一個大型的多中心臨床試驗 (HPTN052) 於2011年發表研究結論，假如治療中的愛滋病患者能保持病毒載量低水平，他們傳播愛滋病予性伴侶的機會是十分輕微的。這些結論促使利用病毒載量數據去形容愛滋病流行概况及評估高效抗逆轉錄病毒療法 (HAART) 干預策略對流行概况的影響。本研究旨在應用社區病毒載量去模擬香港愛滋病流行概况。 / 本研究收集了香港兩間主要愛滋病專科裡愛滋病患者縱向臨床數據，這些匿名的數據根據美國疾病預防控制中心所提議的人群病毒載量框架整合成流行病數據。其中社區、護理群及監測群病毒載量的計算是為了描述愛滋病流行概況，而新創的全社區病毒載量是用於估計社區裡確診與尚未確診的愛滋病感染者的集體病毒載量。香港未來愛滋病流行概況則利用決定性倉室模型模擬。異性模型透過性別分成兩個 (男女) 有聯繫的小模型，同性模型則用系統進化分析的近鄰結合法去劃分成16個獨立的小模型。除了基於現有情況模擬概況，治療、測試和混合干預策略以及外來感染的影響也被模擬。 / 從4362個病患中，一共收集了76,350CD4、64,412病毒載量和1042基因序列的回顧數據 (1985-2012)。當中有83%病患是男性、72%是中國人、89%是透過性接觸感染、74%曾經接受治療。能達到低病毒載量的病患百分比由1997年11%升至2012年76%，與HAART的推行情況方向一致。全社區病毒載量所顯示的上升趨勢於異性群和同性群中較其他病毒載量指標早五年出現。於2010-2020，異性群的愛滋病流行概況將維持不變，而同性群的流行概況將穩步上升但不是指數上升。干預策略中，以混合干預加上高治療保留率的策略對同性和異性群最有效，但增加重點測試對異性群比較可行，因為它舒緩了診斷延誤。另外，外來感染會影響干預策略的成效。 / 假如沒有包含病毒載量因素、外來感染和劃分模型，推測結果會高估流行概況，而治療覆蓋率的影響也不能被反映。基於人群病毒載量的重要性，定期收集所有專科的病毒載量數據並加以整合應該成為監測的一部份。這對於有廣泛治療覆蓋率的香港去研究流行概況是十分重要。 / Introduction: In 2011, a large multicentre trial (HPTN052) concluded that HIV+ persons on treatment with suppressed viral load (SVL) have minimal risk of virus transmission to their seronegative partners through sexual intercourse. These results provided evidence for the epidemiological use of viral load data to describe the HIV epidemics and assess impacts of treatment interventions. This study aims at modelling the HIV epidemic in Hong Kong by incorporating population-level viral load measures. / Methods: Longitudinal clinical data of patients attending two major HIV specialist services in Hong Kong were collected. The anonymized data were combined, adjusted and incorporated in an epidemiologic dataset in accordance with the CDC framework of viral load measures at population level. Specifically, community, in-care and monitored viral load were calculated to describe the HIV epidemic. Full community viral load, a new measure, was developed to infer the viral load burden of both diagnosed and undiagnosed individuals in the community. The HIV epidemic was then projected in a deterministic compartmental model. Gender was used to divide heterosexual model into two interrelated sub-models, while phylogenetic analysis (neighbour-joining tree) was applied to divide men-who-have-sex-with-men (MSM) model into 16 independent sub-models. Intervention scenarios of treatment coverage, testing coverage and retention expansion, and influence of non-local infection were projected and compared by modelling. / Results: A total of 76,350 CD4 and 64,412 viral load measurements of 4362 patients, and 1042 sequences were collected retrospectively (1985-2012). Among the patients included, 89% had acquired infection through sexual intercourse, and 74% had been started on highly active antiretroviral therapy (HAART). From viral load perspective, the proportion of patients in care with SVL (≤500copies/mL) increased sharply from 11% in 1997 to 76% in 2012, coinciding with the implementation of HAART. The growth curve of full community viral load was 5 years ahead of other viral load measures of heterosexuals and MSM. In 2010-2020, the HIV epidemic in heterosexuals would neither grow nor die down while the epidemic in MSM would continue to grow steadily but not exponentially. Among scenarios examined, test-and-treat intervention with high retention rate would be the most effective strategy for controlling the MSM and heterosexual epidemic. However, increasing the HIV testing rate for high risk people would be more feasible and impactful for the heterosexual, as a result of the early detection of HIV which would otherwise become late diagnoses. Non-local infection would affect the impact of interventions on epidemic control. / Conclusion: Without the inclusion of viral load measures, non-local infection and model delineation by subpopulations, epidemiologic projection results could be overestimated. Also, the impacts of treatment coverage on epidemic cannot be reflected if viral load measure is not included for describing epidemic growth. Acknowledging the importance of viral load measure, regular collection and aggregation of viral load measurements from all HIV clinics is recommended to form part of the HIV surveillance system. Such provision is important for studying HIV epidemiology descriptively and analytically in Hong Kong where coverage of HIV care is relatively extensive. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Wong, Ngai Sze. / Thesis (Ph.D.) Chinese University of Hong Kong, 2015. / Includes bibliographical references (leaves 204-219). / Abstracts also in Chinese.

