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Background: Renally adjusted lamivudine dosages are effective. However, some of the kidney failure patients managed with lamivudine-containing regimens are failing to suppress HIV in peritoneal dialysis (CAPD) effluent. The steady-state lamivudine pharmacokinetics among these patients was evaluated. Methods: This overnight open-label pharmacokinetic study enrolled participants living with HIV and managed with CAPD. Lamivudine levels in blood serum and CAPD effluent samples were quantified using liquid chromatography coupled with a mass spectrometer. Pharmacokinetic measures were obtained through non-compartmental analysis. Results: Twenty-eight participants were recruited with a median antiretroviral (ARV) drug duration of 8 (IQR,4.5–10.5) years and a CAPD duration of 13.3 (IQR,3.3–31.9) months. 14.3% (4/28) had detectable unsuppressed HIV-1 viral load in CAPD effluents. The majority (78,6%,22/28) of participants received a 50 mg dose, while 10.7% (3/28), and another 10.7% (3/28) received 75 mg and 300 mg dosages, respectively. Among those treated with 75 and 300 mg, 66.7% (2/3) and 33.3% (1/3) had detectable HIV-VL in CAPD, respectively. The peritoneal membrane characteristics and CAPD system strengths were variable across the entire study population. Lamivudine exposure was increased in blood serum (50 mg-AUC0-24 h, 651.3 ng/mL; 75 mg-AUC0-24 h, 677.84 ng/mL; 300 mg-AUC0-24 h, 3135.89 ng/mL) compared to CAPD effluents (50 mg-AUC0-24 h, 384.91 ng/mL; 75 mg-AUC0-24 h, 383.24 ng/mL; 300 mg-AUC0-24 h, 2001.60 ng/mL) among the entire study population. The Cmax (50 mg, 41.5 ng/mL; 75 mg, 53.2 ng/mL; 300 mg, 199.1 ng/mL) and Cmin (50 mg, 17.8 ng/mL; 75 mg, 16.4 ng/mL; 300 mg, 76.4 ng/mL) measured in serum were within the therapeutic levels. Conclusions: Steady-state lamivudine pharmacokinetic measures were variable among the entire study population. However, the total lamivudine exposure was within the therapeutic levels. Key Learning Points: What was known: steady-state lamivudine pharmacokinetics in persons living with HIV (PLHIV) and managed with peritoneal dialysis (PD). This study adds: HIV-1 shedding into CAPD effluents is not necessarily contributed by reduced lamivudine dosages pharmacokinetics. Potential impact: Renally adjusted lamivudine dosages are effective even in patients shedding HIV-1 into CAPD effluents. [ABSTRACT FROM AUTHOR]

Background: In an attempt to discern lessons to improve future pandemic responses, this study measured the effects of the COVID-19 pandemic on essential public health services (EPHSs) related to primary health care (PHC) and outpatient department (OPD) utilisation, antiretroviral treatment (ART) commencement, drug-susceptible tuberculosis (DS-TB) confirmation and treatment commencement, and Bacillus Calmette-Guérin (BCG) coverage, in the Free State province of South Africa during January 2019 to March 2021. Methods: A pre-post study design comparing EPHS performance between 2019 and 2020/21 was employed. Routinely collected data were analysed. An interrupted time series analysis was used to measure changes in service use and outcomes from January 2019 to March 2021. Median changes were compared using Wilcoxon rank-sum tests. A 5% statistical significance level was considered. Results: Over the study period, the median values for the annual number of PHC visits was 1.80, 55.30% for non-referred OPD visits, 69.40% for ART commencement, 95.10% and 18.70% for DS-TB confirmation and treatment commencement respectively, and 93.70% for BCG coverage. While BCG coverage increased by 5.85% (p = 0.010), significant declines were observed in PHC utilisation (10.53%; p = 0.001), non-referred OPD visits (12.05%; p < 0.001), and ART commencement (9.53%; p = 0.017) rates. Given the importance of PHC in addressing a new pandemic, along with the existing HIV and TB epidemics – as well as the entire quadruple burden of disease – in South Africa, the finding that the PHC utilisation rate statistically significantly decreased in the Free State post-COVID-19 commencement is particularly concerning. Conclusions: The lessons learned from this retrospective review attest to a measure of resilience in EPHS delivery in the Free State in as far as a significant hike in BCG vaccination over the study period, 2019–2020/21 was observed. As evidenced by a decline in PHC service utilisation and the decreased numbers of new patients commencing ART, we also learned that EPHS delivery in the province was fragile. [ABSTRACT FROM AUTHOR]

