Masters Degrees (African Centre for HIV/AIDS Management)

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    Transmission of bedaquiline-resistant tuberculosis in the Western Cape Province, South Africa
    (Stellenbosch : Stellenbosch University, 2022-12) Steinhobel, Amy Debra; Grobbelaar, Melanie; Stellenbosch University. Faculty of Economic and Management Sciences. African Centre for HIV/AIDS Management.
    ENGLISH SUMMARY: Bedaquiline (BDQ) is the first novel drug to be approved for the treatment of multi-drug resistant TB (MDR-TB) in 40 years. Reduced susceptibility to BDQ commonly occurs through variants in the genes Rv0678, atpE and pepQ. The aim of this study was to determine the prevalence of BDQ genotypic resistance in the Western Cape, using a high throughput screening method to investigate the acquisition of variants in the three candidate genes and associated phenotypic resistance, as well as potential transmission network of BDQ-resistance. A total of 326 patient isolates with rifampicin-resistant TB (RR-TB) at baseline were selected between January 2018 to February 2019 using the STATA software for sample processing from the longitudinal drug-resistant strain bank at the Division of Molecular Biology and Human Genetics at Stellenbosch University (SU). Crude DNA was used for library preparation and targeted deep sequencing (TDS) of the BDQ-resistance candidate genes (Rv0678, atpE and pepQ) using a protocol designed by the translational genomics research institute (TGen). The first TDS run was performed at TGen in Flagstaff, USA on an Illumina MiSeq platform and 146 patient isolates were sequenced. The expertise was then transferred to SU and the protocol was optimised. The second TDS run was done at the South African Medical Research Council (SAMRC) on an Illumina MiniSeq platform and 180 patient isolates were sequenced. Data obtained from collective TDS runs were analysed using the TB-specific Amplicon Sequencing Analysis Pipeline and yielded 15 isolates with variants suitable for further phenotypic drug susceptibility testing (pDST) using the BACTEC MGIT 960 system. Of the variants detected; six were Rv0678 variants, eight were pepQ variants and one was an atpE variant. Two of the isolates with Rv0678 indels at high frequencies (>97%) were BDQ-resistant, suggesting a phenotypic BDQ-resistance frequency of 0.61% (2/362). Spoligotyping revealed that 9/13 isolates belonged to lineage 2 (Beijing genotype) and three isolates belonged to lineage 4 (one T1 strain, one LAM3 strain and one LAM1-LAM4 strain). A subset of six isolates, from the first TDS run, was selected for minimum inhibitory concentration (MIC) testing using the CRyPTIC UKMYC6 plates and for whole-genome sequencing (WGS) on the MiniSeq platform. The UKMYC6 plate data and the WGS data for the subset identified the drug-resistant profiles, which ranged from rifampicin mono-resistant to extensively drug-resistant TB. The two isolates presented with identical sub-lineages (2.2.2) and the phylogeny indicated the close relatedness of the patient isolates. The findings from this study suggest that it is possible to use NGS to screen hundreds of patient isolates to identify BDQ resistance-associated variants (RAVs) in the community. However, this approach is dependent on the availability of a comprehensive catalogue of BDQ RAVs with the accompanying pDST and MIC data to support the genotype-phenotype. In the future NGS surveillance methods could be used in clinical decision-making for designing effective treatment regimens containing BDQ, as well as to investigate transmission within the community. Additionally, this could help to preserve this novel antibiotic to ensure its longstanding use in successful drug-resistant TB therapy in the future.
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    Ethical perspectives regarding human immunodeficiency virus (HIV) positive children in childcare centres
    (Stellenbosch : Stellenbosch University, 2020-12) Adams, Sadiya Fatima; Hall, Susan; Stellenbosch University. Faculty of Economic and Management Sciences. African Centre for HIV/AIDS Management.
    ENGLISH SUMMARY : The human immunodeficiency virus (HIV) pandemic gives rise to a vast array of moral and ethical issues. The enrolment of HIV positive children in childcare facilities, in particular, presents a unique set of ethical issues and concerns, including dilemmas with regard to status disclosure, and ethical guidance is required in this regard. The main objective of this study is to argue in favour of a controlled means of disclosure in childcare institutions. However, status disclosure and stigmatisation present a complex relationship that needs to be examined in detail. Against the background of this relationship, this dissertation will attempt to provide a principlist analysis of various ethical considerations with regard to status disclosure, taking into account the perspectives of the guardians of the HIV positive child, the childcare director of the facility, the other children attending the facility, and the HIV positive child him/herself. Finally, this dissertation will attempt to provide a framework for status disclosure of HIV positive children in childcare settings, with specific reference to the Namibian context.
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    The environmental, recreational and conservational reasoning behind hunters’ preferences and activities in South Africa
    (Stellenbosch : Stellenbosch University, 2020-03) Gramberg-Danielsen, Lillian; Ferreira, Sanette; Stellenbosch University. Faculty of Economic and Management Sciences. African Centre for HIV/AIDS Management.
