This project examines the role of immunization registries and their effect on a health care delivery system. Recent efforts to attain coverage of child populations by recommended vaccines have included initiatives by federal and state agencies, as well as private foundations, to develop and implement statewide community-based childhood immunization registries.

MPH / Department of Public Health

The prevalence of Hepatitis C Virus (HCV) in the US is estimated at 3.5 million with 18,153 deaths in 2016. It is the most common bloodborne infection, with a higher age-adjusted mortality rate than Hepatitis B Virus or Human Immunodeficiency Virus. Without treatment, nearly 1.1 million people will die from HCV by 2060. About 41,200 new cases of HCV were reported in 41 states in the US in 2016. The reported cases of acute HCV in 2016 is 2.3 per 100,000 in Tennessee, which is more than twice the national goal set by Healthy People 2020. This is a descriptive study to ascertain the HCV prevalence and usefulness of screening in medical outreach settings (MO) compared to indigent healthcare clinics (IHC) in northeast Tennessee. This study period was from April 2017 – February 2019. Participants (n=250), were adults, who engaged in routine, opt-out HCV testing at 4 IHC and 3 MO sites in the Tri-Cities, TN region. During the screening, demographic information- age, gender, race- were collected and the de-identified data were analyzed using Statistical Analysis System (SAS 9.3) to perform a descriptive analysis. Also, several discrete Chi-Square tests of independence between the demographic variables, screening locations, and HCV antibody prevalence was conducted. A total of 250 clients were screened for HCV. The majority of clients screened were non-Hispanic whites 228 (91.20%); females 136 (54.40%); young adults 131 (52.40%) and at IHC clinics 187 (74.80%). Screening showed HCV antibody prevalence of 14.8%. The majority of positive cases were non-Hispanic whites 36 (97.30%; P=0.1561); females 19 (51.35%; P=0.6867) and young adults 23 (62.16%; P=0.286). The prevalence at the IHC clinics and MO settings were 36 (97.30%; P=0.0006) and 1(2.70%) respectively. This analysis shows the higher yield of targeted HCV screening at IHC clinics. Focused HCV screening is critical in the era of opioid epidemic, particularly when direct-acting antiviral agents (DAAs) which offer a Sustained Virologic Response (SVR) rate of more than 90% are available. The use of case control or cohort study designs to establish causality is recommended for improving focused HCV screening.

PhD (Geography) / Department of Geography and Geo-Information Sciences / Malaria is a climate-change concatenated biological hazard that may, like any other natural hazard, can lead to a disaster if there is a failure in handling emergencies or risks. A holistic solution for malaria mitigation can be provided when indigenous knowledge is complemented with scientific knowledge. Malaria remains a challenge in South Africa and Limpopo province is the highest burdened malaria-endemic region. Specifically, Vhembe District is the highest burdened followed by Mopani District (Raman et al., 2016). This research sought to mitigate malaria transmissions in Mopani District through the integration of indigenous and scientific knowledge. The study was carried out in Mopani District of South Africa and 4 municipalities were involved. These are Ba-Phalaborwa, Greater Tzaneen, Greater Letaba, and Maruleng. A pragmatism philosophy was adopted hence the study took a mixed approach (sequential multiphase design). Data was collected from 381 selected participants through in-depth interviews, a survey and a focus group discussion. Participants for the in-depth interviews were obtained through snowballing and selected randomly for the survey, while for the focus group discussion purposive sampling was used. The study applied constructivist grounded theory to analyze qualitative data and to generate theory. Statistical Package for Social Sciences version 23.0 was used for quantitative data. Based on empirical findings, it was concluded that temperature and rainfall among other various factors exacerbate malaria transmission in