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Wand H, Naidoo S, Govender V, Reddy T, Moodley J. Preventing Stunting in South African Children Under 5: Evaluating the Combined Impacts of Maternal Characteristics and Low Socioeconomic Conditions. J Prev (2022) 2024; 45:339-355. [PMID: 38416314 PMCID: PMC11033229 DOI: 10.1007/s10935-024-00766-2] [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] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/05/2024] [Indexed: 02/29/2024]
Abstract
More than 140 million children under five suffered from stunting in 2020. This highlights the ongoing challenge of addressing childhood malnutrition globally. We utilized data from a nationally representative sample of children under five years of age (n = 14,151) who participated in five cycles of the South African National Income Dynamics Study (SA-NIDS) (2008-2017). We estimated the proportion of stunted children attributed to the mothers' anthropometric characteristics and socioeconomic conditions. We also quantified the population-level burden of low-socioeconomic conditions on hunger/food insecurity among pregnant women (n = 22,814) who participated in the nine rounds of the South African General Household Surveys (GHS) (2008-2021). Results from weighted-multivariate logistic regression were incorporated into the population-level impacts of correlates of stunting and low-socioeconomic conditions. The prevalence of stunting declined from 25% in 2008 to 23% in 2017. Mothers' anthropometric measures (underweight/height < 160 cm), marital status, low education, absence of medical insurance and low-socioeconomic conditions were all identified as the most influential risk factors for stunting. Their population-level impacts on stunting increased substantially from 34% (in 2008) to 65% (in 2017). Comprehensive strategies emphasizing enhanced food security, extended breastfeeding, appropriate nutrition, and access to adequate healthcare and education are urgently needed to reduce the burden of food insecurity low-socioeconomic, malnutrition, and its long-term consequences.
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Affiliation(s)
- Handan Wand
- Biostatistics and Databases Program, Kirby Institute, University of New South Wales (UNSW Sydney), Kirby Institute Level 6, Wallace Wurth Building, Kensington, NSW, 2052, Australia.
| | | | | | - Tarylee Reddy
- Biostatistics Unit, South African Medical Research Council, Durban, Kwazulu-Natal, South Africa
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Bergh K, Toska E, Duby Z, Govindasamy D, Mathews C, Reddy T, Jonas K. Applying the HIV Prevention Cascade to an Evaluation of a Large-Scale Combination HIV Prevention Programme for Adolescent Girls and Young Women in South Africa. AIDS Behav 2024; 28:1137-1151. [PMID: 37462890 PMCID: PMC10940416 DOI: 10.1007/s10461-023-04130-z] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/01/2023] [Indexed: 03/16/2024]
Abstract
Adolescent girls and young women (AGYW) in South Africa are at a three times higher risk of acquiring HIV than their male counterparts. The HIV prevention cascade is a tool which can be used to measure coverage of HIV prevention services, although there is limited empirical evidence to demonstrate its application in low-resourced settings. The unifying framework is a conceptualisation of the HIV prevention cascade which theorises that both motivation and access are required for an individual to effectively use an HIV prevention method. We applied this framework to data from a random sample of 127,951 beneficiaries of a combination HIV prevention programme for AGYW aged 15-24 in South Africa to measure the steps to, and identify key barriers to, effective use of male condoms and oral pre-exposure prophylaxis (PrEP) among this vulnerable population. Barriers to each step were analysed using univariate and multivariable logistic regression. Among self-reported HIV-negative AGYW who had sex in the past 6 months, effective use of condoms (15.2%), access to PrEP (39.1%) and use of PrEP (3.8%) were low. AGYW were: less likely to be motivated to use condoms if they believed that they had a faithful partner (aOR 0.44, 95% CI 0.22-0.90) or disliked condoms (aOR 0.26, 95% CI 0.11-0.57), less likely to access condoms if the place where AGYW accessed them was far away (aOR 0.25, 95% CI 0.10-0.64), more likely to effectively use condoms if they received counselling on how to use them (aOR 2.24, 95% CI 1.05-4.76), less likely to be motivated to use PrEP if they did not believe PrEP was efficacious (aOR 0.35, 95% CI 0.17-0.72), more likely to be motivated if they felt confident that they could use PrEP, and more likely to have access to PrEP if they had ever been offered PrEP (aOR 2.94, 95% CI 1.19-7.22). This combination HIV prevention programme and similar programmes should focus on risk-reduction counselling interventions for AGYW and their male partners to improve effective use of condoms and ensure easy access to condoms and PrEP by making them available in youth-friendly spaces. Our findings demonstrate that the application of HIV prevention cascades can inform AGYW HIV prevention programming in low-resourced settings.
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Affiliation(s)
- Kate Bergh
- Health Systems Research Unit, South African Medical Research Council, Francie Van Zijl Dr, Parrow Valley, Cape Town, 7501, South Africa.
- Department of Psychology, University of Cape Town, Cape Town, South Africa.
| | - Elona Toska
- Department of Sociology, Centre for Social Science Research, University of Cape Town, Cape Town, South Africa
- Department of Social Work and Social Development, University of Cape Town, Cape Town, South Africa
| | - Zoe Duby
- Health Systems Research Unit, South African Medical Research Council, Francie Van Zijl Dr, Parrow Valley, Cape Town, 7501, South Africa
- Division of Social and Behavioural Sciences, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Darshini Govindasamy
- Health Systems Research Unit, South African Medical Research Council, Francie Van Zijl Dr, Parrow Valley, Cape Town, 7501, South Africa
| | - Catherine Mathews
- Health Systems Research Unit, South African Medical Research Council, Francie Van Zijl Dr, Parrow Valley, Cape Town, 7501, South Africa
| | - Tarylee Reddy
- Biostatistics Research Unit, South African Medical Research Council, Durban, South Africa
| | - Kim Jonas
- Health Systems Research Unit, South African Medical Research Council, Francie Van Zijl Dr, Parrow Valley, Cape Town, 7501, South Africa
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Wand H, Moodley J, Reddy T, Naidoo S. Understanding the impact of women's correct risk perception on human immunodeficiency virus diagnosis: Insights from South Africa. Int J STD AIDS 2024:9564624241238525. [PMID: 38492207 DOI: 10.1177/09564624241238525] [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] [Indexed: 03/18/2024]
Abstract
BACKGROUND South African women have the highest burden of HIV infections globally. We investigated the temporal trends and the impact of key factors associated with HIV diagnosis among a nationally representative cohort of South African women. METHODS Total of 24,657 women who participated in the National HIV, Behaviour and Health Surveys conducted from 2002-to-2017. RESULTS Despite decades-long prevention efforts, we observed a significant increase in HIV prevalence over time (22% in 2002 to 21% in 2005-2008 and 29% in 2012-2017). Overall, 46% of the women living with HIV were not aware of their risk of HIV with age-specific disparities. Our findings revealed compelling evidence between HIV seropositivity and high HIV risk-perception (adjusted Odds Ratio (aOR):1.47 to 3.29) which increased overtime and exceeded the other factors. At a population-level, 45% of the HIV diagnoses were exclusively associated with women who believed they were at risk of HIV in 2012-2017. Women who reported using condoms at last sexual act were also at increased risk of HIV infection, with a population attributable risk of 18% (2002) to 21% (2012-2017). CONCLUSION There is an urgent need for culturally, socially, and linguistically appropriate prevention and awareness campaigns with realistic, non-confrontational messages.
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Affiliation(s)
- Handan Wand
- Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | | | - Tarylee Reddy
- Biostatistics Unit, South African Medical Research Council, Durban, South Africa
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Moore DP, Chetty T, Pillay A, Karsas M, Cloete J, Balakrishna Y, Reddy T, Archary M, van Kwawegen A, Thomas R, Nakwa FL, Waggie Z, Magrath S, Goga A, Jeena P. Antibiotic and antifungal use in paediatric departments at three academic hospitals in South Africa. IJID Reg 2024; 10:151-158. [PMID: 38314394 PMCID: PMC10835277 DOI: 10.1016/j.ijregi.2023.12.004] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 12/13/2023] [Accepted: 12/16/2023] [Indexed: 02/06/2024]
Abstract
Objectives South Africa implemented a National Strategic Framework to optimise antimicrobial stewardship in 2014; however, there is limited data on how this has affected prescribing, especially to children treated in academic centres. Methods We conducted a point prevalence survey using the World Health Organization (WHO) methodology to evaluate antibiotic and antifungal prescribing practices in paediatric departments at three academic hospitals in South Africa. Results We recorded 1946 antimicrobial prescriptions in 1191 children, with 55.2% and 39.2% of the antibiotics classified as WHO AWaRe Access and Watch drugs, respectively. There were significant differences in prescription of Reserve antibiotics and antifungals between institutions. Receipt of WHO Watch and Reserve antibiotics was independently associated with infancy (<12 months) and adolescents (13-17 years) (adjusted relative risk [aRR]: 2.09-9.95); prolonged hospitalisation (aRR: 3.29-30.08); rapidly or ultimately fatal illness (aRR: 1.94 to 5.52); and blood transfusion (aRR: 3.28-5.70). Antifungal prescribing was associated with treatment of hospital-associated infection (aRR: 2.90), medical prophylaxis (aRR: 3.30), and treatment in intensive care units (aRR: 2.15-2.27). Conclusions Guidance on optimisation of infection prevention and control practice and strengthening of antimicrobial stewardship would impact positively on the care of sick children in our setting.
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Affiliation(s)
- David P. Moore
- Department of Paediatrics and Child Health, Chris Hani Baragwanath Academic Hospital and University of the Witwatersrand, Johannesburg, South Africa
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Terusha Chetty
- HIV And Other Infectious Diseases Unit, South African Medical Research Council & Discipline of Public Health Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Ashendri Pillay
- Department of Paediatrics and Child Health, Inkosi Alert Luthuli Central Hospital and University of KwaZulu-Natal, Durban, South Africa
| | - Maria Karsas
- Department of Paediatrics and Child Health, Steve Biko Academic Hospital and University of Pretoria, Pretoria, South Africa
| | - Jeané Cloete
- Department of Paediatrics and Child Health, Steve Biko Academic Hospital and University of Pretoria, Pretoria, South Africa
| | - Yusentha Balakrishna
- Biostatistics Research Unit, South African Medical Research Council, Durban, South Africa
| | - Tarylee Reddy
- Biostatistics Research Unit, South African Medical Research Council, Durban, South Africa
| | - Moherndran Archary
- Department of Paediatrics and Child Health, Inkosi Alert Luthuli Central Hospital and University of KwaZulu-Natal, Durban, South Africa
| | - Alison van Kwawegen
- Department of Paediatrics and Child Health, Chris Hani Baragwanath Academic Hospital and University of the Witwatersrand, Johannesburg, South Africa
| | - Reenu Thomas
- Department of Paediatrics and Child Health, Chris Hani Baragwanath Academic Hospital and University of the Witwatersrand, Johannesburg, South Africa
| | - Firdose L. Nakwa
- Department of Paediatrics and Child Health, Chris Hani Baragwanath Academic Hospital and University of the Witwatersrand, Johannesburg, South Africa
| | - Zainab Waggie
- Department of Paediatrics and Child Health, Chris Hani Baragwanath Academic Hospital and University of the Witwatersrand, Johannesburg, South Africa
| | - Stephanie Magrath
- Faculty of Health Sciences, University of the Witwatersrand, York Road, Parktown, Johannesburg, South Africa
| | - Ameena Goga
- Department of Paediatrics and Child Health, Steve Biko Academic Hospital and University of Pretoria, Pretoria, South Africa
- South African Medical Research Council, Pretoria, South Africa
| | - Prakash Jeena
- Department of Paediatrics and Child Health, Inkosi Alert Luthuli Central Hospital and University of KwaZulu-Natal, Durban, South Africa
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Takalani A, Robinson M, Jonas P, Bodenstein A, Sambo V, Jacobson B, Louw V, Opie J, Peter J, Rowji P, Seocharan I, Reddy T, Yende-Zuma N, Khutho K, Sanne I, Bekker LG, Gray G, Garrett N, Goga A. Safety of a second homologous Ad26.COV2.S vaccine among healthcare workers in the phase 3b implementation Sisonke study in South Africa. Vaccine 2024; 42:1195-1199. [PMID: 38278629 DOI: 10.1016/j.vaccine.2024.01.066] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 01/16/2024] [Accepted: 01/21/2024] [Indexed: 01/28/2024]
Abstract
The Sisonke 2 study provided a homologous boost at least 6 months after administration of the priming dose of Ad26.COV2.S for healthcare workers enrolled on the Sisonke phase 3b implementation study. Safety monitoring was via five reporting sources: (i.) self-report through a web-link; (ii.) paper-based case report forms; (iii.) a toll-free telephonic reporting line; (iv.) healthcare professionals-initiated reports; and (v.) active linkage with National Disease Databases. A total of 2350 adverse events were reported by 2117 of the 240 888 (0.88%) participants enrolled; 1625 of the 2350 reported events are reactogenicity events and 28 adverse events met seriousness criteria. No cases of thrombosis with thrombocytopaenia syndrome were reported; all adverse events including thromboembolic disorders occurred at a rate below the expected population rates apart from one case of Guillain Barre Syndrome and one case of portal vein thrombosis. The Sisonke 2 study demonstrates that two doses of Ad26.COV2.S is safe and well tolerated; and provides a feasible model for national pharmacovigilance strategies for low- and middle-income settings.
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Affiliation(s)
- Azwidihwi Takalani
- Fred Hutchinson Cancer Centre Vaccine and Infectious Disease Division, HIV Vaccine Trial Network Leadership Operations Centre South Africa - Hutchinson Center Research Institute of South Africa (HCRISA), Chris Hani Baragwanath Academic Hospital, Soweto, South Africa; Department of Family Medicine and Primary Care, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa.
| | | | | | | | | | - Barry Jacobson
- Department of Molecular Medicine and Haematology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; National Health Laboratory Service, South Africa
| | - Vernon Louw
- Division of Clinical Haematology, Department of Medicine, University of Cape Town, South Africa; Groote Schuur Hospital, Cape Town, South Africa
| | - Jessica Opie
- National Health Laboratory Service, South Africa; Division of Haematology, Department of Pathology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Jonny Peter
- Groote Schuur Hospital, Cape Town, South Africa; Division of Allergy and Clinical Immunology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | | | - Ishen Seocharan
- South African Medical Research Council, Durban, South Africa
| | - Tarylee Reddy
- South African Medical Research Council, Durban, South Africa
| | | | - Kentse Khutho
- Fred Hutchinson Cancer Centre Vaccine and Infectious Disease Division, HIV Vaccine Trial Network Leadership Operations Centre South Africa - Hutchinson Center Research Institute of South Africa (HCRISA), Chris Hani Baragwanath Academic Hospital, Soweto, South Africa
| | - Ian Sanne
- Department of Molecular Medicine and Haematology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Linda-Gail Bekker
- Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa
| | - Glenda Gray
- South African Medical Research Council, Cape Town, South Africa
| | - Nigel Garrett
- Centre for the AIDS Programme of Research in South Africa, Durban, South Africa; School of Nursing and Public Health, Discipline of Public Health Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Ameena Goga
- HIV and Other Infectious Diseases Research Unit, South Africa Medical Research Council, Cape Town, South Africa; Department of Paediatrics and Child Health, University of Pretoria, Pretoria, South Africa.
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Kapwata T, Wright CY, Reddy T, Street R, Kunene Z, Mathee A. Correction to: Relations between personal exposure to elevated concentrations of arsenic in water and soil and blood arsenic levels amongst people living in rural areas in Limpopo, South Africa. Environ Sci Pollut Res Int 2024; 31:16108. [PMID: 38286933 PMCID: PMC10884176 DOI: 10.1007/s11356-024-32103-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2024]
Affiliation(s)
- Thandi Kapwata
- Environment and Health Research Unit, South African Medical Research Council, Johannesburg, 2028, South Africa.
- Environmental Health Department, Faculty of Health Sciences, University of Johannesburg, Johannesburg, 2028, South Africa.
| | - Caradee Y Wright
- Environment and Health Research Unit, South African Medical Research Council, Pretoria, 0084, South Africa
- Department of Geography, Geoinformatics and Meteorology, University of Pretoria, Pretoria, 0001, South Africa
| | - Tarylee Reddy
- Biostatistics Research Unit, South African Medical Research Council, Durban, 4001, South Africa
- School of Mathematics, Statistics and Computer Science, University of KwaZulu Natal, Pietermaritzburg, 3201, South Africa
| | - Renee Street
- Environmental Health Department, Faculty of Health Sciences, University of Johannesburg, Johannesburg, 2028, South Africa
- Environment and Health Research Unit, South African Medical Research Council, Durban, 4001, South Africa
| | - Zamantimande Kunene
- Environment and Health Research Unit, South African Medical Research Council, Johannesburg, 2028, South Africa
- Environmental Health Department, Faculty of Health Sciences, University of Johannesburg, Johannesburg, 2028, South Africa
| | - Angela Mathee
- Environment and Health Research Unit, South African Medical Research Council, Johannesburg, 2028, South Africa
- Environmental Health Department, Faculty of Health Sciences, University of Johannesburg, Johannesburg, 2028, South Africa
- School of Public Health, University of the Witwatersrand, Johannesburg, 2028, South Africa
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Jonas K, Bergh K, Duby Z, Mangoale K, Mogari N, Kuo C, Reddy T, Mathews C. Using prevention cascades to investigate coverage of contraception services among young women enrolled in a large-scale combination HIV prevention program in South Africa. Contraception 2024; 130:110307. [PMID: 37863465 DOI: 10.1016/j.contraception.2023.110307] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 10/06/2023] [Accepted: 10/09/2023] [Indexed: 10/22/2023]
Abstract
OBJECTIVES We investigated the coverage of contraception services (excluding condoms) to prevent unintended pregnancy among young women and girls aged 15 to 24 years who were beneficiaries of one of the two largest combination HIV and pregnancy prevention program in South Africa. STUDY DESIGN We invited 2160 randomly sampled beneficiaries who were living in six of the 12 program districts across six provinces to participate in a telephone survey. We created pregnancy prevention coverage cascades and conducted univariate and multivariable analyses to identify key barriers and facilitators associated with each step of the cascade. RESULTS We achieved a response rate of 23.8%, resulting in 515 respondents, of whom 303 had sex in the 6 months before the survey. Of this subsample, 80.4% had access to contraception services, 60.6% had access and motivation to use contraceptives, and 21.9% had access to, motivation to use, and effectively used contraceptives. Distance to travel to services and not ever being offered contraceptives by health workers were access barriers, while low pregnancy risk perception was a barrier to motivation. CONCLUSIONS Most respondents had access to and were motivated to use contraceptives other than condoms but were not effectively using them. Having been offered contraceptives facilitated better access, while distance to the services was a barrier, suggesting the importance of improving supply-side interventions, such as increasing the number and accessibility of spaces where Sexual and Reproductive Health (SRH) services are offered. We recommend longitudinal behavioral counseling for young people, especially adolescents, as well as risk reduction and information-tailored interventions. IMPLICATIONS Pregnancy prevention cascades are a promising tool to monitor progress toward universal access to contraception services and to identify barriers that need to be addressed to achieve the effective use of contraceptives.
