L'effet protecteur de la circoncision masculine (CM) contre l'acquisition hétérosexuelle du VIH chez les hommes a été démontré dans trois essais contrôlés randomisés menés en Afrique australe et de l'Est, et sa généralisation a été recommandée par l’OMS et l’ONUSIDA comme une composante complémentaire importante des stratégies de prévention du VIH dans les pays à forte incidence du virus et bas taux de CM. Cependant, la généralisation de la CM dans les communautés ou elle n’est pas une norme sociale pose de nombreux défis en ce qui concerne son acceptabilité, son implémentation, son acceptation et son impact sur les comportements sexuels ainsi que sur les connaissances, attitudes et pratiques concernant la CM. Le projet ANRS 12126 Bophelo Pele a été implémenté à la suite des recommandations internationales dans la communauté d’Orange Farm, en Afrique du Sud, site du premier essai randomisé contrôlé sur la CM, et communauté cible de cette stratégie. Les activités de recherche menées au sein du projet prouvent que la généralisation de la CM est acceptable et réalisable rapidement dans une communauté à ressources limitées, selon les directives des instances internationales, de manière sure et coût-efficace. Son acceptation parmi les hommes non-circoncis est satisfaisante. De plus, trois ans après l’implémentation du projet, et bien que les connaissances envers la CM et son effet sur le risque du VIH restent à être améliorées, aucune différence de comportement sexuel n’a été décelée entre les hommes circoncis et les hommes non-circoncis ainsi qu’entre les partenaires des hommes circoncis et celles des hommes non-circoncis. La CM comme méthode de prévention du VIH dans les communautés hyperendémiques est donc une stratégie qui promet d’avoir un impact considérable sur l’épidémie en Afrique australe et de l’Est. / The protective effect of male circumcision (MC) on HIV heterosexual acquisition among men was demonstrated in three randomized controlled trials conducted in Southern and Eastern Africa, and its roll-out has been recommended by the WHO and UNAIDS as an important complementary component of HIV prevention strategies in high incidence communities with low rates of MC. However, the scale-up of MC in communities where it is not a social norm raises several challenges in regards to its acceptability, its implementation, its uptake, and its impact on sexual behavior as well as knowledge, attitudes and practices about MC. The ANRS 12126 Bophelo Pele project was implemented following the international recommendations in the community of Orange Farm (South Africa), site of the first MC randomized controlled trial, and target community of this strategy. Research activities conducted to evaluate the project show that the roll-out of MC is acceptable and can be implemented quickly in limited resources settings according to international recommendations in a safe and cost-effective manner. MC uptake among uncircumcised men is satisfactory. In addition, three years after project implementation, no difference in sexual behavior between circumcised men and uncircumcised men and between female partners of circumcised and uncircumcised men was detected, although knowledge and attitudes about MC and its association with HIV could be improved. MC as an HIV prevention method in hyperendemic communities is a promising strategy which can have a considerable impact on the epidemic in Eastern and Southern Africa.

Rebar carpet is an innovation that favors the working environment of the rebar workers and saves time. Reinforcement workers today are a vulnerable group. Heavy lifts and backbreaking postures are a part of their everyday work. It is already established that work with rebar carpets is both time-saving, economically beneficial and from a working environment point of view better than traditional reinforcement work. Despite all benefits it is used in rather few projects today. The purpose of this study is to identify how the construction industry embraces new innovations related to in situ concrete with post-tensioned reinforcement. The goals are to find out how designers, contractors and manufacturers are working to adopt rebar carpets in the construction process and to shed light on, factors affecting the adoption. The study is based on semi-structured interviews with designers, contractors and a representative of a rebar manufacturing company. Designers and contractors have not, generally speaking, been actively working to adopt rebar carpet. The governing factors for the use of rebar carpets is the designers and contractors knowledge and previous experience of rebar carpet. The contractors who have previous experience of rebar carpet can imagine using rebar carpet again and contractors with no previous experience believe that they need more knowledge of rebar carpet before they dare to try. Design engineers who have designed for rebar carpet before has it in mind when they design other projects. Designers who have no previous experience of rebar carpet demand more knowledge about how they can facilitate the use of rebar carpet.

