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Background: Systemic lupus erythematosus (SLE) is a life-threatening, chronic, autoimmune disease requiring long term subspecialty care due to its complex and chronic nature. Childhood-onset SLE (cSLE) is more severe than adult-onset, and the cSLE population in South Africa has been reported to have an even higher risk than patients elsewhere. Therefore, it is critical to promptly diagnose, treat, and manage cSLE. In this paper, we aim to describe and evaluate barriers and enablers of appropriate long-term care of cSLE South Africa from the perspective of caregivers (parents or family members). Methods: Caregivers (n = 22) were recruited through pediatric and adult rheumatology clinics. Individuals were eligible if they cared for youth (≤ 19 years) who were diagnosed with cSLE and satisfied at least four of the eleven ACR SLE classification criteria. Individual in-depth, semi-structured interviews were conducted between January 2014 and December 2014, and explored barriers to and facilitators of ongoing chronic care for cSLE. Data were analyzed using applied thematic analysis. Results: Four barriers to chronic care engagement and retention were identified: knowledge gap, financial burdens, social stigma of SLE, and complexity of the South African medical system. Additionally, we found three facilitators: patient and caregiver education, robust support system for the caregiver, and financial support for the caregiver and patient. Conclusion: These findings highlight multiple, intersecting barriers to routine longitudinal care for cSLE in South Africa and suggest there might be a group of diagnosed children who don't receive follow-up care and are subject to loss to follow-up. cSLE requires ongoing treatment and care; thus, the different barriers may interact and compound over time with each follow-up visit. South African cSLE patients are at high risk for poor outcomes. South African care teams should work to overcome these barriers and place attention on the facilitators to improve care retention for these patients and create a model for other less resourced settings. [ABSTRACT FROM AUTHOR]

Background: Electronic clinical decision-making support systems (eCDSS) aim to assist clinicians making complex patient management decisions and improve adherence to evidence-based guidelines. Integrated management of Childhood Illness (IMCI) provides guidelines for management of sick children attending primary health care clinics and is widely implemented globally. An electronic version of IMCI (eIMCI) was developed in South Africa. Methods: We conducted a cluster randomized controlled trial comparing management of sick children with eIMCI to the management when using paper-based IMCI (pIMCI) in one district in KwaZulu-Natal. From 31 clinics in the district, 15 were randomly assigned to intervention (eIMCI) or control (pIMCI) groups. Computers were deployed in eIMCI clinics, and one IMCI trained nurse was randomly selected to participate from each clinic. eIMCI participants received a one-day computer training, and all participants received a similar three-day IMCI update and two mentoring visits. A quantitative survey was conducted among mothers and sick children attending participating clinics to assess the quality of care provided by IMCI practitioners. Sick child assessments by participants in eIMCI and pIMCI groups were compared to assessment by an IMCI expert. Results: Self-reported computer skills were poor among all nurse participants. IMCI knowledge was similar in both groups. Among 291 enrolled children: 152 were in the eIMCI group; 139 in the pIMCI group. The mean number of enrolled children was 9.7 per clinic (range 7-12). IMCI implementation was sub-optimal in both eIMCI and pIMCI groups. eIMCI consultations took longer than pIMCI consultations (median duration 28 minutes vs 25 minutes; p = 0.02). eIMCI participants were less likely than pIMCI participants to correctly classify children for presenting symptoms, but were more likely to correctly classify for screening conditions, particularly malnutrition. eIMCI participants were less likely to provide all required medications (124/152; 81.6% vs 126/139; 91.6%, p= 0.026), and more likely to prescribe unnecessary medication (48/152; 31.6% vs 20/139; 14.4%, p = 0.004) compared to pIMCI participants. Conclusions: Implementation of eIMCI failed to improve management of sick children, with poor IMCI implementation in both groups. Further research is needed to understand barriers to comprehensive implementation of both pIMCI and eIMCI. (349) Clinical trials registration: Clinicaltrials.gov ID: BFC157/19, August 2019. [ABSTRACT FROM AUTHOR]

We assess site-specific surface shortwave radiation forecasts from two high-resolution configurations of the South African Weather Service numerical weather prediction model, at 4 and 1.5 km. The models exhibit good skill overall in forecasting surface shortwave radiation, with zero median error for all radiation components. This information is relevant to support a growing renewable energy sector in South Africa, particularly for photovoltaics. Further model performance analysis has shown an imbalance between cloud and solar radiation forecasting errors. In addition, cloud overprediction does not necessarily equate to underestimating solar radiation. Overcast cloud regimes are predicted too often with an associated positive mean radiation bias, whereas the relative abundance of partly cloudy regimes is underpredicted by the models with mixed radiation biases. Challenges highlighted by the misrepresentation of partly cloudy regimes in solar radiation error attribution may be used to inform improvements to the numerical core, namely, the cloud and radiation schemes. Significance Statement: This paper provides the first comprehensive assessment of high-resolution site-specific NWP forecasts of surface shortwave radiation in South Africa, exploring clouds as the main drivers of prediction biases. Error attribution analyses of this kind are close to none for this part of the world. Our study contributes to understanding how cloud and radiation schemes perform over South Africa, representing a step forward in the state of the art. In addition to the scientific interest, the capabilities developed through this work may benefit the second largest economy of the continent. In a country where energy security is of critical relevance, the availability of useful and usable weather information is paramount to support its industry and socioeconomic growth. [ABSTRACT FROM AUTHOR]

