<p>Women, who are HIV-positive, may transmit the virus to their babis during labour and through breast milk. HIV-positive mothers have to be counselled and encouraged to make informed decisions about the feeding of their babies to avoid this transmission. The feeding choices are exclusive breast-feeding , exclusive formula feeeding or modified feeding. this study focused on the perceptions, knowledge and experiences of breastfeeding women living with HIV/AIDS in the Oshakati district, Northern Namibia. A qualitative descriptive research design was used to conduct the study. The sresaerch was conducted at the Prevention of Mother-to-Child Transmission (PMTCT) Clinic, in the intermediate Hospital, Oshakati. The Medical Superitendant of the Hospital gave the researcher permission to conduct the study at the PMTCT clinic. A purposive sample was used consisting of 14 breastfeeding women who are HIV-positive and aged between 15-49 years. the ages of their babies were between one day and six months. The data collected through individual face-face-interviews. The interviews were tape-recorded with the permission of the respondents. The interviews were transcribed verbatim and data were analysed by thematic content analysis. The Health Belief Model guided the description and interpretation of the data. Th study revealed that some women had inadequate knowledge about the transmission of HIV through breastfeeding. Their breastfeeding choices were influennced by their knowledge and perceptions while their experiences were shaped by their relationships with their partners and family.</p>

<p>Women, who are HIV-positive, may transmit the virus to their babis during labour and through breast milk. HIV-positive mothers have to be counselled and encouraged to make informed decisions about the feeding of their babies to avoid this transmission. The feeding choices are exclusive breast-feeding , exclusive formula feeeding or modified feeding. this study focused on the perceptions, knowledge and experiences of breastfeeding women living with HIV/AIDS in the Oshakati district, Northern Namibia. A qualitative descriptive research design was used to conduct the study. The sresaerch was conducted at the Prevention of Mother-to-Child Transmission (PMTCT) Clinic, in the intermediate Hospital, Oshakati. The Medical Superitendant of the Hospital gave the researcher permission to conduct the study at the PMTCT clinic. A purposive sample was used consisting of 14 breastfeeding women who are HIV-positive and aged between 15-49 years. the ages of their babies were between one day and six months. The data collected through individual face-face-interviews. The interviews were tape-recorded with the permission of the respondents. The interviews were transcribed verbatim and data were analysed by thematic content analysis. The Health Belief Model guided the description and interpretation of the data. Th study revealed that some women had inadequate knowledge about the transmission of HIV through breastfeeding. Their breastfeeding choices were influennced by their knowledge and perceptions while their experiences were shaped by their relationships with their partners and family.</p>

Master of Public Health - MPH / Increased uptake of VCT services by pregnant women may be attributed to the development of counseling services and increased availability of rapid tests at the study clinics by the Namibian Health and Social Services. A high knowledge and understanding of HIV and VCT services by pregnant women also probably contributed. / South Africa

Magister Curationis - MCur / Women, who are HIV-positive, may transmit the virus to their babis during labour and through breast milk. HIV-positive mothers have to be counselled and encouraged to make informed decisions about the feeding of their babies to avoid this transmission. The feeding choices are exclusive breast-feeding , exclusive formula feeeding or modified feeding. this study focused on the perceptions, knowledge and experiences of breastfeeding women living with HIV/AIDS in the Oshakati district, Northern Namibia. A qualitative descriptive research design was used to conduct the study. The sresaerch was conducted at the Prevention of Mother-to-Child Transmission (PMTCT) Clinic, in the intermediate Hospital, Oshakati. The Medical Superitendant of the Hospital gave the researcher permission to conduct the study at the PMTCT clinic. A purposive sample was used consisting of 14 breastfeeding women who are HIV-positive and aged between 15-49 years. the ages of their babies were between one day and six months. The data collected through individual face-face-interviews. The interviews were tape-recorded with the permission of the respondents. The interviews were transcribed verbatim and data were analysed by thematic content analysis. The Health Belief Model guided the description and interpretation of the data. Th study revealed that some women had inadequate knowledge about the transmission of HIV through breastfeeding. Their breastfeeding choices were influennced by their knowledge and perceptions while their experiences were shaped by their relationships with their partners and family. / South Africa