Digitalization is hitting the energy industry by empowering energy producers and retailers, butmore importantly it’s empowering the end customers and the energy producers and retailers areno longer in possession of all power. Due to digitalization, energy networks are beingmodernized and new emerging technologies called smart grids and smart meters have beenintroduced. Smart grids can automatically monitor energy flows and adjust to changes in energysupply and demand. Smart meters on the other hand empowers the consumers to adapt theirenergy usage in both time and volume to different energy prices throughout the day by costcuttingtheir energy.With empowered and conscious end-customers, electricity retailers will have to compete in newways or risk losing their business. There is a risk that the majority of the over 100 electricityretailers in Sweden will be wiped out with time if data and information is not leveraged to theend-customers. This is potentially also threatening the business of TSU as well as othercompanies providing IT solutions to the energy market.For long Tieto Smart Utility (TSU) has offered IT services for both electricity retailers anddistributors across the Nordics. In relation to recently developed solutions as well as theopportunities and challenges created by digitalization and disruptive technologies such as smartmeters, the Nordic countries are in the forefront. Hence, TSU sees a potential in increasing itspresence in Western Europe to provide services to the retailers and distributors. However, inorder to expand to Western European countries TSU seeks to have a greater marketunderstanding of the different markets, in terms of for example market size, market structure,regulations. The problem is to have a structured and comprehensive way to increase marketunderstanding when assessing new West European energy markets due to the major differencesin each country.This thesis therefore aims to develop a framework which enables IT solution providers toconduct a market opportunity analysis in order to increase market awareness and assess theopportunities and potential in Western European markets, influenced by the smart-meter roll outand thus facilitate strategic decisions.A framework has been developed on the foundation on existing frameworks and applied onTSU by conducting a case study on a market opportunity assessment tool for energy IT solutionproviders. The framework consists of three levels of analysis; European-, Country- andCustomer Level which intends to identify market opportunities and potential.This thesis provides a framework for companies who wants to assess market opportunities andfacilitates strategic decisions regarding the potential of entering the markets. The findings of thisthesis has shown that the market opportunities for TSU are the greatest in Germany especiallydue to the market magnitude as well as the status for the smart meter roll-out. Furthermore,since IT solution providers usually offers many different services and solutions, the findings canbe used in a larger extent in order to asses the potential depending on type service and solution.

Thesis (PhD)--Stellenbosch University, 2012. / ENGLISH ABSTRACT: Introduction: Since the South African public sector antiretroviral roll-out programme started in 2004, the success of antiretroviral combination therapy (cART) has been experienced in terms of survival, prevention of mother-to-child transmission (PMTCT) and quality of life. However, as the programme matures, viral resistance to the constituent drugs will increase. Monitoring antiretroviral drug resistance (ARVDR) should therefore be a priority in the public health approach to HIV treatment. Methods: A cross-sectional investigation of genotypic antiretroviral drug resistance in: a) HIV-infected mothers who were exposed to a PMTCT regimen of short course azidothymidine (AZT) with single dose nevirapine (NVP) during labour. b) HIV-infected adults and children who were cART-naïve (transmitted or initial resistance). c) HIV-infected adults and children who were failing cART (drug-induced or acquired resistance). In case of adults, this includes patients on a first-line, non-nucleoside reverse transcriptase (NNRTI)-based regimen, or on a second-line, protease inhibitor (PI)-based regimen, and in case of children, this includes patients on a first-line PI-based regimen. Results: In mothers who received a PMTCT-regimen that combined AZT and NVP the prevalence of NNRTI resistance mutations was 17.1% (95% CI: 8.7-25.6%). The prevalence of transmitted ARVDR in adults was low, as was initial ARVDR in young children (mostly PMTCT-exposed), except for NNRTI resistance in children who had received NVP as part of PMTCT. Drug-induced resistance was found in adults failing first-line NNRTI-based cART, with 