Grâce aux combinaison d’antirétroviraux (ART), le taux de transmission mère-enfant (TME) du Virus de l’Immunodéficience Humaine VIH est maintenant réduit à moins de 1%. Des progrès restent néanmoins à faire, en particuliers chez les femmes débutant tardivement leurs consultations prénatales. Mais l’évaluation de nouvelles stratégies ART pour la prévention de la TME (PTME) devient de plus en plus complexe à cause des exigences statistiques liées au fait que les transmissions sont rares. Dés lors, il devient crucial de modéliser l’efficacité des ART sur la charge virale (CV) et la transmission. Dans cette thèse, nous modélisons les mécanismes et le moment de la TME du VIH en utilisant des modèles mixtes. Les données proviennent de 4 études de prévention périnatales du VIH en Thaïlande (PHPT-1, PHPT-2, PHPT-5 1st phase et PHPT-5 2nd phase), une base de données historiques de qualité, collectées de 1996 à 2015, où différentes prophylaxies ART ont été prescrites à plus de 4000 femmes enceintes pendant des durées variables: Zidovudine (ZDV) seule; ZDV + une dose unique de nevirapine périnatale (sdNVP); ZDV+lopinavir/ritonavir (LPV/r) ou ZDV+LPV/r+lamivudine (3TC). Les modèles développés apportent un éclairage sur les mécanismes et le moment de la PTME ainsi que sur le rôle respectif de différents ART sur la réduction de la CV et sur leur contribution à la prophylaxie pre/post exposition. Partant de ces connaissances, une approche bayésienne est appliquée à une étude de cas (essai de supériorité dans le contexte d’un événement rare comme la TME du VIH) afin d’améliorer la puissance statistique tout en limitant la taille de l’échantillon, et comparée à une approche fréquentiste. / Nowadays, with the use of highly efficacious antiretroviral (ART) combination, the rate of mother-to-child transmission (MTCT) of Human Immunodeficiency Virus (HIV) is reduced to less than 1%. However, there are still some gaps to be filled, especially in women who initiate antenatal prophylaxis late. The evaluation of new ART strategies or drug combinations for the prevention of MTCT (PMTCT) of HIV becomes more difficult in view of the statistical requirements in case of rare outcomes. Therefore modeling the impact of ART on maternal viral load (VL) and transmission rate is increasingly important. In this thesis, the mechanisms and timing of MTCT of HIV were investigated using mixed model approaches. Data were derived from four perinatal HIV prevention studies in Thailand (PHPT-1, PHPT-2, PHPT-5 1st phase and PHPT-5 2nd phase), a unique set of quality historical data, consistently collected from 1996 to 2015, in which different ART prophylaxis regimens were provided to more than 4000 HIV-infected pregnant women for varying durations: Zidovudine (ZDV) alone; ZDV plus perinatal single dose nevirapine; ZDV+lopinavir/ritonavir (LPV/r) or ZDV+LPV/r+lamivudine. The developed models provide insights on the mechanisms and timing of PMTCT as well as on the respective role of different ARTs on the maternal VL reduction and in turn on their contribution to pre/post-exposure prophylaxis in MTCT of HIV. With this prior knowledge, a Bayesian design is applied to a case study, a trial aimed at evaluating treatment superiority in the context of rare outcomes such as MTCT of HIV, to improve the statistical power –while limiting sample size— and compared to a frequentist design.

