1,341 results
Search Results
2. The Importance of the Individual in PrEP Uptake: Multilevel Correlates of PrEP Uptake Among Adolescent Girls and Young Women in Tshwane, South Africa.
- Author
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Bonner CP, Minnis AM, Ndirangu JW, Browne FA, Speizer I, Nyblade L, Ahmed K, and Wechsberg WM
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- Humans, Female, Adolescent, South Africa epidemiology, Cluster Analysis, HIV Infections epidemiology, HIV Infections prevention & control, HIV Infections drug therapy, Anti-HIV Agents therapeutic use, Pre-Exposure Prophylaxis
- Abstract
Adolescent girls and young women (AGYW) account for 25% of new HIV infections in South Africa. Pre-exposure prophylaxis (PrEP) is approved by the South African Government, but the factors that promote PrEP uptake among AGYW are not well understood. This study examines multilevel factors associated with PrEP uptake among AGYW in six clinic catchment areas in Tshwane (Pretoria), South Africa. After consent/assent, PrEP-eligible AGYW (n = 448) completed a questionnaire assessing factors at the individual, network/interpersonal, and community levels and were prescribed PrEP in study clinics, if interested. A multivariable model, adjusting for clustering, assessed factors associated with PrEP uptake over a 9-month period. At the individual level, multiple partners in the past 3 months (OR = 0.47), perceived risk of HIV (OR = 0.71), and PrEP-related shame (OR = 0.63) were correlated with lower odds of PrEP uptake (ps ≤ 0.05). The findings highlight modifiable factors that should be addressed to support PrEP uptake efforts., (© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)
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- 2023
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3. Decreased Hepatic Steatosis in South African Adolescents With Perinatal HIV Switching to Dolutegravir-containing Regimens.
- Author
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Rose PC, De la Rey Nel E, Cotton MF, Otwombe K, Browne SH, Frigati LJ, Rabie H, and Innes S
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- Humans, Female, Adolescent, Male, South Africa epidemiology, Heterocyclic Compounds, 3-Ring adverse effects, Weight Gain, Triglycerides, HIV Infections complications, HIV Infections drug therapy, HIV Infections epidemiology, Fatty Liver epidemiology, Fatty Liver drug therapy, Anti-HIV Agents therapeutic use
- Abstract
Background: Although dolutegravir (DTG) has a favorable metabolic profile, it has been linked to excess weight gain. We evaluated changes in hepatic steatosis in adolescents with perinatally acquired HIV switching to DTG-containing antiretroviral therapy (ART)., Methods: Virologically suppressed adolescents switched to dolutegravir for a minimum of 4 months or on unchanged ART (84% protease inhibitor) were assessed prospectively with anthropometry, transient elastography with controlled attenuation parameter (CAP) and fasting metabolic profiles. ART regimens were determined independently of the study., Results: In total 68 adolescents [baseline median age 13.5 years [interquartile range (IQR): 12.5-14.4 years]; 42 (62%) female] were recruited. However, 38 remained on the same regimen and were followed for a median of 98 weeks (IQR: 48-108 weeks), and 30 switched to DTG and were followed for a median of 52 weeks (IQR: 49-101). There was no baseline difference in CAP between groups. There was no significant change in body mass index z-score in either group, but the median CAP in the DTG group decreased by -40dB/m (IQR: -51 to -31 dB/m) after a median of 44 weeks (IQR: 28-50 weeks) on DTG, compared to +1dB/m (IQR: -29 to +14 dB/m) in adolescents not switched ( P < 0 .01). Cholesterol and triglycerides were lower in those switched. Whereas hepatic steatosis prevalence decreased from 17% to 3% in adolescents who switched to dolutegravir, its prevalence doubled from 8% to 16% in those not switched ( P = 0.1)., Conclusions: In this exploratory study, adolescents switched to DTG-containing regimens had reduced hepatic steatosis, cholesterol and triglycerides with no excess weight gain compared to those on unchanged ART., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)
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- 2023
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4. Epileptic spasms: A South African overview of aetiologies, interventions, and outcomes.
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Raga SV, Essajee F, Solomons R, Van Toorn R, and Wilmshurst JM
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- Infant, Child, Humans, Adult, South Africa, Retrospective Studies, Adrenocorticotropic Hormone therapeutic use, Spasm complications, Spasm drug therapy, Electroencephalography adverse effects, Spasms, Infantile drug therapy, HIV Infections complications
- Abstract
Aim: To better understand the aetiologies of epileptic spasms in infants, as well as the safety and efficacy of high dose corticosteroids in tuberculosis and human immunodeficiency virus (HIV) endemic resource-limited settings., Method: This was a retrospective analysis of infants with epileptic spasms managed at the tertiary referral centres in the Western Cape, South Africa., Results: Of 175 children with epileptic spasms, the median age at onset was 6 months (interquartile range 4-8 months). Structural aetiologies were most common (115 out of 175 [66%]), with two-thirds related to perinatal insults. A lead time to treatment (LTTT) of less than 1 month was more likely in the epileptic encephalopathy/developmental and epileptic encephalopathy (DEE) group: 58 out of 92 (63%), compared to 28 out of 76 (37%) of those with developmental encephalopathy (p = 0.001). Failure to recognize preceding developmental delay was common. Ninety-nine children (57%) received first line hormonal therapy such as adrenocorticotropic hormone. A total of 111 out of 172 children (65%) from the developmental encephalopathy and epileptic encephalopathy/DEE groups had clinical and/or electroencephalogram resolution of spasms within 14 days. In our population, children in whom an aetiology could not be identified were statistically more likely to have moderate to profound developmental delay at 1 year of age: 33 out of 44 (p = 0.001). Based on reported incidence of epileptic spasms, 23 to 58 cases per annum would be expected but a far smaller proportion presented to our centres., Interpretation: Whilst this is the largest cohort of infants with epileptic spasms from sub-Saharan Africa, the study size is less than expected; this may reflect misdiagnosis and failure of referral pathways. Despite a reported shorter LTTT, infants with DEE had worse developmental outcomes compared to international studies. Hormonal therapy was safe and effective in our setting, despite exposure to high levels of tuberculosis and HIV., What This Paper Adds: The number of unreferred cases of epileptic spasms in South Africa remains high. Caregivers and health care workers in primary care facilities often fail to recognize developmental delay. The burden of disease from hypoxic-ischaemic encephalopathy remains high in our resource-limited setting. Hormonal treatment (e.g. adrenocorticotropic hormone) was safe and effective despite the high prevalence of human immunodeficiency virus and tuberculosis., (© 2022 Mac Keith Press.)
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- 2023
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5. Time to Scale Up Preexposure Prophylaxis Beyond the Highest-Risk Populations? Modeling Insights From High-Risk Women in Sub-Saharan Africa.
- Author
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Grant H, Gomez GB, Kripke K, Barnabas RV, Watts C, Medley GF, and Mukandavire Z
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- Adult, Anti-HIV Agents therapeutic use, Female, HIV Infections drug therapy, HIV Infections epidemiology, Humans, Kenya epidemiology, Male, Middle Aged, Models, Theoretical, Pre-Exposure Prophylaxis statistics & numerical data, South Africa, Vulnerable Populations, Zimbabwe epidemiology, Anti-HIV Agents administration & dosage, HIV Infections prevention & control, Pre-Exposure Prophylaxis methods
- Abstract
Objectives: New HIV infections remain higher in women than men in sub-Saharan Africa. Preexposure prophylaxis (PrEP) is an effective HIV prevention measure, currently prioritized for those at highest risk, such as female sex workers (FSWs), for whom it is most cost-effective. However, the greatest number of HIV infections in sub-Saharan Africa occurs in women in the general population. As countries consider wider PrEP scale-up, there is a need to weigh the population-level impact, cost, and relative cost-effectiveness to inform priority setting., Methods: We developed mathematical models of HIV risk to women and derived tools to highlight key considerations for PrEP programming. The models were fitted to South Africa, Zimbabwe, and Kenya, spanning a range of HIV burden in sub-Saharan Africa. The impact, cost, and cost-effectiveness of PrEP scale-up for adolescent girls and young women (AGYW), women 25 to 34 years old, and women 35 to 49 years old were assessed, accounting for differences in population sizes and the low program retention levels reported in demonstration projects., Results: Preexposure prophylaxis could avert substantially more infections a year among women in general population than among FSW. The greatest number of infections could be averted annually among AGYW in South Africa (24-fold that for FSW). In Zimbabwe, the greatest number of infections could be averted among women 25 to 34 years old (8-fold that for FSW); and in Kenya, similarly between AGYW and women 25 to 34 years old (3-fold that for FSW). However, the unit costs of PrEP delivery for AGYW, women 25 to 34 years old, and women 35 to 49 years old would have to reduce considerably (by 70.8%-91.0% across scenarios) for scale-up to these populations to be as cost-effective as for FSW., Conclusions: Preexposure prophylaxis has the potential to substantially reduce new HIV infections in HIV-endemic countries in sub-Saharan Africa. This will necessitate PrEP being made widely available beyond those at highest individual risk and continued integration into a range of national services and at community level to significantly bring down the costs and improve cost-effectiveness.
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- 2020
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6. Age-Restriction of a Validated Risk Scoring Tool Better Predicts HIV Acquisition in South African Women: CAPRISA 004.
- Author
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Castor D, Burgess EK, Yende-Zuma N, Heck CJ, and Abdool Karim Q
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- Adolescent, Adult, Female, Herpesvirus 2, Human, Humans, Incidence, Male, Risk Factors, South Africa epidemiology, HIV Infections diagnosis, HIV Infections epidemiology, HIV Infections prevention & control
- Abstract
We examined the predictive ability of the VOICE risk screening tool among adolescent girls and young women at heightened HIV risk in urban and peri-urban Kwa-Zulu-Natal, South Africa. Using participant data from CAPRISA 004's control arm (N = 444), we applied the initial VOICE risk screening score (IRS), a modified risk score (MRS) based on predictive and non-predictive variables in our data, and age-restricted (AIRS and AMRS, respectively). We estimated incidence rates, 95% confidence bounds, sensitivity, specificity, negative and positive predictive values and area under the curve (AUC). The sample's HIV incidence rate was 9.1/100 Person-Years [95% CI 6.9-11.7], resulting from 60 seroconversions (60/660.7 Person-Years). The IRS' ≥ 8 cutpoint produced moderate discrimination [AUC = 0.66 (0.54-0.74), sensitivity = 63%, specificity = 57%]. Restricting to age < 25 years improved the score's predictive ability (AIRS: AUC = 0.69, AMRS: AUC = 0.70), owing mainly to male partner having other partners and HSV-2. The risk tool predicted HIV acquisition at a higher cutpoint in this sample than in the initial VOICE analysis. After age-stratification, fewer variables were needed for maintaining score's predictiveness. In this high incidence setting, risk screening may still improve the efficiency or effectiveness of prevention counseling services. However, PrEP should be offered to all prevention-seeking individuals, regardless of risk ascertainment., (© 2022. The Author(s).)