This paper revisits the literature on regional power-hood and its application to Africa with a view to answering two key questions: one, whether we can talk of regional hegemons in the continent in real terms, and two, whether group hegemonic leadership better explains regional hegemonic behavior in Africa. It uses Sandra Destradi conceptual framework and Miriam Prys' typology of regional power-hood to answer these questions, with South Africa and Nigeria as case studies. Using Prys' typology which distinguishes between regional detached powers, regional hegemons and regional dominators as an analytical framework, the paper confirms what already exists in the literature, viz. that neither South Africa nor Nigeria neatly fit the conception of regional hegemons in Africa. However, it uses both countries as empirical cases to argue that they already act as hegemonic leaders and in cooperative ways that suggest group or shared leadership, using specific Common African Positions they have led in Africa. The analysis concludes by laying out the normative basis for a Group Hegemony composed of not only South Africa and Nigeria, but also other sub-regional leaders in the continent. This is based on the hard power shortfalls and internal weaknesses of both our case studies including their relative soft power resources which have utility in an increasingly intersocial international system. [ABSTRACT FROM AUTHOR]

This paper lies at the intersection of discussions surrounding digitally mediated research methods and transnational research projects. It contributes to the current methodological debate surrounding online interviewing by focusing on tensions and affordances involved in Skype-to-phone interviewing in a transnational research context. While the Skype-to-phone facility does indeed increase further access to global participants, complex power hierarchies and ethical concerns continue to exist in relation to technological access/infrastructure, research governance regimes in different places and interpersonal research relations. We, therefore, propose that online researchers involved in transnational research projects using Skype methods move towards consideration of multiple competing constituencies and diverse social and spatial connectivities and power hierarchies in which they are researching. These social differences and spatial registers are not swept away through research conducted in a uniform virtual digital environment; rather transnational researchers must make explicit the multiple place-based contexts of their digitally mediated research, as they shape the research process in distinct ways. Thus, specific consideration must be given to ethical concerns that emanate from transnational online research. [ABSTRACT FROM AUTHOR]

Introduction: Hip arthroplasty and revision surgery are growing exponentially in OECD countries. In developing countries, it is an infrequent intervention and its practice is limited. It is exposed to a higher rate of infectious and mechanical failures than in developed countries. The aim of the actual study is to provide a review of the literature on total hip arthroplasty series in sub-Saharan Africa followed by an overview of the interest and perspectives of the use of dual mobility (DM) cups. Materials and methods: Scopus, EMBASE, Medline, PubMed, and Safoonline databases were searched including papers published at any date. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines were followed. All papers from South Africa were excluded. Results: We identified 22 series of total hip arthroplasty in 14 SSA countries. The practice of total hip arthroplasty is not very widespread. The cups used are mostly conventional implants, and complications (mechanical and infectious) are frequent. Discussion: The interest for the use of dual mobility cups in sub-Saharan Africa can be summarized in two points: mechanical and socio-economical. Dual mobility cups provide more mechanical stability and a reduction in the overall cost of treatment by reducing the rate of complications. These prospects will make it possible to evaluate this medical device in the long term in a hostile environment conductive to complications. Conclusion: The use of dual mobility deserves to be developed in African settings. [ABSTRACT FROM AUTHOR]

Archaeological explorations of the meaning of 'trade objects', such as glass beads and cowrie shells, remain hampered by theoretical and methodological limitations in both their analyses and interpretations. In this paper, we develop a methodology for critically engaging in multi-scalar questions of the circulation, exchange, and value of cowrie shells in African archaeological contexts. Species, size, dorsal modifications, and depositional contexts were compared across five sites from South Africa dating between 750 and 1350 CE. These results were positioned within a review of cowries from archaeological sites in the region and compared to the documented distribution of cowries from wider African archaeological contexts. Monetaria annulus were the prevalent cowrie species in southern African archaeological contexts over the last 2000 years, with a notable absence of Monetaria moneta, prevalent at contemporaneous sites in West Africa, as well as a variety of endemic southern African species. Breakage patterns on the dorsal surface correspond to different modification techniques, such as chipping and grinding. Combined analyses of modification, use-wear, and depositional patterns show variation, revealing a diversity in the biographies of individual cowries. While a comparison of the distribution of cowries across the continent confirms the circulation of cowries through known trade routes, such as the trans-Saharan trade network and the European mercantile network, they also reveal new pathways for exchange that highlight the need for further exploration of intra African networks. Finally, the breadth of the results of this study demonstrates the value of a focus on a specific artefact to address a wide range of themes, from exchange to the archaeology of everyday life. [ABSTRACT FROM AUTHOR]

