DOCSLIB.ORG

Microcosm: a Model of Social and Structural Drivers of HIV and Interventions to Reduce HIV Incidence in High-Risk Populations in South Africa

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Microcosm: a Model of Social and Structural Drivers of HIV and Interventions to Reduce HIV Incidence in High-Risk Populations in South Africa bioRxiv preprint doi: https://doi.org/10.1101/310763; this version posted April 30, 2018. The copyright holder for this preprint (which was not certified by peer review) is the author/funder, who has granted bioRxiv a license to display the preprint in perpetuity. It is made available under aCC-BY-NC-ND 4.0 International license. MicroCOSM: a model of social and structural drivers of HIV and interventions to reduce HIV incidence in high-risk populations in South Africa Centre for Infectious Disease Epidemiology and Research working paper April 2018 Leigh F. Johnson, Mmamapudi Kubjane, Haroon Moolla Centre for Infectious Disease Epidemiology and Research Correspondence to: Dr Leigh Johnson Centre for Infectious Disease Epidemiology and Research University of Cape Town Anzio Road Observatory 7925 South Africa Tel: +27 21 406 6981 Fax: +27 21 406 6764 Email: [email protected] 1 bioRxiv preprint doi: https://doi.org/10.1101/310763; this version posted April 30, 2018. The copyright holder for this preprint (which was not certified by peer review) is the author/funder, who has granted bioRxiv a license to display the preprint in perpetuity. It is made available under aCC-BY-NC-ND 4.0 International license. Executive summary Background and objectives South Africa has one of the highest HIV incidence rates in the world. Although much research has focused on developing biomedical strategies to reduce HIV incidence, there has been less investment in prevention strategies that address the social drivers of HIV spread. Understanding the social determinants of HIV is closely related to understanding high-risk populations (‘key populations’), since many of the factors that place these key populations at high HIV risk are social and behavioural rather than biological. Mathematical models have an important role to play in evaluating the potential impact of new HIV prevention and treatment strategies. However, most of the mathematical modelling studies that have been published to date have evaluated biomedical HIV prevention strategies, and relatively few models have been developed to understand the role of social determinants or interventions that address these social drivers. In addition, many of the mathematical models that have been developed are relatively simple deterministic models, which are not well suited to simulating the complex causal pathways that link many of the social drivers to HIV incidence. The frequency-dependent assumption implicit in most deterministic models also leads to under-estimation of the contribution of high-risk groups to the incidence of HIV. Agent-based models (ABMs) overcome many of the limitations of deterministic models, although at the expense of greater computational burden. This study presents an ABM of HIV in South Africa, developed to characterize the key social drivers of HIV in South Africa and the groups that are at the highest risk of HIV. The objective of this report is to provide a technical description of the model and to explain how the model has been calibrated to South African data sources; future publications will assess the drivers of HIV transmission in South Africa in more detail. Methods The model is an extension of a previously-published ABM of HIV and other sexually transmitted infections (STIs) in South Africa. This model simulates a representative sample of the South African population, starting from 1985, with an initial sample size of 20 000. The population changes in size as a result of births and deaths. Each individual is assigned a date of birth, sex and race (demographic characteristics). This in turn affects the assignment of socio-economic variables. Each individual is assigned a level of educational attainment, which is dynamically updated as youth progress through school and tertiary education, with rates of progression and drop-out depending on the individual’s demographic characteristics. Each individual is also assigned to an urban or rural location, with rates of movement between urban and rural areas depending on demographic characteristics and educational attainment. The model assigns to each individual a number of healthcare access variables that determine their HIV and pregnancy risk. These include their ‘condom preference’ (a measure of the extent to which they wish to use condoms and are able to access condoms), use of hormonal 2 bioRxiv preprint doi: https://doi.org/10.1101/310763; this version posted April 30, 2018. The copyright holder for this preprint (which was not certified by peer review) is the author/funder, who has granted bioRxiv a license to display the preprint in perpetuity. It is made available under aCC-BY-NC-ND 4.0 International license. contraception and sterilization, use of pre-exposure prophylaxis (PrEP), male circumcision, HIV testing history and uptake of antiretroviral treatment (ART). Access to these healthcare services changes over time, and is also assumed to depend