Capacity development of research ethics committees is generally limited to members, and seldom includes administrators. This study sought to map the capacity development efforts of research ethics administrators. A scoping review was conducted. The literature search yielded 92 potentially relevant records, and further screening yielded 22 studies. The 22 studies were extracted and synthesized; two studies spoke directly on administrators' capacity development, while the remaining 20 focused on the capacity development of committees or of committee members. The two studies which spoke directly on administrators reported about two capacity development efforts targeting administrators in Africa, namely the African Conference for Administrators of Research Ethics Committees, and the West African Bioethics Training Program. [ABSTRACT FROM AUTHOR]

Background/Aim: Antiretroviral therapy (ART) is an important intervention for survival among children in Sub Saharan Africa where HIV infection rates are comparatively high. Only few studies have explored issues relating to paediatric ART initiation and maintenance. This study was conducted to explore the perceptions and experiences of trained professional nurses regarding paediatric ART. Methods: Six focus group discussions (FGDs) were conducted among trained professional nurses in selected health facilities in Free State Province, South Africa. Verbatim transcripts were analysed with a thematic approach. Results: The participants of this study reported counselling as an important component of paediatric ART in health facilities. The problem of non-disclosure, migration, incomplete records from referral health facilities, inadequate health workforce and difficulty in record keeping were cited as barriers against paediatric ART. Conclusion: This study showed that initiation and adherence to antiretroviral therapy among eligible children faces a significant challenge. [ABSTRACT FROM AUTHOR]

Background: Public health sector service delivery challenges leading to poor population health outcomes have been observed in the Free State province of South Africa for the past decade. A multi-method situation appraisal of the different functional domains revealed serious health system deficiencies and operational defects, notably fragmentation of healthcare programmes and frontline services, as well as challenges related to governance, accountability and human resources for health. It was therefore necessary to develop a system-wide intervention to comprehensively address defects in the operation of the public health system and its major components.Methods: This study describes the development of the 'Health Systems Governance & Accountability' (HSGA) intervention model by the Free State Department of Health (FSDoH) in collaboration with the community and other stakeholders following a participatory action approach. Documented information collected during routine management processes were reviewed for this paper. Starting in March 2013, the development of the HSGA intervention model and the concomitant application of Kaplan and Norton's (1992) Balanced Scorecard performance measurement tool was informed by the World Health Organization's (2007) conceptual framework for health system strengthening and reform comprised of six health system 'building blocks.' The multiple and overlapping processes and actions to develop the intervention are described according to the four steps in Kaplan et al.'s (2013) systems approach to health systems strengthening: (i) problem identification, (ii) description, (iii) alteration and (iv) implementation.Results: The finalisation of the HSGA intervention model before end-2013 was a prelude to the development of the FSDoH's Strategic Transformation Plan 2015-2030. The HSGA intervention model was used as a tool to implement and integrate the Plan's programmes moving forward with a consistent focus on the six building blocks for health systems strengthening and the all-important linkages between them.Conclusion: The model was developed to address fragmentation and improve public health service delivery by the provincial health department. In January 2016, the intervention model became an official departmental policy, meaning that it was approved for implementation, compliance, monitoring and reporting, and became the guiding framework for health systems strengthening and transform in the Free State. [ABSTRACT FROM AUTHOR]

Most capacity development efforts for research ethics committees focus on committee members and little on ethics administrators. Increasing studies mandate the focus on administrators' capacity development needs to enable adequate and effective committee support. This study investigated current responsibilities, training requirements, and administrator role needs. An online cross-sectional survey was conducted among administrators from 62 National Health Research Ethics Council-registered research ethics committees in South Africa. In total, 36 administrators completed the questionnaire. Results show that, in addition to administration, they perform managerial, review process and guidance-advisory tasks. Nearly 49% indicated only having received informal research ethics-related training, not targeted formal training, with 81% of the informal training being through workshops. Research ethics administrators' responsibilities have evolved to complex tasks requiring targeted capacity development efforts. [ABSTRACT FROM AUTHOR]