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Affiliation(s)
- Kim Jonas
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa.
| | - Kate Bergh
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa; Department of Psychology, University of Cape Town, Cape Town, South Africa
| | - Zoe Duby
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa; Division of Social and Behavioural Sciences in the School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Kgahliso Mangoale
- Networking HIV and AIDS Community of Southern Africa (NACOSA), Cape Town, South Africa
| | - Neo Mogari
- Networking HIV and AIDS Community of Southern Africa (NACOSA), Cape Town, South Africa
| | | | - Tarylee Reddy
- Biostatistics Research Unit, South African Medical Research Council, Durban, South Africa
| | - Catherine Mathews
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
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Dassaye R, Wand H, Reddy T, Tanser F, Sartorius B, Morris N, Ramjee G. Spatial variations in STIs among women enrolled in HIV prevention clinical trials in Durban, KwaZulu-Natal, South Africa. SAHARA J 2023; 20:2193238. [PMID: 36995287 PMCID: PMC10064823 DOI: 10.1080/17290376.2023.2193238] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 03/14/2023] [Indexed: 03/31/2023] Open
Abstract
South Africa is faced with a high HIV and STI prevalence and incidence, respectively, with pockets of high burden areas driving these diseases. Localised monitoring of the HIV epidemic and STI endemic would enable more effective targeted prevention strategies. We assessed spatial variations in curable STI incidence among a cohort of women enrolled in HIV prevention clinical trials between 2002 and 2012. STI incidence rates from 7557 South African women enrolled in five HIV prevention trials were geo-mapped using participant household GPS coordinates. Age and period standardised incidence rates were calculated for 43 recruitment areas and Bayesian conditional autoregressive areal spatial regression (CAR) was used to identify significant patterns and spatial patterns of STI infections in recruitment communities. Overall age and period standardised STI incidence rate were estimated as 15 per 100 PY and ranged from 6 to 24 per 100 PY. We identified five significant STI high risk areas with higher-than-expected incidence of STIs located centrally (three-locations) and southern neighbouring areas of Durban (two-locations). Younger age (<25), not married/cohabitating, parity <3 and poor education were all significant correlates of high STI communities. Findings demonstrate sustained STI incidence rates across the greater Durban area. The role of STI incidence in HIV acquisition in high HIV endemic areas need to be revisited as current highly effective PrEP interventions do not protect from STI acquisition. In these settings there is an urgent need for integrative HIV and STI prevention and treatment services.
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Affiliation(s)
- Reshmi Dassaye
- HIV and other Infectious Diseases Research Unit, South African Medical Research Council, Durban, South Africa
| | - Handan Wand
- Kirby Institute, University of New South Wales, Kensington, Australia
| | - Tarylee Reddy
- Biostatistics Unit, South African Medical Research Council, Durban, South Africa
| | - Frank Tanser
- University of Lincoln, Lincoln Institute for Health, Lincoln, UK
| | - Benn Sartorius
- Faculty of Infectious and Tropical Diseases (ITD), London School of Hygiene & Tropical Medicine, London, UK
| | - Natashia Morris
- Biostatistics Unit: GIS, South African Medical Research Council, Durban, South Africa
| | - Gita Ramjee
- HIV and other Infectious Diseases Research Unit, South African Medical Research Council, Durban, South Africa
- London School of Hygiene and Tropical Medicine, Department of Epidemiology and Population Health, London, UK
- School of Medicine, Department of Global Health, University of Washington, Seattle, WA, USA
- The Aurum Institute, Johannesburg, South Africa
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Bergh K, Jonas K, Duby Z, Govindasamy D, Mathews C, Reddy T, Slingers N, Whittle G, Abdullah F. Factors Associated with COVID-19 Vaccine Uptake among Schoolgoing Adolescent Girls and Young Women in South Africa. Vaccines (Basel) 2023; 11:1581. [PMID: 37896983 PMCID: PMC10610973 DOI: 10.3390/vaccines11101581] [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: 09/11/2023] [Revised: 10/03/2023] [Accepted: 10/05/2023] [Indexed: 10/29/2023] Open
Abstract
(1) Background: By October 2022, vaccination rates with at least one dose of a COVID-19 vaccine were low among adolescent girls aged 12-17 (38%) and young women aged 18-34 (45%) in South Africa. This study aimed to measure and identify barriers to and facilitators of motivation to take up, access to, and uptake of COVID-19 vaccines among schoolgoing adolescent girls and young women in two districts in South Africa. (2) Methods: Using the theory of the HIV prevention cascade, we conceptualised the relationship between motivation, access, and uptake of COVID-19 vaccines, and associated barriers. Potential barriers and facilitators were identified using bivariate and multivariable Poisson regression. (3) Results: Among all 2375 participants, access was high (69%), but motivation (49%) and vaccination with at least one COVID-19 vaccine (45%) were lower. Fear of injections was a barrier to vaccine uptake (aRR 0.85 95% CI 0.82-0.88), while being tested for COVID-19 (aRR 2.10 95% CI 1.85-2.38) and believing that the COVID-19 vaccine was safe (aRR 1.31 95% CI 1.18-1.44) and would prevent you from getting very sick (aRR 1.11 95% CI 1.04-1.19) were facilitators. (4) Conclusions: The controversy about the value of vaccinating adolescents and the delay in vaccine rollout for adolescents and young adults may have contributed to fears about the safety and efficacy of COVID-19 vaccines, as well as a lack of motivation to get vaccinated.
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Affiliation(s)
- Kate Bergh
- Health Systems Research Unit, South African Medical Research Council, Cape Town 7501, South Africa
- Department of Psychology, University of Cape Town, Cape Town 7700, South Africa
| | - Kim Jonas
- Health Systems Research Unit, South African Medical Research Council, Cape Town 7501, South Africa
| | - Zoe Duby
- Health Systems Research Unit, South African Medical Research Council, Cape Town 7501, South Africa
- Division of Social and Behavioural Sciences, School of Public Health and Family Medicine, University of Cape Town, Cape Town 7925, South Africa
| | - Darshini Govindasamy
- Health Systems Research Unit, South African Medical Research Council, Cape Town 7501, South Africa
| | - Catherine Mathews
- Health Systems Research Unit, South African Medical Research Council, Cape Town 7501, South Africa
- School of Public Health and Family Medicine, University of Cape Town, Cape Town 7925, South Africa
| | - Tarylee Reddy
- Biostatistics Research Unit, South African Medical Research Council, Durban 4091, South Africa
| | - Nevilene Slingers
- Office of AIDS and TB Research, South African Medical Research Council, Pretoria 0001, South Africa
| | - Granville Whittle
- Department of Basic Education, Government of South Africa, Pretoria 0001, South Africa
| | - Fareed Abdullah
- Office of AIDS and TB Research, South African Medical Research Council, Pretoria 0001, South Africa
- Division of Infectious Diseases, Department of Internal Medicine, Steve Biko Academic Hospital and University of Pretoria, Pretoria 0002, South Africa
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Moyo S, Simbayi LC, Zuma K, Zungu N, Marinda E, Jooste S, Ramlagan S, Fortuin M, Singh B, Mabaso M, Reddy T, Parker WA, Naidoo I, Manda S, Goga A, Ngandu N, Cawood C, Moore PL, Puren A. Seroprevalence survey of anti-SARS-CoV-2 antibody and associated factors in South Africa: Findings of the 2020-2021 population-based household survey. PLOS Glob Public Health 2023; 3:e0002358. [PMID: 37747851 PMCID: PMC10519586 DOI: 10.1371/journal.pgph.0002358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 08/13/2023] [Indexed: 09/27/2023]
Abstract
Population-based serological testing is important to understand the epidemiology and estimate the true cumulative incidence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) to inform public health interventions. This study reports findings of a national household population SARS-CoV-2 serosurvey in people 12 years and older in South Africa. This cross-sectional multi-stage random stratified cluster survey undertaken from November 2020 to June 2021 collected sociodemographic data, medical history, behavioural data, and blood samples from consenting participants. The samples were tested for SARS-CoV-2 antibodies using the Roche ElecsysAnti-SARS-CoV-2 chemiluminescence immunoassay (CLIA) Total Antibody Test. The survey data were weighted by age, race, sex, and province with final individual weights benchmarked against the 2020 mid-year population estimates and accounted for clustering. Descriptive statistics summarize the characteristics of participants and seroprevalence. Logistic regression analyses were used to identify factors associated with seropositivity. From 13290 survey participants (median age 33 years, interquartile range (IQR) 23-46 years), SARS-CoV-2 seroprevalence was 37.8% [95% Confidence Interval (CI) 35.4-40.4] and varied substantially across the country's nine provinces, and by sex, age and locality type. In the final adjusted model, the odds of seropositivity were higher in women than in men [aOR = 1.3 (95% CI: 1.0-1.6), p = 0.027], and those living with HIV (self-report) [aOR = 1.6 (95% CI: 1.0-2.4), p = 0.031]. The odds were lower among those 50 years and older compared to adolescents 12-19 years old [aOR = 0.6 (95% CI: 0.5-0.8), p<0.001] and in those who did not attend events or gatherings [aOR = 0.7 (95% CI: 0.6-1.0), p = 0.020]. The findings help us understand the epidemiology of SARS-CoV-2 within different regions in a low-middle-income country. The survey highlights the higher risk of infection in women in South Africa likely driven by their home and workplace roles and also highlighted a need to actively target and include younger people in the COVID-19 response.
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Affiliation(s)
- Sizulu Moyo
- Human Sciences Research Council, Pretoria, South Africa
- School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Leickness C. Simbayi
- Human Sciences Research Council, Pretoria, South Africa
- Department of Psychiatry & Mental Health, University of Cape Town, Cape Town, South Africa
| | - Khangelani Zuma
- Human Sciences Research Council, Pretoria, South Africa
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Nompumelelo Zungu
- Human Sciences Research Council, Pretoria, South Africa
- Department of Psychology, University of Pretoria, Pretoria, South Africa
| | - Edmore Marinda
- Human Sciences Research Council, Pretoria, South Africa
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Sean Jooste
- Human Sciences Research Council, Pretoria, South Africa
| | | | - Mirriam Fortuin
- National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa
| | - Beverley Singh
- National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa
| | | | - Tarylee Reddy
- Biostatistics Research Unit (TR and SMa)/ HIV and other Infectious Diseases Research Unit (AG and NN), South African Medical Research Council, Cape Town, South Africa
| | | | | | - Samuel Manda
- Biostatistics Research Unit (TR and SMa)/ HIV and other Infectious Diseases Research Unit (AG and NN), South African Medical Research Council, Cape Town, South Africa
| | - Ameena Goga
- Biostatistics Research Unit (TR and SMa)/ HIV and other Infectious Diseases Research Unit (AG and NN), South African Medical Research Council, Cape Town, South Africa
- Department of Paediatrics and Child Health, University of Pretoria, Pretoria, South Africa
| | - Nobubelo Ngandu
- Biostatistics Research Unit (TR and SMa)/ HIV and other Infectious Diseases Research Unit (AG and NN), South African Medical Research Council, Cape Town, South Africa
| | | | - Penny L. Moore
- National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa
- SAMRC Antibody Immunity Research Unit, Division of Virology and Immunology, University of the Witwatersrand, Johannesburg, South Africa
| | - Adrian Puren
- National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa
- Division of Virology, School of Pathology, University of the Witwatersrand Medical School, Johannesburg, South Africa
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11
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Mann JK, Reddy T, van der Stok M, Ngubane A, Mulaudzi T, Mchunu N, Nevhungoni P, Manickchund N, Manickchund P, Louise Cairns CH, Govender V, Ndung'u T, Suleman Moosa MY, Gosnell BI. Hen egg white bovine colostrum supplement reduces symptoms of mild/moderate COVID-19: a randomized control trial. Future Sci OA 2023; 9:FSO882. [PMID: 37621850 PMCID: PMC10445555 DOI: 10.2144/fsoa-2023-0024] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 07/03/2023] [Indexed: 08/26/2023] Open
Abstract
Aim The ability of a hen egg white bovine colostrum supplement to prevent severe COVID-19 was tested in a double-blind randomized control study. Methods Adults with mild/moderate COVID-19, risk factors for severe disease, and within 5 days of symptom onset were assigned to the intervention (n = 77) or placebo (n = 79) arms. Symptoms were documented until day 42 post-enrollment and viral clearance was assessed at 11-13 days post-symptom onset. Results One participant developed severe COVID-19. The severe-type symptom score was lower in the active arm at 11-13 days post-symptom onset (p = 0.049). Chest pain, fever/chills, joint pain/malaise, and sore throat were significantly less frequent in the active arm. No differences in viral clearance were observed. Conclusion The intervention reduced symptoms of mild/moderate COVID-19. Clinical Trial Registration DOH-27-062021-9191 (South African National Clinical Trials Register).
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Affiliation(s)
- Jaclyn Kelly Mann
- HIV Pathogenesis Programme, University of KwaZulu-Natal, Durban, 4001, South Africa
| | - Tarylee Reddy
- Biostatistics Research Unit, South African Medical Research Council, Durban, 4091, South Africa
| | - Mary van der Stok
- HIV Pathogenesis Programme, University of KwaZulu-Natal, Durban, 4001, South Africa
| | - Ayanda Ngubane
- HIV Pathogenesis Programme, University of KwaZulu-Natal, Durban, 4001, South Africa
| | - Takalani Mulaudzi
- HIV Pathogenesis Programme, University of KwaZulu-Natal, Durban, 4001, South Africa
| | - Nobuhle Mchunu
- Biostatistics Research Unit, South African Medical Research Council, Durban, 4091, South Africa
| | - Portia Nevhungoni
- Biostatistics Research Unit, South African Medical Research Council, Durban, 4091, South Africa
| | - Nithendra Manickchund
- Department of Infectious Diseases, University of KwaZulu-Natal, Durban, 4001, South Africa
| | - Pariva Manickchund
- Department of Infectious Diseases, University of KwaZulu-Natal, Durban, 4001, South Africa
| | | | | | - Thumbi Ndung'u
- HIV Pathogenesis Programme, University of KwaZulu-Natal, Durban, 4001, South Africa
- Africa Health Research Institute, Durban, 4001, South Africa
- Ragon Institute of Massachusetts General Hospital, Massachusetts Institute of Technology & Harvard University, Cambridge, MA 02139, USA
- Division of Infection & Immunity, University College London, London, WC1E 6BT, UK
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12
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Chetty T, Pillay A, Balakrishna Y, Reddy T, Goga A, Moore DP, Karsas M, Cloete J, Archary M, Kwawegen AV, Thomas R, Nakwa FL, Waggie Z, Magrath S, Jeena P. Healthcare-Associated Infections Drive Antimicrobial Prescribing in Pediatric Departments at Three Academic Hospitals in South Africa. Pediatr Infect Dis J 2023; Publish Ahead of Print:00006454-990000000-00494. [PMID: 37368998 DOI: 10.1097/inf.0000000000003954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/29/2023]
Abstract
BACKGROUND The prevalence of antimicrobial prescriptions for healthcare-associated infections (HAI) in South Africa is largely unknown. This study aimed to estimate the point prevalence of pediatric antibiotic and antifungal usage in 3 South African academic hospitals. METHODS This cross-sectional study included hospitalized neonates and children (0-15 years). We used the World Health Organization methodology for antimicrobial point prevalence studies, with weekly surveys to achieve a sample size of ~400 at each site. RESULTS Overall, 1,946 antimicrobials were prescribed to 1,191 patients. At least 1 antimicrobial was prescribed for 22.9% [95% confidence interval (CI): 15.5-32.5%] of patients. The prevalence of antimicrobial prescribing for HAI was 45.6%. In the multivariable analysis, relative to children 6-12 years, neonates [adjusted relative risk (aRR): 1.64; 95% CI: 1.06-2.53], infants (aRR: 1.57; 95% CI: 1.12-2.21) and adolescents (aRR: 2.18; 95% CI: 1.45-3.29) had significantly increased risk of prescriptions for HAI. Being preterm (aRR: 1.33; 95% CI: 1.04-1.70) and underweight (aRR: 1.25; 95% CI: 1.01-1.54) was predictive of antimicrobial usage for HAI. Having an indwelling device, surgery since admission, blood transfusions and classification as rapidly fatal on McCabe score also increased the risk of prescriptions for HAI. CONCLUSIONS The high prevalence of antimicrobial prescribing for HAI to treat children with recognized risk factors in academic hospitals in South Africa is concerning. Concerted efforts need to be made to strengthen hospital-level infection prevention and control measures, with a critical review of antimicrobial usage through functional antibiotic stewardship programs to preserve the available antimicrobial armamentarium at the hospital level.
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Affiliation(s)
- Terusha Chetty
- From the HIV and Other Infectious Diseases Research Unit, South African Medical Research Council, South Africa
- Discipline of Public Health Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Ashendri Pillay
- Department of Pediatrics and Child Health, University of KwaZulu-Natal, Durban, South Africa
| | - Yusentha Balakrishna
- Biostatistics Research Unit, South African Medical Research Council, Durban, South Africa
| | - Tarylee Reddy
- Biostatistics Research Unit, South African Medical Research Council, Durban, South Africa
- School of Mathematics, Statistics and Computer Science, University of KwaZulu-Natal, Durban, South Africa
| | - Ameena Goga
- Discipline of Public Health Medicine, University of KwaZulu-Natal, Durban, South Africa
- Department of Pediatrics and Child Health, University of Pretoria, Pretoria, South Africa
| | - David P Moore
- Department of Pediatrics and Child Health, Chris Hani Baragwanath Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa
- South African Medical Research Council Vaccine and Infectious Diseases Analytics (VIDA) Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Maria Karsas
- Department of Pediatrics and Child Health, Steve Biko Academic Hospital, University of Pretoria, Pretoria, South Africa
| | - Jeané Cloete
- Maternal and Infant Health Care Strategies Research Unit Centre, University of Pretoria, Pretoria, South Africa
| | - Moherndran Archary
- Department of Pediatrics and Child Health, University of KwaZulu-Natal, Durban, South Africa
| | - Alison van Kwawegen
- Department of Pediatrics and Child Health, Chris Hani Baragwanath Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa
| | - Reenu Thomas
- Department of Pediatrics and Child Health, Chris Hani Baragwanath Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa
| | - Firdose Lambey Nakwa
- Department of Pediatrics and Child Health, Chris Hani Baragwanath Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa
| | - Zainab Waggie
- Discipline of Public Health Medicine, University of KwaZulu-Natal, Durban, South Africa
- Department of Pediatrics and Child Health, Chris Hani Baragwanath Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa
| | - Stephanie Magrath
- Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; and
| | - Prakash Jeena
- Department of Pediatrics and Child Health, University of KwaZulu-Natal, Durban, South Africa
- Department of Pediatrics and Child Health, Inkosi Albert Luthuli Central Hospital, Durban, South Africa
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13
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Kapwata T, Wright CY, Reddy T, Street R, Kunene Z, Mathee A. Relations between personal exposure to elevated concentrations of arsenic in water and soil and blood arsenic levels amongst people living in rural areas in Limpopo, South Africa. Environ Sci Pollut Res Int 2023; 30:65204-65216. [PMID: 37079235 PMCID: PMC10116462 DOI: 10.1007/s11356-023-26813-9] [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] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 03/31/2023] [Indexed: 05/03/2023]
Abstract
Exposure to arsenic even at low levels can lead to adverse health outcomes, however, there is a paucity of research from South Africa in relation to human exposure to arsenic. We investigated long-term exposure of residents in Limpopo province, South Africa, in a cross-sectional study by analysing water, soil and blood arsenic concentrations from two arsenic-exposed (high and medium-low exposure) villages and one non-exposed (control) village. There were statistically significant differences in the distribution of arsenic in water, soil and blood amongst the three sites. The median drinking water arsenic concentration in the high-exposure village was 1.75 µg/L (range = 0.02 to 81.30 µg/L), 0.45 µg/L (range = 0.100 to 6.00 µg/L) in the medium- / low-exposure village and 0.15 µg/L (range = < limit of detection (LOD) to 29.30 µg/L) in the control site. The median soil arsenic concentration in the high-exposure village was 23.91 mg/kg (range = < LOD to 92.10 mg/kg) whilst arsenic concentrations were below the limit of detection in all soil samples collected from the medium-/low-exposure and control villages. In the high-exposure village, the median blood arsenic concentration was 1.6 µg/L (range = 0.7 to 4.2 µg/L); 0.90 µg/L (range = < LOD to 2.5 µg/L) in the medium-/low-exposure village and 0.6 µg/L (range = < LOD to 3.3 µg/L) in the control village. Significant percentages of drinking water, soil and blood samples from the exposed sites were above the internationally recommended guidelines (namely, 10 µg/L, 20 mg/kg and 1 µg/L, respectively). Majority of participants (86%) relied on borehole water for drinking and there was a significant positive correlation between arsenic in blood and borehole water (p-value = 0.031). There was also a statistically significant correlation between arsenic concentrations in participants' blood and soil samples collected from gardens (p-value = 0.051). Univariate quantile regression found that blood arsenic concentrations increased by 0.034 µg/L (95% CI = 0.02-0.05) for each one unit increase in water arsenic concentrations (p < 0.001). After adjusting for age, water source and homegrown vegetable consumption in multivariate quantile regression, participants from the high-exposure site had significantly higher blood concentrations than those in the control site (coefficient: 1.00; 95% CI = 0.25-1.74; p-value = 0.009) demonstrating that blood arsenic is a good biomarker of arsenic exposure. Our findings also provide new evidence for South Africa on the association between drinking water and arsenic exposure, emphasising the need for the provision of potable water for human consumption in areas with high environmental arsenic concentrations.
