Thesis (MTech (Tourism and Hospitality Management))--Cape Peninsula University of Technology, 2006. / The HIV/AIDS pandemic poses one of the greatest challenges to business development in South Africa. The hotel industry is growing rapidly and will be . significantly affected by the HIV/AIDS pandemic. The purpose of this study was to determine the Knowledge, Attitudes and Practices (KAP) regarding HIV/AIDS of staff from nine Protea group hotels in Cape Town. A sample of 200 hotel staff was randomly selected to participate. A structured self-administered anonymous questionnaire was the instrument used to collect the data. The response rate was 81%. There were more females than males, and the majority of the respondents were between the ages of 21-30 years. More than half of the respondents were single, hotel managers and with matriculation as the highest qualification. The respondents demonstrated a reasonably good knowledge on the transmission of HIV/AIDS. Almost half of the respondents believed that HIV/AIDS would not affect the hotel industry. The survey revealed conflicting results on whether HIV-infected staff should be involved in food preparation, and whether staff should serve food to HIV positive hotel guests. There were also concerns of the risk of infection when handling dirty linen used by HIV-infected hotel guests. More males than females were currently sexually active and reported having more than one partner in the past three years. The majority of the respondents believed that condoms were effective, but only one third reported the use of a condom every time they had a sexual encounter. There was a significant relationship between knowledge and attitudes (p-value<0.05, but none between knowledge and practice and attitude and practice. It is recommended that the hotel industry develop effective workplace policies and supportive environments, and that on-going HIV/AIDS education and prevention programmes be implemented to change high risk sexual behaviour and practices.

The world has entered the third decade of the HIV and AIDS epidemic under different times in which the epidemic is treatable. The International Labour Organisation (ILO) (2005) declares HIV and AIDS a developmental crisis destroying developmental gains over generations. Since HIV and AIDS affect the most productive segment of the labour force, it is therefore not only a threat to development but also to the world of work without which development will be sacrificed (ILO, 2001). Collaborative response efforts that seek to mitigate the HIV pandemic by government, business and higher education institutions have been fraught with challenges. The main challenge that beset these efforts is that, in the absence of an HIV vaccine, voluntary counselling and testing remains the gateway to access treatment and care. Regrettably, participation in VCT has been confronted by challenges of low utilisation. This precedes the objectives of this study, which were to explore and describe factors that serve as barriers and facilitators of workplace VCT programmes with the objective to improve participation in these programmes. The current study was a product of a qualitative and exploratory-descriptive research design. A nonprobability convenience sampling method was used to sample participants for this study. The targeted population in this study were the non-academic employees of an academic institution in the Eastern Cape. Data was collected by means of focus group discussions and by using semi-structured interviews. The focus group samples comprised of an equal number of men and women with an overall participation of fifty-six participants. Data obtained was transcribed, thematically analysed and coded using Henning, Van Rensburg, and Smit's (2004) qualitative analysis and interpretation method. Findings of this research revealed that factors that facilitate and inhibit voluntary counselling and testing are psychosocial and cultural by nature. At psychosocial level, participants reported factors that facilitate voluntary counselling and testing to include psychological readiness to go for HIV testing, reassurances of confidentiality of HIV test results and normalising HIV testing (making the process more like that for screening and diagnostic testing). Cultural factors included cultural practices and beliefs such as "intonjane" and traditional circumcision - positive cultural nurturers that could facilitate VCT participation. Results of this study showed a lack of basic knowledge about VCT and fear of knowing one's status, fear of breach of confidentiality, fear of being stigmatised and a lack of trust towards health professional as the major psychosocial factors that serve as barriers to VCT participation. The cultural barriers to VCT pointed to hegemonic masculinity as a socially constructed gender identity that encourages gender inequalities and undermines efforts to improve HIV testing. The study suggested that strategies to increase VCT participation should consider leadership support of VCT programmes, incentivisation of VCT programmes, institutionalisation of HIV and AIDS education and the establishment of integrated wellness services for employees.

