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Objectives: South Africa has made remarkable progress in increasing the coverage of antiretroviral therapy (ART) among pregnant women; however, viral suppression among pregnant women receiving ART is reported to be low. Access to routine viral load testing is crucial to identify women with unsuppressed viral load early in pregnancy and to provide timely intervention to improve viral suppression. This study aimed to determine the coverage of maternal viral load monitoring nationally, focusing on viral load testing, documentation of viral load test results, and viral suppression (viral load < 50 copies/mL). At the time of this study, the first‐line regimen for women initiating ART during pregnancy was non‐nucleoside reverse transcriptase (NNRTI)‐based regimen. Methods: Between 1 October and 15 November 2019, a cross‐sectional survey was conducted among 15‐ to 49‐year‐old pregnant women attending antenatal care in 1589 nationally representative public health facilities. Data on ART status, viral load testing and viral load test results were extracted from medical records. Logistic regression was used to examine factors associated with coverage of viral load testing. Results: Of 8112 participants eligible for viral load testing, 81.7% received viral load testing, and 94.1% of the viral load test results were documented in the medical records. Of those who had viral load test results documented, 74.1% were virally suppressed. Women initiated on ART during pregnancy and who received ART for three months had lower coverage of viral load testing (73%) and viral suppression (56.8%) compared with women initiated on ART before pregnancy (82.8% and 76.1%, respectively). Initiating ART during pregnancy rather than before pregnancy was associated with a lower likelihood of receiving a viral load test during pregnancy (adjusted odds ratio = 1.6, 95% confidence interval: 1.4–1.8). Conclusions: Viral load result documentation was high; viral load testing could be improved especially among women initiating ART during pregnancy. The low viral suppression among women who initiated ART during pregnancy despite receiving ART for three months highlights the importance of enhanced adherence counselling during pregnancy. Our finding supports the WHO recommendation that a Dolutegravir‐containing regimen be the preferred regimen for women who are newly initiating ART during pregnancy for more rapid viral suppression. [ABSTRACT FROM AUTHOR]

South Africa has the largest HIV burden and treatment program in the world. Diversion of HIV prevention and treatment medication for recreational use—or nonmedical use for psychoactive effects—is a public health concern globally and in South Africa. Few South African studies examine recreational use of HIV antiretrovirals (ARVs). The objective of this article is to evaluate the prevalence of recreational ARV use and to identify risk and protective factors associated with use. Data are drawn from a cross-sectional household survey of N = 4399 adolescent girls and young women (AGYW) aged 15–24 years in six districts across South Africa where an evaluation of a South African combination HIV prevention for girls and young women was implemented. The use of ARVs to "get high" was reported by 8.3% of AGYW across all districts. Logistic regressions showed that those engaging in transactional sex were at two times higher odds of recreational ARV use [adjusted odds ratio (aOR) = 2.01; confidence interval (95% CI): 1.51–2.68]. Recreational ARV use was more likely among those who used pre-exposure prophylaxis (PrEP) (aOR = 2.17; 95% CI: 1.36–3.48); HIV-positive participants who were not on ARVs for treatment (aOR = 0.36; 95% CI: 0.18–0.68); and those who were not virally suppressed (aOR, no vs. yes = 2.84; 95% CI: 1.21–6.66). As ARVs become more widely available for prevention and treatment, it will be important to monitor and address the possible emergence of ARVs as a substance for misuse or abuse. [ABSTRACT FROM AUTHOR]

Background To determine the prevalence and determinants of problematic alcohol use (CAGE ≥2) in 25-74-year-old black population in Cape Town in 2008/2009 and examine the changes in self-reported alcohol consumption between 1990 and 2008/2009 in 25-64-year-olds. Methods In 2008/2009, a representative cross-sectional sample, stratified for age and sex, was randomly selected from the same townships sampled in 1990. Socio-demographic characteristics, the ability to cope with psychosocial stress (sense of coherence) and adverse life events were determined. Ordinal logistic regression analysis assessed the determinants of problem drinking. Results There were 1099 participants, 392 men and 707 women, in 2008/2009. Prevalence of alcohol consumption in 2008/2009 (men: 68.5%, 95% CI 62.7 to 73.7; women: 27.4%, 95% CI 23.7 to 31.5) was higher than in 1990 (men: 56.7%, women: 15.1%). Prevalence of problem drinking was significantly higher in men (49.7%, 95% CI 44.6 to 54.9) than in women (18.1% 95% CI 15.3 to 21.2) ( p<0.001). In men, greater alcohol use was associated with >7 years of education ( p=0.012), being unemployed compared with employed (p=0.008) and coping poorly with stress (OR 1.02, 95% CI 1.01 to 1.05, p=0.042), and in women with spending more than half their life in the city (p<0.001) and coping poorly with stress (OR 1.02, 95% CI 1.01 to 1.04, p=0.039). The odds for greater alcohol use with increasing number of adverse life events, after adjusting for the other factors, was significant in men (OR 1.11, 95% CI 1.02 to 1.19, p=0.010) and women (OR 1.09, 95% CI 1.03 to 1.16, p=0.005). Conclusions Problem drinking is a major problem in this population and requires urgent interventions to curtail the misuse. [ABSTRACT FROM AUTHOR]