    ENGLISH SUMMARY : South Africa is one of the most popular hunting destinations in Africa. International as well as local hunters enjoy the country’s diverse landscapes and rich variety of wildlife species. Hunting for meat and trophy hunting – two forms of consumptive tourism – are perceived as appropriate wildlife management tools but both are causing emotional and heated debates between opponents and advocates of hunting. If conducted in an ecological sustainable way, hunting can help to provide the financial means for nature conservation and create job opportunities in rural areas. The opponents of hunting question these potential benefits and they highlight the ethical considerations inherent to the sport. The study aimed to contribute to the academic knowledge on hunting by assessing the geography (the what, where and why) of meat and trophy hunting in South Africa as well as the hunters’ perceptions of and attitudes to their recreational hunting activities and their contributions to wildlife conservation in general. The six research objectives were first to review the appropriate international literature on the history of hunting; the theories on human-environment relationships and pro-environmental behaviour, as well as the constructs and concepts about hunters’ motivations to hunt; available case studies on consumptive wildlife tourism and the different types of hunting; and the link between hunting and conservation. The second objective was to review literature relevant to assessing the larger picture of meat and trophy hunting in South Africa. Third, it sought to create a demographic profile for the local biltong-and-trophy-hunter community in South Africa. Fourth was to question the hunters in which municipalities they live and in which they hunt so as to map the geography of hunters and hunting areas in South Africa. The fifth objective was to assess the environmental, recreational and conservational reasoning behind South African hunters’ hunting preferences, decisions and activities. Last was to assess the hunters’ perceptions of uploading hunting photographs on social media. The study followed a mixed-methods approach. A questionnaire survey was undertaken among members of two South African hunting associations (South African Hunters and Game Conservation Association and the Professional Hunters’ Association of South Africa). One-thousand-four-hundred-and-nine (1409) completed questionnaires were received back. Data were captured and analysed using STATISTICA, Excel and ArcMap. The findings indicated that South African hunters have a high degree of awareness of the environmental problems facing the African continent. Although most of the respondents in the survey exclusively hunt for meat, they do approve of trophy hunting. It was found that the hunters’ concerns revolve around the long-term effects of hunting on the genetic pool of species and the possible unethical nature of hunting. Their approval depends on the type of wildlife hunted and the income generated. The principal hunter-generating areas were Gauteng and Western Cape while the district municipalities receiving the most hunters were Waterberg in Limpopo and Pixley ka Seme in Northern Cape. The most important reasons for hunting were the wish to obtain meat for consumption, to be outdoors and to enjoy the sport of hunting. The possibility to shoot trophy animals was ranked lowest. It was also found that the proponents approve of sharing photographs of hunting trips online but they do not do so for fear of public reaction. Furthermore, respondents with a higher level of education are the most likely to support nature conservation efforts financially. A few limitations were encountered. Questions number 8 and 28 of the questionnaire survey dealt with the origin of the hunters (district municipality) and their hunting destinations (district municipality). These questions were developed as open-ended questions. Unfortunately, some of the respondents did not indicate the exact locations for the district municipalities in which they reside or hunt in. Therefore, the locations of only 659 responses could be pinpointed and used in the mapping of the origins of hunters and their hunting destination. Recommendations include further research on the connection between hunting and social media as well as on the spatio-temporal relationship between hunters and their hunting destinations.
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    Services needed to be offered by HIV counselling and testing (HCT) to counter the factors contributing to the high rate of HIV/AIDS infection among long distance truck drivers
    (Stellenbosch : Stellenbosch University, 2016-03) Tsawe, Nokwazi; Augustyn, J. C. D.; Stellenbosch University. Faculty of Economic and Management Sciences. Dept. of Industrial Psychology. Africa Centre for HIV/AIDS Management.
    ENGLISH ABSTRACT: The issue of HIV epidemic among Long Distance Truck Drivers (LDTD) has become a concern for the South African transport industry. This study reports on a qualitative study that investigated services needed to be offered by HIV Counselling and Testing (HCT) to counter the factors contributing to the high rate of HIV/AIDS infection among long distance truck drivers. Data was collected through focus group discussions. The results revealed the need for HIV intervention programmes to fight the rate of HIV transmission among the long distance truck drivers. It is clear that drivers do have some knowledge about HIV transmission and prevention. However, they do not put the knowledge into practice. Therefore, the study recommends that depots and truck stops wellness centres promote user-friendly approach, and introduce flexible operating hours to ensure accessibility to healthcare services.
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    Perceptions of HIV/AIDS and HIV-related activities among school-going learners : where do we currently stand
    (Stellenbosch : Stellenbosch University, 2014-12) Mukenge, Kapena; Davis, Burt; Stellenbosch University. Faculty of Economic and Management Sciences. Dept. of Industrial Psychology. Africa Centre for HIV/AIDS Management.
    ENGLISH ABSTRACT: This study explored the HIV-related perceptions of school going learners’ (aged between 15 and 18) at a high school in the Western Cape with the objective of identifying possible factors that could improve current HIV-related programs and activities at the school. An explorative cross-sectional design using a structured questionnaire was used to obtain the responses from participants. The findings revealed that most participants had relatively high HIV-related knowledge levels. However, when asked about the ‘window period’, many of the respondents were unsure what was meant by this term. Participants had overall optimistic beliefs around condom use. Yet, many believed their peers do not make use of condoms when engaging in sexual activities. This warrants further investigation. Based on the general positive findings on their beliefs around condom availability in school, it is suggested that condoms should be made available at the school. Participants also had positive intentions toward encouraging their friends to use condoms as well using condoms themselves should they have sex. Respondents’ perceived effectiveness of the sex education and HIV awareness programme at the school were generally encouraging. It is recommended that the current school programme to be expanded to include younger learners.