83% having resistance to ≥1 drug. In contrast, adult patients failing second-line PI-based cART had a low prevalence of PI resistance; the predominant reason for failure was poor drug exposure, as detected by measuring lopinavir concentrations in blood plasma and hair samples. In contrast, PI resistance in children was not rare, largely due to historic exposure to un-boosted PIs. This resulted in extensive resistance to PIs and reverse transcriptase inhibitors (RTI) in some children. Conclusions: A combined regimen of short course AZT with intrapartum NVP for PMTCT may, in addition to reducing the risk of neonatal infection, also reduce the risk of NVP resistance in the mothers compared to a regimen of NVP only. In South Africa, the prevalence of transmitted ARVDR remains low relative to industrialised countries, probably as comparatively little time has elapsed since the scale-up of cART. Adults failing first-line cART are likely to respond to second-line cART, without failure due to resistance. However some children with PI and RTI resistance cannot be adequately treated with drugs currently available through the roll-out programme. This emphasizes the urgent need for a rational and science-based approach to managing cART-experienced children, including access to additional drugs to form a third-line paediatric cART regimen. / AFRIKAANSE OPSOMMING: Inleiding: Sedert die begin van die Suid Afrikaanse publieke sektor antiretrovirale uitrol program in 2004 is die sukses van antiretrovirale kombinasie-behandeling (k-ARB) ervaar in terme van oorlewing, voorkoming van moeder na kind oordrag (VMKO) en lewenskwaliteit. Nietemin, sal weerstandigheid teen die middels wat in die antiretrovirale program gebruik word toeneem soos wat die program gevestig raak. Die monitoring van antiretrovirale middel-weerstandigheid is derhalwe ‘n prioriteit in gemeenskap-gesondheid benadering tot MIV behandeling. Metodes: ‘n Deursnit ondersoek van genotipiese antiretrovirale middel-weerstandigheid in: a) MIV-geïnfekteerde moeders wat blootgestel is aan VMKO regimen bestaande uit ‘n kort kursus AZT met ‘n enkeldosis nevirapien (NVP) tydens kraam. b) MIV-geïnfekteerde volwassenes en kinders wat komibinasieterapie-naïef (oorgedraagde of inisiële weerstandigheid) is. c) MIV-geïnfekteerde volwassenes en kinders wat k-ARB faal (middel-geïnduseerde weerstandigheid). In geval van volwassenes, sluit dit pasiënte op ‘n eerste-linie, non-nucleosied tru-transkriptase inhibitor (NNRTI)-regimen, en tweede-linie protease inhibitor (PI)-gebaseerde regimen, en in geval van kinders, sluit dit pasiënte in op ‘n eerste-linie PI-gebaseerde regimen. Resultate: In moeders wat ‘n gekombineerde AZT en NVP VMKO-regimen ontvang het, was die voorkoms van NNRTI weerstandigheid 17.1% (95%-vertrouensinterval: 8.7-25.6%). Die voorkoms van oorgedraagde ARVMW in MIV-geïnfekteerde volwassenes en kinders wat kombinasieterapie-naïef is, was laag, so ook ARVMW in jong kinders (meestal VMKO-blootgestel), behalwe vir non-nukleosied tru-transkriptase inhibitor (NNRT) weerstandigheid in kinders wat NVP ontvang het deur VMKO. Middel-geïnduseerde weerstandigheid was gevind in volwassenes wat die eerste-linie NNRTI-gebaseerde k-ARB gefaal het, met 83% wat weerstandigheid teen ≥1 middel het. Volwassenes wat ‘n tweede-linie protease inhibitor (PI) –gebaseerde k-ARB gefaal het , het ‘n lae voorkoms van PI weerstandigheid, met die oorwegenede oorsaak, swak middel-bloostelling, soos bepaal deur van lopinavir-konsentrasies in bloed plasma en hare. In teenstelling hiermee was PI weerstandigheid nie skaars in kinders nie, hoofsaaklik weens historiese blootstelling an ongeskraagde PI-behandeling. Dit het tot uitgebreide weerstandigheid tot PIs en tru-transkritptase inhibitors (RTI) in sommige kinders gelei. Gevolgtrekkings: ‘n Gekombineerde regimen van ‘n kort kursus AZT met NVP tydens kraam vir VKMO, mag bykomend tot die vermindering die risiko van pasgebore infeksie, ook die kans vir weerstandigheid teen NVP in die moeders verlaag in vergelyking met ‘n regimen van NVP-alleen. Die voorkoms van oorgedraagde ARVMW is tans laag in vergelyking met geïndustrialiseerde lande, waarskynlik aangesien daar nog betreklik min tyd verloop het sedert k-ART wyd beskikbaar gemaak is. Volwassenes wat eerstelyn kombinasie terapie faal sal waarskynlik goed reageer op tweede-linie terapie, sonder terapie faling weens middelweerstandigheid. Daarenteen kan sommige kinders met protease inhibitor en tru-transkriptase weerstandigheid nie voldoende behandel word met die huidig-beskikbare middels in die uitrol program nie. Dit beklemtoon die dringende noodsaaklikheid van ‘n rasionele en wetenskaplike benadering tot k-ART in kinders, met ‘n lang terapie geskiedenis, wat toegang tot bykomende medikasie behels om `n derde-linie regimen saam te stel.

