Made available in DSpace on 2016-08-18T17:27:38Z (GMT). No. of bitstreams: 1 Dissertacao LUIS FERNANDO BOGEA PEREIRA.pdf: 908998 bytes, checksum: a39235dcff5d0b2b802f9a1440dd8254 (MD5) Previous issue date: 2014-04-28 / In 2007 were estimated 9.27 million TB cases, 1.4 million of these were also seropositive for HIV. That same year were 456 000 registered cases of deaths from TB who were also infected with HIV. The association between tuberculosis (TB) and HIV infection affects mortality in two ways: TB presents significant lethality for people infected with HIV, and HIV acts as an indirect cause of the increased incidence of TB. Has to analyze the prevalence and factors associated with TB / HIV in patients with tuberculosis in the state of Maranhão. We conducted a cross-sectional analytical study of time series of TB cases notified in the period 2001 to 2011 in the state of Maranhão, totaling 4,553 cases of tuberculosis. Information was collected from the database of State Department of State Health Information Disease Surveillance System (SINAN). To identify associations between outcome (TB / HIV) and the independent variables (age, sex, race / color, education, middle region, place of residence, clinical type, input type, foreclosure situation), we used regression Poisson with robust adjustment of variance. Prevalence ratios (PR) and the ranges of 95 % confidence intervals (95 % CI) were estimated. We found a prevalence of TB / HIV coinfection of 15,1 % in the state. The highest prevalence ranged from 52.9 % in 2001, 11.8% in 2011, and the minimum prevalence ranged of1, 8 % in 2001, 5.9% in 2011. The prevalence of anti - HIV tests ranged from 4.3 % in 2001, 65.9% in 2011. According to the crude analysis, the most significant associations for TB / HIV were males (p ≤ 0.001), age group 20-39 years (p = 0.003) and 40-59 years (p = 0.036) have ≤ 8anos study (p = 0.001), be transferred (p = 0.053), living on the west mesoregion state (p = 0.009) and have closure for oncompliance (p = 0.016) or death (p ≤ 0.001). In the adjusted analysis, both males, age 29-30 years ≤ 8 years, living in the middle region west of the state, like having closure due to death, proved significant for TB / HIV coinfection. On the other hand, the non-white category and Pulmonary TB is presented both as a protective factor in the crude analysis as adjusted, and age ≥ 60 years in only adjusted. High rate of TB / HIV in the state (15,1%), being clear that young males with low education may be contributing to this increase was observed. There needs to adopt specific strategies to monitor this clientele, seeking to reduce the rate of coinfection. / Em 2007 foram estimados 9,27 milhões de casos de TB no mundo, destes 1,4 milhão também eram soropositivos para o Vírus da Imunodeficiência Humana (HIV). Nesse mesmo ano foram registrados 456 mil casos de mortes por TB que também estavam infectados pelo HIV. A interação entre o Mycobacterium tuberculosis e o Vírus da Imunodeficiência Humana (HIV) afeta a mortalidade de duas formas: a TB traz uma importante letalidade para as pessoas infectadas pelo HIV, e o HIV atua como causa indireta do aumento da incidência da TB. Tem-se como objetivo analisar a prevalência e os fatores associados à coinfecção TB/HIV em portadores de tuberculose no estado do Maranhão. Realizou-se um estudo transversal analítico com os casos de TB notificados no período de 2001 a 2011 no estado do Maranhão, totalizando 4.553 casos . As informações foram coletadas a partir do banco de dados do Sistema de Informação de Agravos de Notificação (SINAN) da Secretaria de Estado de Saúde do Estado. Para identificar as associações entre desfecho (coinfecção TB/HIV) e as variáveis independentes (idade, sexo, raça/cor, escolaridade, mesorregião, zona de residência, forma clínica, tipo de entrada, situação de encerramento), utilizou-se a regressão de Poisson, com ajuste robusto da variância. Foram estimadas as razões de prevalência (RP) e os intervalos de 95% de confiança (IC 95%). Encontrou-se uma prevalência geral da coinfecção TB/HIV de 15,1% no Estado. A prevalência máxima variou de 52,9 % em 2001 a 11,8% em 2011, e a prevalência mínima variou de1,8 % em 2001 a 5,9% em 2011. A prevalência de testes anti-HIV realizados variou de 4,3% em 2001 a 65,9 % em 2011. De acordo com a análise bruta, as associações mais significativas para coinfecção TB/HIV foram o sexo masculino (p≤0,001), as faixas etárias de 20 a 39 anos (p=0,003) e 40 a 59 anos (p=0,036), ter ≤ 8anos de estudo (p=0,001), ser transferido (p=0,053), residir na mesorregião oeste do Estado (p=0,009) e ter encerramento por abandono (p=0,016) ou óbito (p≤0,001). Na análise ajustada, o sexo masculino, idade de 29 a 30 anos, ≤8 anos de estudo, residir na mesorregião Oeste do Estado, encerramento por óbito, permaneceram associados à coinfecção TB/HIV. Por outro lado, a categoria não branca e a forma clínica pulmonar apresentaram-se como fator protetor tanto na análise bruta como na ajustada, e a idade≥60 anos somente na ajustada. Foi observada alta taxa de coinfecção TB/HIV no Estado (15,1%), sendo nítido que jovens do sexo masculino com baixa escolaridade e o desfecho do tratamento por abandono ou óbito podem estar contribuindo para este aumento. Há necessidades de se adotar estratégias específicas de acompanhamento dessa clientela, buscando reduzir essa taxa de coinfecção.

