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This research joins people-centered approaches to development in understanding how social relationships are integrated into the efficacy of human development organizations in South Africa during a crisis. It positions itself within a Relational Thinking approach. A relational tool was applied to measure the relational dynamics within two organizations in South Africa who provided support to people economically affected by the COVID-19 crisis and the accompanying lockdowns. An existing computer-generated program called the Relational Health Audit (RHA) was used to study the proximity or distance between individuals and groups in their organizations. The findings show the relational footprint of development organizations due to deepened connections, continuity, understanding of context, sensitivity to power dynamics and commonality. These relationships allowed quick adjustments and responses to people's needs in the crisis. Through a relational approach, the article highlights why development cannot simply be viewed through a singular lens, but instead needs to be understood through a wide ranging and open-ended set of inquiries into systems, interventions, and outcomes. [ABSTRACT FROM AUTHOR]

Alien invasive plants (AIPs) pose a threat to the existence of plant and animal biodiversity in the ecosystems they invade. They need to be cleared, monitored and eventually eradicated from the landscape. The potential and the economic viability to supply non-woody AIP biomass for electricity generation were assessed in this study, which was conducted on samples from 13 common non-woody AIPs in South Africa, namely: Arundo donax (giant reed), Lantana camara (lantana), Pontederia cordata (pickerel weed), Ricinus communis (castor-oil plant), Opuntia ficus-indica (sweet prickly pear), Solanum mauritianum (bugweed), Atriplex nummularia (saltbush), Cestrum laevigatum (inkberry), Senna didymobotrya (peanut butter cassia), Chromoleana odorata (chromoleana), Eichhornia crassipes (water hyacinth), Cerus jamacaru (queen of the night) and Agave sisilana (sisal plant). Proximate and ultimate analysis was made in order to assess the suitability of the biomass for different thermo-chemical conversion techniques for electricity generation. A financial evaluation of the costs to supply biomass to the plant gate was performed by combining the harvesting, chipping and transport costs. The results showed that the biomass of giant reed, lantana, bugweed, saltbush, inkberry, cassia and Chromoleana may be used to generate electricity through combustion, although the total average cost was approximately 50% higher than that of woody biomass feedstock, requiring a 'fuel cost subsidy' to justify their utilisation for energy production [ABSTRACT FROM AUTHOR]

Rapid diagnostic tools have been shown to improve linkage of patients to care. In the context of infectious diseases, assessing the impact and cost-effectiveness of such tools at the population level, accounting for both direct and indirect effects, is key to informing adoption of these tools. Point-of-care (POC) CD4 testing has been shown to be highly effective in increasing the proportion of HIV positive patients who initiate ART. We assess the impact and cost-effectiveness of introducing POC CD4 testing at the population level in South Africa in a range of care contexts, using a dynamic compartmental model of HIV transmission, calibrated to the South African HIV epidemic. We performed a meta-analysis to quantify the differences between POC and laboratory CD4 testing on the proportion linking to care following CD4 testing. Cumulative infections averted and incremental cost-effectiveness ratios (ICERs) were estimated over one and three years. We estimated that POC CD4 testing introduced in the current South African care context can prevent 1.7% (95% CI: 0.4% - 4.3%) of new HIV infections over 1 year. In that context, POC CD4 testing was cost-effective 99.8% of the time after 1 year with a median estimated ICER of US$4,468/DALY averted. In healthcare contexts with expanded HIV testing and improved retention in care, POC CD4 testing only became cost-effective after 3 years. The results were similar when, in addition, ART was offered irrespective of CD4 count, and CD4 testing was used for clinical assessment. Our findings suggest that even if ART is expanded to all HIV positive individuals and HIV testing efforts are increased in the near future, POC CD4 testing is a cost-effective tool, even within a short time horizon. Our study also illustrates the importance of evaluating the potential impact of such diagnostic technologies at the population level, so that indirect benefits and costs can be incorporated into estimations of cost-effectiveness. [ABSTRACT FROM AUTHOR]