One of the most valuable features of Capital and Ideology is its concern to take history seriously and consider how the emergence of different political and economic regimes relate to discourses about fairness and justice across time. This paper pushes this agenda further by acknowledging that the experience of a few developed nations should not be taken as the template for the generalized study of inequality dynamics across time and space. In this paper, we interrogate Piketty's analysis and policy proposals against specificities that are central to understanding the production and reproduction of inequalities within South Africa. We reflect on the South African case, the structure of inequality and its changes since 1994. We review a battery of policy interventions that have been implemented to address inequality in the last 25 years. We emphasize that the long shadow cast by centuries of colonialism and various forms of apartheid strongly affirm Piketty's emphasis on understanding history. But this is both affirmation and critique given the foundational, imbedded impact that this specific legacy has had on post‐apartheid society and its policies. Piketty is aware that the levels of inequality in South Africa are so high that this is "unknown territory." We map out some of this territory to reveal how these extreme initial wealth and racial inequities inform the reproduction of inequalities in all dimensions and undermine well intentioned policies. We claim that understanding extractive histories, imbedded wealth inequalities, and complex social and political institutions allows us to understand and confront some of the reasons why even in light of progressive policies, many of which are in line with the proposals from Piketty, government interventions have thus far failed to reduce inequality. [ABSTRACT FROM AUTHOR]

This paper profiles research on housing policy in Africa and evaluates its scale and quality. Using databases developed from Scopus, we reviewed papers on housing policy research from 1989 to 2018, in Africa and in South Africa in particular. We found a steady increase in the number of papers. The disciplines that have contributed most are geography, health-related disciplines, planning, development studies and economics, in that order, and there has been a shift towards disciplines with a more applied focus. Most researchers had not been involved in housing policy research for very long, apart from some in South Africa. We did not find strong research links between the rest of Africa and South Africa. A large proportion of researchers in the rest of Africa were affiliated to institutions outside Africa, unlike South Africa, which had more local affiliation. We argue that, despite room for improvement, it is understandable that the research mainly reflects the housing reality on the ground rather than analysing it theoretically, given the need to draw African governments' notice to the continent's severe housing problems and the need to develop implementable African housing policy. [ABSTRACT FROM AUTHOR]

Objectives: HIV virological failure remains a major threat to programme success in sub‐Saharan Africa. While HIV drug resistance (HIVDR) and inadequate adherence are the main drivers of virological failure, the individual, clinical and health system characteristics that lead to poor outcomes are not well understood. The objective of this paper is to identify those characteristics among people failing first‐line antiretroviral therapy (ART). Methods: We enrolled a cohort of adults in HIV care experiencing virological failure on first‐line ART at five sites and used standard statistical methods to characterize them with a focus on three domains: individual/demographic, clinical, and health system, and compared each by country of enrolment. Results: Of 840 participants, 51% were women, the median duration on ART was 3.2 years [interquartile range (IQR) 1.1, 6.4 years] and the median CD4 cell count prior to failure was 281 cells/µL (IQR 121, 457 cells/µL). More than half of participants [53%; 95% confidence interval (CI) 49–56%] stated that they had > 90% adherence and 75% (95% CI 72–77%) took their ART on time all or most of the time. Conversely, the vast majority (90%; 95% CI 86–92%) with a completed genotypic drug resistance test had any HIV drug resistance. This population had high health system use, reporting a median of 3 (IQR 2.6) health care visits and a median of 1 (IQR 1.1) hospitalization in the preceding 6 months. Conclusions: Patients failing first‐line ART in sub‐Saharan Africa generally report high rates of adherence to ART, have extremely high rates of HIV drug resistance and utilize significant health care resources. Health systems interventions to promptly detect and manage treatment failure will be a prerequisite to establishing control of the HIV epidemic. [ABSTRACT FROM AUTHOR]

In this paper, three topics concerning the genus Fissidens Hedw. are addressed. Firstly, description of five new species of the genus, viz. the Malagasy Fissidens arboricola Brugg.-Nann. and F. granulidens Brugg.-Nann., the Mauritian F. papillisetus Brugg.-Nann., the Tanzanian F. rotundifolius Brugg.-Nann. and the Brazilian F. pseudoscindulatus Brugg.-Nann. All five belong to F. subgen. Polypodiopsis (Müll. Hal.) Broth. sect. Antennidens (Müll.Hal.) Paris, are corticolous and have anomalous peristomes. Secondly, taxonomic studies revealed that F. subgen. Aloma (Kindb.) Pursell & Brugg.-Nann. is subsumed under F. subgen. Polypodiopsis (Müll.Hal.) Broth. and F. sect. Semilimbidium Müll.Hal. under sect. Antennidens (Müll.Hal.) Paris and their names are considered new synonyms of the names of the respective infrageneric taxa. Fissidens jonesii Bizot ex Pócs, previously considered conspecific with F. lagenarius Mitt. is re-instated as a good species, described, illustrated and compared to F. lagenarius. Thirdly, Fissidens lagenarius is newly recorded for the Republic of South Africa and its African distribution is amended and updated, with consideration of the revised taxonomic concept of F. jonesii. [ABSTRACT FROM AUTHOR]

Chinese migration to Africa has been limited both in size and scope until relatively recently. It was only in the late 1990s and the 2000s that significant numbers of Chinese migrants began arriving in Africa, with the first significant waves hitting South African shores. Chinese entrepreneurs, fortune seekers, and professionals, together with temporary workers – from across China – made their way in increasing numbers to destinations across the African continent. Many entered Africa with or following Chinese state-owned and private companies, on contracts to work on construction, oil, and mining projects. Beyond these large state-sponsored and private-sector projects, reports of the development of Chinatowns, Chinese shops, and Chinese farms and factories across the African continent have been circulating for nearly three decades. This paper examines these new, intensified Chinese flows to Africa and explores the possibilities of their future on the continent. Based on my in-depth examination of developments in South Africa, I argue that while the Chinese state's global ambitions and African ambivalence towards these latest arrivals influence Chinese migrant lives and destinies, the migrants themselves are also having impacts on their African host nations and changing the way we understand human flows. [ABSTRACT FROM AUTHOR]

