"She is my teacher and if it was not for her I would be dead" : exploration of rural South African Community Health Worker's informational and mediating roles in the home

This thesis seeks to fill the gap in the literature by exploring CHW IEC roles through: a protocol for the Health Information in the Home (HIH) study of the quality of IEC services by Community Care Workers; a structured literature review of the current state of the evidence and a journal manuscript based on the HIH study findings

Genetic structure of the high dispersal Atlanto-Mediterreanean sea star Astropecten aranciacus revealed by mitochondrial DNA sequences and microsatellite loci

To investigate the impact of potential marine barriers on gene-flow in high dispersal marine invertebrates, we assessed the population genetic structure of the sea star Astropecten aranciacus. Samples were obtained from nine locations within the Atlantic and the Mediterranean Sea including populations east of the Siculo-Tunisian Strait. We obtained both DNA sequence data of the mitochondrial control region and genotype data at four microsatellite loci. Both markers were highly polymorphic and showed a great level of genetic diversity. Genetic differentiation between populations (F ST) was in general low, particularly for nuclear data, as is often the case in high dispersal marine invertebrates. Nevertheless, both marker sets indicated a significant genetic differentiation of the population from the island of Madeira to most other populations. Our results also demonstrate a clear pattern of isolation-by-distance supported by both mitochondrial and nuclear markers. Therefore, we conclude that larval dispersal of A. aranciacus is somewhat limited even within the basins of the Atlantic, the west Mediterranean and the east Mediterranean. Microsatellite loci further revealed genetic differentiation between the three basins; however, it is not clear whether this is truly caused by marine barriers. Genetic differentiation between basins might also be a result of isolation-by-distance allowing for any grouping to be significant as long as geographical neighbors are clustered together. Although levels of genetic differentiation were less pronounced in microsatellite data, both datasets were coherent and revealed similar patterns of genetic structure in A. aranciacu

Within and Between Subject Spectral Fingerprints of EEG-Microstate Parameters.

Early reports have claimed that EEG microstate features (e.g. their mean duration or percent of time covered) are largely independent from EEG spectra. This has meanwhile been questioned for conceptual and empirical reasons, but so far, EEG spectral power map correlates of microstate features have not been reported. We present the results of such analyses, conducted both within and between subjects, and report patterns of systematic changes in local EEG spectral amplitude associated with the mean duration, frequency of occurrence and relative contribution of particular microstate classes. The combination of EEG microstate analysis with spectral analysis may therefore be helpful to come to a deeper understanding of local patterns of activation and inhibition associated with particular microstate classes

The size, characteristics and partnership networks of the health-related non-profit sector in three regions of South Africa: implications of changing primary health care policy for community-based care

Web of Scienc

Adolescent Bereavement After Sudden Loss of a Close Friend

Despite the prevalence of sudden death in adolescence, there is a deficiency of resources and support for adolescents who have lost a close friend to premature death. These resources are vital, as the sudden and unexpected death of a close friend is often traumatizing and can contribute to a sense of instability in young people. Although a great deal of academic research has been conducted on sibling or parental grief during adolescence, there existed a need for further research on peer loss during adolescence. Therefore, the purpose of the study was to describe the essence and meaning of the lived experience of bereaved emerging adults who have undergone the sudden death of a close friend during adolescence, which was reflected in the primary phenomenological research question. The present study was grounded in post-traumatic growth (PTG) theory, which is a way of describing the positive personal growth that individuals may come to experience after living through a traumatic event. Interpretative phenomenological analysis was used as the methodological framework for this research, wherein eight participants engaged in semi-structured interviews. Data were analyzed through first open coding and then axial coding methods. The results indicated that adolescents experienced a host of negative effects after loss, often came to experience PTG outcomes, were rarely offered formal bereavement resources, found intangible supports to be valuable, and exhibited ambivalent attitudes and behaviors. Ultimately, by improving the scholarly understanding of this phenomenon, efforts to improve this demographic’s long-term PTG outcomes can be reinforced, leading to positive social change by making a small contribution towards benefitting bereaved young people