This study investigates the possible socioeconomic impact of the phasing out of nearly 22 500 ha of plantations within the Southern and Western Cape regions of South Africa as a result of a decision made by government in 2000. Data was collected in 2007 from three plantations (one near Grabouw in the Western Cape, and two near George in the Southern Cape) managed by Mountain to Ocean Forestry (Pty) Ltd (currently Cape Pine Investment Holdings Ltd), among three different plantation stakeholder groups. These groups are (1) forest-dependent communities, (2) stakeholders among the forestry value chain and (3) indirect stakeholders. This study indicates that there are significant differences between the potential impacts of the phasing-out process within the Southern and Western Cape regions. Communities and secondary processing companies in the Southern Cape are much more dependent on forestry than those in the Western Cape region. The study highlights three aspects related to the phasing-out process that need urgent attention. These are (1) to increase public awareness and community participation among local beneficiaries and companies to be impacted on by the phasing-out process, (2) provide appropriate training and capacity-building and thus increased skills level of workers who face unemployment and (3) the identification of alternative employment opportunities for the unemployed affected by the phasing-out process. [ABSTRACT FROM AUTHOR]

Memory after violent conflict is a contentious issue. The way in which the past has been remembered has often been the impetus for renewed violence rather than healing and reconciliation. Exploring individual and collective memory in the Rwandan and South African contexts, this article argues that how we remember is more important than what we remember, if the process of remembering is to contribute positively to the post-conflict recovery process. This article considers some preliminary thoughts related to memory after violent conflict by comparing how South Africa and Rwanda have remembered their violent pasts. A significant difference between these two countries is that South Africa has allowed for contending narratives about the past to be in dialogue with one another, whereas Rwanda has chosen the route of preferring one narrative over others. Some possible implications of this will be explored in this article. [ABSTRACT FROM AUTHOR]

Woodcarving is an important informal sector industry that is heavily dependent on tourism and yet sustains the livelihoods of many migrant communities in South Africa. In the Cape Town area, the trade appears to be dominated by sellers from neighbouring countries, including Zimbabwe, Malawi and the Democratic Republic of Congo. The most traded wood species are Dalbergia melanoxylon (African ebony), Brachylaena huillensis (silver oak or muhuhu) and Afzelia quanzensis (pod mahogany). This study found that the average gross income from the trade was R6450 and R2692 per month in the tourism peak and off seasons, respectively. However, while the woodcarving industry provides an important source of informal employment, it has contributed to the scarcity of highly prized hardwood species, especially in impoverished, underdeveloped areas. [ABSTRACT FROM AUTHOR]

The article provides information on Pipistrellus nanus or the African Banana bat. It has bicolored hair throughout pelage, sub sickle-shaped tragus with rounded outer margin and a semicircular antitragus. This aerial insectivore is the smallest mammal in the world that are usually found in the southern African regions. Some males and females possess tail glands. The male reproductive tract consists of paired testes and associated epididymides.