the study area. Results of the study also show that people in Mopani District predict the malaria season onset by forecasting rainfall using various indigenous knowledge based indicators. The rainfall indicators mentioned by participants in the study were used in the developed early warning system. An Early warning system is an essential tool that builds the capacities of communities so that they can reduce their vulnerability to hazards or disasters. In the design of the system, Apache Cordova, JDK 1.8, Node JS, and XAMPP software were used. The study recommends malaria management and control key stakeholders to adopt the developed early warning system as a further mitigation strategy to the problem of malaria transmission in Mopani District. / NRF

Bakgrund: Icke smittsamma sjukdomar, som diabetes typ 2, är en stor och ökande utmaning för ett hållbart samhälle. Diabetes typ 2 går att förebygga och behandla genom hälsosamma levnadsvanor. Digitala motivationsprogram som använder sig av beteendemodeller har visat sig vara kostnadseffektiva interventioner för att förbättra levnadsvanor. Vid utveckling av dessa tjänster är användarens behov viktigt för att få reda på vilka faktorer som bidrar till ett långsiktigt användande. Syfte: Syftet med studien var att undersöka hur personer med diabetes typ 2 och prediabetes upplevde användandet av en evidensbaserad digital tjänst som stödjer hälsosamma levnadsvanor. Metod: Studien var en kvalitativ explorativ studie där semistrukturerade intervjuer användes för att samla in data. Data analyserades med en kvalitativ induktiv innehållsanalys med fokus på det manifesta innehållet. Resultat: Resultatet visade på vikten av att det digitala motivationsprogrammet var användarvänligt för att optimera stöd för hälsosamma vanor och för att innehållet i det skulle nå fram till användaren. Appen upplevdes innehålla många uppskattade funktioner som stödjer möjligheten till mer hälsosamma vanor. Flera av funktionerna skulle ha haft ett högre användarvärde om de varit anpassade efter målgruppen och om användarvänligheten förbättrades. Slutsats: För att möjliggöra stöd till hälsosamma vanor behöver digitala motivationsprogram vara användarvänliga och anpassade efter den tänkta målgruppen. Genom att optimera tjänsten utifrån användarens upplevelse kan evidensbaserade digitala motivationsprogram bidra till att förbättra folkhälsan. Fler studier behövs för att studera vad som främjar långsiktigt användande och långtidseffekter. / Background: Non-communicable diseases, such as type 2 diabetes, are a major and increasing challenge for a sustainable society. Type 2 diabetes can be prevented and treated through healthy lifestyle habits. Digital motivational programs using behavioral models have been shown to be cost-effective interventions to improve lifestyle habits. When developing these programs, the user's needs are important in order to find out which factors contribute to long-term use. Purpose: The aim of the study was to explore how people with diabetes type 2 and prediabetes experienced the use of an evidence-based digital service that supports healthy lifestyle habits. Method: A qualitative explorative design was applied where semi-structured interviews were used to collect data. The data was analyzed with a qualitative inductive content analysis with a focus on the manifest content. Results: The result showed the importance of the digital motivation program being user-friendly in order to optimize support for healthy lifestyle habits and for its content to reach the user. The app was perceived to contain many appreciated features that support the possibility of healthy lifestyle habits. Several of the functions would have had a higher user value if they had been adapted to the target group and if the user-friendliness had been improved. Conclusion: To enable support for healthy lifestyle habits, digital motivation programs need to be user-friendly and adapted to the intended target group. By optimizing the program based on the user's experience, evidence-based digital motivation programs can contribute to improving public health. More studies are needed to explore what promotes long-term use and long-term effects.

