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1
Luo, Chewe Angela. "Mother to child transmission of HIV : maternal and child characteristics". Thesis, University of Liverpool, 2000. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.367181.
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A prospective study at the University Teaching Hospital of 306 women with their infants, who were enrolled at delivery, was conducted in 1997. The primary aim was to define the magnitude and effects of maternal human immuno-deficiency virus (HIV) infection on obstetric problems and infant outcome. Women were mainly over 19 years (87.3%), literate (73.7%) and married (91.4%), with no formal income (75.7%). 48.2% and 46.7% had antenatal or post-partum anaemia (PPA) and of these 1.8% and 6.2% were severely anaemic. Low post-partum (PP) serum retinol «0.7f.lmoI/L) and CD4 counts «400 cells/mm3 ) occurred in 12.8% and 16.2% of the women. The commonest obstetric problems were previous child death (32.4%), malaria treatment during pregnancy (32.6%), previous abortion (16.4%) and hypertension (13.7%). Post-partum, 30.1% of the women were HIV infected, 14.9% rapid plasma reagin (RPR) positive and 4.5% hepatitis B surface antigen (HBsAg) positive. Factors independently associated with HIV infection were: alcohol intake during pregnancy (RR 5.67); ante-partum haemorrhage (RR 5.85); PP HBsAg positivity (RR 27.45); low PP CD4 cell count (RR 10.63) and PPA (RR 3.99). Primigravidae had a lower risk ofHIV infection (RR OJ). For PPA independent risk factors were: caesarean section (RR 9.95); HIV infection (RR 2.81) and low PP mean corpuscular haemoglobin concentration (MCHC) (RR 8.33); mean corpuscular volume (MCV) (RR 2.39) and serum retinol (RR 3.03). Alcohol intake during pregnancy (RR 0.22) and low PP maternal weight (RR 0.10) were associated with reduced risk ofPPA. The prevalence of low birth weight (LBW; weight <2.5kg), pre-term delivery «37 weeks gestation) and intra-uterine growth retardation (IUGR; weight < lOth centile for gestational age) were 18.9%, 23.8% and 25.9%. These showed no association with maternal HIV infection although the mean birth weight was significantly lower in children born of HIV infected mothers (P=0.006). In HN non-infected women, antenatal anaemia was independently associated with increased risk pre-term delivery (RR 5.l2) and low birth weight (RR 5.08). Low PP serum retinol increased the risk of IUGR (RR 3.10). In HN infected women, lack of paternal income was associated with pre-term delivery (RR 11.7), IUGR with LBW (RR 3.59) and antibiotic treatment in pregnancy with IUGR (RR 5.85). The cumulative rate of HN mother to child transmission (MTCT) at 1 year of age was 31 %, with 10.3%, 1O.l% and 9.l% of infants DNA polymerase chain reaction (PCR) positive at birth, 1 month and 4 to 12 months respectively. On multivariate analysis, PP maternal viral load (>50,OOOcopies Iml) was the only risk factor associated with early infant HN acquisition (birth and 1 month) (P = 0.005) and cumulative infections at one year (P=O.OOI). At a year of age, HIV infected children were severely undernourished (weight for age median Z-score -3.46) and stunted (height for age median Z-score -4.44). Stunting was the main form of malnutrition in uninfected infants regardless of maternal HN status. Reported morbidity in infancy was unaffected by HN status. The infant mortality rate was 136 per 1000 live births, 85 per 1000 in HN uninfected children of uninfected mothers, 272 per 1000 in infants of infected mothers and 424 per 1000 in infected infants. After correcting for confounders, maternal HN infection (HR 0.28) and primigravidae (HR 0.20) were significant risk factors for infant survival. The population attributable risk percentage of infant mortality was 41.3% for maternal HN infection and 24.9% when the infant was HN infected as well.
2
Nuwagaba-Biribonwoha, Harriet. "Prevention of mother-to-child transmission of HIV in Uganda". Thesis, University of Oxford, 2004. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.413514.
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Joubert, Bonnie R. Meshnick Steven R. "Human genetic susceptibility to mother to child transmission of HIV a study of mother-infant pairs in Malawi /". Chapel Hill, N.C. : University of North Carolina at Chapel Hill, 2009. http://dc.lib.unc.edu/u?/etd,2860.
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Thesis (Ph. D.)--University of North Carolina at Chapel Hill, 2009.Title from electronic title page (viewed Jun. 4, 2010). "... in partial fulfillment of the requirements of the degree of Doctor of Philosophy in the Department of Epidemiology." Discipline: Epidemiology; Department/School: Public Health.
4
Wu, Dadong. "Controlling mother-to-child transmission of syphilis and HIV in China : a comparative policy analysis to inform promotion of political prioritization for elimination of mother-to-child transmission of syphilis". Thesis, University College London (University of London), 2017. http://discovery.ucl.ac.uk/1576496/.
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Despite a large and growing burden of mother-to-child transmission (MTCT) of syphilis in China, the problem languished on the national policy agenda prior to 2010 when the Ministry of Health first committed to eliminating the infection (by 2020). In contrast, MTCT of HIV became one of the country’s foremost public health priorities in the early 2000s despite its relatively lower burden and less cost-effective interventions. Based on review of literature and policy-relevant documents, a puzzle was raised of why China responded contrastingly to MTCT of syphilis and MTCT of HIV, both of which shared a number of issue characteristics and can be eliminated by integrated interventions. To resolve the puzzle, this PhD study was conducted to identify those factors driving or hampering political prioritisation within the Chinese health policy arena, through investigating the two policy cases. Policy-relevant data were collected through stakeholder interviews, documentation review as well as observation of relevant activities, and analysed by using a nine-factor framework. A set of highly interrelated factors were identified as accounting for the significant slowness in China’s policy response to MTCT of syphilis. These factors include (1) relative neglect of the issue at global level; (2) dearth of international financial and technical assistances; (3) a poorly unified national policy community, (4) absence of capability political entrepreneurs to lead the initiative; (5) policymakers’ insufficient understanding of the problem; (6) unclear policy alternatives; as well as (7) a prevailing negative framing of syphilis that resulted in serious stigmatisation. However, not all these factors functioned at subnational level of China, but whether or not and how MTCT of syphilis was prioritised at provincial and municipal levels was mainly influenced by performance of the local policy communities. Drawing upon the findings, this study concluded with a set of recommendations for promoting political prioritisation for control of MTCT of syphilis and other neglected health issues in China. Special attention was given to how to maintain consistent political priority at multiple administrative levels in order for the country to eliminate MTCT of syphilis in the near future. In addition, the analytical framework was modified to advance its applicability in studying the Chinese health policy process.
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Singh, Vikesh. "Implementation of the dual therapy prevention of mother-to-child transmission protocol". Thesis, Nelson Mandela Metropolitan University, 2010. http://hdl.handle.net/10948/1374.
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Antiretroviral drugs taken during pregnancy, reduce the rates of mother-to-child transmission from 35 percent to as low as 1 to 2 percent (UNAIDS, 2009). In 2002, the Prevention of Mother-to-Child Transmission (PMTCT) programme was implemented in South Africa. Studies on the implementation of the PMTCT programme have shown that understaffed and under-developed health care facilities were key barriers to the provision of PMTCT services (Health Systems Trust, 2002: 6; Skinner et al., 2003). The aim of this study was to assess the challenges experienced by health care workers working in public sector facilities in the Nelson Mandela Metropole after implementation of the dual therapy PMTCT programme. Four areas were investigated: Infrastructure; Drug Supply Management; Clinic Procedures and Staffing. A quantitative descriptive study was conducted in August 2009 at nine public health care facilities in the Nelson Mandela Metropole, South Africa. Questionnaires were issued to 81 nurses and 41 pharmacy personnel (pharmacists and pharmacist assistants). Checklist audit forms were issued to the Facility Manager of each facility and completed with the researcher. The key findings for Infrastructure were lack of space at patient waiting rooms (9; 100 percent n=9), counselling area (5; 55.5 percent; n=9), nurse consultation rooms (6; 66.6 percent; n=9), storage areas (5; 55.5 percent; n=9) and filing areas (7; 77.7 percent; n=9). The key findings for Drug Supply Management were none of the dispensaries (0 percent; n=10) were fully compliant with Good Pharmacy Practice, pharmacy personnel indicated that there were no stock cards for medication (13; 31.7 percent; n=41); there was less than two weeks supply of buffer stock kept for zidovudine and nevirapine (13; 35.1percent; n=37) and medication orders were placed without any reference to minimum and maximum levels of medication (15; 36.5 percent; n=41) . The key findings for Clinic Procedures were only two facilities followed up on patients that had missed appointments (22.2 percent; n=9) and four facilities (44.4 percent; n=9) had a tracking system for patients that had defaulted. Of the nine facilities only three (33.3 percent; n=9) updated patient demographic details regularly. The key findings for Staffing were a shortage of doctors, nurses, counsellors and pharmacists at the facilities. One of the major challenges identified was the lack of training offered on new PMTCT protocols with 56.2 percent (45; n=80) of the nurses stating that no training was provided on the dual PMTCT protocol. Only 54.3 percent (44; n=81) of nurses stated that they knew the criteria to start the mother on dual PMTCT therapy. In conclusion there is an urgent need for barriers such as lack of staff, lack of space, lack of training on PMTCT and standard procedures for follow up of patients to be addressed in order to ensure the successful scaling up of PMTCT.
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Pembrey, Lucy Jane. "Mother-to-child transmission of hepatitis C virus : a European epidemiological collaboration". Thesis, University College London (University of London), 2006. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.429494.
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Garber, Andrea R. "The Transmission of Alcohol Use from Mother to Child: A Life-Course Perspective". Bowling Green State University / OhioLINK, 2012. http://rave.ohiolink.edu/etdc/view?acc_num=bgsu1342458908.
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Protopapas, Stella A. B. A. "Mother to Child Transmission of Hepatitis C Virus in the Greater Cincinnati Area". University of Cincinnati / OhioLINK, 2018. http://rave.ohiolink.edu/etdc/view?acc_num=ucin154392119827537.
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Plipat, Tanarak. "Cost effectiveness of antiretroviral drug therapy to reduce mother to child HIV transmission in Thailand". Diss., Restricted to subscribing institutions, 2007. http://proquest.umi.com/pqdweb?did=1428863231&sid=1&Fmt=2&clientId=1564&RQT=309&VName=PQD.
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Cândido, Elaine Cristina 1976. "Transmissão vertical de hepatite em gestantes no CAISM Campinas = HBV mother to child transmission at CAISM UNICAMP". [s.n.], 2013. http://repositorio.unicamp.br/jspui/handle/REPOSIP/312690.