Background: The long-term impact of universal home-based testing and treatment as part of universal testing and treatment (UTT) on HIV incidence is unknown. We made projections using a detailed individual-based model of the effect of the intervention delivered in the HPTN 071 (PopART) cluster-randomised trial., Methods: In this modelling study, we fitted an individual-based model to the HIV epidemic and HIV care cascade in 21 high prevalence communities in Zambia and South Africa that were part of the PopART cluster-randomised trial (intervention period Nov 1, 2013, to Dec 31, 2017). The model represents coverage of home-based testing and counselling by age and sex, delivered as part of the trial, antiretroviral therapy (ART) uptake, and any changes in national guidelines on ART eligibility. In PopART, communities were randomly assigned to one of three arms: arm A received the full PopART intervention for all individuals who tested positive for HIV, arm B received the intervention with ART provided in accordance with national guidelines, and arm C received standard of care. We fitted the model to trial data twice using Approximate Bayesian Computation, once before data unblinding and then again after data unblinding. We compared projections of intervention impact with observed effects, and for four different scenarios of UTT up to Jan 1, 2030 in the study communities., Findings: Compared with standard of care, a 51% (95% credible interval 40-60) reduction in HIV incidence is projected if the trial intervention (arms A and B combined) is continued from 2020 to 2030, over and above a declining trend in HIV incidence under standard of care., Interpretation: A widespread and continued commitment to UTT via home-based testing and counselling can have a substantial effect on HIV incidence in high prevalence communities., Funding: National Institute of Allergy and Infectious Diseases, US President's Emergency Plan for AIDS Relief, International Initiative for Impact Evaluation, Bill & Melinda Gates Foundation, National Institute on Drug Abuse, and National Institute of Mental Health., Competing Interests: Declaration of interests AC reports funding from the National Institute for Health and Care Research (NIHR), Sergei Brin Foundation, and US Agency for International Development, and from Pfizer for lecturing. CF reports funding from the US National Institutes of Health (NIH), the National Institute of Allergy and Infectious Diseases (NIAID), the US President's Emergency Plan for AIDS Relief (PEPFAR), International Initiative for Impact Evaluation (3ie), the Bill & Melinda Gates Foundation, the National Institute on Drug Abuse (NIDA), and the National Institute of Mental Health (NIMH). DM reports funding from NIH, 3ie, PEPFAR, and the Bill & Melinda Gates Foundation. DJD reports funding from NIH and participation on a DSMB for COVID-19 studies. EP-M reports funding from NIH. HA reports funding from NIH, 3ie, and PEPFAR. MP reports funding from the Bill & Melinda Gates Foundation. SFl reports funding from NIH, 3ie, PEPFAR, and the Bill & Melinda Gates Foundation. TS reports funding from NIAID/NIH. WJMP reports funding from Li Ka Shing Foundation and is a consultant with WHO. All other authors declare no competing interests., (Copyright © 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved.)

Background: The HPTN 071 (PopART) trial showed that a combination HIV prevention package including universal HIV testing and treatment (UTT) reduced population-level incidence of HIV compared with standard care. However, evidence is scarce on the costs and cost-effectiveness of such an intervention., Methods: Using an individual-based model, we simulated the PopART intervention and standard care with antiretroviral therapy (ART) provided according to national guidelines for the 21 trial communities in Zambia and South Africa (for all individuals aged >14 years), with model parameters and primary cost data collected during the PopART trial and from published sources. Two intervention scenarios were modelled: annual rounds of PopART from 2014 to 2030 (PopART 2014-30; as the UNAIDS Fast-Track target year) and three rounds of PopART throughout the trial intervention period (PopART 2014-17). For each country, we calculated incremental cost-effectiveness ratios (ICERs) as the cost per disability-adjusted life-year (DALY) and cost per HIV infection averted. Cost-effectiveness acceptability curves were used to indicate the probability of PopART being cost-effective compared with standard care at different thresholds of cost per DALY averted. We also assessed budget impact by projecting undiscounted costs of the intervention compared with standard care up to 2030., Findings: During 2014-17, the mean cost per person per year of delivering home-based HIV counselling and testing, linkage to care, promotion of ART adherence, and voluntary medical male circumcision via community HIV care providers for the simulated population was US$6·53 (SD 0·29) in Zambia and US$7·93 (0·16) in South Africa. In the PopART 2014-30 scenario, median ICERs for PopART delivered annually until 2030 were $2111 (95% credible interval [CrI] 1827-2462) per HIV infection averted in Zambia and $3248 (2472-3963) per HIV infection averted in South Africa; and $593 (95% CrI 526-674) per DALY averted in Zambia and $645 (538-757) per DALY averted in South Africa. In the PopART 2014-17 scenario, PopART averted one infection at a cost of $1318 (1098-1591) in Zambia and $2236 (1601-2916) in South Africa, and averted one DALY at $258 (225-298) in Zambia and $326 (266-391) in South Africa, when outcomes were projected until 2030. The intervention had almost 100% probability of being cost-effective at thresholds greater than $700 per DALY averted in Zambia, and greater than $800 per DALY averted in South Africa, in the PopART 2014-30 scenario. Incremental programme costs for annual rounds until 2030 were $46·12 million (for a mean of 341 323 people) in Zambia and $30·24 million (for a mean of 165 852 people) in South Africa., Interpretation: Combination prevention with universal home-based testing can be delivered at low annual cost per person but accumulates to a considerable amount when scaled for a growing population. Combination prevention including UTT is cost-effective at thresholds greater than $800 per DALY averted and can be an efficient strategy to reduce HIV incidence in high-prevalence settings., Funding: US National Institutes of Health, President's Emergency Plan for AIDS Relief, International Initiative for Impact Evaluation, Bill & Melinda Gates Foundation., (Copyright © 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved.)