Introduction : Les maladies chroniques non transmissibles (MCNT) tuent chaque année près de 41 millions de personnes au monde, ce qui représente 71% du taux de mortalité mondiale. Le taux d’accroissement de ces maladies est plus élevé en Afrique Sub-Saharienne (ASS) comparativement au reste des pays du monde. Le Cameroun n’est pas en reste avec 35% du taux de mortalité attribuable aux MCNT dont l’hypertension artérielle (HTA) et le diabète de type 2 (DT2) qui sont en tête de liste, avec une prévalence de 32,1% et de 5,8% respectivement. L'HTA et le DT2 sont des maladies chroniques, coûteuses pour les patients et leurs familles qui supportent généralement seuls les coûts de traitement au Cameroun, compte tenu de l'insuffisance ou l’absence d'un système d'assurance maladie. De plus, ce qui est scientifiquement bien défini n’est pas toujours socialement/culturellement acceptable ou ne donne pas lieu à des changements de comportements attendus. Il en résulte une prépondérance de la non-observance des plans thérapeutiques par les patients. Il est donc urgent de mettre en œuvre des interventions à faible coût/efficacité axées sur les patients, qui leur permettent de mieux contrôler et de gérer leur maladie. Les interventions basées sur l’autonomisation des patients et de leurs familles, en plus d’améliorer la qualité des soins de santé, seraient utiles pour assurer l’observance des patients. Elles favoriseraient un meilleur contrôle de leurs paramètres biochimiques et physiques ainsi qu’une amélioration de leur mode de vie, notamment quand il s’agit des MCNT comme l’HTA et le DT2. L’objectif de la présente recherche est d’explorer les obstacles et facilitateurs de l’autonomisation des patients atteints de DT2 ou HTA au niveau individuel, organisationnel et systémique selon le point de vue et l’expérience de différents acteurs du système de soins camerounais. Méthodologie : Pour réaliser cette recherche, nous avons utilisé différentes méthodes de collecte et d’analyse des données. Nous avons d’abord réalisé́ une revue systématique avec méta-analyse pour identifier les interventions basées sur l’autonomisation des patients et leur efficacité dans le contrôle du DT2 en ASS. Nous avons utilisé les données issues de la revue systématique et d’autres écrits scientifiques pour développer un cadre conceptuel intégré multiniveau, adapté à notre contexte d’étude, le Cameroun. Nous avons ensuite eu recours à une étude qualitative multiniveau. Cette étude réalisée sur le terrain était une étude de cas unique à trois niveaux d’analyse imbriquée (macro, méso, micro). Pour explorer les barrières et les facilitateurs à l’autonomisation des patients, des entrevues semi-structurées ont été réalisées avec les patients (n = 23 participants) et leurs familles (n = 17 participants), les professionnels de la santé (six infirmiers/infirmières, deux médecins généralistes, et quatre médecins spécialistes) et les décideurs politiques (deux décideurs institutionnels et six décideurs centraux). Un groupe de discussion a été réalisé avec les patients préalablement interviewés (six participants). Des observations non participantes des consultations (n = 29) dans les bureaux des médecins spécialistes et des dispensations des services et soins de santé (n = 7) dans les salles d’hospitalisation ont été faites. Puis, des documents en rapport avec la prise en charge des patients diabétiques et hypertendus (n = 9) ont été analysés. Nous avons analysé ces données qualitatives à l'aide d'analyses thématiques et lexicométriques. Résultats: La revue systématique avec méta-analyse nous a permis de mettre en exergue l’efficacité des interventions basées sur l’autonomisation des patients en Afrique subsaharienne dans le contrôle du DT2 via l’amélioration de la glycémie et de la pression artérielle. Cette étude soutient les conclusions selon lesquelles les interventions à long terme et les interventions liées aux habitudes de vie seraient les plus efficaces dans l'amélioration du contrôle de la glycémie et de la pression artérielle. Cette efficacité était surtout liée à la fréquence des rencontres, au soutien à l’éducation des patients et à la participation active d’une équipe multidisciplinaire. L’étude multiniveau réalisée à l’hôpital de district de santé de Byiem-Assi (HDSB) au Cameroun a révélé que les facteurs exerçant une influence sur l'autonomisation des patients dans le contrôle de la maladie, identifiés par les différents participants à l’étude étaient similaires dans le même groupe de participants, et variaient beaucoup d’un groupe de participants à l’autre (ex : patients versus professionnels de la santé). Les participants identifiaient majoritairement les facteurs aux niveaux individuels et organisationnels, comparés à ceux du niveau central ou national, très peu ou pas connus des patients et leurs familles. Parallèlement, les décideurs politiques semblaient méconnaitre plusieurs facteurs au niveau individuel qui influencent l’autonomisation des patients. Les facteurs présents au niveau