Background Routine voluntary HIV screening has been found to be cost-effective in regions with undiagnosed prevalence > 0.1%. However, a large proportion of infected patients are still unaware of their status and presenting to care late, leading to greater risk s for infection. As expanded ART has been shown to be highly effective in improving patient health and reducing HIV viral load, a strategy of expanded screening with earlier initiation of ART may be effective at reducing the numbers of new infections. Aim A systematic review was carried out with the aim of understanding what drives the cost-effectiveness of expanded HIV screening at low prevalence rates. A thorough investigation of sensitivity analysis was done to determine if low prevalent regions can implement screening at good value for cost and how money should be spent to maximize benefits. Methods An extensive literature review of studies published in English between 1996 and 2010 were identified from various electronic databases, included gray literature search and hand search. A qualitative assessment of the literature was undertaken. Results Results of the analysis found that expanded screening can be cost-effective at undiagnosed prevalence rates below that of current recommendations. Factors of linkage to care, and benefits of reduced secondary transmissions through reduced risk behaviors had the most impact on models. Screening while maximizing benefits due to linkage to care and secondary transmissions can may be appropriate for low prevalence regions such as Hong Kong, however further analysis would be necessary. / published_or_final_version / Public Health / Master / Master of Public Health

This dissertation has made an attempt at exploring the psychological factors that motivates individuals into opting for or against undertaking an HIV-test. The Health Belief Model is used to ascertain its predictive powers towards the motivation for undertaking such a test. Literature on HIV-testing indicates non-exploration of voluntary HIV-testing, as opposed to massive reporting on mandatory HIV-testing. Therefore, the focus of this dissertation is on voluntary HIV-testing. The sample used for the study. comprised of antenatal mothers who were offered HIV/Aids education and then presented with an option of either undertaking the HIV-test, or not. The results of the study indicate that the Health Belief Model has failed in its predictive powers towards motivations for or against HIV-testing. However, the study provided valuable psychological factors that are associated with the decision to undertake the HIV-test, which will be important for future research on HIV/Aids and on the control in the spread of the disease. / Thesis (M.A.)-University of Natal, Pietermaritzburg, 1999.

The study sought to identify factors motivating young people aged 14-25 years to use voluntary counseling and testing (VCT) for HIV in Malawi by interviewing 145 young people. The study identified barriers affecting and strategies promoting young people's access to VCT. The research results indicate that young people go for VCT mainly to know their HIV status. The availability of VCT services, and the provision of VCT services by peers motivate young people to access VCT. Some young people do not access VCT services due to fears of being found HIV+ve and because of the poor attitudes of the health service providers. Providing more information about VCT, involving young people as VCT providers, using youth friendly health service providers, providing VCT in a separate room for young people and through mobile services will increase young people's access to VCT services in Malawi. / Health Studies / M.A. (Public Health)

Using a logistic regression model, this dissertation employed a macro level Gateway Provider Model to explore eight factors that may influence community health center HIV testing approach. The logistic regression model indicated that three variables related to community health center HIV testing approach. First, all else equal, the odds of offering routine HIV testing for community health centers that perceived their patients and community to be at average risk for HIV were 3.676 times the odds for those centers that perceived their patients and community to be at low or no risk for HIV. Further, the odds of offering routine HIV testing for community health centers that perceived their patients and community to be at high risk for HIV were 4.693 times the odds for those centers that perceived the community to be at low or no HIV risk. Second, all else equal, the odds of offering routine HIV testing for community health centers in which an HIV testing policy exists were 2.202 times the odds for those centers in which an HIV testing policy does not exist. Third, all else equal, the odds of offering routine HIV testing for community health centers that received funding specifically for HIV testing were 2.938 times the odds for those centers that did not receive such funding. No other individual predictor variables in the model were related to community health center HIV testing approach.

