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Mabuto T, Woznica DM, Ndini P, Moyo D, Abraham M, Hanrahan C, Charalambous S, Zack B, Baral S, Owczarzak J, Hoffmann CJ. Transitional community adherence support for people leaving incarceration in South Africa: a pragmatic, open-label, randomised controlled trial. Lancet HIV 2024; 11:e11-e19. [PMID: 38071994 PMCID: PMC10894448 DOI: 10.1016/s2352-3018(23)00235-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 08/15/2023] [Accepted: 09/11/2023] [Indexed: 12/25/2023]
Abstract
BACKGROUND People released from correctional facilities face multifactorial barriers to continuing HIV treatment. We hypothesised that barriers faced in the first 6 months of community re-entry would be decreased by a multilevel group-based and peer-led intervention, the Transitional Community Adherence Club (TCAC). METHODS We did a pragmatic, open-label, individually randomised controlled trial in five correctional facilities in Gauteng, South Africa. Participants aged 18 years and older and receiving antiretroviral therapy (ART) in correctional facilities were enrolled before release and randomly assigned (1:2) to either passive referral (usual care) or TCACs. TCACs followed a 12-session curriculum over 6 months and were facilitated by trained peer and social workers. Participants were followed up by telephone and in person to assess the primary outcome: post-release enrolment in HIV treatment services at 6 months from the date of release. We did an intention-to-treat analysis to determine the effectiveness of TCACs compared with usual care. The trial was registered with the South African National Clinical Trials Register (DOH-27-0419-605) and ClinicalTrials.gov (NCT03340428). This study is completed and is listed as such on ClinicalTrials.gov. FINDINGS From March 1, to Dec 13, 2019, we screened 222 individuals and enrolled 176 participants who were randomly assigned 1:2 to the usual care group (n=59) or TCACs (n=117). 175 participants were included in the final analysis. In the usual care group, 21 (36%) of 59 participants had enrolled in HIV treatment services at 6 months, compared with 71 (61%) of 116 in the TCAC group (risk ratio 1·7, 95% CI 1·2-2·5; p=0·0010). No adverse events were reported. INTERPRETATION We found strong evidence that a differentiated service delivery model with curriculum and peer support designed specifically to address the needs of people with HIV returning from incarceration improved the primary outcome of enrolment in HIV treatment services. Our approach is a reasonable model to build further HIV treatment continuity interventions for individuals in the criminal justice system in South Africa and elsewhere. FUNDING National Institute of Mental Health.
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Affiliation(s)
- Tonderai Mabuto
- Department of Implementation Research, The Aurum Institute, Johannesburg, South Africa.
| | | | - Pretty Ndini
- Department of Implementation Research, The Aurum Institute, Johannesburg, South Africa
| | - Derrick Moyo
- Department of Implementation Research, The Aurum Institute, Johannesburg, South Africa
| | - Munazza Abraham
- Department of Psychology, University of Maryland, College Park, MD, USA
| | - Colleen Hanrahan
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Salome Charalambous
- Department of Implementation Research, The Aurum Institute, Johannesburg, South Africa; The University of the Witwatersrand School of Public Health, Johannesburg, South Africa
| | | | - Stefan Baral
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Jill Owczarzak
- Department of Health, Behavior, and Society, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Christopher J Hoffmann
- The University of the Witwatersrand School of Public Health, Johannesburg, South Africa; Johns Hopkins University School of Medicine, Baltimore, MD, USA
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An Y, Hoffmann CJ, Bhoora U, Ndini P, Moyo D, Steiner L, Tshuma S, Mabuto T, Hugo J, Owczarzak J, Marcus TS. Opioid use and HIV treatment services experiences among male criminal justice-involved persons in South Africa: a qualitative study. Harm Reduct J 2023; 20:90. [PMID: 37480041 PMCID: PMC10360229 DOI: 10.1186/s12954-023-00834-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Accepted: 07/17/2023] [Indexed: 07/23/2023] Open
Abstract
BACKGROUND Opioid use disorder (OUD) is overrepresented among people with criminal justice involvement; HIV is a common comorbidity in this population. This study aimed to examine how formerly incarcerated men living with HIV and OUD in South Africa experienced HIV and OUD services in correctional facilities and the community. METHODS Three focus group discussions were conducted with 16 formerly incarcerated men living with HIV and OUD in Gauteng, South Africa. Discussions explored available healthcare services in correctional facilities and the community and procedural and practice differences in health care between the two types of settings. Data were analyzed thematically, using a comparative lens to explore the relationships between themes. RESULTS Participants described an absence of medical services for OUD in correctional facilities and the harms caused by opioid withdrawal without medical support during incarceration. They reported that there were limited OUD services in the community and that what was available was not connected with public HIV clinics. Participants perceived correctional and community HIV care systems as readily accessible but suggested that a formal system did not exist to ensure care continuity post-release. CONCLUSIONS OUD was perceived to be medically unaddressed in correctional facilities and marginally attended to in the community. In contrast, HIV treatment was widely available within the two settings. The current model of OUD care in South Africa leaves many of the needs of re-entrants unmet. Integrating harm reduction into all primary care medical services may address some of these needs. Successful HIV care models provide examples of approaches that can be applied to developing and expanding OUD services in South Africa.