central, bien que peu nombreux et moins connus par les patients et leurs familles ainsi que certains professionnels de la santé, étaient généralement à l’origine des facteurs d’ordre individuel et organisationnel. Les facteurs identifiés par les patients étaient principalement liés à l'autogestion de la maladie. Il s’agissait des facteurs directement liés à la gestion de la maladie, identifiés au niveau individuel, en rapport avec les habitudes de vie des patients et sur lesquels ils pouvaient exercer un certain contrôle. Les facteurs au niveau organisationnel / hospitalier étaient plus ciblés par les membres de la famille, à l’exemple de long temps d’attente, indirectement liés à la gestion de la maladie par les patients et sur lesquels ils n’avaient aucun contrôle. L’implication des patients et leurs familles dans le processus de prise de décision et les supports à l’autogestion de la maladie aidaient ces derniers à mieux s’approprier leur rôle dans le contrôle de la maladie et à être responsables de leurs actions, et ultimement à développer un fort sentiment de cohérence. Cette étude met en exergue le rôle important que jouent les membres de la famille dans le développement de l’autonomisation des patients pour un meilleur contrôle de l’HTA et du DT2. Les facteurs identifiés par les professionnels de la santé étaient principalement liés à la prestation des services et soins de santé au niveau organisationnel et à l'autogestion de la maladie au niveau individuel. Les décideurs politiques étaient principalement axés sur les politiques / programmes élaborés au niveau central du ministère de la Santé et sur la prestation de services et soins de santé au niveau organisationnel. L’implication des professionnels de la santé dans le processus de prise de décision pour la prestation des services et soins de santé contribuait à promouvoir leur sentiment d'appropriation et de responsabilité sur ce qu'ils faisaient pour aider leurs patients à développer leurs capacités d'autogestion pour mieux contrôler leur maladie. Conclusion : A notre connaissance, cette étude est une première au Cameroun et dans l’ensemble des pays de l’ASS. Elle intègre les différents niveaux du système de soins avec la participation de différents acteurs pour l’exploration des facteurs qui contribuent ou pas à l’autonomisation des patients. Bien que les interventions axées sur la modification des facteurs au niveau individuel soient essentielles, il est nécessaire de développer aussi des interventions ciblant les obstacles organisationnels et politiques au développement de l’autonomisation des patients. Les interventions ciblant simultanément ces facteurs à plusieurs niveaux peuvent être plus efficaces que les interventions à un seul niveau. Le cadre conceptuel intégré que nous avons développé est une véritable contribution pour l’avancement de la science et pour le développement et la mise en œuvre des interventions futures de lutte contre les MCNT telles que l’HTA et le DT2. Dans l'ensemble, les résultats de cette thèse seront importants pour les cliniciens, les chercheurs, les patients et les décideurs politiques directement ou indirectement impliqués dans la prévention et le contrôle de l’HTA et du DT2 au Cameroun ainsi que dans des contextes similaires aux pays à revenu faible ou intermédiaire. / Background: Chronic noncommunicable diseases (CNCDs) kill nearly 41 million people worldwide each year, accounting for 71% of the global mortality rate. The rate of growth of these diseases is higher in Sub-Saharan Africa (SSA) compared to the rest of the world. In Cameroon, 35% of the mortality rate is attributable to CNCDs; hypertension (HTN) and type 2 diabetes (T2D) on the top of the list with the prevalence of 32.1% and 5.8%, respectively. HTN and T2D are long-term management diseases, financially draining for patients and their families generally bearing treatment costs in Cameroon, given the inadequate or non-existence of a health insurance system. Furthermore, what is scientifically known is not always socially or culturally acceptable or results in expected behavioural changes. This has resulted in a preponderance of patients’ being non-adherent to therapeutic plans. Thus, there is an urgent need to implement cost-effective patient-based interventions that empower patients to control and manage their own disease. Interventions based on patient empowerment have shown that, in addition to improving the quality of health care are necessary for patient adherence, allowing them to better control their biochemical and physical parameters as well as their lifestyle, especially when it comes to CNCDs such as HTN and T2D that patients are likely to deal with for the rest of their lives. The objective of this research is to explore the potential barriers and facilitators to patient empowerment at the individual, organizational, and systemic levels from the perspective and experience of different actors in the Cameroonian health care system. Method: For this thesis, we used different methods of data