on demographic and socioeconomic variables, as well as on the individual’s health status. Sexual behaviour is simulated by assigning to each individual an indicator of their propensity for concurrent partnerships (‘high risk’ individuals are defined as individuals who have a propensity for concurrent partnerships or commercial sex). Each individual is also assigned a sexual preference, which can change over their life course. Three types of relationship are modelled: sex worker-client contacts, short-term (non-marital) relationships and long-term (marital or cohabiting) relationships. Individuals are assumed to enter into short-term relationships at rates that depend on their risk group and demographic characteristics. Each time a new short-term partner is acquired, the individual is linked to another individual in the population, with the probability of linkage depending on the individual’s sexual preference and preference for individuals of the relevant age, risk group, race, location and educational attainment. Individuals marry their short-term partners at rates that depend on their demographic characteristics. Frequencies of sex are assumed to depend on demographic characteristics and relationship type, and migrant couples are assumed to have reduced coital frequency. Probabilities of condom use also depend on demographic characteristics and relationship type, and are assumed to be strongly associated with levels of educational attainment. Women’s risk of falling pregnant is assumed to depend on their sexual behaviour, natural fertility level, contraceptive usage and breastfeeding status. Adoption and discontinuation of hormonal contraception is assumed to depend on demographic characteristics, sexual behaviour and past pregnancy and contraceptive experience. Girls who fall pregnant while in school are assumed to be less likely to complete their schooling than those who do not fall pregnant. Probabilities of HIV transmission per act of sex are assumed to depend on several biological factors, including the viral load of the HIV-positive partner, whether the HIV-positive partner is on ART, the presence of other STIs, the type of contraceptive used, the age and sex of the susceptible partner, male circumcision, the type of relationship, and the use of new HIV prevention methods such as PrEP. If an individual acquires HIV, they are assigned a CD4 count and viral load, both of which change dynamically over the course of HIV infection. The HIV mortality risk is determined by the individual’s CD4 count. HIV-positive individuals are diagnosed at rates that depend on their demographic characteristics and CD4 count, and if they disclose their HIV status to their sexual partners after diagnosis, this is assumed to lead to increased rates of condom use. Assumptions about HIV transmission probabilities have been set in such a way that the model matches the observed trends in HIV prevalence, by age and sex, in national South African antenatal and household surveys. The model also simulates male incarceration. Rates of incarceration are assumed to depend on men’s demographic characteristics and educational attainment, and are also assumed to be higher in men who have previously been incarcerated. 3 bioRxiv preprint doi: https://doi.org/10.1101/310763; this version posted April 30, 2018. The copyright holder for this preprint (which was not certified by peer review) is the author/funder, who has granted bioRxiv a license to display the preprint in perpetuity. It is made available under aCC-BY-NC-ND 4.0 International license. Results and conclusions The model matches reasonably closely the observed levels of HIV prevalence in South Africa by age and sex, as well as the observed changes in HIV prevalence over time. The model also matches observed patterns of HIV prevalence by educational attainment, by urban-rural location and by history of recent migration. Estimates of HIV prevalence in key populations (sex workers, MSM and prisoners) are roughly consistent with surveys. The model has also been calibrated to match total numbers of HIV tests and male circumcision operations performed in South Africa. The model estimates of levels of HIV diagnosis and ART coverage are consistent with the Thembisa model, an HIV model that has been calibrated to South African HIV testing and ART data. Although many of the phenomena simulated in the MicroCOSM model have been simulated in previously-published HIV models, MicroCOSM is the first model that systematically describes all of these phenomena in a fully integrated model. This makes it possible to use the model to describe complex interactions between socio-economic and behavioural factors, and their influence on disease and health-seeking behaviour. It also provides a framework for understanding socio-economic and racial inequality in health outcomes in South Africa, and for assessing the potential impact of strategies to reduce these inequalities. 4 bioRxiv preprint doi: https://doi.org/10.1101/310763; this version posted April 30, 2018. The copyright holder for this preprint (which was not certified by peer review) is the author/funder, who has granted bioRxiv a license to display the preprint in perpetuity. It is made available under aCC-BY-NC-ND 4.0 International license.