All over the world, raising concerns about energy conservation and the environmental impacts of greenhouse gas emissions has promoted the development of a sustainable mobility transition. Successful electric vehicle (EV) deployment plays a vital role in this manner but is still facing obstacles, where public charging infrastructure is one of them. Additionally, digitization is transforming and introducing new industries worldwide, contributing with new constructs to be used in the evolving transition. Simultaneously, technology is surpassing the competition, and is one of the most potent transformational force affecting customer relations in the energy sector, leading to customers anticipating more from the power utility companies. To attain a long-termsustainable competitive advantage, firms have to retain, sustain, and nurture their customer base. To do so, corporations have comprehended the value of embracing customer-centric incentives, enabling them to capture more indirect business values. Furthermore, this thesis was done in collaboration with a power utility company, referred to as ‘Org X’ or ‘the CPO’. Influenced by the reasoning above, it investigated the opportunity to create indirect business values through a demand-driven roll-out of the national charging infrastructure with the use of crowdfunding. This was achieved by adopting an exploratory methodology approach, where a mixed inductive-deductive design was used. A multi-method qualitative data collection was made; consisting mainly of semi-structured-, and unstructured interviews with experts in the field. Thus, a profound perspective of the EV-charging market landscape was attained, which enabled adequate reasoning when proposing a strategy approach for the cause. Additionally, quantitative secondary data was used to develop a tool for an initial location evaluation, that is part of the recommended approach. This tool was also used to enhance the understanding of the national EV-charging market landscape, the customer segments, as well the potential market for a co-creating platform. The findings suggest that the perceived readiness level of crowdfunding charging infrastructure varies depending on what aspect that is being accommodated. A platform that connects stakeholders is encouraged by actors in the field, but crowdfunding through solely end-users is questioned as close proximity to the end-user’s location is a key-factor regarding motivation to fund a charging point. A ‘Tier based framework’, that facilitates this transition was therefore developed and evaluated. Additionally, the framework was considered in the market analysis case study, which further included a recommended implementation and communication approach. If used accordingly, this framework could bring both indirect- and direct business values to the power utility company in question, as well as the involved stakeholders. / Oro över energieffektiviseringar och miljökonsekvenser från utsläpp av växthusgaser världen över har främjat utvecklingen av ett hållbart energisystem. En framgångsrik marknadspenetration av elbilar (EVs) har en viktig roll i denna aspekt, men står fortfarande inför hinder där publik laddningsinfrastruktur är en del av problemet. Digitaliseringen leder till transformation och nya industrier vilket bidrar med ytterligare konstruktioner som används i övergången till ett mer hållbart samhälle. Samtidigt driver teknikutvecklingen till ökad konkurrens och har en kraftfull påverkan på vad kunderna förväntar sig från företagen. För att uppnå mer långsiktigt hållbara konkurrensfördelar måste företag sträva efter att behålla, upprätthålla och ta hand sin kundbas. Företag börjar förstå det ökade värde som finns i att utöva mer kundcentrerade incitament och strategier, vilket potentiellt bidrar till mer indirekta affärsvärden. Denna uppsats är i samarbete med ett Svenskt energiföretag, följaktligen refererat till som 'Org X' eller 'CPO'. Baserat på resonemanget ovan, har möjligheten att skapa indirekta affärsvärden genom verkställandet av en mer efterfrågedriven utveckling av den nationella elbilsladdning infrastruktur med hjälp av crowdfunding undersökts. Detta uppnåddes genom att använda ett utforskat tillvägagångssätt, där en blandad induktiv-deduktiv design användes. En kvalitativ datainsamling gjordes på flera sätt; huvudsakligen bestående av semistrukturerade och ostrukturerade intervjuer med experter inom området. Således uppnåddes ett djupgående perspektiv på av elbilsladdning marknaden vilket möjliggjorde sakliga resonemang kring den presenterade och rekommenderade strategin. Ytterligare användes kvantitativ sekundärdata för att utveckla ett verktyg för en initial plats bedömning, vilket är en del av den rekommenderade strategin. Detta verktyg användes dessutom för att öka förståelsen för den nationella elbilsladdning marknaden, kundsegmenten, liksom den potentiella marknaden för en samskapande plattform. Resultaten tyder på att den upplevda beredskapsnivån att crowdfunda laddningsinfrastruktur varierar beroende på plats och kundgrupp. En plattform som ansluter intressenter uppmuntras av aktörer på marknaden, men crowdfunding genom enbart slutanvändare ifrågasätts då närhet till slutanvändarens läge är en nyckelfaktor när det gäller motivationen att medverka i finansieringen. Därav har ett tier based framework utvecklats och presenterats, som bör underlätta transformationen mot en mer kunddriven affärsmöjlighet. Dessutom beaktades ramverket i fallstudien för marknadsanalysen, som ytterligare inkluderade en rekommenderad strategi för implementering och kommunikation. Om den används i enlighet bör ramverket ge både indirekta och direkta affärsvärden till det aktuella energi företaget, liksom till berörda intressenter.