Background: Mathematical models are widely used to simulate the effects of interventions to control HIV and to project future epidemiological trends and resource needs. We aimed to validate past model projections against data from a large household survey done in South Africa in 2012., Methods: We compared ten model projections of HIV prevalence, HIV incidence, and antiretroviral therapy (ART) coverage for South Africa with estimates from national household survey data from 2012. Model projections for 2012 were made before the publication of the 2012 household survey. We compared adult (age 15-49 years) HIV prevalence in 2012, the change in prevalence between 2008 and 2012, and prevalence, incidence, and ART coverage by sex and by age groups between model projections and the 2012 household survey., Findings: All models projected lower prevalence estimates for 2012 than the survey estimate (18·8%), with eight models' central projections being below the survey 95% CI (17·5-20·3). Eight models projected that HIV prevalence would remain unchanged (n=5) or decline (n=3) between 2008 and 2012, whereas prevalence estimates from the household surveys increased from 16·9% in 2008 to 18·8% in 2012 (difference 1·9, 95% CI -0·1 to 3·9). Model projections accurately predicted the 1·6 percentage point prevalence decline (95% CI -0·3 to 3·5) in young adults aged 15-24 years, and the 2·2 percentage point (0·5 to 3·9) increase in those aged 50 years and older. Models accurately represented the number of adults on ART in 2012; six of ten models were within the survey 95% CI of 1·54-2·12 million. However, the differential ART coverage between women and men was not fully captured; all model projections of the sex ratio of women to men on ART were lower than the survey estimate of 2·22 (95% CI 1·73-2·71)., Interpretation: Projections for overall declines in HIV epidemics during the ART era might have been optimistic. Future treatment and HIV prevention needs might be greater than previously forecasted. Additional data about service provision for HIV care could help inform more accurate projections., Funding: Bill & Melinda Gates Foundation., (Copyright © 2015 Eaton et al. Open Access article distributed under the terms of CC BY-NC-ND. Published by Elsevier Ltd.. All rights reserved.)

Objective(s): Many countries are considering expanding HIV treatment following recent findings emphasizing the effects of antiretroviral therapy (ART) on reducing HIV transmission in addition to already established survival benefits. Given the close interaction of tuberculosis (TB) and HIV epidemics, ART expansion could have important ramifications for TB burden. Previous studies suggest a wide range of possible TB impacts following ART expansion. We used three independently developed TB-HIV models to estimate the TB-related impact of expanding ART in South Africa., Design: We considered two dimensions of ART expansion--improving coverage of pre-ART and ART services, and expanding CD4-based ART eligibility criteria (from CD4 <350 to CD4 <500 or all HIV-positive)., Methods: Three independent mathematical models were calibrated to the same data pertaining to the South African HIV-TB epidemic, and used to assess standardized ART policy changes. Key TB impact indicators were projected from 2014 to 2033., Results: Compared with current eligibility and coverage, cumulative TB incidence was projected to decline by 6-30% over the period 2014-2033 if ART eligibility were expanded to all HIV positive individuals, and by 28-37% if effective ART coverage were additionally increased to 80%. Overall, expanding ART was estimated to avert one TB case for each 10-13 additional person-years of ART. All models showed that TB incidence and mortality reductions would grow over time, but would stabilize towards the end of the projection period., Conclusion: ART expansion could substantially reduce TB incidence and mortality in South Africa and could provide a platform for collaborative HIV-TB programs to effectively halt HIV-associated TB.