EXPERIENCES OF FEMALE SEX WORKERS ALONG THE HIV CARE CONTINUUM IN SANTO DOMINGO, DOMINICAN REPUBLIC

Introduction Approximately 12% of all female sex workers (FSWs) around the world are living with HIV. FSWs confront heightened vulnerability not only to HIV infection, but also to social, economic and systemic barriers throughout the HIV care continuum and have sub-optimal engagement in HIV care. Despite this large burden of disease, there is very limited evidence on the HIV care experiences of FSWs living with HIV. Methods This study utilized a mixed methods approach to investigate FSWs’ experiences along the HIV care continuum. The first manuscript explored the experiences of 44 FSWs living with HIV throughout the HIV care continuum through in-depth interviews and focus group discussions in Santo Domingo, Dominican Republic. Informed by the findings from this thematic and narrative analysis, the second manuscript analyzed a quantitative, cross-sectional survey to describe the baseline HIV care continuum among 268 FSWs living with HIV in Santo Domingo. The manuscript then specifically examined factors associated with experience of antiretroviral therapy (ART) interruption using multiple logistic regression. The final manuscript determined the factors associated with retention in HIV care in the same study population using multiple measure of retention. Results FSWs living with HIV disengaged at each step of the HIV care continuum. Engagement in HIV care was not a static construct as participants continually negotiated engagement within a broader context of structural constraints and social conditions. FSWs described critical influences across multiple levels that either facilitated (re)engagement in HIV care or led to disengagement. Key individual-level factors identified in the qualitative analysis were physical and mental health as post-diagnosis depression was often followed by disengagement in HIV care until declines in physical health were noted. Interpersonal factors centered on disclosure of HIV or FSW status and existent support. At the environmental level, participants frequently described systemic delays and the high costs of care, but good relationships with HIV care providers. Some experiences of discrimination within the clinic environment were, however, described. Lack of economic resources and pervasive HIV stigma and discrimination also complicated adherence to clinical appointments and ART. Within the quantitative sample, most participants linked to HIV care (92%), attended HIV services in the past six months (85%) and were initiated onto ART (78%), but discontinuation of treatment and irregular adherence to clinical appointments were frequent. A total of 36% of the participants ever initiated onto ART reported lifetime experience with an interruption of ART. The odds of ART interruption were 3.24 times higher among women who experienced sex work (SW)-related discrimination (95% confidence interval [CI]: 1.28, 8.20), 2.41 times higher among women who reported ever using any drug (95% CI: 1.09, 5.34) and 2.35 times higher among women who worked in a SW establishment (95% CI: 1.20, 4.60). Self-stigmatizing beliefs related to SW were associated with higher odds of interruption as each additional point on the SW self-stigma scale was associated with a 9% increase in the odds of ART interruption (95% CI: 1.02, 1.16). Positive perceptions of HIV providers were protective with each additional point on the perception of HIV provider scale associated with a 9% reduction in the odds of treatment interruption (95% CI: 0.85, 0.98). The final manuscript determined that a retention measure which included both attended and missed visits was the most appropriate measure of retention in this study population. A total of 37% of the women who attended HIV services in the past six months had missed at least one clinical appointment. The odds of being retained in HIV care were higher among participants with more positive perceptions of HIV service providers (adjusted relative odds [ARO]: 1.17; 95% confidence interval [CI]: 01.09, 1.25). The odds of retention were lower among women who reported recent alcohol consumption (ARO: 0.50; 95% CI: 0.28, 0.92) and among women with self-stigmatizing beliefs related to SW (ARO: 0.93; 95% CI: 0.88, 0.98). Conclusions Individual, interpersonal, environmental and structural factors were important influences on engagement in HIV care among FSWs throughout the HIV care continuum. In addition to challenges faced by the general population living with HIV, FSWs confronted additional economic instability and the compounded stigma of being both HIV-infected and a FSW. Given the clear importance of improving engagement in HIV care to maximize individual and public health, there is an urgent need for multi-level interventions to help support FSWs throughout the HIV care continuum

Correlates of Delayed Diagnosis among Human Immunodeficiency Virus-Infected Pulmonary Tuberculosis Suspects in a Rural HIV Clinic, South Africa

Delay in pulmonary tuberculosis (PTB) diagnosis is one of the major factors that affect outcome and threatens continued spread of tuberculosis. This study aimed at determining factors associated with delayed PTB diagnosis among human immunodeficiency virus (HIV) infected individuals. Methods. A retrospective observational study was done using clinic records of HIV-infected PTB suspects attending an HIV/AIDS clinic at Tintswalo rural hospital in South Africa (SA) between January 2006 and December 2007. Using routine clinic registers, 480 records were identified. Results. PTB diagnosis delay was found among 77/176 (43.8%) of the patients diagnosed with PTB. The mean delay of PTB diagnosis was 170.6 days; diagnosis delay ranged 1–30 days in 27 (35.1%) patients, 31–180 days in 24 (33.8%) patients; 24 (31.2%) patients remained undiagnosed for ≥180 days. Independent factors associated with delayed diagnosis were: older age >40 years (Odds Ratio (OR) 3.43, 95% CI 1.45–8.08) and virological failure (OR 2.72, 95% CI 1.09–6.74). Conclusion. There is a considerable delayed PTB diagnosis among HIV-infected patients in rural SA. Older patients as well as patients with high viral load are at a higher risk of PTB diagnosis delay. Therefore efforts to reduce PTB diagnosis delay need to emphasised