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Affiliation(s)
- Thandi Kapwata
- Environment and Health Research Unit, South African Medical Research Council, Johannesburg, 2028, South Africa.
- Environmental Health Department, Faculty of Health Sciences, University of Johannesburg, Johannesburg, 2028, South Africa.
| | - Caradee Y Wright
- Environment and Health Research Unit, South African Medical Research Council, Pretoria, 0084, South Africa
- Department of Geography, Geoinformatics and Meteorology, University of Pretoria, Pretoria, 0001, South Africa
| | - Tarylee Reddy
- Biostatistics Research Unit, South African Medical Research Council, Durban, 4001, South Africa
- School of Mathematics, Statistics and Computer Science, University of KwaZulu Natal, Pietermaritzburg, 3201, South Africa
| | - Renee Street
- Environmental Health Department, Faculty of Health Sciences, University of Johannesburg, Johannesburg, 2028, South Africa
- Environment and Health Research Unit, South African Medical Research Council, Durban, 4001, South Africa
| | - Zamantimande Kunene
- Environment and Health Research Unit, South African Medical Research Council, Johannesburg, 2028, South Africa
- Environmental Health Department, Faculty of Health Sciences, University of Johannesburg, Johannesburg, 2028, South Africa
| | - Angela Mathee
- Environment and Health Research Unit, South African Medical Research Council, Johannesburg, 2028, South Africa
- Environmental Health Department, Faculty of Health Sciences, University of Johannesburg, Johannesburg, 2028, South Africa
- School of Public Health, University of the Witwatersrand, Johannesburg, 2028, South Africa
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14
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Reddy T, Kapoor NR, Kubota S, Doubova SV, Asai D, Mariam DH, Ayele W, Mebratie AD, Thermidor R, Sapag JC, Bedregal P, Passi-Solar Á, Gordon-Strachan G, Dulal M, Gadeka DD, Mehata S, Margozzini P, Leerapan B, Rittiphairoj T, Kaewkamjornchai P, Nega A, Awoonor-Williams JK, Kruk ME, Arsenault C. Associations between the stringency of COVID-19 containment policies and health service disruptions in 10 countries. BMC Health Serv Res 2023; 23:363. [PMID: 37046260 PMCID: PMC10096103 DOI: 10.1186/s12913-023-09363-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 04/03/2023] [Indexed: 04/14/2023] Open
Abstract
BACKGROUND Disruptions in essential health services during the COVID-19 pandemic have been reported in several countries. Yet, patterns in health service disruption according to country responses remain unclear. In this paper, we investigate associations between the stringency of COVID-19 containment policies and disruptions in 31 health services in 10 low- middle- and high-income countries in 2020. METHODS Using routine health information systems and administrative data from 10 countries (Chile, Ethiopia, Ghana, Haiti, Lao People's Democratic Republic, Mexico, Nepal, South Africa, South Korea, and Thailand) we estimated health service disruptions for the period of April to December 2020 by dividing monthly service provision at national levels by the average service provision in the 15 months pre-COVID (January 2019-March 2020). We used the Oxford COVID-19 Government Response Tracker (OxCGRT) index and multi-level linear regression analyses to assess associations between the stringency of restrictions and health service disruptions over nine months. We extended the analysis by examining associations between 11 individual containment or closure policies and health service disruptions. Models were adjusted for COVID caseload, health service category and country GDP and included robust standard errors. FINDINGS Chronic disease care was among the most affected services. Regression analyses revealed that a 10% increase in the mean stringency index was associated with a 3.3 percentage-point (95% CI -3.9, -2.7) reduction in relative service volumes. Among individual policies, curfews, and the presence of a state of emergency, had the largest coefficients and were associated with 14.1 (95% CI -19.6, 8.7) and 10.7 (95% CI -12.7, -8.7) percentage-point lower relative service volumes, respectively. In contrast, number of COVID-19 cases in 2020 was not associated with health service disruptions in any model. CONCLUSIONS Although containment policies were crucial in reducing COVID-19 mortality in many contexts, it is important to consider the indirect effects of these restrictions. Strategies to improve the resilience of health systems should be designed to ensure that populations can continue accessing essential health care despite the presence of containment policies during future infectious disease outbreaks.
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Affiliation(s)
- Tarylee Reddy
- Biostatistics Research Unit, South African Medical Research Council, Durban, South Africa
- School of Mathematics, Statistics and Computer Science, University of KwaZulu Natal, Durban, South Africa
| | - Neena R Kapoor
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, USA
| | - Shogo Kubota
- World Health Organization, Vientiane, Lao People's Democratic Republic, Vientiane, Laos
| | - Svetlana V Doubova
- Epidemiology and Health Services Research Unit CMN Siglo XXI, Mexican Institute of Social Security, Mexico City, Mexico
| | - Daisuke Asai
- World Health Organization, Vientiane, Lao People's Democratic Republic, Vientiane, Laos
| | - Damen Haile Mariam
- School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Wondimu Ayele
- School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Anagaw Derseh Mebratie
- School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Roody Thermidor
- Studies and Planning Unit, Ministry of Public Health and Population, Port-Au-Prince, Haiti
| | - Jaime C Sapag
- Public Health Department, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Paula Bedregal
- Public Health Department, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Álvaro Passi-Solar
- Public Health Department, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | | | - Mahesh Dulal
- Office of the Member of Federal Parliament Gagan Kumar Thapa, Kathmandu, Nepal
| | | | - Suresh Mehata
- Ministry of Health, Koshi Province, Biratnagar, Nepal
| | - Paula Margozzini
- Public Health Department, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Borwornsom Leerapan
- Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | | | | | - Adiam Nega
- School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | | | - Margaret E Kruk
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, USA
| | - Catherine Arsenault
- Department of Global Health, The George Washington University Milken Institute School of Public Health, Washington, USA.
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15
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Naicker D, Sonela N, Jin SW, Mulaudzi T, Ojwach D, Reddy T, Brockman MA, Brumme ZL, Ndung'u T, Mann JK. HIV-1 subtype C Nef-mediated SERINC5 down-regulation significantly contributes to overall Nef activity. Retrovirology 2023; 20:3. [PMID: 37004071 PMCID: PMC10067162 DOI: 10.1186/s12977-023-00618-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 03/10/2023] [Indexed: 04/03/2023] Open
Abstract
BACKGROUND Nef performs multiple cellular activities that enhance HIV-1 pathogenesis. The role of Nef-mediated down-regulation of the host restriction factor SERINC5 in HIV-1 pathogenesis is not well-defined. We aimed to investigate if SERINC5 down-regulation activity contributes to HIV-1 subtype C disease progression, to assess the relative contribution of this activity to overall Nef function, and to identify amino acids required for optimal activity. We measured the SERINC5 down-regulation activity of 106 subtype C Nef clones, isolated from individuals in early infection, for which the Nef activities of CD4 and HLA-I down-regulation as well as alteration of TCR signalling were previously measured. The relationship between SERINC5 down-regulation and markers of disease progression, and the relative contribution of SERINC5 down-regulation to a Nef fitness model-derived E value (a proxy for overall Nef fitness in vivo), were assessed. RESULTS No overall relationship was found between SERINC5 down-regulation and viral load set point (p = 0.28) or rate of CD4+ T cell decline (p = 0.45). CD4 down-regulation (p = 0.02) and SERINC5 down-regulation (p = 0.003) were significant determinants of E values in univariate analyses, with the greatest relative contribution for SERINC5 down-regulation, and only SERINC5 down-regulation remained significant in the multivariate analysis (p = 0.003). Using a codon-by-codon analysis, several amino acids were significantly associated with increased (10I, 11V, 38D, 51T, 65D, 101V, 188H and, 191H) or decreased (10K, 38E, 65E, 135F, 173T, 176T and, 191R) SERINC5 down-regulation activity. Site-directed mutagenesis experiments of selected mutants confirmed a substantial reduction in SERINC5 down-regulation activity associated with the mutation 173T, while mutations 10K, 135F, and 176T were associated with more modest reductions in activity that were not statistically significant. CONCLUSIONS These results suggest that SERINC5 down-regulation is a significant contributor to overall Nef function and identify potential genetic determinants of this Nef function that may have relevance for vaccines or therapeutics.
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Affiliation(s)
- Delon Naicker
- HIV Pathogenesis Programme, The Doris Duke Medical Research Institute, University of KwaZulu-Natal, Durban, 4001, South Africa
| | - Nelson Sonela
- HIV Pathogenesis Programme, The Doris Duke Medical Research Institute, University of KwaZulu-Natal, Durban, 4001, South Africa
- Chantal BIYA International Reference Centre for Research on HIV/AIDS Prevention and Management (CIRCB), P.O. Box 3077, Yaoundé, Cameroon
| | - Steven W Jin
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, V5A 1S6, Canada
| | - Takalani Mulaudzi
- HIV Pathogenesis Programme, The Doris Duke Medical Research Institute, University of KwaZulu-Natal, Durban, 4001, South Africa
| | - Doty Ojwach
- HIV Pathogenesis Programme, The Doris Duke Medical Research Institute, University of KwaZulu-Natal, Durban, 4001, South Africa
| | - Tarylee Reddy
- Medical Research Council, Biostatistics Unit, Durban, 4001, South Africa
| | - Mark A Brockman
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, V5A 1S6, Canada
- Molecular Biology and Biochemistry, Simon Fraser University, Burnaby, BC, V5A 1S6, Canada
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, V6Z 1Y6, Canada
| | - Zabrina L Brumme
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, V5A 1S6, Canada
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, V6Z 1Y6, Canada
| | - Thumbi Ndung'u
- HIV Pathogenesis Programme, The Doris Duke Medical Research Institute, University of KwaZulu-Natal, Durban, 4001, South Africa
- Africa Health Research Institute, Durban, 4001, South Africa
- Ragon Institute of Massachusetts General Hospital, Massachusetts Institute of Technology and Harvard University, Cambridge, MA, USA
- Division of Infection and Immunity, University College London, London, WC1E 6BT, UK
| | - Jaclyn K Mann
- HIV Pathogenesis Programme, The Doris Duke Medical Research Institute, University of KwaZulu-Natal, Durban, 4001, South Africa.
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16
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Abdelatif N, Naidoo I, Dunn S, Mazinu M, Essack Z, Groenewald C, Maharaj P, Msomi N, Reddy T, Roberts B, Zuma K. Heterogeneity in COVID-19 infection among older persons in South Africa: Evidence from national surveillance data. Front Public Health 2023; 11:1009309. [PMID: 37006523 PMCID: PMC10061133 DOI: 10.3389/fpubh.2023.1009309] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 02/24/2023] [Indexed: 03/18/2023] Open
Abstract
BackgroundThe 2021 World Health Organization study on the impact of COVID-19 on older people (≥60 years) in the African region highlighted the difficulties they faced as the virus spread across borders and dominated the way of life. These difficulties included disruptions to both essential health care services and social support, as well as disconnections from family and friends. Among those who contracted COVID-19, the risks of severe illness, complications, and mortality were highest among near-old and older persons.ObjectiveRecognizing that older persons are a diverse group including younger- and older-aged individuals, a study was conducted to track the epidemic among near-old (50–59 years) and older persons (≥60 years) in South Africa covering the 2 years since the epidemic emerged.MethodsUsing a quantitative secondary research approach, data for near-old and older persons were extracted for comparative purposes. COVID-19 surveillance outcomes (confirmed cases, hospitalizations, and deaths) and vaccination data were compiled up to March 5th, 2022. COVID-19 surveillance outcomes were plotted by epidemiological week and epidemic waves to visualize the overall growth and trajectory of the epidemic. Means for each age-group and by COVID-19 waves, together with age-specific rates, were calculated.ResultsAverage numbers of new COVID-19 confirmed cases and hospitalizations were highest among people aged 50–59- and 60–69-years. However, average age-specific infection rates showed that people aged 50–59 years and ≥80 years were most vulnerable to contracting COVID-19. Age-specific hospitalization and death rates increased, with people aged ≥ 70 years most affected. The number of people vaccinated was slightly higher among people aged 50–59 years before Wave Three and during Wave Four, but higher among people aged ≥ 60 years during Wave Three. The findings suggest that uptake of vaccinations stagnated prior to and during Wave Four for both age groups.DiscussionHealth promotion messages and COVID-19 epidemiological surveillance and monitoring are still needed, particularly for older persons living in congregate residential and care facilities. Prompt health-seeking should be encouraged, including testing and diagnosis as well as taking up vaccines and boosters, particularly for high-risk older persons.
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Affiliation(s)
- Nada Abdelatif
- Biostatistics Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Inbarani Naidoo
- Centre for Community Based Research, Human and Social Capabilities Division, Human Sciences Research Council, Durban, South Africa
- *Correspondence: Inbarani Naidoo
| | - Shanaaz Dunn
- School of Built Environment and Development Studies, University of KwaZulu-Natal, Durban, South Africa
| | - Mikateko Mazinu
- Biostatistics Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Zaynab Essack
- Centre for Community Based Research, Human and Social Capabilities Division, Human Sciences Research Council, Pietermaritzburg, South Africa
- Honorary Research Fellow, School of Law, and Honorary Research Associate, Centre for the AIDS Programme of Research in South Africa, University of KwaZulu-Natal, Durban, South Africa
| | - Candice Groenewald
- Centre for Community Based Research, Human and Social Capabilities Division, Human Sciences Research Council, Durban, South Africa
- Honorary Research Associate, Rhodes University, Grahamstown, South Africa
| | - Pranitha Maharaj
- School of Built Environment and Development Studies, University of KwaZulu-Natal, Durban, South Africa
| | - Nokukhanya Msomi
- Discipline of Virology, University of KwaZulu-Natal and National Health Laboratory Services, Durban, South Africa
| | - Tarylee Reddy
- Biostatistics Research Unit, South African Medical Research Council, Durban, South Africa
| | - Benjamin Roberts
- Developmental, Capable and Ethical State Division, Human Sciences Research Council, Durban, South Africa
| | - Khangelani Zuma
- Human and Social Capabilities Division, Human Sciences Research Council, Pretoria, South Africa
- Wits School of Public Health, University of Witwatersrand, Johannesburg, South Africa
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17
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Wand H, Vujovich-Dunn C, Derrick K, Moodley J, Reddy T, Naidoo S. Geospatial variations in socioeconomic conditions and health outcomes in COVID-19 era: insights from South Africa (2020-2022). GeoJournal 2023; 88:1-17. [PMID: 38625344 PMCID: PMC9988606 DOI: 10.1007/s10708-023-10851-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 02/20/2023] [Indexed: 04/17/2024]
Abstract
South Africa also has the highest burden of coronavirus disease 2019 (COVID-19) related comorbidities in Africa. We aimed to quantify the temporal and geospatial changes in unemployment, food insecurity, and their combined impact on depressive symptoms among South Africans who participated into several rounds of national surveys. We estimated the population-attributable risk percent (P A R % ) for the combinations of the risk factors after accounting for their correlation structure in multifactorial setting. Our study provided compelling evidence for immediate and severe effect of the pandemic where 60% of South Africans reported household food insecurity or household hunger, shortly after the pandemic emerged in 2020. Despite the grants provided by the government, these factors were also identified as the most influential risk factors (adjusted odds ratios (aORs) ranged from 2.06 to 3.10, p < 0.001) for depressive symptoms and collectively associated with 62% and 53% of the mental health symptoms in men and women, respectively. Similar pattern was observed among pregnant women and 41% of the depressive symptoms were exclusively associated with those who reported household hunger. However, aORs associated with the concerns around pandemic and vaccine were mostly not significant and ranged from 1.12 to 1.26 which resulted substantially lower impacts on depressive symptoms (PAR%:7%-and-14%). Our findings suggest that South Africa still has unacceptably high rates of hunger which is accelerated during the pandemic. These results may have significant clinical and epidemiological implications and may also bring partial explanation for the low vaccine coverage in the country, as priorities and concerns are skewed towards economic concerns and food insecurity.
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Affiliation(s)
- Handan Wand
- Biostatistics and Databases Program ,Kirby Institute, University of New South Wales, Level 6, Wallace Wurth Building, Kensington, NSW 2052 Australia
| | - Cassandra Vujovich-Dunn
- Biostatistics and Databases Program ,Kirby Institute, University of New South Wales, Level 6, Wallace Wurth Building, Kensington, NSW 2052 Australia
| | - Kate Derrick
- Emergency Department, Royal Prince Alfred Hospital, Sydney, Australia
| | | | - Tarylee Reddy
- Biostatistics Unit, South African Medical Research Council, Durban, Kwazulu-Natal South Africa
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18
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Jacobson BF, Schapkaitz E, Takalani A, Rowji P, Louw VJ, Opie J, Bekker LG, Garrett N, Goga A, Reddy T, Yende-Zuma N, Sanne I, Seocharan I, Peter J, Robinson M, Collie S, Khan A, Takuva S, Gray G. Vascular thrombosis after single dose Ad26.COV2.S vaccine in healthcare workers in South Africa: open label, single arm, phase 3B study (Sisonke study). bmjmed 2023; 2:e000302. [PMID: 37063238 PMCID: PMC10083528 DOI: 10.1136/bmjmed-2022-000302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 02/23/2023] [Indexed: 04/05/2023]
Abstract
ObjectiveTo assess the rates of vascular thrombotic adverse events in the first 35 days after one dose of the Ad26.COV2.S vaccine (Janssen/Johnson & Johnson) in healthcare workers in South Africa and to compare these rates with those observed in the general population.DesignOpen label, single arm, phase 3B study.SettingSisonke study, South Africa, 17 February to 15 June 2021.ParticipantsThe Sisonke cohort of 477 234 healthcare workers, aged ≥18 years, who received one dose of the Ad26.COV2.S vaccine.Main outcome measuresObserved rates of venous arterial thromboembolism and vaccine induced immune thrombocytopenia and thrombosis in individuals who were vaccinated, compared with expected rates, based on age and sex specific background rates from the Clinical Practice Research Datalink GOLD database (database of longitudinal routinely collected electronic health records from UK primary care practices using Vision general practice patient management software).ResultsMost of the study participants were women (74.9%) and median age was 42 years (interquartile range 33-51). Twenty nine (30.6 per 100 000 person years, 95% confidence interval 20.5 to 44.0) vascular thrombotic events occurred at a median of 14 days (7-29) after vaccination. Of these 29 participants, 93.1% were women, median age 46 (37-55) years, and 51.7% had comorbidities. The observed to expected ratios for cerebral venous sinus thrombosis with thrombocytopenia and pulmonary embolism with thrombocytopenia were 10.6 (95% confidence interval 0.3 to 58.8) and 1.2 (0.1 to 6.5), respectively. Because of the small number of adverse events and wide confidence intervals, no conclusions were drawn between these estimates and the expected incidence rates in the population.ConclusionsVaccine induced immune thrombocytopenia and thrombosis after one dose of the Ad26.COV2.S vaccine was found in only a few patients in this South African population of healthcare workers. These findings are reassuring if considered in terms of the beneficial effects of vaccination against covid-19 disease. These data support the continued use of this vaccine, but surveillance is recommended to identify other incidences of venous and arterial thromboembolism and to improve confidence in the data estimates.Trial registrationClinicalTrials.govNCT04838795.