Objectives: The aim of this study was to explore the experiences and perceptions of counsellors and patients towards a new counselling model for HIV-positive pregnant women on Option B+ at an antenatal clinic in South Africa and to describe the cohort of HIV-positive pregnant women who experienced the new counselling model. Methods: A mixed methods study design was employed. The quantitative data collection involved using retrospective cohort quantitative data of women that were initiated on Option B+ during the period of 1 October 2013 to 30 June 2014. The variables of interest included: age, gravidity, antiretroviral therapy initiation date, viral load result and number of counselling sessions completed. These were obtained from patient folders and from the Department of Health patient electronic health record. The data was analysed using STATA 12. The qualitative data involved semi-structured interviews of patients and counsellors who had experienced the counselling model. Results: The number of women who completed a total of 1, 2, 3 or 4 counselling sessions was 25%, 26%, 48% and 1% respectively. The percentage of women that were retained in care for more than 8 weeks postnatal was 53%. Of the women with VL results, 92% were virally suppressed. The Fisher's exact test showed a P-value of 0.05 at a level of significance of P ≤ 0.05. Therefore there is sufficient evidence to show that there is a positive association between the number of counselling sessions completed and number of postnatal days in care. The study also found that from the counselling, the women gained social support, knowledge about: antiretroviral therapy, HIV, drug side effects and infant feeding. Conclusion: The poor uptake of the counselling intervention includes poor communication, service delivery challenges and social factors. The main motivation for initiating ART and maintaining adherence to treatment was to protect the baby and as a result, some women maintained adherence despite not completing the counselling. Women valued the education that they received during the counselling sessions and this influenced their adherence. Psychosocial support from the counsellors and peers was found to be vital to the women and this highlighted the need to incorporate a support group for the pregnant women, as part of the intervention. The findings also suggest that when offering counselling interventions to pregnant women, a balance between psychosocial support, practical support and patient education needs to be struck. Finally, education of the community on the importance of counselling is important in order to improve the uptake of the counselling because interventions aimed at mothers do not always take into account the influence of the social environment on the uptake of the intervention.

Introduction: Use of highly effective antiretroviral drugs to eliminate new paediatric HIV infections is the keystone of all prevention of mother-to-child transmission (PMTCT) programmes. Time on antiretroviral treatment (ART) before delivery reduces maternal viral load and decreases the risk of transmission in utero, during labour and whilst breastfeeding. Currently, many PMTCT programmes across Africa initiate HIV-infected pregnant women on lifelong antiretroviral therapy (ART) on the first day of antenatal care ("same-day" initiation). However concerns have been raised regarding patient readiness and whether same-day initiation in pregnancy may contribute to subsequent ART non-adherence. Methods: As part of a larger study of ART in pregnancy, consecutive ART-eligible pregnant women making their first antenatal care (ANC) visit at a primary care facility in Cape Town, South Africa were enrolled into a prospective cohort between March 2013 and June 2014. Before July 2013, eligibility was based on CD4 cell count ≤350 cells/μL ("Option A"), with a 1-2 week delay from the first ANC visit to ART initiation; thereafter all women were eligible regardless of CD4 cell count ("Option B+") and typically offered ART on the same day as first ANC visit. All women received standardized counselling before starting a fixed-dose regimen. Study interviews were conducted separately from the ART service through one week postpartum with self-reported adherence from 30- day recall. Results: Among 625 consecutive ART-eligible women (median age, 28 years; median gestation, 21 weeks; 55% newly diagnosed with HIV), 72% of women started ART same-day; this proportion was higher under "Option B+" versus "Option A" (p< 0.001). Of those with adherence assessments data available (n=618), 29% reported at least one missed ART dose during pregnancy. Missed doses were reported more frequently among women with previous use of PMTCT (p=0.014), of younger age (p=0.029) and starting ART under Option B+ (p=0.019). In women initiating ART same-day, 31% reported a missed dose compared to 23% among women who delayed ART start following first ANC visit (odds ratio, 1.07; 95% CI: 0.61 – 1.88). This finding did not vary after adjustment for demographic and clinical measures, and was consistent when restricted to women with CD4 cell counts ≤350 cells/μL. Conclusions: These results suggest same-day ART initiation in pregnant women is not associated with increased non-adherence during the antenatal period. While these results are reassuring for ART programmes implementing "Option B+", further research is required to examine adherence over time, particularly postpartum.