Thesis (MPH.) -- University of Limpopo, 2021 / Introduction: HIV/AIDS remains a disease of public health importance and mother-to-child transmission (MTCT) is one of the major problems. Sub-Saharan Africa is the most severely affected region, accounting for more than 90 percent of paediatric HIV infections. Most of these infections occurred during pregnancy, delivery or breastfeeding making the prevention of mother-to-child transmission (PMTCT) a public health priority. Over the last few years, efforts have been made in Sub-Saharan countries to improve PMTCT and the success of prevention of mother‐to‐child transmission of HIV (PMTCT) is dependent upon high retention of mother‐infant pairs within the PMTCT cascade. Assessing the risk factors for MTCT will help to decrease child morbidity and mortality and strengthen PMTCT programs as there is dearth of evidence regarding factors determining MTCT HIV infection to infants born to HIV positive mothers. The purpose of this study was to investigate the determinants for the human Immunodeficiency Virus positivity rates in the Greater Letaba Municipality. The study objectives were to describe the demographic characteristics of mothers and babies who tested polymerase chain reaction test (PCR)-positive in the Greater Letaba Municipality during the two-year period from 2015 to 2016, in order to determine maternal and neonatal factors associated with high positive PCR; and to determine health system-related factors associated with a high positive PCR result. Methodology The current study followed a quantitative approach in which convenient and purposive sampling was used, focusing on records of infants born from HIV-positive women in all clinics at Greater Letaba Municipality were reviewed. All records of infants who were tested for HIV and the PCR results were positive from birth up to 12 months of age were retrospectively reviewed and for the health care workers, all nurses working as managers of a clinic were interviewed. The Statistical Package for the Social Sciences (SPSS) version 23 computer software and Stata 15 was used. for comparison of categorical variables was done using a Chi-Squared test, whereas continuous variables were compared using a t-test and P-value of <0.05 was considered significant. To determine maternal and neonatal factors associated with high positive PCR, Factor analysis was used with rotated factor loadings done using the Varimax method. Results: A total of 107 records were retrieved and audited. Fisher’s exact test was used to determine the relationship between selected variables, where p<0.05 was set as level of significance. The findings reveal that the number of infants exposed to HIV during pregnancy has steadily increased. The current study further indicates that health system factors such as unskilled or untrained NIM-ART nurses in the facilities is a contributory factor to infant’s positivity rate in Greater Letaba hospital. Equal proportions of both male and female babies were found to be PCR positive at 6 weeks. The study further revealed that the highest proportion of the mothers who gave birth to PCR positive babies for the reporting period were married mothers, in the age group 25-29 years (46.1%). The second largest proportion of mothers who gave birth to PCR positive babies were single mothers in the age group 25-29 years (38.4%). The results show that high PCR positivity can be attributed to about 5 main Factors namely: maternal antenatal history (22% contribution to total variance), maternal HIV care history (18% contribution to total variance), measures of adherence to treatment (17% contribution to total variance), maternal exposure to HIV (14% contribution to total variance) and lastly the ART regimen (12% contribution to total variance). Conclusion: The study findings revealed that there is still vertical transmission of HIV to infants and the prevalence of HIV among infants born from seropositive mothers despite the availability of the latest Prevention of Mother to Child Transmission (PMTCT) Guidelines in all health care facilities. Even though transmission is reduced to the meaningful number (< 5%), there are still appropriate measures that should be taken to reduce the transmission of HIV from mothers to infants. The delayed diagnosis, adherence to ART by mothers, infant ARV prophylaxis at birth and feeding practices contributed the vertical transmission of HIV to infants. Strengthening of the PMTCT of HIV programme, increasing antenatal HIV screening and linking it to care and treatment of HIV positive mothers to obtain zero infant HIV prevalence in the region. Infant prophylaxis and maternal PMTCT interventions should be provided to all exposed infants and mothers based on the guidelines by the health institutions. Nurse-initiated management of antiretroviral treatment (NIM-ART) training of professional nurses is being offered by the Department of Health in South Africa, but it does not yield positive results as far as the PMTCT is concerned. This may be due to shortage of staff, especially trained professional nurses (PN), as well as the workload. Key concepts: Infant and Human immune deficiency virus

