3. Electronic Theses and Dissertations (ETDs) - All submissions
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Item A descriptive study of aspects of the prevention of mother to child transmission of HIV programme at selected hospitals and clinics in Gauteng(2010-10-14) Ismail, FarrahAIM: To evaluate aspects of the PMTCT programmes at selected hospitals and clinics in Gauteng. METHOD: A cross sectional survey of post partum women in Gauteng was undertaken during April- June 2006. Data was collected at four hospitals and eight Midwife Obstetric Units (MOUs) in four regions in Gauteng. Mothers, irrespective of HIV status, who delivered in the previous 48 hours were interviewed. This was followed by a review of the mother’s and infant’s records as well as relevant registers. RESULTS: Interviews with, and record reviews, of 182 mother-infant pairs were conducted/obtained; 69 (38%) at MOUs and 113 (62%) at hospitals. The majority (172 [95%]) of mothers were “booked” of whom 155 (85%) had undergone an antenatal HIV test. Forty-two mothers (23%) were HIV positive. Nevirapine was issued antenatally to 37/42 (89%) of eligible mothers; 30/42 (71%) took it during labour. Three women (8%) received the drug for the first time during labour; thus 33/42 (79%) of eligible mothers received nevirapine. Thirtytwo (76%) of babies born to HIV positive mothers received nevirapine. However, in only 24/42 of mother-infant pairs (57%) was receipt of nevirapine by both parties, recorded. There was no significant difference in nevirapine administration rates to mothers at clinics compared to hospitals (76% vs. 81%, p=0.71). Infants were more likely to receive nevirapine at clinics compared to hospitals (90% vs. 62%, p= 0.03). CONCLUSION: Four years after introduction of a PMTCT programme in Gauteng, nevirapine uptake and administration rates remained sub-optimal, with at least a quarter of eligible (identified) women and infants not receiving the intervention. The findings highlight the need to prioritise and consolidate PMTCT activities in the province.Item Factors affecting enrolment into the programme of prevention of mother-to-child transmission (PMTCT) of HIV, among post-partum women, in a public maternity centre in the Limpopo Province(2010-04-15T13:19:56Z) Ajewole, Olusesan JoshuaBACKGROUND Until recent years, uptake of voluntary counselling and testing for HIV (VCT) and enrolment into the programme of prevention of mother-to-child transmission of HIV (PMTCT) was very poor among pregnant women. This study aims to identify factors influencing enrolment into the programme of PMTCT among post-partum women. METHODS Cross sectional interview of 200 consecutive post-partum women was conducted using an interviewer-administered questionnaire. Forms of those who declined to participate were kept and marked “refusal”. Data was analysed using Epi info software. RESULTS The response rate was 84.5%. VCT uptake was 96.9% among participants and PMTCT uptake among HIV+ve mothers was 90.9%. The mean age of participants was 25 years, ranged from 14 to 41 years. Women in the age-group 20-29 were more likely to accept VCT and enroll for PMTCT than women in the other age-groups (p=0.0114). CONCLUSIONS AND RECOMMENDATIONS Provision of clear and well-defined policy guidelines and strong commitment to implementation of these guidelines have been largely responsible for impressive uptake of VCT among participants and high rates of satisfaction with PMTCT programme among HIV-infected women. Training of more lay-counsellors is recommended for its cost-effectiveness.Item Assessment of risk factors and transmission for HIV comparing discordant and concordant couples in Hlabisa Demographic Surveillance System (DSS) site.(2010-03-02T09:05:09Z) Adjei, GeorgeObjective To compare risk factors between HIV-positive concordant and discordant couples. Study design This is a cross-sectional secondary data analysis study using data from Africa Centre Demographic Information System (ACDIS) database (June 2003 to December 2004) and data from the first round of population-based HIV surveillance conducted by the Africa Centre for Health and Population Studies. Methods Eighty-five HIV-positive concordant couples (both partners were HIV-positive) and 73 discordant couples (one partner was HIV-positive and other partner HIV-negative) were identified and selected from the first round of population-based HIV surveillance conducted from June 2003 to December 2004 in Hlabisa Demographic Surveillance System site. Partners health and sexual behaviour data were collected together with