica e os servidores do IFF Guarus. Para a coleta de dados trabalhou-se em momentos distintos, primeiramente com os discentes, com a realização de entrevista semiestruturada e caracterização, depois com os servidores, através de oficinas de Educação Permanente sobre IST. Dos 127 alunos convidados, 64% participaram e dos 161 servidores convidados, 11% compareceram às oficinas. Para análise de dados, foram utilizados os preceitos de Bardin e como referencial teórico, Paulo Freire e Dorothéa Orem. E assim, emergiram quatro categorias: Desconhecimento + Infecção Sexualmente Transmissível = Perigo; Educação e Saúde em Ambiente Escolar; Educação Permanente na Escola; A importância da sensibilização para reconstrução de atitudes e valores profissionais. Como produto de pesquisa, elaborou-se uma Fan Page e como subproduto, um Guia para realização de Educação Permanente na Escola sobre IST, situações problemas baseadas na coleta de dados para serem utilizadas em metodologia ativa de ensino e um roteiro de Sistematização da assistência de enfermagem para adolescentes com foco na prevenção de IST. Conclui-se que a Educação Permanente é um recurso pedagógico que poderá auxiliar nos problemas relacionados à vida dos atores envolvidos no ambiente de trabalho e que saúde também pode e deve se aprender na escola, priorizando a criança e o adolescente, pois é uma fase propícia para mudança e aquisição de novos comportamentos. A proposta é que educadores e educandos possam juntos intervir no mundo, através de pedagogia educativa que tem com o foco principal o ser humano, compartilhando experiências e vivenciando cada conquista por dias melhores na saúde e educação. / This study ai,ms to identify the doubts of the students of the Federal Institute Fluminense (IFF) Campus Guarus Courses on Sexually Transmitted Infection (STI) and propose a more appropriate educational approach or methodology, plan and carry out the Continuing Education at the Federal Fluminense Institute, taking as its starting point the theme IST; as well as draw up a Fan Page to provide continuing education workshops for health professionals and education on STIs. The problems that led to the development of this research arose from the perception by authors and in the classroom, knowing that the number of subjects to be portrayed is great, and having to develop the educational content, teachers do not keep a dialogue about personal and family matters with students, and the servers very often do not know how to deal with adolescent sexuality. On the other hand, family and modern parents have increasingly less time to talk with their children. Thus, the question: who can contribute to the prevention of STIs with teens and other problems related to self-care? It is important that school servers participate in a continuing education project? So, this research is a descriptive study with a qualitative methodological approach, field research, participatory action research of the kind held in IFF Guarus. Being a research involving human beings, it was submitted to the ethics committee and approved on 08.08.2014 with the opinion number 741,076. As subjects of this research we have the first year high school of Environment course, the Electronics course and servers IFF Guarus. For data collection we worked at different times, first with the students with the realization of semi-structured interviews and characterization, then with the servers through workshops of Continuing Education on STIs. Of the 127 invited students, 64% participated and 161 servers, 11% attended the workshops. For data analysis, the precepts of Bardin and theoretical reference of Paulo Freire and Dorothea Orem were used. And so, four categories emerged: Ignorance + Sexually Transmitted Infection = Danger; Education and Health in School Environment; Continuing Education in School; The importance of raising awareness to changing attitudes and professional values. As a research product, we developed a Fan Page and as a byproduct, a Guide for realization of Continuing Education at the School of IST, problem situations based on the collection of data for use in active teaching methodology and SAE script for teen with focus on prevention of STIs. We conclude that Permanent Education is an educational resource that can assist in problems related to the life of the actors involved in the work environment and health can and should be learned in school, giving priority to children and adolescents, because it is a propitious stage to change and acquire new behaviors. The proposal is for teachers and students together to intervene in the world through educational pedagogy that is the main focus on the human, sharing experiences and experiencing each achievement for better days in health and education.