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- 2022
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7. Women's Economic Contribution, Relationship Status and Risky Sexual Behaviours: A Cross-Sectional Analysis from a Microfinance-Plus Programme in Rural South Africa.
- Author
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Tolmay J, Knight L, Muvhango L, Polzer-Ngwato T, Stöckl H, and Ranganathan M
- Subjects
- Aged, Cross-Sectional Studies, Female, Humans, Sexual Behavior, Sexual Partners, South Africa epidemiology, Acquired Immunodeficiency Syndrome, HIV Infections epidemiology, HIV Infections prevention & control
- Abstract
In sub-Saharan Africa, women bear a disproportionate burden of HIV/AIDS while also facing economic and gender inequalities. To explore the association of women's economic contribution and relationship status with risky sexual behaviour, this study analysed cross-sectional data from 626 women aged 22 to 84 in rural South Africa. All women were enrolled in a microfinance plus gender training programme (Intervention with Microfinance for AIDS and Gender Equity (IMAGE)). We used univariable and multivariable logistic regression to explore the associations of relationship status and women's household income contribution with inconsistent condom use, multiple sexual partners and transactional sex, respectively. We found that married, older women had the highest odds of inconsistent condom use, while those contributing all the household income had higher odds of multiple sexual partnerships, but lower odds of transactional sex compared to those with no contribution. Income contribution and relationship status have a nuanced relationship with sexual risk behaviours. Thus, economic strengthening interventions should target relevant vulnerable women while also addressing the broader social and economic drivers of risky sexual behaviour., (© 2022. The Author(s).)
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- 2022
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8. Stay-at-Home: The Impact of the COVID-19 Lockdown on Household Functioning and ART Adherence for People Living with HIV in Three Sub-districts of Cape Town, South Africa.
- Author
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Campbell LS, Masquillier C, Knight L, Delport A, Sematlane N, Dube LT, and Wouters E
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- Anti-Retroviral Agents therapeutic use, Communicable Disease Control, Humans, Medication Adherence, South Africa epidemiology, COVID-19 epidemiology, HIV Infections drug therapy, HIV Infections epidemiology, HIV Infections prevention & control
- Abstract
In March 2020, the South African government imposed a lockdown to control COVID-19 transmission. Lockdown may affect people living with HIV's (PLWH) antiretroviral therapy (ART) adherence. Data from a cluster randomised control trial was collected from 152 PLWH in Cape Town sub-districts from October 2019-March 2020 when the lockdown halted collection. Subsequently, 83 PLWH were followed-up in June-July 2020. Random effects models were used to analyse: (1) changes between baseline and follow-up and (2) correlates of adherence during lockdown. At follow-up, there was an increase in the odds of being below the poverty line and the odds of experiencing violence decreased. Measures for well-being, household functioning, stigma and HIV competency improved. Violence, depression, food insecurity, and stigma were associated with poorer ART adherence; higher well-being scores were associated with better adherence. During lockdown, governments need to ensure financial support, access to (mental) health services, and services for those experiencing violence.Clinical Trial Number: Pan African Clinical Trial Registry, PACTR201906476052236. Registered on 24 June 2019., (© 2021. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)
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- 2022
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9. The Effect of HIV Programs in South Africa on National HIV Incidence Trends, 2000-2019.
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Johnson LF, Meyer-Rath G, Dorrington RE, Puren A, Seathlodi T, Zuma K, and Feizzadeh A
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- Adolescent, Anti-Retroviral Agents therapeutic use, Bayes Theorem, Female, Humans, Incidence, Male, Pregnancy, South Africa epidemiology, Circumcision, Male, HIV Infections drug therapy, HIV Infections epidemiology, HIV Infections prevention & control
- Abstract
Background: Recent studies have shown HIV incidence declines at a population level in several African countries. However, these studies have not directly quantified the extent to which incidence declines are attributable to different HIV programs., Methods: We calibrated a mathematical model of the South African HIV epidemic to age- and sex-specific data from antenatal surveys, household surveys, and death registration, using a Bayesian approach. The model was also parameterized using data on self-reported condom use, voluntary medical male circumcision (VMMC), HIV testing, and antiretroviral treatment (ART). Model estimates of HIV incidence were compared against the incidence rates that would have been expected had each program not been implemented., Results: The model estimated incidence in 15-49 year olds of 0.84% (95% CI: 0.75% to 0.96%) at the start of 2019. This represents a 62% reduction (95% CI: 55% to 66%) relative to 2000, a 47% reduction (95% CI: 42% to 51%) relative to 2010, and a 73% reduction (95% CI: 68% to 77%) relative to the incidence that would have been expected in 2019 in the absence of any interventions. The reduction in incidence in 2019 because of interventions was greatest for ART and condom promotion, with VMMC and behavior change after HIV testing having relatively modest impacts. HIV program impacts differed significantly by age and sex, with condoms and VMMC having greatest impact in youth, and overall incidence reductions being greater in men than in women., Conclusions: HIV incidence in South Africa has declined substantially since 2000, with ART and condom promotion contributing most significantly to this decline., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2022 The Author(s). Published by Wolters Kluwer Health, Inc.)
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- 2022
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10. Can a combination of interventions accelerate outcomes to deliver on the Sustainable Development Goals for young children? Evidence from a longitudinal study in South Africa and Malawi.
- Author
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Mebrahtu H, Skeen S, Rudgard WE, Du Toit S, Haag K, Roberts KJ, Gordon SL, Orkin M, Cluver L, Tomlinson M, and Sherr L
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- Adolescent, Child, Child, Preschool, Humans, Longitudinal Studies, Malawi epidemiology, South Africa epidemiology, HIV Infections epidemiology, HIV Infections prevention & control, HIV Infections psychology, Sustainable Development
- Abstract
Background: This study aimed to identify possible entry points for interventions that can act as development accelerators for children and adolescents in South Africa and Malawi., Methods: This study was a secondary data analysis. Data were sourced from the Child Community Care longitudinal study which tracked child well-being outcomes among 989 children (4-13 years) and their caregivers affected by HIV and enrolled in community-based organizations in South Africa and Malawi. We examined associations between five hypothesized accelerating services/household provisions-measured as access at baseline and follow-up and 12 child outcomes that relate to indicators within the Sustainable Development Goals (SDGs) framework. We calculated the adjusted probabilities of experiencing each SDG aligned outcome conditional on receipt of single, combined or all identified accelerators., Results: The results show household food security is associated with positive child education and cognitive development outcomes. Cash grants were positively associated with nutrition and cognitive development outcomes. Living in a safe community was positively associated with all mental health outcomes. Experiencing a combination of two factors was associated with higher probability of positive child outcomes. However, experiencing all three accelerators was associated with better child outcomes, compared with any of the individual factors by themselves with substantial improvements noted in child education outcomes., Conclusions: Combined delivery of specific interventions or services may yield greater improvements in child outcomes across different developmental domains. It is recommended that multiple support avenues in combination like improving food security and safe communities, as well as social protection grants, should be provided for vulnerable children to maximize the impact., (© 2021 John Wiley & Sons Ltd.)
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- 2022
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11. The Role of Families in Adolescent and Young Adults' PrEP Use.
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Atujuna M, Montgomery ET, Hartmann M, Ndwayana S, Browne EN, Sindelo S, Bekker LG, and Minnis AM
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- Adolescent, Adult, Black People, Counseling, Disclosure, Humans, South Africa epidemiology, Young Adult, Anti-HIV Agents therapeutic use, HIV Infections epidemiology, Pre-Exposure Prophylaxis
- Abstract
While pre-exposure prophylaxis (PrEP) is a key HIV prevention tool for adolescents and young adults (AYAs), its initiation and sustained use is shaped by AYAs' unique social contexts, including family. We explored the role of families in AYAs' PrEP use through qualitative in-depth interview (IDI) data from iPrevent, an end-user study designed to identify factors that could optimize PrEP adherence among South African youth (18-24 years old). These data were collected using a semi structured guide and were analysed using an inductive approach. Several themes describing family influence on AYAs' PrEP use emerged including family support; family attitude towards PrEP; and the family's ability to obviate PrEP disclosure challenges. In addition, dimensions of family closeness, categorized as 'close', 'in-between' and 'loose-knit,' appeared important in contextualizing family influence on AYAs' PrEP use. We found that family remains a proximal and fundamental social system in which AYA are socialized and greater family engagement could aid PrEP implementation in this priority population., (© 2021. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)
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- 2022
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12. Additive quantile mixed effects modelling with application to longitudinal CD4 count data.
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Yirga AA, Melesse SF, Mwambi HG, and Ayele DG
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- Adolescent, Adult, Aged, Antiretroviral Therapy, Highly Active methods, CD4 Lymphocyte Count, Female, Follow-Up Studies, HIV Infections epidemiology, HIV Infections virology, Humans, Linear Models, Longitudinal Studies, Middle Aged, Prognosis, Risk Factors, South Africa epidemiology, Treatment Outcome, Viral Load, Young Adult, Anti-HIV Agents therapeutic use, Disease Progression, HIV, HIV Infections drug therapy, HIV Infections immunology
- Abstract
Quantile regression offers an invaluable tool to discern effects that would be missed by other conventional regression models, which are solely based on modeling conditional mean. Quantile regression for mixed-effects models has become practical for longitudinal data analysis due to the recent computational advances and the ready availability of efficient linear programming algorithms. Recently, quantile regression has also been extended to additive mixed-effects models, providing an efficient and flexible framework for nonparametric as well as parametric longitudinal forms of data analysis focused on features of the outcome beyond its central tendency. This study applies the additive quantile mixed model to analyze the longitudinal CD4 count of HIV-infected patients enrolled in a follow-up study at the Centre of the AIDS Programme of Research in South Africa. The objective of the study is to justify how the procedure developed can obtain robust nonlinear and linear effects at different conditional distribution locations. With respect to time and baseline BMI effect, the study shows a significant nonlinear effect on CD4 count across all fitted quantiles. Furthermore, across all fitted quantiles, the effect of the parametric covariates of baseline viral load, place of residence, and the number of sexual partners was found to be major significant factors on the progression of patients' CD4 count who had been initiated on the Highly Active Antiretroviral Therapy study., (© 2021. The Author(s).)