<p>Breastfeeding from HIV-infected mothers is one of the major sources of pediatric HIV-1 infection; however, an intervention that promotes exclusive breastfeeding has significantly reduced vertical HIV transmission rates and infant mortality. The mechanisms underlying this phenomenon remain unknown; however, have been closely linked to high levels of innate immune factors in breast milk. Indeed, the level of several innate factors in breast milk correlate with protection and/or have direct anti-viral properties <em>in vitro.</em> The innate immune factor, soluble TLR2 (sTLR2) is found in high concentration in breast milk and has previously been investigated for its anti-bacterial properties; however, its anti-viral properties remain poorly understood. Thus, the research presented in this thesis extended our understanding of sTLR2 by characterizing the mechanisms by which sTLR2 inhibited HIV-induced inflammation and infection. Chapter 2 examined the predominant forms of sTLR2 in breast milk from different women, its cellular source, bioavailability and kinetics postpartum. Functionally, we confirmed sTLR2’s anti-bacterial properties and extended to show, for the first time, that sTLR2 directly inhibited HIV infection <em>in vitro.</em> Chapter 3 documented a potential mechanism of sTLR2’s direct inhibition of HIV infection <em>in vitro</em> and, investigated sTLR2 and TLR2 expression in HIV uninfected compared to HIV infected breast milk and breast milk cells, respectively. Chapter 4 investigated the role of TLR2’s recognition of novel HIV pathogen associated molecular patterns (PAMPs), and whether TLR2 expression increased HIV infection and integration. Taken together, we present novel anti-viral functions of sTLR2 by demonstrating that sTLR2 bound to specific HIV PAMPs, which led to significantly decreased HIV-induced inflammation, co-receptor expression, and HIV infection. Furthermore, we demonstrated, for the first time, that TLR2 recognizes specific HIV PAMPs, which led to significantly increased pro-inflammatory cytokine production, co-receptor expression and HIV infection. Thus, sTLR2 and TLR2 represent innate immune factors that might have preventative and therapeutic applications for both infants and adults in the future.<strong><br /> </strong></p> / Doctor of Philosophy (Medical Science)

The aim of this study was to assess the extent on how effective was the prevention of mother-to-child transmission of Human Immunodeficiency Virus (HIV) infection at Oshakati District Health Centre. Explanatory survey was used to conduct the research. A total of 160 nurses experienced in prevention of mother-to-child transmission and women who attended antenatal care and post natal care services participated in the study. Respondents expressed unsatisfactory with the promoting involvement of male partners, high quality voluntary counselling and testing services, couple counselling and testing, integration of Highly Active Antiretroviral Therapy services, administration of short course of Zidovudine to pregnant mothers and the provision of antiretroviral drugs to infants. Therefore, promoting involvement of male partners, couple counselling and testing, administration of short course of Zidovudine to pregnant mothers and educating women about exclusive breastfeeding prior to delivery are some of recommendations for effective prevention of mother-to-child transmission of HIV infections. / Health Studies / (M.A. (Public Health))