South Africa‘s high prevalence of HIV/AIDS coupled with a high crime rate and incidence of sexual violence necessitated the enquiry and study into the role of criminal law to address the wilful transmission of HIV.1 This study shows that criminal law can be used to punish offenders for wrongdoing and therefore finds application in the wilful transmission of HIV.2 The study distinguishes the dividing line between the justifiable use of criminal law and where use of the criminal law becomes discriminatory in nature and counterproductive to public health measures. The United Nations (hereinafter referred to as the UN) laid down guiding principles for countries to adopt when using the criminal law and stated that countries should use existing criminal law offences to prosecute intentional HIV infections.3 The South African Law Commission (hereinafter referred to as the SALC) endorses this approach. South Africa‘s use of the criminal law, in response to harmful HIV behaviour is in line with the UN recommendations as it uses the existing common law offences to prosecute the wilful transmission of HIV, namely murder, attempted murder and assault. Drawing from the writer‘s comparative study in Chapter Six below, South Africa, members of the Zimbabwean parliament, Canada, as well as the American Bar Association have all concluded that the use of specific HIV-related legislation creates some a form of stigmatization towards people living with HIV and is therefore not warranted. This study shows that criminal law has a role to play in the wilful transmission of HIV; however the creation of HIV specific legislation is not recommended and existing criminal law offences should be used to address harmful HIV related behaviour. Such an approach is in line with the guiding principles laid down by the UN and SALC.

The Human Immunodeficiency Virus (HIV)1 and the Acquired Immunodeficiency Syndrome (AIDS)2 have become a global epidemic. With an average of 35.3 million people infected with the virus worldwide, countries are desperate to curb HIV infections.3 Most HIV positive men, women and children are found in Sub-Saharan Africa.4 In an attempt to fight HIV/AIDS, some countries have opted for an approach of criminalization, where it is a crime to infect or expose another person to the virus.5 Other countries, such as South Africa, have chosen to avoid the criminalization approach, and to focus rather on public health schemes that can assist in the prevention of transmission. The United Nations (UN) has stated that overly broad application of criminal law to HIV raises serious human rights and public health concerns.7 Because of these concerns, the Joint United Nations Programme on HIV/AIDS (UNAIDS) has urged states to limit application of criminal law to HIV-related cases.8 Furthermore, UNAIDS has urged states to rather employ scientifically proven methods to prevent HIV transmission. This treatise will set out the laws adopted by Canada, Zimbabwe, the United Kingdom, New Zealand and South Africa. Out of all five countries, South Africa is the only country that does not criminalize HIV transmission or exposure.10 In setting out the common law, statute law, case law as well as academic considerations, this treatise will attempt to identify trends in the current criminalization of HIV climate. In addition to setting out the law in the five countries, this treatise seeks to show that South Africa is one of the few countries with a developed legal system to shy away from criminalization. This treatise also seeks to establish whether South Africa’s approach is a suitable option for the country, considering it boasts the highest HIV infection rate in the world.

Orientador: Maria Rita de Camargo Donalisio / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-04T02:24:43Z (GMT). No. of bitstreams: 1 Oliveira_TiagoFeitosade_M.pdf: 646726 bytes, checksum: 4689e80905264ac5b08fc1258252b586 (MD5) Previous issue date: 2004 / Resumo: A oferta de testes sorológicos tem sido colocada como uma das estratégias de combate à epidemia de HIV/aids. Inicialmente a testagem dava-se apenas nos serviços especializados, os chamados COAS ou CTA mas, devido à magnitude alcançada pela epidemia de HIV/aids, bem como a necessidade de diagnóstico precoce dos casos, fez-se necessário a disponibilização do teste anti-HIV na rede básica de saúde. O aconselhamento tem sido apontado como uma técnica a ser aplicada na oferta e na entrega do resultado do teste. Este se baseia na mudança de comportamento de pessoas e grupos sociais, proporcionando-lhes a oportunidade de adotarem práticas sexuais mais seguras ou reduzindo o dano de um determinado comportamento de risco. Através de pesquisa qualitativa, analisamos a oferta