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- 2021
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13. Maternal Health Outcomes and Male Partner Involvement Among HIV Infected Women in Rural South Africa.
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Matseke MG, Ruiter RAC, Rodriguez VJ, Peltzer K, and Sifunda S
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- Female, Health Knowledge, Attitudes, Practice, Humans, Infant, Newborn, Infectious Disease Transmission, Vertical prevention & control, Interpersonal Relations, Male, Outcome Assessment, Health Care, Pregnancy, Prenatal Care, Rural Population, South Africa epidemiology, HIV Infections epidemiology, HIV Infections transmission, Pregnancy Complications, Infectious epidemiology
- Abstract
Introduction: This study aimed to investigate the association between Male Partner Involvement (MPI) and maternal health outcomes among women attending Prevention of Mother-to-Child Transmission of HIV (PMTCT) services in rural South Africa. The association between Male Partner Participation in the main study (MPP) and maternal health outcomes among these women was also investigated., Methods: The study utilized data collected from 535 HIV infected women in a randomized controlled trial between 2015 and 2016. Maternal health outcome data (delivery mode, pregnancy systolic and diastolic blood pressure, pregnancy body mass index, pregnancy CD4 count, and pregnancy viral load) were collected from the women's antenatal record forms accessed from the primary healthcare facilities. Bivariate and multivariable logistic regression models were used to estimate the association between socio-demographic characteristics of the women, MPI, and MPP with maternal health outcomes., Results: The mean age of the women was 29.03 years (SD = 5.89). No significant associations were found between MPI and any of the maternal health outcomes contrary to what was hypothesized. Both the bivariate and multivariate analysis indicated a significant association between MPP and higher pregnancy viral load, contrary to the study hypothesis. Insignificant associations were found between MPP and both pregnancy CD4 count and pregnancy blood pressure. The only significant association between maternal health outcomes and socio-demographic characteristics, was between educational attainment and higher pregnancy CD4 count in both the bivariate and multivariate analysis., Conclusion for Practice: The study showed no significant support for MPI in improving maternal health outcomes of women in PMTCT in rural South Africa. Future studies should include additional maternal health outcomes for investigation.
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- 2021
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14. Validation of the Bayley Infant Neurodevelopmental Screener Among HIV-Exposed Infants in Rural South Africa.
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Rodriguez VJ, Zegarac M, La Barrie DL, Parrish MS, Matseke G, Peltzer K, and Jones DL
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- Adult, Developmental Disabilities diagnosis, Female, HIV-1, Humans, Infant, Infectious Disease Transmission, Vertical, Male, Neuropsychological Tests, Pregnancy, Risk Factors, Rural Population, South Africa epidemiology, Young Adult, Child Development, HIV Infections complications, HIV Infections epidemiology
- Abstract
Introduction: Screening for developmental delays during critical periods of infant development is essential for early detection and intervention. Among high-risk infants in resource-limited settings, including those who are HIV exposed, there is a greater need for screening. This study expanded on previous analyses of the Bayley Infant Neurodevelopmental Screener (BINS) by providing psychometric properties to evaluate the appropriateness of using the BINS in a sample of HIV-exposed infants in rural South Africa., Method: A total of 160 mothers with HIV, their infants, and their male partners were recruited. The BINS was administered to the infants, and their weights were recorded. Mothers completed measures of depression, intimate partner violence, male involvement, and adherence. Male partners reported their own involvement in perinatal care., Results: Results demonstrated support for a 5-factor structure consistent with previous transcultural adaptations of the BINS, demonstrating construct validity, and adequate reliability. Convergent validity was partially supported, as shown by associations with intimate partner violence and male involvement as reported by men and women and maternal adherence, although not with birth weight or maternal depression. The BINS showed adequate discriminating power, with only a few low-performing items., Conclusion: In rural South Africa, a resource-limited setting, the BINS seems to be an adequate screening tool for developmental delays in children that may be used to identify those in need of intervention. Considering the high prevalence of delays identified in this study, antiretroviral therapy-exposed and HIV-exposed infants may benefit from further assessment to determine a need for intervention in community-based clinics.
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- 2020
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15. Effectiveness of Isoniazid Preventive Therapy to Reduce Tuberculosis Incidence in the Context of Antiretroviral Therapy.
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Boffa JM, Fisher DA, Mayan MJ, Sauve RS, and Williamson TS
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- Adolescent, Adult, Anti-Retroviral Agents therapeutic use, CD4 Lymphocyte Count, Female, HIV Infections complications, HIV Infections epidemiology, Humans, Incidence, Male, Middle Aged, South Africa epidemiology, Tuberculosis epidemiology, Young Adult, HIV Infections drug therapy, Isoniazid therapeutic use, Tuberculosis drug therapy, Tuberculosis prevention & control
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- 2020
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16. Human Papillomavirus Seroprevalence and Seroconversion Among Men Living With HIV: Cohort Study in South Africa.
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Chikandiwa A, Faust H, Chersich MF, Mayaud P, Dillner J, and Delany-Moretlwe S
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- Adult, Antibodies, Viral, Cohort Studies, DNA, Viral isolation & purification, Humans, Male, Middle Aged, Papillomavirus Infections virology, Seroepidemiologic Studies, South Africa epidemiology, Young Adult, HIV Infections complications, HIV Infections epidemiology, Papillomaviridae, Papillomavirus Infections complications, Papillomavirus Infections epidemiology
- Abstract
Background: Men living with HIV (MLHIV) have a high burden of human papillomavirus (HPV)-related cancer. Understanding serological dynamics of HPV in men can guide decisions on introducing HPV vaccination and monitoring impact. We determined HPV seroprevalence and evaluated factors associated with HPV seroconversion among MLHIV in Johannesburg, South Africa., Methods: We enrolled 304 sexually active MLHIV 18 years and older and collected sociobehavioral data, blood samples (CD4 counts, HIV-1 plasma viral load, and HPV serology), and genital and anal swabs [HPV DNA and HPV viral load (VL)] at enrollment and 6-monthly for up to 18 months. Antibodies to 15 HPV types were measured using HPV pseudovirions. Generalized estimating equations were used to evaluate correlates of HPV seroconversion., Results: Median age at enrollment was 38 years (IQR: 22-59), 25% reported >1 sexual partner in the past 3 months, and 5% reported ever having sex with other men. Most participants (65%) were on antiretroviral therapy (ART), with median CD4 count of 445 cells/µL (IQR: 328-567). Seroprevalence for any HPV type was 66% (199/303). Baseline seropositivity for any bivalent (16/18), quadrivalent (6/11/16/18), and nonavalent (6/11/16/18/31/33/45/52/58) vaccine types was 19%, 37%, and 60%, respectively. At 18 months, type-specific seroconversion among 59 men whose genital samples were HPV DNA positive but seronegative for the same type at enrollment was 22% (13/59). Type-specific seroconversion was higher among men with detectable HIV plasma viral load (adjusted odds ratio = 2.78, 95% CI: 1.12 to 6.77) and high HPV VL (adjusted odds ratio = 3.32, 95% CI: 1.42 to 7.74)., Conclusions: Seropositivity and exposure to nonavalent HPV types were high among MLHIV. HPV vaccination of boys before they become sexually active could reduce the burden of HPV infection among this at-risk population.
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- 2020
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17. Screening for invasive fungal disease using non-culture-based assays among inpatients with advanced HIV disease at a large academic hospital in South Africa.
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van Schalkwyk E, Mhlanga M, Maphanga TG, Mpembe RS, Shillubane A, Iyaloo S, Tsotetsi E, Pieton K, Karstaedt AS, Sahid F, Menezes CN, Tsitsi M, Motau A, Wadula J, Seetharam S, van den Berg E, Sriruttan C, and Govender NP
- Subjects
- AIDS-Related Opportunistic Infections epidemiology, Academic Medical Centers, Adult, Antigens, Fungal blood, Antigens, Fungal urine, Cross-Sectional Studies, Cryptococcosis diagnosis, Cryptococcosis epidemiology, Female, HIV Infections microbiology, Histoplasmosis diagnosis, Histoplasmosis epidemiology, Humans, Inpatients, Invasive Fungal Infections epidemiology, Lipopolysaccharides blood, Male, Point-of-Care Systems, Prevalence, Prospective Studies, South Africa, Tuberculosis diagnosis, Tuberculosis epidemiology, AIDS-Related Opportunistic Infections diagnosis, HIV Infections complications, Invasive Fungal Infections diagnosis
- Abstract
Introduction: Despite widespread access to antiretroviral therapy (ART), the burden of advanced HIV disease in South Africa is high. This translates into an increased risk of AIDS-related opportunistic infections, including invasive mycoses., Methods: Using a limited number of non-culture-based diagnostic assays, we aimed to determine the prevalence of invasive mycoses and tuberculosis among hospitalised adults with very advanced HIV (CD4 counts < 100 cells/µL) at a large academic hospital. We conducted interviews and prospective medical chart reviews. We performed point-of-care finger stick and serum cryptococcal antigen lateral flow assays; serum (1 → 3) ß-D-glucan assays; urine Histoplasma galactomannan antigen enzyme immunoassays and TB lipoarabinomannan assays., Results: We enrolled 189 participants from 5280 screened inpatients. Fifty-eight per cent were female, with median age 37 years (IQR: 30-43) and median CD4 count 32 cells/µL (IQR: 13-63). At enrolment, 60% (109/181) were receiving ART. Twenty-one participants (11%) had a diagnosis of an invasive mycosis, of whom 53% (11/21) had cryptococcal disease. Thirteen participants (7%) had tuberculosis and a concurrent invasive mycosis. ART-experienced participants were 60% less likely to have an invasive mycosis than those ART-naïve (adjusted OR: 0.4; 95% CI 0.15-1.0; P = .03). Overall in-hospital mortality was 13% (invasive mycosis: 10% [95% CI 1.2-30.7] versus other diagnoses: 13% (95% CI 8.4-19.3))., Conclusions: One in ten participants had evidence of an invasive mycosis. Diagnosis of proven invasive fungal disease and differentiation from other opportunistic infections was challenging. More fungal-specific screening and diagnostic tests should be applied to inpatients with advanced HIV disease., (© 2020 Blackwell Verlag GmbH.)