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

Master of Public Health - MPH / Curricula should be strengthened by teaching the curability of STIs and the importance of STI treatment to prevent HIV transmission. This study focused on the control of sexually transmitted infections as a key HIV prevention strategy. Sexually transmitted infections act as a strong cofactor in the sexual transmission of HIV. Effective STI management can limit the spread of HIV. / South Africa

The socio-economic impact of HIV/AIDS on South Africa has resulted in lower gross domestic product, loss of skills in key sectors such as education, and increased health-care costs in providing access to treatment. Currently active pharmaceutical ingredients (API’s) such as stavudine (d4T) and azidothymidine (AZT) are imported from India and China, while formulation is conducted locally. A strategy was initiated between CSIR Biosciences and LIFElab under the auspices of Arvir Technologies to investigate the feasibility of local antiretroviral manufacture (d4T and AZT) or the manufacture of a key intermediate such as β- thymidine (dT). Several advantages associated with successful implementation of this strategy include ensuring a local supply of API’s, thus reducing reliance on procurement from foreign sources and reducing the effect of foreign exchange rate fluctuations on providing cost effective access to treatment. A local supply source would also reduce the imports and thus aid the balance of payments deficit, and in addition to this, provide stimulus in the local pharmaceutical manufacturing industry (which has been in decline for several decades), resulting in increased skills and employment opportunities. This thesis describes the development of a superior chemo-enzymatic process for the production of β-thymidine (72 percent yield, prior to isolation), a key intermediate in the preparation of anti-retrovirals. Alternative processes based purely on chemical or bioprocess transformations to prepare either 5-methyluridine (5-MU) or dT suffer from several disadvantages: lengthy transformations due to protection/deprotection strategies, low selectivties and product yields (30 percent in the chemical process) and isolation of the product from dilute process streams requiring the use of large uneconomical reactors (bioprocesss). This contributes significantly to the cost of d4T and AZT manufacture. Our novel chemoenzymatic process comprises of a biocatalytic reaction for the production of 5-MU, with subsequent chemical transformation into dT (3 steps) negating and circumventing the limitations of the chemical or bioprocess routes. During the course of this project development, the β-thymidine selling price declined from 175 $/kg (2005) to 100 $/kg (2008). However, the process described in this work is still competitive based on the current β- thymidine selling price of 100 $/kg. The process economics show that with further optimization and increasing the isolated dT yield from 70 percent to 90 percent, the variable cost decreases from 136 $/kg to 110 $/kg. The increase in isolated yield is highly probable, based on solubility data of β-thymidine. The decrease in β-thymidine selling price and technological improvement in dT manufacture should translate into lower API manufacture costs and more cost effective access to treatment. Our novel biocatalytic process producing 5-MU uses a coupled enzyme system employing PNP, Purine Nucleoside Phosphorylase and PyNP, Pyrimidine Nucleoside Phosphorylase. The overall transglycosylation reaction may be decoupled into the phosphorolysis reaction (PNP) and synthesis reaction (PyNP). During the phosphorolysis reaction, guanosine is converted into guanine and ribose-1-phosphate (R-1-P) in the presence of PNP enzyme. The reaction intermediate R-1-P is then coupled to thymine in the presence of PyNP enzyme during the synthesis reaction, producing 5-MU. The process was scaled up from lab-scale to bench-scale (10 - 20 L) and demonstrated to be robust and reproducible. This is evident from the average guanosine conversion (94.7 percent ± 2.03) and 5-MU yield (88.2 percent ± 6.21) and mole balance (104 percent ± 7.61) which were obtained at bench-scale (3 replicates, 10 L). The reaction was carried out at reactor productivities of between 7 – 11 g.L-1.h-1. The integration of the biocatalytic process and chemical processes was successfully carried out, showing that 5-MU produced using our novel biocatalytic process behaved similarly to commercially available 5- MU (ex. Dayang Chemicals, China). A PCT patent application (Ref. No. P44422PC01) on this chemo-enzymatic process has been filed and currently public private partnerships are being explored through Arvir Technologies to evaluate and validate this technology at one ton scale.