Thesis (MScMedSc)--Stellenbosch University, 2012. / ENGLISH ABSTRACT: Hepatitis B virus (HBV) immunisation protocols in much of Africa are based on data from the pre-human immunodeficiency virus (pre-HIV) era that indicated that HBV transmission occurs predominantly horizontally between siblings and play-mates rather than vertically from mother to child. The immunosuppression associated with HIV infection however may release HBV from immune control resulting in higher HBV viral loads, which may increase the risk of perinatal mother to child transmission of HBV. The aim of this study was to determine the prevalence and characteristics of chronic HBV infection in HIV-infected pregnant women compared to HIV-uninfected pregnant women in the Western Cape province of South Africa. Ethical approval was obtained to conduct a retrospective, matched case-control, unlinked anonymous study using residual plasma samples from the 9355 pregnant women included in the Western Cape's 2008 National HIV and Syphilis Antenatal Survey. Samples were tested for HBsAg on the AxSYM (Abbott, Chicago, IL) and confirmed by neutralization. Confirmed HBsAg-positive samples were tested for HBeAg, anti-HBe and anti-HD (Diasorin, Saluggia, Italy) and had HBV viral load and genotyping done. In addition, HBsAg-negative samples were tested for anti-HBc. Samples from 1549 HIV-infected pregnant women were included and matched to the same number of samples from age- and race-matched HIV-uninfected women. Median age of 26 years, parity and education were similar in the two groups. The prevalence of HBsAg was 3.4% for the HIV-infected group and 2.9% for the HIV-uninfected group. HBV DNA loads of greater than 104 IU/ml were detected in 32.1% of HBsAg-positive, HIV/HBV co-infected women, and in 14.3% HBsAg positive, HBV mono-infected women. Among the HIV-infected group 18.9% of HBsAg-positive were HBeAg positive, with a median viral load of 7.93 log10 IU/ml; whilst 15.5% HIV-uninfected women were positive for HBeAg with a median viral load of 6.07 log10 IU/ml. Genotype A was seen in 92.6% of the isolates while 7.4% of the isolates were genotype D. Serum total anti-HBc antibodies that are a marker of past infection were detected in 42.2% of HIV-infected and in 24.1% of HIV-uninfected women that were negative for HBsAg. No positive sample for anti-HD was seen among all HBsAg-positive samples. This data indicates that there is increased exposure to HBV in HIV-infected pregnant women than in HIV-uninfected women and that a greater proportion of HIV-infected pregnant women compared to HBV mono-infected pregnant women may be at increased risk of transmitting HBV to their infants. Further studies are needed to determine the rate of vertical transmission of HBV in the HIV era. / AFRIKAANSE OPSOMMING: Hepatitis B virus (HBV) immunisasie protokolle vir meeste dele van Afrika is gebaseer op data versamel in die era voor MIV. Die data dui aan dat HBV oordrag hoofsaaklik deur horisontale transmissie tussen broers, susters en speelmaats eerder as vertikale transmissie van moeder na kind plaasvind. Die onderdrukking van die immuunstelsel as gevolg van MIV infeksie kan egter lei tot 'n verhoogde risiko van perinatale HBV oordrag van moeder na kind. Die doel van hierdie studie was om die voorkoms en karakter van chroniese HBV infeksie in MIV-positiewe swanger vroue te vergelyk met die van MIV-negatiewe swanger vroue. Etiese goedkeuring is verkry om 'n retrospektiewe, deursnee-, ongekoppelde anonieme studie uit te voer wat gebruik maak van oorblywende plasma monsters van 9355 swanger vroue wat ingesluit is in die Wes-Kaap 2008 Nasionale MIV en Sifilis Voorgeboortelike Opname. Die monsters was getoets vir HBsAg antiliggame (AxSYM, Abbott, Chicago, IL) en bevestig deur neutralisasie toetse. Positiewe monsters was getoets vir HBeAg en anti-HBe (Diasorin, Saluggia, Italië). HBV viruslading en genotipering was ook op HBsAg positiewe monsters gedoen. Die HBsAg negatiewe monsters was getoets vir die teenwoordigheid van anti-HBc. Monsters van 1549 MIV-positiewe swanger vroue was ingesluit in die studie. Dieselfde aantal monsters van MIV-negatiewe vroue, met ooreenstemende ouderdom en etnisiteit, was ingesluit as kontroles. Die gemiddelde ouderdom van albei groepe was 26 jaar. Pariteit en opvoeding was dieselfde in albei groepe. Die voorkomssyfer van HbsAg was 3.4% in die MIV-positiewe groep en 2.8% in die MIV-negatiewe groep. HBV DNS ladings van meer as 104 IU/ml was waargeneem in 32.1% van die MIV-mede-geinfekteerde vroue en in 14.3% van die MIV-negatiewe groep. In die MIV-positiewe groep was 18.9% vroue HBeAg positief, met 'n gemiddelde virale lading van 7.93 log10 IU/ml, terwyl 15.5% MIV-negatiewe vroue positief was vir HBeAg met 'n gemiddelde virale lading van 6.07 log10 IU/ml. In ons studie was 92.6% van die monsters genotipe A en 7.4% genotipe D. Toatale anti-HBc antiliggame, 'n merker van vorige infeksie, was gevind in 42.2% van MIV-mede-geïnfekteerde vroue en 24.1% van MIV-negatiewe vroue wat negatief was vir HBsAg antiliggame. Data van ons studie dui op 'n verhoogde risiko vir vertikale HBV transmissie van MIV-positiewe moeders na hul babas. Verdere studies word benodig om vas te stel of vertikale transmissie van HBV van MIV-positiewe vroue na hul babas plaasvind. / Wellcome Trust / Poliomyelitis Research Foundation