Background: Peritoneal dialysis (PD) is an easily implementable dialysis modality in end-stage renal disease (ESRD). PD may improve access to renal replacement therapy in low- and middle-income countries; however, these countries have a higher prevalence of protein-energy wasting in patients and poorer socioeconomic conditions. We evaluated the effects of HIV infection on serum albumin levels in ESRD patients starting continuous ambulatory PD (CAPD) and mortality outcomes. Methods: We conducted a single-center prospective cohort study of consecutive incident CAPD patients recruited from two hospitals in Durban, South Africa, from September 2012 to February 2015. Seventy HIV-negative and 70 HIV-positive ESRD patients were followed monthly for serum albumin levels and mortality events during the first 18 months of CAPD therapy. Results: The HIV-positive cohort recorded 28 deaths (40%) among patients with a functional CAPD catheter at 18 months and 13 deaths (18.6%) in the HIV-negative cohort (p = 0.005). The mean serum albumin levels were lower in the HIV-positive cohort than in the HIV-negative cohort during the 18-month follow-up. The mean difference in serum albumin levels between the two cohorts was 4.24 g/L (95% confidence interval [CI] 2.02–6.46, p<0.001) at baseline and 3.99 g/L (95% CI 1.19–6.79, p = 0.006) at 18 months. HIV-positive status (adjusted regression coefficient -2.84, CI -5.00–-0.67, p = 0.011), diabetes (adjusted coefficient -2.85; CI, -5.58–-0.12; p = 0.041), and serum C-reactive protein and blood hemoglobin levels were independent predictors of serum albumin levels on multivariable linear regression. Baseline serum albumin <25 g/L (subdistribution-hazard ratio [SHR] 13.06, 95% CI 3.09–55.14, p<0.001) and CD4+ cell count <200 cells/μL (SHR 3.2, CI 1.38–7.45, p = 0.007) were independent predictors of mortality in our competing risk model. Conclusions: HIV infection can adversely affect serum albumin levels in ESRD patients managed with CAPD, while low baseline serum albumin levels and impaired immunity reliably predict mortality. [ABSTRACT FROM AUTHOR]

Background: Since 1990, reduction of tuberculosis (TB) mortality has been lower in South Africa than in other high-burden countries in Africa. This research investigated the influence of routinely captured demographic and clinical or programme variables on death in TB patients in the Free State Province.Methods: A retrospective review of case information captured in the Electronic TB register (ETR.net) over the years 2003 to 2012 was conducted. Extracted data were subjected to descriptive and logistic regression analyses. The outcome variable was defined as all registered TB cases with 'died' as the recorded outcome. The variables associated with increased or decreased odds of dying in TB patients were established. The univariate and adjusted odds ratios (OR and AOR) together with their corresponding 95% confidence intervals (CI) were estimated, taking the clustering effect of the districts into account.Results: Of the 190,472 TB cases included in the analysis, 30,991 (16.3%) had 'died' as the recorded treatment outcome. The proportion of TB patients that died increased from 15.1% in 2003 to 17.8% in 2009, before declining to 15.4% in 2012. The odds of dying was incrementally higher in the older age groups: 8-17 years (AOR: 2.0; CI: 1.5-2.7), 18-49 years (AOR: 5.8; CI: 4.0-8.4), 50-64 years (AOR: 7.7; CI: 4.6-12.7), and ≥65 years (AOR: 14.4; CI: 10.3-20.2). Other factors associated with increased odds of mortality included: HIV co-infection (males - AOR: 2.4; CI: 2.1-2.8; females - AOR: 1.9; CI: 1.7-2.1) or unknown HIV status (males - AOR: 2.8; CI: 2.5-3.1; females - AOR: 2.4; CI: 2.2-2.6), having a negative (AOR: 1.4; CI: 1.3-1.6) or a missing (AOR: 2.1; CI: 1.4-3.2) pre-treatment sputum smear result, and being a retreatment case (AOR: 1.3; CI: 1.2-1.4).Conclusions: Although mortality in TB patients in the Free State has been falling since 2009, it remained high at more than 15% in 2012. Appropriately targeted treatment and care for the identified high-risk groups could be considered. [ABSTRACT FROM AUTHOR]