Load more

Recommended publications
  • Qualitative Study to Explore the Knowledge and Attitude of Pregnant Women Regarding HIV/AIDS Testing in Kotayk Region and in Yerevan, Armenia
    Qualitative study to explore the knowledge and attitude of pregnant women regarding HIV/AIDS testing in Kotayk region and in Yerevan, Armenia Utilizing Professional Publication Framework Henrik Khachatryan, MD, MPH candidate, American University of Armenia Primary Adviser: M. Thompson, MS, DrPH Secondary Adviser: K. White, RN, PhD, CNAA October 2005 Table of Contents INTRODUCTION ...........................................................................................................................................................1 Background Information and Literature review....................................................................................................1 Rationale for the Research and Research Questions.............................................................................................4 METHODS AND MATERIALS........................................................................................................................................5 Study design...........................................................................................................................................................5 Study population ....................................................................................................................................................5 Sampling and Study Setting...................................................................................................................................6 Data collection Instrument.....................................................................................................................................6
    [Show full text]
  • Partners with Mixed HIV Status
    Partners With Mixed HIV Status SERODISCORDANT RELATIONSHIPS Relationships in which one or more people has HIV and one or more people do not have HIV are sometimes called serodiscordant or mixed serostatus. The term serodiscordant is made up of two roots: 1. Sero—meaning blood 2. Discordant—meaning different or non-matching HIV isn’t the first topic that comes up when most people start dating. You may not know the HIV status of your partner(s). You might not even have been tested yourself. It can be very difficult to talk about HIV status. WHAT ARE THE SPECIAL ISSUES FOR SERODISCORDANT RELATIONSHIPS? People in mixed HIV status relationships face all the same things as other people in relationship. But there are some extra issues: The partner(s) with HIV might focus on not infecting their partner(s). The partner(s) who do not have HIV may concentrate on taking care of the person/people with HIV. This can cause a serious lack of balance in the relationship. HIV can cause changes in the body. Antiretroviral medications (ARVs) may have unpleasant side effects. This might give the partner(s) with HIV negative feelings about their body and their health. It may be difficult to feel attractive and have a normal romantic relationship. Fear of transmitting HIV can cause an excess of caution. This might even stop all sexual activity. Review the following fact sheets for more information: Stopping the Spread of HIV Safer Sex Guidelines Condoms Ways HIV is Transmitted Try to have open discussions about your desires, your fears, and your limits.
    [Show full text]
  • Sexually Transmitted Diseases Treatment Guidelines, 2015
    Morbidity and Mortality Weekly Report Recommendations and Reports / Vol. 64 / No. 3 June 5, 2015 Sexually Transmitted Diseases Treatment Guidelines, 2015 U.S. Department of Health and Human Services Centers for Disease Control and Prevention Recommendations and Reports CONTENTS CONTENTS (Continued) Introduction ............................................................................................................1 Gonococcal Infections ...................................................................................... 60 Methods ....................................................................................................................1 Diseases Characterized by Vaginal Discharge .......................................... 69 Clinical Prevention Guidance ............................................................................2 Bacterial Vaginosis .......................................................................................... 69 Special Populations ..............................................................................................9 Trichomoniasis ................................................................................................. 72 Emerging Issues .................................................................................................. 17 Vulvovaginal Candidiasis ............................................................................. 75 Hepatitis C ......................................................................................................... 17 Pelvic Inflammatory