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- 2020
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18. The Cost-effectiveness of a Point-of-Care Paper Transaminase Test for Monitoring Treatment of HIV/TB Co-Infected Persons.
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Rajasingham, Radha, Pollock, Nira R, and Linas, Benjamin P
- Subjects
DRUG therapy for tuberculosis ,POINT-of-care testing ,AMINOTRANSFERASES ,AUTOMATION ,COST effectiveness ,DECISION making ,DRUG side effects ,HIV infections ,LIVER diseases ,LONGITUDINAL method ,EVALUATION of medical care ,MEDICAL care costs ,SCIENTIFIC observation ,HIGHLY active antiretroviral therapy ,QUALITY-adjusted life years ,ECONOMICS - Abstract
Background Persons with HIV and tuberculosis (TB) co-infection require transaminase monitoring while on hepatotoxic medications. A novel paper-based, point-of-care transaminase test is in development at an anticipated cost of $1 per test. Methods To project long-term clinical outcomes and estimate the cost-effectiveness of using a paper-based fingerstick test to monitor for drug-induced liver injury (DILI), as compared with automated testing and with no laboratory monitoring. The design was a decision analytic model, including deterministic and probabilistic sensitivity analyses. Data sources were observational cohorts and a validation study of the paper-based test. The target population was HIV/TB co-infected persons in South Africa on antiretroviral therapy who were initiating TB therapy. Interventions: (1) clinical (no laboratory) monitoring; (2) monitoring using the paper-based test with a ≥120 IU/mL threshold for positivity; (3) monitoring using the paper-based test with a ≥200 IU/mL threshold for positivity; (4) monitoring using the paper-based test using 1 of 3 categories: <120 IU/mL, 120 to 200 IU/mL, and >200 IU/mL (“bin placement”); (5) monitoring using automated ALT testing using the same 3 categories (“automated testing”). The outcome measures were discounted quality-adjusted life-years (QALYs), costs, and incremental cost-effectiveness ratios (ICERs). Results The ICER of automated testing was $5180/QALY. Use of the paper-based test with the bin placement strategy was cost-effective compared with clinical monitoring alone. Conclusion At its current performance, monthly DILI monitoring by bin placement using the paper-based test was cost-effective, compared with clinical monitoring, in HIV/TB co-infected persons in South Africa. [ABSTRACT FROM AUTHOR]
- Published
- 2017
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19. Criminalising unprotected sex.
- Author
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Leggett T
- Subjects
- Africa, Africa South of the Sahara, Africa, Southern, Behavior, Developing Countries, Disease, Health Planning, Organization and Administration, South Africa, Virus Diseases, Evaluation Studies as Topic, HIV Infections, Legislation as Topic, Policy Making, Risk-Taking, Sexual Behavior
- Published
- 1999
20. Protocol of a cost-effectiveness analysis of a combined intervention for depression and parenting compared with enhanced standard of care for perinatally depressed, HIV-positive women and their infants in rural South Africa.
- Author
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Christian CS, Nkonki L, Desmond C, Hoegfeldt C, Dube S, Rochat T, and Stein A
- Subjects
- Female, Humans, Infant, Infant, Newborn, Pregnancy, Depression therapy, Depression, Postpartum therapy, Depression, Postpartum economics, Parenting, Randomized Controlled Trials as Topic, Rural Population, South Africa, Standard of Care, Research Design, Cost-Effectiveness Analysis methods, HIV Infections
- Abstract
Introduction: Poverty, HIV and perinatal depression represent a triple threat to public health in sub-Saharan Africa because of their combined negative effects on parenting and child development. In the resource-constrained context of low-income and middle-income countries, a lay-counsellor-delivered intervention that combines a psychological and parenting intervention could offer the potential to mitigate the consequences of perinatal depression while also optimising scarce resources for healthcare.Measuring the cost-effectiveness of such a novel intervention will help decision-makers to better understand the relative costs and effects associated with replicating the intervention, thereby supporting evidence-based decision-making. This protocol sets out the methodological framework for analysing the cost-effectiveness of a cluster randomised controlled trial (RCT) that compares a combined intervention to enhanced standard of care when treating depressed, HIV-positive pregnant women and their infants in rural South Africa., Methods and Analysis: This cost-effectiveness analysis (CEA) protocol complies with the Consolidated Health Economic Evaluation Reporting Standards 2022 checklist. A societal perspective will be chosen.The proposed methods will determine the cost and efficiency of implementing the intervention as per the randomised control trial protocol, as well as the cost of replicating the intervention in a non-research setting. The costs will be calculated using an appropriately adjusted version of the Standardised Early Childhood Development Costing Tool.Primary health outcomes will be used in combination with costs to determine the cost per improvement in maternal perinatal depression at 12 months postnatal and the cost per improvement in child cognitive development at 24 months of age. To facilitate priority setting, the incremental cost-effectiveness ratios for improvements in child cognitive development will be ranked against six other child cognitive-development interventions according to Verguet et al 's methodology (2022).A combination of activity-based and ingredient-based costing approaches will be used to identify, measure and value activities and inputs for all alternatives. Outcomes data will be sourced from the RCT team., Ethics and Dissemination: The University of Oxford is the sponsor of the CEA. Ethics approval has been obtained from the Human Sciences Research Council (HSRC, #REC 5/23/08/17), South Africa and the Oxford Tropical Research Ethics Committee (OxTREC #31-17), UK.Consent for publication is not applicable since no participant data are used in this protocol.We plan to disseminate the CEA results to key policymakers and researchers in the form of a policy brief, meetings and academic papers., Trial Registration Details: ISRCTN registry #11 284 870 (14/11/2017) and SANCTR DOH-27-102020-9097 (17/11/2017)., Competing Interests: Competing interests: The authors, including the principal investigators, declare no financial or non-financial competing interests., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY. Published by BMJ.)
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- 2024
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21. Defining community-led monitoring and its role in programme-embedded learning: lessons from the Citizen Science Project in Malawi and South Africa.
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Lauer KJ, Soboyisi M, Kassam CA, Mseu D, Oberth G, and Baptiste SL
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- Malawi, South Africa, Humans, Program Evaluation, COVID-19 epidemiology, Community Participation, Female, Male, HIV Infections drug therapy, Citizen Science methods
- Abstract
Introduction: Programme Science (PS) and community-led monitoring (CLM) intersect in unexpected and promising ways. This commentary examines a CLM initiative in Malawi and South Africa to highlight the crucial role of CLM in bolstering the PS framework. By leveraging data sources often overlooked by conventional research and evaluation approaches, CLM emerges as a pivotal element in enhancing programme effectiveness. This paper delineates the fundamental principles of CLM, presents programme outcomes derived from CLM methodologies and contextualizes these findings within the broader framework of PS., Discussion: The Citizen Science Project implements CLM continuously at 33 health facilities: 14 in Malawi (eight in Kasungu District and six in Dedza District), and 19 in South Africa (all in the West Rand District), representing a total catchment area of 989,848 people. Monitoring indicators are developed in an iterative process with community groups. The indicators are unique to each country, but both focus on the uptake of health services (quantitative) and barriers to access (qualitative). Monthly clinic records surveys capture 34 indicators in Malawi and 20 in South Africa and are supplemented by qualitative interviews with care recipients and healthcare workers. Qualitative interviews provide additional granularity and help confirm and explain the more macro trends in service coverage as described in quantitative data. The resulting data analysis reveals key themes that help stakeholders and decision-makers to solve problems collaboratively. Noteworthy outcomes include a substantial increase in multi-month dispensing of antiretroviral therapy (ART) during COVID-19 (from 6% to 31%) with a subsequent recovery surpassing of HIV service benchmarks in Malawi post-pandemic., Conclusions: While quantifying direct impact remains challenging due to the project's design, CLM proves to be a robust methodology that generates credible data and produces impactful outcomes. Its potential extends beyond the health sector, empowering community leadership and fostering interventions aligned with community needs. As CLM continues to evolve, its integration into PS promises to improve relevance, quality and impact across diverse disciplines., (© 2024 The Author(s). Journal of the International AIDS Society published by John Wiley & Sons Ltd on behalf of International AIDS Society.)
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- 2024
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22. 'Remember there is that thing called confidentiality': experiences of institutional discrimination in the health system among adolescent boys and young men living with HIV in the Eastern Cape province of South Africa.
- Author
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Gittings L, Hodes R, Kom P, Mbula S, and Pantelic M
- Subjects
- Humans, Male, South Africa, Adolescent, Young Adult, Qualitative Research, Interviews as Topic, HIV Infections psychology, Confidentiality, Social Stigma
- Abstract
Adolescents and men are two populations that perform poorly within the HIV cascade of care, having worse AIDS-related health outcomes, and experiencing higher levels of HIV-related stigma. This paper explores institutional health system discrimination as experienced by adolescent boys with perinatally-acquired HIV, situating them within the social and gendered contexts of the Eastern Cape Province, South Africa. Life history narratives ( n = 36) and in-depth semi-structured interviews ( n = 32) with adolescent boys living with HIV aged 13-22 were conducted in 2017-2018. In-depth semi-structured interviews with biomedical and traditional health practitioners ( n = 14), analysis of health facility files ( n = 41) and clinic observations were also conducted. Together, triangulated sources point to an incongruence between the complex needs of adoelscent boys and young men living with HIV and their experiences within the health system. Two institutional discrimination-related deterrents to retention in care were identified: (1) lack of confidentiality due to health facility layouts and practices that visibilised people living with HIV; and (2) mistreatment in the form of shouting. This article contributes to the limited literature on the experiences of young men within the HIV continuum of care, focusing on how stigma influences how young men experience and engage with the health sector.