Background In the recent decade resurgence of syphilis was noted in a global scale, especially in high-risk communities like men who have sex with men (MSM) and commercial sex workers (CSW). Syphilis co-infection is important in people living with human immunodeficiency virus and acquired immunodeficiency syndrome (HIV/AIDS) because of their similar transmission routes, mutual interactions at pathophysiology level, relation to socioeconomic factors and public health implications. Methods Retrospective analysis of syphilis co-infections among the HIV/AIDS patients who have been under the care of the AIDS Clinical Service, Queen Elizabeth Hospital of Hong Kong which has served as a tertiary referral center since the beginning of the AIDS epidemic. Details of syphilis co-infection including their clinical stages on diagnosis, evidence of central nervous system (CNS) invasion and recurrence were analyzed. Results In the 1,567 subjects studied 223 (14.2%) had HIV/syphilis co-infection. There are significantly more MSM in the HIV/syphilis co-infected group (P < 0.001). Among the coinfected, 111 (49.8%) had undiagnosed and untreated syphilis at the time of HIV/AIDS diagnosis. Sixty two subjects (27.8%) acquired syphilis as totally new infections after followed up for HIV/AIDS, with a median time of 284.6 weeks (range 3.7-862.3 weeks). Twenty subjects (9.0%) showed evidence of neurosyphilis on cerebrospinal fluid study. Thirty two (14.3%) had recurrent syphilis infections and more than 80% of them occurred in MSM. The total follow up duration was 8616.58 person-years. By Poisson regression, the adjusted total syphilis incidence was 7.07 cases per 100 person-years. MSM had the highest syphilis incidence of 20.25 cases per 100 person-years. In addition syphilis incidence in MSM recruited after the year 2000 was higher than those MSM recruited before. When Comparing subjects with HIV infection diagnosed before 2000 with those having HIV infection diagnosed after 2000, latter have higher cumulative incidence of first syphilis events (P < 0.001). Using Cox regression analysis, MSM (hazard ratio 3.26, 95% CI 1.93 – 5.51, P < 0.0005), bisexual contact (hazard ratio 2.95, 95% CI 1.49 – 5.82, P < 0.005) and infection with HIV-1 subtype B (hazard ratio 1.65, 95% CI 1.08 – 2.53, P = 0.02) were associated with development of first event of syphilis infection during follow up. Conclusions The result of this study corresponded to the global trend of HIV/syphilis syndemic. New and recurrent syphilis infections continued to appear after combination antiretroviral therapy (cART) initiation. MSM, bisexual subjects and infection by HIV-1 subtype B were risk factors for syphilis events. MSM contained the highest syphilis burden. Urgent attention and measures are needed to target syphilis and HIV infection in the Hong Kong MSM population. / published_or_final_version / Public Health / Master / Master of Public Health