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Affiliation(s)
- Barry Frank Jacobson
- Molecular Medicine and Haematology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Elise Schapkaitz
- Molecular Medicine and Haematology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Azwi Takalani
- Hutchinson Centre Research Institute of South Africa (HCRISA), Chris Hani Baragwanath Hospital, Johannesburg, South Africa
| | - Pradeep Rowji
- The Southern African Society of Thrombosis and Haemostasis, Neurology Association of South Africa, Johannesburg, South Africa
| | - Vernon Johan Louw
- Division of Clinical Haematology, Department of Medicine, Faculty of Health Sciences, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
| | - Jessica Opie
- Division of Haematology, Department of Pathology, University of Cape Town and National Health Laboratory Service, Cape Town, South Africa
| | - Linda-Gail Bekker
- Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa
| | - Nigel Garrett
- Centre for the AIDS Programme of Research in South Africa, Durban, South Africa
- Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - Ameena Goga
- HIV and Other Infectious Diseases Research Unit, South African Medical Research Council, Cape Town, South Africa
- Paediatrics and Child Health, University of Pretoria, Pretoria, South Africa
| | - Tarylee Reddy
- Biostatistics Research Unit, South African Medical Research Council, Durban, South Africa
| | - Nonhlanhla Yende-Zuma
- Nelson R Mandela School of Medicine, Centre for the AIDS Programme of Research in South Africa, University of KwaZulu Natal, Durban, South Africa
| | - Ian Sanne
- Clinical HIV Research Unit, University of the Witwatersrand Faculty of Sciences, Johannesburg, South Africa
| | - Ishen Seocharan
- Biostatistics Research Unit, South African Medical Research Council, Durban, South Africa
| | - Jonny Peter
- Division of Allergy and Clinical Immunology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- Allergy and Immunology Unit, University of Cape Town Lung Institute, Cape Town, South Africa
| | | | | | - Amber Khan
- Molecular Medicine and Haematology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Simbarashe Takuva
- School of Health Systems and Public Health, University of Pretoria, Faculty of Health Sciences, Pretoria, South Africa
- Perinatal HIV Research Unit, University of the Witwatersrand, Faculty of Health Sciences, Johannesburg, South Africa
| | - Glenda Gray
- HIV and Other Infectious Diseases Research Unit, South African Medical Research Council, Cape Town, South Africa
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19
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Nkambule S, Johnson R, Mathee A, Mahlangeni N, Webster C, Horn S, Mangwana N, Dias S, Sharma JR, Ramharack P, Louw J, Reddy T, Surujlal-Naicker S, Mdhluli M, Gray G, Muller C, Street R. Wastewater-based SARS-CoV-2 airport surveillance: key trends at the Cape Town International Airport. J Water Health 2023; 21:402-408. [PMID: 37338319 PMCID: wh_2023_281 DOI: 10.2166/wh.2023.281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/21/2023]
Abstract
Monitoring of SARS-CoV-2 RNA in wastewater has revealed the role of mobility in the transmission of coronavirus disease (COVID-19), and the surveillance of airport wastewater in cities across the world has demonstrated how travel entry points can give an indication of trends in transmission. This study undertook wastewater surveillance at the Cape Town International Airport (CTIA) to assess the use of a WBE approach to provide supplementary information on the presence of COVID-19 at a key air travel entry point in South Africa. Grab wastewater samples (n = 55) were collected from the CTIA wastewater pump station and analysed using quantitative real-time polymerase chain reaction (qRT-PCR) method. The study found a correlation between the wastewater data and clinical cases reported in the City of Cape Town during various time periods and during the peak of a COVID-19 wave. Highly elevated viral loads in the wastewater were observed at times there was increased mobility through the airport. The study also revealed elevated viral load levels at the airport despite the stricter restrictions and through the lower restrictions. The study findings indicate wastewater surveillance and airports can provide supplementary information to airport authorities to assess the impacts of imposed travel restrictions.
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Affiliation(s)
- Sizwe Nkambule
- Environment & Health Research Unit, South African Medical Research Council (SAMRC), Durban 4091, South Africa E-mail:
| | - Rabia Johnson
- Biomedical Research and Innovation Platform (BRIP), South African Medical Research Council (SAMRC), Tygerberg 7505, South Africa; Centre for Cardio-Metabolic Research in Africa, Division of Medical Physiology, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch 7600, South Africa
| | - Angela Mathee
- Environment & Health Research Unit, South African Medical Research Council (SAMRC), Durban 4091, South Africa E-mail: ; Environmental Health Department, Faculty of Health Sciences, University of Johannesburg, Johannesburg, South Africa; School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Nomfundo Mahlangeni
- Environment & Health Research Unit, South African Medical Research Council (SAMRC), Durban 4091, South Africa E-mail:
| | - Candice Webster
- Environment & Health Research Unit, South African Medical Research Council (SAMRC), Durban 4091, South Africa E-mail:
| | - Suranie Horn
- Environment & Health Research Unit, South African Medical Research Council (SAMRC), Durban 4091, South Africa E-mail: ; Occupational Hygiene and Health Research Initiative, North-West University, Potchefstroom, South Africa
| | - Noluxabiso Mangwana
- Biomedical Research and Innovation Platform (BRIP), South African Medical Research Council (SAMRC), Tygerberg 7505, South Africa; Department of Microbiology, Stellenbosch University, Stellenbosch 7600, South Africa
| | - Stephanie Dias
- Biomedical Research and Innovation Platform (BRIP), South African Medical Research Council (SAMRC), Tygerberg 7505, South Africa
| | - Jyoti Rajan Sharma
- Biomedical Research and Innovation Platform (BRIP), South African Medical Research Council (SAMRC), Tygerberg 7505, South Africa
| | - Pritika Ramharack
- Biomedical Research and Innovation Platform (BRIP), South African Medical Research Council (SAMRC), Tygerberg 7505, South Africa; Discipline of Pharmaceutical Sciences, School of Health Sciences, University of KwaZulu-Natal, Westville Campus, Durban 4001, South Africa
| | - Johan Louw
- Biomedical Research and Innovation Platform (BRIP), South African Medical Research Council (SAMRC), Tygerberg 7505, South Africa; Department of Biochemistry and Microbiology, University of Zululand, KwaDlangezwa 3886, South Africa
| | - Tarylee Reddy
- Biostatistics Unit, South African Medical Research Council (SAMRC), Durban 4091, South Africa
| | - Swastika Surujlal-Naicker
- Scientific Services, Water and Sanitation Department, City of Cape Town Metropolitan Municipality, Cape Town 8000, South Africa
| | - Mongezi Mdhluli
- Chief Research Operations Office, South African Medical Research Council, Tygerberg 7050, South Africa
| | - Glenda Gray
- Office of the President, South African Medical Research Council, Tygerberg 7050, South Africa
| | - Christo Muller
- Biomedical Research and Innovation Platform (BRIP), South African Medical Research Council (SAMRC), Tygerberg 7505, South Africa; Centre for Cardio-Metabolic Research in Africa, Division of Medical Physiology, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch 7600, South Africa; Department of Biochemistry and Microbiology, University of Zululand, KwaDlangezwa 3886, South Africa
| | - Renee Street
- Environment & Health Research Unit, South African Medical Research Council (SAMRC), Durban 4091, South Africa E-mail: ; Environmental Health Department, Faculty of Health Sciences, University of Johannesburg, Johannesburg, South Africa
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20
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Wand H, Vujovich-Dunn C, Moodley J, Reddy T, Naidoo S. Population-level impact of beliefs and attitudes on vaccine decision-making in South Africa: results from the COVID-19 Vaccine Survey (2021/2022). Public Health 2023; 216:58-65. [PMID: 36801593 PMCID: PMC9829597 DOI: 10.1016/j.puhe.2023.01.007] [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] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Revised: 12/11/2022] [Accepted: 01/04/2023] [Indexed: 01/11/2023]
Abstract
OBJECTIVES In addition to being home to more than seven million HIV-infected individuals, South Africa also has a high burden of COVID-19 and related comorbidities worldwide. We aimed to identify the most influential "beliefs" and "attitudes" on vaccine decision-making behavior. STUDY DESIGN This study used panel data from cross-sectional surveys. METHODS We used the data from Black South Africans who participated in the "COVID-19 Vaccine Surveys" (November 2021 and February/March 2022) in South Africa. Besides standard risk factor analysis, such as multivariable logistic regression models, we also used the modified version of population attributable risk percent and estimated the population-level impacts of beliefs and attitudes on vaccine decision-making behavior using the methodology in multifactorial setting. RESULTS A total of 1399 people (57% men and 43% women) who participated in both surveys were analyzed. Of these, 336 (24%) reported being vaccinated in survey 2. Overall low perceived risk, concerns around efficacy, and safety were identified as the most influential factors and associated with 52%-72% (<40 years) and 34%-55% (40+ years) of the unvaccinated individuals. CONCLUSION Our findings highlighted the most influential beliefs and attitudes on vaccine decision-making and their population-level impacts, which are likely to have significant public health implications exclusively for this population.
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Affiliation(s)
- H Wand
- Kirby Institute, University of New South Wales, Kensington, 2052, New South Wales, Australia. http://kirby.unsw.edu.au
| | - C Vujovich-Dunn
- Kirby Institute, University of New South Wales, Kensington, 2052, New South Wales, Australia.
| | - J Moodley
- The Aurum Institute, Johannesburg, South Africa.
| | - T Reddy
- Biostatistics Unit, South African Medical Research Council, Durban, Kwazulu-Natal, South Africa.
| | - S Naidoo
- Numolux Group, Pretoria, South Africa.
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21
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Asher L, Rapiya B, Repper J, Reddy T, Myers B, Hanlon C, Petersen I, Brooke-Sumner C. Peer-led recovery groups for people with psychosis in South Africa (PRIZE): protocol for a randomised controlled feasibility trial. Pilot Feasibility Stud 2023; 9:19. [PMID: 36726164 PMCID: PMC9890934 DOI: 10.1186/s40814-022-01232-8] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 12/16/2022] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND The available care for people with psychosis in South Africa is inadequate to support personal recovery. Group peer support interventions are a promising approach to foster recovery, but little is known about the preferences of service users, or the practical application of this care model, in low- and middle-income countries (LMIC). This study aims to assess the acceptability and feasibility of integrating peer-led recovery groups for people with psychosis and their caregivers in South Africa into existing systems of care, and to determine key parameters in preparation for a definitive trial. METHODS The study is set in Nelson Mandela Bay Metropolitan district of the Eastern Cape Province, South Africa. The design is an individually randomised parallel group feasibility trial comparing recovery groups in addition to treatment as usual (TAU) with TAU alone in a 1:1 allocation ratio. We aim to recruit 100 isiXhosa-speaking people with psychosis and 100 linked caregivers. TAU comprises anti-psychotic medication-focused outpatient care. The intervention arm will comprise seven recovery groups, including service users and caregiver participants. Recovery groups will be delivered in two phases: a 2-month phase facilitated by an auxiliary social worker, then a 3-month peer-led phase. We will use mixed methods to evaluate the process and outcomes of the study. Intervention acceptability and feasibility (primary outcomes) will be assessed at 5 months post-intervention start using qualitative data collected from service users, caregivers, and auxiliary social workers, along with quantitative process indicators. Facilitator competence will be assessed with the GroupACT observational rating tool. Trial procedures will be assessed, including recruitment and retention rates, contamination, and validity of quantitative outcome measures. To explore potential effectiveness, quantitative outcome data (functioning, unmet needs, personal recovery, internalised stigma, health service use, medication adherence, and caregiver burden) will be collected at baseline, 2 months, and 5 months post-intervention start. DISCUSSION This study will contribute to the sparse evidence on the acceptability and feasibility of peer-led and recovery-oriented interventions for people with psychosis in LMIC when integrated into existing care systems. Results from this feasibility trial will inform preparations for a definitive trial and subsequent larger-scale implementation. TRIAL REGISTRATION Pan-African Clinical Trials Register PACTR202202482587686. Registered on 28 February 2022. https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=21496 .
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Affiliation(s)
- Laura Asher
- Academic Unit of Lifespan and Population Health, School of Medicine, University of Nottingham, Nottingham, UK.
| | - Bongwekazi Rapiya
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Francie Van Zijl Drive, Parow Valley, Cape Town, 7501, South Africa
| | - Julie Repper
- Implementing Recovery through Organisational Change, Nottingham, UK
| | - Tarylee Reddy
- Biostatistics Research Unit, South African Medical Research Council, Durban, South Africa
| | - Bronwyn Myers
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Francie Van Zijl Drive, Parow Valley, Cape Town, 7501, South Africa.,Curtin enAble Institute, Curtin University, Perth, Western Australia, 6151, Australia.,Department of Psychiatry and Mental Health, University of Cape Town, J-Block, Groote Schuur Hospital, Observatory, Cape Town, South Africa
| | - Charlotte Hanlon
- Centre for Global Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,Department of Psychiatry, College of Health Sciences, School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia
| | - Inge Petersen
- Centre for Rural Health, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Carrie Brooke-Sumner
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Francie Van Zijl Drive, Parow Valley, Cape Town, 7501, South Africa
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22
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Turcotte-Tremblay AM, Leerapan B, Akweongo P, Amponsah F, Aryal A, Asai D, Awoonor-Williams JK, Ayele W, Bauhoff S, Doubova SV, Gadeka DD, Dulal M, Gage A, Gordon-Strachan G, Haile-Mariam D, Joseph JP, Kaewkamjornchai P, Kapoor NR, Gelaw SK, Kim MK, Kruk ME, Kubota S, Margozzini P, Mehata S, Mthethwa L, Nega A, Oh J, Park SK, Passi-Solar A, Perez Cuevas RE, Reddy T, Rittiphairoj T, Sapag JC, Thermidor R, Tlou B, Arsenault C. Tracking health system performance in times of crisis using routine health data: lessons learned from a multicountry consortium. Health Res Policy Syst 2023; 21:14. [PMID: 36721180 PMCID: PMC9888332 DOI: 10.1186/s12961-022-00956-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 12/28/2022] [Indexed: 02/02/2023] Open
Abstract
COVID-19 has prompted the use of readily available administrative data to track health system performance in times of crisis and to monitor disruptions in essential healthcare services. In this commentary we describe our experience working with these data and lessons learned across countries. Since April 2020, the Quality Evidence for Health System Transformation (QuEST) network has used administrative data and routine health information systems (RHIS) to assess health system performance during COVID-19 in Chile, Ethiopia, Ghana, Haiti, Lao People's Democratic Republic, Mexico, Nepal, South Africa, Republic of Korea and Thailand. We compiled a large set of indicators related to common health conditions for the purpose of multicountry comparisons. The study compiled 73 indicators. A total of 43% of the indicators compiled pertained to reproductive, maternal, newborn and child health (RMNCH). Only 12% of the indicators were related to hypertension, diabetes or cancer care. We also found few indicators related to mental health services and outcomes within these data systems. Moreover, 72% of the indicators compiled were related to volume of services delivered, 18% to health outcomes and only 10% to the quality of processes of care. While several datasets were complete or near-complete censuses of all health facilities in the country, others excluded some facility types or population groups. In some countries, RHIS did not capture services delivered through non-visit or nonconventional care during COVID-19, such as telemedicine. We propose the following recommendations to improve the analysis of administrative and RHIS data to track health system performance in times of crisis: ensure the scope of health conditions covered is aligned with the burden of disease, increase the number of indicators related to quality of care and health outcomes; incorporate data on nonconventional care such as telehealth; continue improving data quality and expand reporting from private sector facilities; move towards collecting patient-level data through electronic health records to facilitate quality-of-care assessment and equity analyses; implement more resilient and standardized health information technologies; reduce delays and loosen restrictions for researchers to access the data; complement routine data with patient-reported data; and employ mixed methods to better understand the underlying causes of service disruptions.