    [Show full text]
  • This Project Has Been Supported with Unrestriced Grants from Abbvie Gilead Sciences HEXAL Janssen-Cilag MSD Viiv Healthcare By
    This project has been supported with unrestriced grants from AbbVie Gilead Sciences HEXAL Janssen-Cilag MSD ViiV Healthcare By Marcus Altfeld, Hamburg/Boston (USA) Achim Barmeyer, Dortmund Georg Behrens, Hannover Dirk Berzow, Hamburg Christoph Boesecke, Bonn Patrick Braun, Aachen Thomas Buhk, Hamburg Rob Camp, Barcelona (Spain/USA) Rika Draenert, Munich Christian Eggers, Linz (Austria) Stefan Esser, Essen Gerd Fätkenheuer, Cologne Gunar Günther, Windhoek (Namibia) Thomas Harrer, Erlangen Christian Herzmann, Borstel Christian Hoffmann, Hamburg Heinz-August Horst, Kiel Martin Hower, Dortmund Christoph Lange, Borstel Thore Lorenzen, Hamburg Tim Niehues, Krefeld Christian Noah, Hamburg Ramona Pauli, Munich Ansgar Rieke, Koblenz Jürgen Kurt Rockstroh, Bonn Thorsten Rosenkranz, Hamburg Bernhard Schaaf, Dortmund Ulrike Sonnenberg-Schwan, Munich Christoph D. Spinner, Munich Thomas Splettstoesser (Figures), Berlin Matthias Stoll, Hannover Hendrik Streeck, Essen/Boston (USA) Jan Thoden, Freiburg Markus Unnewehr, Dortmund Mechthild Vocks-Hauck, Berlin Jan-Christian Wasmuth, Bonn Michael Weigel, Schweinfurt Thomas Weitzel, Santiago (Chile) Eva Wolf, Munich HIV 2015/16 www.hivbook.com Edited by Christian Hoffmann and Jürgen K. Rockstroh Medizin Fokus Verlag IV Christian Hoffmann, M.D., Ph.D. ICH Stadtmitte (Infektionsmedizinisches Centrum Hamburg) Glockengiesserwall 1 20095 Hamburg, Germany Phone: + 49 40 2800 4200 Fax: + 49 40 2800 42020 [email protected] Jürgen K. Rockstroh, M.D., Ph.D. Department of Medicine I University of Bonn Sigmund-Freud-Strasse 25 53105 Bonn, Germany Phone: + 49 228 287 6558 Fax: + 49 228 287 5034 [email protected] HIV Medicine is an ever-changing field. The editors and authors of HIV 2015/16 have made every effort to provide information that is accurate and complete as of the date of publication.
    [Show full text]
  • Use of Withdrawal (Coitus Interruptus) for Both Pregnancy and HIV Prevention Among Young Adults in Rakai, Uganda
    2421 Use of Withdrawal (Coitus Interruptus) for Both Pregnancy and HIV Prevention among Young Adults in Rakai, Uganda Jenny A. Higgins, PhD, MPH,* Laura Gregor, BS,* Sanyukta Mathur, DrPH, MS,† Neema Nakyanjo, MS,‡ Fred Nalugoda, MHS,‡ and John S. Santelli, MD, MPH† *University of Wisconsin, Madison, WI, USA; †Columbia University, New York, NY, USA; ‡Rakai Health Sciences Program, Kalisizo, Rakai District, Uganda DOI: 10.1111/jsm.12375 ABSTRACT Introduction. Although understudied in the context of AIDS, use of withdrawal (coitus interruptus) with or in place of other prevention methods affects exposure to both pregnancy and human immunodeficiency virus (HIV). Aim. We used mixed methods to assess use of withdrawal among 15–24-year-olds in a rural Ugandan setting with considerable HIV prevalence. Methods. We measured withdrawal reporting among (i) sexually active 15–24-year-olds enrolled in a quantitative community survey (n = 6,722) and (ii) in-depth qualitative interview participants systematically selected from the latest round of the community survey (N = 60). Respondents were asked about family planning and HIV prevention practices, including a direct question about withdrawal in the in-depth interviews. Main Outcome Measures. The main outcome measures were reports of current use of withdrawal on the quanti- tative survey (general question about family planning methods) and reports of current or recent use withdrawal in qualitative interviews (specific question about withdrawal). Qualitative interviews also probed for factors associated with withdrawal use. Results. Although less than 1% of quantitative survey participants spontaneously named withdrawal as their current family planning method, 48% of qualitative interview respondents reported current or lifetime use of withdrawal.