collection and analysis. We first conducted́ a systematic review and meta-analysis to identify patient empowerment-based interventions and their effectiveness in controlling T2D in sub-Saharan Africa. We did the literature review to develop an integrated multi-level conceptual framework adapted to our study context in Cameroon. The qualitative study that followed was a single case study with entailing three levels of embedded analysis within the primary healthcare district hospital (PHCDH) in Cameroon (macro, meso, micro). To explore barriers and facilitators to the development of patient empowerment, semi-structured interviews were conducted with patients (n = 23 participants) and their families (n = 17 participants), health professionals (six nurses, two general practitioners, four specialists) and policy makers (two institutional decision makers, six central decision makers). A focus group was conducted with patients (six participants), non-participant observations of consultations (n = 29) and health care delivery (n = 7), and document reviews related to the management of diabetic and hypertensive patients (n = 9). We analyzed these qualitative data using thematic and lexicometric analysis. Results: The systematic review and meta-analysis supports the findings that interventions based on patient empowerment may improve glycemia (HbA1c) and blood pressure of patients with T2D in SSA. The long-term and lifestyle interventions appeared to be the most effective interventions for glycemic control. Effectiveness that was mainly related to the frequency of meetings, the support for patient education and the active participation of a multidisciplinary team. The multilevel study conducted at the PHCDH in Cameroon revealed that factors influencing the development of patient empowerment in disease control identified by the different participants were similar within the same group and different between groups. There was a preponderance of factors identified at the individual and organizational levels, compared to factors identified at the central level. While patients and families knew very little about the central level factors, at the same time, policy makers seemed to be unaware of several factors at the individual level that influence the development of patient empowerment. The factors present at the central level were generally trigger those identified at the individual and organizational levels. Factors identified by patients were mainly associated with disease self-management. Present at the individual healthcare system level, they were related to patients' lifestyles, over which they could exercise some control. Factors at the organizational/hospital level were more targeted by family members, such as long waiting times, which were indirectly related to the patients' management of the disease and over which they had no control. Involving patients and their families in the decision-making process and providing them with supports for self-management of the disease helped them to have a sense of ownership and responsibility over what they are doing which leads to a sense of empowerment. This study further emphasizes the important role that family members called "caregivers" play in the development of patient empowerment in the disease-control process. Factors identified by health professionals were mainly related to the delivery of health care and services at the organizational level and to self-management of the disease at the individual level. Policy makers were mainly focused on policies/programs developed at the central level of the ministry of health and on the delivery of health care and services at the organizational level. Involving health care professionals in the decision-making process for the delivery of health care services tended to increase their sense of ownership and responsibility over what they were doing to help their patients develop self-management skills to better control their disease. Conclusion: To our knowledge, no prior study to this exists in Cameroon and in SSA countries that integrates the different levels of the health care system with different participants to explore the factors that contribute or not to the development of patient empowerment. While interventions focused on changing patient-level factors are essential, there is a need for more interventions addressing organizational and political barriers to the development of patient empowerment. Interventions simultaneously targeting these multilevel factors may be more effective than single-level interventions. The integrated conceptual framework we have developed is a real contribution to the advancement of science and to the development and implementation of future interventions for CNCDs such as HTN and T2D. Overall, the results of this thesis will be important for clinicians, researchers, patients, and policy makers directly or indirectly involved in the prevention and control of HTN and T2D in Cameroon as well as in similar settings in low- and middle-income countries.