do teste para detecção do HIV nas Unidades de Saúde da Família da rede municipal de saúde de Recife-PE, sob a ótica dos profissionais de saúde. Verificamos que a indicação do referido teste se dá, quase sempre no consultório, durante a consulta clínica. O que motiva a oferta do teste é, geralmente um quadro sindrômico compatível com a aids ou o programa de assistência ao pré-natal. Os profissionais revelaram dificuldades em absorver a demanda espontânea pelo teste. A maioria dos entrevistados desconhece o aconselhamento, quanto técnica para ofertar o exame, reverter comportamentos de risco e dar o resultado do teste anti-HIV. Isso aponta para a necessidade urgente de qualificar a oferta do teste na rede básica, fazendo com que ela seja, de fato, instrumento de combate ao avanço da epidemia do HIV/aids / Abstract: The offering of serologic tests has been placed as one of the strategies in the HIV/AIDS epidemic disease combat. At first, the testate were applied in the specialized services only, the called COAS or CTA, however, with the magnitude reached by the HIV/AIDS epidemy, as well the necessity of a precocious diagnostic to the cases, the availability at the health public service of the anti-HIV test was necessary. The counselling has been pointed as a technique to be applied in the offering and delivery of the test result. That is based in the behaviour changed of social groups and people, providing them the opportunity to adopt safe sexual practices or reducing the damage of determinate risk behaviour. Through the qualitative search, we analyse the test offering to detect the HIV in the Family Health Units in the municipal public health of Recife-PE, under the health professional¿s optics. We realised that the indication of the referred test happens, almost often, in the doctor¿s office during the procedure. What motivate the test offering is, in general, a syndromic diagnostic compatible with AIDS or the pre-natal assistance program. The professions revelled some difficult in absolving the spontaneous demand for the test. The majority of the interviewed does not know the counselling as a technique to offer the exam, revert behaviour risks and give the anti-HIV result. This points to the urgent necessity of qualify the test offering into the public service, turning it to a combative instrument against the HIV/AIDS epidemy advance, indeed. / Mestrado / Saude Coletiva / Mestre em Saude Coletiva

This study provides data suggesting that adolescent girls who receive education and hormonal contraceptive methods at a school-based clinic in the Fontana Unified School District, are more likely to have a signficant improvement in condom use, which improves safe sex practices and reduces the risks of sexually transmitted diseases.

INTRODUÇÃO: O virus linfotrópico de células T humanas do tipo 1 (HTLV-1) é endêmico em várias partes do mundo e transmitido primariamente através de relações sexuais ou da mãe para o filho. MÉTODOS: Estes modos de transmissão foram investigados na coorte de pacientes com HTLV-1 acompanhados no Instituto de Infectologia Emílio Ribas de São Paulo comparando-se casais soroconcordantes e sorodiscordantes, para estudo da transmissão sexual, e binômios mãe-filho soroconcordantes e com filho soronegativo para estudo da transmissão vertical. Os dados foram consolidados e depois analisados utilizando o sistema RedCap (Research Electronic Data Capture) e o programa computacional estatístico Stata/IC 13.1. Resultados com valor de p < 0,05 foram considerados estatisticamente significativos. Variáveis com p < 0,2 na análise bivariada foram incluídos na análise multivariada. RESULTADOS: Entre janeiro de 2013 e maio de 2015, de 178 pacientes com HTLV-1 que se declararam casados, 107 (46 homens e 61 mulheres) tinham parceiro testado, resultando em 81 casais (26 homens e 26 mulheres já formavam pares entre si). Foram excluídos aqueles com HIV ou HTLV-2. A taxa de soroconcordância entre casais foi 46,9%. A carga proviral (PVL) de HTLV-1 foi comparada entre 19 casais soroconcordantes e 37 sorodiscordantes, e os casais soroconcordantes apresentaram cargas provirais mais elevadas (p = 0,03). Não houve diferença entre os grupos de acordo com idade, tempo de relacionamento, ter mãe ou irmão com HTLV-1, raça, local de nascimento, escolaridade, história de hemotransfusão, HAM/TSP, ATL ou soropositividade para hepatite C. Na análise multivariada, no entanto, o tempo de relacionamento (> 20 anos) manteve-se independentemente associado com a ocorrência de soroconcordância entre casais (p = 0,031). Por sua vez, no período de junho de 2006 a agosto de 2016 havia 192 mães com infecção pelo HTLV-1, resultando em 499 filhos expostos. Destes, 288 (57,7%) foram testados para