    [Show full text]
  • HIV and Pregnancy: a Short Review Sofoudis C* 2Nd Department of Obstetrics and Gynecology University of Athens, Aretaieion Hospital, Greece
    ical C lin as C e f R o l e Sofoudis, J Clin Case Rep 2014, 4:10 a p n o r r DOI: 10.4172/2165-7920.1000436 t u s o J Journal of Clinical Case Reports ISSN: 2165-7920 Case Report Open Access HIV and Pregnancy: A Short Review Sofoudis C* 2nd Department of Obstetrics and Gynecology University of Athens, Aretaieion Hospital, Greece Abstract The incidence and existence of human immunodeficiency virus concerning women of reproductive age continues to increase globally. The care of HIV-infected women is not simple and must be focused on including the current and future health of these women, the minimization of the risk of maternal–infant transmission and the maintenance of the well-being of the fetus and neonate. Many maternal and obstetrical factors can affect the vertical transmission. The answer to this problem is the optimal medical and obstetrical care. Keywords: Pregnancy; HIV; Vertical transmission of the correlation between its presence and the immunsupression [12,13]. There are many pathological connections which can clear Introduction out this correlation. To begin with, we must give a great attention to The human immunodeficiency virus continues to be expanded the compromised immune status and general poor health of HIV- around the world causing an estimated 16,000 new infections per day infected women which allow them to become more vulnerable to [1]. 2.1 million women and 590,000 children below age of 15 were infections and mostly to puerperal sepsis [14]. Additionally, HIV newly infected through their mothers before or during birth or through related thrombocytopenia may lead to increased risk of hemorrhage.
    [Show full text]
  • FAQ113 -- HIV and Pregnancy
    AQ The American College of Obstetricians and Gynecologists FREQUENTLY ASKED QUESTIONS FAQ113 fPREGNANCY HIV and Pregnancy • What is human immunodeficiency virus (HIV)? • How do you get HIV? • How do you get AIDS? • How long does it take for HIV to develop into AIDS? • Can HIV be treated? • If I am infected with HIV and pregnant, can I pass HIV to my baby? • What can I do to reduce the risk of passing HIV on to my baby? • Why is HIV treatment recommended during pregnancy? • Are there any side effects of HIV drugs? • What is my viral load? • Why is it important for my viral load and CD4 cell count to be monitored? • Should I still use condoms during sex even though I am pregnant? • Are there extra risks for me if I am HIV positive and I have a cesarean delivery? • After I give birth, how will I know if my baby is infected with HIV? • Glossary What is human immunodeficiency virus (HIV)? Human immunodeficiency virus (HIV) is the virus that causes acquired immunodeficiency syndrome (AIDS). How do you get HIV? HIV enters the bloodstream by way of body fluids, such as blood or semen. Once in the blood, the virus invades and kills CD4 cells. CD4 cells are key cells of the immune system. When these cells are destroyed, the body is less able to fight disease. How do you get AIDS? AIDS occurs when the number of CD4 cells decreases below a certain level and the person gets sick with diseases that the immune system would normally fight off.