Thesis (PhD)--Stellenbosch University, 2015. / ENGLISH ABSTRACT: The prevention of mother-to-child transmission (PMTCT) of HIV is a key maternal and child health intervention in the context of the HIV/AIDS pandemic in South Africa. Accordingly, the PMTCT programme has been incorporated in the District Health Management Information System (DHMIS) that collects monthly facility-based data to support the management of public health services. To date, there has not been a comprehensive evaluation of the PMTCT information system. By comparing the experiences in two health districts, using the Performance of Routine Information System Management (PRISM) framework and tools, this study seeks to evaluate the availability, quality and use of process and output indicators for monitoring PMTCT interventions. A comparative analytical and observational study was undertaken using a multi-method approach which included: a self-administered survey of health information personnel to assess confidence and competence levels for routine health information system (RHIS) tasks, an assessment of the routine PMTCT data for quality, completeness, accuracy, and data use; and a facility survey of RHIS processes and resources. In addition, in-depth interviews with 22 key informants and observations in health facilities were conducted. Data were collected from 57 health facilities in a convenience sample of two health districts, and also from 182 health information personnel in the 57 health facilities, three sub-districts, and two district offices. Descriptive statistics, χ2-test, correlation and multiple regression analyses were conducted using STATA® Version 13. A general inductive approach was also used to analyse the qualitative data, which was used for triangulation. The study revealed considerable data quality concerns for the PMTCT information with an average accuracy between the register and routine monthly report of 51% and between the routine monthly reports and DHMIS database of 84% suggesting that the primary point of departure for accurate transfer of data is during the collation process. The importance of human factors was emphasised by the observation that the average confidence level for performing RHIS-related tasks (69%) was not commensurate with the average competence levels (30%). Education was found to be associated with competence, implying that levels of education may be associated with the level at which RHIS competencies are acquired; and that three years or more of post-matriculation education is necessary. Motivation, on the other hand was not associated Stellenbosch University https://scholar.sun.ac.za iv with competence. The study observed the absence of processes such as data-quality checks and data-analysis in place in facilities. There was a general absence of a culture of information use, as a result of lack of trust in the data, and the inability of programme and facility managers to analyse, interpret and use information. We observed differences in the data accuracy by organisational authority, and multivariate analysis and qualitative information suggested that feedback may be an essential process to ensure quality. Although the PRISM framework has been developed from a multi-disciplinary evidence base, this study has been able to validate some of the internal assumptions but has also found some aspects that were not supported such as motivation and data display. Data collected from a larger number of facilities will be required to investigate this further. Institutional capacity to improve RHIS processes, ensure core competencies for RHIS-related tasks are needed, and in the longer term, measures to tackle problems associated with low pass rates in numeracy subjects among high school learners are needed. Further exploration of the possible factors that may influence data accuracy, such as supervision, training and leadership are needed as well as investigating the relationships between human and institutional agency-related aspects, in particular, how individual actions can bring about changes in