Background: New WHO guidelines recommend initiation of antiretroviral therapy for HIV-positive adults with CD4 counts of 500 cells per μL or less, a higher threshold than was previously recommended. Country decision makers have to decide whether to further expand eligibility for antiretroviral therapy accordingly. We aimed to assess the potential health benefits, costs, and cost-effectiveness of various eligibility criteria for adult antiretroviral therapy and expanded treatment coverage., Methods: We used several independent mathematical models in four settings-South Africa (generalised epidemic, moderate antiretroviral therapy coverage), Zambia (generalised epidemic, high antiretroviral therapy coverage), India (concentrated epidemic, moderate antiretroviral therapy coverage), and Vietnam (concentrated epidemic, low antiretroviral therapy coverage)-to assess the potential health benefits, costs, and cost-effectiveness of various eligibility criteria for adult antiretroviral therapy under scenarios of existing and expanded treatment coverage, with results projected over 20 years. Analyses assessed the extension of eligibility to include individuals with CD4 counts of 500 cells per μL or less, or all HIV-positive adults, compared with the previous (2010) recommendation of initiation with CD4 counts of 350 cells per μL or less. We assessed costs from a health-system perspective, and calculated the incremental cost (in US$) per disability-adjusted life-year (DALY) averted to compare competing strategies. Strategies were regarded very cost effective if the cost per DALY averted was less than the country's 2012 per-head gross domestic product (GDP; South Africa: $8040; Zambia: $1425; India: $1489; Vietnam: $1407) and cost effective if the cost per DALY averted was less than three times the per-head GDP., Findings: In South Africa, the cost per DALY averted of extending eligibility for antiretroviral therapy to adult patients with CD4 counts of 500 cells per μL or less ranged from $237 to $1691 per DALY averted compared with 2010 guidelines. In Zambia, expansion of eligibility to adults with a CD4 count threshold of 500 cells per μL ranged from improving health outcomes while reducing costs (ie, dominating the previous guidelines) to $749 per DALY averted. In both countries results were similar for expansion of eligibility to all HIV-positive adults, and when substantially expanded treatment coverage was assumed. Expansion of treatment coverage in the general population was also cost effective. In India, the cost for extending eligibility to all HIV-positive adults ranged from $131 to $241 per DALY averted, and in Vietnam extending eligibility to patients with CD4 counts of 500 cells per μL or less cost $290 per DALY averted. In concentrated epidemics, expanded access for key populations was also cost effective., Interpretation: Our estimates suggest that earlier eligibility for antiretroviral therapy is very cost effective in low-income and middle-income settings, although these estimates should be revisited when more data become available. Scaling up antiretroviral therapy through earlier eligibility and expanded coverage should be considered alongside other high-priority health interventions competing for health budgets., Funding: Bill & Melinda Gates Foundation, WHO., (Copyright © 2014 Eaton et al. Open Access article distributed under the terms of CC BY-NC-ND. Published by .. All rights reserved.)

It is estimated that 10.3 million people aged 15-24 are living with HIV infection/AIDS worldwide, with 7000 new infections occurring each day. Many of these infections occur during the adolescent years. These rates of infection make adolescents an important target for research in primary prevention. Currently, preparations are under way by the National Institutes of Health-supported HIV networks--the Adolescent Trials Network, the Pediatric AIDS Clinical Trials Group, and the HIV Vaccines Trials Network--for phase 1/2 HIV vaccine trials involving adolescents in the United States. Identifying the challenges to conducting HIV vaccine trials with this population is a crucial component of these preparations. Challenges to HIV vaccine trials with adolescents were identified by reviewing previous vaccine research for adolescents and HIV infection in adolescents and speaking with experts in HIV/AIDS and adolescent medicine. Adolescents (typically those younger than 18 years of age) are minors and fall under ethical and regulatory safeguards for their participation in clinical research including parental permission. Adolescents may not appropriately perceive personal risk, posing challenges for informed consent as well as prevention counseling during a trial. Safety and immunogenicity studies of adolescents are likely to be required by the US Food and Drug Administration before vaccine approval for this population. Early identification and subsequent follow-up of high-risk adolescents are problematic. Vaccine-induced seropositivity may present potential barriers to military service, employment, marriage, and acquiring health insurance. The age at optimal immunization, particularly for girls in some countries, may be during preadolescence. The successful completion of HIV vaccine trials with adolescents must address these challenges both in the United States and internationally. This report addresses relevant background information, identifies the issues surrounding HIV vaccine trials with adolescents, discusses what progress has been made, and addresses plans and implications for the implementation of these trials.