Unlike the adaptive immune system, the innate immune system has classically been characterized as being devoid of memory functions. However, recent research shows that innate myeloid and lymphoid cells have the ability to retain memory of prior pathogen exposure and become primed to elicit a robust, broad-spectrum response to subsequent infection. This phenomenon has been termed innate immune memory or trained immunity. Innate immune memory is induced via activation of pattern recognition receptors and the actions of cytokines on hematopoietic progenitors and stem cells in bone marrow and innate leukocytes in the periphery. The trained phenotype is induced and sustained via epigenetic modifications that reprogram transcriptional patterns and metabolism. These modifications augment antimicrobial functions, such as leukocyte expansion, chemotaxis, phagocytosis, and microbial killing, to facilitate an augmented host response to infection. Alternatively, innate immune memory may contribute to the pathogenesis of chronic diseases, such as atherosclerosis and Alzheimer's disease.

Indiana University-Purdue University Indianapolis (IUPUI) / Vaccinia virus (VV) is the prototypical member of the orthopoxvirus genus of the Poxviridae family, and is currently being evaluated as a vector for vaccine development and cancer cell-targeting therapy. Despite the importance of studying poxvirus effects on the human immune system, reports of the direct interactions between poxviruses and primary human leukocytes (PHLs) are limited. We studied the specific molecular events that determine the VV tropism for major PHL subsets including monocytes, B cells, neutrophils, NK cells, and T cells. We found that VV exhibited an extremely strong bias towards binding and infecting monocytes among PHLs. VV binding strongly co-localized with lipid rafts on the surface of these cell types, even when lipid rafts were relocated to the cell uropods upon cell polarization. In humans, monocytic and professional antigen-presenting cells (APCs) have so far only been reported to exhibit abortive infections with VV. We found that monocyte-derived macrophages (MDMs), including granulocyte macrophage colony-stimulating factor (GM-CSF)-polarized M1 and macrophage colony-stimulating factor (M-CSF)-polarized M2, were permissive to VV replication. The majority of virions produced in MDMs were extracellular enveloped virions (EEV). Visualization of infected MDMs revealed the formation of VV factories, actin tails, virion-associated branching structures and cell linkages, indicating that infected MDMs are able to initiate de novo synthesis of viral DNA and promote virus release. Classical activation of MDMs by LPS plus IFN-γ stimulation caused no effect on VV replication, whereas alternative activation of MDMs by IL-10 or LPS plus IL-1β treatment significantly decreased VV production. The IL-10-mediated suppression of VV replication was largely due to STAT3 activation, as a STAT3 inhibitor restored virus production to levels observed without IL-10 stimulation. In conclusion, our data indicate that PHL subsets express and share VV protein receptors enriched in lipid rafts. We also demonstrate that primary human macrophages are permissive to VV replication. After infection, MDMs produced EEV for long-range dissemination and also form structures associated with virions which may contribute to cell-cell spread.

This work follows the studies focused on obesity, its global extent and its serious health and economic impact. At the same time, the work examines the unsuccessful fight of public policies which try to reverse growing prevalence of obesity. Nevertheless, the main goal of the thesis is a discussion about priorities of new orientation in the research on the causes of the obesity epidemic and effectiveness of precautions that were taken in many countries and international organizations with the main aim to stop the obesity and its consequences. The discussion leads to the more detailed description of the problems connected with obesity, for instance, environmental aspects, housing culture in relation to physical activities, lifestyle in relation to advertisement/marketing, psychological and socio- psychological aspects, combating stress, etc. My intention was to find out utility of contemporary research on obesity for setting of policy fighting against obesity. At the same time, I wanted to find out other possible directions in the research into this field and discover how the discussion about priorities of the research in the experimental community proceeds. Two international dimensions of paradigmatic approaches separated to the certain degree can be considered as relevant with regard to the global...