Over the 30 years since it was first identified, the HIV/AIDS epidemic has had historically unprecedented severity and impact. There are approximately 33.4 million people living with HIV-1/AIDS which urges to seek novel approaches for HIV-1 diagnosis and HIV-1 therapy. Men who have sex with men (MSM) are severely affected by HIV-1 and constitute a large proportion of HIV-infected individuals. In Hong Kong, the transmission route of homosexual and bisexual contacts accounted for nearly 50% of incidence in 2012. To investigate HIV-1 prevalence among MSM in Hong Kong, the combination of fast antibody test (FAT) and real-time dried-blood-spot-based quantitative polymerase chain reaction (DBS-qPCR) was employed for 474 participants chosen randomly from community testing sites of MSM within a one-year period which showed a 4.01% (19/474) rate of HIV-1 prevalence among MSM in Hong Kong with three cases at the acute phase among the newly infected participants. The new survey demonstrated that the risk factors of MSM are mostly correlated with the receptive role during anal sex and syphilis infection. In this study, two traditional Chinese herbal medicines (TCHM), Sanguisorba officinalis (SO) and Spatholobus suberectus (SS), inhibited the infection of model cell lines expressing HIV-1 targets by HIV-1 pseudoviruses, while the anti-HIV-1 properties of SO were demonstrated for the first time. Both SO and SS were able to block not only infection by pseudoviral HIV-1 CCR5-tropic and CXCR4-tropic strains, but also RT and PI drug-resistant strains. Mechanistic studies revealed that SO and SS interact with the viral envelope to prevent the infection of target cells by HIV-1. Two compounds derived from SO and SS, named Gallic acid (GA) and Jiazhi (JZ), retained anti-HIV-1 properties and blocked HIV-1 infection by acting on the viral envelope. Small molecules derived from TCHM were also investigated for their capacity to activate HIV-1 from latency. A small molecule derived from SS, Daidzein (DDZ), demonstrated the potentials to trigger HIV-1 reactivation in latently infected cell lines. DDZ enhanced gene expression from HIV-1 LTR in which the Sp1 binding site plays an important role. The Akt pathway is also involved in the initiation of DDZ-induced activation. Phosflow analysis revealed that DDZ activated the Akt pathway in various subpopulations of T cells, including memory CD4+ T cells which are considered to be a major reservoir for HIV-1. The structure-activity relationships (SARs) study demonstrated the 4'-hydroxyisoflavone as bio-functional core structure. Addition of a hydroxyl group on C-5 position significantly decreases its biological function of HIV-1 latency activation. In summary, this study investigates HIV prevalence and incidence using an assay for early HIV-1 diagnosis and performs an analysis of risk factors of behavior which contributes to the effective control of HIV transmission in Hong Kong and its neighbors in Asia. It also demonstrates a drug research sourced from traditional Chinese herbal medicines that which sheds lights on drug discovery from traditional herbal medicines and facilitates mechanistic drug design for HIV-1 eradication. / published_or_final_version / Microbiology / Doctoral / Doctor of Philosophy

Human Immunodeficiency Virus (HIV) infection has continued to increase in Hong Kong and China. Since about 2006 the incidence of new HIV infections has significantly increased among homosexual men or men who have sex with men (MSM) while new infections among heterosexuals has remained steady. There are several risk factors that may be contributing to the increasing infection rates among MSM including: source for sexual partners, condom use, location of sexual partners, and how new technology may be effecting the spread of HIV. There are gaps in the literature available on MSM and HIV in Hong Kong; particularly in the methods used to identify individuals for study, and the lack of randomized controlled trials to study public health interventions to stop the spread of HIV in Hong Kong. / published_or_final_version / Public Health / Master / Master of Public Health

published_or_final_version / abstract / Medical Sciences / Master / Master of Medical Sciences