To end the HIV epidemic, prevention of new HIV infections will be contingent on preventing at-risk individuals from acquiring HIV and supporting people living with HIV in achieving and sustaining viral suppression throughout their lifetime. The underlying motivation for this dissertation is the recent evidence that new HIV infections can be prevented when people living with HIV achieve and maintain viral suppression. In response, three studies were conducted. The goal of this dissertation was to advance our understanding of HIV viral suppression patterns over time among clinically engaged adults living with HIV and examine current limitations in viral suppression monitoring. First, a systematic review evaluated the existing literature for evidence of longitudinal assessments of viral suppression among people living with HIV. Among 896 publications identified during the database search, 50 publications met the study criteria and were included in the review. Among these studies, 78% were implemented in the United States, 72% assessed viral suppression using viral load results abstracted from clinical medical records, and 22% used surveillance data from HIV-laboratory based reporting. Five distinct longitudinal measurement methods were identified, including (a) estimates requiring more than one viral load within an observation period to be below a suppression threshold; (b) estimates comparing the first and last viral load during an observation period; (c) reporting multiple proportions of participants maintaining viral suppression across an observation period; (d) estimating viremia copy-years and estimating person-time above a suppression threshold, and; (e) other methodology to assess longitudinal viral suppression such as data weighting and group-based trajectory modeling. Half of the studies reported the proportion of individuals with all viral loads below a certain threshold (e.g., ≤200 copies/mL). Most studies (70.0%; 35/50) were published in the last five years (2015 – 2019) and describe viral load data collected between 2013 and 2018, highlighting recent efforts by researchers to describe viral suppression using longitudinal approaches. Next, data from a longitudinal electronic medical record-based prospective cohort study of people living with HIV seeking care in Washington, District of Columbia, were used to describe longitudinal changes in viral suppression and assess the relationship between prior virologic history and virologic failure events during follow-up. Among 3556 participants, 29% did not maintain viral suppression during a five-year period, and instances of viral suppression status fluctuations were observed. Participants with a history of fluctuating viral suppression were found to have a higher rate (RR=2.40; 95% CI: 2.03 – 2.84; P<0.01) of virologic failure events during follow-up, compared to participants with sustained viral suppression before the observation period. Lastly, a third study used the same data source to assess differences between viral suppression estimates derived from different measurement methods and evaluate the impact of data triangulation on longitudinal viral suppression measures. Among 3452 participants (median age 48; 73% cisgender males; 77% non-Hispanic black), 69% had all viral load results suppressed (<200 copies/mL) during a four-year observation period, 28% had both suppressed and unsuppressed viral loads, and 2% had all viral loads unsuppressed. Compared to cross-sectional viral suppression measurement methods, longitudinal measurement methods resulted in lower proportions of virally suppressed participants. Data triangulation added 2293 viral load data points and resulted in lower viral suppression estimates. These findings highlight the need to reconsider current viral suppression measurement methods to improve the accuracy of estimates reported in surveillance reports and epidemiologic studies. Overall, this dissertation addresses important questions related to viral suppression by describing the frequency of viral suppression status fluctuations that occur throughout an extended observation period, quantifying the occurrence of repeated virologic failure events, and comparing several measurement techniques to assess appropriate methods to describe viral suppression over time. Recently, the United States Department of Health and Human Services, together with the White House, set forth the “Ending the HIV Epidemic: A Plan for America” initiative, with a goal to end the HIV epidemic in the United States within the next ten years. To reach this goal, the initiative calls for a 75% reduction in new HIV infections by 2025 and a 90% reduction by 2030. Treating people living with HIV rapidly and effectively with ART is an important strategy to carry out these efforts. This dissertation demonstrates that assessing the ability of people living with HIV to maintain viral suppression over time is also critical.

No description available.