The Joint Africa–EU Strategy (JAES, 2007), aimed to break with the traditional donor-recipient relationship between the EU and Africa and to develop a true partnership. This paper investigates whether the JAES has succeeded in this aim. Particularly, it focuses on the principle of equality, defined as a situation where the more powerful partner does not impose its will on the less powerful partner. Empirically, it investigates the thematic partnerships on peace and security and democratic governance and human rights. Based on a review of primary and secondary literature and 32 expert interviews, the paper argues that the EU has overall treated its African counterparts as equal partners in these thematic partnerships, namely by respecting ownership and jointly deciding on what to discuss in the partnership. Nonetheless, divergences based on differences in interests and values have in some cases led to the perception from African partners that the EU did not treat them as equals. [ABSTRACT FROM AUTHOR]

Proper records management is central to the promotion of good governance. Africa is a continent which has generally been riddled with poor governance. Principles of good governance such as accountability, transparency and the rule of law are ascertained with available records. Poor records management practices promote bad economic practices such as corruption and fraud. An assessment of the performance of government can thus be realised through proper records management and access to information. Good records management practices therefore lead to good governance and vice versa; thus, the role of records management in promoting good governance cannot be overemphasised. However, there are some likely impediments that may hinder the promotion of good governance through records management in the African context. This paper explored the role played by records management in ensuring good governance in Africa. It then suggests strategies to promote good governance through proper records management practices. The paper contends that outdated archival laws, backlog of unprocessed records and absence of access to information laws in some African countries are the major impediments to the promotion of good governance. The paper recommends an amendment of outdated laws and the promulgation of access to information legislation as major initiatives, among others, which put records management in the forefront of promoting good governance in the continent. [ABSTRACT FROM AUTHOR]

Effective knowledge sharing and community engagement can be major enablers in the pursuit of socially relevant benefits from ecological restoration and rehabilitation. Focusing on two ecological restoration and rehabilitation practitioner organizations and their workers, this paper evaluates perceptions of the extent to which short‐term knowledge exchange contributes to social goals in ecological restoration and rehabilitation in South Africa through (1) stakeholder engagement and awareness of community well‐being, and (2) knowledge enrichment. Data collected through impact questionnaires, participatory site visits, practical work exchange, focus group discussions, and a workshop are analyzed using thematic analysis framed by the International Principles and Standards for the Practice of Ecological Restoration #1 and #2. We explore participants' perceptions of knowledge exchange benefits and discuss implications for future collaboration in establishing long‐term knowledge exchange. Findings show that knowledge exchange is perceived to result in enhanced teamwork engagement, and strengthened knowledge on restoration techniques through mutual learning, inspiration, and a strengthened sense of community. Findings suggest that sustained knowledge exchange and engagement activities between different practitioner organizations is key to realize and transform short‐term perceived benefits into long‐term applied socioecological impacts across landscapes in dryland Africa. There is a need to progress from short‐term, horizontal learning, to long‐term (horizontal and vertical) knowledge exchange, to inform restoration project design and implementation. [ABSTRACT FROM AUTHOR]

With the public frenzy over Thabo Mbeki's speech, "I am an African" that was delivered in 1996, South Africa has since become a subject of debate as to who is an African and what constitutes as African. This has been going on for almost two decades and a half now. Mbeki's speech appears to have evoked solemn questions relating to the issues of identity and culture. Subsequent to that speech, the South African public began to question what it meant to be African. The central point of enquiry was: what makes one an African? Is it the color of their skin? Their citizenship? Or is one merely an African because others regard him or her as such? These and many other questions arise when one touches upon the subject of Africans. These perplexing questions, however, are not only unique to the South African context; they apply, to some extent, to the general continent of Africa. With talks and debates about African renaissance, decoloniality, and indigenization, the question of African identity and culture resurfaces. Here, the discussion hubs around the issue of African persona and what it means to be authentically African. By means of document analysis, this paper critically employs a philosophical approach in order to grapple with the subject of identity and culture. This is done through a systematic discussion of the following facets: (a) history, (b) identity, and (c) culture. These three facets are therefore critically engaged in order to establish what constitute an African and what can be characterized as an African identity. [ABSTRACT FROM AUTHOR]

Given the socioeconomic and health security ramifications of the COVID-19 sickness since the beginning of the year 2020, the discovery of vaccinations has been a huge breakthrough. The international community and national governments' common commitment to preserve citizens' right to the greatest attainable health standards have fuelled the urgent need for vaccine development. Even though any COVID-19 vaccination should be seen as a global public good, the African continent has lagged in the dissemination of COVID-19 vaccines. The human rights implications of the COVID-19 vaccination roll-out on the African continent are examined in this research, which is based on secondary data sources and focuses on Zimbabwe and South Africa, two neighbouring Southern African countries. The research demonstrates that the African continent is confronted with a slew of concerns, including vaccine accessibility, price, and transparency. The paper also reveals a conflict that has arisen between governments' recommendations that everyone is vaccinated to protect all members of society and the freedom of some members of society to interpret the vaccine through the lens of their religious and cultural beliefs, including their freedom to express their beliefs and choose whether or not to be vaccinated. This circumstance is providing and will continue to pose a significant challenge for African governments in their efforts to implement mass immunization. [ABSTRACT FROM AUTHOR]

