11 research outputs found
Dissertationem academicam de fideli patriota, praeside magnifico academiae rectore, dn. m. Joh. Bernh. Munster, philosoph. pract. & hist. profess. consent. vero ampl. facult. philos. in Academia Aboënsi, pro gradu magisterii, publico examini offert Nicolaus Mathesius, Ostro-Bothn. In auditorio majori ad diem III. Novemb. an. M. D.CC.
No full textVariantti B.Invokaatio: I.N.J.Dedikaatio: Johannes Gezelius, Jacobus Falander, Petrus Portinus, Martinus Peitzius, Johannes Tammelander, Gabriel Brenner, Achatius Blackman.Gratulaatio: S[amuel] T[igerstedt], Henrich Korss.Painovuosi nimekkeestä.Arkit: 3 arkintunnuksetonta lehteä, A-F4 G1. - Viimeinen sivu tyhjä
OmpA controls order in the outer membrane and shares the mechanical load
No full textOmpA, a predominant outer membrane (OM) protein in Escherichia coli, affects virulence, adhesion, and bacterial OM integrity. However, despite more than 50 y of research, the molecular basis for the role of OmpA has remained elusive. In this study, we demonstrate that OmpA organizes the OM protein lattice and mechanically connects it to the cell wall (CW). Using gene fusions, atomic force microscopy, simulations, and microfluidics, we show that the β-barrel domain of OmpA is critical for maintaining the permeability barrier, but both the β-barrel and CW-binding domains are necessary to enhance the cell envelope's strength. OmpA integrates the compressive properties of the OM protein lattice with the tensile strength of the CW, forming a mechanically robust composite that increases overall integrity. This coupling likely underpins the ability of the entire envelope to function as a cohesive, resilient structure, critical for the survival of bacteria
OmpA controls order in the outer membrane and shares the mechanical load
No full textOmpA, a predominant outer membrane (OM) protein in Escherichia coli, affects virulence, adhesion, and bacterial OM integrity. However, despite more than 50 y of research, the molecular basis for the role of OmpA has remained elusive. In this study, we demonstrate that OmpA organizes the OM protein lattice and mechanically connects it to the cell wall (CW). Using gene fusions, atomic force microscopy, simulations, and microfluidics, we show that the β-barrel domain of OmpA is critical for maintaining the permeability barrier, but both the β-barrel and CW–binding domains are necessary to enhance the cell envelope’s strength. OmpA integrates the compressive properties of the OM protein lattice with the tensile strength of the CW, forming a mechanically robust composite that increases overall integrity. This coupling likely underpins the ability of the entire envelope to function as a cohesive, resilient structure, critical for the survival of bacteria
Couple experiences of provider-initiated couple HIV testing in an antenatal clinic in Lusaka, Zambia: lessons for policy and practice.
No full textBACKGROUND: Couple HIV testing has been recognized as critical to increase uptake of HIV testing, facilitate disclosure of HIV status to marital partner, improve access to treatment, care and support, and promote safe sex. The Zambia national protocol on integrated prevention of mother-to-child transmission of HIV (PMTCT) allows for the provision of couple testing in antenatal clinics. This paper examines couple experiences of provider-initiated couple HIV testing at a public antenatal clinic and discusses policy and practical lessons. METHODS: Using a narrative approach, open-ended in-depth interviews were held with couples (n = 10) who underwent couple HIV testing; women (n = 5) and men (n = 2) who had undergone couple HIV testing but were later abandoned by their spouses; and key informant interviews with lay counsellors (n = 5) and nurses (n = 2). On-site observations were also conducted at the antenatal clinic and HIV support group meetings. Data collection was conducted between March 2010 and September 2011. Data was organised and managed using Atlas ti, and analysed and interpreted thematically using content analysis approach. RESULTS: Health workers sometimes used coercive and subtle strategies to enlist women's spouses for couple HIV testing resulting in some men feeling 'trapped' or 'forced' to test as part of their paternal responsibility. Couple testing had some positive outcomes, notably disclosure of HIV status to marital partner, renewed commitment to marital relationship, uptake of and adherence to treatment and formation of new social networks. However, there were also negative repercussions including abandonment, verbal abuse and cessation of sexual relations. Its promotion also did not always lead to safe sex as this was undermined by gendered power relationships and the desires for procreation and sexual intimacy. CONCLUSIONS: Couple HIV testing provides enormous bio-medical and social benefits and should be encouraged. However, testing strategies need to be non-coercive. Providers of couple HIV testing also need to be mindful of the intimate context of partner relationships including couples' childbearing aspirations and lived experiences. There is also need to make antenatal clinics more male-friendly and responsive to men's health needs, as well as being attentive and responsive to gender inequality during couselling sessions
HIV transmission risk through anal intercourse: systematic review, meta-analysis and implications for HIV prevention.