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Orientador: Helaine Maria Besteti Pires Mayer MilanezDissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas
Made available in DSpace on 2018-08-24T05:11:32Z (GMT). No. of bitstreams: 1 Candido_ElaineCristina_M.pdf: 1043425 bytes, checksum: 4797b5103af38ecbe53b5dd29b496856 (MD5) Previous issue date: 2013
Resumo: Objetivos: avaliar a transmissão vertical (TV) em gestantes portadoras de hepatite B crônica, em um serviço universitário. Sujeitos e Método: foram analisadas as sorologias para hepatite B de todas as gestantes atendidas no serviço entre 2000 e 2005, identificando-se as HbsAg +; nessas foi realizado levantamento de prontuários, avaliando a presença do marcador de replicação viral (HbeAg positivo), imunoprofilaxia neonatal e taxa de TV. Análise de dados: foi avaliada a proporção de casos com HbsAg+ e nessas a presença do HbeAg. Para as portadoras de hepatite B, analisaram-se características clínicas e epidemiológicas através de frequências simples e a presença de TV. Resultados: entre 2000 e 2005 foram rastreadas para hepatite B no CAISM 5638 mulheres; dessas 28 (0,5%) apresentavam HbsAg+, definindo-se como portadoras crônicas. Não se encontrou nenhuma com replicação viral (HbeAg+). A idade média foi de 25 anos, com escolaridade média de sete anos, sendo 57% de brancas. O número de gestações médio foi de dois, sendo 52% de nulíparas. A categoria de exposição foi ignorada em 20; em quatro a via foi a sexual, em duas por TV e em duas por uso de drogas. A média de Idade gestacional ao parto foi de 38 semanas, com uma taxa de cesárea de 42%. O peso médio ao nascimento foi de 3094g e todos os recém-nascidos apresentaram boas condições de vitalidade e receberam imunoprofilaxia neonatal (vacina e imunoglobulina específica) nas primeiras horas de vida. Não houve TV. Conclusões: Nas gestantes atendidas no período, a prevalência de hepatite B crônica foi de 0,5%. Todas as crianças receberam imunoprofilaxia neonatal nas primeiras horas de vida e não ocorreu nenhum caso de TV, reforçando que para as gestantes sem replicação viral, as medidas de imunoprofilaxia neonatal protegeram a totalidade de seus recém-nascidos
Abstract: The purpose of this paper is to evaluate mother-to-child transmission of chronic hepatitis B in a university hospital. Subjects and methods: Hepatitis B serologic studies were pooled from all pregnant women referred to this prenatal service from 2000 to 2005. HBsAg positive patients were selected and, for those, clinical, laboratory and epidemiologic data were analyzed, including presence of HBeAg marker, immunoprophylactic procedures for the newborn and mother-to-child transmission rates. Data analysis: HBsAg carriers were characterized for clinical and epidemiologic factors associated with mother-to-child transmission. Results: Between 2000 and 2005, 5638 pregnant women were referred to high-risk prenatal care at our facility; of these, 28 women (0,5%) were HbsAg+ ¿ defined as chronic Hepatitis B virus (HBV) carriers. None of these were seropositive for HBeAg. Mean age was 25 years with a mean of 7 years of formal education and 57% were white; 52% were nulliparous. Exposure to hepatitis B virus was ignored in 20 women, sexual in 4, from mother-to-child transmission in 2 and associated with drug use in 2. Mean gestational age at delivery was 38 weeks with cesarean delivery in 42% of women. Mean weight at birth was 3094g and all newborns presented with good vitality and received immunoprophylactic procedures. There were no cases of mother-to-child transmission. Conclusion: Among all pregnant women seen at this tertiary high risk prenatal care facility between 2000 and 2005, chronic HBV infection was detected in 0,5% of patients. All newborns received immunoprophylaxis during the first hours after delivery and no case of mother-to-child transmission was detected. Our findings support that, among pregnant chronic HBV carriers without serologic evidence of active viral replication, immunoprophylactic measures are effective in preventing mother-to-child transmission in all instances
Mestrado
Saúde Materna e Perinatal
Mestra em Ciências da Saúde
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Chopra, Mickey. "Prevention of Mother to Child Transmission of HIV in Africa : Operational Research to Reduce Post-natal Transmission and Infant Mortality". Doctoral thesis, Uppsala universitet, Institutionen för kvinnors och barns hälsa, 2008. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-9331.
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This thesis assesses the effectiveness of the National Prevention of Mother to Child Transmission of HIV (PMTCT) programme in 3 sites in South Africa, and the quality of infant feeding counselling across four countries, Botswana, Kenya, Malawi and Uganda . Implementation and outcome of PMTCT services were very different across the 3 sites. The Paarl site is achieving results comparable to clinical trial studies with a HIV-free survival rate of 85% at 36 weeks, while Umlazi is somewhat lower (74%) and Rietvlei, with HIV-free survival of 64%. Maternal viral load, prematurity and site were independent risk factors for infection and/or death. The regression analysis suggests that some of this difference is explained by the differences in quality of health systems across the sites. Traditional risk factors (e.g. viral load, prematurity) do not seem to explain the substantial differences in HIV-free survival between the Paarl and Rietvlei sites. The overall mortality rate for HIV exposed infants in this cohort was 155 per 1000 live births at 36 weeks, a level higher than most other HIV exposed cohorts. The excess mortality is occurring almost completely amongst HIV infected infants who had a nine fold increased risk of mortality compared with HIV exposed but HIV negative infants. There was no significant difference in 36 week survival rates between those HIV exposed but uninfected infants and those who were not HIV exposed, Hazard ratio 0.7 (95% CI 0.3-1.5). With respect to HIV and infant feeding most health workers across the four countries (234/334, 70%) were unable to correctly estimate the transmission risks of breastfeeding. Exposure to PMTCT training made little difference to this. Infant feeding options were mentioned in 307 out of 640 (48%) observations of PMTCT counselling session and in only 35 (5.5%) were infant feeding issues discussed in any depth; of these 19 (54.3%) were rated as poor. South Africa was similar with only two out of thirty four HIV positive mothers being asked about essential conditions for safe formula feeding before a decision was made. This body of work has demonstrated that the gap between efficacy and effectiveness can be significant.
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Warning, Julia Carolyn Women's & Children's Health Faculty of Medicine UNSW. "Microtransfusion and viral exposure in infants born to HIV-infected women". Publisher:University of New South Wales. Women's & Children's Health, 2008. http://handle.unsw.edu.au/1959.4/42097.
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Introduction: Mechanisms facilitating mother-to-child transmission (MTCT) of HIV have not been elucidated. Small quantities of blood pass from mother to infant during childbirth, termed 'microtransfusion'; this is one possible mechanism for HIV entry into the infant's circulation. HIV-specific cellular immune responses have been detected in some uninfected infants born to HIV-infected women, indicating transient virus exposure or replication in these infants. Both microtransfusion and HIV-specific immune responses in infants born to HIV-infected women has not previously been investigated. Methods: 46 uninfected infants born to HIV-infected women were included in this study. Infants were grouped according to interventions utilised by the mother: none or antiretroviral therapy (ART; group A, n = 16), ART with elective caesarean section (elCS; group B, n = 12), highly active antiretroviral therapy (HAART) only (group C, n = 7), and HAART with elCS (group D, n = 11). HLA-A and -B alleles were typed for all mother-baby pairs to identify the non-inherited maternal allele (NIMA). Microtransfusion was detected using flow cytometry or by qPCR targeting the NIMA. HIV-specific immune responses were detected using 51Cr-release and IFN-?????? ELISpot assays. Results: Microtransfusion was detected in umbilical cord blood of 9 of 11 infants, and in peripheral blood of 4 of 11 infants up to 1 week old. One infant without detectable microtransfusion in umbilical cord blood had detectable maternal cells in peripheral blood. 8/46 infants had HIV-specific T cell responses, 5 were in group A, 2 in group B, and 1 in group C, while no infants in group D had detectable responses (p = 0.04). Blood samples from 2 of these 8 infants were also available for the analysis of microtransfusion. Microtransfused maternal cells were present in the umbilical cord blood of both infants. Conclusion: In this study, the number of infants with HIV-specific immune responses decreased with the use of MTCT interventions, indicating reduced exposure to HIV in these infants. This is the first study to demonstrate both microtransfusion and HIV-specific immune responses in uninfected infants. Microtransfusion may facilitate viral exposure, resulting in the development of potentially protective immune responses in infants born to HIV-infected women.
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Stinson, Kathryn Lee. "Coverage of prevention of mother-to-child transmission services in Cape Town, South Africa". Doctoral thesis, University of Cape Town, 2012. http://hdl.handle.net/11427/12644.
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Includes bibliographical references.The effectiveness of prevention of mother-to-child of HIV (PMTCT) programmes depends on the successful coverage of a series of interventions through pregnancy, intrapartum and postpartum. Routine monitoring systems based on service data and limited to women on the PMTCT programme may overestimate intervention coverage at multiple points along this cascade. Methods: Cord blood specimens with individually linked anonymous demographic and pregnancy data were collected from three delivery services in the Western Cape Province, South Africa, and screened for HIV. Seropositive specimens were tested for the presence of antiretrovirals.
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Kasenga, Fyson. "Making it happen prevention of mother to child transmission of HIV in rural Malawi /". Doctoral thesis, Umeå : Umeå university, 2009. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-26223.
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Velapi, Linda. "The experiences of mothers living with HIV of the PMTCT programme in Khayelitsha, Cape Town". University of the Western Cape, 2021. http://hdl.handle.net/11394/8100.
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Magister Curationis - MCurThe 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.
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Staflin, Emma, i Jennie Lundkvist. "Nurses’ counseling to mothers to prevent mother to child transmission of HIV through breastfeeding : A qualitative study". Thesis, Linköpings universitet, Omvårdnad, 2011. http://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-76743.
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Introduction: HIV is a serious problem in Namibia, 13.1% of the adult population is HIV-positive or is a carrier of AIDS. This is one of the highest numbers in the world. HIV is passed from mother to child during pregnancy, during labour or through breast milk. 18.8 % of the pregnant mothers in Namibia who is in contact with the maternity welfare have HIV. Aim: The aim of the study was to describe nurses’ counseling to mothers to prevent mother to child transmission of HIV through breastfeeding. Method: Eight nurses working with PMTCT of HIV were interviewed in Namibia. The interviews were transcribed and a content analysis was made. 18 sub-categories and seven categories were found. Findings: It is important that nurses provide individual counseling, are supportive and motivate the mothers. Poverty is an obstacle for the mothers, stigmatization occurs and cultural differences can have influence on the mothers. It is also important that nurses are updated in counseling and PMTCT. Conclusion: Nurses should provide mothers with the correct information in a pedagogical way. Nurses need to be aware of obstacles for the mothers and their families to be able to meet their different demands. Men are not involved in PMTCT-counseling and nurses think that partner involvement would benefit PMTCT of HIV.
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Magaso, Farai Beverley. "Assessing the barriers to accessing prevention of mother-to-child transmission (PMTCT) services in Marondera Zimbabwe". Master's thesis, University of Cape Town, 2011. http://hdl.handle.net/11427/11433.
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Although Zimbabwe has invested in nationwide scale-up of prevention of mother to child transmission (PMTCT) services, high HIV-specific under-five mortality rates continue to be observed. This study aimed to document the potential reasons for low PMTCT uptake by examining factors constraining access to PMTCT services.