Background: Large numbers of young people die yearly due to homicide, but little is known about homicide during adolescence. Research primarily focuses on youth violence among young men and masks important gender-related factors inherent in the adolescent age group. Although young women are less likely to be victims of homicide, violence against women is an important form of violence experienced during adolescence. In this paper, we describe the prevalence of and gender difference in adolescent homicide in South Africa in 2009. Methods: We conducted a retrospective national mortuary-based study to identify all child homicides (boys and girls < 18 years) in 2009 in a proportionate sample of mortuaries. Victim, perpetrator and crime data were collected in three phases: cases were identified from the mortuary register, the autopsy report and from police interviews. In this paper we focus on the adolescent group, aged 10 to 17 years. Findings: We identified 674 (95% CI: 520–823) adolescent homicides for 2009, with more male (520) than female (154) homicides. This gender disparity increased as children aged, with the male homicide rate 27.9/100 000 population (95% CI: 20.3–35.5), nearly 5 times the female rate (4.5:1) of 6.5/ 100 000 population (95% CI: 4.7–8.2) in older adolescents (15–17 year old). Adolescent males were significantly more likely (61.2%) to die in a public space compared to female adolescents (39.3%) but more adolescent females (48.4%) died at home compared to adolescent males (32.9%). Adolescent females (42.1%) were mainly killed by a family member or intimate partner while adolescent males were predominantly (58%) killed by an acquaintance. Conclusion: We found a distinct gender pattern for adolescent homicide in South Africa. This pattern appears to be driven by gender norms that support violence. South Africa requires an investment in developing evidence informed interventions to reduce violence. [ABSTRACT FROM AUTHOR]

Background: In economic analyses of HIV interventions, South Africa is often used as a case in point, due to the availability of good epidemiological and programme data and the global relevance of its epidemic. Few analyses however use locally relevant cost data. We reviewed available cost data as part of the South African HIV Investment Case, a modelling exercise to inform the optimal use of financial resources for the country’s HIV programme. Methods: We systematically reviewed publication databases for published cost data covering a large range of HIV interventions and summarised relevant unit costs (cost per person receiving a service) for each. Where no data was found in the literature, we constructed unit costs either based on available information regarding ingredients and relevant public-sector prices, or based on expenditure records. Results: Only 42 (5%) of 1,047 records included in our full-text review reported primary cost data on HIV interventions in South Africa, with 71% of included papers covering ART. Other papers detailed the costs of HCT, MMC, palliative and inpatient care; no papers were found on the costs of PrEP, social and behaviour change communication, and PMTCT. The results informed unit costs for 5 of 11 intervention categories included in the Investment Case, with the remainder costed based on ingredients (35%) and expenditure data (10%). Conclusions: A large number of modelled economic analyses of HIV interventions in South Africa use as inputs the same, often outdated, cost analyses, without reference to additional literature review. More primary cost analyses of non-ART interventions are needed. [ABSTRACT FROM AUTHOR]

Background: Tuberculosis (TB) incidence in South Africa is among the highest globally. Initial loss to follow-up (ILFU), defined as not starting on TB treatment within 28 days of testing positive, is undermining control efforts. We assessed the feasibility, acceptability, and potential of a mHealth application to reduce ILFU. Methods: An mHealth application was developed to capture patients TB investigation data, provide results and monitor treatment initiation. This was implemented in two primary health clinics (PHC) in inner-city Johannesburg. Feasibility was assessed by comparing documentation of personal details, specimen results for same individuals during implementation period (paper register and Mhealth application). Effectiveness was assessed by comparing proportion of patients with results within 48 hours, and proportion started on treatment within 28 days of testing TB positive during pre- implementation (paper register) and implementation (mHealth application) periods. In-depth interviews with patients and providers were conducted to assess acceptability of application. Results: Pre-implementation, 457 patients were recorded in paper registers [195 (42.7%) male, median age 34 years (interquartile range IQR (28–40), 45 (10.5%) sputum Xpert positive]. During implementation, 319 patients were recorded in paper register and the mHealth application [131 (41.1%) male, median age 32 years (IQR 27–38), 33 (10.3%) sputum Xpert positive]. The proportion with complete personal details: [mHealth 95.0% versus paper register 94.0%, (p = 0.54)] and proportion with documented results: [mHealth 97.4% versus paper register 97.8%, (p = 0.79)] were not different in the two methods. The proportion of results available within 48 hours: [mHealth 96.8% versus paper register 68.6%), (p <0.001)], and the proportion on treatment within 28 days [mHealth 28/33 (84.8%) versus paper register 30/44 (68.2%), (p = 0.08)] increased during implementation but was not statistically significant. In-depth interviews showed that providers easily integrated the mHealth application into routine TB investigation and patients positively received the delivery of results via text message. Time from sputum collection to TB treatment initiation decreased from 4 days (pre-implementation) to 3 days but was not statistically significant. Conclusions: We demonstrated that implementation of the mHealth application was feasible, acceptable to health care providers and patients, and has potential to reduce the time to TB treatment initiation and ILFU in PHC settings. [ABSTRACT FROM AUTHOR]