The intervention of Voluntary Counselling and Testing (VCT) for the Human Immunodeficiency Virus (HIV) is rapidly gaining ground as an essential component in the health care system in an effort to combat and confront the spread of this disease. In South Africa where this intervention is gradually being introduced the application of VCT and the benefits and consequences likely to ensue from the application of the procedure were evaluated in-depth using a grounded theory and quantitative approach to describe the psychosocial dynamics. The interactive transfer of information embodied in VCT forms an integral part of the intervention and will continue to do so even when antiretroviral dnugs are uniformly available throughout the South African healthcare service. The way in which the women who will undergo this procedure internalise and respond to the information imparted to them during the counselling is highly significant from an educational and empowering perspective, regardless of the outcome of the test result. The aim of the counselling is primarily to promote a rising consciousness amongst patients and subsequently within their communities in an endeavour to move away from what is termed 'exceptionalism' and towards 'normalisation' of the treatment of HIV/AIDS. Communicating the facts about HIV will help to dispel the myths and stigma which still surround the disease. A convenience sample of one hundred and twelve women were interviewed whilst attending antenatal clinics at four different sites in KwaZulu-Natal. In addition a small cross-sectional sample of service providers and key informants in communities situated near to the chosen sites were interviewed to explore the perceptions of VCT and HIV in the current health service and community environment. The findings revealed that there is to date no mandatory policy which offers VCT routinely at any of the health centres primarily due to the cost of testing, lack of posts for trained counsellors and timeous laboratory facilities. Confusion amongst health personnel regarding current policies of treatment regimens for HIV/AIDS patients, as well as differing opinions about feeding options for infants, can undermine counsellors' confidence to handle complex issues competently from an informed position. Recommendations are that trained counsellor posts with opportunities for updating of current policies, easily accessible laboratory facilities and suitable space for confidential counselling (both oral and visual) be implemented as a priority in the health service. A more comprehensive service should be universally implemented, not just in antenatal and communicable disease clinics for ethical reasons of equity between all members of society. In the same vein the networking and cumulative energy of NGOs, religious groups and health professionals must be harnessed to work synergistically to provide sustainable solutions for those living with HIV and those at risk of becoming infected. / Thesis (M.A.)-University of Natal, Durban, 2001.

The study sought to identify factors motivating young people aged 14-25 years to use voluntary counseling and testing (VCT) for HIV in Malawi by interviewing 145 young people. The study identified barriers affecting and strategies promoting young people's access to VCT. The research results indicate that young people go for VCT mainly to know their HIV status. The availability of VCT services, and the provision of VCT services by peers motivate young people to access VCT. Some young people do not access VCT services due to fears of being found HIV+ve and because of the poor attitudes of the health service providers. Providing more information about VCT, involving young people as VCT providers, using youth friendly health service providers, providing VCT in a separate room for young people and through mobile services will increase young people's access to VCT services in Malawi. / Health Studies / M.A. (Public Health)

Submitted in fulfillment of the requirements for the Degree in Master of Health Sciences (Nursing), Durban University of Technology, Durban, South Africa, 2016. / Background South Africa, especially KwaZulu-Natal remains heavily burdened with HIV and AIDS. Timely HIV testing is the cornerstone to HIV prevention in terms of early diagnosis and access to treatment, care and support services. Factors that influence delayed HIV testing must be investigated and reported to inform plans that are directed at improving implementation of HIV testing services and access to care, treatment and support services for people living with HIV. Purpose of the study This study was aimed at identifying factors that lead to delayed HIV testing in a sample of people attending a Primary Health Care clinic in KwaZulu-Natal, South Africa. Methodology A descriptive qualitative design was used in this study. The population in this study was HIV positive patients who had recently tested for HIV and received their first CD4 count result of 350 mm3 or less. Purposive sampling, which is a type of non-probability sampling, was used to select the study participants from the population. Semi structured interviews using an interview schedule were used to collect data. Data was collected until data saturation was reached. Results The data was analysed by means of content analysis and raw data was coded and sorted into sub categories and categories. The underlying meaning of categories was formulated into one overarching theme: Testing for HIV is daunting and embedded with issues of stigma, denial and a fear of knowing one’s positive status. Conclusion To encourage early HIV testing before HIV positive people become noticeably ill requires efforts directed at change of attitude and improvement of support for HIV positive people in families, communities and health service institutions. Community forums to be actively involved in eliminating the stigma and discrimination associated with HIV positive people by creating awareness of these matters and encouraging community and family support for people with HIV. / M