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- 2024
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23. Patterns and Predictors of HIV Comorbidity among Adolescents and Young Adults in South Africa.
- Author
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van Wyk B and Roomaney RA
- Subjects
- Humans, Adolescent, South Africa epidemiology, Young Adult, Male, Female, Prevalence, Risk Factors, HIV Infections epidemiology, Comorbidity
- Abstract
Adolescents and young adults (AYA) are identified as a high-risk group for HIV acquisition. However, health services are generally not sensitive to the needs of this priority population. In addition, multimorbidity (having more than one disease in an individual) is not well studied among AYA, as it is typically associated with older individuals. This paper reports on commonly co-occurring disease conditions and disease patterns in AYA, aged 15-24 years, who took part in the 2016 South African Demographic and Health Survey. Chi-squared tests and logistic regression were used to examine the weighted prevalence of disease among those with/without HIV, and the risk factors associated with HIV. Latent class analysis (LCA) was conducted to identify common co-occurring diseases. Of the 1787 individuals included in our analysis, the weighted prevalence of HIV was 8.7%. Hypertension (30.5%), anaemia (35.8%) and diabetes (2.0%) were more prevalent among those with HIV. HIV and anaemia, hypertension and anaemia, and HIV and hypertension comprise the largest disease burden of co-occurring diseases. Co-morbidity was high among those with HIV, emphasizing the need for integrated care of HIV and non-communicable diseases.
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- 2024
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24. The per-patient costs of HIV services in South Africa: Systematic review and application in the South African HIV Investment Case.
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Meyer-Rath, Gesine, van Rensburg, Craig, Chiu, Calvin, Leuner, Rahma, Jamieson, Lise, and Cohen, Steve
- Subjects
HIV infections ,MEDICAL databases ,MEDICAL care costs ,HEALTH programs - Abstract
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]
- Published
- 2019
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25. Stroke as the index presentation of traditional cardiovascular risk factors and Human Immunodeficiency Virus in a South African population.
- Author
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Sadiq E, von Klemperer A, Woodiwiss A, Norton G, and Modi G
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- Adult, Humans, Middle Aged, Risk Factors, HIV, South Africa epidemiology, Heart Disease Risk Factors, Cardiovascular Diseases epidemiology, HIV Infections complications, HIV Infections diagnosis, HIV Infections epidemiology, Stroke diagnosis, Stroke epidemiology, Stroke complications, Dyslipidemias diagnosis, Dyslipidemias epidemiology, Dyslipidemias complications
- Abstract
Objectives: We sought to identify what proportion of each cardiovascular risk factor and Human Immunodeficiency Virus (HIV) was first diagnosed at the time of stroke, compared to those that were diagnosed prior to the event, and to explore if this had any impact on the severity of stroke., Methods: Adult patients presenting with a new stroke to a quaternary hospital in Johannesburg between 2014 and 2017 were prospectively recruited. Patients were investigated for undiagnosed traditional cardiovascular risk factors (hypertension, diabetes mellitus, dyslipidaemia, atrial fibrillation, obesity and smoking), as well as HIV infection. Stroke severity was assessed using the National Institutes of Health Stroke Scale (NIHSS)., Results: 346 patients were included. Stroke was the index presentation for at least one risk factor in 199 (57.5 %) patients. Dyslipidaemia was newly diagnosed in 76.0 % of all dyslipidaemics (95 out of 125). Newly-diagnosed dyslipidaemia was associated with a more severe neurological deficit (Median NIHSS of 12 (8-16) vs 7 (4-12), p=0.0007) and younger age on presentation (53 (44-63) years vs 62 (51-71) years, p=0.02) as compared to previously-diagnosed dyslipidaemia., Conclusions: More than half of patients had previously undiagnosed modifiable risk factors at the time of their stroke. Dyslipidaemia was undiagnosed in a very high proportion, and this was associated with a higher stroke severity and younger age of presentation., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 The Author(s). Published by Elsevier Inc. All rights reserved.)
- Published
- 2024
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26. Comparing the Integration of Syndromic versus Etiological Management of Sexually Transmitted Infections Into HIV Pre-Exposure Prophylaxis Services for Adolescent Girls and Young Women, in South Africa.
- Author
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Mullick S, Cox LA, Martin CE, Fipaza Z, and Ncube S
- Subjects
- Female, Male, Adolescent, Humans, HIV, South Africa epidemiology, Homosexuality, Male, Pre-Exposure Prophylaxis, HIV Infections epidemiology, HIV Infections prevention & control, Sexually Transmitted Diseases epidemiology, Sexually Transmitted Diseases prevention & control
- Abstract
South Africa has a high incidence of human immunodeficiency virus and sexually transmitted infections (STIs), particularly among adolescent girls and young women. National and global guidelines recommend varied strategies for integrating STI and pre-exposure prophylaxis (PrEP) services., Purpose: This paper describes the implementation of a syndromic compared to an etiological approach to STI integration within PrEP services in South Africa., Methods: We analysed program data from eight fixed and four mobile clinics to describe a cascade of STI care and integration of syndromic management among clients accessing PrEP services. Diagnostic testing was conducted in a subset of clients to determine the prevalence of STIs and estimate the burden of disease missed using a syndromic approach., Results: Between December 2018 and December 2021, 22,505 clients sought services and a high proportion (92.9%) was screened for STI symptoms. Of these, 9% of females and 3% of males had symptoms and 89.5% had recorded treatment. In a subset of PrEP clients (406 females, 70 males) screened through laboratory testing, chlamydia was identified in 25.7% of female and 20.0% of male samples, gonorrhea in 14.1% of female and 18.6% of male samples, and syphilis in 2.3% of female and 1.4% of male samples. Highest prevalence was found among females aged 18-20 years., Discussion: Syndromic STI screening and management can be integrated into routine PrEP service delivery and can identify symptomatic STIs, but misses asymptomatic infections. PrEP clients have a high prevalence of treatable STIs. Etiologic approaches can identify more infections than syndromic screening, but cheap point-of-care tests are needed., (Copyright © 2023 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.)
- Published
- 2023
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27. Eita! Reaching Communities and Young People to Drive Demand for Oral Pre-Exposure Prophylaxis in South Africa.
- Author
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Briedenhann E, Rosenberg P, Sheobalak N, Pleaner M, Martin CE, and Mullick S
- Subjects
- Adolescent, Humans, Female, South Africa, HIV Infections prevention & control, HIV Infections drug therapy, Pre-Exposure Prophylaxis, Anti-HIV Agents therapeutic use, Acquired Immunodeficiency Syndrome
- Abstract
Purpose: This paper describes a holistic but flexible demand creation strategy for pre-exposure prophylaxis (PrEP) in national public health-care settings in low-income to middle-income countries., Methods: We describe the development and implementation of a model to drive demand for oral PrEP uptake and use as part of comprehensive sexual and reproductive health services in South Africa: The Eita!, Model: The project adapted two existing response hierarchy models (marketing models used to describe the stages individuals move through from being unaware to using a product), to formulate the Eita!, Model: Using the RE-AIM framework, we report on the reach, effectiveness, adoption, implementation, and maintenance of the Eita!, Results: More than 34 million connections were made from December 2018 to 2021 through a variety of channels: social media and websites, at events and mobile clinic outreach, and radio and community dialogs. There were 42,447 adolescent girls and young women reached in-person during this time, 16,823 adolescent girls and young women presented for sexual and reproductive health services, and of those 14,637 (87%) initiated on PrEP. The model was implemented in eight health-care facilities and four mobile clinics in three provinces in South Africa. A total of 26 trainings were delivered to project staff implementing the strategy. Various demand creation resources, such as materials and online platforms, have since been adopted by the National Department of Health as national tools., Discussion: The Eita! model was successfully implemented to support the uptake of HIV prevention services and rollout of biomedical prevention products, and can be adapted by other low-income to middle-income countries., (Copyright © 2023 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.)
- Published
- 2023
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28. " … [I] f I can [be] infected now that means I am going to die … ": an explorative study focusing on vulnerable, immunocompromised groups and caregivers experiences and perceptions of the Covid-19 pandemic in South Africa.
- Author
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North A, Cloete A, Ramlagan S, Manyaapelo T, Ngobeni A, Vondo N, and Sekgala D
- Subjects
- Humans, Aged, Caregivers psychology, South Africa epidemiology, Pandemics, SARS-CoV-2, HIV Infections epidemiology, HIV Infections psychology, COVID-19
- Abstract
ABSTRACT In this paper, we explored how vulnerable, immunocompromised groups and caregivers of the elderly experienced and perceived the onset of the Covid-19 pandemic in South Africa. Semi-structured interviews were conducted remotely between the 5th andthe 18th of April 2020 in the three South African provinces hardest hit by Covid-19, namely Gauteng, KwaZulu-Natal and the Western Cape. In total, 60 qualitative key informant interviews and one focus group discussion were conducted. Study participants expressed concerns for elderly people and people with underlying health conditions because of their increased vulnerability to Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). People living with HIV expressed an increased fear of infection following the advent of the Covid-19 pandemic in South Africa. The sidelining of healthcare services and stock-outs of medication proved to be an added concern in particular for vulnerable and immunocompromised groups. Overall, the data suggest that the fear of infection is ubiquitous for people who live in unstable environments such as overcrowded townships and informal settlements. Given the increased fears of infection brought on by the Covid-19 pandemic, the mental health of vulnerable communities and those caring for them becomes an added burden for people living in unstable environments.
- Published
- 2023
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29. Mental Health Needs of Adolescent and Young Adult PrEP Users in South Africa: Implications for Sexual and Reproductive Health Programming.