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Ikeakanam, Ottilie Tangeni Omuwa. "Infant feeding practices in the prevention of mother to child transmission in Onandjokwe district hospital, Namibia". Thesis, Stellenbosch : Stellenbosch University, 2011. http://hdl.handle.net/10019.1/17794.
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Thesis (MCur)--Stellenbosch University, 2011.ENGLISH ABSTRACT: The impact of infant feeding practices in the prevention of mother-to-childtransmission of HIV raised concerns in the field of health services. Breast feeding adds an additional 15-30% risk of HIV transmission to the infant; therefore, mothers who are HIV-positive are in need of information regarding safe infant feeding. A descriptive design for this particular study was applied with a primary quantitative approach. A convenient sample of sixty (n=60) participants between the ages of 15 – 37 were taken from subjects that enrolled in the prevention of mother-to-child transmission (PMTCT) programme in Onandjokwe district. The sample formed 85% of the target population (N=71). A structured questionnaire with closed and openended questions was used and completed by the researcher. Ethical approval for the study was obtained from the Ethics Committee at the Faculty of Health Sciences, University of Stellenbosch. Permission to conduct the research was obtained from the Ministry of Health and Social Services, Namibia, and the Onandjokwe district Hospital. A pilot study was conducted that constituted 25% of the sample. Validity and reliability was insured by the pilot study and the consultation of an expert in HIV research and an expert in nursing research. The presentation of results was mostly descriptive in nature by using frequency tables and a pie chart. The results showed that all participants (n=60/100%) were offered HIV counselling and testing during antenatal care. Mothers who were HIV positive knew that there is a possibility that the baby might be infected through breast milk. Furthermore, the study found that 70% (n=42) of participants used breast feeding exclusively, 20% (n=12) used replacement feeding and 10% (n=6) used mixed feeding practices. It was concluded that pregnant women and mothers known to be HIV-infected should be informed of the infant feeding practice recommended by the national or subnational authority to improve HIV-free survival of HIV-exposed infants. This includes information about the risks and benefits of various infant feeding options based on local assessments and guidance in selecting the most suitable option for their own situation.
AFRIKAANSE OPSOMMING: Die invloed van voedingspraktyke vir babas by die voorkoming van moeder-na-kindoordrag van die menslike immuungebrekvirus (MIV) het kommer op die gebied van gesondheidsdienste laat ontstaan. Borsvoeding dra ’n addisionele 15–30% risiko van MIV-oordrag tot die baba by en daarom benodig moeders wat MIV-positief is inligting ten opsigte van veilige voeding van hulle babas. 'n Beskrywende ontwerp vir hierdie besondere studie is gebruik tesame met 'n primêr kwantitatiewe benadering. 'n Gerieflikheidsteekproef van sestig (n=60) deelnemers tussen die ouderdomme 15–37 jaar is gekies uit persone wat ingeskryf het vir die voorkoming van moeder-na-kind-oordrag (VMNKO) program in Onandjokwe-distrik. Die steekproef het 85% van die teikenpopulasie (N=71) uitgemaak. 'n Gestruktureerde vraelys met geslote en oop vrae is gebruik en deur die navorser voltooi. Etiese goedkeuring vir die studie is verkry van die Etiese Kommitee van die Fakulteit Gesondheidswetenskappe, Universiteit Stellenbosch. Toestemming om die navorsing te doen, is verkry van die Ministerie van Gesondheid en Maatskaplike Dienste, Namibië, en die Onandjokwe Distrikshospitaal. 'n Loodsstudie is onderneem wat 25% van die steekproef behels het. Geldigheid en betroubaarheid is verseker deur die loodsstudie en oorlegpleging met 'n kundige op die gebied van MIV-navorsing en 'n kundige in verpleegnavorsing. Die aanbieding van resultate was meestal deskriptief van aard deur van frekwensietabelle en 'n sektordiagram gebruik te maak. Die resultate het getoon dat MIV-berading en -toetsing gedurende voorgeboortesorg aan alle deelnemers (n=60/100%) aangebied is. Moeders wat MIV-positief is, het geweet dat daar 'n moontlikheid bestaan dat die baba moontlik deur moedersmelk geïnfekteer kan word. Verder het die studie bevind dat 70% (n=42) van deelnemers uitsluitlik borsvoeding gebruik, 20% (n=12) gebruik ’n vervanging vir moedersmelk en 10% (n=6) gebruik gemengde voedingspraktyke. Daar is tot die slotsom gekom dat swanger vroue en moeders van wie bekend is dat hulle MIV-geïnfekteer is, ingelig behoort te word oor die babavoedingspraktyk aanbeveel deur die nasionale of subnasionale owerheid vir die verbetering van MIVvrye oorlewing van babas wat aan die MIV blootgestel is. Dit sluit in inligting oor die risiko’s en voordele van verskeie babavoedingsopsies gebaseer op plaaslike assesserings en leiding ten opsigte van die kies van die geskikste opsie vir hulle eie situasie.
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Links, Nomvuyiseko. "Postnatal women's experiences of the prevention of mother-to-child transmittion of HIV programme". Thesis, Nelson Mandela Metropolitan University, 2007. http://hdl.handle.net/10948/545.
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This research study endeavoured to explore and describe the experiences of women who participated in the Prevention of Mother-To-Child Transmission (PMTCT) of HIV Programme. Data relating to evaluation of the PMTCT Programme in the piloted sites compiled by other researchers in the Department of Health focus on the process, progress and extent of service implementation. There appears to be a dearth of information available from women participants in the PMTCT Programme. The objectives of the study were to: · Explore and describe postnatal women’s experiences of the PMTCT Programme offered in the East London Hospital Complex. · Propose recommendations into the existing guidelines for midwives who implement the PMTCT Programme in the health services to ensure optimal implementation of this programme. The research population included postnatal women who participated in the PMTCT of HIV Programme at the East London Hospital Complex (Frere site). Permission to conduct the research was obtained from the Eastern Cape Department of Health Ethics Committee, Chief Executive Officer of the hospital complex and the Advanced Degrees Committee and Human Ethics Committee at the Nelson Mandela Metropolitan University. The research study was qualitative, exploratory, descriptive and contextual in design. Data collection was carried out by face-to-face semi-structured interviews with postnatal women at the East London Hospital Complex (Frere site). The tape-recorded interviews were transcribed verbatim with the aid of field notes. Data analysis was done according to Tesch’s method of data analysis (in De Vos et al, 2000:343). Themes were identified from the transcriptions and finalised after consensus discussions with an independent coder who was experienced in qualitative research. Literature control, guided by the themes identified in the interviews, was carried out to compare and verify the findings of the study. Three major themes with sub-themes were identified during data analysis. The major themes were identified as follows: · The participants expressed feelings of being devastated by the results that confirmed their HIV positive status. · The participants expressed a thirst for knowledge on how to live with the diagnosis and on how to continue with the PMTCT Programme. · The physical environment where counselling and testing were done, as well as the practical arrangements, were not conducive to the full implementation of the PMTCT Programme at the antenatal clinic. Conclusions were drawn and recommendations were made in the form of additional guidelines for midwives implementing the PMTCT Programme in the antenatal clinic health services. Guidelines for further midwifery-related research were formulated.
20
Korsman, Stephen Nicolaas Jacques. "Molecular epidemiology of mother-to-child transmission of HIV-1 in children at Tygerberg Hospital". Thesis, Link to the online version, 2006. http://hdl.handle.net/10019/1074.
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21
Osman, Yusuf Ismail. "The cost effectiveness of a mother-to-child-transmission prevention programme in the Western Cape". Thesis, Stellenbosch : Stellenbosch University, 2003. http://hdl.handle.net/10019.1/49791.
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Thesis (MBA)--Stellenbosch University, 2003.Some digitised pages may appear illegible due to the condition of the original hard copy
ENGLISH ABSTRACT: After sexual transmission of HIV, mother-to-child (MTCT) transmission is the most common cause of HIV infection in South Africa. The Western Cape government, through the Premier, has committed itself to providing access for all HIV positive women in the province attending antenatal clinics to MTCT prevention programmes by the end of 2003. The MTCT prevention programme is aimed at intervening transmission during pregnancy, during the birth of the baby and post delivery during breast-feeding of the newborn baby. The HIV virus attacks and destroys the cells of the immune system by being incorporated into the reproductive cycle of the cell. Antiretroviral drugs in the fight against HIV target two aspects of this replication cycle of the virus and as such do not halt the infection but slow it down by preventing the replication of the virus. MTCT internationally has been reduced dramatically by the use of antiretroviral drugs (AZT) antenatally, during birth and post-natally for mother and baby. However this regimen was found to be not suitable for resource-poor countries due to the complexity in administration, compliance and costs. Poor countries have developed alternative MTCT prevention programmes based on shorter course regimens and on alternative antiretroviral drugs. MTCT prevention In South Africa initially did not have the support of the national government. However, the -Western Cape Administration had developed a regional programme phasing in MTCT prevention at all state clinics within the province. The cost drivers associated with the MTCT prevention programme include costs associated with the HIV tests, costs for pre- and post-test counselling, costs for the antiretroviral drugs and costs for substitute feeding to replace breast-feeding to prevent viral transmission during breast-feeding. Depending on the option exercised, costs can be calculated per HIV positive baby averted. As regards substitute feeding, which is a substantial cost driver and a major disadvantage to the newborn baby as regards protection from common childhood diseases such as diarrhea, research from Tanzania showed that ARV therapy during childbirth could suppress HIV transmission through breast-feeding during the first few weeks after childbirth, thus enabling an optimal combination of breast-feeding in the first few crucial weeks of the newborn's life for the protective benefits of breast-milk and formula feeding thereafter to ensure protection for the infant from HIV transmission through breastfeeding. The data were subjected to a sensitivity or a "what-if' analysis usmg an Excel spreadsheet. Costs per HIV averted were calculated for each assumed parameter in the model that was developed. As regards prevalence, the MTCT prevention programme is most cost effective at the lower levels of the seroprevalence of HIV in the population served. If the seroprevalence is above the "cross-over" or "optimal" point for the regimen an alternative regimen should be assessed. As regards levels of identification and number accepting intervention the principle of an economy of scale applies and therefore, a level of 100 percent in both cases should be targeted. This will be dependent on wide scale advertisements and support for the programme with active efforts to destigmatise the infection. Innovative programmes such as the mothers-to-mothers-to-be (M2M2B) programme must be encouraged.