    [Show full text]
  • British HIV Association Guidelines for the Management of HIV in Pregnancy and Postpartum 2018 (2019 Second Interim Update)
    British HIV Association guidelines for the management of HIV in pregnancy and postpartum 2018 (2019 second interim update) BHIVA guidelines on the management of HIV in pregnancy and postpartum Guideline writing group Dr Yvonne Gilleece (Chair) Honorary Clinical Senior Lecturer and Consultant Physician in HIV and Genitourinary Medicine, Brighton and Sussex University Hospitals NHS Trust Dr Shema Tariq Postdoctoral Clinical Research Fellow, University College London, and Honorary Consultant Physician in HIV, Central and North (Vice-chair) West London NHS Foundation Trust Ms Funmi Awosusi Barts Health NHS Trust, London/HIV Pharmacy Association Dr Alasdair Bamford Consultant in Paediatric Infectious Diseases, Great Ormond Street Hospital for Children NHS Foundation Trust, London Dr Sanjay Bhagani Consultant Physician in Infectious Diseases, Royal Free Hospital NHS Trust, London Dr Laura Byrne Locum Consultant in HIV Medicine, St George’s University Hospitals NHS Foundation Trust, London Dr Emily Clarke Consultant in Genitourinary Medicine, Royal Liverpool and Broadgreen University Hospitals NHS Trust Ms Polly Clayden UK Community Advisory Board representative/HIV treatment advocates network Dr Hermione Lyall Clinical Director for Children’s Services and Consultant Paediatrician in Infectious Diseases, Imperial College Healthcare NHS Trust, London Dr Rebecca Metcalfe Consultant in Sexual Health and HIV Medicine, NHS Greater Glasgow and Clyde Dr Adrian Palfreeman Consultant in Genitourinary Medicine, University Hospitals of Leicester NHS Trust
    [Show full text]
  • HIV During Pregnancy, Labor and Delivery, and After Birth
    A Service of the U.S. Department of Health and Human Services HIV During Pregnancy, Labor and Delivery, and After Birth Health Information for HIV Positive Pregnant Women January 2006 Fact Sheets P.O. Box 6303, Rockville, MD 20849-6303 Telephone: 1-800-448-0440 International: 301-519-0459 Fax: 301-519-6616 TTY/TTD: 888-480-3739 Live Help: http://aidsinfo.nih.gov/LiveHelp E-mail: [email protected] Web: http://aidsinfo.nih.gov A Service of the U.S. Department of Health and Human Services HIV During Pregnancy, Labor and Delivery, and After Birth This series of fact sheets is intended for women who are HIV positive and pregnant or have recently given birth. These fact sheets describe the steps an HIV positive pregnant woman can take to preserve her health and prevent transmission of HIV to her baby. These fact sheets are designed as a series but can also be used as stand-alone documents. The information in these fact sheets is based on the U.S. Public Health Service's Recommendations for Use of Antiretroviral Drugs in Pregnant HIV-1-Infected Women for Maternal Health and Interventions to Reduce Perinatal HIV-1 Transmission in the United States and Guidelines for the Use of Antiretroviral Agents in Pediatric HIV Infection (available at http://aidsinfo.nih.gov/guidelines). Table of Contents HIV Testing and Pregnancy Drug Regimens for HIV Positive Pregnant Women Safety and Toxicity of Anti-HIV Medications During Pregnancy Delivery Options for HIV Positive Pregnant Women HIV Positive Women and Their Babies After Birth This information is based on the U.S.
    [Show full text]
  • Hoffmann Rockstroh |
    Hoffmann| Rockstroh HIV 2015/2016 www.hivbook.com Medizin Fokus Verlag This project has been supported with unrestriced grants from AbbVie Gilead Sciences HEXAL Janssen-Cilag MSD ViiV Healthcare By Marcus Altfeld, Hamburg/Boston (USA) Achim Barmeyer, Dortmund Georg Behrens, Hannover Dirk Berzow, Hamburg Christoph Boesecke, Bonn Patrick Braun, Aachen Thomas Buhk, Hamburg Rob Camp, Barcelona (Spain/USA) Rika Draenert, Munich Christian Eggers, Linz (Austria) Stefan Esser, Essen Gerd Fätkenheuer, Cologne Gunar Günther, Windhoek (Namibia) Thomas Harrer, Erlangen Christian Herzmann, Borstel Christian Hoffmann, Hamburg Heinz-August Horst, Kiel Martin Hower, Dortmund Christoph Lange, Borstel Thore Lorenzen, Hamburg Tim Niehues, Krefeld Christian Noah, Hamburg Ramona Pauli, Munich Ansgar Rieke, Koblenz Jürgen Kurt Rockstroh, Bonn Thorsten Rosenkranz, Hamburg Bernhard Schaaf, Dortmund Ulrike Sonnenberg-Schwan, Munich Christoph D. Spinner, Munich Thomas Splettstoesser (Figures), Berlin Matthias Stoll, Hannover Hendrik Streeck, Essen/Boston (USA) Jan Thoden, Freiburg Markus Unnewehr, Dortmund Mechthild Vocks-Hauck, Berlin Jan-Christian Wasmuth, Bonn Michael Weigel, Schweinfurt Thomas Weitzel, Santiago (Chile) Eva Wolf, Munich HIV 2015/16 www.hivbook.com Edited by Christian Hoffmann and Jürgen K. Rockstroh Medizin Fokus Verlag IV Christian Hoffmann, M.D., Ph.D. ICH Stadtmitte (Infektionsmedizinisches Centrum Hamburg) Glockengiesserwall 1 20095 Hamburg, Germany Phone: + 49 40 2800 4200 Fax: + 49 40 2800 42020 [email protected] Jürgen K. Rockstroh, M.D., Ph.D. Department of Medicine I University of Bonn Sigmund-Freud-Strasse 25 53105 Bonn, Germany Phone: + 49 228 287 6558 Fax: + 49 228 287 5034 [email protected] HIV Medicine is an ever-changing field. The editors and authors of HIV 2015/16 have made every effort to provide information that is accurate and complete as of the date of publication.