- Author
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Gordon KJ, Martin CE, Kutywayo A, Cox LA, Nongena P, and Mullick S
- Subjects
- Male, Female, Humans, Young Adult, Adolescent, Reproductive Health, Mental Health, South Africa epidemiology, Cross-Sectional Studies, Sexual Behavior, HIV Infections epidemiology, HIV Infections prevention & control, HIV Infections psychology
- Abstract
Purpose: Poor mental health is associated with sexual and reproductive health (SRH) risks, including human immunodeficiency virus (HIV) and pre-exposure prophylaxis discontinuation. Adolescents and young people (AYP) are vulnerable to HIV and depression. This paper describes the prevalence and severity of depression and associated factors in AYP accessing SRH services in South Africa., Methods: A cross-sectional analysis of enrollment data (January 2019 to December 2021) from a cohort of individuals receiving pre-exposure prophylaxis services at eight clinics in three provinces in South Africa was conducted. Females (n = 1,074) and males (n = 231) aged 15-24 years were included. Interviewer-administered questionnaires were conducted, and the prevalence and severity of depression assessed using the Patient Health Questionnaire-9. Multivariate analysis was used to identify factors associated with depression., Results: Over 40% of participants had experienced any depression symptoms (43.7% of females, 38.5% of males). For males, experiencing intimate partner violence was the only predictor of depression symptoms (adjusted odds ratio (AOR) 8.81, 95% confidence intervals (CI) 1.03-75.44). For females, living with both parents (AOR 1.70, 95% CI 1.15-2.51), having transactional sex (AOR 1.63, 95% CI 1.00-2.65), experiencing any intimate partner violence (AOR 1.96, 95% CI 1.34-2.89), and using drugs (AOR 1.78, 95% CI 1.03-3.11) were all positively associated with depression symptoms. Resilience was a protective factor against depression symptoms for both sexes (males: AOR 0.96, 95% CI 0.93-0.98; females: AOR 0.96, 95% CI 0.95-0.97)., Discussion: There is a high burden of depression among AYP accessing SRH services in South Africa. Mental health screening should be integrated into SRH and HIV prevention programs for AYP., (Copyright © 2023 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.)
- Published
- 2023
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30. Implementing Differentiated and Integrated HIV Prevention Services for Adolescent Girls and Young Women: Experiences From Oral PrEP Rollout in Primary Care Services in South Africa.
- Author
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Butler V, Kutywayo A, Martin CE, Pleaner M, Mojapele MV, Ncube S, Fipaza Z, Mundeta B, and Mullick S
- Subjects
- Humans, Female, Adolescent, HIV, South Africa, Primary Health Care, HIV Infections prevention & control, HIV Infections drug therapy, Anti-HIV Agents therapeutic use, Pre-Exposure Prophylaxis methods
- Abstract
Purpose: In South Africa, adolescent girls and young women (AGYW, aged 15-24 years) are disproportionately affected by human immunodeficiency viruses (HIV). Oral pre-exposure prophylaxis (PrEP) has been available in South Africa since 2016; however, there is limited evidence on oral PrEP implementation and integration in real-world settings, particularly among AGYW. Project PrEP is an implementation science project that sought to inform the introduction and integration of oral PrEP as part of combination HIV prevention and sexual and reproductive health services (SRH) in South Africa. The project focused on AGYW, as a priority population in need of HIV prevention. This paper presents strategies Project PrEP employed to increase oral PrEP and SRH service access and utilization., Methods: We present strategies employed to increase oral PrEP and SRH services uptake. Using routine monitoring data, facility assessments, stakeholder engagement, training and progress reports, and observations, we share implementation lessons learned and describe how strategies can be adapted by HIV prevention programs in different contexts., Results: Approximately 22, 000 people initiated on oral PrEP (December 2018-December 2021) across eight facilities and four mobile clinics. Two-thirds (67%) of initiated clients were AGYW., Discussion: Lessons are to be learned from the introduction of oral PrEP as implementers prepare for the introduction of new PrEP methods. Stakeholders must be continuously engaged to ensure buy-in, and social mobilization and demand creation should be contextual, focused, and innovative. Continuous staff training is needed to reinforce knowledge, and AGYW service delivery models must be local context relevant., (Copyright © 2023 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.)
- Published
- 2023
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31. 'A difficult conversation': community stakeholders' and key informants' perceptions of the barriers to talking about sex and HIV with adolescents and young people in KwaZulu-Natal, South Africa.
- Author
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Knight L, Humphries H, Van der Pol N, Ncgobo N, Essack Z, Rochat T, and van Rooyen H
- Subjects
- Adult, Humans, Adolescent, Young Adult, South Africa epidemiology, Sexuality, Communication, Sexual Behavior, HIV Infections prevention & control, HIV Infections epidemiology
- Abstract
Adolescence and young adulthood are important periods of transition and therefore for action and intervention to ensure future sexual and reproductive health (SRH). Caregiver-adolescent communication about sex and sexuality is a protective factor for SRH, but there are often barriers to this. Adults' perspectives are limited within the literature but important as they should lead this process. This paper uses exploratory qualitative data from in-depth interviews with 40 purposively sampled community stakeholders and key informants to explore their insights into the perceived, experienced or expected challenges adults' experience when having these conversations within a high HIV prevalence, South African context. Findings suggest that respondents recognised the value of communication and were generally willing to try it. However, they identified barriers such as fear, discomfort and limited knowledge and perceived capacity to do so. They show that in high prevalence contexts adults grapple with their own personal risks, behaviours and fears that may affect their ability to have these conversations. This demonstrates the need to equip caregivers with the confidence and ability to communicate about sex and HIV, alongside managing their own complex risks and situations to overcome barriers. It is also necessary to shift the negative framing of adolescents and sex.
- Published
- 2023
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32. Young people, HIV / AIDS, and intervention: barriers and gateways to behaviour change.
- Author
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Varga CA
- Subjects
- Africa, Africa South of the Sahara, Africa, Southern, Age Factors, Behavior, Contraception, Demography, Developing Countries, Disease, Education, Family Planning Services, Population, Population Characteristics, South Africa, Virus Diseases, Acquired Immunodeficiency Syndrome, Adolescent, Condoms, Decision Making, HIV Infections, Sex Education, Sexual Behavior
- Published
- 2000
33. Will HIV / AIDS undermine democracy in South Africa?
- Author
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Willan S
- Subjects
- Africa, Africa South of the Sahara, Africa, Southern, Developing Countries, Disease, Political Systems, South Africa, Virus Diseases, Acquired Immunodeficiency Syndrome, Democracy, Disease Outbreaks, HIV Infections, Politics
- Published
- 2000
34. HIV / AIDS in KwaZulu-Natal and South Africa.
- Author
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Smith A
- Subjects
- Africa, Africa South of the Sahara, Africa, Southern, Developing Countries, Disease, Research, Research Design, South Africa, Virus Diseases, Acquired Immunodeficiency Syndrome, HIV Infections, Prevalence
- Published
- 2000
35. Local government transformation and the challenge of HIV / AIDS.
- Author
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Smart R
- Subjects
- Africa, Africa South of the Sahara, Africa, Southern, Developing Countries, Disease, Economics, Organization and Administration, Politics, Population, South Africa, Virus Diseases, Acquired Immunodeficiency Syndrome, Disease Outbreaks, Geography, Government, HIV Infections, Social Change
- Published
- 1999
36. Integrating reproductive health: myth and ideology.
- Author
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Lush L, Cleland J, Walt G, and Mayhew S
- Subjects
- Adult, Child, Family Planning Services, Female, Ghana, Humans, Kenya, Poverty, South Africa, Women's Health, Zambia, Delivery of Health Care, Integrated, HIV Infections prevention & control, Primary Health Care, Reproductive Medicine, Sexually Transmitted Diseases prevention & control
- Abstract
Since 1994, integrating human immunodeficiency virus/sexually transmitted disease (HIV/STD) services with primary health care, as part of reproductive health, has been advocated to address two major public health problems: to control the spread of HIV; and to improve women's reproductive health. However, integration is unlikely to succeed because primary health care and the political context within which this approach is taking place are unsuited to the task. In this paper, a historical comparison is made between the health systems of Ghana, Kenya and Zambia and that of South Africa, to examine progress on integration of HIV/STD services since 1994. Our findings indicate that primary health care in Ghana, Kenya and Zambia has been used mainly by women and children and that integration has meant adding new activities to these services. For the vertical programmes which support these services, integration implies enhanced collaboration rather than merged responsibility. This compromise between comprehensive rhetoric and selective reality has resulted in little change to existing structures and processes; problems with integration have been exacerbated by the activities of external donors. By comparison, in South Africa integration has been achieved through political commitment to primary health care rather than expanding vertical programmes (top-down management systems). The rhetoric of integration has been widely used in reproductive health despite lack of evidence for its feasibility, as a result of the convergence of four agendas: improving family planning quality; the need to improve women's health; the rapid spread of HIV; and conceptual shifts in primary health care. International reproductive health actors, however, have taken little account of political, financial and managerial constraints to implementation in low-income countries.
- Published
- 1999
37. Experiences and perceptions of urine sampling for tuberculosis testing among HIV patients: a multisite qualitative descriptive study.
- Author
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Lissouba P, Rücker SCM, Otieno LA, Akatukwasa C, Xulu S, Monjane C, Akinyi M, Okal B, Lubega AV, Stewart R, Bossard C, Ohler L, Antabak NT, Musoke M, Muyindike W, and Huerga H
- Subjects
- Adult, Humans, Point-of-Care Systems, Sputum, South Africa, HIV Infections diagnosis, Tuberculosis diagnosis
- Abstract
Objectives: Evidence on the acceptability of urine-based assays for tuberculosis (TB) diagnosis among patients remains limited. We sought to describe patients' experiences and perceptions of urine sampling for TB testing at point of care., Setting: Study sites in Kenya, Uganda, Mozambique and South Africa., Participants: Adult ambulatory HIV patients enrolled in a TB diagnostic study were selected purposively., Intervention: For this qualitative descriptive study, audiorecorded individual interviews conducted with consenting participants were translated, transcribed and analysed using content analysis. Ethical agreement was obtained from relevant ethical review committees., Results: Fifty-eight participants were interviewed. Three domains were identified. Overall, participants described urine sampling as easy, rapid and painless, with the main challenge being lacking the urge. Urine was preferred to sputum sampling in terms of simplicity, comfort, stigma reduction, convenience and practicality. While perceptions regarding its trustworthiness for TB diagnosis differed, urine sampling was viewed as an additional mean to detect TB and beneficial for early diagnosis. Participants were willing to wait for several hours for same-day results to allay the emotional, physical and financial burden of having to return to collect results, and would rather not pay for the test. Facilitators of urine sampling included cleanliness and perceived privacy of sampling environments, comprehensive sampling instructions and test information, as well as supplies such as toilet paper and envelopes ensuring confort and privacy when producing and returning samples. Participants motivation for accepting urine-based TB testing stemmed from their perceived susceptibility to TB, the value they attributed to their health, especially when experiencing symptoms, and their positive interactions with the medical team., Conclusions: This study suggests that urine sampling is well accepted as a TB diagnostic method and provides insights on how to promote patients' uptake of urine-based testing and improve their sampling experiences. These results encourage the future broad use of urine-based assays at point of care., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
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- 2023
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38. Lay counsellors' experiences of administering the AUDIT-C as a brief screening tool in a South African township.