Tam, Ka Po. / Thesis submitted in: September 2008. / Thesis (M.Phil.)--Chinese University of Hong Kong, 2009. / Includes bibliographical references (leaves 151-161). / Abstracts in English and Chinese. / Abstract --- p.i / Acknowledgement --- p.vi / Chapter 1 --- Introduction --- p.1 / Chapter 1.1 --- Human Immunodeficiency Virus --- p.1 / Chapter 1.2 --- Sexual Transmission of HIV --- p.3 / Chapter 1.3 --- HIV Prevalence in MSM Worldwide --- p.5 / Chapter 1.4 --- Risk Factors for Homosexual Men --- p.8 / Chapter 1.4.1 --- Individual Factors --- p.8 / Chapter 1.4.2 --- Societal Factors --- p.12 / Chapter 1.5 --- HIV Prevalence of MSM in Hong Kong --- p.17 / Chapter 2 --- Literature Review --- p.21 / Chapter 2.1 --- The Literature Search --- p.22 / Chapter 2.2 --- Results --- p.25 / Chapter 2.3 --- Reasons to Conduct Social Network Study --- p.26 / Chapter 2.4 --- Review on Methodologies --- p.29 / Chapter 2.4.1 --- Data Source --- p.29 / Chapter 2.4.2 --- Sampling Methods --- p.30 / Chapter 2.5 --- Review on Major Findings --- p.33 / Chapter 2.5.1 --- Individual Characteristics --- p.33 / Chapter 2.5.2 --- Partnerśة Characteristics --- p.34 / Chapter 2.5.3 --- Network Characteristics --- p.38 / Chapter 2.6 --- Critique --- p.40 / Chapter 2.7 --- Implication --- p.46 / Chapter 3 --- Methods --- p.49 / Chapter 3.1 --- Study Design --- p.49 / Chapter 3.1.1 --- Sampling --- p.50 / Chapter 3.1.2 --- Terminology --- p.51 / Chapter 3.2 --- Instruments --- p.56 / Chapter 3.2.1 --- Self-administered Questionnaire --- p.56 / Chapter 3.2.2 --- Demographics --- p.57 / Chapter 3.2.3 --- Setting of Infection --- p.57 / Chapter 3.2.4 --- Partnership Pattern --- p.59 / Chapter 3.2.5 --- Semi-structured Interviewing Guide --- p.61 / Chapter 3.2.6 --- Last Sexual Episode --- p.62 / Chapter 3.2.7 --- Sexual Role --- p.63 / Chapter 3.2.8 --- Partner Selection --- p.63 / Chapter 3.2.9 --- Bem Sex-Role Inventory --- p.64 / Chapter 3.3 --- Data Analysis --- p.66 / Chapter 3.4 --- Ethical Considerations --- p.70 / Chapter 4 --- Results --- p.74 / Chapter 4.1 --- Sampling --- p.74 / Chapter 4.2 --- Characteristics of Respondents --- p.75 / Chapter 4.2.1 --- Demographics --- p.75 / Chapter 4.2.2 --- Settings of Infection --- p.77 / Chapter 4.2.3 --- HIV Test --- p.79 / Chapter 4.3 --- Partnership Pattern --- p.82 / Chapter 4.3.1 --- Partner Types --- p.83 / Chapter 4.3.2 --- Location for Partner Sourcing --- p.84 / Chapter 4.3.3 --- Characteristics of Sex Partners --- p.86 / Chapter 4.3.4 --- Sexual Behavioural Pattern --- p.87 / Chapter 4.3.5 --- The Influence of Partner Types --- p.92 / Chapter 4.3.6 --- Last Sex with Lover(s) and/or Regular Partner(s) --- p.95 / Chapter 4.3.7 --- Sexual Role in Anal Intercourse --- p.98 / Chapter 4.4 --- Networking Pattern --- p.103 / Chapter 4.4.1 --- Individual Network --- p.104 / Chapter 4.4.2 --- Cluster Analysis (with 2-mode correspondence analysis) --- p.108 / Chapter 4.4.3 --- Social Network Analysis --- p.115 / Chapter 5 --- Discussion --- p.122 / Chapter 5.1 --- Possible Existence of 2 Sexual Networks in Hong Kong --- p.123 / Chapter 5.1.1 --- Network Configuration --- p.123 / Chapter 5.1.2 --- Network-related Behaviours --- p.128 / Chapter 5.2 --- Impact of Partnership Pattern on HIV Transmission --- p.129 / Chapter 5.3 --- The Importance of Sexual Role --- p.135 / Chapter 5.4 --- Limitations --- p.136 / Chapter 5.5 --- Implications --- p.141 / Appendices --- p.145 / Chapter A --- Self-administered Questionnaire --- p.145 / Bibliography --- p.151

吳木欣. / "2008年7月". / "2008 nian 7 yue". / Thesis (M.Phil.)--Chinese University of Hong Kong, 2008. / Includes bibliographical references (leaves 169-174). / Abstracts in Chinese and English. / Wu Muxin. / 目錄 / 引言 --- p.9 / Chapter 第一章 --- 文獻回顧 / Chapter 1 --- 何謂 MSM? --- p.11 / Chapter 2 --- 回顧亞洲男男性接觸者感染愛滋病之情況 --- p.11 / Chapter 3 --- 愛滋病感染率急升之原因 --- p.14 / Chapter 3.1 --- 香港同性戀者情況 --- p.17 / Chapter 4 --- 各地政府和NGOs之回應 --- p.19 / Chapter ■ --- 歧視與愛滋病的關連 --- p.20 / Chapter 4.1 --- 美國經驗´ؤ´ؤ活動取向之多元 --- p.21 / Chapter 4.2 --- 亞洲經驗一政府的不支持，非政府組織的無力 --- p.23 / Chapter 5 --- 回顧政府和香港非政府組織(NGOs)的角色 --- p.24 / Chapter 5.1 --- 香港政府採取的措施 --- p.24 / Chapter 5.1.1 --- ACA的建議政策角色 --- p.26 / Chapter 5.1.2 --- ATF的撥款機制角色 --- p.28 / Chapter 5.1.3 --- 非政府組織的工作 --- p.35 / Chapter 6 --- 是次研究的分析框架和概念 --- p.38 / Chapter 7 --- 研究重要之處 --- p.45 / Chapter 第二章 --- 研究方法 --- p.47 / Chapter 第三章 --- 誰是決策者 --- p.52 / Chapter 第四章 --- 主流組織的失敗一一反思一筆過撥款的弊端 --- p.73 / Chapter 第五章 --- 愛滋病非政府組織的無力 --- p.94 / Chapter 第六章 --- 草根組織的掙扎求存 --- p.103 / Chapter 第七章 --- 政府的割裂 --- p.115 / Chapter 第八章 --- 非政府組織的工作---愛滋病只是愛滋病嗎？ --- p.130 / Chapter 第九章 --- 總結 --- p.158 / 參考文獻 --- p.169 / 附件一 --- p.175 / 附件二 --- p.176

Li, Huizhen. / "March 2008." / Thesis (M.Phil.)--Chinese University of Hong Kong, 2008. / Includes bibliographical references (leaves 139-150). / Abstracts in English and Chinese. / Abstract --- p.ii / Acknowledgement --- p.vii / Abbreviations --- p.ix / Introduction --- p.1 / Chapter 1.1 --- HIV and AIDS --- p.4 / Chapter 1.1.1 --- HIV Transmission Routes --- p.5 / Chapter 1.1.2 --- HIV Related Risk Behaviors --- p.6 / Chapter 1.2 --- HIV Burden --- p.7 / Chapter 1.2.1 --- HIV Infection in China --- p.7 / Chapter 1.2.2 --- HIV Infection in Hong Kong --- p.9 / Chapter 1.2.3 --- Methadone Treatment in Hong Kong --- p.10 / Chapter 1.3 --- Objectives and Hypothesis --- p.14 / Chapter 1.4 --- Organization of This Thesis --- p.15 / Literature Review --- p.16 / Chapter 2.1 --- Search Methods --- p.18 / Chapter 2.1.1 --- Formulating Review Questions --- p.18 / Chapter 2.1.2 --- Search Strategy --- p.19 / Chapter 2.1.3 --- Inclusion and Exclusion Criteria --- p.21 / Chapter 2.2 --- Assessing the Quality of Studies --- p.22 / Chapter 2.3 --- Search Results --- p.23 / Chapter 2.3.1 --- Descriptive Summary --- p.25 / Chapter 2.3.2 --- Critique of Reviewed Articles --- p.33 / Chapter 2.4 --- Implication on Planning of Current Study --- p.37 / Chapter 2.4.1 --- Summary of Reviewed Articles --- p.37 / Methods for Exploring Predictors of HIV Risk --- p.40 / Chapter 3.1 --- Data Source --- p.42 / Chapter 3.1.1 --- Data Management in Methadone Clinics --- p.42 / Chapter 3.1.2 --- Source of Data --- p.43 / Chapter 3.2 --- Data Transformation --- p.45 / Chapter 3.3 --- Framework for assessing outcome --- p.48 / Chapter 3.3.1 --- Study population in different analyses --- p.48 / Chapter 3.3.2 --- Risk Score --- p.49 / Chapter 3.3.3 --- Independent Variables --- p.50 / Chapter 3.4 --- Generalized Linear Model --- p.52 / Chapter 3.5 --- Logistic Regression Model --- p.54 / Chapter 3.6 --- Multilevel Analyses --- p.55 / Chapter 3.6.1 --- Variables --- p.56 / Chapter 3.6.2 --- Definition of 'Neighborhood' --- p.56 / Chapter 3.6.3 --- Individual Variables --- p.60 / Chapter 3.6.4 --- Framework for Analyses --- p.60 / Chapter 3.7 --- Field Study --- p.63 / Results: Community Variation of HIV Risk --- p.65 / Chapter 4.1 --- Demographic Description --- p.67 / Chapter 4.1.1 --- Age distribution --- p.67 / Chapter 4.1.2 --- Gender Distribution --- p.68 / Chapter 4.1.3 --- Proportion of New Admission --- p.72 / Chapter 4.2 --- Drug Taking Profile --- p.74 / Chapter 4.2.1 --- Heroin Use --- p.74 / Chapter 4.2.2 --- Injecting Heroin Users --- p.77 / Chapter 4.3 --- HIV related risk behaviors --- p.81 / Chapter 4.3.1 --- Injection History --- p.81 / Chapter 4.3.2 --- Risky Injection Practices --- p.87 / Chapter 4.3.3 --- Sexual Behaviors --- p.93 / Chapter 4.4 --- Correlation between Demographics and Risk Score --- p.94 / Chapter 4.4.1 --- General Linear Regression Model Coefficient --- p.94 / Chapter 4.4.2 --- Risk Predictors in Logistic Regressions --- p.95 / Chapter 4.5 --- Neighborhood Effect --- p.100 / Chapter 4.6 --- On-site Observation --- p.103 / Chapter 4.6.1 --- Demographic Variations --- p.103 / Chapter 4.6.2 --- Drug Use Variations --- p.104 / Chapter 4.6.3 --- Social Background --- p.105 / Discussion --- p.111 / Chapter 5.1 --- Neighborhood Effect --- p.113 / Chapter 5.1.1 --- Variation across Communities --- p.113 / Chapter 5.1.2 --- Implication on Social Network of IDUs --- p.115 / Chapter 5.2 --- Decline of Admissions --- p.117 / Chapter 5.2.1 --- Decrease of New Admissions --- p.117 / Chapter 5.2.2 --- Decline of Readmission in 2003 --- p.119 / Chapter 5.3 --- Female IDU Population --- p.121 / Chapter 5.4 --- Limitations --- p.125 / Chapter 5.4.1 --- Importance of Individual Level Variables and Community Level Variables --- p.125 / Chapter 5.4.2 --- Reliability of Self-reported Data --- p.126 / Chapter 5.4.3 --- Duplicates of Readmissions --- p.126 / Chapter 5.4.4 --- Definition of Syringe Reuse --- p.127 / Chapter 5.4.5 --- Choice of Models --- p.129 / Conclusion and Future Directions --- p.131 / Chapter 6.1 --- Summary of Results --- p.133 / Chapter 6.2 --- Implication of results --- p.134 / Chapter 6.3 --- Future Directions --- p.136 / Bibliography --- p.139