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Affiliation(s)
- Anne-Marie Turcotte-Tremblay
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, 401 Park Drive, 3Rd Floor East, room L3-015A5, Landmark Center, Boston, MA, 02215, USA. .,Université Laval, Québec, Canada.
| | - Borwornsom Leerapan
- grid.10223.320000 0004 1937 0490Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Patricia Akweongo
- grid.8652.90000 0004 1937 1485School of Public Health, University of Ghana, Accra, Ghana
| | - Freddie Amponsah
- Policy, Planning, Monitoring and Evaluation, Ghana Health Services, Accra, Ghana
| | - Amit Aryal
- grid.6612.30000 0004 1937 0642Swiss TPH, University of Basel, Basel, Switzerland
| | - Daisuke Asai
- World Health Organization, Vientiane, Lao People’s Democratic Republic
| | | | - Wondimu Ayele
- grid.7123.70000 0001 1250 5688School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Sebastian Bauhoff
- grid.38142.3c000000041936754XDepartment of Global Health and Population, Harvard University, Boston, USA
| | - Svetlana V. Doubova
- grid.419157.f0000 0001 1091 9430Epidemiology and Health Services Research Unit CMN Siglo XXI, Mexican Institute of Social Security, Mexico City, Mexico
| | | | - Mahesh Dulal
- Office of the Member of Federal Parliament Gagan Kumar Thapa, Kathmandu, Nepal
| | - Anna Gage
- grid.38142.3c000000041936754XDepartment of Global Health and Population, Harvard T.H. Chan School of Public Health, 401 Park Drive, 3Rd Floor East, room L3-015A5, Landmark Center, Boston, MA 02215 USA
| | - Georgiana Gordon-Strachan
- grid.461576.70000 0000 8786 7651Caribbean Institute for Health Research, University of West Indies, Kingston, Jamaica
| | - Damen Haile-Mariam
- grid.7123.70000 0001 1250 5688School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Jean Paul Joseph
- Hôpital Universitaire de Mirebalais, Zanmi Lasante, Arrondissement de Mirebalais, Haïti
| | - Phanuwich Kaewkamjornchai
- grid.10223.320000 0004 1937 0490Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Neena R. Kapoor
- grid.38142.3c000000041936754XDepartment of Global Health and Population, Harvard T.H. Chan School of Public Health, 401 Park Drive, 3Rd Floor East, room L3-015A5, Landmark Center, Boston, MA 02215 USA
| | | | - Min Kyung Kim
- Tufts Clinical and Translational Science Institute, Boston, USA
| | - Margaret E. Kruk
- grid.38142.3c000000041936754XDepartment of Global Health and Population, Harvard University, Boston, USA
| | - Shogo Kubota
- World Health Organization, Vientiane, Lao People’s Democratic Republic
| | - Paula Margozzini
- grid.7870.80000 0001 2157 0406Public Health Department, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Suresh Mehata
- Ministry of Health and Population, Government of Nepal, Kathmandu, Nepal
| | - Londiwe Mthethwa
- grid.16463.360000 0001 0723 4123School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - Adiam Nega
- grid.7123.70000 0001 1250 5688School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Juhwan Oh
- Tufts Clinical and Translational Science Institute, Boston, USA ,grid.31501.360000 0004 0470 5905Seoul National University College of Medicine, Seoul, South Korea
| | - Soo Kyung Park
- Korea National Health Insurance Services, Health Insurance Research Institute, Wonju, Gangwon-Do South Korea
| | - Alvaro Passi-Solar
- grid.7870.80000 0001 2157 0406Public Health Department, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | | | - Tarylee Reddy
- grid.415021.30000 0000 9155 0024Biostatistics Unit, South African Medical Research Council, Durban, South Africa
| | - Thanitsara Rittiphairoj
- grid.10223.320000 0004 1937 0490Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Jaime C. Sapag
- grid.7870.80000 0001 2157 0406Public Health Department, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Roody Thermidor
- Studies and Planning Unit, Ministry of Public Health and Population, Port-Au-Prince, Haiti
| | - Boikhutso Tlou
- grid.16463.360000 0001 0723 4123School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - Catherine Arsenault
- grid.38142.3c000000041936754XDepartment of Global Health and Population, Harvard T.H. Chan School of Public Health, 401 Park Drive, 3Rd Floor East, room L3-015A5, Landmark Center, Boston, MA 02215 USA
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23
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Mahlangeni N, Street R, Horn S, Mathee A, Mangwana N, Dias S, Sharma JR, Ramharack P, Louw J, Reddy T, Surujlal-Naicker S, Nkambule S, Webster C, Mdhluli M, Gray G, Muller C, Johnson R. Using Wastewater Surveillance to Compare COVID-19 Outbreaks during the Easter Holidays over a 2-Year Period in Cape Town, South Africa. Viruses 2023; 15:162. [PMID: 36680203 PMCID: PMC9863979 DOI: 10.3390/v15010162] [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] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 12/22/2022] [Accepted: 12/28/2022] [Indexed: 01/06/2023] Open
Abstract
Wastewater surveillance of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has shown to be an important approach to determine early outbreaks of infections. Wastewater-based epidemiology (WBE) is regarded as a complementary tool for monitoring SARS-CoV-2 trends in communities. In this study, the changes in the SARS-CoV-2 RNA levels in wastewater during Easter holidays in 2021 and 2022 in the City of Cape Town were monitored over nine weeks. Our findings showed a statistically significant difference in the SARS-CoV-2 RNA viral load between the study weeks over the Easter period in 2021 and 2022, except for study week 1 and 4. During the Easter week, 52% of the wastewater treatment plants moved from the lower (low viral RNA) category in 2021 to the higher (medium to very high viral RNA) categories in 2022. As a result, the median SARS-CoV-2 viral loads where higher during the Easter week in 2022 than Easter week in 2021 (p = 0.0052). Mixed-effects model showed an association between the SARS-CoV-2 RNA viral loads and Easter week over the Easter period in 2021 only (p < 0.01). The study highlights the potential of WBE to track outbreaks during the holiday period.
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Affiliation(s)
- Nomfundo Mahlangeni
- Environment & Health Research Unit, South African Medical Research Council (SAMRC), Johannesburg 2028, South Africa
| | - Renée Street
- Environment & Health Research Unit, South African Medical Research Council (SAMRC), Johannesburg 2028, South Africa
- Environmental Health Department, Faculty of Health Sciences, University of Johannesburg, Johannesburg 2028, South Africa
| | - Suranie Horn
- Occupational Hygiene and Health Research Initiative, North-West University, Potchefstroom 2531, South Africa
| | - Angela Mathee
- Environment & Health Research Unit, South African Medical Research Council (SAMRC), Johannesburg 2028, South Africa
- Environmental Health Department, Faculty of Health Sciences, University of Johannesburg, Johannesburg 2028, South Africa
| | - Noluxabiso Mangwana
- Biomedical Research and Innovation Platform (BRIP), South African Medical Research Council (SAMRC), Tygerberg 7505, South Africa
- Department of Microbiology, Stellenbosch University, Stellenbosch 7600, South Africa
| | - Stephanie Dias
- Biomedical Research and Innovation Platform (BRIP), South African Medical Research Council (SAMRC), Tygerberg 7505, South Africa
| | - Jyoti Rajan Sharma
- Biomedical Research and Innovation Platform (BRIP), South African Medical Research Council (SAMRC), Tygerberg 7505, South Africa
| | - Pritika Ramharack
- Biomedical Research and Innovation Platform (BRIP), South African Medical Research Council (SAMRC), Tygerberg 7505, South Africa
- Discipline of Pharmaceutical Sciences, School of Health Sciences, University of KwaZulu-Natal, Westville Campus, Durban 4001, South Africa
| | - Johan Louw
- Biomedical Research and Innovation Platform (BRIP), South African Medical Research Council (SAMRC), Tygerberg 7505, South Africa
- Department of Biochemistry and Microbiology, University of Zululand, KwaDlangezwa 3886, South Africa
| | - Tarylee Reddy
- Biostatistics Research Unit, South African Medical Research Council (SAMRC), Durban 4091, South Africa
| | - Swastika Surujlal-Naicker
- Scientific Services, Water and Sanitation Department, City of Cape Town Metropolitan Municipality, Cape Town 8000, South Africa
| | - Sizwe Nkambule
- Environment & Health Research Unit, South African Medical Research Council (SAMRC), Johannesburg 2028, South Africa
| | - Candice Webster
- Environment & Health Research Unit, South African Medical Research Council (SAMRC), Johannesburg 2028, South Africa
| | - Mongezi Mdhluli
- Chief Research Operations Office, South African Medical Research Council (SAMRC), Tygerberg 7050, South Africa
| | - Glenda Gray
- Office of the President, South African Medical Research Council (SAMRC), Tygerberg 7050, South Africa
| | - Christo Muller
- Biomedical Research and Innovation Platform (BRIP), South African Medical Research Council (SAMRC), Tygerberg 7505, South Africa
- Department of Microbiology, Stellenbosch University, Stellenbosch 7600, South Africa
- Division of Medical Physiology, Faculty of Medicine and Health Sciences, Centre for Cardio-Metabolic Research in Africa, Stellenbosch University, Stellenbosch 7600, South Africa
| | - Rabia Johnson
- Biomedical Research and Innovation Platform (BRIP), South African Medical Research Council (SAMRC), Tygerberg 7505, South Africa
- Division of Medical Physiology, Faculty of Medicine and Health Sciences, Centre for Cardio-Metabolic Research in Africa, Stellenbosch University, Stellenbosch 7600, South Africa
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Owokotomo OE, Manda S, Cleasen J, Kasim A, Sengupta R, Shome R, Subhra Paria S, Reddy T, Shkedy Z. Modeling the positive testing rate of COVID-19 in South Africa using a semi-parametric smoother for binomial data. Front Public Health 2023; 11:979230. [PMID: 36908419 PMCID: PMC9992730 DOI: 10.3389/fpubh.2023.979230] [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: 06/28/2022] [Accepted: 01/13/2023] [Indexed: 02/24/2023] Open
Abstract
Identification and isolation of COVID-19 infected persons plays a significant role in the control of COVID-19 pandemic. A country's COVID-19 positive testing rate is useful in understanding and monitoring the disease transmission and spread for the planning of intervention policy. Using publicly available data collected between March 5th, 2020 and May 31st, 2021, we proposed to estimate both the positive testing rate and its daily rate of change in South Africa with a flexible semi-parametric smoothing model for discrete data. There was a gradual increase in the positive testing rate up to a first peak rate in July, 2020, then a decrease before another peak around mid-December 2020 to mid-January 2021. The proposed semi-parametric smoothing model provides a data driven estimates for both the positive testing rate and its change. We provide an online R dashboard that can be used to estimate the positive rate in any country of interest based on publicly available data. We believe this is a useful tool for both researchers and policymakers for planning intervention and understanding the COVID-19 spread.
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Affiliation(s)
| | - Samuel Manda
- Department of Statistics, University of Pretoria, Pretoria, South Africa
| | - Jürgen Cleasen
- Center for Statistics, Data Science Institute, I-BioStat, Hasselt University, Hasselt, Belgium
| | - Adetayo Kasim
- Department of Anthropology, Durham Research Methods Centre, Durham University, Durham, United Kingdom
| | - Rudradev Sengupta
- The Janssen Pharmaceutical, Companies of Johnson & Johnson, Beerse, Belgium
| | - Rahul Shome
- Department of Computer Science, Rice University, Houston, TX, United States
| | - Soumya Subhra Paria
- School of Mathematics and Statistics, The Open University, Milton Keynes, United Kingdom
| | - Tarylee Reddy
- Biostatistics Research Unit, South African Medical Research Council, Capetown, South Africa
| | - Ziv Shkedy
- Center for Statistics, Data Science Institute, I-BioStat, Hasselt University, Hasselt, Belgium
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25
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Duby Z, Bergh K, Jonas K, Reddy T, Bunce B, Fowler C, Mathews C. “Men Rule… this is the Normal Thing. We Normalise it and it’s Wrong”: Gendered Power in Decision-Making Around Sex and Condom Use in Heterosexual Relationships Amongst Adolescents and Young People in South Africa. AIDS Behav 2022; 27:2015-2029. [PMID: 36441410 PMCID: PMC10149448 DOI: 10.1007/s10461-022-03935-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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] [Accepted: 11/12/2022] [Indexed: 11/30/2022]
Abstract
AbstractWe examined power and decision-making in heterosexual relationships amongst South African adolescents and young people. A survey conducted with 515 adolescent girls and young women (AGYW) included items from the Sexual Relationship Power Scale (SRPS) adapted for South African women. Qualitative interviews with fifty AGYW aged between 15 and 24, and nine males aged 18 years and above, explored decision-making in heterosexual relationships, particularly relating to timing of sex and condom use. Theories of gendered power, sexual relationship power and sexual scripting were used in interpreting the data. Findings showed that the power AGYW have in sexual relationships determines their ability to use condoms, and that males generally control condom use and timing of sex. Both survey and interview data suggest that male control over female partners’ behaviour also extends beyond the sexual domain. Although while male power is pervasive and enduring, it is simultaneously contested and negotiated. Despite some young people believing that gendered power in decision-making should be equal, it is not always possible for AGYW to enact agency in the dyadic context of heterosexual relationships. Whilst adolescents and young people in South Africa move away from traditional cultural gendered expectations, relationship power inequity and hegemonic masculinities continue to legitimise men’s power over women, constraining the sexual agency of adolescent girls and young women and discouraging them from taking control of their own sexual interests and sexual health.
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Affiliation(s)
- Zoe Duby
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa.
- Division of Social and Behavioural Sciences in the School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.
| | - Kate Bergh
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Kim Jonas
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Tarylee Reddy
- Biostatistics Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Brittany Bunce
- Institute for Global Sustainable Development (IGSD), University of Sheffield, Sheffield, UK
| | - Chantal Fowler
- Division of Social and Behavioural Sciences in the School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Catherine Mathews
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
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26
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Mchunu NN, Mwambi HG, Rizopoulos D, Reddy T, Yende-Zuma N. Using joint models to study the association between CD4 count and the risk of death in TB/HIV data. BMC Med Res Methodol 2022; 22:295. [PMID: 36401214 PMCID: PMC9675185 DOI: 10.1186/s12874-022-01775-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 10/26/2022] [Indexed: 11/20/2022] Open
Abstract
Background The association structure linking the longitudinal and survival sub-models is of fundamental importance in the joint modeling framework and the choice of this structure should be made based on the clinical background of the study. However, this information may not always be accessible and rationale for selecting this association structure has received relatively little attention in the literature. To this end, we aim to explore four alternative functional forms of the association structure between the CD4 count and the risk of death and provide rationale for selecting the optimal association structure for our data. We also aim to compare the results obtained from the joint model to those obtained from the time-varying Cox model. Methods We used data from the Centre for the AIDS Programme of Research in South Africa (CAPRISA) AIDS Treatment programme, the Starting Antiretroviral Therapy at Three Points in Tuberculosis (SAPiT) study, an open-label, three armed randomised, controlled trial between June 2005 and July 2010 (N=642). In our analysis, we combined the early and late integrated arms and compared results to the sequential arm. We utilized the Deviance Information Criterion (DIC) to select the final model with the best structure, with smaller values indicating better model adjustments to the data. Results Patient characteristics were similar across the study arms. Combined integrated therapy arms had a reduction of 55% in mortality (HR:0.45, 95% CI:0.28-0.72) compared to the sequential therapy arm. The joint model with a cumulative effects functional form was chosen as the best association structure. In particular, our joint model found that the area under the longitudinal profile of CD4 count was strongly associated with a 21% reduction in mortality (HR:0.79, 95% CI:0.72-0.86). Where as results from the time-varying Cox model showed a 19% reduction in mortality (HR:0.81, 95% CI:0.77-0.84). Conclusions In this paper we have shown that the “current value” association structure is not always the best structure that expresses the correct relationship between the outcomes in all settings, which is why it is crucial to explore alternative clinically meaningful association structures that links the longitudinal and survival processes.
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27
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Snyman J, Hwa SH, Krause R, Muema D, Reddy T, Ganga Y, Karim F, Leslie A, Sigal A, Ndung’u T. Similar Antibody Responses Against Severe Acute Respiratory Syndrome Coronavirus 2 in Individuals Living Without and With Human Immunodeficiency Virus on Antiretroviral Therapy During the First South African Infection Wave. Clin Infect Dis 2022; 75:e249-e256. [PMID: 34472583 PMCID: PMC8522359 DOI: 10.1093/cid/ciab758] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND There is limited understanding of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pathogenesis in African populations with a high burden of infectious disease comorbidities such as human immunodeficiency virus (HIV). The kinetics, magnitude, and duration of virus-specific antibodies and B-cell responses in people living with HIV (PLWH) in sub-Saharan Africa have not been fully characterized. METHODS We longitudinally followed SARS-CoV-2-infected individuals in Durban, KwaZulu-Natal, South Africa, and characterized SARS-CoV-2 receptor-binding domain-specific immunoglobulin (Ig) M, IgG, and IgA weekly for 1 month and at 3 months post-diagnosis. Thirty of 72 (41.7%) were PLWH, 25/30 (83%) of whom were on antiretroviral therapy (ART) with full HIV suppression. Plasma neutralization was determined using a live virus neutralization assay, and antibody-secreting cell population frequencies were determined by flow cytometry. RESULTS Similar seroconversion rates, time to peak antibody titer, peak magnitude, and durability of anti-SARS-CoV-2 IgM, IgG, and IgA were observed in people not living with HIV and PLWH with complete HIV suppression on ART. In addition, similar potency in a live virus neutralization assay was observed in both groups. Loss of IgA was significantly associated with age (P = .023) and a previous diagnosis of tuberculosis (P = .018). CONCLUSIONS Similar antibody responses and neutralization potency in people not living with HIV and PLWH on stable ART in an African setting suggest that coronavirus disease 2019 (COVID-19) natural infections may confer comparable antibody immunity in these groups. This provides hope that COVID-19 vaccines will be effective in PLWH on stable ART.
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Affiliation(s)
- Jumari Snyman
- HIV Pathogenesis Programme, University of KwaZulu-Natal, Durban, South Africa
- Department of Basic and Translational Science, Africa Health Research Institute, KwaZulu-Natal, South Africa
- School of Laboratory Medicine and Medical Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Shi Hsia Hwa
- Department of Basic and Translational Science, Africa Health Research Institute, KwaZulu-Natal, South Africa
- Division of Infection and Immunity, University College London, London, United Kingdom
| | - Robert Krause
- Department of Basic and Translational Science, Africa Health Research Institute, KwaZulu-Natal, South Africa
- School of Laboratory Medicine and Medical Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Daniel Muema
- HIV Pathogenesis Programme, University of KwaZulu-Natal, Durban, South Africa
- Department of Basic and Translational Science, Africa Health Research Institute, KwaZulu-Natal, South Africa
- School of Laboratory Medicine and Medical Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Tarylee Reddy
- Biostatistics Unit, South African Medical Research Council, Durban, South Africa
| | - Yashica Ganga
- Department of Basic and Translational Science, Africa Health Research Institute, KwaZulu-Natal, South Africa
| | - Farina Karim
- Department of Basic and Translational Science, Africa Health Research Institute, KwaZulu-Natal, South Africa
- School of Laboratory Medicine and Medical Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Alasdair Leslie
- Department of Basic and Translational Science, Africa Health Research Institute, KwaZulu-Natal, South Africa
- Division of Infection and Immunity, University College London, London, United Kingdom
| | - Alex Sigal
- Department of Basic and Translational Science, Africa Health Research Institute, KwaZulu-Natal, South Africa
- School of Laboratory Medicine and Medical Sciences, University of KwaZulu-Natal, Durban, South Africa
- Systems Infection Biology Group, Max Planck Institute for Infection Biology, Berlin, Germany
| | - Thumbi Ndung’u
- HIV Pathogenesis Programme, University of KwaZulu-Natal, Durban, South Africa
- Department of Basic and Translational Science, Africa Health Research Institute, KwaZulu-Natal, South Africa
- School of Laboratory Medicine and Medical Sciences, University of KwaZulu-Natal, Durban, South Africa
- Division of Infection and Immunity, University College London, London, United Kingdom
- Systems Infection Biology Group, Max Planck Institute for Infection Biology, Berlin, Germany
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28
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Wand H, Vujovich-Dunn C, Moodley J, Reddy T, Naidoo S. Developing and Validating Risk Algorithm for Hypertension in South Africa: Results from a Nationally Representative Cohort (2008-2017). High Blood Press Cardiovasc Prev 2022; 29:451-461. [PMID: 35917033 PMCID: PMC9537209 DOI: 10.1007/s40292-022-00534-5] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 07/04/2022] [Indexed: 11/26/2022] Open
Abstract
Introduction There is compelling evidence of significant country-level disparities where African countries, particularly South Africa, have the highest hypertension rates in the world. Aim To develop and validate a simple risk scoring algorithm for hypertension in a large cohort (80,270) of South African men and women. Methods Multivariable logistic regression models were used to build our hypertension risk scoring algorithm and validated externally and internally using the standard statistical techniques. We also compared our risk scores with the results from the Framingham risk prediction model for hypertension. Results Six factors were identified as the significant correlates of hypertension: age, education, obesity, smoking, alcohol intake and exercise. A score of ≥ 25 (out of 57) for men and ≥ 35 (out of 75) for women were selected as the optimum cut-points with 82% (43%) and 83% (49%) sensitivity (specificity) for males and females, respectively in the development datasets. We estimated probabilities of developing hypertension using the Framingham risk prediction model, which were higher among those with higher scores for hypertension. Conclusions Identifying, targeting and prioritising individuals at highest risk of hypertension will have significant impact on preventing severe cardiometabolic diseases by scaling up healthy diet and life-style factors. Our six-item risk scoring algorithm may be included as part of hypertension prevention and treatment programs by targeting older individuals with high body fat measurements who are at highest risk of developing hypertension. Supplementary Information The online version contains supplementary material available at 10.1007/s40292-022-00534-5.
