Magister Artium (Medical Anthropology) - MA(Med Ant) / This study focuses on socio-cultural issues, which affect Kavango women's decision to participate in the PMTCT programme. It investigates the treatment methods used by HIV-positive pregnant women for themselves and their unborn babies, neonatally, during pregnancy and after delivery, particularly in relation to the prevention of transmission of HIV. The thesis further investigates whether women choose alternative services such as traditional healers for medical attention during pregnancy, birth and post-natally. The research aims to establish and describe the role of local notions and practices concerning anti-retrovirals on the aforementioned programme. Ethnographic and thus qualitative research methods were used to gather and analyze data. I spent three months working as a nurse in two health facilities that offer PMTCT in Rundu, Kavango. I also held semi-structured and open-ended interviews, formal and informal discussions, formal and informal focus groups with nurses, community counselors, pregnant women, women who had recently given birth in the health care facility and traditional health care practitioners. In the case of the latter, I utilized narratives of healing to understand their perception of HIV/AIDS, their beliefs and practices as well as their healing methods. Furthermore, I employed other informal conversations outside the formal research participants. The study shows that there is a paucity of partner involvement and in some cases women have to first seek permission from their partner before enrolling into the programme. My research findings further indicate that women utilized various traditional herbal medicines for themselves and their babies as part of their cultural beliefs and practices. It was evident that some of these, such as Likuki, affect women's participation in and adherence to the protocols of the PMTCT programme. / South Africa

The outbreak of Human Immunodeficiency Virus (HIV) is one of the largest public health challenges in history. South Africa disproportionately bears the burden of HIV infections with an estimated 7.7-million people living with HIV. Although a comprehensive treatment and prevention program has been enacted in the country, the health gains achieved by these interventions have fallen short of targets set by the United Nations Programme on HIV/AIDS. Significant proportions of the population are unaware they have contracted HIV and knowledge about HIV transmission is generally lacking. For patients accessing HIV treatment services, adherence to prescribed regimens is a principal barrier to positive health outcomes. These challenges are further compounded by the development of resistance to HIV treatments. Between 2017-2022, South Africa will implement the four-generation ‘National Strategic Plan on HIV, Tuberculosis, and Sexually Transmitted Infections.’ This framework outlines interventions that will address the biomedical, behavioral, and structural barriers that have sustained HIV transmission while accelerating health advances for people living with HIV. As a result of this integrated approach and the targeted intervention population, South Africa operates the largest HIV treatment program in the world. Evaluation of South Africa’s HIV treatment and prevention activities are needed to ensure the enacted programs continually meet the needs of the population as they change over time. Additionally, program evaluation ensures limited resources are allocated in a judicious manner. Collectively, these evaluations can result in program alterations that deliver the maximum health benefit for all South African citizens. Upon analysis of the South Africa’s National Strategic Plan, several flaws in current program delivery, funding allocations, and accountability actions are immediately evident. The four generation Plan does not include specific steps outlining the exact actions that should be followed by local health officials. The Plan architects failed to incorporate key recommendations from previous investigations there were specific to the South African HIV care delivery model. If these shortcomings persist, South Africa is unlikely to meet proposed HIV reduction targets set by global health organizations. From this analysis, several amendments are recommended to the current plan, including the application of artificial intelligence behavioral mapping for at risk populations and the reallocation of funding to condom distribution, medical-male circumcisions, and social behavior change activities. These amendments represent actionable items that can spur health advancements for the HIV treatment and prevention program in South Africa. / 2022-06-08T00:00:00Z

Master of Public Health - MPH / Gay men and other men who have sex with men (MSM) and a subset within this group who are people who inject drugs (PWID) face difficulties when trying to access humanimmune deficiency virus (HIV)/ anti-retroviral treatment (ART) services and adhere to ART, due to the intersecting forms of oppression they face. Current interventions to address adherence to ART are mostly bio-medical in nature, and support the presumption that individual-level factors are the most pertinent barriers to adherence to ART. This mini-thesis presents findings from a qualitative study that explored individual, health systems and structural factors that shape experiences of adherence to ART amongst gay men and other MSM and a subset within this group who are PWID

Master of Public Health - MPH / PMTCT is an effective strategy in preventing paediatric HIV infection. In Zimbabwe the success of PMTCT is entirely dependent on pregnant women accessing antenatal care services and through that, getting linked to PMTCT. Failure of pregnant women to book for antenatal care through the course of pregnancy presents a missed opportunity for PMTCT and a high risk for maternal HIV transmission. It is therefore important to determine the burden of unbooked women and the factors associated with it, if elimination of maternal HIV transmission is to be achieved in the country.

No description available.

yes / This briefing presents research on a small project on the use of a rights-based approach by groups of People Living with HIV/AIDS (PLWHA) in Northern Tanzania. It concludes that with support the groups were able to use the 2008 HIV/AIDS act to claim their rights to tackle stigma and access ARV medication. However, the fulfillment of these rights is limited by chronic poverty and structural weakness of the state.