AFRIKAANSE OPSOMMING: Na seksuele oordraging van HIV is moeder tot kind (MTK) oordraging die algemeenste rede van HIV infeksie in Suid Afrika. Die Wes-Kaapse regering, deur die Premier, het hulself verbind om toegang vir alle HIV positiewe vroue in die provinsie, wat voorgeboorte klinieke bywoon, tot MTK voorkomingsprogramme voor die einde van 2003 moontlik te maak. Die MTK voorkomingsprogram is gerig op die tussenkoms van transmissie gedurende swangerskap, gedurende die geboorte en die nasorg tydens die borsvoeding periode van die pasgebore baba. Die HIV virus val die selle van die immuun sisteem aan en' vernietig dit. Die virus word geïnkorporeer tot die reproduksie siklus van die sel. Antiretrovirale wat teen die virus gerig is, is gerig teen twee aspekte van die replikasie siklus van die virus en sodoende sal die medikasie die infeksie nie staak nie, maar eerder vertraag as gevolg van die voorkoming van die replikasie. Moeder-tot-kind infeksie is internasionaal drasties verminder deur die gebruik van antiretrovirale (AZT) gedurende die tydperk voor geboorte, gedurende die geboorte en gedurende nasorg van die moeder en baba. Hierdie regimen is egter nie altyd moontlik in arm lande nie vanweë die kompleksiteit van die administratiewe toepassing en kostes. Arm lande het alternatiewe MTK voorkomingsprogramme ontwikkel, gebaseer op korter kursusse en alternatiewe antiretrovirale. Die voorkoming van MTK infeksie in Suid-Afrika het eers nie die ondersteuning van die nasionale regering geniet nie. Die Wes-Kaapse Adminstrasie het onafhanklik van die nasionale regering, streeksprogramme ontwikkel vir die infasering van MTK voorkoming in alle klinieke in die Provinsie. Die kostedrywers wat met MTK voorkomingsprogramme geassosieer word, sluit in die koste van HIV toetse, koste van voor-en-na toets berading, koste van die antiretrovirale en alternatiewe voeding om virale transmissie te voorkom gedurende die tydperk van borsvoeding. Afhangende van die opsies wat gebruik is, kan die koste van elke baba wat nie HIV opdoen nie, bereken word. Sover dit alternatiewe voeding aangaan, wat 'n belangrike kostedrywer is en 'n nadeel vir elke baba is sover dit teen beskerming van algemene kindersiekte soos diarrhea gaan het navorsing in Tanzanië bewys dat ARV terapie gedurende geboorte ook HIV transmissie deur borsvoeding gedurende die eerste paar weke na geboorte onderdruk wat 'n optimale kombinasie van borsvoeding in die eerste paar kritiese weke van die nuutgebore baba se lewe vir die beskermende voordele van moedersmelk en formulêre voeding daarna te versterk met beskerming van die baba teen HIV transmissie deur borsvoeding. Deur die gebruik van 'n Excel werkblad en 'n "wat as" metode van analiese koste van HIV opdoen in bereken word vir elke aanvaarding. Sover dit voorkoms betref is die MTK voorkomingsprogramme die mees effektief hoe laer die "seroprevalence" van HIV in die populasie gedien word. As die "seroprevalence" hoër as die optimale punt is, moet 'n ander metode bereken word. Sover dit die mate van identifisering en hoeveelheid die tussenkoms aanvaar in 'n mate van 100 persent moet in beide gevalle die mikpunt wees. Dit sal afhang van grootskaalse advertensies en ondersteuning van die programme met bedrywige pogings om die' infeksie te destigmatiseer. Nuwe programme soos die moeder tot nuwe moeder (M2M2B) program moet aangemoedig word.
22
Ngcongwane, Phindile G. "Missed Opportunities of Preventing Mother to Child Transmission Programme at Germiston District Hospital in 2004". Diss., University of Pretoria, 2006. http://hdl.handle.net/2263/61725.
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Background: The vertical transmission of HIV from mother to child ranges from 15 to
40%. The preventing mothers to child transmission programme (PMTCT) services have
been introduced during the past five years in South Africa; however vertical transmission
of HIV remains high.
Objectives: The objectives of the study were:
1. To describe the clinical and demographic characteristics of women attending the
ANC clinic and delivering at the Germiston Hospital;
2. To determine the proportion of women who were offered voluntary counselling
and testing (VCT) in 2004;
3. To determine the proportion of women who subsequently received PMTCT.
Methods: This is a cross-sectional study I which a sample of 776 patient files were
retrospectively, systematically and randomly sampled from 1, 500 antenatal files for the
period 2004 (Jan-Dec), in an urban district hospital in the Gauteng Province. A checklist
was used to extract specific information. Data was entered into EpiData and analysed
using STATA version 8. Pearson's chi-square test was used to obtain measures of
association for all categorical variables. The multiple logistic regression method was
used to investigate predictors for missed PMTCT opportunities.
Results: The pre_yalence proportion of syphilis was 14.19% {95%CI (11.81-16.85)};
prevalence proportion ofHIV was 33.76% {95% CI (27.53-37.13)}. The mean age ofthe
sample population was 26.37 years (min=22, max=30). Forty eight per cent of the sample had registered late in the third trimester of pregnancy. Pregnant women presenting with
syphilis were more likely to have a missed PMTCT opportunity {OR=2.2, 95%CI (1.16-
4.20), p=0.02}. Women having made fewer than two ANC visits were more likely to
have a missed PMTCT/VCT opportunity than women having made more than two visits
{OR=O.Sl, 95%CI (0.30-0.86), p=O.Ol}.
Conclusions: The prevalence proportion of HIV is high in this setting (33%) and the
prevalence of syphilis is seven times greater than the national prevalence. Every antenatal
care visit is an opportunity for the healthcare worker to offer voluntary counselling and
testing. All women identified as having syphilis infection are at high risk of acquiring
HIV. Therefore every woman identified and treated for syphilis should be counselled and
tested for HIV. Women must be offered HIV and AIDS education at every ANC visit.
Routine opt-out counselling should be offered at every ANC visit for those who have not
been previously tested.
Recommendation: In order to increase the uptake of the PMTCT programme healthcare
workers should have training and re-orientation on:
1. The need to use every opportunity in antenatal care and maternity wards
to offer HIV counselling and testing to mothers;
2. HIV and AIDS in pregnancy, PMTCT, as well as the treatment and care
of pregnant women.Dissertation (MPH)--University of Pretoria, 2006.
School of Health Systems and Public Health (SHSPH)
MPH
Unrestricted
23
Warrier, Nisha. "Lack of Knowledge of Mother-to-Child Transmission in Kenya Among Women Ages 15-49". VCU Scholars Compass, 2006. http://scholarscompass.vcu.edu/etd/723.
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Purpose: The epidemic of mother-to-child transmission (MTCT) of HIV/AIDS in resource-poor countries is dramatic; it is responsible for nearly 90% of childhood infections. The primary purpose of analysis was to understand the distribution of factors and their association with lack of knowledge of MTCT in Kenya. In parallel, another aim was to identify the relationship between media, particularly frequency of radio exposure, and lack of knowledge.Methods: This study used the 2003 Kenya Demographic and Health Survey (DHS) collected for 8,195 women, ages 15-49. Descriptive analysis, univariate analysis, and logistic regression were completed on SPSS 14 software.Results: In the sample, 1151 women (14.0%) lacked the knowledge of transmission. Univariate analysis suggested significant crude association for region (except Nairobi and Eastern), residence, education, religion, ethnicity, literacy, parity, prenatal care from someone, current work status, SES, and frequency of listening to the radio. In the logistic regression model after adjusting for the confounding variables, not listening to the radio at all had a significant association with lack of knowledge of MTCT (adjusted POR 2.38; 95% CI 2.00-2.82), while listening to radio less than once a week yielded no significant association.Conclusions: The results elucidate why Kenyan women do not know about MTCT and particularly the role of radio use as means of acquiring this information. MTCT prevention programs can use this information to accordingly tailor the programs to the needs in the community.
24
Phuti, Angel. "Exclusive breastfeeding in the prevention of HIV-1 transmission from mother to child : a systematic review". Thesis, Stellenbosch : Stellenbosch University, 2012. http://hdl.handle.net/10019.1/20326.
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Thesis (MCurr)--Stellenbosch University, 2012.ENGLISH ABSTRACT: HIV infection poses a major obstacle in breastfeeding as it represents the most common way by which children acquire HIV. Exclusive breastfeeding has been discovered as the most effective intervention in preventing mother-to-child transmission of HIV, mortality and promotion of HIV free survival. The main objective was to evaluate the evidence on the effectiveness of exclusive breastfeeding versus formula feeding and/ or mixed feeding in the prevention of HIV-1 transmission from mother to child. To identify the studies, an electronic search was conducted using PUBMED/MEDLINE, CINAHL, CENTRAL and EMBASE databases. Electronic journals, which include the Southern African Journal of HIV medicine (SAJHIV), HIV Medicine Journal and American Journal of Public Health, were also accessed. Manual searches were carried out. In addition, relevant experts were contacted in order to locate more data. There were no limitations with regards to date and language. The review considered studies on infants who were vertically HIV-1 exposed (mother HIV positive during pregnancy, birth and breastfeeding). These infants were exclusively breastfed for six months with administration of antiretroviral prophylaxis and were compared to infants exclusively formula fed. The outcomes measured were vertically acquired HIV infection; mortality and HIV free survival up to 24 months of age. Two reviewers independently selected articles which met the inclusion criteria. They independently extracted the data using a data extraction tool. Disagreements were solved by discussion. Data was then meta-analysed using Rev Man 5.1.0. Methodological quality of each trial was assessed by the reviewers using the Cochrane assessment tool for risk of bias. Two randomised clinical trials and one intervention cohort study (n=2112 infants) comparing exclusive breastfeeding with exclusive formula feeding were included. HIV infection was associated with exclusive breastfeeding as compared with exclusive formula feeding (Risk ratio 1.67, 95% CI 1.26 to 2.23, p=0.0005). Exclusive formula feeding was associated with high mortality from infections (Risk ratio of 0.67 95% CI 0.43 to 0.83, p=0.002 Chi²= 1.30, p=0.52, I²=0%). There were no statistically significant differences in HIV free survival between exclusive breastfeeding and exclusive formula feeding as measured by trialists at 9, 18 and 24 months (Risk ratio 1.19, 95% CI, 0.92 to 1.54, p=0.19, Chi²= 3.15, p=0.21, I²=36 % 3 studies, 1012 infants). None of the studies included reported on mixed feeding. Complete avoidance of breastfeeding is effective in preventing mother-to-child transmission of HIV. HIV infection during breastfeeding might be an indicator of mixed feeding and poor adherence. Formula feeding is only applicable in settings where formula milk is accessible, feasible, acceptable, safe and sustainable (AFASS) because formula feeding carries a high risk of mortality from causes other than HIV. If the AFASS criteria cannot be met, mothers should be encouraged to exclusively breastfeed and ensure that their infants completely adhere to the antiretroviral prophylaxis because they decrease the rate of vertical HIV-1 transmission.