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Affiliation(s)
- Handan Wand
- Biostatistics and Databases Program, Kirby Institute, University of New South Wales (UNSW Sydney), Level 6, Wallace Wurth Building, Kensington, Sydney, NSW 2052 Australia
| | - Cassandra Vujovich-Dunn
- Biostatistics and Databases Program, Kirby Institute, University of New South Wales (UNSW Sydney), Level 6, Wallace Wurth Building, Kensington, Sydney, NSW 2052 Australia
| | | | - Tarylee Reddy
- Biostatistics Unit, South African Medical Research Council, Durban, Kwazulu-Natal South Africa
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29
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Goga A, Bekker LG, Garrett N, Reddy T, Yende-Zuma N, Fairall L, Moultrie H, Takalani A, Trivella V, Faesen M, Bailey V, Seocharan I, Gray GE. Breakthrough SARS-CoV-2 infections during periods of delta and omicron predominance, South Africa. Lancet 2022; 400:269-271. [PMID: 35809579 PMCID: PMC9259009 DOI: 10.1016/s0140-6736(22)01190-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 03/14/2022] [Accepted: 06/17/2022] [Indexed: 11/17/2022]
Affiliation(s)
- Ameena Goga
- HIV and other Infectious Diseases Research Unit, South African Medical Research Council, Cape Town 7505, South Africa; University of Pretoria, Pretoria, South Africa.
| | - Linda-Gail Bekker
- Desmond Tutu HIV Centre, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Nigel Garrett
- Centre for the AIDS Programme of Research in South Africa, Durban, South Africa; School of Nursing and Public Health, Discipline of Public Health Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Tarylee Reddy
- Biostatistics Research Unit, South African Medical Research Council, Cape Town 7505, South Africa
| | | | - Lara Fairall
- Desmond Tutu HIV Centre, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa; King's Global Health Institute, King's College London, London, UK
| | - Harry Moultrie
- School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; National Institute for Communicable Diseases, Division of the National Health Laboratory Service, Johannesburg, South Africa
| | - Azwidihwi Takalani
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | | | | | - Veronique Bailey
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Ishen Seocharan
- Biostatistics Research Unit, South African Medical Research Council, Cape Town 7505, South Africa
| | - Glenda E Gray
- Office of the President and CEO, South African Medical Research Council, Cape Town 7505, South Africa
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30
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George G, Beckett S, Reddy T, Govender K, Cawood C, Khanyile D, Kharsany AB. Role of Schooling and Comprehensive Sexuality Education in Reducing HIV and Pregnancy Among Adolescents in South Africa. J Acquir Immune Defic Syndr 2022; 90:270-275. [PMID: 35302969 PMCID: PMC9177157 DOI: 10.1097/qai.0000000000002951] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 02/11/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Comprehensive sexuality education (CSE) seeks to reduce risky sexual behaviour and subsequent incidence of unintended pregnancy and HIV among schoolgoing adolescents. This study estimates the association between exposure to CSE and key biomedical and behavioural indicators among adolescent girls in South Africa. SETTING Four DREAMS implementation districts in Gauteng and KwaZulu-Natal provinces in South Africa. METHODS Data from a household-based representative sample of adolescent girls (between the ages 12-18 years) (n = 9673) was collected. Independent variables included school attendance and exposure to CSE, with outcome variables measuring prevalence of HIV, pregnancy, and sexual risky behaviour, including condom use, incidence of age-disparate relationships, and transactional sex. RESULTS Adolescent girls in school and who had attended CSE classes in the previous 12 months were associated with reduced adjusted odds of being HIV-positive [full sample: adjusted odds ratios (AOR): 0.76, 95% confidence interval [CI]: 0.61 to 0.95, P < 0.05; sexually active sample: AOR: 0.62, 95% CI: 0.40 to 0.96, P < 0.05]. Those in school who attended CSE in the previous 12 months were also more likely to get tested for HIV (AOR: 1.48, 95% CI: 1.32 to 1.65, P < 0.001). CONCLUSIONS The results indicate that school attendance and exposure to CSE is associated with a reduction in risky sexual behaviour. Exposure to CSE is also associated with increased access to HIV testing for adolescent girls both in and out of school. Keeping adolescent girls in school produces the greatest positive sexual behavioural effect; this, coupled with the delivery of quality CSE, is a key strategy for reducing HIV risk.
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Affiliation(s)
- Gavin George
- Health Economics and HIV and AIDS Research Division (HEARD), University of KwaZulu-Natal, Durban, South Africa
| | - Sean Beckett
- Health Economics and HIV and AIDS Research Division (HEARD), University of KwaZulu-Natal, Durban, South Africa
| | - Tarylee Reddy
- Biostatistics Research Unit, South African Medical Research Council (SAMRC), Durban, South Africa
| | - Kaymarlin Govender
- Health Economics and HIV and AIDS Research Division (HEARD), University of KwaZulu-Natal, Durban, South Africa
| | - Cherie Cawood
- Epicentre AIDS Risk Management (Pty) Limited, Durban, South Africa; and
| | - David Khanyile
- Epicentre AIDS Risk Management (Pty) Limited, Durban, South Africa; and
| | - Ayesha B.M. Kharsany
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), University of KwaZulu-Natal, Durban, South Africa
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Arsenault C, Gage A, Kim MK, Kapoor NR, Akweongo P, Amponsah F, Aryal A, Asai D, Awoonor-Williams JK, Ayele W, Bedregal P, Doubova SV, Dulal M, Gadeka DD, Gordon-Strachan G, Mariam DH, Hensman D, Joseph JP, Kaewkamjornchai P, Eshetu MK, Gelaw SK, Kubota S, Leerapan B, Margozzini P, Mebratie AD, Mehata S, Moshabela M, Mthethwa L, Nega A, Oh J, Park S, Passi-Solar Á, Pérez-Cuevas R, Phengsavanh A, Reddy T, Rittiphairoj T, Sapag JC, Thermidor R, Tlou B, Valenzuela Guiñez F, Bauhoff S, Kruk ME. COVID-19 and resilience of healthcare systems in ten countries. Nat Med 2022; 28:1314-1324. [PMID: 35288697 PMCID: PMC9205770 DOI: 10.1038/s41591-022-01750-1] [Citation(s) in RCA: 121] [Impact Index Per Article: 60.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 02/17/2022] [Indexed: 02/07/2023]
Abstract
Declines in health service use during the Coronavirus Disease 2019 (COVID-19) pandemic could have important effects on population health. In this study, we used an interrupted time series design to assess the immediate effect of the pandemic on 31 health services in two low-income (Ethiopia and Haiti), six middle-income (Ghana, Lao People's Democratic Republic, Mexico, Nepal, South Africa and Thailand) and high-income (Chile and South Korea) countries. Despite efforts to maintain health services, disruptions of varying magnitude and duration were found in every country, with no clear patterns by country income group or pandemic intensity. Disruptions in health services often preceded COVID-19 waves. Cancer screenings, TB screening and detection and HIV testing were most affected (26-96% declines). Total outpatient visits declined by 9-40% at national levels and remained lower than predicted by the end of 2020. Maternal health services were disrupted in approximately half of the countries, with declines ranging from 5% to 33%. Child vaccinations were disrupted for shorter periods, but we estimate that catch-up campaigns might not have reached all children missed. By contrast, provision of antiretrovirals for HIV was not affected. By the end of 2020, substantial disruptions remained in half of the countries. Preliminary data for 2021 indicate that disruptions likely persisted. Although a portion of the declines observed might result from decreased needs during lockdowns (from fewer infectious illnesses or injuries), a larger share likely reflects a shortfall of health system resilience. Countries must plan to compensate for missed healthcare during the current pandemic and invest in strategies for better health system resilience for future emergencies.
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Affiliation(s)
- Catherine Arsenault
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston MA, USA.
| | - Anna Gage
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston MA, USA
| | - Min Kyung Kim
- Seoul National University College of Medicine, Seoul, South Korea
| | - Neena R Kapoor
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston MA, USA
| | | | - Freddie Amponsah
- Policy, Planning, Monitoring and Evaluation, Ghana Health Services, Accra, Ghana
| | - Amit Aryal
- Office of the Member of Federal Parliament Gagan Kumar Thapa, Kathmandu, Nepal
| | - Daisuke Asai
- World Health Organization, Vientiane, Lao People's Democratic Republic, Vientiane, Laos
| | | | - Wondimu Ayele
- School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Paula Bedregal
- Public Health Department, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Svetlana V Doubova
- Epidemiology and Health Services Research Unit CMN Siglo XXI, Mexican Institute of Social Security, Mexico City, Mexico
| | - Mahesh Dulal
- Office of the Member of Federal Parliament Gagan Kumar Thapa, Kathmandu, Nepal
| | | | | | | | - Dilipkumar Hensman
- World Health Organization, Vientiane, Lao People's Democratic Republic, Vientiane, Laos
| | - Jean Paul Joseph
- Hôpital Universitaire de Mirebalais, Zanmi Lasante, Arrondissement de Mirebalais, Mirebalais, Haïti
| | | | | | | | - Shogo Kubota
- World Health Organization, Vientiane, Lao People's Democratic Republic, Vientiane, Laos
| | - Borwornsom Leerapan
- Faculty of Medicine Ramathibodi Hospital, Madidol University, Bangkok, Thailand
| | - Paula Margozzini
- Public Health Department, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | | | - Suresh Mehata
- Ministry of Health and Population, Government of Nepal, Kathmandu, Nepal
| | - Mosa Moshabela
- School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - Londiwe Mthethwa
- School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - Adiam Nega
- School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Juhwan Oh
- Seoul National University College of Medicine, Seoul, South Korea
| | - Sookyung Park
- Korea National Health Insurance Services, Health Insurance Research Institute, Gangwon-do, South Korea
| | - Álvaro Passi-Solar
- Public Health Department, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Ricardo Pérez-Cuevas
- Division of Social Protection and Health, Inter-American Development Bank, Kingston, Jamaica
| | - Alongkhone Phengsavanh
- Faculty of Medicine, University of Health Sciences, Vientiane, Lao People's Democratic Republic, Vientiane, Laos
| | - Tarylee Reddy
- Biostatistics Unit, South African Medical Research Council, Durban, South Africa
| | | | - Jaime C Sapag
- Public Health Department, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Roody Thermidor
- Studies and Planning Unit, Ministry of Public Health and Population, Port-au-Prince, Haiti
| | - Boikhutso Tlou
- School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | | | - Sebastian Bauhoff
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston MA, USA
| | - Margaret E Kruk
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston MA, USA
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Takuva S, Takalani A, Seocharan I, Yende-Zuma N, Reddy T, Engelbrecht I, Faesen M, Khuto K, Whyte C, Bailey V, Trivella V, Peter J, Opie J, Louw V, Rowji P, Jacobson B, Groenewald P, Dorrington RE, Laubscher R, Bradshaw D, Moultrie H, Fairall L, Sanne I, Gail-Bekker L, Gray G, Goga A, Garrett N. Safety evaluation of the single-dose Ad26.COV2.S vaccine among healthcare workers in the Sisonke study in South Africa: A phase 3b implementation trial. PLoS Med 2022; 19:e1004024. [PMID: 35727802 PMCID: PMC9212139 DOI: 10.1371/journal.pmed.1004024] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 05/19/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Real-world evaluation of the safety profile of vaccines after licensure is crucial to accurately characterise safety beyond clinical trials, support continued use, and thereby improve public confidence. The Sisonke study aimed to assess the safety and effectiveness of the Janssen Ad26.COV2.S vaccine among healthcare workers (HCWs) in South Africa. Here, we present the safety data. METHODS AND FINDINGS In this open-label phase 3b implementation study among all eligible HCWs in South Africa registered in the national Electronic Vaccination Data System (EVDS), we monitored adverse events (AEs) at vaccination sites through self-reporting triggered by text messages after vaccination, healthcare provider reports, and active case finding. The frequency and incidence rate of non-serious and serious AEs were evaluated from the day of first vaccination (17 February 2021) until 28 days after the final vaccination in the study (15 June 2021). COVID-19 breakthrough infections, hospitalisations, and deaths were ascertained via linkage of the electronic vaccination register with existing national databases. Among 477,234 participants, 10,279 AEs were reported, of which 138 (1.3%) were serious AEs (SAEs) or AEs of special interest. Women reported more AEs than men (2.3% versus 1.6%). AE reports decreased with increasing age (3.2% for age 18-30 years, 2.1% for age 31-45 years, 1.8% for age 46-55 years, and 1.5% for age > 55 years). Participants with previous COVID-19 infection reported slightly more AEs (2.6% versus 2.1%). The most common reactogenicity events were headache (n = 4,923) and body aches (n = 4,483), followed by injection site pain (n = 2,767) and fever (n = 2,731), and most occurred within 48 hours of vaccination. Two cases of thrombosis with thrombocytopenia syndrome and 4 cases of Guillain-Barré Syndrome were reported post-vaccination. Most SAEs and AEs of special interest (n = 138) occurred at lower than the expected population rates. Vascular (n = 37; 39.1/100,000 person-years) and nervous system disorders (n = 31; 31.7/100,000 person-years), immune system disorders (n = 24; 24.3/100,000 person-years), and infections and infestations (n = 19; 20.1/100,000 person-years) were the most common reported SAE categories. A limitation of the study was the single-arm design, with limited routinely collected morbidity comparator data in the study setting. CONCLUSIONS We observed similar patterns of AEs as in phase 3 trials. AEs were mostly expected reactogenicity signs and symptoms. Furthermore, most SAEs occurred below expected rates. The single-dose Ad26.COV2.S vaccine demonstrated an acceptable safety profile, supporting the continued use of this vaccine in this setting. TRIAL REGISTRATION ClinicalTrials.gov NCT04838795; Pan African Clinical Trials Registry PACTR202102855526180.
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Affiliation(s)
- Simbarashe Takuva
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, United States of America
- School of Health Systems and Public Health, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
- * E-mail:
| | - Azwidhwi Takalani
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, United States of America
- Department of Family Medicine and Primary Care, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Ishen Seocharan
- South African Medical Research Council, Durban, South Africa
| | | | - Tarylee Reddy
- South African Medical Research Council, Durban, South Africa
| | | | | | - Kentse Khuto
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, United States of America
| | - Carmen Whyte
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, United States of America
- School of Health Systems and Public Health, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Veronique Bailey
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, United States of America
| | | | - Jonathan Peter
- Division of Allergy and Clinical Immunology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Jessica Opie
- Division of Haematology, Department of Pathology, Faculty of Health Sciences, University of Cape Town and National Health Laboratory Service, Groote Schuur Hospital, Cape Town, South Africa
| | - Vernon Louw
- Division of Clinical Haematology, Department of Medicine, Faculty of Health Sciences, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
| | | | - Barry Jacobson
- Department of Molecular Medicine and Haematology, Charlotte Maxeke Johannesburg Academic Hospital National Health Laboratory System Complex and University of the Witwatersrand, Johannesburg, South Africa
| | - Pamela Groenewald
- Burden of Disease Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Rob E. Dorrington
- Centre for Actuarial Research, Faculty of Commerce, University of Cape Town, Cape Town, South Africa
| | - Ria Laubscher
- South African Medical Research Council, Durban, South Africa
| | - Debbie Bradshaw
- Burden of Disease Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Harry Moultrie
- National Institute for Communicable Diseases, National Health Laboratory Service, Sandringham, South Africa
| | - Lara Fairall
- Knowledge Translation Unit, University of Cape Town Lung Institute, Department of Medicine, University of Cape Town, Cape Town, South Africa
- King’s Global Health Institute, King’s College London, London, United Kingdom
| | - Ian Sanne
- Right to Care, Johannesburg, South Africa
| | - Linda Gail-Bekker
- Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa
| | - Glenda Gray
- South African Medical Research Council, Cape Town, South Africa
| | - Ameena Goga
- Department of Paediatrics and Child Health, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
- HIV Prevention Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Nigel Garrett
- Centre for the AIDS Programme of Research in South Africa, Durban, South Africa
- School of Nursing and Public Health, Discipline of Public Health Medicine, University of KwaZulu-Natal, Durban, South Africa
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George G, Beckett S, Reddy T, Govender K, Cawood C, Khanyile D, Kharsany ABM. Determining HIV risk for Adolescent Girls and Young Women (AGYW) in relationships with "Blessers" and age-disparate partners: a cross-sectional survey in four districts in South Africa. BMC Public Health 2022; 22:973. [PMID: 35568839 PMCID: PMC9107706 DOI: 10.1186/s12889-022-13394-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 05/06/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND HIV incidence among adolescent girls and young women (AGYW) remains high, with their male partners a prominent factor in sustaining these elevated rates. Partnership characteristics remain important metrics for determining HIV risk, with evidence indicating that AGYW engaged in transactional and age-disparate relationships face greater HIV exposure. This study examines the risk posed to AGYW in a relationship with a "Blesser", defined as male who provides his female partner with their material needs or desires in exchange for a sexual relationship, an age-disparate (5 or more years older) partner, and the potential compounded risk of being a relationship with a partner or partners who are considered both a "Blesser" and age-disparate. METHODS A cross -sectional household based representative sample of AGYW (aged between 12-24 years) were enrolled in the study (n = 18 926) from the districts of City of Johannesburg and Ekurhuleni in the Gauteng province and the Districts of eThekwini and uMgungundlovu in the province of KwaZulu-Natal (KZN) in South Africa between March 13, 2017 to June 22, 2018. Participants completed a structured questionnaire and provided finger-prick blood samples for laboratory measurements. Our analysis used descriptive statistics and multiple binary logistic regressions accounting for survey weights, clustering and stratification. FINDINGS The median age of the sample was 21 years old (Interquartile range: 19-23) and nearly three quarters (73.7%) were currently attending school. Whilst all relationships exposed AGYW to potential HIV risk, multiple binary logistic regression analysis revealed that AGYW in a relationship with both a Blesser and an age-disparate partner were more likely to be HIV positive (AOR: 3.12, 95% CI: 1.76-5.53, p < 0.001), diagnosed with an STI (AOR: 4.60, 95% CI: 2.99-7.08, p < 0.001), had 2 or more sexual partners in the previous 12 months (AOR: 6.37, 95% CI: 3.85-10.54, p < 0.001), engaged in sexual activity at age 15 or younger (AOR: 3.67, 95% CI: 2.36-5.69, p < 0.001) and more likely to have ever been pregnant (AOR: 2.60, 95% CI: 1.24-5.45, p < 0.05) than those not in a relationship with either a Blesser or age-disparate partner. CONCLUSION Different relationships present different HIV risk to AGYW. AGYW who had engaged in relationships with both a Blesser and an age-disparate partner were at greater HIV risk when examined against these relationships independent of one another. The data reveals the compounded HIV risk of being in both a transactional and age-disparate relationship.