Although HIV/AIDS constitute a significant health burden among children in South Africa, testing and counselling of exposed children are inadequate. It is therefore imperative that factors relating to paediatric HCT services offered by health workers are examined. This study was conducted to explore and describe the perceptions and experiences of trained professional nurses regarding HIV counselling and testing among children. We conducted six focus group discussions among trained professional nurses in health facilities in a district in Free State Province, South Africa. All verbatim transcripts were analysed with a thematic approach and emergent codes were applied. Forty-seven trained professional nurses participated in the study and two of them were males. The age of the participants ranges from 38 to 60 years while the median age was 50 years. Most participants in the focus groups explained how HCT occurs during regular health talks and that lay counsellors are doing most of the counselling. While a few participants thought that children should not be bothered with HCT, most of them seek consent from caregivers for HIV test for children. While children whose parents are negative are usually not tested, most children are tested only when they become ill. Identified barriers to HCT among children include refusal of consent, work overload, lack of encouragement, and poor record keeping. Participants recommended improvement of issues relating to community mobilization and increasing trained staff strength for optimal paediatric HCT service delivery. Developing guidance and policies with respect to obtaining consent, recruiting more health providers, and addressing structural issues in the society to reduce stigma and discrimination were identified as key priority issues by majority of the participants. The perspectives of these participants who provide paediatric HCT services offer vital insight which may be useful to inform policy interventions. [ABSTRACT FROM PUBLISHER]

Little is known about the drivers of two-month sputum smear non-conversion in the South African context. Our study sought to determine these factors in new sputum smear positive tuberculosis (TB) patients in South Africa's Free State Province. A retrospective record review was conducted for all TB patients on treatment between 2003 and 2009. Two-month sputum smear non-conversion was defined by a positive sputum smear result. Data was subjected to univariate, bivariate and regression analyses. Generalized linear regression models were used to estimate the risk for two-month sputum smear non-conversion. Age, pre-treatment sputum smear grading, HIV status and TB disease classification influenced two-month sputum smear non-conversion. Significant associations were thus established between health systems, microbiological, clinical and demographic factors, and two-month sputum smear non-conversion. This study provides program managers with evidence to support the development of more tailored TB care. [ABSTRACT FROM AUTHOR]

Background: This study investigated the extent and predictors of condom use and condom refusal in the Free State province in South Africa. Methods: Through a household survey conducted in the Free Sate province of South Africa, 5,837 adults were interviewed. Univariate and multivariate survey logistic regressions and classification trees (CT) were used for analysing two response variables 'ever used condom' and 'ever refused condom'. Results: Eighty-three per cent of the respondents had ever used condoms, of which 38% always used them; 61% used them during the last sexual intercourse and 9% had ever refused to use them. The univariate logistic regression models and CT analysis indicated that a strong predictor of condom use was its perceived need. In the CT analysis, this variable was followed in importance by 'knowledge of correct use of condom', condom availability, young age, being single and higher education. 'Perceived need' for condoms did not remain significant in the multivariate analysis after controlling for other variables. The strongest predictor of condom refusal, as shown by the CT, was shame associated with condoms followed by the presence of sexual risk behaviour, knowing one's HIV status, older age and lacking knowledge of condoms (i.e., ability to prevent sexually transmitted diseases and pregnancy, availability, correct and consistent use and existence of female condoms). In the multivariate logistic regression, age was not significant for condom refusal while affordability and perceived need were additional significant variables. Conclusions: The use of complementary modelling techniques such as CT in addition to logistic regressions adds to a better understanding of condom use and refusal. Further improvement in correct and consistent use of condoms will require targeted interventions. In addition to existing social marketing campaigns, tailored approaches should focus on establishing the perceived need for condom-use and improving skills for correct use. They should also incorporate interventions to reduce the shame associated with condoms and individual counselling of those likely to refuse condoms. [ABSTRACT FROM AUTHOR]

The aims of this study were to examine whether use of tobacco, alcohol, and illicit drugs predicts dropout among secondary school students in Cape Town, South Africa. A self-report instrument was administered to 1,470 Grade 8 students. The proportion of students that dropped out of school between the onset of the study and 4 years later was 54.9%. After adjusting for a range of confounders, dropout was significantly predicted by absenteeism, poverty (as assessed by a possession index), and past month cigarette use, but not by past month alcohol use and lifetime illicit drug use. Contrary to findings from developed countries, alcohol and illicit drug use did not predict dropout. It is possible that predictors of dropout documented elsewhere may not be pertinent in developing countries. [ABSTRACT FROM AUTHOR]