AFRIKAANSE OPSOMMING: MIV besmetting veroorsaak ‘n groot struikelblok vir borsvoeding, omdat dit die mees algemene manier is waarop babas met MIV besmet word. Eklusiewe borsvoeding is as die mees effektiewe intervensie ontdek in die voorkoming van moeder na kind oordrag van MIV, morbiditeit en die bevordering van MIV vrye oorlewing. Die hoofdoelwit is om die effektiwiteit van eksklusiewe borsvoeding teenoor formule-voeding en of gemengde voeding in die voorkoming van MIV oordrag van moeder na kind te evalueer. Elektroniese navorsing is gedoen deur gebruik te maak van PUBMED/MEDLINE, CINAHL, CENTRAL en EMBASE databasisse. Elektroniese joernale wat die Southern African Journal of HIV medicine (SAJHIV), HIV Medicine Journal and American Journal of Public Health insluit, is ook gebruik. Handnavorsing is ook gedoen, asook relevante data van kenners op die gebied, is verkry. Geen beperking is geplaas op taal of tyd nie. Studies op babas wat blootgestel is aan die MIV-1 (moeder MIV positief gedurende swangerskap en borsvoeding) is in die oorsig oorweeg. Hierdie babas is eksklusief vir 6 maande gerborsvoed, met of sonder anti-retrovirale behandeling, en is vergelyk met eksklusiewe formule-voeding. Die resultaat was dat almal tot op 24 maande gemeet is aan MIV besmetting, mortaliteit en MIV vrye oorlewing. Twee resensente het onafhanklik artikels geselekteer wat aan die ingeslote kriteria voldoen het. Hulle het onafhanklik data geselekteer deur van ’n selekteringsinstrument gebruik te maak. Misverstande is deur besprekings opgelos. Data was daarna gemeet en gemetaanaliseer deur Rev Man 5.1.0. Die metadologiese kwaliteit van elk proeflopie is geassesseer deur die resensente wat gebruik gemaak het van die Cochrane evalueringsinstrument om die risiko van onewewigtigheid uit te skakel. Twee ewekansige kliniese proewe en een intervensie kohort studie (n = 2112 babas) wat eksklusiewe borsvoeding vergelyk met 'n eksklusiewe formule-voeding is ingesluit. MIVinfeksie wat verband hou met 'n eksklusiewe borsvoeding is vergelyk met eksklusiewe formule-voeding (risiko verhouding van 1.67, 95% CI 1.26 tot 2,23, p=0.0005). Eksklusiewe formule-voeding hou verband met 'n hoë mortaliteit van infeksies met ’n risiko verhouding van 0.67, 95% CI 0.43 tot 0.83, p = 0.52, Chi ² = 1.30, p = 0.52, I ² = 0%. Daar is geen statisties beduidende verskille in MIV-vrye oorlewing tussen eksklusiewe borsvoeding en eksklusiewe formule-voeding nie wat deur die proefnemers gemeet is op 9, 18 en 24 maande (risiko verhouding 1.19, 95% CI, 0.92 tot 1.54, p = 0,19, Chi ² = 3,15, p = 0.21, I ² = 36% 3 studies, 1012 babas). Nie een van die ingeslote studies het verslag gedoen oor gemengde voeding nie. Algehele vermyding van borsvoeding is effektief in die voorkoming van Moeder na Kind oordrag van MIV. MIV-infeksie gedurende borsvoeding mag ’n aanduiding van gemengde voeding en swak nakoming wees. Formule voeding is alleenlik van toepassing in situasies waar formule-melk toeganklik, uitvoerbaar, veilig en volhoubaar is, want formule-voeding dra ’n hoë risiko van mortaliteit weens ander oorsake buiten MIV. Indien daar nie aan hierdie kriteria voldoen kan word nie, behoort moeders aangemoedig te word om eksklusief te borsvoed en seker te maak dat hulle babas die antiretrovirale profilaksie getrou neem, want dit verlaag die koers van vertikale MIV-1 oordrag.
25
Kalimba, Hilma Ndesheetulua. "The perceptions, knowledge and experiences of breast-feeding women living with HIV/AIDS in the Oshakati district - Northern Namibia". Thesis, University of the Western Cape, 2007. http://etd.uwc.ac.za/index.php?module=etd&action=viewtitle&id=gen8Srv25Nme4_9696_1256305408.
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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.
26
Weinel, Martin. "Technological decision-making under scientific uncertainty : preventing mother-to-child transmission of HIV in South Africa". Thesis, Cardiff University, 2010. http://orca.cf.ac.uk/55502/.
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The normative analysis focuses on three aspects. First, it is evaluated whether the government acted correctly when it ignored expert advice that suggested the benefits of using AZT to prevent the risk of mother-to-child transmission outweighed the risks. Second, by exploring Thabo Mbeki's level of expertise, it explored whether he was in a position to make a reliable judgement about the state of the scientific discourse about the safety of AZT. Third, a proposal is made that prescribes how actors should proceed if they want to judge the authenticity of scientific controversies that are involved in the context of technological decision-making processes.
27
Gourlay, A. "Improving the usage of prevention of mother-to-child transmission of HIV services in rural Tanzania". Thesis, London School of Hygiene and Tropical Medicine (University of London), 2015. http://researchonline.lshtm.ac.uk/2101870/.
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This thesis aims to investigate the use of prevention of mother-to-child transmission (PMTCT) of HIV services in rural Tanzania. Paper A, a systematic literature review of barriers and facilitating factors to the uptake of antiretroviral drugs for PMTCT in sub-Saharan Africa, identified many influencing factors at the level of individuals, their communities and health systems. Paper B discusses the challenges, including lack of unique identification numbers, associated with using routine clinic data for monitoring PMTCT programmes in Africa. Papers C and D use clinic data linked to community HIV cohort data to describe community-level access to PMTCT services among HIVpositive pregnant women. Paper C documented low, but increasing, coverage with PMTCT services in 2005-2012, with weaknesses throughout the PMTCT service continuum. Paper D identified women from remote areas, younger women, and unmarried women as less likely to access PMTCT services. Voluntary counselling and HIV testing before pregnancy, longer duration of HIV-infection, and more recent pregnancies were associated with improved PMTCT service use. Paper E critiques the use of a vignette within a qualitative investigation of barriers to PMTCT service uptake, suggesting that vignettes can be used successfully in rural Africa to draw out barriers to PMTCT service use. The qualitative analysis for paper F revealed a pivotal role for patient-provider interactions in PMTCT service use, through decision-making processes, trust, and features of care. The collective findings highlight the considerable barriers to uptake of PMTCT services that must be tackled in order to successfully eliminate new paediatric HIV infections. Potential positive impacts of ‘Option B+’ (initiating all HIV-positive pregnant women onto life-long antiretroviral therapy) may be limited by these barriers. Addressing health systems issues, particularly stock-outs of HIV test kits, drugs and delivery materials, and improving patient-provider relationships, may have the greatest immediate impact on PMTCT service use in this setting.
28
Fleek, Kimberly Anne. "Perspectives of HIV + Women on the Mother to Child Transmission of HIV in Addis Ababa, Ethiopia". Scholar Commons, 2014. https://scholarcommons.usf.edu/etd/5355.
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Purpose and rationale: In 2012, an estimated 9,500 infants in Ethiopia were born with HIV. Mortality for these infants is high, and preventing infection offers the best hope for reducing the childhood death rates. Effective measures exist which can reduce the likelihood of a child acquiring HIV from its mother to less than 2%, and the necessary anti-retroviral medications are free and accessible to Ethiopian women. However, Prevention of Mother to Child Transmission of HIV (PMTCT) efforts in the country have not kept pace with the global reduction in infant infections over the last decade, and the Ethiopian MTCT rate was still 20% in 2012. Although a large number of women are getting tested for HIV during pregnancy, only 41% of eligible women in the country complete PMTCT therapy. The purpose of this exploratory study was to elicit the perspectives of HIV+ mothers on the unique socio-contextual factors which affect them during pregnancy, both positively and negatively, including the beliefs, attitudes, cultural norms and individuals who have influence over their reproductive health decisions. Methods: The mixed-methods study was done at a community level in Addis Ababa, Ethiopia. With the assistance of several large networks of people living with HIV (PLHIV), PLHIV mothers who have a child at least one year of age were recruited by mixed purposeful sampling; various socio-economic demographics were represented. In-depth interviews, focus groups and surveys were then completed in Amharic with a research assistant translating to English. Results: 98 women in total took part in the study: 23 completed interviews, 28 participated in focus groups, and 49 completed additional surveys. The greatest barriers to PMTCT completion identified were: feelings of hopelessness and carelessness, a general lack of understanding of the efficacy of ARVs, negative religious influences, stigma and poverty. The strongest facilitators to PMTCT use expressed by the women were: PLHIV peer support, faith, and gaining hope. It was recommended that PLHIV mothers be utilized in all PMTCT planning and interventions in the future. Implications: Program managers and health officials can build on these findings to modify existing PMTCT programs and to develop innovative and effective new PMTCT interventions. This will ultimately result in increased PMTCT uptake and adherence amongst HIV + pregnant women and a reduction in infant HIV transmission.
29
Cloete, Alrese. "Birth order, delivery and concordance of mother-to-child transmission of Human Immunodeficiency Virus in twin pregnancies". Master's thesis, University of Cape Town, 2013. http://hdl.handle.net/11427/3040.
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Includes abstract.Includes bibliographical references.
Despite two decades of studies of mother to child transmission of HIV, very little data is available regarding vertical transmission in twin pregnancies. There is uncertainty whether discordance of HIV transmission exists between the first born (Twin A) and second born (Twin B) infant. Primary aim of the study was to examine if there is any discordance of HIV transmission in twin pregnancies when comparing Twin A to Twin B. Secondary objectives were to identify possible additional risk factors for HIV transmission in twin pregnancies. We assessed antenatal care, antiretroviral therapy, birth order, delivery route and feeding options as risk factors for mother to child transmission of HIV in twin pregnancies.
30
Behumbiize, Prosper T. "Factors influencing male’s involvement in prevention of mother to child transmission (PMTCT) services in Kibaale District, Uganda". UWC, 2009. http://hdl.handle.net/11394/2683.
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Magister Public Health - MPHGlobally, 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.
31
Kanyinda, Muya. "Reasons for pregnancy among women on prevention of mother-to-child transmission (PMTCT)program in Serowe-Botswana". Thesis, University of Limpopo (Medunsa Campus), 2009. http://hdl.handle.net/10386/245.