institutional routines. Further study is needed to determine how decision for planning and evaluating key programmes such as PMTCT are made, and what informs such decisions if not routine data. / AFRIKAANSE OPSOMMING: In die lig van Suid Afrika se MIV/VIGS-pandemie kan ’n ingryping op gesondheidsvlak ’n belangrike rol speel om moeder-na-kind-oordrag (beter bekend as PMTCT) van MIV te voorkom. ’n Inligtingstelsel vir distriksgesondheidsbestuur – die DHMIS – was ontwerp vir die invordering van maandelikse fasiliteitsdata, wat gebruik kan word om die bestuur van openbare gesondheidsdienste en -programme te ondersteun. Die inligtingstelsel self was nog nie omvattend evalueer nie. Hierdie studie het die ervarings van twee gesondheidsdistrikte vergelyk met behulp van die PRISM- (Performance of Routine Information System) raamwerk en -instrumente. Derhalwe het hierdie studie die beskikbaarheid, gehalte en gebruik van proses- en uitsetaanwysers probeer bepaal om die PMTCT-ingrypings te monitor. ’n Vergelykende analitiese en waarnemingstudie is onderneem met behulp van ’n veelvuldige benadering. Die verskillende metodes het ’n selfopname onder gesondheidsinligtingspersoneel ingesluit om hul selfvertroue en bevoegdheid in roetinegesondheidsinligtingstelsel (RHIS)-take te evalueer. Daar was ook ’n assessering van die PMTCT-roetinedata om datagehalte, -volledigheid, -akkuraatheid en -gebruik te beoordeel.’n Fasiliteitsopname oor RHIS-prosesse en –hulpbronne was ook gedoen. Ander navorsingsmetodes het diepte-onderhoude met 22 sleutelpersone ingesluit, sowel as waarnemings in gesondheidsfasiliteite. Data is van 182 gesondheidsinligtingpersoneel van die 57 gesondheidsfasiliteite in ’n geriefsteekproef van twee gesondheidsdistrikte ingesamel. Deskriptiewe statistiek, χ2-toetsing, korrelasie en veelvoudige regressie is met behulp van STATA® weergawe 13 ontleed. ʼn Algemene induktiewe benadering is ook gevolg om die kwalitatiewe data te ontleed. Die studie toon dat menslike faktore ’n impak op datagehalte en -inligting kan hê, met ’n gemiddelde akkuraatheidsyfer van 51% van beide die register en roetine maandelikse verslae. Die akkuraatheid van die maandelikse verslae en RHIS databasis is 84%, wat aandui dat akkuraatheid slegs toegepas word indien inligting uit die staanspoor korrek aangeteken word. Die impak van menslike hulpbronafaktore was beklemtoon toe daar bevind was dat hoewel 69% van RHIS-dataverwerkers vertroue getoon het in die gebruik van RHIS-verwante take, slegs 30% wel bevoeg was om die werk te doen. Opvoeding was grootliks geassosieer met bevoegdheid, wat moontlik voorstel dat sekere vlakke van opvoeding benodig word vir spesifieke RHIS-bevoegdhede. Minsten drie jaar tersiêre opleiding word aanbebeel. Motivering was nie met Stellenbosch University https://scholar.sun.ac.za vi bevoegdheid geklassifeer nie. Die studie het bevind dat daar te min aandag aan datagehalte en –analise gegee word in fasiliteite. Oor die algemeen was daar nie ’n ordentlike kultuur van inligtinggebruik nie, a.g.v. die feit dat daar nie vertroue in die data was nie. Terselftertyd was program- en fasiliteitbestuurders nie bevoeg om inligting te analiseer en ontleed nie. Ons het verskille in die akkuraatheid van data opgetel wat deur organisasie-hoofde gedoen was. Meervoudige analise en kwalitatiewe informasie stel voor dat terugvoering ’n belangrike deel van die proses moet wees om kwaliteit te verseker. Hoewel die PRISM-raamwerk saamgestel was uit ’n multi-dissiplinêre bewyslewering, kon hierdie studie sommige van die interne voorneme valideer, maar daar was aspekte wat nie gestaaf kon word nie. Inligting van ’n groter aantal fasiliteite sal benodig word om verder hierna ondersoek in te stel. Institusionele kapasiteit word benodig om RHIS-prosesses te verbeter en basiese vaardighede vir RHIS-verwante take te verseker. Op langtermynvlak moet daar ook gekyk word na probleme wat lei tot laë slaagsyfers in syfervaardighede in hoërskoolleerders. Verdere ondersoek moet ingestel word om vas te stel watter faktore moontlik akkurate data teweeg kan bring. Dit sluit toesig, opleiding en leierskap, asook die verhoudings tussen menslike en agentskap-verwante aspekte in. Die feit dat optrede op individuele vlak veranderings in institusionele roetines kan aanbring, moet spesifiek na gekyk word. Verdere studies kan help om vas te stel hoe besluite vir beplanning en evaluaring vir hoofprogramme soos PMTCT gemaak word – asook hoe die besluite gemaak word indien hulle nie roetine voorafgaan nie.