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Affiliation(s)
- Gavin George
- Health Economics and HIV and AIDS Research Division (HEARD), University of KwaZulu-Natal, Durban, South Africa.
| | - Sean Beckett
- Health Economics and HIV and AIDS Research Division (HEARD), University of KwaZulu-Natal, Durban, South Africa
| | - Tarylee Reddy
- Biostatistics Research Unit, South African Medical Research Council (SAMRC), Durban, South Africa
| | - Kaymarlin Govender
- Health Economics and HIV and AIDS Research Division (HEARD), University of KwaZulu-Natal, Durban, South Africa
| | - Cherie Cawood
- Epicentre AIDS Risk Management (Pty) Limited, Durban, South Africa
| | - David Khanyile
- Epicentre AIDS Risk Management (Pty) Limited, Durban, South Africa
| | - Ayesha B M Kharsany
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), University of KwaZulu-Natal, Durban, South Africa.,School of Laboratory Medicine & Medical Sciences, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
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34
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Wand H, Morris N, Moodley J, Naidoo S, Reddy T. Impact of marital status on risk of HIV in South Africa (2002-2017). AIDS Care 2022; 35:739-744. [PMID: 35503713 DOI: 10.1080/09540121.2022.2067312] [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] [Indexed: 10/18/2022]
Abstract
After decades of research, South African women continue to have the highest burden of HIV in the world. The aim of the study is to investigate the impact of marital status on HIV using population and community-level data sources. We included data 13,469 and 5682 South African women who participated to South African HIV behavioural surveys in 2002-2012 and 2017, respectively. HIV prevalence and incidence rates were significantly higher among single/not-cohabiting women compared to those married/cohabiting with a partner in all survey participants (adjusted odds ratio (aOR): 1.60 and 1.58 in 2002-2012 and 2017, respectively). A quarter of the HIV diagnoses were attributed to those who were single/not-cohabiting women (population attributable risk (PAR%): 25% and 24%, respectively). More than 40% of the HIV infections were exclusively associated with single women (PAR%: 42%, 95% CI: 33%, 51%). Our results provided strong evidence for the profound impact of marital status on excess HIV infection rates. Targeting and reaching single/not-cohabiting women with multiple risk factors can potentially play a crucial role in the trajectories of the epidemic.
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Affiliation(s)
- Handan Wand
- Kirby Institute, University of New South Wales, Kensington, Australia
| | - Natashia Morris
- Biostatistics Unit: GIS, South African Medical Research Council, Durban, South Africa
| | - Jothi Moodley
- HIV Prevention Research Unit, South African Medical Research Council, Durban, South Africa.,The Aurum Institute, Johannesburg, South Africa
| | - Sarita Naidoo
- HIV Prevention Research Unit, South African Medical Research Council, Durban, South Africa.,The Aurum Institute, Johannesburg, South Africa
| | - Tarylee Reddy
- Biostatistics Unit, South African Medical Research Council, Durban, South Africa
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Govender K, Beckett S, Reddy T, Cowden RG, Cawood C, Khanyile D, Kharsany ABM, George G, Puren A. Association of HIV Intervention Uptake With HIV Prevalence in Adolescent Girls and Young Women in South Africa. JAMA Netw Open 2022; 5:e228640. [PMID: 35452103 PMCID: PMC9034400 DOI: 10.1001/jamanetworkopen.2022.8640] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
IMPORTANCE In South Africa, adolescent girls and young women aged 15 to 24 years are among the most high-risk groups for acquiring HIV. Progress in reducing HIV incidence in this population has been slow. OBJECTIVE To describe HIV prevalence and HIV risk behaviors among a sample of adolescent girls and young women and to model the association between exposure to multiple or layered interventions and key HIV biological and behavioral outcomes. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional survey was conducted between March 13, 2017, and June 22, 2018, in 2 districts in Gauteng province and in 2 districts in KwaZulu-Natal province in South Africa. A stratified cluster random sampling method was used. Participants included adolescent girls and young women aged 12 to 24 years who lived in each sampled household. Overall, 10 384 participants were enrolled in Gauteng province and 7912 in KwaZulu-Natal province. One parent or caregiver was interviewed in each household. Data analysis was performed from March 12, 2021, to March 1, 2022. EXPOSURES DREAMS (Determined, Resilient, Empowered, AIDS-free, Mentored, and Safe)-like interventions. MAIN OUTCOMES AND MEASURES The primary outcome was HIV prevalence. HIV status was obtained from laboratory-based testing of peripheral blood samples. Secondary outcomes included HIV testing and antiretroviral therapy uptake as well as numerous HIV risk variables that the DREAMS program sought to improve, such as pregnancy, sexually transmitted infection, intimate partner violence, and age-disparate sex. RESULTS The final sample included 18 296 adolescent girls and young women (median [IQR] age, 19 [15-21] years) in 10 642 households. Approximately half of participants (49.9%; n = 8414) reported engaging in sexual activity, and 48.1% (n = 3946) reported condom use at the most recent sexual encounter. KwaZulu-Natal province had a higher HIV prevalence than Gauteng province (15.1% vs 7.8%; P < .001). Approximately one-fifth of participants (17.6%; n = 3291) were not exposed to any interventions, whereas 43.7% (n = 8144) were exposed to 3 or more interventions. There was no association between exposure to DREAMS-like interventions and HIV status. Adolescent girls and young women who accessed 3 or more interventions were more likely to have undergone HIV testing (adjusted odds ratio, 2.39; 95% CI, 2.11-2.71; P < .001) and to have used condoms consistently in the previous 12 months (adjusted odds ratio, 1.68; 95% CI, 1.33-2.12; P < .001) than those who were not exposed to any interventions. CONCLUSIONS AND RELEVANCE Results of this study suggest that self-reported exposures to multiple or layered DREAMS-like interventions were associated with favorable behavioral outcomes. The beneficial aspects of layering HIV interventions warrant further research to support the sexual and reproductive health of adolescent girls and young women.
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Affiliation(s)
- Kaymarlin Govender
- Health Economics and HIV and AIDS Research Division, University of KwaZulu-Natal, Durban, South Africa
| | - Sean Beckett
- Health Economics and HIV and AIDS Research Division, University of KwaZulu-Natal, Durban, South Africa
| | - Tarylee Reddy
- Biostatistics Research Unit, South African Medical Research Council, Durban, South Africa
| | - Richard G. Cowden
- Human Flourishing Program, Harvard University, Cambridge, Massachusetts
| | - Cherie Cawood
- Epicentre AIDS Risk Management Limited, Cape Town, South Africa
| | - David Khanyile
- Epicentre AIDS Risk Management Limited, Cape Town, South Africa
| | - Ayesha B. M. Kharsany
- Centre for the AIDS Programme of Research in South Africa, University of KwaZulu-Natal, Durban, South Africa
| | - Gavin George
- Health Economics and HIV and AIDS Research Division, University of KwaZulu-Natal, Durban, South Africa
| | - Adrian Puren
- National Institute for Communicable Diseases, Johannesburg, South Africa
- National Priority Programmes, National Health Laboratory Services, Johannesburg, South Africa
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36
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Bekker LG, Garrett N, Goga A, Fairall L, Reddy T, Yende-Zuma N, Kassanjee R, Collie S, Sanne I, Boulle A, Seocharan I, Engelbrecht I, Davies MA, Champion J, Chen T, Bennett S, Mametja S, Semenya M, Moultrie H, de Oliveira T, Lessells RJ, Cohen C, Jassat W, Groome M, Von Gottberg A, Le Roux E, Khuto K, Barouch D, Mahomed H, Wolmarans M, Rousseau P, Bradshaw D, Mulder M, Opie J, Louw V, Jacobson B, Rowji P, Peter JG, Takalani A, Odhiambo J, Mayat F, Takuva S, Corey L, Gray GE. Effectiveness of the Ad26.COV2.S vaccine in health-care workers in South Africa (the Sisonke study): results from a single-arm, open-label, phase 3B, implementation study. Lancet 2022; 399:1141-1153. [PMID: 35305740 PMCID: PMC8930006 DOI: 10.1016/s0140-6736(22)00007-1] [Citation(s) in RCA: 37] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Revised: 11/18/2021] [Accepted: 12/13/2021] [Indexed: 12/30/2022]
Abstract
BACKGROUND We aimed to assess the effectiveness of a single dose of the Ad26.COV2.S vaccine (Johnson & Johnson) in health-care workers in South Africa during two waves of the South African COVID-19 epidemic. METHODS In the single-arm, open-label, phase 3B implementation Sisonke study, health-care workers aged 18 years and older were invited for vaccination at one of 122 vaccination sites nationally. Participants received a single dose of 5 × 1010 viral particles of the Ad26.COV2.S vaccine. Vaccinated participants were linked with their person-level data from one of two national medical insurance schemes (scheme A and scheme B) and matched for COVID-19 risk with an unvaccinated member of the general population. The primary outcome was vaccine effectiveness against severe COVID-19, defined as COVID-19-related admission to hospital, hospitalisation requiring critical or intensive care, or death, in health-care workers compared with the general population, ascertained 28 days or more after vaccination or matching, up to data cutoff. This study is registered with the South African National Clinical Trial Registry, DOH-27-022021-6844, ClinicalTrials.gov, NCT04838795, and the Pan African Clinical Trials Registry, PACTR202102855526180, and is closed to accrual. FINDINGS Between Feb 17 and May 17, 2021, 477 102 health-care workers were enrolled and vaccinated, of whom 357 401 (74·9%) were female and 119 701 (25·1%) were male, with a median age of 42·0 years (33·0-51·0). 215 813 vaccinated individuals were matched with 215 813 unvaccinated individuals. As of data cutoff (July 17, 2021), vaccine effectiveness derived from the total matched cohort was 83% (95% CI 75-89) to prevent COVID-19-related deaths, 75% (69-82) to prevent COVID-19-related hospital admissions requiring critical or intensive care, and 67% (62-71) to prevent COVID-19-related hospitalisations. The vaccine effectiveness for all three outcomes were consistent across scheme A and scheme B. The vaccine effectiveness was maintained in older health-care workers and those with comorbidities including HIV infection. During the course of the study, the beta (B.1.351) and then the delta (B.1.617.2) SARS-CoV-2 variants of concerns were dominant, and vaccine effectiveness remained consistent (for scheme A plus B vaccine effectiveness against COVID-19-related hospital admission during beta wave was 62% [95% CI 42-76] and during delta wave was 67% [62-71], and vaccine effectiveness against COVID-19-related death during beta wave was 86% [57-100] and during delta wave was 82% [74-89]). INTERPRETATION The single-dose Ad26.COV2.S vaccine shows effectiveness against severe COVID-19 disease and COVID-19-related death after vaccination, and against both beta and delta variants, providing real-world evidence for its use globally. FUNDING National Treasury of South Africa, the National Department of Health, Solidarity Response Fund NPC, The Michael & Susan Dell Foundation, The Elma Vaccines and Immunization Foundation, and the Bill & Melinda Gates Foundation.
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Affiliation(s)
- Linda-Gail Bekker
- The Desmond Tutu HIV Centre, Cape Town, South Africa; University of Cape Town, Cape Town, South Africa
| | - Nigel Garrett
- Doris Duke Medical Research Institute, University of KwaZulu-Natal, Durban, South Africa
| | - Ameena Goga
- HIV Prevention Research Unit, Cape Town, South Africa; Department of Paediatrics and Child Health, University of Pretoria, Pretoria, South Africa
| | - Lara Fairall
- The Desmond Tutu HIV Centre, Cape Town, South Africa; King's Global Health Institute, King's College London, London, UK
| | - Tarylee Reddy
- Biostatistics Research Unit, South African Medical Research Council, Durban, South Africa
| | - Nonhlanhla Yende-Zuma
- Nelson R Mandela School of Medicine, Centre for the AIDS Programme of Research in South Africa, University of KwaZulu-Natal, Durban, South Africa
| | - Reshma Kassanjee
- Centre of Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, Cape Town, South Africa
| | | | - Ian Sanne
- Clinical HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Witwatersrand, South Africa; Right to Care, Houghton South Africa
| | - Andrew Boulle
- Centre of Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, Cape Town, South Africa; Western Cape Government Health, Cape Town, South Africa; Wellcome Centre for Infectious Diseases Research in Africa, Cape Town, South Africa
| | - Ishen Seocharan
- Biostatistics Research Unit, South African Medical Research Council, Durban, South Africa
| | | | - Mary-Ann Davies
- Centre of Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, Cape Town, South Africa; Western Cape Government: Health Centre for Infectious Disease Epidemiology and Research, Cape Town, South Africa
| | | | | | | | | | | | - Harry Moultrie
- Centre for Tuberculosis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa
| | - Tulio de Oliveira
- KwaZulu-Natal Research Innovation, School of Laboratory Medicine and Medical Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Richard John Lessells
- KwaZulu-Natal Research Innovation, School of Laboratory Medicine and Medical Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Cheryl Cohen
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Witwatersrand, South Africa; Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa
| | - Waasila Jassat
- National Institute for Communicable Diseases, Sandringham, South Africa
| | - Michelle Groome
- School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Witwatersrand, South Africa; Division of Public Health Surveillance and Response, National Institute for Communicable Diseases, Johannesburg, South Africa
| | - Anne Von Gottberg
- Department of Pathology, Cape Town, South Africa; School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Witwatersrand, South Africa; Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa
| | - Engelbert Le Roux
- Hutchinson Center Research Institute of South Africa (HCRISA), Chris Hani Baragwanath Academic Hospital, Soweto, South Africa
| | - Kentse Khuto
- Hutchinson Center Research Institute of South Africa (HCRISA), Chris Hani Baragwanath Academic Hospital, Soweto, South Africa
| | - Dan Barouch
- Center for Virology and Vaccine Research, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Hassan Mahomed
- Metro Health Services, Western Cape Government Health, Cape Town, South Africa; Division of Health Systems and Public Health, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | | | | | - Debbie Bradshaw
- South African Medical Research Council, Tygerberg, South Africa
| | - Michelle Mulder
- South Africa Medical Research Council, Cape Town, South Africa
| | - Jessica Opie
- University of Cape Town, Cape Town, South Africa; National Health Laboratory Service, Cape Town, South Africa
| | - Vernon Louw
- Division of Clinical Haematology, Department of Medicine, Cape Town, South Africa; Groote Schuur Hospital, Cape Town, South Africa
| | - Barry Jacobson
- Faculty of Health Sciences, and Allergy and Immunology Unit, Cape Town, South Africa
| | - Pradeep Rowji
- Neurology Association of South Africa, The Southern African Society of Thrombosis and Haemostasis, Johannesburg, South Africa
| | - Jonny G Peter
- Division of Allergy and Clinical Immunology, Cape Town, South Africa
| | - Azwi Takalani
- Hutchinson Center Research Institute of South Africa (HCRISA), Chris Hani Baragwanath Academic Hospital, Soweto, South Africa
| | - Jackline Odhiambo
- Hutchinson Center Research Institute of South Africa (HCRISA), Chris Hani Baragwanath Academic Hospital, Soweto, South Africa
| | - Fatima Mayat
- Perinatal HIV Research Unit (PHRU), Chris Hani Baragwanath Academic Hospital, University of the Witwatersrand, Witwatersrand, South Africa
| | - Simbarashe Takuva
- School of Health Systems and Public Health, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa; Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Lawrence Corey
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Glenda E Gray
- South Africa Medical Research Council, Cape Town, South Africa.
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Spooner E, Reddy S, Ntoyanto S, Sakadavan Y, Reddy T, Mahomed S, Mlisana K, Dlamini M, Daniels B, Luthuli N, Ngomane N, Kiepiela P, Coutsoudis A. TB testing in HIV-positive patients prior to antiretroviral treatment. Int J Tuberc Lung Dis 2022; 26:224-231. [PMID: 35197162 PMCID: PMC8886959 DOI: 10.5588/ijtld.21.0195] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND: TB diagnosis in patients with HIV is challenging due to the lower sensitivities across tests. Molecular tests are preferred and the Xpert® MTB/RIF assay has limitations in lower-income settings. We evaluated the performance of loop-mediated isothermal amplification (LAMP) and the lipoarabinomannan (LAM) test in HIV-positive, ART-naïve clinic patients.METHODS: A total of 783 eligible patients were enrolled; three spot sputum samples of 646 patients were tested using TB-LAMP, Xpert, smear microscopy and culture, while 649 patients had TB-LAM testing. Sensitivity, specificity, and negative and positive predictive values were estimated with 95% confidence intervals.RESULTS: Sensitivities for smear microscopy, TB-LAMP and Xpert were respectively 50%, 63% and 74% compared to culture, with specificities of respectively 99.2%, 98.5% and 97.5%. An additional eight were positive on TB-LAM alone. Seventy TB patients (9%) were detected using standard-of-care testing, an additional 27 (3%) were detected using study testing. Treatment was initiated in 57/70 (81%) clinic patients, but only in 56% (57/97) of all those with positive TB tests; 4/8 multidrug-resistant samples were detected using Xpert.CONCLUSION: TB diagnostics continue to miss cases in this high-burden setting. TB-LAMP was more sensitive than smear microscopy, and if followed by culture and drug susceptibility testing as required, can diagnose TB in HIV-positive patients. TB-LAM is a useful add-in test and both tests at the point-of-care would maximise yield.
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Affiliation(s)
- E Spooner
- Department of Paediatrics and Child Health, University of KwaZulu-Natal, Durban, South Africa, HIV Prevention Research Unit, South African Medical Research Council, Durban, South Africa
| | - S Reddy
- South African Medical Research Council, Durban, South Africa
| | - S Ntoyanto
- HIV Prevention Research Unit, South African Medical Research Council, Durban, South Africa
| | - Y Sakadavan
- HIV Prevention Research Unit, South African Medical Research Council, Durban, South Africa
| | - T Reddy
- Biostatistics Unit, South African Medical Research Council, Durban, South Africa
| | - S Mahomed
- School of Laboratory Medicine and Medical Sciences, University of KwaZulu-Natal, Durban, South Africa, Medical Microbiology Department, National Health Laboratory Services, Durban, South Africa, Centre for AIDS Programme Research in South Africa, Durban, South Africa
| | - K Mlisana
- School of Laboratory Medicine and Medical Sciences, University of KwaZulu-Natal, Durban, South Africa, Medical Microbiology Department, National Health Laboratory Services, Durban, South Africa
| | - M Dlamini
- Medical Microbiology Department, National Health Laboratory Services, Durban, South Africa
| | - B Daniels
- HIV Prevention Research Unit, South African Medical Research Council, Durban, South Africa
| | - N Luthuli
- EThekwini Health Unit, EThekwini Municipality, Durban, South Africa
| | - N Ngomane
- Occupational Health, Durban, South Africa
| | - P Kiepiela
- South African Medical Research Council, Durban, South Africa
| | - A Coutsoudis
- Department of Paediatrics and Child Health, University of KwaZulu-Natal, Durban, South Africa
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Spooner E, Reddy T, Mchunu N, Reddy S, Daniels B, Ngomane N, Luthuli N, Kiepiela P, Coutsoudis A. Point-of-care CD4 testing: Differentiated care for the most vulnerable. J Glob Health 2022; 12:04004. [PMID: 35136596 PMCID: PMC8818294 DOI: 10.7189/jogh.12.04004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background South Africa, with the highest burden of HIV infection globally, has made huge strides in its HIV/ART programme, but AIDS deaths have not decreased proportionally to ART uptake. Advanced HIV disease (CD4 < 200 cells/mm3) persists, and CD4 count testing is being overlooked since universal test-and-treat was implemented. Point-of-care CD4 testing could address this gap and assure differentiated care to these vulnerable patients with low CD4 counts. Methods A time randomised implementation trial was conducted, enrolling 603 HIV positive non-ART, not pregnant patients at a primary health care clinic in Durban, South Africa. Weeks were randomised to either point-of-care CD4 testing (n = 305 patients) or standard-of-care central laboratory CD4 testing (n = 298 patients) to assess the proportion initiating ART at 3 months. Cox regression, with robust standard errors adjusting for clustering by week, were used to assess the relationship between treatment initiation and arm. Results Among the 578 (299 point-of-care and 279 standard-of-care) patients eligible for analysis, there was no significant difference in the number of eligible patients initiating ART within 3 months in the point-of-care (73%) and the standard-of-care (68%) groups (P = 0.112). The time-to-treat analysis was not significantly different in patients with CD4 counts of 201-500 cells/mm3 which could have been due to appointment scheduling to cope with the large burden of cases. However, in patients with advanced HIV disease (CD4 < 200cells/mm3) 65% more patients started ART earlier in the point-of-care group (HR 1.65 (95% confidence interval (CI) = 0.99-2.75; P = 0.052) compared to the standard-of-care group. Conclusions Point-of-care testing decreased time-to-treatment in those with advanced HIV disease. With universal test and treat for HIV, rollout of simple point-of-care CD4 testing would ensure early diagnosis of advanced HIV disease and facilitate differentiated care for these vulnerable patients as per the World Health Organisation 2020 target product profile for point-of-care CD4 testing. Trial registration ISRCTN14220457.