the blood sample for HIV test during the same round. Socio-economic and demographic data of partners were obtained from the ACDIS database and were collected within the same period (June 2003 to December 2004). The behavioural, biological, demographic and socio-economic risk factors for HIVpositive concordance and transmission within discordant couples were analysed. Circumcision and area of residence respectively were the biological and demographic factors considered. Number of household assets was used as a proxy for socioeconomic status. The behavioural factors considered were male condom-use, sexual debut (age at first sex), number of lifetime partners and premarital partners. The age and educational level of partners were considered as potential confounders. 5 RESULTS The uncircumcised men were more likely to be in HIV-positive concordant couples than to be in discordant couples (OR =10.8, 95% CI [1.93 – 60.30], p=0.007). Partners living in urban area were 4.7 times more at risk of being in a HIV-positive concordant relationship than to be in discordant relationship (OR=4.7, 95% CI [2.09 - 10.39], p<0.001). Male not using condom on regular basis with female partners, early sexual debut, greater number of premarital partners, household assets and lifetime partners were found not to be significantly associated with HIV-positive concordance. Conclusion There are several biologic, socio-economic, demographic and behavioural risk factors for HIV-positive concordance. However, identifying some of them might be used to address transmission of HIV among discordant couples through intervention programs. Although cross-sectional studies are not ideal for establishing temporality, this study corroborates the findings of other studies that living in urban areas and circumcision are associated with HIV transmission.Item Uptake of the prevention of mother-to-child-transmission programme at a primary care level in Sedibeng District(2009-04-29T09:54:51Z) Berthet, EmilieIntroduction: Prevention of mother-to-child-transmission of HIV is a priority public health problem in Africa as pregnant women and their children are the most vulnerable. In South Africa, a prevention of mother to child transmission of HIV (PMTCT) programme has been implemented in antenatal clinics to reduce paediatric HIV/AIDS. It is necessary to assess the uptake of this programme by pregnant women. Objectives The purpose of this study was to determine the uptake of the PMTCT programme in the antenatal clinics of Sedibeng district. Using data coming from all the antenatal clinics (ANC) at a primary health care levelin Sedibeng for 2005 and 2006, we determined the proportion of ANC attendees who accepted to be counselled, the proportion of these who accepted to be tested for HIV, the proportion of these who came back for results and the proportion who were HIV positive. Nevirapine (NVP)uptake was determined as well among HIV positive women and babies born to HIV positive women. Methods Data collection was by a record review of PMTCT records from all antenatal clinics in the district. To determine maternal uptake of PMTCT, data were extracted from antenatal clinics monthly collation sheets for 2005 and 2006. Nevirapine uptake for the babies born to HIV positive mothers was determined in one facility: data were v - collected in the midwife obstetric unit of the community health centre from both the Nevirapine register and the mothers’ delivery records. Results A total of 8010 women attended in Sedibeng antenatal clinics in 2005 and 10217 in 2006. In 2005 95 % of attendee women accepted to be counselled among whom 91% accepted to be tested for HIV. In 2006 93% women accepted to be counselled among whom 91% accepted to be tested. Almost all tested women came back for results: 99% came back for results in 2005 and 98% in 2006. The proportion of HIV positive women in the attendees population was 23% in 2005 and 24% in 2006. Nevirapine was dispensed to only 600 per 1000 HIV positive women in 2005 and 539 per 1000 HIV positive women in 2006. From June 2005 to May 2006 only 59% of babies born to an HIV positive mother received NVP. Discussion and conclusion The study showed a good uptake of voluntary counselling and HIV testing in Sedibeng district antenatal clinics. But a low proportion of HIV positive women and HIV-exposed babies received NVP. There was probably a loss of follow up of women between ANC visits and delivery. Nevirapine uptake must be improved in Sedibeng antenatal clinics and further investigations need to be done to understand the factors influencing uptake.