The study sought to determine the meaning and interpretation by facility managers and nurses on utilisation of expanded programme on immunisation and integrated management of childhood illnesses (EPI and IMCI) programmes for follow-up and antibody testing of HIV-exposed infants (HEI) at 18 months. Also to understand the factors within the health systems that influence the follow-up and antibody testing. The study setting selected was six facilities in Steve Tshwete subdistrict in Nkangala district of Mpumalanga province in South Africa. The study used a hermeneutic phenomenology using in-depth interviews for collecting data from 4 facility managers and 12 nurses. The major themes that emerged from the interviews were referral, defaulting, integration, stigma, and off-site ART initiation within the health system. These were found to influence the utilisation of HEI and IMCI services for follow-up and management of HEI. It was also found that the importance of integrating the management of HEI into the EPI and IMCI cannot be overemphasised. It was concluded that the Health Department needs to be vigilant and use all available resources to manage HEI to meet the MDG 4 of prevention of infant mortality / Health Studies / M.A. (Nursing Science)

Alors que les politiques de santé sont passées au cours des dix dernières années d'un traitement de la procréation en contexte VIH comme une « exception » à un discours de « normalisation », la thèse vise à comprendre les conditions et les effets de cette évolution. L'enquête ethnographique a été conduite sur une période de dix ans auprès de personnes vivant avec le VIH sous thérapie antirétrovirale, de femmes vivant avec le VIH ayant eu une expérience de procréation, et de professionnels de santé intervenant en PTME dans deux structures de santé de la reproduction au Sénégal. Cette étude met en lumière un « système moral » de la prévention du VIH, contradictoire à certains égards, qui offre aux femmes peu de moyens socialement acceptables pour se protéger du risque VIH. La procréation peut être perçue comme une stratégie pour réaffirmer une identité féminine, tester la capacité d'un corps « normalisé » par les ARV à enfanter sans transmettre le VIH, raffermir les liens conjugaux en souffrance et réduire les risques de stigmatisation sociale. Ces logiques ne sont pas toujours comprises par des professionnels de santé « spécialistes du VIH » souvent débordés dans la prise en charge médicale et psychosociale des PvVIH, qui soutiennent peu ces processus. Les hommes vivant avec le VIH apparaissent isolés, fragiles, voire « oubliés » . Ce travail montre les multiples usages sociaux de la procréation : objet d'émulation, de résistance, de souffrance et de rivalité pour les femmes VIH et leurs conjoints. Parallèlement à la normalisation « décrétée » par les instances de santé publique, les femmes vivant avec le VIH se sont réapproprié la possibilité de procréer. / Since the last decade has seen a transition from treating childbearing in the context of HIV as an “exception” to a discourse of “normalization,” this dissertation aims to understand the conditions and effects of this change. This ethnographic survey was conducted over a period of ten years among people living with HIV receiving antiretroviral therapy, women living with HIV who experienced childbearing and healthcare professionals working in PMTCT in two reproductive health facilities in Senegal. This study sheds lights on a “moral system” for HIV prevention, contradictory in some respects, that provides women few socially acceptable means to protect themselves from the risk of HIV. Childbearing may be perceived as a strategy to reaffirm female identity, test the capacity of a body made “normal” by ARVs to give birth without transmitting HIV, strengthening strained marital bonds, and reducing the risk of social stigmatization. Men living with HIV appear isolated, fragile, unsupported, and even “forgotten” relative to childbearing while they themselves are suffering or are affected by the situations of their wives or families. Health professionals now integrate HIV counseling and testing in their practices but continue to project attitudes of “exception” about treating PLHIV and pregnant HIV-Positive women. This study shows the various social uses of childbearing : a subject leading to emulation, resistance, suffering, and rivalry for women living with HIV and their spouses. Alongside the normalization “decreed” by public health officials, women living with HIV have reclaimed the possibility to procreate.