    [Show full text]
  • Hiv in Pregnancy
    WHO/RHT/98.24 UNAIDS/98.44 Distr.: General HIV IN PREGNANCY: A REVIEW ACKNOWLEDGEMENTS This paper was prepared by James McIntyre, Perinatal HIV Research Unit, Department of Obstetrics and Gynaecology, University of the Witwatersrand, Johannesburg, South Africa. A working group on HIV in pregnancy, composed of staff from WHO’s Reproductive Health Programme and UNAIDS, oversaw this work and the subsequent review of the paper. © World Health Organization, 1998 © Joint United Nations Programme on HIV/AIDS (UNAIDS), 1998 This document is not a formal publication of the World Health Organization (WHO) and UNAIDS, but all rights are reserved by these agencies. The document may, however, be freely reviewed, abstracted, reproduced and translated, in part or in whole, but not for sale nor for use in conjunction with commercial purposes. For authorization to translate the work in full, and for any use by commercial entities, application and enquiries should be addressed to Department of Reproductive Health, World Health Organization, Geneva, Switzerland, which will be glad to provide the latest information on any changes made to the text, plans for new editions, and the reprint and translations that are already available. The designations employed and the presentation of the material in this work does not imply the expression of any opinion whatsoever on the part of WHO and UNAIDS concerning the legal status of any country, territory, city or area of its authorities, or concerning the delimitation of its frontiers and boundaries. The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by the World Health Organization in preference to others of a similar nature that are not mentioned.
    [Show full text]
  • A Study Into the Use of and Need for Healthcare Services, for HIV Infected People, from Diagnosis Until Death
    University of Wollongong Thesis Collections University of Wollongong Thesis Collection University of Wollongong Year 1995 A study into the use of and need for healthcare services, for HIV infected people, from diagnosis until death Margaret I. Jamieson University of Wollongong Jamieson, Margaret I., A study into the use of and need for healthcare services, for HIV infected people, from diagnosis until death, Doctor of Philosophy thesis, Department of Public Health and Nutrition, University of Wollongong, 1995. http://ro.uow.edu.au/theses/1701 This paper is posted at Research Online. A study into the use of and need for healthcare services, for HIV infected people, from diagnosis until death. A thesis presented in partial fulfillment of the requirements for the degree of Doctor of Philosophy. from University of Wollongong by Margaret I. Jamieson. BA(Glas.C.T) MPH (Dundee). Department of Public Health and Nutrition. 1995. 11 I hereby declare that I am the sole author of this thesis. This thesis does not incorporate without ackowledgement any material previously pubUshed or written by another person except where due reference is made in the text. Margaret I Jamieson. Ill ABSTRACT The aim of this study was to determine the use of the healthcare system by people with HIV /AIDS, and to identify and compare variations in service provision to patients with similar needs, and variations between needs and service provision. The variations would suggest changes in service management in the interests of improvements in cost /effectiveness. Central to health service management is the need for information. The primary hypothesis of this study is that information systems need to be refined to support management of AIDS/HIV as a chronic, infectious condition, from initial manifestation through to death.
    [Show full text]