In the past decade, the rising incidence of human immunodeficiency virus (HIV) in men who have sex with men (MSM) calls for targeted epidemiological investigations. However, the approach of most current epidemiological studies might be inadequate for characterising transmission risks of MSM, as they focus largely on the practice of risk behaviours in population context and have assumed a homogeneous distribution of such behaviours and their resultant risks in HIV transmission. A study investigating the networking pattern of MSM, in addition to their sexual behaviour, was therefore proposed to re-examine HIV epidemiology in Hong Kong and model HIV transmission dynamics. / Following literature review on network analyses conducted in MSM, it was found that the use of two-mode network data for constructing sexual affiliation network had not been widely applied. Such two-mode network approach could be more feasible in describing sexual structure of MSM, who are connected by their preferred social venues. To adopt this approach, a two-part study, composing a field survey and a modelling study, was performed. A cross-sectional questionnaire survey was conducted between January and April 2013 to obtain data about sex-networking venues and associated behavioural profiles of MSM in Hong Kong. Comparisons of networking patterns, risk behaviour and demographics between MSM in different networks, delineated by two-mode network analysis, were made. Based on the survey data and assumptions derived from other network-based and behavioural studies, HIV transmission dynamics was simulated by building a stochastic agent-based model. / In the field survey, a total of 932 respondents were recruited from physical venues (n=625), including nine bars and six saunas, and the Internet (n=307). The proportion of MSM using condom for every anal sex with casual partners met in physical venues was 66.6% (225/338), while that for partners met in the Internet was 62.6% (139/222). Only 51.5% (204/396) MSM always used condom while having anal sex with regular partners. Community detection by networks of social venues identified nine clusters of MSM from three network bases. The simulation model gave a median number of new HIV infections over a 5-year period at 83 per 1000 MSM. The median numbers of annual infections ranged between 14 and 20. In over 30% of MSM networked through the Internet, having regular sex partners or practising receptive anal sex, more than 50 infections out of 500 iterations could occur in the model simulation, suggesting their higher risk of HIV infection. / In conclusion, the modelling results suggested that HIV transmission in Hong Kong might have occurred largely between regular partners. The potential impact of local sex-networking pattern through social venues with casual partners on HIV transmission is relatively little and indirect. To prevent HIV from spreading into new networks, intervention shall be targeted at MSM having unprotected anal sex with regular partners and seeking casual partners in social venues, especially through the Internet. Network approach in HIV epidemiology, such as collection of network-based data from HIV-infected MSM as part of surveillance, and assessing the network configuration from time to time, shall also be considered. / 過去十年間，透過同性性行為感染愛滋病病毒的個案持續上升，令針對男男性接觸者的流行病學研究顯得重要。現時大部分相關研究都假設所涉行為和相應的傳染風險是平均分佈於研究人群中，採用這研究方法去了解男男性接觸者間的病毒傳播風險明顯有所不足。有鑑於此，本研究透過了解男男性接觸者的社交網絡模式及其風險行為，重新審視本地愛滋病病毒感染的流行病學狀況及設計相關模型，用以了解病毒的傳播及流行規律。 / 探討過往文獻發現，雖然二模網絡能勾劃出男男性接觸者與其結識性伴侶的社交場所間的關係，卻未被廣泛應用於流行病學研究。本研究採納二模網絡的分析方法，並分兩部分進行。實地調查部分於二零一三年一月至四月期間進行，透過問卷收集本港男男性接觸者結交性伴侶的場所及相關性行為等資料，並比較其網絡模式、風險行為及人口特徵。建模研究部分則是利用調查所得之數據及參考其他研究去建立模型，用以模擬愛滋病病毒的傳播規律。 / 問卷調查從九間酒吧、六間桑拿及互聯網中，招募了九百三十二位受訪者參與研究。受訪者中，每次肛交均使用安全套的比率因性伴侶的種類而異，比率介乎百分之五十二至六十七。透過分析三種社交場所的網絡結構，本港男男性接觸者社群共可分為九個群組。由模擬模型得知，五年間新增的愛滋病病毒感染個案為八十三宗（每千人計），而相應的年度感染數字則介乎十四至二十宗。從五百次模擬運算中，發現超過三成透過互聯網結識性伴侶或擁有固定性伴侶的男男性接觸者與及受體肛交者的感染次數多於五十次，顯示其較高的愛滋病病毒感染風險。 / 總括而言，研究發現本港愛滋病病毒的傳播多於固定性伴侶間發生。相反，透過本地社交場所結識非固定性伴侶的網絡模式只間接影響本港愛滋病病毒的散播。為有效預防愛滋病病毒散播，干預措施應針對有與固定伴侶進行不安全性行為及透過互聯網結識性伴侶的男男性接觸者，同時衛生部門亦可考慮將感染愛滋病病毒的男男性接觸者的網絡數據納入恆常監測及不時評估同志社群間的網絡結構。 / Poon, Chin Man. / Thesis Ph.D. Chinese University of Hong Kong 2015. / Includes bibliographical references (leaves 112-121). / Abstracts and appendix B also in Chinese. / Title from PDF title page (viewed on 07, October, 2016). / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only.