HTLV-1, constituindo-se na amostra final para o estudo, juntamente com respectivas 134 mães. Entre os filhos testados, 41 foram positivos para HTLV-1, indicando taxa de transmissão vertical de 14,2%. Sete dos 134 núcleos familiares concentraram 20 (48,8%) do total de 41 filhos soropositivos e cinco apresentavam prole com três ou mais filhos soropositivos para HTLV-1. Estiveram associadas à soropositividade do filho: duração da amamentação >= 12 meses, PVL materna >= 100 cópias/104 PBMC, idade da mãe no parto > 26 anos, raça/etnia asiática, estado civil divorciada, filho com avó soropositiva para HTLV-1, ter irmão com HTLV-1. Na análise multivariada, amamentação >= 12 meses, PVL materna elevada e ter irmão com HTLV-1 mantiveram-se independentemente associados ao desfecho. CONCLUSÕES: Os resultados indicam que o HLTV-1 vem sendo transmitido ativamente na coorte, tanto por via sexual como materno infantil, com agregação familiar de casos e que o risco de transmissão entre casais persiste após décadas (mais de 20 anos) de sorodiscordância. Foi observada associação entre PVL e transmissão do vírus, tanto por via sexual como materno-infantil, mesmo depois de anos após o desfecho. PVL materna elevada e amamentação prolongada estiveram independentemente associados à transmissão vertical, sendo necessários outros estudos avaliando a influência de fatores genéticos. / INTRODUCTION: Human T-cell lymphotropic virus type 1 (HTLV-1) is transmitted primarily either through sexual intercourse or from mother to child. METHODS: The current study investigated sexual and vertical transmission among individuals diagnosed as HTLV-1-positive who have been followed up at the Institute of Infectious Diseases \"Emilio Ribas\". In order to study the sexual transmission and mother-to-child transmission, the selected individuals with their respective pairs (couples or mother and son, repectively) were classified into seroconcordant or serodiscordant groups according to serological findings. Data were collected and managed using Research Electronic Data Capture (REDCap) and Stata/IC 13.1 for Windows. p values < 0.05 were considered statistically significant. Variables with p < 0.2 in bivariate analysis were included in multivariate analysis. RESULTS: Between January 2013 and May 2015, 178 HTLV-1-positive patients had spouses, 107 of which (46 men and 61 women) had tested partners, thus forming the initial sample (81 couples). Individuals co-infected with HTLV-2 or human immunodeficiency virus were not included in the analysis. The rate of seroconcordance was 59.8%. The HTLV-1 proviral load was compared between 19 and 37 seroconcordant and serodiscondant couples, respectively, and the concordant couples showed higher proviral loads (p = 0.03). There were no differences between the groups according to age, relationship length, having a mother or sibling with HTLV-1, race, ethnicity, nationality, education, history of blood transfusion, HAM/TSP, ALT, or hepatitis C virus status. In multivariate analysis, relationship time (over 20 years) was shown associated with ocurrence of seroconcordance status (p = 0.031). In turn, between June 2006 and August 2016 there were 192 mothers with HTLV-1 infection, resulting in 499 exposed children. Of these, 288 (57.7%) were tested for HTLV-1, forming the final sample for the study with 134 respective mothers. Among the tested soons, 41 were positive for HTLV-1, indicating vertical transmission rate of 14.2%. Of 41 positive sons for HTLV-1, 40 (48.8%) were clustered in seven of 134 households, and five households had their offspring with three or more sons seropositive for HTLV-1. The following variables were associated with positive son for HTLV-1: breastfeeding duration >= 12 months, maternal PVL >= 100 copies/104 PBMC, mother\'s age at delivery > 26 years, asian race/ethnicity, divorced marital status, child with grandmother seropositive for HTLV-1, have brother with HTLV-1. In multivariate analysis, breastfeeding >= 12 months, higher maternal proviral load and have brother with HTLV-1 remained independently associated with the outcome. CONCLUSIONS: The results indicate that the HLTV-1 is actively transmitted in the cohort both sexually and vertically, with ocurrence of familial clustering. The sexual transmission risk persists among couples even after decades (over 20 years) of serodiscordance. PVL remained associated with the outcome even several years after the occurrence of the transmission both sexually and vertically. High maternal provirus load and breastfeeding beyond 12 months were independently associated with positive son for HTLV-1, but it is necessary further studies to evaluating the influence of genetic factors on the mother-to-child transmission.