No full textBACKGROUND: The human immunodeficiency virus (HIV) infectiousness of anal intercourse (AI) has not been systematically reviewed, despite its role driving HIV epidemics among men who have sex with men (MSM) and its potential contribution to heterosexual spread. We assessed the per-act and per-partner HIV transmission risk from AI exposure for heterosexuals and MSM and its implications for HIV prevention. METHODS: Systematic review and meta-analysis of the literature on HIV-1 infectiousness through AI was conducted. PubMed was searched to September 2008. A binomial model explored the individual risk of HIV infection with and without highly active antiretroviral therapy (HAART). RESULTS: A total of 62,643 titles were searched; four publications reporting per-act and 12 reporting per-partner transmission estimates were included. Overall, random effects model summary estimates were 1.4% [95% confidence interval (CI) 0.2-2.5)] and 40.4% (95% CI 6.0-74.9) for per-act and per-partner unprotected receptive AI (URAI), respectively. There was no significant difference between per-act risks of URAI for heterosexuals and MSM. Per-partner unprotected insertive AI (UIAI) and combined URAI-UIAI risk were 21.7% (95% CI 0.2-43.3) and 39.9% (95% CI 22.5-57.4), respectively, with no available per-act estimates. Per-partner combined URAI-UIAI summary estimates, which adjusted for additional exposures other than AI with a 'main' partner [7.9% (95% CI 1.2-14.5)], were lower than crude (unadjusted) estimates [48.1% (95% CI 35.3-60.8)]. Our modelling demonstrated that it would require unreasonably low numbers of AI HIV exposures per partnership to reconcile the summary per-act and per-partner estimates, suggesting considerable variability in AI infectiousness between and within partnerships over time. AI may substantially increase HIV transmission risk even if the infected partner is receiving HAART; however, predictions are highly sensitive to infectiousness assumptions based on viral load. CONCLUSIONS: Unprotected AI is a high-risk practice for HIV transmission, probably with substantial variation in infectiousness. The significant heterogeneity between infectiousness estimates means that pooled AI HIV transmission probabilities should be used with caution. Recent reported rises in AI among heterosexuals suggest a greater understanding of the role AI plays in heterosexual sex lives may be increasingly important for HIV prevention
Universal testing and treatment as an HIV prevention strategy: research questions and methods.