The purpose of this study is to explore and describe the challenges experienced by non-governmental organisations with regards to the roll-out of ART, with an aim to facilitate strategy development to overcome the challenges and enhance the success of ART rollout by the NGOs. A qualitative, exploratory and descriptive study was conducted. Data collection was done using in-depth semi-structured interviews. Three groups of respondents participated in the study; programme coordinators who directed and supervised ART programmes; doctors who were responsible for prescribing, monitoring and dealing with ART complications; and registered nurses who were responsible for monitoring, referring and providing nursing care to patients on ART. The findings revealed five broad areas of challenges namely; challenges related to sustainability, challenges related to adherence, challenges related to health systems, challenges related to stigma and challenges related to behavior. Of interest were the surge of whoonga and the infiltration of ART roll-out by crime and violence. / Health Studies / MA (Public Health)

The purpose of this study is to explore and describe the challenges experienced by non-governmental organisations with regards to the roll-out of ART, with an aim to facilitate strategy development to overcome the challenges and enhance the success of ART rollout by the NGOs. A qualitative, exploratory and descriptive study was conducted. Data collection was done using in-depth semi-structured interviews. Three groups of respondents participated in the study; programme coordinators who directed and supervised ART programmes; doctors who were responsible for prescribing, monitoring and dealing with ART complications; and registered nurses who were responsible for monitoring, referring and providing nursing care to patients on ART. The findings revealed five broad areas of challenges namely; challenges related to sustainability, challenges related to adherence, challenges related to health systems, challenges related to stigma and challenges related to behavior. Of interest were the surge of whoonga and the infiltration of ART roll-out by crime and violence. / Health Studies / M.A. (Public Health)

Social economy community development organizations (SECDOs) are social service organizations that provide poverty relief but do not necessarily inspire a counter-hegemonic antipoverty strategy against a neoliberal welfare state. Tension between providing human social services and engaging in advocacy is at the core of how SECDOs may be both complicit to as well as working against the neoliberalization of the welfare state. This study explores how SECDOs can nurture a new paradigm for community economic development organizations. Through a case study of a Canadian settlement house, the research demonstrates how transforming work may encourage a culture of organic intellectualism or, a culture of emancipatory consciousness-raising. By re-organizing workplace practices, such as working collaboratively, providing a hub for services and engaging in popular education, transformative SECDOs help provide the conditions for citizens to affect governance. The research theorizes how SECDOs may foster a culture of organic intellectualism to promote the transformative social economy.

Social economy community development organizations (SECDOs) are social service organizations that provide poverty relief but do not necessarily inspire a counter-hegemonic antipoverty strategy against a neoliberal welfare state. Tension between providing human social services and engaging in advocacy is at the core of how SECDOs may be both complicit to as well as working against the neoliberalization of the welfare state. This study explores how SECDOs can nurture a new paradigm for community economic development organizations. Through a case study of a Canadian settlement house, the research demonstrates how transforming work may encourage a culture of organic intellectualism or, a culture of emancipatory consciousness-raising. By re-organizing workplace practices, such as working collaboratively, providing a hub for services and engaging in popular education, transformative SECDOs help provide the conditions for citizens to affect governance. The research theorizes how SECDOs may foster a culture of organic intellectualism to promote the transformative social economy.