This paper maps out the shifting and restrictive nature of immigration laws on the wives of resident Indians moving to South Africa. The turn of the century witnessed a gradual entry of women seeking to join their spouses in South Africa. However, on arrival some discovered that they were ‘prohibited’ immigrants, as Indian customary marriages came under intense scrutiny from immigration officials, Appeal Boards and courts. This paper argues that immigration and judicial officials, at times, became a law unto themselves by becoming official gatekeepers determining who was really a ‘wife’ and who could therefore enter the country. It shows how immigration officials, through a system of documentation and verification procedures, carefully scrutinised and monitored the entry of resident Indian wives into the Union. Thus, ‘what is the meaning of the word “wife”’ became a highly contested and complex issue at the turn of the century. The shifting and restrictive nature of immigration laws limited citizenship rights to resident Indian wives. This article adds to current debates on gender and citizenship in historical migrations amongst non-indentured, free Indian women immigrants to South Africa - a topic that is yet to be fully explored. [ABSTRACT FROM AUTHOR]

Adolescents and youth with disabilities in South Africa still lack access to sexual and reproductive health and rights services including comprehensive sexuality education, which may increase their vulnerability to SRHR issues such as HIV and sexual violence. This is exacerbated for learners with intellectual disabilities whose educators often lack skills and tools to accommodate these learners in comprehensive sexuality education lessons. The following paper outlines the findings of a formative evaluation of an innovative sexuality training approach for educators of learners with diverse disabilities (Breaking the Silence approach). This approach was developed and piloted with educators across eight schools for learners with intellectual disabilities in KwaZulu-Natal, South Africa. The paper discusses the educators’ understanding and experiences of using this approach. The findings revealed that although educators were able to implement parts of the approach, contextual factors impacted the degree of implementation. These factors were related to perceptions of socio-cultural norms, interpersonal engagement with peers and management, the structural environment of school settings, and the wider community setting. Educators began to address cultural taboos related to talking about sexuality, but were challenged by untrained staff and the larger socio-cultural context, which includes a heighted risk of sexual violence against their learners. The paper concludes with recommendations for a further investigation of the approach within a whole school setting considering the needs of educators to not only acquire skills and knowledge but also to address their larger socio-cultural context in which they have to implement comprehensive sexuality education. [ABSTRACT FROM AUTHOR]

Climate change is arguably one of the biggest challenges globally. In order for countries to meet the commitments of the Paris Agreement, climate investments need to be scaled up for adaptation and mitigation strategies. Green bonds are one of the most emerging climate finance mechanisms for large-scale climate projects and offer investment opportunities for many developing countries. Most developing countries are heavily reliant on climate funds which are insufficient. Hence, the urgent need to tap into emerging climate finances such as green bonds. Out of all the regions, Africa is expected to be the worst impacted by climate change and green bonds can contribute to the much needed climate finances. The growth of the green bond market has been observed in the economic hubs of the continent with countries such as Kenya, Nigeria and South Africa demonstrating huge potential in being active and contributing to the growth of the market. However, this paper recommends that for the green bond market to further expand in these countries and rest of the continent, there needs to be public–private partnerships fostered, integrated policies, political will as well as effective institutional frameworks. [ABSTRACT FROM AUTHOR]

Background: We sought to describe linkage to care, ART continuity, and factors associated with linkage to care among people with HIV following release from incarceration in South Africa.Methods: We conducted a study of South African correctional service community reentrants who were receiving ART at the time of release. The study was implemented in three of 46 correctional service management areas. Participants were enrolled prior to corrections release and followed up to 90 days post-release to obtain self-reported linkage to care status and number of days of ART provided at corrections release. Clinic electronic and paper charts were sought and abstracted to verify self-reported linkage to care. Log-binomial regression, adjusted for facility, was used to identify associations with post-release linkage to care (self-reported and verified). We sought to specifically assess for associations with HIV diagnosis during index incarceration, ART initiation during index incarceration, and duration of incarceration.Results: From May 2014 to December 2016, 554 inmates met eligibility and 516 (93%) consented to participate; 391 were released on ART, 40 of whom were excluded from analysis post-release. Of the remaining 351, 301 (86%) were men and the median age was 35 years (interquartile range 30, 40). Linkage to care was self-reported by 227 (64%) and linkage to care could be verified for 121 (34%). At most, 47% of participants had no lapse in ART supply. Initiating ART during the index incarceration showed a trend toward increased self-reported post-release linkage to care. Age > 35 years was associated with increased verified linkage to care while HIV diagnosis outside of a correctional setting and ART initiation during the index incarceration showed trends toward association with increased verified linkage to care.Discussion: The results of our study are the first description of retention in care following correctional facility release from an African setting and indicate high levels of attrition during the transition from correctional facility to community care. Initiating ART within a correctional facility did not impair post-release linkage to care. [ABSTRACT FROM AUTHOR]