The aim of this study was to assess the extent on how effective was the prevention of mother-to-child transmission of Human Immunodeficiency Virus (HIV) infection at Oshakati District Health Centre. Explanatory survey was used to conduct the research. A total of 160 nurses experienced in prevention of mother-to-child transmission and women who attended antenatal care and post natal care services participated in the study. Respondents expressed unsatisfactory with the promoting involvement of male partners, high quality voluntary counselling and testing services, couple counselling and testing, integration of Highly Active Antiretroviral Therapy services, administration of short course of Zidovudine to pregnant mothers and the provision of antiretroviral drugs to infants. Therefore, promoting involvement of male partners, couple counselling and testing, administration of short course of Zidovudine to pregnant mothers and educating women about exclusive breastfeeding prior to delivery are some of recommendations for effective prevention of mother-to-child transmission of HIV infections. / Health Studies / M.A. (Public Health)

Breast-feeding by Human Immunodeficiency Virus (HIV) positive mothers poses a risk of transmitting HIV infection from the mother to the baby. This study attempted to describe and explore the knowledge of antenatal women in Gaborone, Botswana on the transmission of HIV through breast-feeding. The research results, obtained from interview schedules, revealed that the respondents had: a greater knowledge of transmission of HIV in adults than mother-to-child-transmission (MTCT); a moderate understanding of infant feeding methods; poor understanding of the risk of HIV transmission through different infant feeding methods and feelings that infant feeding method reveals ones HIV status, which indicate stigma and discrimination. The study findings may assist health care providers to intensify educational programmes and counselling in the antenatal clinics and communities to reduce MTCT. / Health Studies / M. A. (Health Studies)

The study reports on the perceptions of the midwives and pregnant women of the PMTCT of HIV programme at the antenatal care and maternity ward at the Johan Heyns Community Health Centre. A qualitative approach was adopted to conduct the study. Purposive sampling was used to select participants and was informed by social behavioural theories. Data was collected using interviews and analysed using thematic categorisation. The findings show that at the first PMTCT encounter participants had little to no knowledge of the PMTCT programme, generally displayed a lack of interest, experienced emotional distress, and fear at the thought of having to disclosing their HIV-positive status to their partners/family and had certain trepidations about participating in the PMTCT programme. The participants’ perception on their roles was that their roles were interlinked, midwife needs the recipients (pregnant woman) and pregnant woman needs the provider (midwife) therefore one cannot do PMTCT without the other. The study recommends that the capacity building of pregnant women be optimised, that PMTCT awareness campaigns for women of childbearing age should be a priority and PMTCT skills to be prerequisite for midwives deployed to ANC clinics and maternity ward units. / Health Studies / M. A. (Social Behaviour Studies in HIV/AIDS)

Vertical transmission of HIV is still a growing concern in South Africa. Breastfed infants are still at risk as HIV is present in breast milk, leaving HIV-positive mothers unsure of the best feeding option for their infants. However, there are various infant feeding techniques that HIV-positive mothers can use to supplement breastfeeding and flash-heat is one of them. Flash-heat is heat treating expressed breast milk to deactivate HIV for infant feeding. This study explored the possibility of HIV-positive mothers to practice flash-heating method for their infants exclusively for four months as a strategy to prevent vertical transmission of HIV. A descriptive, explorative and contextual design using a mixed method was used to obtain data from mothers in a post natal ward at Tembisa hospital. The mixed method used was useful in identifying the number of HIV-positive mothers who would adopt the flash-heat technique, the characteristics of mothers whom the technique could be promoted to, the factors that influence/affect the choice of infant feeding for these mothers, as well as their feelings associated with the feeding technique. Most (74%) mothers had a positive response to the flash-heat technique compared to 10% who were uncertain. They believed that heat treating their breast milk would result in their infants being HIV-free. In addition they believed that this method was cheaper than formula feeding and expressed positive feelings about touching their breast milk while expressing with no adverse feelings of expressing into a glass jar. Furthermore, findings of this study indicated that HIV-positive mothers in a public health facility would adopt flash-heat as an alternative infant feeding method. Thus practical guidelines to promote this feeding method were proposed. The proposed draft guidelines which promote the use of the flash-heat infant feeding method for HIV-positive mothers in public sector facilities will be communicated to relevant authorities such as the National Department of Health. These guidelines support the new policy shift to exclusive breastfeeding as a child survival strategy in South Africa. / Health Studies / D.Litt. et Phil. (Health Studies)