O presente estudo consiste na investigação psicanalítica das configurações assumidas pelo campo contratransferencial que se estabelece no atendimento psicológico, psicanaliticamente orientado, de pacientes soropositivos para o HIV. Quatro adolescentes, soropositivos em decorrência de transmissão vertical, foram psicanaliticamente assistidos por meio de diferentes enquadres clínicos, que incluíram sessões de psicoterapia individual, oficinas psicoterapêuticas e atividades extramuros, segundo a demanda. Esse complexo acontecer clínico deu origem à elaboração de quatro narrativas transferenciais, que foram psicanaliticamente revisitadas, na busca de criação/encontro de campos contratransferenciais. O quadro geral permite afirmar que, para além de ressonâncias contratransferenciais associadas a peculiaridades relativas ao adolescer e às vicissitudes das histórias individuais, é possível detectar a vigência de um campo contratransferencial nitidamente caracterizado pela compaixão. Tal configuração suscita reflexões teórico-clínicas que apontam que tanto as questões ontológicas relativas à precariedade, limitação e finitude, como as decorrentes das condições concretas de vida, tais como o adoecimento, a experiência da dor, o severo tratamento, a orfandade e a exclusão social, devem ser profundamente levadas em conta no cuidado a esses pacientes / This study aims to show the psychoanalytical investigation of the settings assumed by the countertransference field, which is established in psychological sessions, psychoanalytically oriented, in patients infected with HIV. Four teenagers, positives for HIV by vertical transmission, were psychoanalytically assisted by different clinical setting, which included individual psychotherapy sessions, psychotherapeutic workshops and outdoors activities, according to demand. This complex clinical case originates the development of four transference narratives, which were psychoanalytically revisited, in search of the creation/gathering of countertransference fields. The overall clinical picture allows us to state that, beyond the countertransference resonances associated to peculiarities related to adolescence and to the vicissitude of individual stories, is possible to detect the presence of a countertransference field clearly characterized by compassion. This configuration suscitate theoretical-clinical reflections that point out that the ontological issues caused by precariousness, limitation and finitude, as the current real life conditions, such as illness, experience of pain, severe treatment, the orphanhood and the social exclusion, must be thoroughly considered in the care of these patients

No abstract available. / Dissertation (LLM)--University of Pretoria, 2013. / gm2014 / Centre for Human Rights / unrestricted

Magister Public Health - MPH / Background: The Baby Friendly Hospital Initiative (BFHI) is considered one of the most successful international efforts to protect, promote and support breastfeeding. The initiative has proven impact, increasing the likelihood of babies being exclusively breastfed for six months. Official designation as Baby Friendly requires careful assessment completed by a trained external team to confirm that the institution is truly carrying out all Ten Steps of successful breastfeeding and conforming to the International Code of Marketing of Breastmilk Substitutes (BMS).The implementation of these principles are however challenging for facilities as it requires "strategic planning, implementation and maintaining change" within the facilities. Aim: To assess the factors influencing the implementation of BFHI principles in non accredited MOU` s in the Metropole region of the Western Cape. / South Africa