Philosophiae Doctor - PhD / The sexual behaviours, attitudes, beliefs and communication of 1896 black first-year university students were examined by means of a structured questionnaire for their contribution to the development of a university-based sex counselling programme. The areas of sexuality investigated included intra-familial communication about contraception and sexuality, belief in sex myths, knowledge of and myths about AIDS and the manner of acquisition of sex knowledge. The results of this study are consistent in reflecting much greater deficits in the knowledge of respondents about sexuality than encountered in the literature. Statistically significant gender differences were found for intra-familial communication about contraception, prejudice towards AIDS victims, knowledge of the modes of HIV infection, prejudice towards homosexuals, belief in myths about sexuality, age at which sex information was acquired, the preferred source of information about sexuality, attitude towards pre-marital intercourse, experience of pre-marital intercourse, belief about the acceptability of abortion, experience of pre-marital intercourse and worry about masturbation. No gender differences were found for belief in myths about high-risk AIDS infection, exposure to sex information within educational institutions and approval of sex education. The statistically significant gender differences which were found for most of the questionnaire items reflect the different sexual socialization experiences of respondents. Male and female students may therefore require counselling interventions geared to their respective needs Concern about AIDS has become central to university student sexual behaviour as well as protection against rape and sexual harassment and male responsibility for contraception. All campus counsellors will eventually experience the impact of AIDS and other sexually·transmitted diseases in their sessions with clients. Sexual harassment, rape, contraceptive failure and abortion will also increasingly impact on counselling sessions and require the university-based counsellor's involvement in broader university-wide prevention programmes as well as group based interventions. The development of a university-based sex counselling programme requires comprehensive interventions ranging from individual counselling to human sexuality courses. An awareness of the high profile sexuality problems as perceived by students, is essential for the development of preventive programmes at the group and academic class level as well as at the level of inf luencing uni versi ty policy. Knowledge of the merits of different theoretical positions and interventions for particular sexual problems is crucial for counselling intervention or referral. A systemic model of intervention for sexuality problems is proposed. The task of university-based sex counselling programmes is made more onerous by the paucity and ineffectiveness of sex information students are exposed to, the lack of sex education in the schools and the inadequate quality and degree of intrafamilial communication about sexuality. A significant proportion of respondents engage in pre-marital sexual intercourse without the benefit of adequate sex knowledge. The results of this study emphasize the need for research on the sexuality of, black South Africans, the particular vulnerabilities of first-year university students to sexuality problems and the dire need for structured sex education programmes at school as well as university.

Quantification of progesterone and 17-β estradiol in mouse serum by liquid chromatography-tandem mass spectrometry Authors: Benjamin Kennard, Allison Cobble, Amy Gravitte, Keleigh Galloway, Jen Kintner, Jennifer Hall, Stacy Brown Introduction: In the United States, Chlamydia trachomatis is a commonly appearing sexually transmitted infection1. It affects the U.S. healthcare system to a tune of about $500 million dollars annually2. In women, it generally appears asymptomatic and can lead to severe secondary complications such as pelvic inflammatory diseases or infertility1. Female sex hormones, estrogen and progesterone, are being identified to have a role in chlamydial infection. Specifically, this study aims to create quantification methods to detect levels of estrogen and progesterone in mice, infected with Chlamydia muridarum, plasma samples. Methods: Progesterone samples were prepared using solid-liquid extraction (SLE+) cartridges with ethyl acetate as the elution solvent. Estradiol samples were prepared using liquid-liquid extraction (LLE) with methyl tert-butyl ether and subsequent derivatization with DMIS. Following sample preparation, hormones were quantified in samples using LC-MS/MS with a gradient elution of 1 mM ammonium fluoride in water and acetonitrile. The separation was achieved using a UCT C18 column (100 x 21.mm, 1.8 μm particle size) maintained at 50oC. The mass spectrometer was set up to isolate molecular ions for progesterone (m/z 315.0910) and derivatized estradiol (m/z 431.1835). Quantification was facilitated by the use of deuterium-labeled internal standards and their corresponding molecular ions in the mass spectrometer (d9-progesterone; m/z 324.1230 and d5-estradiol; m/z 436.2922). Results: Several aspects of the assay presented have been optimized for maximum analyte recovery and analytical sensitivity, including column choice, mobile phase, derivatizing agents for estradiol, and extraction protocols for progesterone. The LC-MS/MS method was investigated for precision and accuracy