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Thesis (MPH)--University of Limpopo,2009.Background: Women living with HIV frequently report in the clinic with pregnancy despite their health status and knowledge of mother-to-child transmission HIV. This study assessed the level of knowledge of Prevention of Mother-to-Child Transmission (PMTCT) and the reasons for pregnancy among women on PMTCT in Serowe, Botswana. Objectives: The objectives of this study were to assess the level of knowledge of the PMTCT program and vertical transmission among HIV-positive women in Serowe; evaluate the reasons for pregnancy among HIV-positive pregnant women enrolled in the PMTCT program as well as describe the practices of family planning among these women in Serowe. Methodology: The study was a cross-sectional descriptive survey using qualitative method. Twenty six (26) participants attending PMTCT clinics at Serowe clinic, Nutrition clinic, and Kadimo clinic participated in the study between October and December 2008 after consenting to participate. Research assistants conducted in-depth interviews to collect socio-demographic data of the participants. Qualitative methods were used to collect data about the women’s level of understanding of the PMTCT program, reasons for falling pregnant, types and duration of their relationships with their partners and family planning practices. The interviews were conducted in the local language (Setswana) and then translated into English by the research assistant for transcribing. Their responses were audio taped. Results: The results indicated that most of pregnancies were unplanned. However, 26.9 % of participants said that they became pregnant because they desire to have another child. A number of participants ( 15.4%) indicated that they became pregnant because their partners wanted a child. Although all 26 participants had good knowledge and understanding of the family planning practices, but only 18 (69.2 %) had used the family planning methods before falling pregnant. The findings in this study revealed good social suport from the family members and the disclosure of HIV status was not a big issue to the participants. Majority of respondents (66.6%)) had good knowledge and understanding of the PMTCT program. One-third of the participants were single, ninety- six percentages of participants were unemployed, and about one-third of them live on less than 50 U$ dollars per month. Conclusion: As the desire to have children is usually perceived as a normal part of life for all women, including women living with HIV. Most women chose not to become pregnant after knowing their HIV status (HIV-positive) but the found themselves with unplanned pregnacy. The women with a procreative inclination were found to be more likely to choose to become pregnant which outweighed social support and personal health concerns. Additional factors included fear of transmitting HIV to their child, personal health-related concerns, unemploment and poverty. Participants had good knowledge of PMTCT program. The use of family planning by participants was poor despiste their good knowledge about it
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Mtombeni, Sifelani. "Community perceptions, attitudes and knowledge regarding mother to child transmission of HIV: a baseline evaluation before the implementation of the Prevention of Mother to Child Transmission of HIV Program using a short course of Nevirapine at Onandjokwe Hospital, Namibia". Thesis, University of the Western Cape, 2004. http://etd.uwc.ac.za/index.php?module=etd&.
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Each year approximately 600 000 infants, most of them in Sub-Saharan Africa are born with HIV infection as a result of mother to child transmission of HIV. Whereas significant progress has been made in reduction of mother to child transmission of HIV in developed countries, the situation remains desperate in developing countries. Progress has been hampered by shortage of staff, facilities, limited access to voluntary counselling and testing and lack of support for women by their partners and communities. The challenge is to increase voluntary counselling and testing uptake during antenatal care. Onandjokwe district in Northern Namibia is currently introducing the Prevention of Mother to Child Transmission Program (PMTCT). It has been found the previous PMTCT programs have failed because they adopted a top down approach where there was no community consultation. This study was conducted to explore the community perceptions, knowledge and attitudes regarding mother to child transmission of HIV through focus group discussions and in-depth interviews of key community members.
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Nguni, Catherine Musakanya. "Exploration and description of barriers to male participation in antenatal and prevention of mother-to-child transmission of HIV (pmtct) services in Mumbwa district, in Zambia". University of Western Cape, 2013. http://hdl.handle.net/11394/3918.
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Magister Public Health - MPHThe 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.
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Jumare, Fadila. "Factors influencing utilization and adherence to Prevention of Mother to Child Transmission of HIV/AIDS services in Rivers State, Nigeria". Doctoral thesis, Faculty of Humanities, 2019. http://hdl.handle.net/11427/31221.
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Effectiveness of services for Prevention of Mother to Child Transmission (PMTCT) of Human Immunodeficiency Virus (HIV) depends on viable and efficient health systems, adherence to and utilization of services. Despite strategies to provide access to PMTCT of HIV services, utilization of these services remain low in Nigeria thereby increasing child morbidity and mortality from HIV-related causes. Adherence to comprehensive HIV/AIDS care, for both the mother and baby, remain a challenge for HIV positive women. Utilizing the Health Belief Model and Social Support Theory, this qualitative study explores factors influencing utilization and adherence to PMTCT services by mothers living with HIV/AIDS in Rivers State, Nigeria. Purposive sampling procedures were used to select 40 study participants including 20 HIV positive mothers and 20 health care workers as key informants. Findings indicate that high self-perceived susceptibility to HIV influences utilization and adherence to PMTCT services among mothers living with HIV and AIDS in Rivers State. Although utilization and adherence to PMTCT were reported very high among this population, there were however challenges and barriers to optimal utilization of PMTCT. These include unavailability of test kits, antiretroviral medication stock-outs, and inadequate human resources for health. High transport, PMTCT and antenatal care costs were identified as the major socio-economic barriers to PMTCT administration as well as the high financial burden of formula feeding for women that preferred exclusive formula feeding. In addition to increased numbers of health care workers trained in PMTCT service delivery, recommendations for a public health approach to service delivery and a streamlined primary care strategy are proposed. These include social and community activities to address HIV/AIDS stigma, improving awareness of PMTCT facts, addressing gender relations and encouraging male participation. Inter-ministerial collaborations and targeted partnerships are also recommended for expanding coverage and ensuring optimal utilization of PMTCT services.
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Ladur, Alice Norah. "Factors influencing male involvement in prevention of mother-to-child transmission services in Khayelitsha, Cape Town, South Africa". Master's thesis, University of Cape Town, 2011. http://hdl.handle.net/11427/11287.
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This study sought to explore the role of men in the prevention of mother-to-child transmission services in Khayelitsha, South Africa. Two focus group discussions were held with 25 men of unknown status and one focus group discussion held with 12 HIV-positive women in the community. In-depth interviews were also conducted with four HIV-positive couples and five service providers purposely sampled from the community and a health facility, respectively.
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Cunnama, Lucy. "Economic evaluation of models of prevention of mother-to-child transmission of HIV intervention for large scale implementation". Doctoral thesis, Faculty of Health Sciences, 2021. http://hdl.handle.net/11427/33604.
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Background: Huge successes have been seen in the prevention of mother-to-child transmission of HIV (PMTCT) towards its elimination. Now amidst a landscape of universal antiretroviral therapy (ART), focus has been placed on different models of care to support and retain mother-infant pairs in the vulnerable postpartum phase. Methods The aim was to establish economic evidence for scaling-up approaches and models of care for PMTCT particularly during the postpartum period in Southern Africa. The economic data were collected during three studies, Safe Generations (Eswatini), MCH-ART and PACER (South Africa), using mixed bottom-up and top-down methodology. Outcomes of these studies were used to estimate the cost-effectiveness using an incremental cost effectiveness ratio (ICER, calculated by the difference in cost divided by the difference in effects) of lifelong ART in comparison to Option A (the standard of care at the time) in Eswatini; and to estimate the annual costs, costeffectiveness and budget impact of three models of care (Model I: Routine Care - mothers in general ART and infants in well-baby clinics; Model II: Integrated Care - mothers-infant pairs in integrated care in midwife obstetric unit; and Model III: Community Care - mothers in community adherence clubs and infants in well-baby clinics) in South Africa, from the provider and patient's perspectives. Costs are presented in 2019 United States Dollars (US $). Results Lifelong ART can be considered cost-effective in Eswatini with an ICER of US $984 per mother retained in care to six months postpartum. In Cape Town, South Africa, Routine Care cost US $226 per mother-infant pair per annum; Integrated Care cost US $341; and Community Care cost US $254. Annual patient costs (direct and indirect costs) for Models I-III, were US $30-55, US $23-45 and US $76 per mother-infant pair respectively. Comparatively Community Care was the most cost-effective model with an ICER of US $97 per mother-infant pair retained and mother virally suppressed. Scaling-up Community Care nationally in South Africa would require US $5 720 096 more than Routine Care, 0.2% of the total health budget for 2020/21. Conclusions This work has generated novel empirical data in the form of new cost estimates and cost comparisons across different models of care. It has also provided a unique comparison of the different models of care using a cost-effectiveness analysis; and further a novel budget impact analysis of different approaches to rolling these strategies out. This data has helped to fill the gap in the evidence base for instance lifelong ART was implemented in Eswatini as a direct result of the Safe Generations study findings. Community Care was found to be cost-effective and if scaled up nationally in South Africa would only require a small increment of the total health budget. However, we recommend a mixture of models of care to cater for the needs and preferences of patients. Decision makers can use the empirical findings to help set realistic budgets in Southern Africa and explore ideal model implementation to support mother-infant pairs in the crucial postpartum phase.
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Olagunju, Adeniyi. "Pharmacogenetics of antiretroviral drugs used for prevention of mother-to-child transmission of HIV during pregnancy and lactation". Thesis, University of Liverpool, 2015. http://livrepository.liverpool.ac.uk/2035139/.
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The use of antiretroviral therapy (ART) during pregnancy and lactation has significantly reduced the rate of mother-to-child transmission (MTCT) of HIV. However, pregnancy is known to affect the pharmacokinetics of many drugs, including key antiretroviral (ARV) drugs. In addition, ARV use during lactation raises questions about unintended exposure of breastfed infants to maternal drugs through breast milk. For drugs with significant genetic contribution to observed pharmacokinetic variability, we hypothesised that polymorphisms in drug disposition genes may accentuate or attenuate pregnancy-induced changes and/or breastfed infants’ exposure. HIV positive pregnant women and nursing mothers taking efavirenz (EFV)- or nevirapine (NVP)-based ART were recruited from three hospitals in Benue State, Nigeria. A novel strategy involving a preliminary pharmacogenetic association study was used to investigate the magnitude of pregnancy-induced changes in EFV and NVP pharmacokinetics in women stratified by single nucleotide polymorphisms (SNPs) in disposition genes. EFV apparent clearance (CL/F) was higher and AUC0-24, Cmax and Cmin were significantly lower in pregnant compared with postpartum women. When stratified based on the SNP with the highest predictive power, pregnant women with CYP2B6 516GG genotype were especially at risk. In the NVP cohort, exposure was also significantly lower in pregnant compared with postpartum women. When stratified based on composite CYP2B6 516G > T and 983T > C genotypes, Cmin was below target in most patients with combined CYP2B6 516GG and 983TT during pregnancy and postpartum. Cmin was below target in at least 50% of pregnant women with one or two variant alleles, compared with 0% in postpartum women. The intensive pharmacokinetics of EFV and NVP in breast milk and pharmacogenetic predictors were described for the first time. Breast milk pharmacokinetic parameters of EFV in breast milk differed significantly between patient groups stratified by CYP2B6 516G > T. The median time averaged milk-to-plasma concentration (M/P) ratio was 1.10 (range: 0.57-1.71) and the paediatric dose weight-adjusted exposure index was 4.05% (1.08-13.8). The resulting infant plasma concentration was influenced by CYP2B6 516G > T, highest up to 8 days of age at 1590 ng/mL (190-4631) and decreased by about 90% in the age stratum 9 days to 3 months. NVP AUC0-12, Cmax and Cmin in breast milk were significantly lower in patients with composite CYP2B6 516GG/983TT than those with at least one variant allele. The M/P ratio was 0.88 (0.74-1.2) and paediatric dose weight-adjusted exposure index was 3.64% (1.99-9.88). Infant plasma concentration differed significantly based on CYP2B6 516G > T/983T > C and CYP3A4 20230G > A (*1G), highest in those exposed through both breast milk and post-exposure prophylaxis compared with either alone. A breastfeeding physiologically-based pharmacokinetic (PBPK) model to predict infant exposure to maternal drugs through breast milk was developed and validated, with over 90% of all individual observed data points within the predictive interval. This thesis presents details about five different studies where these findings were observed. Their clinical implications in the context of current knowledge and practice were also explored.