We describe a methodology for analysing self-reported risk behaviour transitional patterns in a binary outcome variable, subject to misclassification and a large loss to follow-up. The motivation stems from the analysis of self-reported transitional patterns in responses to the question 'have you ever smoked a whole cigarette?' in a cohort of South African school children. The partially complete records analysis (PCRA) introduced, estimates the transitional probability as: the ratio of the joint probability of the response at two time points based on the complete records for this time sequence over the marginal probabilities of the response based on the complete records at the first time point, and assumes a non-informative missing pattern. A comparison was made using un-weighted complete records and inverse probability weighted logistic regression. The estimates of the probabilities of reporting ever having smoked a cigarette obtained from the three methods were similar for a particular transition. The PCRA method lacked precision compared with the inverse probability weighted logistic regression. A simulation study indicated an association between bias and reporting error in all three methods. The PCRA method can be considered as a method for the estimation of transition probabilities in a cohort study where there is consistency in the self-reported risk behaviour pattern and the sample size is large at baseline. The inverse probability weighting approach is more precise and is suitable for this setting in order to determine risk factors for the incidence of self-reported substance used in a cohort with a high dropout rate. Copyright © 2008 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Abstract: This prospective cohort study investigated whether leisure boredom predicts high school dropout. Leisure boredom is the perception that leisure experiences do not satisfy the need for optimal arousal. Participants completed a self-report questionnaire which included the Leisure Boredom Scale. The original cohort of grade 8 students (n=303) was followed up twice at 2-yearly intervals. Of the 281 students at the second follow-up, 149 (53.0%) students had dropped out of school. The effect of leisure boredom on dropout was investigated using logistic regression taking into account the clustering effect of the schools in the sampling strategy, and adjusting for age, gender and racially classified social group. Leisure boredom was a significant predictor of dropout (OR=1.08; 95% CI: 1.01–1.15) in students 14 years and older, but not so in younger students (OR=1.0; 95% CI: 0.95–1.05). The study has shown that measuring leisure boredom in grade 8 students can help identify students who are more likely to dropout of school. Further research is needed to investigate the longitudinal association between leisure boredom and school dropout. [Copyright &y& Elsevier]

Bullying is generally defined as largely unprovoked, negative physical or psychological actions perpetrated repeatedly over time between bully/ies and victims. Bullying can lead to fear of school, absenteeism, and stunted academic progress, which in turn are precursors to dropping out of school. This paper's aim is to report rates of bullying behaviour, and to investigate whether bullying behaviour predicts high school dropout in Cape Town, South Africa. Stratified, proportional sampling yielded 39 from a total of 214 schools, from which 40 learners were randomly selected from the combined class list of two, randomly chosen, Grade 8 classes in each of the 39 participating schools. Thus 1 470 learners (from a total of 181 018) completed a self-report questionnaire in 1997, and were followed-up in 2001. This report focuses on those learners who had dropped out of school between 1997 and 2001 (n = 776; 55.2%). Univariate and multiple logistic regression models were used to investigate the relationship between bullying behaviours and dropout, controlling for factors known to be strongly related to high school dropout, namely age, socioeconomic status, race, or ethnicity, being raised by a single parent, repeating a grade, and substance use. Odds ratios and 95 per cent confidence intervals were calculated, taking the clustering of schools into account. In1997, 52% of the boys and 37% of the girls had been involved in bullying behaviours. Of the three bullying categories (bully, victim, and bully-victim), girls but not boys in the 'bully-victim' category were significantly more likely to drop out of school (OR 1.82; CI 1.09-3.04, and when controlling for confounders OR 2.60; CI 1.32-5.10). The pervasiveness of both high school dropout and bullying behaviour points to an urgent need for future research, and intervention in these areas. [ABSTRACT FROM AUTHOR]

The article focuses on the effectiveness of antiretroviral treatment program in South Africa. The author mentions that the effectiveness of antiretroviral treatment programs in South Africa is unknown, and that most observational studies are biased. The research was conducted in 14,267 patients in South Africa, 3619 patients received a highly active antiretroviral treatment (HAART) for a maximum of 19 months. The author concludes that the South African government needed a faster expansion of HAART.