Objective: To investigate whether methamphetamine use is associated with sexual risk behavior among adolescents. Method: A cross-sectional survey of 1,561 male and female high school students in Cape Town (mean age 14.9 years) was conducted using items from the Problem Oriented Screening Instrument for Teenagers (POSIT) HIV Risk Scale. Results: Nine percent of the students had tried methamphetamine and 30% of male and 17% of female students reported sexual debut. Multinomial logistic regression analyses showed that methamphetamine use in the past year was significantly associated with being in a higher HIV/STI risk category (RRR = 2.1, 95% CI: 1.10–4.03, p < 0.05). Conclusions: Methamphetamine use, coupled with a high HIV prevalence in South Africa, raises serious cause for concern about the potential for methamphetamine to further exacerbate the prevalence and spread of HIV in Cape Town. [ABSTRACT FROM AUTHOR]

Objectives: This cross-sectional study examined the nutritional factors associated with the high levels of stunting in 2- to 5-y-old children in an impoverished South African setting where liver is frequently eaten and vitamin A deficiency known to be absent. Methods: Children's dietary intake was assessed by a single 24-h recall. Heights and weights were measured and information was obtained on breast-feeding history, the child's habitual milk intake, as well as substance use by the mother during pregnancy (n = 150). Results: The overall prevalence of stunting was 36.9% (CI 29.2, 44.6) and increased with age, being 49% in the 4- to 5-y-old age category. Birth weight correlated significantly with height-for-age z-scores (HAZ; r = 0.250, P = 0.003), and was lower in children whose mothers smoked and used alcohol during pregnancy than in children whose mothers abstained (P < 0.0001). Median intake of energy, carbohydrate and protein was adequate. Median intake for all micronutrients was at least 90% of the estimated average requirement, except for calcium, vitamin D and vitamin E, which was 21%, 15%, and 32%, respectively. Intake of fat, calcium, phosphorous, vitamin D, riboflavin, and vitamin B12 (nutrients that typically occur in milk) was significantly lower in stunted than in non-stunted children (P < 0.05). When excluding children with low birth weight, intake of calcium, vitamin D, and riboflavin were still significantly lower (P < 0.05). HAZ was higher in children who habitually drank milk compared to those who did not (P = 0.003). Conclusions: Inadequate calcium and vitamin D intake, presumably because of low intake of milk after weaning, may have contributed to stunting in this population. [ABSTRACT FROM AUTHOR]

Objective To describe age- and sex-specific rates of child homicide in South Africa. Methods A cross-sectional mortuary-based study was conducted in a national sample of 38 medicolegal laboratories operating in 2009. These were sampled in inverse proportion to the number that were operational in each of three strata defined by autopsy volume: < 500, 500-1499 or > 1499 annual autopsies. Child homicide data were collected from mortuary files, autopsy reports and police interviews. Cause of death, evidence of abuse and neglect or of sexual assault, perpetrator characteristics and circumstances surrounding the death were investigated. Findings An estimated 1018 (95% confidence interval, CI: 843-1187) child homicides occurred in 2009, for a rate of 5.5 (95% CI: 4.6-6.4) homicides per 100 000 children younger than 18 years. The homicide rate was much higher in boys (6.9 per 100 000; 95% CI: 5.6-8.3) than in girls (3.9 per 100 000; 95% CI: 3.2-4.7). Child abuse and neglect had preceded nearly half (44.5%) of all homicides, but three times more often among girls than among boys. In children aged 15 to 17 years, the homicide rate among boys (21.7 per 100 000; 95% CI: 14.2-29.2) was nearly five times higher than the homicide rate among girls (4.6 per 100 000; 95% CI: 2.4-6.8). Conclusion South Africa's child homicide rate is more than twice the global estimate. Since a background of child abuse and neglect is common, improvement of parenting skills should be part of primary prevention efforts. [ABSTRACT FROM AUTHOR]