The Australian HIV Observational Database (AHOD) is a collaboration of hospitals, sexual health clinics and specialist general practices throughout Australia, established in April 1999. Core data variables collected include demographic data, immunological and virological markers, AIDS diagnosis, antiretroviral and prophylactic treatment and cause of death. The first electronic data transfer occurred in September 1999 followed by six monthly data transfers thereafter. All analyses included in this thesis are based on patients recruited to AHOD by March 2004. By March 2004, 2329 patients had been recruited to AHOD from 27 sites throughout Australia. Of these, 352 (15%) patients were recruited from non-metropolitan clinics. The majority of patients were male (94%), and infected with HIV through male homosexual contact (73%). Almost 90% of AHOD patients are antiretroviral treatment experience, and the majority of patients are receiving triple therapy as mandated by standard of care guidelines in Australia. Antiretroviral treatment use has changed in Australia reflecting changes in the availability of new treatment strategies and agents. The crude mortality rate was 1.58 per 100 person years, and of the 105 deaths, more than half died from HIV-unrelated deaths. The prevalence of HBV and HCV in AHOD was 4.8% and 10.9%, respectively. HIV disease progression in the era of highly active antiretroviral treatment (HAART) among AHOD patients is consistent with what has been reported in developed countries. Common factors associated with HIV disease progression were low CD4 cell count, high viral load and prior treatment with mono or double therapy at the time of commencing HAART. This was demonstrated in AHOD in terms of long-term CD4 cell response, the rate of changing combination antiretroviral therapy and factors predicting death. HBV and HCV coinfection is also relatively common in AHOD, similar to other developed country cohorts. Coinfection does not appear to be serious impediments to the treatment of HIV infected patients. However, HIV disease outcome following HAART does appear to be adversely affected by HIV/HCV coinfection but not in terms of HIV/HBV coinfection. Patients attending non-metropolitan sites were found to be similar to those attending metropolitan sites in terms of both immunological response and survival.

This thesis examines HIV disease natural history and response to antiretroviral treatment (ART) in patients from The TREAT Asia HIV Observational Database (TAHOD), a mulitcentre, prospective observational cohort of HIV-infected patients from countries in the Asia-Pacific region. By September 2005, 2979 patients have been recruited to TAHOD from 15 participating sites. The majority were male (73%), median age 37 years. Chinese (37%), Thai (25%) and Indian (17%) were the main ethnicities. Most patients reported HIV infection through heterosexual (59%) and homosexual contact (23%); 5% injecting drug use. At baseline, 41% of patients were diagnosed with AIDS defining illness, and 77% were being treated with highly active antiretroviral therapy (HAART). Baseline and retrospective data suggest that the overall response to HAART in TAHOD is similar to that seen in western cohorts, with mean CD4 count increase of 115 cells/μL and 69% achieving a viral load less than 400 copies/mL six-month after HAART initiation. Baseline CD4 count was the strongest predictor of short-term disease progression. Prognostic models based on routine clinical data and haemoglobin gave a good estimation of disease progression. The rate of new AIDS defining illness was 26% in the first 90 days after HAART initiation, which may partly be due to immune reconstitution syndrome occurring shortly after treatment. The most frequently used first-line ART combination was stavudine/lamivudine/nevirapine. Approximately 22% of patients receiving this treatment changed or stopped at least one drug in the first year, with adverse effect (including lipodystrophy, hepatitis, rash and peripheral neuropathy) the major reasons. The rates of discontinuation of efavirenz or nevirapine as part of HAART were similar (16 vs. 20/100 person years). Older age and positive HCV antibody were associated with an elevated liver function (ALT) test. Both prevalence of HBV and HCV coinfection with HIV were approximately 10%. The impact of hepatitis coinfection on immunological and virological responses to ART and HIV disease progression was not statistically significant. Both HBV and HCV remained independently associated with elevated ALT in the multivariate models. The overall HIV disease progression and response to ART in TAHOD patients were similar to those seen in the western countries.