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Xia, Jianhong. "Integrated Health Services for Prevention of Mother to Child Transmission of HIV/AIDS in China: Challenges and Strategies". Thesis, Griffith University, 2016. http://hdl.handle.net/10072/367713.
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Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome (HIV/AIDS) has emerged as a major global health threat in the last three decades (UNAIDS and WHO, 2013). Mother-To-Child Transmission (MTCT) of HIV increases the risk of HIV being transmitted from high risk populations to the general population, taking a heavy toll on children’s health (UNICEF, 2013). Prevention of MTCT (PMTCT) measures have effectively reduced the risk of MTCT in many developed countries; however difficulties in service delivery and various access issues impede implementation of PMTCT in resource limited countries (UNICEF and WHO, 2013), including China. Hence, it is imperative that we investigate better ways to implement PMTCT to reduce the risk of MTCT of HIV.
A priority strategy to reduce MTCT of HIV promoted by WHO is the integration of HIV prevention and treatment services with maternal and child health services (WHO, 2011b). This requires a shift in the management model from providing stand-alone prevention of HIV services to integrative PMTCT services. However, the effectiveness of integrated PMTCT services delivery is uneven across different health service systems around the world (Youngleson et al., 2010). In particular, delivery of integrated services is very difficult in complex health systems such as that in China.Thesis (PhD Doctorate)
Doctor of Philosophy (PhD)
Griffith School of Environment
Science, Environment, Engineering and Technology
Full Text
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Jenkins, Lorna Elizabeth. "Mother- to - Child Transmission of HIV and congenital syphilis: A snapshot of an Epidemic in the Republic of Panama". Scholar Commons, 2013. http://scholarcommons.usf.edu/etd/4692.
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ABSTRACT
Background: Worldwide HIV is going through a feminization and rejuvenation as more women are living with HIV/AIDS, increasing the risk of vertical transmission. Despite the efforts in Latin America and the Caribbean (LAC) by 2010, Panama was the third most affected country in the region with HIV/AIDS, with females aged 15-24 twice as affected as men.
Methods: This descriptive epidemiological study of HIV vertical transmission in Panama reviewed clinical charts to identify health care personnel's practices during pregnancies in 2008. This study also examines the impact of interventions comparing the HIV outcome of the children at the end of the 18-month follow-up period (March 2011).
Results: This study found 290 clinical charts; 116 from women and girls living with HIV who were pregnant in 2008 and 174 clinical charts of prenatally exposed children to HIV in 2008. During pregnancy, 58.05% of the mothers received HAART, and 68.39% received intravenous zidovudine during labor. The 81.03% of the children received oral zidovudine six weeks after birth, and 54.02% were fed with infant-adapted formula. During the follow-up period 12.64% of children studied were diagnosed as HIV positive and 36.36% of those children had an older seropositive sibling.
Discussion: The Republic of Panama has made efforts to prevent vertical HIV transmission. The current study shows early interventions such as receiving HAART during pregnancy, intravenous zidovudine during labor, caesarean section birth, receiving oral zidovudine six weeks after birth, and feeding with infant-adapted formula that show statistical significance when compared to final diagnosis of the prenatally exposed children to HIV.
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Neves, Lis Aparecida de Souza. ""Prevenção da transmissão vertical do HIV/aids: compreendendo as crenças e percepções das mães soropositivas"". Universidade de São Paulo, 2005. http://www.teses.usp.br/teses/disponiveis/22/22132/tde-06082005-154027/.
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As medidas preventivas da transmissão vertical do HIV podem efetivamente reduzir as taxas da infecção nas crianças. No entanto, são necessárias a participação e adesão das mães ao tratamento. Buscando compreender as crenças que influenciam o comportamento das mães portadoras do HIV em relação às medidas profiláticas da transmissão vertical, desenvolvemos este estudo qualitativo. Foram entrevistadas 14 mulheres portadoras do HIV cujos filhos nasceram no município de Ribeirão Preto e tinham no mínimo 6 meses de vida. Os dados foram tratados de acordo com o método da Análise de Conteúdo e interpretados utilizando-se como referencial teórico o Modelo de Crenças em Saúde (Rosenstock, 1974), composto pelas dimensões susceptibilidade percebida, severidade percebida, benefícios percebidos e barreiras percebidas. Na análise emanaram categorias que evidenciam as contradições da epidemia da aids: na susceptibilidade percebida emergiram invulnerabilidade antes da gravidez, o pré-natal e susceptibilidade da criança; quanto à severidade da doença subestimação do HIV e medo da morte; crescer saudável e não ser como eu, foram os benefícios percebidos pelas mães; em relação às barreiras possíveis, encontramos a descrença na existência do vírus, dificuldades financeiras e omissão do diagnóstico. Alguns aspectos das crenças podem ser considerados tanto como facilitadores como dificultadores da adesão materna, dependendo do contexto sócio-econômico e cultural em que vive a mãe. Conhecer a percepção das mães acerca das crenças que motivam os seus comportamentos proporciona aos profissionais de saúde maior compreensão desses comportamentos, permitindo ainda a possibilidade de elaboração de um planejamento mais efetivo de cuidados dentro de um contexto culturalmente significativo, com maior probabilidade de promover a adesão da clientela.Prevention measures for the mother-to-child transmission of the HIV virus may effectively reduce infection rates in children. However, for such effectiveness to come true, mothers have to comply with the treatment. This study was carried out aiming to understand the beliefs which influence the HIV positive mothers behaviors towards prevention methods against mother-to-child transmission. Fourteen HIV infected women whose children were at least 6 months old and all born in Ribeirão Preto county were interviewed. Data were studied according to the Content Analyses method and interpreted using as a theoretical reference the Health Belief Model (Rosenstock, 1974), formed by the following dimensions: perceived susceptibility, perceived severity, perceived benefits and perceived obstacles. As we analyzed those data we came up with some under categories showing the AIDS epidemic paradox: in the perceived susceptibility appeared: invulnerability prior to pregnancy; pre delivery; a childs susceptibility as for the disease seriousness. Underestimation of the HIV virus; fear of death; healthy growing up; and not the same as me were the benefits mentioned by the mothers. As for the possible barriers, we found things like: disbelief in the virus existence; financial problems; diagnosis omission. Some aspects of the beliefs may be considered both helpers and trouble-makers for a mothers adhesion, varying according to the social, economic and cultural environment the mother lives in. Getting to know a mothers perception regarding the beliefs motivating their behaviors provides the health professionals a higher understanding of such behaviors, allowing the possibility of making up an effective care plan within the context culturally meaningful, with a higher probability of promoting patients adhesion.
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Shangula, Maria N. "Factors affecting voluntary counseling and HIV testing among pregnant women in Tsumeb district, Oshikoto region, Namibia". Thesis, University of the Western Cape, 2006. http://etd.uwc.ac.za/index.php?module=etd&action=viewtitle&id=gen8Srv25Nme4_5201_1183462266.
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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.
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Wang, Bin. "Molecular mechanisms in human immunodeficiency virus type-1 (HIV-1) pathogenesis and mother to child transmission of HIV-1". Thesis, The University of Sydney, 1996. https://hdl.handle.net/2123/27541.
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This thesis is divided into three parts (1) the mechanisms by which HIV—1 generates genetic diversity in vivo to escape the human immune system and generate a hybrid genome, (2) the viral factors responsible for long-term survival of HIV-1 infected patients, and (3) the molecular mechanisms in HIV-1 transmission from mother to child and also non—transmission.
Recombination has long been known to represent an important means by which retroviruses genetic diversity. Recombination between HIV- strains involving divergent strains has been previously reported, but so far, the in vivo recombinational events between closely related HIV-1 strains/variants (belonging to the same subtype) have been difficult to detect. If the recombination is happening between closely related strains or within the same subtypes of HIV-1, it may pose a threat to designing of subtype based vaccines for HIV-1 control.
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Haines, Robyn A. "Development and Characterization of Early Immunological Events of a Rabbit Model of Milk-Borne Transmission of Human T-Lymphotropic Virus Type 1 Infection". The Ohio State University, 2012. http://rave.ohiolink.edu/etdc/view?acc_num=osu1337181159.
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Steiner, Kevin Lee. "Prenatal priming to malaria antigens increases susceptibility to HIV infection". Case Western Reserve University School of Graduate Studies / OhioLINK, 2011. http://rave.ohiolink.edu/etdc/view?acc_num=case1321827400.
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Jumare, Fadila. "Prevention of mother to child transmission (PMTCT) of HIV/AIDS: a review of using PMTCT services in South Africa". Thesis, Nelson Mandela Metropolitan University, 2012. http://hdl.handle.net/10948/d1011508.
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Despite good intentions and commitment from health providers, it is difficult for HIV positive pregnant women to access Prevention of Mother to Child Transmission of HIV (PMTCT) services (Skinner et al 2005:115). The aim of this research was to find out the extent to which socio-economic and cultural factors influence access to and utilization of PMTCT services. It appeared that despite having a legal plan and framework to ensure that PMTCT services are available and free, the realities confronting HIV positive women in South Africa as suggested by the literature contradicted this objective. Inevitably, these contradictions were identified as some of the main factors contributing to lack of access and inadequate utilization of PMTCT services. These factors were identified through a review of fifteen studies selected based on their relevance to the research aim. The findings were presented according to the following themes: Functioning of clinics, adherence to ART, uptake of VCT and infant feeding practices. According to research evidence, the major socio-cultural factors influencing access and utilization of PMTCT services include fear of stigma and discrimination which are related to cultural norms and practices. The socio-economic factors include transport costs, lack of food, medicines and formula milk which are all related to poverty and unemployment. The research also found that health system constraints such as long waiting times in clinics, stock-outs of formula milk, medicines and test kits influenced the utilization of PMTCT services by HIV positive women.
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Langwenya, Nontokozo. "Adherence to antiretroviral treatment (ART) among HIV-infected pregnant women starting treatment immediately vs delayed: a cohort study". Master's thesis, University of Cape Town, 2016. http://hdl.handle.net/11427/22899.
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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.
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Castellani, Mayra Moreira Xavier. "Contar ou não contar, eis a questão: um olhar psicanalítico sobre a experiência da revelação diagnóstica de HIV, em jovens infectados por transmissão vertical". Universidade de São Paulo, 2014. http://www.teses.usp.br/teses/disponiveis/47/47133/tde-16032015-102901/.