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Goldschmidt L, Mncina B, Langa M, Rebello S, Budaza T, Tshabalala J, and Achoki T
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- Humans, Counseling methods, South Africa, Emotions, HIV Infections diagnosis, Counselors
- Abstract
Background: South Africa presents one of the riskiest patterns of alcohol consumption, with per capita consumption above the African regional average. Globally, there has been an increased focus on the potential of appointing lay counsellors to administer alcohol intervention strategies in resource-limited contexts. Given the increasing need for relevant and efficient intervention strategies in response to high-risk alcohol consumption, screening instruments such as the AUDIT-C have gained increased attention., Methods: This paper explores the experiences of 15 lay counsellors in response to the training received on how to administer the AUDIT-C instrument, as well as provide interventions such as brief advice or an appropriate referral, in the resource-limited South African township of Alexandra, Johannesburg. A focus group was facilitated for this purpose and, thereafter, a thematic content analysis was applied to identify the themes most central to the lay counsellors' experiences., Results: The research findings suggest that the lay counsellors perceived the training to be adequate in preparing them for administrating the AUDIT-C and for providing any relevant interventions, and that their confidence in administering the instrument developed as the project progressed. However, recruitment and administration challenges were experienced in primary healthcare and community settings, and lay counsellors perceived home visits to be more appropriate with respect to issues related to confidentiality and stigmatisation., Conclusion: Overall, while lay counsellors feel that the training they received on the tool and the tool itself is useful for effectively implementing the AUDIT-C in low-resource communities, the availability and efficiency of alcohol treatment services in Alexandra Township need to be improved., (© 2023. The Author(s).)
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- 2023
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39. HIV and contraception.
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- Africa, Africa South of the Sahara, Africa, Southern, Developing Countries, Disease, Family Planning Services, South Africa, Virus Diseases, Congresses as Topic, Contraception, Contraceptive Agents, HIV Infections
- Published
- 1997
40. The AIDS crisis: review of psychological issues and implications, with special reference to the South African situation.
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Lindegger G and Wood G
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- Africa, Africa South of the Sahara, Africa, Southern, Behavior, Developing Countries, Disease, South Africa, Virus Diseases, Acquired Immunodeficiency Syndrome, HIV Infections, Psychology
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- 1995
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41. Stress, social support and biopsychosocial dynamics in HIV-AIDS.
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Schlebusch L and Cassidy MJ
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- Africa, Africa South of the Sahara, Africa, Southern, Behavior, Developing Countries, Disease, Family Characteristics, Interpersonal Relations, South Africa, Virus Diseases, Acquired Immunodeficiency Syndrome, Emotions, HIV Infections, Psychology, Social Support
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- 1995
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42. An evaluation of an education programme on HIV infection using puppetry and street theatre.
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Skinner D, Metcalf CA, Seager JR, de Swardt JS, and Laubscher JA
- Subjects
- Adult, Female, Health Education organization & administration, Health Knowledge, Attitudes, Practice, Humans, Male, Program Evaluation, South Africa, Surveys and Questionnaires, Videotape Recording, Drama, HIV Infections prevention & control, HIV-1, Health Education standards, Play and Playthings
- Abstract
'Puppets Against AIDS' is a novel educational medium being used to try to reduce the spread of HIV infection in South Africa. It involves the use of street theatre employing two-metre-high puppets who act out a story of how one person, who is infected with HIV, passes it onto a series of other people until he eventually dies. The puppet show was evaluated in two phases. The first involved a content analysis of a video recording of the show by a multidisciplinary group, according to a set of criteria for appropriate education on HIV infection. This show was found to be professional and comprehensive in terms of the educational messages provided. Some suggestions were made for improvements. The second phase was a before and after study of the impact on the audience at a series of live shows. The show made a significant contribution to knowledge and intended behaviour in the short term. Overall it was felt that the show does make a valuable contribution, but could be made more effective if incorporated into existing community-based education programmes on HIV infection.
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- 1991
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43. Exploring the potential causes of HIV prevalence among young women in South Africa: a critical literature review.
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Zakeyo, Karin and Nyashanu, Mathew
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HIV infections ,CAUSES of death ,HUMAN sexuality ,SYSTEMATIC reviews ,AGE distribution ,DISEASE incidence ,HIV seroconversion ,SOCIAL factors ,SEX distribution ,HUMAN services programs ,SOCIAL isolation ,SEXUALLY transmitted diseases ,PRE-exposure prophylaxis ,SEX customs ,EPIDEMICS ,DESCRIPTIVE statistics ,CAUSALITY (Physics) ,WOMEN'S health ,HIV - Abstract
Purpose: The purpose of this study is to explore the potential causes of HIV prevalence among young women in South Africa. Human immunodeficiency virus (HIV) is one of the leading causes of death in sub-Saharan Africa. South Africa (SA) has the largest HIV pandemic in the world with approximately 7.2 million people living with HIV as of 2017. There is a disproportionate incidence of HIV between women and men, particularly affecting young women 15–24 years of age. This paper reviewed 10 articles on the impact of HIV in SA among young women. Design/methodology/approach: A total of 10 articles on HIV in SA were selected for review using academic databases including Library One Search Pro, Google Scholar, the British Medical Journal and Elsevier. The search generated 11,095 articles, which were narrowed down to 10 by the criteria of being specific to gender and age and publication period. Findings: Five themes were identified from the findings as to the potential causes of HIV prevalence among young women these included age-disparate relationships, social factors and sexual behaviour. Impact of HIV on communities and individuals, gender and patriarchy including poverty and social isolation. Originality/value: The paper shows the impact of inequalities between men and women leading to HIV infection among young women. It also shows some gaps that require further research with regards to HIV infections among young women. [ABSTRACT FROM AUTHOR]
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- 2023
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44. Health Economics Research on Non-surgical Biomedical HIV Prevention: Identifying Gaps and Proposing a Way Forward.
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Torres-Rueda S, Terris-Prestholt F, Gafos M, Indravudh PP, Giddings R, Bozzani F, Quaife M, Ghazaryan L, Mann C, Osborne C, Kavanagh M, Godfrey-Faussett P, Medley G, and Malhotra S
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- Pregnancy, Female, Humans, Costs and Cost Analysis, South Africa, Outcome Assessment, Health Care, HIV Infections prevention & control
- Abstract
Background and Objective: Although HIV prevention science has advanced over the last four decades, evidence suggests that prevention technologies do not always reach their full potential. Critical health economics evidence at appropriate decision-making junctures, particularly early in the development process, could help identify and address potential barriers to the eventual uptake of future HIV prevention products. This paper aims to identify key evidence gaps and propose health economics research priorities for the field of HIV non-surgical biomedical prevention., Methods: We used a mixed-methods approach with three distinct components: (i) three systematic literature reviews (costs and cost effectiveness, HIV transmission modelling and quantitative preference elicitation) to understand health economics evidence and gaps in the peer-reviewed literature; (ii) an online survey with researchers working in this field to capture gaps in yet-to-be published research (recently completed, ongoing and future); and (iii) a stakeholder meeting with key global and national players in HIV prevention, including experts in product development, health economics research and policy uptake, to uncover further gaps, as well as to elicit views on priorities and recommendations based on (i) and (ii)., Results: Gaps in the scope of available health economics evidence were identified. Little research has been carried out on certain key populations (e.g. transgender people and people who inject drugs) and other vulnerable groups (e.g. pregnant people and people who breastfeed). Research is also lacking on preferences of community actors who often influence or enable access to health services among priority populations. Oral pre-exposure prophylaxis, which has been rolled out in many settings, has been studied in depth. However, research on newer promising technologies, such as long-acting pre-exposure prophylaxis formulations, broadly neutralising antibodies and multipurpose prevention technologies, is lacking. Interventions focussing on reducing intravenous and vertical transmission are also understudied. A disproportionate amount of evidence on low- and middle-income countries comes from two countries (South Africa and Kenya); evidence from other countries in sub-Saharan Africa as well as other low- and middle-income countries is needed. Further, data are needed on non-facility-based service delivery modalities, integrated service delivery and ancillary services. Key methodological gaps were also identified. An emphasis on equity and representation of heterogeneous populations was lacking. Research rarely acknowledged the complex and dynamic use of prevention technologies over time. Greater efforts are needed to collect primary data, quantify uncertainty, systematically compare the full range of prevention options available, and validate pilot and modelling data once interventions are scaled up. Clarity on appropriate cost-effectiveness outcome measures and thresholds is also lacking. Lastly, research often fails to reflect policy-relevant questions and approaches., Conclusions: Despite a large body of health economics evidence on non-surgical biomedical HIV prevention technologies, important gaps in the scope of evidence and methodology remain. To ensure that high-quality research influences key decision-making junctures and facilitates the delivery of prevention products in a way that maximises impact, we make five broad recommendations related to: improved study design, an increased focus on service delivery, greater community and stakeholder engagement, the fostering of an active network of partners across sectors and an enhanced application of research., (© 2023. The Author(s).)
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- 2023
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45. A qualitative study to explore daily versus on-demand oral pre-exposure prophylaxis (PrEP) in young people from South Africa, Uganda and Zimbabwe.