Few studies have assessed the optimum second line highly active anti-retroviral therapy (HAART) regimen in patients who had failed on the first-line HAART in resource-limited settings. This study aimed to compare the Protease inhibitor (PI)-based second line HAART regimens used in one clinic in Trinidad by comparing immunological, virological and clinical outcomes of patients on the different second line HAART regimens. The records of 35 treatment-experienced patients, over 21years of age and on PI-based regimens for at least six months, were analysed using SPSS version 20. The regimen containing TDF/FTC/AZT/LPV/r proved to produce superior outcomes compared to the other second line regimens. Due the small number of usable patients’ records, the findings cannot be generalised but indicate directions for future studies attempting to compare the treatment outcomes of different second line HAART regimens / Health Studies / M. A. (Public Health)

Few studies have assessed the optimum second line highly active anti-retroviral therapy (HAART) regimen in patients who had failed on the first-line HAART in resource-limited settings. This study aimed to compare the Protease inhibitor (PI)-based second line HAART regimens used in one clinic in Trinidad by comparing immunological, virological and clinical outcomes of patients on the different second line HAART regimens. The records of 35 treatment-experienced patients, over 21years of age and on PI-based regimens for at least six months, were analysed using SPSS version 20. The regimen containing TDF/FTC/AZT/LPV/r proved to produce superior outcomes compared to the other second line regimens. Due the small number of usable patients’ records, the findings cannot be generalised but indicate directions for future studies attempting to compare the treatment outcomes of different second line HAART regimens / Health Studies / M. A. (Public Health)

This study sought to explore the views of healthcare workers regarding paediatric anti-retroviral therapy (ART) adherence in Nigeria. An exploratory descriptive qualitative research design was used to identify and describe healthcare workers’ views in Kano and Lagos, Nigeria. Three focus group discussions were held. The transcribed data was analysed using the framework approach of data analysis. Healthcare providers perceived poverty, illiteracy, stigma and discrimination, inappropriate care approaches, and parental dynamics as factors influencing ART adherence. Recommendations for enhancing paediatric ART adherence levels in Nigeria included: mainstreaming adherence counselling in paediatric ART and adopting a comprehensive family centred care approach were identified as measures for improving paediatric ART adherence. Other measures included free ART services, quality improvement in paediatric ART services, parental empowerment and stigma and discrimination reduction programmes. / Health Studies / M.A. (Public Health)

A perda de densidade mineral óssea (DMO) é uma complicação conhecida da infecção pelo HIV e seu tratamento, particularmente com terapia antirretroviral (TARV) contendo tenofovir disoproxil fumarato (TDF). Embora a disfunção tubular proximal renal e a fosfatúria sejam comuns com o TDF, não se sabe se a perda da DMO resulta de mineralização inadequada. Nós avaliamos a mudança na DMO por densitometria óssea de dupla absorção de raios-X (DXA) e na histomorfometria óssea por biópsias de crista transilíaca com dupla marcação por tetraciclina em homens jovens vivendo com HIV antes (N = 20) e 12 meses após (N = 16) iniciar TDF/lamivudina/efavirenz. Examinamos as relações de hormônios calciotrópicos, excreção de fósforo urinário, citocinas pró-inflamatórias e proteínas relacionadas à remodelação óssea com alterações na DMO e histomorfometria. A média de idade dos participantes foi de 29,6 ± 5,5 anos, com contagem média de linfócitos T CD4+ de 473 ± 196 células/mm3. No início do estudo, taxa de formação óssea diminuída e intervalo de tempo para mineralização aumentado foram identificados em 16 (80%) e 12 (60%) participantes, respectivamente. Após 12 meses, detectamos diminuição na DMO na coluna lombar, colo do fêmur e quadril total por DXA. Pela histomorfometria, observamos aumento na espessura cortical, no volume osteóide e nas superfícies de osteoblastos e osteoclastos. Não observamos piora significativa da excreção renal de fósforo ou nos parâmetros histomorfométricos de mineralização. Aumentos no PTH se correlacionaram com diminuição da DMO, mas não com os parâmetros histomorfométricos. Nossos achados sugerem que anormalidades na formação e mineralização ósseas são comuns entre homens com infecção pelo HIV mesmo antes da exposição a TARV. Com a TARV contendo TDF, há um aumento na remodelação óssea, refletida pelo aumento das superfícies de osteoblastos e osteoclastos, mas uma persistência no defeito de mineralização, resultando em aumento do volume osteóide / Bone mineral density (BMD) loss is a known complication of HIV infection and its treatment, particularly with tenofovir disoproxil fumarate (TDF)-containing antiretroviral therapy (ART). While renal proximal tubular dysfunction and phosphaturia are common with TDF exposure, it is unknown whether BMD loss results from inadequate mineralization. We evaluated changes in BMD by DXA and bone histomorphometry by tetracycline double labeled transiliac crest biopsies in young men living with HIV before (N=20) and 12 months after (N=16) initiating TDF/lamivudine/efavirenz. We examined relationships between calciotropic hormones, urinary phosphate excretion, pro-inflammatory and pro-resorptive cytokines and bone remodeling-related proteins with changes in BMD and histomorphometry. Mean age was 29.6±5.5 years, with mean CD4+ T cell count of 473±196 cells/mm3. At baseline, decreased bone formation rate and increased mineralization lag time were identified in 16 (80%) and 12 (60%) patients, respectively. After 12 months, we detected a decrease in lumbar spine, total hip and femoral neck BMD by DXA. By histomorphometry, we observed increases in cortical thickness, osteoid volume, and osteoblast and osteoclast surfaces. We did not observe significant worsening of renal phosphate excretion or mineralization parameters. Increases in PTH levels correlated with decreased BMD but not with histomophometric parameters. Our findings suggest that abnormalities in bone formation and mineralization are common among HIV-infected men even before ART exposure. With TDF-containing ART, there is an increase in bone remodeling, reflected by increased osteoblast and osteoclast surfaces, and a persistence in mineralization defect, resulting in increased osteoid volume