TB is rated as one of the world’s deadliest diseases and South Africa ranks 9th out of the 22 countries with hardest hit of TB. Although many pieces of research have been carried out on this subject, this paper steps further by inculcating past knowledge into the model, using Bayesian approach with informative prior. Bayesian statistics approach is getting popular in data analyses. But, most applications of Bayesian inference technique are limited to situations of non-informative prior, where there is no solid external information about the distribution of the parameter of interest. The main aim of this study is to profile people living with TB in South Africa. In this paper, identical regression models are fitted for classical and Bayesian approach both with non-informative and informative prior, using South Africa General Household Survey (GHS) data for the year 2014. For the Bayesian model with informative prior, South Africa General Household Survey dataset for the year 2011 to 2013 are used to set up priors for the model 2014. [ABSTRACT FROM AUTHOR]

This paper draws felicity from approaching the question of the idea of an African university through probing it from the vantage point of the imagination and its antecedent in the imaginary. Taken as such, the imaginary is that which enables us to be taken up in certain imaginative relations as to how we are predisposed to understand, interpret and take positions which in respect of our purposes are about how we might relate, in the context of Africa, to the Western, Modern "idea of the university". Concretely, it means developing an argument which engages with the Western, Modern idea of the university in its sociohistorical contexts, in this instance, Europe and Africa, to consider ways in which this idea of the university pivots around its social and epistemic imaginaries. It is contended that the over-determination of the social vis-à-vis the epistemic signals the shift from foregrounding the classical Western, Modern "idea of the university", i.e. an epistemic imaginary in pursuit of knowledge for knowledge sake to a transformative idea of the university, i.e. its social imaginary. In this shift the argument is made for the university as critical institutional site for extending the emergence of radical imaginaries and thus for its relevance in nurturing the radical imaginations in pursuit of the "idea of the African University" and what might be encompassed in such a critical reimagining. [ABSTRACT FROM AUTHOR]

Introduction: HIV self-testing (HIVST) offers a useful addition to HIV testing services and enables individuals to test privately. Despite recommendations to the contrary, repeat HIV testing is frequent among people already on anti-retroviral treatment (ART) and there are concerns that oral self-testing might lead to false negative results. A study was conducted in Khayelitsha, South Africa, to assess feasibility and uptake of HIVST and linkage-to-care following HIVST. Methods: Participants were recruited at two health facilities from 1 March 2016 to 31 March 2017. People under 18 years, or with self-reported previously-diagnosed HIV infection, were excluded. Participants received an OraQuick Rapid HIV-1/2 Antibody kit, and reported their HIVST results by pre-paid text message (SMS) or by returning to the facility. Those not reporting within 7 days were contacted by phone. Electronic and paper-based clinical and laboratory records were retrospectively examined for all participants to identify known HIV outcomes, after matching for name, date of birth, and sex. These findings were compared with self-reported HIVST results where available. Results: Of 639 participants, 401 (62.8%) self-reported a negative HIVST result, 27 (4.2%) a positive result, and 211 (33.0%) did not report. The record search identified that of the 401 participants self-reporting a negative HIVST result, 19 (4.7%) were already known to be HIV positive; of the 27 self-reporting positive, 12 (44%) were known HIV positive. Overall, records showed 57/639 (8.9%) were HIV positive of whom 39/57 (68.4%) had previously-diagnosed infection and 18/57 (31.6%) newly-diagnosed infection. Of the 428 participants who self-reported a result, 366 (85.5%) reported by SMS. Conclusions: HIVST can improve HIV testing uptake and linkage to care. SMS is acceptable for reporting HIVST results but negative self-reports by participants may be unreliable. Use of HIVST by individuals on ART is frequent despite recommendations to the contrary and its implications need further consideration. [ABSTRACT FROM AUTHOR]

Introduction: In many sub-Saharan African countries, confronting the dual epidemic of HIV and NCDs is a public health priority especially in high HIV burden countries such as South Africa. Evidence shows that poor health as a consequence of NCDs and HIV among the workforce increases absenteeism and leads to decrease in productivity. However, the prevalence of these co-occurring chronic conditions and associated factors is unknown in the educator workforce. Improved understanding has implications for their management and wellbeing of educators. This paper reports the prevalence of selected NCDs and associated factors among HIV positive educators in South Africa using the 2015/6 survey of Educators in Public Schools in South Africa. Methods: This was a second-generation surveillance undertaken among educators in selected public schools in all nine provinces in South Africa. A multi-stage stratified cluster design with probability proportional to size sampling was used to draw a random sample of schools. Factors associated with presence of NCDs were determined using a multivariate backward stepwise logistic regression analysis. Results: A total of 1 365 schools were sampled within which 21 495 (85.5%) educators were interviewed. Out of 2691, HIV Positive educators that responded to the questions on NCDs, 36.9% reported having NCDs. The most commonly reported NCDs were high blood pressure (17.4%), and stomach ulcers (13.5%). The increased odds of reporting the presence of NCDs was significantly associated with being female than male [aOR = 1.5: 95% CI (1.1–1.9), p<0.002], age 45 to 54 years [aOR = 1.8: 95% CI (1.4–2.2), p = p<0.001], and age 55 years and older than those 18 to 24 years [aOR = 2.7: 95% CI (1.8–3.9), p<0.001). The decreased odds of reporting the presence of NCDs was significantly associated with not being absent from school for health reasons [aOR = 0.7: 95% CI (0.6–0.9), p = 0.003]. Conclusion: NCDs care and active screening should be an integral part of HIV programmes including interventions such as prevention, treatment, care and support amongst public school educators in SA. The education department will need to invest in health promotion intervention programmes to prevent and mitigate the negative impact of NCDs and HIV on the sector. [ABSTRACT FROM AUTHOR]