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Affiliation(s)
- Yangxi An
- Krieger School for the Arts and Sciences, Johns Hopkins University, Baltimore, USA
| | - Christopher J Hoffmann
- School of Medicine, Johns Hopkins University, 1550 Orleans St, CRBII 1M11, Baltimore, MD, 21207, USA.
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, USA.
- Aurum Institute, Johannesburg, South Africa.
| | - Urvisha Bhoora
- Community Oriented Substance Use Programme, Tshwane, South Africa
- Community Oriented Primary Care Research Unit, University of Pretoria, Tshwane, South Africa
- Department of Family Medicine, University of Pretoria, Tshwane, South Africa
| | | | | | - Laura Steiner
- School of Medicine, Johns Hopkins University, 1550 Orleans St, CRBII 1M11, Baltimore, MD, 21207, USA
| | - Sukholuhle Tshuma
- Community Oriented Substance Use Programme, Tshwane, South Africa
- Department of Family Medicine, University of Pretoria, Tshwane, South Africa
| | | | - Jannie Hugo
- Community Oriented Substance Use Programme, Tshwane, South Africa
- Community Oriented Primary Care Research Unit, University of Pretoria, Tshwane, South Africa
- Department of Family Medicine, University of Pretoria, Tshwane, South Africa
| | - Jill Owczarzak
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, USA
| | - Tessa S Marcus
- Community Oriented Primary Care Research Unit, University of Pretoria, Tshwane, South Africa
- Department of Family Medicine, University of Pretoria, Tshwane, South Africa
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Moyo D. 1439 Principles of fitness for duty evaluations. Occup Med (Lond) 2018. [DOI: 10.1136/oemed-2018-icohabstracts.1055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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Chivandi E, Moyo D, Dangarembizi R, Erlwanger K. Effect of dietary Ximenia caffra kernel meal on blood and liver metabolic substrate content and the general clinical biochemistry of Sprague Dawley rats. J Anim Physiol Anim Nutr (Berl) 2015; 100:471-7. [PMID: 26344703 DOI: 10.1111/jpn.12393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Accepted: 07/23/2015] [Indexed: 11/29/2022]
Abstract
We investigated (at the University of the Witwatersrand: GPS coordinates 26°10' 52.96″S; 28°2' 33.61″E) the effects of substituting soya bean meal (SBM) with Ximenia caffra kernel meal (XCKM) as a dietary protein source on blood and liver metabolic substrates content, serum markers of liver and kidney function and the general clinical biochemistry of Sprague Dawley (SD) rats. Five diets with similar energy and protein content were formulated (D1-D5) where XCKM replaced SBM on a crude protein basis at 0, 25, 50, 75 and 100%. Forty weanling male SD rats were randomly assigned to diets D1-D5, fed for 37 days and weighed twice weekly. The rats were then fasted overnight, and fasting blood glucose and triglyceride concentrations were determined from tail-vein-drawn blood. Immediately thereafter, the rats were euthanised and blood was collected via cardiac puncture. Serum was used to assay for markers of the general health profile. Livers were removed and weighed, and samples were used to determine lipid and glycogen content. Rats fed D4 (75% substitution level) had significantly lower (p < 0.05) blood triglyceride content compared with rats fed D2 (25% level of substitution). The substitution of SBM with XCKM did not affect (p > 0.05) fasting blood glucose and cholesterol concentrations, liver glycogen and lipid content. Additionally, it had no effect (p > 0.05) on serum activity/concentration of surrogate markers of liver (alanine aminotransferase and alkaline phosphatase activity and urea, total bilirubin, globulin and albumin concentrations) and kidney (phosphorus, calcium and creatinine concentrations) function and the general clinical biochemistry of the rats. Defatted XCKM could substitute SBM in rat diets without compromising blood glucose and cholesterol homeostasis, liver and kidney function and the general clinical biochemistry of growing male Sprague Dawley rats.