No full textAchieving high coverage of antiretroviral treatment (ART) in resource-poor settings will become increasingly difficult unless HIV incidence can be reduced substantially. Universal voluntary counselling and testing followed by immediate initiation of ART for all those diagnosed HIV-positive (universal testing and treatment, UTT) has the potential to reduce HIV incidence dramatically but would be very challenging and costly to deliver in the short term. Early modelling work in this field has been criticised for making unduly optimistic assumptions about the uptake and coverage of interventions. In future work, it is important that model parameters are realistic and based where possible on empirical data. Rigorous research evidence is needed before the UTT approach could be considered for wide-scale implementation. This paper reviews the main areas that need to be explored. We consider in turn research questions related to the provision of services for universal testing, services for immediate treatment of HIV-positives and the population-level impact of UTT, and the research methods that could be used to address these questions. Ideally, initial feasibility studies should be carried out to investigate the acceptability, feasibility and uptake of UTT services. If these studies produce promising results, there would be a strong case for a cluster-randomised trial to measure the impact of a UTT intervention on HIV incidence, and we consider the main design features of such a trial
Factors influencing uptake of HIV testing and non-initiation of and attrition from antiretroviral therapy care in Lusaka, Zambia
No full textThe Human Immunodeficiency Virus (HIV) still remains a global public health burden with an estimated 34 million people living with HIV; 69% of these residing in sub-Saharan Africa (SSA). Although many countries have made steady progress in reducing HIV prevalence, not everyone knows his or her HIV status and not all HIV-infected individuals who need antiretroviral therapy (ART) care are receiving it. Against this background, the aim of this PhD thesis was to explore factors influencing uptake of HIV testing and non-initiation of and attrition from antiretroviral therapy care in Lusaka, Zambia. The PhD study was conducted in Lusaka’s Jack compound residential area and nearby communities. The surrounding communities were Chawama, Kuku, Misisi, Kuomboka, John Howard, Kamwala south and Lilayi. The study settings are predominantly low-income, high-density urban residential areas located about 10 km south of Lusaka city centre, the capital city of Zambia. To explore the barriers and facilitators of uptake of HIV testing, a synthesis of qualitative findings on factors influencing uptake of HIV testing in SSA was first undertaken using meta-ethnographic approach first put forward by Noblit and Hare (1988). 5,686 citations were identified out of which 56 were selected for full-text review and synthesised 42 papers from 13 countries. Malpass’ (2009) notion of first-, second-, and third-order constructs was used to identify and interpret the findings. In addition, qualitative research was undertaken in Zambia to explore why individuals who knew the HIV-positive status of their marital partners opted not to seek HIV testing, and how couple HIV testing was achieved in an antenatal clinic. To investigate reasons for non-uptake of antiretroviral treatment, in-depth interviews were conducted with people living with HIV (PLHIV) that had dropped out of treatment or opted not to initiate treatment, health care providers, traditional medicine providers, herbalists and faith healers. The fieldwork in Zambia was conducted between March 2010 and September 2011. Atlas ti was used to organise and manage the data and latent content analysis was used to analyse and interpret the data. The social ecological framework was used to guide data analysis of factors undermining patient uptake of and retention into ART care. The predominant factors enabling uptake of HIV testing are deterioration of physical health and/or death of sexual partner or child. The roll-out of various HIV testing initiatives such as ‘opt-out’ provider-initiated HIV testing and mobile HIV testing has improved uptake of HIV testing by being conveniently available and attenuating fear of HIV-related stigma and financial costs. However, ‘opt-out’ HIV testing was reportedly being coercively implemented. Other enabling factors are availability of treatment and guarantees of social network support linked to maintenance of social relationships and economic support regardless of outcome of HIV-test results. Major barriers to uptake of HIV testing comprise perceived low risk of HIV infection, perceived health workers’ inability to maintain confidentiality and fear of HIV-related stigma. While the increasingly wider availability of life-saving treatment in SSA is an incentive to test, the perceived psychological burden of living with HIV inhibits uptake of HIV testing. Other barriers are direct and indirect financial costs of accessing HIV testing, and gender inequality, which undermines women’s decision making autonomy about HIV testing. Despite differences across SSA, the findings suggest comparable factors influencing HIV testing. Factors