Magister Scientiae (Physiotherapy) - MSc(Physio) / Peripheral neuropathy (PN) is a common neurological complication occurring in the asymptomatic and symptomatic stages of human immune deficiency virus (HIV) infection. The pain and other symptoms caused by PN can impair functional ability and limit physical activity that could affect quality of life (QoL). Additionally, studies done on quality of life of people living with HIV/AIDS have shown that, HIV-related neurological syndromes, including PN, significantly reduce QoL. The aim of this study was to determine the prevalence of peripheral neuropathy amongst and the quality of life of adults living with HIV/AIDS attending the out-patient clinic at Rutongo Hospital in Rulindo District in Rwanda. / South Africa

Philosophiae Doctor - PhD / The global impact of the converging dual epidemics of tuberculosis (TB) and human immunodeficiency virus (HIV) is one of the major public health challenges of our time, because in many countries, human immunodeficiency virus (HIV) and mycobacterium tuberculosis (TB) are among the leading causes of morbidity and mortality. It is found that infection with HIV increases the risk of reactivating latent TB infection, and HIV-infected individuals who acquire new TB infections have high rates of disease progression. Research has shown that these two diseases are enormous public health burden, and unfortunately, not much has been done in terms of modeling the dynamics of HIV-TB co-infection at a population level. In this thesis, we study these models and design and analyze robust numerical methods to solve them. To proceed in this direction, first we study the sub-models and then the full model. The first sub-model describes the transmission dynamics of HIV that accounts for behavior change. The impact of HIV educational campaigns is also studied. Further, we explore the effects of behavior change and different responses of individuals to educational campaigns in a situation where individuals may not react immediately to these campaigns. This is done by considering a distributed time delay in the HIV sub-model. This leads to Hopf bifurcations around the endemic equilibria of the model. These bifurcations correspond to the existence of periodic solutions that oscillate around the equilibria at given thresholds. Further, we show how the delay can result in more HIV infections causing more increase in the HIV prevalence. Part of this study is then extended to study a co-infection model of HIV-TB. A thorough bifurcation analysis is carried out for this model. Robust numerical methods are then designed and analyzed for these models. Comparative numerical results are also provided for each model. / South Africa

Magister Public Health - MPH / Globally, approximately 600,000 infants each year are born with HIV infection in Sub-Saharan Africa as a result of mother to child transmission (MTCT) (UNAIDS, 2001). Whereas there is significant progress in reduction of mother to child transmission of HIV in Uganda, the Western Region of Uganda has low rates of PMTCT service utilization. The progress has been hampered by many factors including low male involvement (MOH, 2005). The main objective of this study was therefore to identify some of the factors that discourage men from participating in PMCT services in this region. The study was conducted in Kibaale District in the Western Region of Uganda for a period of one month in mid 2009. Data was collected using a qualitative methodology. The tools that were used for data collection were key informant in-depth interviews and focus group discussions (FGDs) guides. Data was collected from PMTCT service providers, women of reproductive age group and men whose partners had given birth during the last year (2008). For the focus groups, a purposive sample of men and women who had some children born in 2008, followed by random sampling from the list of potential subjects was used to select participants. The study sample comprised of three FGDs of women who had given birth in year 2008 and male partners of women who had also given birth in 2008. Each FGD consisted of eight participants. One FGD was with women only, the other with men only, while the third was with both men and women.

Magister Public Health - MPH / Since the advent of the HIV pandemic, efforts have been made to find and implement interventions to reduce the risk of transmission of the infection in various risk groups. Mother to child transmission is responsible for a great majority of childhood HIV infections. Interventions have been developed which reduce considerably the risk of mother to child transmission to babies born to women who are infected. To be able to access these interventions, pregnant women first have to know their status by being tested at antenatal clinics. Initial testing protocols in most countries were based on the opt-in, client-initiated approach. However, in many countries, this did not result in many women getting tested and being able to access interventions. Accordingly, many countries have now adopted the routine opt-out approach as a way of increasing testing rates among women attending antenatal clinics. Ghana has had a PMTCT programme since 2004 initially based on opt-in testing. In 2007, there was a change in this testing regimen to the opt-out approach. The aim of this study was to assess the quality, acceptability and factors influencing the acceptability of the use of routine verbal opt-out strategy for HIV testing during pregnancy for women attending antenatal clinics in the Kassena-Nankana district of northern Ghana. A cross-sectional analytical study design was used in this study. The study was conducted in the Kassena-Nankana district of northern Ghana using a structured questionnaire in face to face exit interviews with pregnant women after they had completed their first antenatal clinic visit. A total of 251 women aged between 15-49 years were interviewed after informed consent had been obtained from them. Data was captured with Epidata and analysed with EpiInfo. Cross-tabulations and logistic regression analyses were done. Of the 251 respondents who were interviewed in this survey, 85% of them were aware of MTCT, 82% knew at least one PMTCT strategy, 92% felt they had experienced good quality counselling that day at the ANC and 81% thought that the opt-out testing was acceptable. The perception of the women in the study about the quality of counselling they were given, their exposure to radio and their ethnicity were significantly associated with their acceptability of opt-out testing for HIV. While majority of the respondents felt that the quality of the counselling they received was good and a majority also felt that the opt-out strategy was acceptable, there were concerns about the quality of counselling provided. Recommendations include the need to improve counselling practices in the antenatal clinics by providing more structured information to the women. The District Health Management Team also needs to provide more information to people in the communities about PMTCT using radio as a medium.

