Search

Transforming spoken words into written text in qualitative research is a vital step in familiarizing and immersing oneself in the data. We share a three-step approach of how data transcription facilitated an interpretative act of analysis in a study using qualitative data collection methods on the barriers and facilitators of HIV testing and treatment in KwaZulu-Natal, South Africa.

Opioids and stimulants are often used in combination for both recreational and non-recreational purposes. High-efficacy mu opioid agonists generally increase the behavioral effects of stimulants, whereas opioid receptor antagonists generally attenuate the behavioral effects of stimulants; however, less is known regarding the interactions between stimulants and opioids possessing low to intermediate efficacy at the mu receptor. The purpose of this study was to examine the role of an opioid's relative efficacy at the mu receptor in altering the behavioral effects of dextro(d-)amphetamine. To this end, opioids possessing a range of relative efficacy at the mu receptor were examined alone and in combination with cumulative doses of d-amphetamine on a test of open-field, locomotor activity in male rats. Levorphanol, buprenorphine, butorphanol, nalbuphine, (-)-pentazocine, (-)-metazocine, (-)-cyclazocine, (-)-NANM, and nalorphine increased the locomotor effects of d-amphetamine in either an additive or greater-than-additive manner according to an effect-additive model. Only the selective, high-efficacy kappa agonist, spiradoline, and the non-selective opioid receptor antagonist, naloxone, failed to increase the effects of d-amphetamine under the conditions examined. These data indicate that opioids possessing a large range of relative efficacy at the mu receptor, including those possessing very low relative efficacy, significantly increase the locomotor effects of d-amphetamine.

Lario Viljoen,1 Rhoda Ndubani,2 Virginia Bond,2,3 Janet Seeley,3 Lindsey Reynolds,4,5 Graeme Hoddinott1 On behalf of the HPTN 071 (PopART) Study Team 1Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa; 2Zambia AIDS-related Tuberculosis Project (Zambart), School of Medicine, Lusaka, Zambia; 3Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK; 4Population Studies and Training Center, Brown University, Providence, RI, USA; 5Department of Sociology and Social Anthropology, Stellenbosch University, Stellenbosch, South Africa Abstract: Public health researchers repeatedly represent women as a group vulnerable to ill health. This has been particularly true in the field of HIV research, where women are disproportionately affected by HIV in terms of disease burden and the social effects of the epidemic. Although women have been the focus of many prevention and treatment programs, structural barriers to implementation of these targeted programs persist. In this article we explore how high HIV-burden communities in South Africa and Zambia engage with the concepts of “woman” and “HIV risk”. The data are drawn from participatory storytelling activities completed with 604 participants across 78 group discussions between December 2012 and May 2013. During discussions we found that participants made use of the core archetypal caricatures of “goodness,” “badness,” and “vulnerability” when describing women’s HIV risk. Community members shifted between these categories in their characterizations of women, as they acknowledged the multiple roles women play, internalized different stories about women, and sometimes shifted register in the same stories. Findings suggest that health implementers, in consultation with community members, should consider the multiple positions women occupy and how this impacts the wider community’s understandings of women and “risk”. This approach of taking on board community understandings of the complexity of HIV risk can inform the design and implementation of HIV prevention and care programs by rendering programs more focused and in-line with community needs. Keywords: HIV/AIDS, gender, vulnerability, community beliefs

ABSTRACT [ILLUSTRATION OMITTED] Aflatoxins are secondary metabolites produced by Aspergillus flavus and A. parasiticus species of fungi. They are highly toxic and have been designated by the International Agency for [...]