undermining uptake of HIV treatment and retention in ART care are lack of self-efficacy, negative perceptions of medication, desire to avoid stigma and maintain social identity and relationships and fear of treatment-induced physical body changes, all modulated by feeling healthy. Social relationships generated and perpetuated these health and treatment beliefs. Long waiting times at ART clinics, concerns about long-term availability of treatment and taking strong medication amidst livelihood insecurity also dissuaded PLHIV from being on treatment. PLHIV opted for herbal remedies and faith healing as alternatives to ART, with the former being regarded as effective as ART while the latter contributed to restoring normalcy through the promise of being healed. A complex and dynamic interplay of personal, social, health system and structural-level factors coalesce to influence uptake of ART care. In conclusion, improving uptake of HIV testing requires addressing perception of low risk of HIV infection and perceived psychological burden of living with an incurable condition. Building confidence in the health system through improving delivery of health care and scaling up HIV testing strategies that attenuate social and economic costs could also contribute towards increasing uptake of HIV testing in SSA. HIV testing initiatives that target social relationships – couple and household HIV testing – also require promotion while being mindful of the fragility of these social relationships. Ensuring PLHIV uptake of ART care requires interventions at different levels, addressing in particular, people’s health and treatment beliefs, changing perceptions about effectiveness of herbal remedies and faith healing, improving ART delivery to attenuate social and economic costs and allaying concerns about future non-availability of treatment
The Contribution of Pharmacy to The Management of HIV Patients at Maitama District Hospital, Abuja, Nigeria
No full textThis thesis is submitted in partial fulfilment of the requirements for the award of the degree of Doctor of Philosophy (PhD) of the University of WolverhamptonHuman immunodeficiency virus (HIV) is a worldwide problem, with more than 34 million people infected with HIV/AIDS in 2011. At the end of 2011, in Nigeria, an estimated 3.7% of the adult population were living with HIV/AIDS. HIV services in Nigeria are secondary-care led, involving multidisciplinary teams and access to free antiretroviral. However, evaluations of service provision from both patient and healthcare professional perspectives, especially, pharmacists in Nigeria have never been conducted, and are the aims of this research. This study involved grounded theory methodology, using In-depth semi-structured interviews with adults infected with HIV, pharmacists, and administrators involved in the management and care of those patients at Maitama District Hospital in Abuja. HIV pharmacists working for the NHS in the UK were interviewed for comparative purposes. Thirty-five patients were interviewed. Five concepts were identified that influenced how they accessed hospital services after diagnosis. These include faith in God and antiretroviral, social issues with emphasis on HIV stigma and discrimination, patient journeys at the hospital with delays and repeat visits, obstacles such as ARV unavailability and their expectations. Also, five concepts were identified from the pharmacists’ interviews which include clinical service, impressions of service provided, social issues the patients encountered, the obstacles faced with clinical service provided and expectations for improvement. Ten patients were shadowed on their clinic days to observe the patient journey articulated. Furthermore, the administrators interviewed re-affirmed the opinions of the patients and pharmacists about many patients attending HIV clinic, few staff attending to patients, medicines unavailability, especially ARV drugs, and lack of working space for staff. Delays, few pharmacists/many patients and shortage of ART as barriers to service provision ii emerged as dominant themes across the three groups of interviewees in Nigeria. Also, it has been found that there is a wide gap between HIV patients’ hospital management in the UK and Nigeria as regards availability of antiretroviral, staff strength, number of patients in attendance on clinic days and weekly clinic days. Pharmacy was found to have a substantial role in the management of HIV/AID patients but it appears from this study that service improvements, both human and material resources are needed. Twenty three recommendations, which are further synthesised into six potential areas, are made, which, if implemented, would dramatically improve the service provision for HIV/AIDS patients at Maitama District Hospital
An evaluation of a provider-initiated HIV testing and counselling (PITC) intervention for patients with sexually transmitted infections in Cape Town, South Africa
No full textThe objectives of the study were to assess the impact of a PITC intervention on HIV test uptake rates and on access to HIV care, to evaluate the extent to which ethical principles were upheld in its implementation, and to examine the influence of implementation factors on the intervention