This study emanates from the need to understand the socio-economic factors that might have contributed to the patients dropping out of the MASA antiretroviral therapy programme in Botswana. The aim of the study was to explore the socio-economic factors that are involved in compliance to antiretroviral therapy. It is crucial to know what these factors are and the strategies that can be deployed to address them. This will assist in the achievement of the programme goals. The type of research that was used is applied research. One of the primary rationales of applied research is that the study may have some practical use. The purpose of applied research is to contribute knowledge that will help people understand the nature of the problem in order to intervene, and this was the main motivation for this study. Since the MASA programme was launched, there were some patients who were ‘lost to follow-up’. As a result, there was a need to understand the reasons behind this phenomenon, so that the patients who are enrolled on the programme are retained. In order to gain an in-depth understanding of how the socio-economic factors affect compliance with antiretroviral therapy, phenomenology was used as a research strategy. Using the phenomenological strategy helps in understanding the nature or meaning of the respondents’ everyday experiences and to transform experiences into consciousness. The sampling method that was used is probability sampling, utilising availability sampling. The population for this study was HIV positive adults who had dropped out of the MASA Programme at Princess Marina Hospital, IDCC clinic in Botswana. The data collection instrument that was used was the interview schedule. From the conclusions, it is apparent that the socio-economic factors are crucial and should therefore be given more attention if better compliance is to be realised. In the same breath, patients require counselling that will focus, not only on the medical aspects of HIV/AIDS but also on the socio-economic factors. As shown in this study it is predominantly the socio-economic factors that led to patients dropping out of the programme. Social workers can play a critical role in this regard as they are equipped with counselling skills. Lastly, the conclusions and recommendation arising from this study are provided. / Dissertation (MA (Social Health Care))--University of Pretoria, 2007. / Social Work and Criminology / unrestricted

This study presents a qualitative analysis of the dichotomy between official HIV and AIDS policy and its implementation in a Human Rights based, United Nations (UN) agency, located in South Africa. The study demonstrates that although HIV and AIDS policy is an intrinsic part of the commitment of this large organisation, the implementation of the policy, in the form of a Workplace Wellness Programme supported by budgetary resources, is weak and incomplete. The thesis integrates detailed vignettes in drawing attention to how personnel in the South Africa office perceive and experience the implementation of HIV and AIDS policy. Additionally, the voices of bureaucrats are also integrated in an effort to interrogate management attitudes and mindsets on matters of policy and treatment of staff. The study explores staff members’ sense of being stigmatised and discriminated, when living with the virus and their responses to it. In this, I bring a personal perspective to the study, by relating my own views of living with a potentially life-threatening disease to the views of the participants in the workplace in which the study is conducted. Classical Weberian and contemporary accounts of ‘bureaucracy’ and the organisational ‘rule book‘ are drawn upon. It is argued that whilst the value systems and politics of managers in the United Nations system lead them to be defined as progressive, some of the practices within their own institutions are contradictory, indifferent and manipulative leading to the perpetuation of discrimination and anxiety amongst HIV-positive staff. Thus, human agency and ingenuity supersedes organisational structure and the rigour of organisational policies and rules. The contradictions highlighted necessitate a careful scrutiny of organisational dynamics, within the wider international development scenario, and organisational introspection within individual UN offices vis-à-vis HIV and AIDS policy implementation. It is envisaged that the study will induce the commissioning of a larger study carried out by an independent body and funded by the United Nations, enabling the validation and enhancement of the argument presented in the case study and provide more recommendations for the way forward for the United Nations. / Thesis (DPhil)--University of Pretoria, 2010. / Sociology / unrestricted