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Dietrich JJ, Ahmed N, Tshabalala G, Wu M, Mulaudzi M, Hornschuh S, Atujuna M, Muhumuza R, Ssemata AS, Stranix-Chibanda L, Nematadzira T, Bekker LG, Martinson N, Seeley J, and Fox J
- Subjects
- Adolescent, Female, Male, Humans, South Africa, Uganda, Zimbabwe, HIV Infections prevention & control, Pre-Exposure Prophylaxis, Drug-Related Side Effects and Adverse Reactions
- Abstract
Background: Adolescents in sub-Saharan Africa (SSA) remain vulnerable to HIV infection. While pre-exposure prophylaxis (PrEP) is highly effective in preventing HIV transmission as a daily or on-demand regimen, tailored approaches are necessary. The Combined HIV Adolescent PrEP and Prevention Study (CHAPS) is a mixed-methods research program investigating the acceptability and feasibility of implementing daily and on-demand PrEP among young people in SSA. It also aims to determine an on-demand dosing schedule for insertive sex. For this paper, we explored preferences for daily versus on-demand PrEP amongst adolescents as part of CHAPS., Methods: Purposive sampling was used to recruit participants from Soweto and Cape Town (South Africa), Wakiso district (Uganda) and Chitungwiza (Zimbabwe). At the time of the study in 2018/2019, Uganda had not rolled out PrEP to the general population; in Zimbabwe, PrEP for young people was only available at selected sites with one located within the study recruitment area. In South Africa, PrEP was made available to selected high-risk groups. We conducted 60 in-depth interviews and 24 group discussions amongst young people aged 13-24 without HIV in South Africa, Uganda, and Zimbabwe. All in-depth interviews and group discussions were audio-recorded, transcribed verbatim and translated to English. Data were analysed using framework analysis. The main themes were centered around preferences for daily and on-demand PrEP., Results: Reasons for on-demand preferences included stigma, pill fatigue, adherence and side effects. Reasons for daily PrEP preferences included factors related to sexual risk behaviour, continuous protection against incidents of unintentional exposure, and the increased efficacy of a daily dose. Participants at all sites preferring daily PrEP identified the same reasons, with more males than females citing inadvertent blood contact or perceived increased efficacy. Similarly, participants at all sites preferring on-demand PrEP gave the same reasons for their preferences for on-demand PrEP; the exception was South Africans who did not mention the hope of having fewer side effects by not taking daily PrEP. Additionally, more males than females cited intermittent sex as a reason for opting for on-demand PrEP., Conclusions: Our study is the first known to explore and describe youth preferences for daily versus on-demand PrEP. While the choice is clear-cut, the reasons cited in the different options provide invaluable insights into their decisions, and the actual and perceived facilitators and barriers to access to PrEP. Further education is needed amongst young people, not only about PrEP but also in other areas of comprehensive sexuality education. Exploring all options of HIV prevention is crucial to provide a tailored, one-size-does-not-fit-all approach to adolescent care in SSA to reduce and, the continued and increasing risk of this preventable infection., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Dietrich et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)
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- 2023
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46. Incidence, recurrence, and prevalence of bacterial vaginosis from acute to chronic HIV infection in a prospective cohort of women in South Africa.
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Asare K, Ngcapu S, Osman F, Vandormael A, Mindel A, Naicker N, Khanyile M, S Abdool Karim S, Tomita A, and Garrett N
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- Female, Humans, Adult, South Africa epidemiology, Prospective Studies, Incidence, Prevalence, HIV Infections epidemiology, HIV Infections complications, Vaginosis, Bacterial epidemiology, Vaginosis, Bacterial complications
- Abstract
Purpose: We investigated the incidence, recurrence, prevalence, and risk factors for bacterial vaginosis (BV) diagnosis starting from acute HIV infection among South African women., Methods: The Centre for the AIDS Programme of Research in South Africa 002 study tested and treated women for BV (Nugent score 7-10) once/twice annually from acute to chronic HIV infection (2004-2020). We estimated BV incidence as the number of new cases and recurrence as the number of subsequent diagnoses per 100 person-years (PYs). We fitted Anderson-Gil Cox-proportional-hazard regression models to determine factors associated with BV incidence or recurrence., Results: Of 235 participants, the median age at enrollment was 25 years (Inter Quartile Range [IQR] 22-29). BV prevalence at enrollment was 50.6%. BV incidence was 23.9 cases per 100 PYs, and recurrence was 51.3 cases per 100 PYs. BV incidence/recurrence was associated with younger age (<25 years: adjusted hazard ratio [aHR] 1.70, 95% confidence interval [CI] 1.27-2.27), detectable HIV viral load (aHR 1.54, 95% CI 1.27-1.87) and lower CD4 count (<350 cells/μL: aHR 1.33, 95% CI 1.01-1.76)., Conclusions: Our findings underscore the need for early antiretroviral treatment initiation with diagnostic BV and sexually transmitted infection care, especially among younger women., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Inc. All rights reserved.)
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- 2023
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47. Prevalence and risk factors for HIV infection in truck drivers: a systematic review of global evidence.
- Author
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SeyedAlinaghi, SeyedAhmad, Shahidi, Ramin, Matini, Parisa, Mirzapour, Pegah, Arjmand, Ghazal, Amiri-Fard, Iman, Siami, Haleh, Yarmohammadi, Soudabeh, Mehraeen, Esmaeil, and Dadras, Omid
- Subjects
HIV infections ,TRUCK drivers ,SEXUALLY transmitted diseases ,UNSAFE sex ,CONSCIOUSNESS raising - Abstract
Transporting and driving long distances might be associated with an increased risk of contracting HIV in truck drivers, which is recognized as a link to network transmission of HIV among this population. The present study aims to systematically review the prevalence and risk factors of HIV infection in truck drivers globally. A comprehensive search of the databases of Embase, PubMed, Scopus, and Web of Science was carried out. The original papers reporting statistics on the prevalence and risk factors of HIV infection among truck drivers were included. In this study, 23 original articles that met the eligibility criteria were reviewed. All articles were crosssectional studies in which a total number of 16,315 truck drivers were studied to estimate the prevalence and risk factors of HIV infection. Findings indicated high HIV seroprevalence among truck drivers, with the highest prevalence of 56% in South Africa. HIV/AIDS awareness and condom use among truckers were reported low. Having sex with other men, circumcision status, time away from home, marital status, years working as a truck driver, education, income, and drug/alcohol use are the most important risk factors for HIV in truck drivers. Longer time on the road can increase the risk of infection by creating conditions for unsafe sex, in particular, having sex with other men. Low socioeconomic status exacerbates the condition. HIV risk-reduction interventions for long-distance truck drivers are necessary to enhance the awareness of sexually transmitted infections and introduce protective measures such as condoms. [ABSTRACT FROM AUTHOR]
- Published
- 2023
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48. Pulsing bodies and embodying pulse: musical effervescence in a South African HIV/AIDS community outreach program.
- Author
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Robert Walker, Gavin
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AIDS treatment ,HIV infections ,BUSINESS management of health facilities ,MATHEMATICAL models ,MUSIC therapy ,ETHNOLOGY research ,COMMUNITY-based social services ,THEORY - Abstract
Early in South Africa's HIV/AIDS crisis, entertainment education emerged as a powerful vehicle for communicating health and social messaging to combat the epidemic. Applied theatre now accounts for the majority of arts-based HIV interventions in sub-Saharan Africa, and continues a history of theatre for social change in South Africa in particular. While much has been written about the dramaturgical and communication theories that support such interventions, the role of music, a formidable tool in the applied theatre intervention arsenal, has received considerably less attention within applied arts intervention scholarship. This paper draws from Durkheim's collective effervescence to propose a theoretical approach to music within the creation and maintenance of effervescent assemblies that is being employed by HIV/AIDS interventions to encourage participation in HIV testing. The theoretical model of musical effervescence is situated within ethnographic fieldwork conducted while accompanying an applied HIV/AIDS theatre company on a national tour of South Africa. [ABSTRACT FROM AUTHOR]
- Published
- 2022
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49. The impact of child mortality on fertility in South Africa: Do child support grants and antiretroviral treatment matter?
- Author
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Bidzha ML, Johnson LF, Dorrington RE, Ngepah N, and Greyling T
- Subjects
- Pregnancy, Child, Female, Humans, South Africa epidemiology, Child Custody, Fertility, Marriage, Mortality, Child Mortality, HIV Infections drug therapy, HIV Infections epidemiology
- Abstract
This paper investigates the effect of under-five mortality, child support grant (CSG) coverage and the rollout of antiretroviral therapy (ART) on fertility in South Africa. The study employs the quality-quantity trade-off framework to analyse the direct and indirect factors affecting fertility using the two stage least squares fixed effects instrumental variable approach. The analysis uses balanced panel data covering nine provinces from 2001-2016. This period was characterised by significant increases in the child support grant coverage and ART coverage. Furthermore, this period was characterised by a significant decline in the under-five mortality rate. We find no evidence to support the hypothesis that increases in the CSG coverage are associated with an increase in fertility. This finding aligns with previous literature suggesting that there are no perverse incentives for childbearing associated with the child support grant. On the other hand, results indicate that an increase in ART coverage is associated with an increase in fertility. Results also show that a decrease in under-five mortality is associated with a decline in fertility over the sample period. HIV prevalence, education, real GDP per capita, marriage prevalence and contraceptive prevalence are also important determinants of fertility in South Africa. Although the scale up of ART has improved health outcomes, it also appears to have increased fertility in HIV-positive women. The ART programme should therefore be linked with further family planning initiatives to minimise unintended pregnancies., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Bidzha et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)
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- 2023
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50. Negotiating sexual and gender diversity in rural and peri-urban KwaZulu-Natal, South Africa.
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Epprecht M and Mngoma N
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- Female, Humans, Male, South Africa, Negotiating, Sexual Behavior psychology, Gender Identity, HIV Infections
- Abstract
A noticeable tendency in the first generation of scholarship on sexual orientation and gender identity/expression (SOGIE) in Africa has been the focus on urban or modern institutional settings. A dominant theme is to document people's struggles against stigma, fear and violence to better inform interventions to strengthen human rights and sexual health for all. In some cases, unintentionally, the impression conveyed of Africa is of a continent with cultures that are uniformly, hostile to SOGIE rights. The present study arises from a large survey among boys and men in KwaZulu-Natal, South Africa that problematises that impression. The study revealed unexpectedly high levels of same-sex sexual experience among boys and men in a mostly rural, culturally conservative setting. Following from that revelation, we conducted in-depth interviews to gain insight into their lives. Informants did indeed recount many incidents of discrimination and violence and admitted to sometimes severe emotional health problems. Yet they also spoke of finding love, acceptance, allies, resources, humour and hope for the future. In this paper, we tease out key themes from the interviews in relation to trends in the scholarship.
- Published
- 2023
- Full Text
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