over three separate days. The dynamic range of the progesterone assay was 5 – 100 ng/mL, with a limit of detection of 1 ng/mL. Likewise, the estradiol assay was linear in the range of 5 – 100 ng/mL, with a limit of detection of 0.5 ng/mL. The average precision, represented by % RSD was 0.74 – 8.5% and 6.3 – 13.4% for progesterone and estradiol, respectively. The accuracy of the method, represented by % error was 1.6 – 14.4% and 4.0 – 10.5% for progesterone and estradiol, respectively. Successful validation was defined as < 15% RSD and error (< 20% at the limit of quantification), per current FDA Guidelines. Conclusions: The developed LC-MS/MS method is specific for progesterone and estradiol, and the extraction is suitable for preparation of mouse serum samples. This assay could be successfully applied to hormone quantification in mouse samples to support the investigation of the link between chlamydia infection and hormone levels in female animals. References 1. Chlamydia - 2017 Sexually Transmitted Diseases Surveillance. https://www.cdc.gov/std/stats17/chlamydia.htm. Accessed October 23, 2018. 2. Owusu-Edusei K, Chesson HW, Gift TL, et al. The Estimated Direct Medical Cost of Selected Sexually Transmitted Infections in the United States, 2008. Sex Transm Dis. 2013;40(3):197-201. doi:10.1097/OLQ.0b013e318285c6d2

Over the past decade, and accelerated due to the COVID-19 pandemic, there has been increasing adoption of decentralized diagnostic testing, where the testing is brought closer to the patient. This trend has largely been fueled by the development of more accurate diagnostic tools and faster and more reliable data connectivity. Decentralized testing has been shown to greatly reduce turnaround times while increasing accessibility to users in remote regions. However, there are challenges that limit its widespread adoption. In this dissertation, we detail the development of tools and technologies to overcome these barriers and expedite the shift towards decentralized diagnostic testing. First, we demonstrate the ability to develop point-of-care (POC) diagnostic tests with performance that rivals that of traditional lab-based methods. We developed a rapid, multiplexed, microfluidic serological test for Lyme disease, a tick-borne disease caused by the Borrelia burgdorferi bacterium. The recommended testing, the standard 2-tiered (STT) approach, is not sensitive for early-stage infections, is labor-intensive, has long turnaround times, and requires the use of two immunoassays (enzyme-linked immunosorbent assay (ELISA) and the Western Blot). We developed a standalone multiplexed sandwich ELISA assay and adapted it to the mChip microfluidic platform. We validated the assay on a rigorously characterized panel of human serum samples and demonstrated that our approach outperforms the STT algorithm on sensitivity while matching its specificity. The form factor of this technology is amenable to use in physician’s offices and urgent care clinics. We also showed exploratory work towards adapting the mChip platform for diagnosis of Zika disease, a mosquito-borne disease caused by the Zika virus, and acute kidney injury, a syndrome characterized by loss of kidney excretory function. Next, we worked on increasing the adoption of rapid diagnostic tests for self- and partner-testing designed to be used in at-home settings. We developed a smartphone application to be used alongside the INSTI Multiplex test for detecting HIV and syphilis infections. The application was designed to provide users with i) instructions on running the test, ii) an automated deep-learning-based image interpretation algorithm to interpret the rapid test results from a smartphone image, iii) a way to save test results and display/share them, and iv) resources for follow-up care. We adopted a user-centered, iterative design process where we worked with a cohort of study participants composed of men who have sex with men and transgender women at high risk for contracting sexually transmitted infections. We then field tested the application with 48 participants over a duration of three months and found high acceptability for the application, both in terms of functionality and helpfulness. Finally, we sought to address a key limitation with deep-learning-based image classification techniques, specifically, the requirement for large numbers of annotated images for training. We developed a deep-learning image interpretation algorithm that could be quickly adapted to new rapid test kits using only a fraction of the images that would otherwise be needed for training the model. The interpretation algorithm followed a three-step, modular process. First, the rapid test kit and the membrane were extracted from the smartphone image. Second, the constituent zones were cropped from the extracted membrane. Finally, a classifier detected the presence or absence of a line in the individual zones. Fast adaptation was demonstrated by adapting a base model, trained using images of a single COVID-19 rapid test kit, to four different rapid test kits, each with different form factors, using few-shot domain adaptation. After training with 20 or fewer images, the classification accuracies of all the adapted models were > 95%. This approach can provide a digital health platform for improved pandemic preparedness and enable quality assurance and linkage to care for consumers operating new LFAs in widespread decentralized settings. Together, these methods provide a suite of tools that could expedite the shift towards decentralized, POC testing.