: Introduction: Many HIV‐positive individuals in Africa have advanced disease when initiating antiretroviral therapy (ART) so have high risks of opportunistic infections and death. The REALITY trial found that an enhanced‐prophylaxis package including fluconazole reduced mortality by 27% in individuals starting ART with CD4 Methods: The REALITY trial enrolled from June 2013 to April 2015. A decision‐analytic model was developed to estimate the cost‐effectiveness of six management strategies in individuals initiating ART in the REALITY trial countries. Strategies included standard‐prophylaxis, enhanced‐prophylaxis, standard‐prophylaxis with fluconazole; and three CrAg testing strategies, the first stratifying individuals to enhanced‐prophylaxis (CrAg‐positive) or standard‐prophylaxis (CrAg‐negative), the second to enhanced‐prophylaxis (CrAg‐positive) or enhanced‐prophylaxis without fluconazole (CrAg‐negative) and the third to standard‐prophylaxis with fluconazole (CrAg‐positive) or without fluconazole (CrAg‐negative). The model estimated costs, life‐years and quality‐adjusted life‐years (QALY) over 48 weeks using three competing mortality risks: cryptococcal meningitis; tuberculosis, serious bacterial infection or other known cause; and unknown cause. Results: Enhanced‐prophylaxis was cost‐effective at cost‐effectiveness thresholds of US$300 and US$500 per QALY with an incremental cost‐effectiveness ratio (ICER) of US$157 per QALY in the CD4 Conclusions: The REALITY enhanced‐prophylaxis package in individuals with advanced HIV starting ART reduces morbidity and mortality, is practical to administer and is cost‐effective. Efforts should continue to ensure that components are accessed at lowest available prices., Introduction In low‐ and middle‐income settings, more than a third of HIV‐positive individuals starting antiretroviral therapy (ART) present with advanced disease (CD4 ≤ 200 cells/mm[sup.3]); over half of these have [...]

Background: We investigate how the risk of sexually acquiring or transmitting HIV in adolescent girls and young women (AGYW) changed following the real-world implementation of DREAMS (Determined, Resilient, Empowered, AIDS [...]

Background: HIV elimination in South Africa calls for innovative approaches. We investigated HIV self-testing (HIVST) for increasing demand for HIV care and prevention services, comparing two peer-distribution approaches (direct distribution and an incentivized social-network approach) against peer-navigators providing information and referrals only. Methods: Restricted randomisation (1:1:1) allocated 24 peer-navigator pairs in rural Kwa-Zulu Natal into: (1) incentivized-peer-networks (IPN): peer-navigators recruited 'seeds' to distribute 5 packs to 18 to 30 year olds within their social networks. Packs contained 2 HIVST kits (OraQuick) and standard of care (SOC) materials. 'Seeds' received 20 Rand (US$1.5) for each recipient who went on to distribute packs themselves; (2) peer-navigator-distribution (PND): peer-navigators distributed HIVST packs and SOC materials directly; (3) SOC: peer-navigators distributed barcoded clinic referral slips and sexual health information promoting HIV testing, pre-exposure prophylaxis (PrEP) and antiretroviral therapy (ART). PrEP/ART linkage rates were defined as numbers screened for PrEP eligibility or starting ART within 90 days of referral slip distribution per peer-navigator outreach month (pnm). The primary outcome compared PrEP/ART linkage rates between arms for women aged 18 to 24 years. Secondary outcomes included linkage rates for youth (18 to 30 years). Intention to treat analysis was used. Investigators and statisticans were blinded to allocation. Results: Between March and December 2019, 7563 (2055 IPN, 2069 PND, 2539 SOC) packs were distributed during 144 peer-navigator outreach months, with 272 young adults linked to PrEP/ART (1.9/pnm). Linkage rates for women aged 18 to 24 years were lower for IPN (n = 26, 0.54/pnm) than PND (n = 45, 0.80/pnm) and SOC n = 49, 0.85/pnm), although not significantly so (rate ratios [RR] 0.68, 95% CI 0.28 to 1.66 and 0.64, 95% CI 0.38 to 2.36, respectively). Adding HIVST kits to peer-navigator distribution (PND vs SOC) did not change linkage rates (RR 0.95, 95% CI 0.38 to 2.36). Youth (18 to 30 years), results were similar but with stronger evidence of lower linkage rates (0.88/pnm) for IPN than PND (2.11/pnm, RR 0.42, 95% CI 0.18 to 0.98) and SOC (2.07/pnm, RR 0.42 95% CI 0.18 to 1.02). Conclusions: Peer-based HIVST distribution reached large numbers of young men and women, but did not increase demand for PrEP/ART, unless combined with peer-navigator PrEP/ART promotion. Incentivized peer network models resulted in fewer linkages compared to direct peer-navigator mobilization with or without HIVSTs. Registration: NCT03751826., OA21.04 M. Shahmanesh (1); N. Mthiyane (2); C. Herbst (2); O. Adeagbo (2); M. Neuman (3); P. Mee (3); J. Dreyer (2); N. Chimbindi (2); T. Smit (2); N. Okesola [...]

Background: Violence against women and girls is associated with an increased risk of HIV acquisition, with effects both direct (e.g. rape) and indirect (e.g. from child maltreatment). We examined violence [...]