For many African countries, the structure of the economy is still tilted towards agriculture and agro-allied industries. In recent times, investment in agriculture is being championed as one of the key routes to bolstering African economies, providing jobs for the burgeoning youthful population, and lifting many Africans out of poverty. However, the form of agriculture that will deliver these lofty goals (ambitious outcomes) cannot rely on the typical way agriculture has been, and is being practised, in many parts of Africa. It will have to draw heavily on locally relevant, sound science based, and well adopted agricultural research and innovations, tailored to African contexts. In this paper, drawing from the outputs of a foresight workshop by African agricultural experts, we explored the plausible futures of agricultural research and innovations in Africa. In the end, four future scenarios of African agricultural research and innovations derived from the combination of dominant drivers as conceived by African experts are presented. [ABSTRACT FROM AUTHOR]

This paper is a response to the growing reference to archaeological evidence by linguists and geneticists interested in the spread of early farmers and pastoralists in southern Africa. It presents two databases. The first contains the archaeological evidence for pastoralism and farming in southern Africa, for the period 550 BC to AD 1050. This is the first time that the seven different types of archaeological evidence that have traditionally been used to identify both spread events are presented together at this scale. This was stimulated by our interest in investigating the antiquity of an early ‘Iron Age package’ relative to the spread of single archaeological traits. The analysis shows that the package appears approximately 700 years after sites containing pottery, cattle and sheep, without agriculture, appear in the drier parts of the sub-continent. It post-dates the appearance of earlier sites with pottery associated with farmers, metal-working and cultivation in the eastern half of the sub-continent. While poor preservation undoubtedly explains the absence of some parts of the package, the analysis suggests that other explanations should be considered. The second database is a quantitative, spatial study of archaeological publications on southern African farming and pastoralism for the period 1950 to 2016, covering the same geographical area and archaeological timeframe. This is presented as a proxy for research-intensive areas in attempt to show the gaps in archaeological fieldwork and knowledge. [ABSTRACT FROM AUTHOR]

Background: Operational research is required to design delivery of pre-exposure prophylaxis (PrEP) and early antiretroviral treatment (ART). This paper presents the primary analysis of programmatic data, as well as demographic, behavioural, and clinical data, from the TAPS Demonstration Project, which offered both interventions to female sex workers (FSWs) at 2 urban clinic sites in South Africa.Methods and Findings: The TAPS study was conducted between 30 March 2015 and 30 June 2017, with the enrolment period ending on 31 July 2016. TAPS was a prospective observational cohort study with 2 groups receiving interventions delivered in existing service settings: (1) PrEP as part of combination prevention for HIV-negative FSWs and (2) early ART for HIV-positive FSWs. The main outcome was programme retention at 12 months of follow-up. Of the 947 FSWs initially seen in clinic, 692 were HIV tested. HIV prevalence was 49%. Among those returning to clinic after HIV testing and clinical screening, 93% of the women who were HIV-negative were confirmed as clinically eligible for PrEP (n = 224/241), and 41% (n = 110/270) of the women who were HIV-positive had CD4 counts within National Department of Health ART initiation guidelines at assessment. Of the remaining women who were HIV-positive, 93% were eligible for early ART (n = 148/160). From those eligible, 98% (n = 219/224) and 94% (n = 139/148) took up PrEP and early ART, respectively. At baseline, a substantial fraction of women had a steady partner, worked in brothels, and were born in Zimbabwe. Of those enrolled, 22% on PrEP (n = 49/219) and 60% on early ART (n = 83/139) were seen at 12 months; we observed high rates of loss to follow-up: 71% (n = 156/219) and 30% (n = 42/139) in the PrEP and early ART groups, respectively. Little change over time was reported in consistent condom use or the number of sexual partners in the last 7 days, with high levels of consistent condom use with clients and low use with steady partners in both study groups. There were no seroconversions on PrEP and 7 virological failures on early ART among women remaining in the study. Reported adherence to PrEP varied over time between 70% and 85%, whereas over 90% of participants reported taking pills daily while on early ART. Data on provider-side costs were also collected and analysed. The total cost of service delivery was approximately US$126 for PrEP and US$406 for early ART per person-year. The main limitations of this study include the lack of a control group, which was not included due to ethical considerations; clinical study requirements imposed when PrEP was not approved through the regulatory system, which could have affected uptake; and the timing of the implementation of a national sex worker HIV programme, which could have also affected uptake and retention.Conclusions: PrEP and early ART services can be implemented within FSW routine services in high prevalence, urban settings. We observed good uptake for both PrEP and early ART; however, retention rates for PrEP were low. Retention rates for early ART were similar to retention rates for the current standard of care. While the cost of the interventions was higher than previously published, there is potential for cost reduction at scale. The TAPS Demonstration Project results provided the basis for the first government PrEP and early ART guidelines and the rollout of the national sex worker HIV programme in South Africa. [ABSTRACT FROM AUTHOR]