Background and Objectives: Postpartum haemorrhage (PPH) and mother to child transmission (MTCT) of the Human Immune Deficiency Virus (HIV) are major threats to maternal and foetal health, especially in low and middle income countries. This thesis addressed two main objectives: 1) to investigate strategies for the prevention of PPH, with a focus on misoprostol; 2) to investigate strategies for prevention of mother to child transmission (PMTCT) of HIV, with a focus on the male partner. Methods: We employed a number of study designs including a cross sectional design, a retrospective chart review, and a systematic review which included Classical and Bayesian approaches of meta- analysis. Key methodological issues addressed include the use of propensity score matching methods to address channeling bias; comparison and combination of evidence from different sources; sensitivity analysis in health research; and methods for developing new tools for measurement in health research. Results and Conclusions: Our findings suggests that an oxytocin-misoprostol combination is better than the current standard of care of oxytocin-only which is recommended by the World Health Organisation for the prevention of PPH. Secondly, effectiveness data from well-designed observational studies may be used to inform clinical decisions on misoprostol in the prevention of PPH. Thirdly, using a new tool we have created, it is possible to objectively identify HIV positive women who lack the support of their male partners in adhering to PMTCT recommendations. / Background and Objectives: Postpartum haemorrhage (PPH) and mother to child transmission (MTCT) of the Human Immune Deficiency Virus (HIV) are major threats to maternal and foetal health, especially in low and middle income countries. This thesis addressed two main objectives: 1) to investigate strategies for the prevention of PPH, with a focus on misoprostol; 2) to investigate strategies for prevention of mother to child transmission (PMTCT) of HIV, with a focus on the male partner. Methods: We employed a number of study designs including a cross sectional design, a retrospective chart review, and a systematic review which included Classical and Bayesian approaches of meta- analysis. Key methodological issues addressed include the use of propensity score matching methods to address channeling bias; comparison and combination of evidence from different sources; sensitivity analysis in health research; and methods for developing new tools for measurement in health research. Results and Conclusions: Our findings suggests that an oxytocin-misoprostol combination is better than the current standard of care of oxytocin-only which is recommended by the World Health Organisation for the prevention of PPH. Secondly, effectiveness data from well-designed observational studies may be used to inform clinical decisions on misoprostol in the prevention of PPH. Thirdly, using a new tool we have created, it is possible to objectively identify HIV positive women who lack the support of their male partners in adhering to PMTCT recommendations. / Thesis / Doctor of Philosophy (PhD)

Magister Curationis - MCur / The pandemic of HIV is the most severe health challenge affecting children across the world and it is estimated that more than 90% of all HIV infections in children result from Mother to Child Transmissions (MTCT). The global target of <2% MTCT risk of HIV has still not been achieved despite the duration of the implementation of the programme and its great progress. The prevention of mother to child transmission (PMTCT) programme is a programme developed to enable health care practitioners to provide essential care to mothers in order to prevent the transmission of the virus to their infants.

Magister Public Health - MPH / The reproductive health of women is hugely dependent on the involvement of their male partners. Men also serve as gatekeepers to women’s access to reproductive health services. Male involvement is an important recommendation for the Prevention of Mother-to-Child Transmission of HIV (PMTCT) program as their participation in antenatal care and HIV testing has been found to decrease infant HIV infection and increase HIV free survival. Male involvement is not just about promoting men to accompany their partners to antenatal clinic, but for men to provide supportive roles in their families, and also to bring men into HIV preventive and care services. Male involvement in PMTCT is defined as the fathers’ active involvement in attending antenatal care services and HIV testing during the antenatal period as well as the couple’s acceptance of PMTCT if the mother is found to be HIV positive. Men are traditionally not directly involved in their partner’s health in many sub-Saharan countries, although they most often make decisions about use of services. They may provide financial support but attending health services with their partner is not seen as part of the male’s role. There are therefore huge challenges in efforts to get men involved in reproductive health services and there is a need to better understand how to promote male involvement in different settings. Male involvement in PMTCT was adopted by the Zambian Government in 1999 but not much is known on how best to initiate and develop male involvement in their partner’s health.

<p>Increased uptake of VCT services by pregnant women may be attributed to the development of counseling services and increased availability of rapid tests at the study clinics by the Namibian Health and Social Services. A high knowledge and understanding of HIV and VCT services by pregnant women also probably contributed.</p>