L’utilisation d’un traitement antirétroviral, chez la femme enceinte ou chez l’enfant infecté par le VIH, doit être optimale en termes d’efficacité et de tolérance. De nombreuses modifications physiologiques ont lieu tout au long de la grossesse ainsi que pendant les premières années de vie d’un enfant. Ces changements peuvent intervenir à tous les niveaux du devenir du médicament dans l’organisme. Une mauvaise connaissance des variations pharmacocinétiques associées à ces changements physiologiques peut amener à une toxicité ou à une inefficacité de ces traitements. Il est donc primordial de connaître la pharmacocinétique des différentes molécules antirétrovirales recommandées chez la femme enceinte et l’enfant infectés par le VIH. Les pharmacocinétiques de deux inhibiteurs non nucléosidiques de la transcriptase inverse, la zidovudine et l’abacavir et celle d'un inhibiteur de protéase, le lopinavir, ont été étudiées chez la femme enceinte et/ou chez l'enfant par une approche de population. L’évaluation et l’optimisation des recommandations posologiques de ces trois molécules ont été réalisées en tenant compte de relations concentration-effet et/ou concentration-toxicité précédemment établies. L'étude décrivant la pharmacocinétique de l’abacavir a montré qu’une adaptation posologique n’était pas nécessaire pendant la grossesse. En revanche, les études sur la pharmacocinétique de la zidovudine ont montré que les doses recommandées, chez la femme enceinte et chez l’enfant, devraient être diminuées afin de limiter les risques de toxicité. Pour finir, l’étude sur la pharmacocinétique du lopinavir a suggéré qu’il n’était pas nécessaire d’augmenter les posologies pendant la grossesse, contrairement à ce qui est recommandé dans la littérature. / The use of an antiretroviral therapy in pregnant women or in HIV-infected child should be optimal in terms of efficacy and safety. Important physiological changes occur during pregnancy and the first years of life. These changes can affect drug pharmacokinetics. Poor knowledge of pharmacokinetic variations associated with these physiological changes can lead to toxicity or failure of these treatments. Therefore, it is important to know the antiretroviral pharmacokinetics of recommended drugs in pregnant women and in HIV-infected children. The pharmacokinetics of two nucleoside reverse transcriptase inhibitors, zidovudine and abacavir and one protease inhibitor, lopinavir, have been studied in pregnant women and/or in children with a population approach. The evaluation and optimization of dosage recommendations of these three molecules have been achieved using concentration-efficacy and/or concentration-toxicity relationships previously established. The study describing the abacavir pharmacokinetics showed that a dose adjustment was not necessary during pregnancy. However, studies on zidovudine pharmacokinetics presented that the doses recommended in pregnant women and in children should be reduced in order to limit the toxicity risks. Finally, the study on lopinavir pharmacokinetics suggested not to increase the lopinavir dosage during pregnancy contrary to the recommendations of previous studies.

<p>&nbsp / </p> <p align="left">This study explores the challenges faced by nurse counselors in the implementation of HIV and Infant Feeding Policy in Amathole District of the Eastern Cape. <b><font face="Times New Roman">Objectives: </font></b><font face="Times New Roman">To describe the demographic characteristics of the study population / Toexplore the challenges faced by nurse counselors in the implementation of current HIV and infant feeding policy and guidelines / &nbsp / To establish the nurse counselors&rsquo / perspectives on the infant feeding policy and guidelines for HIV positive mothers / To examine the support system available to the nurse counselors who give infant feeding advice to HIV positive mothers.</font></p>

Diss. (sammanfattning) Umeå : Umeå universitet, 2009. / Felaktigt serienummer 1251. Härtill 4 uppsatser.

<p>&nbsp / </p> <p align="left">This study explores the challenges faced by nurse counselors in the implementation of HIV and Infant Feeding Policy in Amathole District of the Eastern Cape. <b><font face="Times New Roman">Objectives: </font></b><font face="Times New Roman">To describe the demographic characteristics of the study population / Toexplore the challenges faced by nurse counselors in the implementation of current HIV and infant feeding policy and guidelines / &nbsp / To establish the nurse counselors&rsquo / perspectives on the infant feeding policy and guidelines for HIV positive mothers / To examine the support system available to the nurse counselors who give infant feeding advice to HIV positive mothers.</font></p>

The study sought to determine the meaning and interpretation by facility managers and nurses on utilisation of expanded programme on immunisation and integrated management of childhood illnesses (EPI and IMCI) programmes for follow-up and antibody testing of HIV-exposed infants (HEI) at 18 months. Also to understand the factors within the health systems that influence the follow-up and antibody testing. The study setting selected was six facilities in Steve Tshwete subdistrict in Nkangala district of Mpumalanga province in South Africa. The study used a hermeneutic phenomenology using in-depth interviews for collecting data from 4 facility managers and 12 nurses. The major themes that emerged from the interviews were referral, defaulting, integration, stigma, and off-site ART initiation within the health system. These were found to influence the utilisation of HEI and IMCI services for follow-up and management of HEI. It was also found that the importance of integrating the management of HEI into the EPI and IMCI cannot be overemphasised. It was concluded that the Health Department needs to be vigilant and use all available resources to manage HEI to meet the MDG 4 of prevention of infant mortality / Health Studies / M.A. (Nursing Science)

Magister Public Health - MPH / This study explores the challenges faced by nurse counselors in the implementation of HIV and Infant Feeding Policy in Amathole District of the Eastern Cape. Objectives: (i) To describe the demographic characteristics of the study population; (ii) To explore the challenges faced by nurse counselors in the implementation of current HIV and infant feeding policy and guidelines; (iii) To establish the nurse counselors perspectives on the infant feeding policy and guidelines for HIV positive mothers; (iv) To examine the support system available to the nurse counselors who give infant feeding advice to HIV positive mothers. / South Africa