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Affiliation(s)
- E Chivandi
- School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - D Moyo
- School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - R Dangarembizi
- School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - K Erlwanger
- School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Moyo D, Tanthuma G, Cary MS, Mushisha O, Kwadiba G, Chikuse F, Steenhoff AP, Reid MJA. Cohort study of diabetes in HIV-infected adult patients: evaluating the effect of diabetes mellitus on immune reconstitution. Diabetes Res Clin Pract 2014; 103:e34-6. [PMID: 24485344 PMCID: PMC3989401 DOI: 10.1016/j.diabres.2013.12.042] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2013] [Accepted: 12/26/2013] [Indexed: 12/11/2022]
Abstract
We conducted a retrospective cohort study assessing the association between diabetes mellitus (DM) and immune recovery in HIV-infected adults. Immune reconstitution after initiating antiretroviral therapy was more rapid in DM patients (120.4 cells/year) compared to non-DM patients (94.2 cells/year, p<0.023). Metformin use was associated with improved CD4 recovery (p=0.034).
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Affiliation(s)
- D Moyo
- Institute for Health Sciences, Gaborone, Botswana
| | - G Tanthuma
- Institute for Health Sciences, Gaborone, Botswana
| | - M S Cary
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, United States
| | - O Mushisha
- Institute for Health Sciences, Gaborone, Botswana
| | - G Kwadiba
- Institute for Health Sciences, Gaborone, Botswana
| | - F Chikuse
- Institute for Health Sciences, Gaborone, Botswana
| | - A P Steenhoff
- Botswana-UPenn Partnership, Gaborone, Botswana; Perelman School of Medicine, University of Pennsylvania, United States; Center for AIDS Research, University of Pennsylvania, United States; Department of Pediatrics, Division of Infectious Diseases, The Children's Hospital of Philadelphia, United States; University of Botswana, School of Medicine, Botswana
| | - M J A Reid
- Botswana-UPenn Partnership, Gaborone, Botswana; Perelman School of Medicine, University of Pennsylvania, United States.
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Mohan K, Dziva F, Mukarati NL, Moyo D. Possible new Chlamydophila
species causing chlamydiosis in farmed Nile crocodiles (Crocodylus niloticus
). Vet Rec 2005; 157:23-5. [PMID: 15995239 DOI: 10.1136/vr.157.1.23] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- K Mohan
- Faculty of Veterinary Science, University of Zimbabwe, Harare, Zimbabwe
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Muvavarirwa P, Mudenge D, Moyo D, Javangwe S. Detection of bovine-virus-diarrhoea-virus antibodies in cattle with an enzyme-linked immunosorbent assay. Onderstepoort J Vet Res 1995; 62:241-4. [PMID: 8668322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
The serum-neutralization (SN) and the indirect-immunofluorescence (IIF) assays have invariably been used for detecting antibodies against bovine virus diarrhoea virus (BVDV) in cattle sera. An enzyme-linked immunosorbent assay (ELISA) was applied which has a sensitivity comparable with the SN and IIF in detecting antibody to BVDV. A total of 472 bovine sera were assayed and a high prevalence of 79.2% was recorded. Positive correlations between the ELISA and the SN were found when certain sera were assayed, implying that the former test could then be used for routine diagnosis of BVDV.
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Affiliation(s)
- P Muvavarirwa
- Department of Paraclinical Veterinary Studies, Faculty of Veterinary Science, University of Zimbabwe, Harare, Zimbabwe
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