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O presente trabalho tem por objetivo investigar e fundamentar teoricamente, a partir da teoria psicanalítica de orientação freud-lacaniana, como se dá a experiência da revelação do diagnóstico de HIV, para a parceria afetivo-sexual, em adolescentes e jovens adultos infectados por transmissão vertical. É absolutamente compreensível a relação que se estabelece no âmbito da Saúde, entre revelação do diagnóstico e cuidados preventivos. No entanto, a clínica psicanalítica com os pacientes envolvidos nesta problemática nos indica que a revelação do diagnóstico é, para o paciente, uma experiência que ultrapassa muito o ato de informar um dado, sendo, antes, uma experiência subjetiva da revelação de uma identidade herdada. Por esse motivo, percebemos ser fundamental uma compreensão dos processos psíquicos envolvidos na experiência da revelação do diagnóstico destes jovens, levando em conta a singularidade de cada caso. Partimos de duas hipóteses: a revelação do diagnóstico ao parceiro afetivo-sexual pode ser influenciada por como lhe foi revelado seu diagnóstico, ou seja, sua herança do HIV, transmitida por sua mãe; a angústia associada à experiência da revelação do diagnóstico de HIV por transmissão vertical para o parceiro pode ser uma resposta à fantasia de desamparo. Na tentativa de compreender esse cenário, elegemos alguns conceitos psicanalíticos como bússola, que podem contribuir para o cerzimento de articulações teórico-clínicas, são eles: tabu, transmissão, identificação, fantasia e angústia. Além disso, realizamos entrevistas semi-dirigidas com quatro pacientes, que tinham diagnóstico de HIV/aids por transmissão vertical. A análise das falas dos entrevistados foi realizada a partir do referencial psicanalítico, utilizando principalmente as teorias construídas por Freud e Lacan. A partir disso, pudemos concluir que guardar o diagnóstico de HIV como segredo implica resguardar a posição do sujeito em sua fantasia fundamental, que funciona de anteparo para a angústia e está diretamente ligada ao Outro. Nesse sentido a solução para ausência de sofrimento psíquico não seria nem direcionar o sujeito para a denúncia do segredo, nem tampouco, sugestioná-lo a manter o segredo a sete chaves. Neste momento, é fundamental compreender o lugar que o segredo encena na subjetividade dos jovens, por meio da escuta psicanalítica. Além disso, é imprescindível cuidar da resposta do psicanalista no âmbito institucional, como membro da equipe de saúde, defendendo um manejo delicado entre o tempo de cada sujeito e a importância da revelação do diagnóstico, uma vez que o paradigma da subjetividade pode ser uma alternativa competente para resolver uma problemática ainda muito incompreendida em serviços de saúde especializados em HIV/AidsThe present study aims to investigate and to formalize theoretically, according to the psychoanalytic theory of Freud and Lacan, how is the experience of the disclosure of HIV serostatus to an intimate partnership, for adolescents and young adults infected by mother-to-child-transmission. The connection established under Healths context, between the disclosure of HIV serostatus and preventive care is absolutely understandable. However, the psychoanalytic treatment of patients involved in this issue indicates that disclosure of HIV diagnosis is an experience that exceeds just the act of informing, it is actually a subjective experience of revelation of an inherited identity. For this reason, we consider that it is fundamental to understand which psychological processes are involved in the experience of disclosing the HIV diagnosis, taking into account the uniqueness of each case. We have two hypotheses: the disclosure of HIV diagnosis to the partner may be influenced by how the individual received its own diagnosis, that represents the heritage of HIV, transmitted by the mother; the anguish associated with the experience of disclosing the HIV diagnosis through mother-to-child-transmission to the partner may be a response to the fantasy of helplessness. In trying to understand this scenario, we elect some psychoanalytic concepts such as a compass, that can contribute to make the theoretical and clinical link, they are: taboo, transmission, identification, fantasy and angst. In addition, we conducted semi-structured interviews with four patients who were diagnosed with HIV/AIDS through mother-to-child-transmission. The analysis of the interviewed peoples speeches was done by the psychoanalytic theoretical basis, mainly using the theories constructed by Freud and Lacan. The course of this research allowed us to conclude that keep HIV diagnosis as a secret means to safeguard the position of the individual in its fundamental fantasy, which works as a screen for anxiety and is directly linked to the Other. In this context, the solution to the absence of psychological pain would be neither to guide the individual to denunciate its secret, nor suggests to keep the secret under lock and key. At this point, it is essential to understand the place that the secret stages in the subjectivity of young people, through the psychoanalytic listening. Moreover, it is also essential to take care of the psychoanalysts work in the health institution, as a member of the health team, protecting the delicate handling between the time of each subject and the importance of disclosure, since the paradigm of subjectivity can be a competent alternative to solve a misunderstood issue inside the HIV/Aids specialized health services
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Kirya, Viola. "A mixed methods study to explore the outcomes, experiences and perceptions of women who attended a new counselling model for HIV-positive pregnant women accessing antenatal services in Khayelitsha, Cape Town, South Africa". Master's thesis, University of Cape Town, 2016. http://hdl.handle.net/11427/21194.
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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.
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Mkontwana, Phumeza Eudicia. "An assessment of infant and young child feeding policy implementation of HIV mother-to-child transmission in the Nelson Mandela Bay Municipality health care facilities". Thesis, Nelson Mandela Metropolitan University, 2012. http://hdl.handle.net/10948/d1011632.
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This descriptive study aimed to assess the Infant and Young Child Feeding (IYCF) policy implementation in the Prevention of Mother-to-Child Transmission of HIV (PMTCT) among healthcare workers in the Nelson Mandela Bay Municipality public health care facilities. A convenience sampling method was used to gather information from nurses (n=32) rendering maternal and child health services in nineteen permanent Nelson Mandela Bay public health care facilities (MOU’s, paediatric sections, well baby clinics and PMTCT sites). Recommendations included to the need develop indicators for measuring the IYCF policy objectives and regularly collect data on infant and young child feeding, standardising infant feeding education given by peer educators / lay counsellors from various organisations, capacity building and training of staff on IYCF and scaling up monitoring and evaluation of the IYCF policy impact.
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Mamudu, Rashidat Amanosi. "Knowledge, attitude and practices of prevention of mother to child transmission of HIV(PMTCT) among women of child bearing age, in Karu Village, Abuja, Nigeria". Thesis, Stellenbosch : Stellenbosch University, 2014. http://hdl.handle.net/10019.1/86249.
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Thesis (MPhil)--Stellenbosch University, 2014.ENGLISH ABSTRACT: An estimated 34 million people worldwide are infected with HIV with 52% of them being women (UNAIDS, 2011), of this figure, an estimated 3.4 million are said to be children below the age of 15years. Sub Saharan Africa accounts for up to 90% of this burden in children. Nigeria, the most populous nation is Saharan African still contributes up to 30% of the global burden of mother to child transmission of HIV which is a major source of infection in children. According to the Federal ministry of health 2010 ANC survey report, the country has a prevalence of 4.1%. The Federal Capital Territory (FCT) where Karu village is located ranked 5th among the 36 states and Federal capital territory in Nigeria with a prevalence of 8.7%. Urban prevalence is 8.6% while the rural prevalence is 8.2%. An exploratory descriptive study was conducted among women of child bearing age (18 to 49years) living in Karu village, Abuja, FCT, North central Nigeria. A semi structured questionnaire designed to assess the knowledge, attitude and practices of prevention of mother to child transmission of HIV was administered by the researcher on 120 women of child bearing age living in Karu village after obtaining their consent. The study received an ethical review and approval from FCT human research ethics committee at the Health Department of the Federal capital development agency and Stellenbosch University, ethic committee. Findings from the 120 women who gave consent to participate showed that 28.33% had sufficient knowledge of how MTCT can occur with 77% having insufficient knowledge of how MTCT occur, 51.67% of them have sufficient knowledge of how PMTCT can be achieved while 48.33% do not. Of the participant surveyed, 89.17% of them have ever been pregnant while 24.17% were pregnant at the time of the survey, the bulk of the participants were between the ages of 18 to 34 with only 22.5% of them within the age of 35 – 49 years. From this study, women in Karu village were identified to have high level of general knowledge regarding MTCT and PMTCT of HIV but in-depth knowledge of both is still insufficient among a large group of women. Health workers and mass media were identified as key sources of information regarding MTCT and PMTCT of HIV and majority of women have favourable attitude towards PMTCT interventions but practices of these interventions is still relatively low.
AFRIKAANSE OPSOMMING: Ongeveer 34 miljoen mense is wêreldwyd aangetas deur MIV, waarvan 52% vroue is (UNAIDS, 2011). Hiervan is ongeveer 3.4 miljoen na bewering kinders onder die ouderdom van 15 jaar. Tot 90% van hierdie infeksie by kinders kom in sub-Sahara-Afrika voor. Nigerië, die digsbevolkte staat in sub-Sahara-Afrika, dra tot 30% van die globale las van moeder-tot-kind-oordrag van MIV, wat ’n groot bron van infeksie onder kinders is. Volgens die Federale Ministerie van Gesondheid 2010 ANC-opnameverslag het die land ’n voorkomssyfer van 4.1%. Die Federal Capital Territory (FCT), waar die dorp Karu geleë is, is as 5de van die 36 state in Nigerië geklassifiseer met ’n voorkomssyfer van 8.7%. Die stedelike voorkomssyfer is 8.6% teenoor die landelike voorkomssyfer van 8.2%. ’n Ondersoekende, beskrywende studie is uitgevoer onder vroue van vrugbare leeftyd (18 tot 49 jaar) wat in die dorp Karu, Abuja, FCT, Noord-sentrale Nigerië, woon. ’n Halfgestruktureerde vraelys is ontwerp om die kennis, houdings en voorkomingspraktyke van moeder-tot-kind-oordrag (MTCT) van MIV te beoordeel. Dit is deur die navorser toegepas op 120 vroue van vrugbare leeftyd wat in die dorp Karu woon nadat hul toestemming daartoe verkry is. Die studie het ’n etiese oorsig en goedkeuring van die FCT mensenavorsing-etiekkomitee by die Departement van Gesondheid van die federale hoofstad se ontwikkelingsagentskap en die Universiteit Stellenbosch se etiekkomitee ontvang. Bevindings van die 120 vroue wat ingestem het om deel te neem het getoon dat 28.33% toereikende kennis gehad het van hoe MTCT kan voorkom, met 77% wat onvoldoende kennis gehad het van hoe MTCT voorkom. Van hulle het 51.67% genoegsame kennis gehad van hoe PMTCT verkry kan word, terwyl 48.33% nie oor hierdie kennis beskik het nie. Van die deelnemers wat waargeneem is, was 89.17% al swanger, terwyl 24.17% tydens die opname swanger was. Die meerderheid van die deelnemers was tussen 18 en 34 jaar oud, met slegs 22.5% wat in die ouderdomsgroep 35 – 49 jaar geval het. Uit hierdie studie het geblyk dat vroue van die dorp Karu geïdentifiseer is as mense wat ’n hoë vlak van algemene kennis omtrent MTCT en PMTCT van MIV gehad het, maar dieptekennis van albei sake is steeds ontoereikend by ’n groot groep vroue. Gesondheidswerkers en die massamedia is geïdentifiseer as sleutelbronne van kennis oor MTCT en PMTCT van MIV en die meeste vroue het ’n gunstige houding teenoor PMTCT-intervensies, maar die toepassing van hierdie intervensies is nog betreklik laag.