Includes bibliographical references (p. 51-57). / Exclusive breastfeeding (mother's milk only, with the exclusion of all other food or drink) reduces breast milk transmission of HIV compared with mixed feeding. This study was part of formative work for a community-based un-blinded randomised controlled trial (RCT) in an urban township with high antenatal HIV prevalence in KwaZulu-Natal (KZN), South Africa. The RCT sought to determine whether an integrated package of home-based care delivered by community health workers (CHWs) increases uptake of prevention of mother-to-child-transmission (PMTCT) interventions and improves neonatal outcomes. One example of where counselling is used is in Behaviour Change Communication (BCC) approaches. A counselling booklet, used by CHWs during home visits, was part of the integrated package. The primary objective of this study was to document the socio-cultural context in which infant feeding and caring decisions were made. The secondary objective was to field test the draft counselling booklet for the RCT. Methods This qualitative study used focus groups (n=8 groups) and individual interviews (n=6). All participants, of unknown HIV status, were purposively sampled from the study site. The focus group participants included, in separate groups, eight MRC researchers; 14 pregnant women (two separate groups of seven each); six non-pregnant women; eight older women; five men and 15 CHWs (separated into two groups). Results Data showed that socio-cultural factors, like the lack of social support systems; uncertainty regarding the role of men in infant feeding and caring issues; local beliefs and practices that encouraged risky infant caring practices; the lack of supply of formula and CHWs' lack of breastfeeding knowledge and experience; and HIV-related stigma may directly or indirectly, drive mothers to practice non-exclusive infant feeding. BCC principles acknowledge that people are affected greatly by social pressures exerted not only by their peers, but also by their larger communities (Bentley et al., 1999). For vi example, with regard to the support systems, both pregnant as well as younger women felt that feeding and caring decisions regarding their infants were mostly made by older women ' their husbands were seldom involved in such decisions. In relation to HIV-related stigma, many pregnant women felt that some clinics were not very supportive regarding HIV disclosure. In terms of health system factors, CHWs said that they were sometimes ill-equipped to deal with issues of disclosure due to a lack of training and confusion around the key feeding and caring messages. With regard to infant caring practices, the data revealed risky practices (using soap enemas and inappropriate hand washing practices), even amongst CHWs. Participants said they would share the booklet with others in the community as it taught them important lessons regarding infant feeding and caring practices. For some, the pictures in the booklet enhanced their understanding of 'old' messages. Participants identified several weaknesses in the booklet and suggested that it be less repetitive; that voluntary counselling and testing (VCT) be given priority in earlier rather than later visits; that unfamiliar terms is explained; more pictures included; and the general tone of messages improved. Literacy rates were low among older women and some men in the study. Conclusion and Recommendations Socio-cultural factors drive mothers to practice non-exclusive feeding and care for their infants in ways that may unwittingly increase the risk of HIV transmission. There is a need for CHWs to include family members in discussions about feeding so that they can change their thinking around infant-feeding and caring issues. The data suggests that VCT is not given priority in the counselling booklet and support is lacking in some clinics, therefore policy makers should ensure that support for VCT becomes a priority in the future. Furthermore, some CHWs were confused about the messages they are disseminating, therefore, the training that facility managers give to CHWs should be adapted to suit socio-cultural contexts so that CHWs are better equipped to communicate messages pertaining to infant feeding and caring appropriately to mothers. With the data revealing general acceptability of risky infant caring practices, even amongst CHWs, the vii health system needs to look at how it will effectively change health-related practices among health professionals. With literacy rates being low among older women and some men in the study, it was therefore recommended that gaining skills in materials design and improving CHWs' understanding of the BCC process, booklets such as this one needs to be designed together with the primary user in mind.

This study aimed at assessing factors related to male participation in PMTCT in three public hospitals in Addis Ababa, Ethiopia. A quantitative, descriptive correlational design was used to assess correlation between male participation and socio-demographics, knowledge and awareness in HIV/PMTCT, socio-cultural belief, programmatic factors and reported risk. Male partners (n=216) were interviewed and reviews of HIV counselling and testing (HCT) acceptance formats were made. The major findings were 54.5% (n=156) males reported receiving HCT during their visit to partner’s antenatal care. Some 71.5 % (n=677) of women were accompanied to labour wards by male partners; 86.5% (n=208) of males accepted intra-partum HCT; 55.1% (n=216) scored above the mean score (10) on a 15-point scale for male participation. Male participation in PMTCT was found to have a statistically significant but weak correlation with educational level (r=0.193), income (r=0.167), PMTCT knowledge and awareness (r=0.172), socio-cultural belief (r=-0.164) and reported risk (r=-0.23). / Health Studies / M.A. (Public Health)