Purpose This research project was an attempt to determine situational aspects of HIV and AIDS among the designated farming communities in the Vhembe and Mopani districts of Limpopo Province. Questions arising from the pilot project were premised on the capacity of farmers in these areas to adequately address the daunting reality and prevalence of HIV and AIDS in their communities. Research Design and Methodology The research was designed to facilitate the integration of both qualitative and quantitative approaches. A sample of 228 respondents was involved in a triangulated participatory action research method. To the extent that the data collection techniques were triangulated in both nature and focus, HIV/AIDS-related data and information within the designated farming communities was attained with a maximum degree of validity. The data collection techniques used in this regard were: questionnaires, which were distributed to 228 respondents; participant observation; exploratory investigation; unstructured interviews; naturalistic observation; focus group interviews and discussion; and review of documents. The reviewed documents include (primary) sources on HIV/AIDS by the Department of Health and (secondary) sources of literature by various authors presenting a range of perspectives on HIV/AIDS in farming areas. Findings The results of the study revealed the absence of a coordinated policy on HIV/AIDS in particular, and health in general; and a vacuous prevalence of basic HIV/AIDS-related information. For instance, knowledge on condom usage as a prevention strategy was ostensibly scant. Currently, primary healthcare services in the area are not available. The sampled farm workers themselves unanimously corroborated that there was no HIV/AIDS policy on the SAFM farms. Conclusion Based on the main findings established above, it has become indispensable that comprehensive and multidisciplinary HIV/AIDS policy interventions be initiated by all the relevant stakeholders. Local and provincial healthcare authorities need to provide policy guidelines for the development of such policy, taking the particular needs and circumstances of farm workers. The pervasive degree of insufficient HIV/AIDS knowledge among this group necessitates that such a policy should integrate both a labour perspective and healthcare orientation, rather than perpetuating a separation of the two paradigms. This form of integration ensures that the observance of a human rights dimension becomes a sacrosanct component of the prevention of HIV/AIDS among farm workers, as well as their education concerning their healthcare-related rights as farm employees. Furthermore, the prevalence of a national HIV and AIDS policy is mainly aimed at facilitating broad guidelines, not addressing the specific contexts of every public, corporate and rural employment sector (DoH, 2007: 11-12; Muhlemann, et al., 1992: 479). In order that the education, prevention and treatment initiatives in the Vhembe and Mopani farming communities are achieved, the most important parameters of the policy should indicate: ,,X The systematic institutionalisation of local, provincial, and national HIV and AIDS programmes, notwithstanding the provision of healthcare facilities such as clinics; ,,X The promotion of basic healthcare education in general, and HIV/AIDS awareness and prevention among farm workers in particular; ,,X The development of HIV/AIDS work place policy by SAFM as employer; ,,X The systematic involvement and formation of partnerships between policy makers, local and international funders, HIV/AIDS healthcare workers and practitioners, NGOs and SAFM. As a critical factor and unit of analysis in the study, SAFM is expected to fulfil a developmental function among its employees, their families, and the local communities. This function could be enhanced further with the collaboration between SAFM and other farmers in the distribution of basic information regarding HIV/AIDS and other sexually transmitted diseases at the workplace, as well as extensive healthcare education and training for their farming personnel. Trained personnel, especially managers, are a salient factor in the implementation of organisational health and safety requirements (DoH, 2007: 6, 8; Muhlemann, et al., 1992: 478-479). / Health Studies / D. Litt. et Phil. (Health Studies)