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Affiliation(s)
- Elizabeth Spooner
- Department of Paediatrics and Child Health, University of KwaZulu-Natal, Durban, South Africa
- South African Medical Research Council, HIV Prevention Research Unit, Durban, South Africa
| | - Tarylee Reddy
- South African Medical Research Council, Biostatistics Unit, Durban, South Africa
| | - Nobuhle Mchunu
- South African Medical Research Council, Biostatistics Unit, Durban, South Africa
- School of Mathematics, Statistics and Computer Science, University of KwaZulu-Natal, Pietermaritzburg, South Africa
| | | | - Brodie Daniels
- South African Medical Research Council, HIV Prevention Research Unit, Durban, South Africa
| | | | | | | | - Anna Coutsoudis
- Department of Paediatrics and Child Health, University of KwaZulu-Natal, Durban, South Africa
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Johnson R, Sharma JR, Ramharack P, Mangwana N, Kinnear C, Viraragavan A, Glanzmann B, Louw J, Abdelatif N, Reddy T, Surujlal-Naicker S, Nkambule S, Mahlangeni N, Webster C, Mdhluli M, Gray G, Mathee A, Preiser W, Muller C, Street R. Tracking the circulating SARS-CoV-2 variant of concern in South Africa using wastewater-based epidemiology. Sci Rep 2022; 12:1182. [PMID: 35064174 PMCID: PMC8783013 DOI: 10.1038/s41598-022-05110-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 12/31/2021] [Indexed: 12/13/2022] Open
Abstract
This study uses wastewater-based epidemiology (WBE) to rapidly and, through targeted surveillance, track the geographical distribution of SARS-CoV-2 variants of concern (Alpha, Beta and Delta) within 24 wastewater treatment plants (WWTPs) in the Western Cape of South Africa. Information obtained was used to identify the circulating variant of concern (VOC) within a population and retrospectively trace when the predominant variant was introduced. Genotyping analysis of SARS-CoV-2 showed that 50% of wastewater samples harbored signature mutations linked to the Beta variant before the third wave, with the Delta variant absent within the population. Over time, the prevalence of the beta variant decreased steadily. The onset of the third wave resulted in the Delta variant becoming the predominant variant, with a 100% prevalence supporting the theory that the Delta variant was driving the third wave. In silico molecular docking analysis showed that the signature mutations of the Delta variant increased binding to host proteins, suggesting a possible molecular mechanism that increased viral infectivity of the Delta variant.
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Affiliation(s)
- Rabia Johnson
- Biomedical Research and Innovation Platform (BRIP), South African Medical Research Council (SAMRC), Tygerberg, 7505, South Africa.
- Division of Medical Physiology, Faculty of Medicine and Health Sciences, Centre for Cardiometabolic Research in Africa, Stellenbosch University, Stellenbosch, South Africa.
| | - Jyoti R Sharma
- Biomedical Research and Innovation Platform (BRIP), South African Medical Research Council (SAMRC), Tygerberg, 7505, South Africa
| | - Pritika Ramharack
- Biomedical Research and Innovation Platform (BRIP), South African Medical Research Council (SAMRC), Tygerberg, 7505, South Africa
- Pharmaceutical Sciences, School of Health Sciences, University of KwaZulu-Natal, Westville Campus, Durban, 4001, South Africa
| | - Noluxabiso Mangwana
- Biomedical Research and Innovation Platform (BRIP), South African Medical Research Council (SAMRC), Tygerberg, 7505, South Africa
| | - Craig Kinnear
- Genomics Centre, South African Medical Research Council (SAMRC), Tygerberg, 7505, South Africa
- Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, DSI-NRF Centre of Excellence for Biomedical Tuberculosis Research, South African Medical Research Council Centre for Tuberculosis Research, Stellenbosch University, Cape Town, South Africa
| | - Amsha Viraragavan
- Genomics Centre, South African Medical Research Council (SAMRC), Tygerberg, 7505, South Africa
| | - Brigitte Glanzmann
- Genomics Centre, South African Medical Research Council (SAMRC), Tygerberg, 7505, South Africa
- Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, DSI-NRF Centre of Excellence for Biomedical Tuberculosis Research, South African Medical Research Council Centre for Tuberculosis Research, Stellenbosch University, Cape Town, South Africa
| | - Johan Louw
- Biomedical Research and Innovation Platform (BRIP), South African Medical Research Council (SAMRC), Tygerberg, 7505, South Africa
| | - Nada Abdelatif
- Biostatistics Research Unit, South African Medical Research Council (SAMRC), Durban, South Africa
| | - Tarylee Reddy
- Biostatistics Research Unit, South African Medical Research Council (SAMRC), Durban, South Africa
| | - Swastika Surujlal-Naicker
- Scientific Services, Water and Sanitation Department, City of Cape Town Metropolitan Municipality, Cape Town, South Africa
| | - Sizwe Nkambule
- Environment and Health Research Unit, South African Medical Research Council (SAMRC), Durban, South Africa
| | - Nomfundo Mahlangeni
- Environment and Health Research Unit, South African Medical Research Council (SAMRC), Durban, South Africa
| | - Candice Webster
- Environment and Health Research Unit, South African Medical Research Council (SAMRC), Johannesburg, South Africa
| | - Mongezi Mdhluli
- Office of the President, South African Medical Research Council, Tygerberg, 7050, South Africa
| | - Glenda Gray
- Office of the President, South African Medical Research Council, Tygerberg, 7050, South Africa
| | - Angela Mathee
- Environment and Health Research Unit, South African Medical Research Council (SAMRC), Johannesburg, South Africa
| | - Wolfgang Preiser
- Division of Medical Virology at NHLS Tygerberg Hospital and Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Christo Muller
- Biomedical Research and Innovation Platform (BRIP), South African Medical Research Council (SAMRC), Tygerberg, 7505, South Africa
- Division of Medical Physiology, Faculty of Medicine and Health Sciences, Centre for Cardiometabolic Research in Africa, Stellenbosch University, Stellenbosch, South Africa
| | - Renee Street
- Environment and Health Research Unit, South African Medical Research Council (SAMRC), Durban, South Africa
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40
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Wand H, Reddy T. Temporal trends in correlates of HIV testing uptake in South Africa: evaluation and population-level impacts of socio-economic factors and information sources. J Public Health (Oxf) 2022. [DOI: 10.1007/s10389-020-01271-6] [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: 11/27/2022] Open
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Mabaso M, Maseko G, Sewpaul R, Naidoo I, Jooste S, Takatshana S, Reddy T, Zuma K, Zungu N. Trends and correlates of HIV prevalence among adolescents in South Africa: evidence from the 2008, 2012 and 2017 South African National HIV Prevalence, Incidence and Behaviour surveys. AIDS Res Ther 2021; 18:97. [PMID: 34906170 PMCID: PMC8670218 DOI: 10.1186/s12981-021-00422-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 12/01/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Adolescents are at increased risk of HIV infection compared to other age groups. There is an urgent need for strategic information that will inform programmes to reduce risk and vulnerability to HIV and reverse the pattern of increasing HIV infection as they transition to adulthood. This paper analysed trends and factors associated with HIV prevalence among adolescents in South Africa using the national HIV population-based household surveys conducted in 2008, 2012 and 2017. METHODS All three surveys used a multistage cross-sectional design. A trend analysis was conducted to assess the differences in HIV prevalence and covariates overtime using P-trend Chi-squared statistic. Univariate and multivariate logistic regression models were used to determine factors associated with HIV prevalence. RESULTS Overall there was a significant increase in HIV prevalence among adolescents aged 12-19 years from 3.0% (n = 2892) in 2008 to 3.2% (n = 4829) in 2012 and 4.1% (n = 3937) in 2017 (p = 0.031). The odds of being HIV positive among adolescents aged 12-19 years was significantly higher among females [AOR = 2.24; 95% CI (1.73-2.91); p < 0.001] than males, those residing in KwaZulu-Natal province [AOR = 2.01; 95% CI (1.-3.99); p = 0.027] than Northern Cape, and those who did not attend an educational institution and were unemployed [AOR = 2.66; 95% CI (1.91-3.67); p < 0.001] compared to those attending an educational institution. The odds were significantly lower among Whites [AOR = 0.29; 95% CI (0.09-0.93); p = 0.037], Coloureds [AOR = 0.21; 95% CI (0.11-0.37); p ≤ 0.001] and Indian/Asian [AOR = 0.08; 95% CI (0.02-0.34); p = 0.001] population groups than Black Africans. CONCLUSION The observed increasing trend and gender disparities in HIV prevalence suggests an urgent need for age appropriate and gender specific HIV interventions tailored and targeted at identified drivers of HIV infection among adolescents.
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Affiliation(s)
- Musawenkosi Mabaso
- Human and Social Capabilities Research Division, Human Sciences Research Council, Pretoria, South Africa.
| | - Goitseone Maseko
- Human and Social Capabilities Research Division, Human Sciences Research Council, Pretoria, South Africa
| | - Ronel Sewpaul
- Human and Social Capabilities Research Division, Human Sciences Research Council, Pretoria, South Africa
| | - Inbarani Naidoo
- Human and Social Capabilities Research Division, Human Sciences Research Council, Pretoria, South Africa
| | - Sean Jooste
- Human and Social Capabilities Research Division, Human Sciences Research Council, Pretoria, South Africa
| | - Sinovuyo Takatshana
- Human and Social Capabilities Research Division, Human Sciences Research Council, Pretoria, South Africa
| | - Tarylee Reddy
- Biostatistics Unit, South African Medical Research Council, Durban, South Africa
| | - Khangelani Zuma
- Human and Social Capabilities Research Division, Human Sciences Research Council, Pretoria, South Africa
| | - Nompumelelo Zungu
- Human and Social Capabilities Research Division, Human Sciences Research Council, Pretoria, South Africa
- Department of Psychology, University of Pretoria, Pretoria, South Africa
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Hanass-Hancock J, Carpenter B, Reddy T, Nzuza A, Gaffoor Z, Goga A, Andrasik M. Participants' characteristics and motivations to screen for HIV vaccine and monoclonal antibody trials in KwaZulu-Natal, South Africa. Trials 2021; 22:897. [PMID: 34895272 PMCID: PMC8665490 DOI: 10.1186/s13063-021-05792-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 11/03/2021] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND HIV is one of the greatest public health challenges in South Africa. Potential HIV vaccines and antibodies are thought to be cost-effective biomedical HIV prevention methods and are currently under investigation in phase I, II, and III trials. Consequently, current and future clinical trials need to ensure sufficient recruitment and retention. To achieve this goal, clinical trial staff need to understand the socio-demographic and behavioural characteristics of people volunteering to screen for these trials and their reasons for volunteering. METHODS We conducted a secondary analysis of participant screening data across five vaccine and monoclonal antibody trials at four sites in KwaZulu-Natal, South Africa. Our study reviewed the demographic, behavioural, motivational, and health-related data from the case report forms and screening questionnaires. Descriptive statistics, chi-squared, and one-way ANOVA tests were used to analyse participants' characteristics and motivation to participate in HIV vaccine and monoclonal antibody trials. Analyses were conducted using R version 3.5.2. RESULTS Screening data from 1934 participants, including 79.2% of women, were obtained across all five trials (1034 enrolled, 900 screened out/declined). Screened participants predominately self-identified as black, heterosexual, cisgender women or men, many with lower educational backgrounds (43.9% did not complete secondary/high school), and several self-reported HIV-risk behaviours among themselves and their partners. 10.8% of the screened participants were living with HIV. Avoiding HIV risk was the main motivation to participate in clinical trials, followed by altruistic reasons such as a desire to help the community or helping to find a vaccine. DISCUSSION The current recruitment approach of these trials attracts heterosexual participants who seek to reduce HIV risk and support their community. Hence, the data suggest the need for and potential acceptance of continued ongoing HIV prevention efforts. Current trials attract participants with lower educational levels, which may be driven by the site locations, current community mobilisation strategies and research site opening hours. The sites could consider more flexible working hours to accommodate working participants and find ways to connect participants to educational support and opportunities to upgrade education levels for the current clientele. TRIAL REGISTRATION HVTN 100: A Safety and Immune Response Study of 2 Experimental HIV Vaccines, NCT02404311 . Registered on March 17, 2015. HVTN 111: Safety and Immune Response to a Clade C DNA HIV Vaccine, NCT02997969. Registered on December 16, 2016. HVTN 108: Evaluating the Safety and Immunogenicity of HIV Clade C DNA Vaccine and MF59- or AS01B-Adjuvanted Clade C Env Protein Vaccines in Various Combinations in Healthy, HIV-Uninfected Adults, NCT02915016. Registered on September 22, 2016. HVTN 702: Pivotal Phase 2b/3 ALVAC/Bivalent gp120/MF59 HIV Vaccine Prevention Safety and Efficacy Study in South Africa, NCT02968849. Registered on November 1, 2016. HVTN 703/HPTN 081: Evaluating the Safety and Efficacy of the VRC01 Antibody in Reducing Acquisition of HIV-1 Infection in Women, NCT02568215 . Registered on October 1, 2015.
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Affiliation(s)
- Jill Hanass-Hancock
- South African Medical Research Council, Gender and Health Research Unit, Cape Town, South Africa. .,University of KwaZulu Natal School of Health Science, Durban, South Africa.
| | - Bradley Carpenter
- South African Medical Research Council, Gender and Health Research Unit, Cape Town, South Africa.,University of KwaZulu Natal School of Health Science, Durban, South Africa
| | - Tarylee Reddy
- South African Medical Research Council, Biostatistics Research Unit, Seattle, USA
| | - Ayanda Nzuza
- South African Medical Research Council, Gender and Health Research Unit, Cape Town, South Africa
| | - Zakir Gaffoor
- South African Medical Research Council, HIV Prevention Research Unit, Seattle, USA
| | - Ameena Goga
- South African Medical Research Council, HIV Prevention Research Unit, Seattle, USA
| | - Michele Andrasik
- HIV Vaccine Trials Network, Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, USA
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43
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Street R, Mathee A, Mangwana N, Dias S, Sharma JR, Ramharack P, Louw J, Reddy T, Brocker L, Surujlal-Naicker S, Berkowitz N, Malema MS, Nkambule S, Webster C, Mahlangeni N, Gelderblom H, Mdhluli M, Gray G, Muller C, Johnson R. Spatial and Temporal Trends of SARS-CoV-2 RNA from Wastewater Treatment Plants over 6 Weeks in Cape Town, South Africa. Int J Environ Res Public Health 2021; 18:12085. [PMID: 34831841 PMCID: PMC8618134 DOI: 10.3390/ijerph182212085] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 10/13/2021] [Accepted: 10/20/2021] [Indexed: 11/22/2022]
Abstract
Recent scientific trends have revealed that the collection and analysis of data on the occurrence and fate of SARS-CoV-2 in wastewater may serve as an early warning system for COVID-19. In South Africa, the first COVID-19 epicenter emerged in the Western Cape Province. The City of Cape Town, located in the Western Cape Province, has approximately 4 million inhabitants. This study reports on the monitoring of SARS-CoV-2 RNA in the wastewater of the City of Cape Town's wastewater treatment plants (WWTPs) during the peak of the epidemic. During this period, the highest overall median viral RNA signal was observed in week 1 (9200 RNA copies/mL) and declined to 127 copies/mL in week 6. The overall decrease in the amount of detected viral SARS-CoV-2 RNA over the 6-week study period was associated with a declining number of newly identified COVID-19 cases in the city. The SARS-CoV-2 early warning system has now been established to detect future waves of COVID-19.
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Affiliation(s)
- Renée Street
- Environment & Health Research Unit, South African Medical Research Council (SAMRC), Tygerberg 7505, South Africa; (A.M.); (M.S.M.); (S.N.); (C.W.); (N.M.)
| | - Angela Mathee
- Environment & Health Research Unit, South African Medical Research Council (SAMRC), Tygerberg 7505, South Africa; (A.M.); (M.S.M.); (S.N.); (C.W.); (N.M.)
- Environmental Health Department, Faculty of Health Sciences, University of Johannesburg, Johannesburg 2092, South Africa
| | - Noluxabiso Mangwana
- Biomedical Research and Innovation Platform (BRIP), South African Medical Research Council (SAMRC), Tygerberg 7505, South Africa; (N.M.); (S.D.); (J.R.S.); (P.R.); (J.L.); (C.M.); (R.J.)
- Department of Microbiology, Stellenbosch University, Stellenbosch 7600, South Africa;
| | - Stephanie Dias
- Biomedical Research and Innovation Platform (BRIP), South African Medical Research Council (SAMRC), Tygerberg 7505, South Africa; (N.M.); (S.D.); (J.R.S.); (P.R.); (J.L.); (C.M.); (R.J.)
| | - Jyoti Rajan Sharma
- Biomedical Research and Innovation Platform (BRIP), South African Medical Research Council (SAMRC), Tygerberg 7505, South Africa; (N.M.); (S.D.); (J.R.S.); (P.R.); (J.L.); (C.M.); (R.J.)
| | - Pritika Ramharack
- Biomedical Research and Innovation Platform (BRIP), South African Medical Research Council (SAMRC), Tygerberg 7505, South Africa; (N.M.); (S.D.); (J.R.S.); (P.R.); (J.L.); (C.M.); (R.J.)
| | - Johan Louw
- Biomedical Research and Innovation Platform (BRIP), South African Medical Research Council (SAMRC), Tygerberg 7505, South Africa; (N.M.); (S.D.); (J.R.S.); (P.R.); (J.L.); (C.M.); (R.J.)
- Department of Biochemistry and Microbiology, University of Zululand, KwaDlangezwa 3886, South Africa
| | - Tarylee Reddy
- Biostatistics Unit, South African Medical Research Council (SAMRC), Tygerberg 7505, South Africa;
| | - Ludwig Brocker
- Department of Microbiology, Stellenbosch University, Stellenbosch 7600, South Africa;
| | - Swastika Surujlal-Naicker
- Scientific Services, Water and Sanitation Department, City of Cape Town Metropolitan Municipality, Cape Town 8000, South Africa;
| | - Natacha Berkowitz
- Community Services and Health, City Health, City of Cape Town, Hertzog Boulevard, Cape Town 8001, South Africa;
| | - Mokaba Shirley Malema
- Environment & Health Research Unit, South African Medical Research Council (SAMRC), Tygerberg 7505, South Africa; (A.M.); (M.S.M.); (S.N.); (C.W.); (N.M.)
| | - Sizwe Nkambule
- Environment & Health Research Unit, South African Medical Research Council (SAMRC), Tygerberg 7505, South Africa; (A.M.); (M.S.M.); (S.N.); (C.W.); (N.M.)
| | - Candice Webster
- Environment & Health Research Unit, South African Medical Research Council (SAMRC), Tygerberg 7505, South Africa; (A.M.); (M.S.M.); (S.N.); (C.W.); (N.M.)
| | - Nomfundo Mahlangeni
- Environment & Health Research Unit, South African Medical Research Council (SAMRC), Tygerberg 7505, South Africa; (A.M.); (M.S.M.); (S.N.); (C.W.); (N.M.)
| | - Huub Gelderblom
- COVID-19 Prevention Network (COVPN), Fred Hutchinson Cancer Research Center, Seattle, WA 98109, USA;
| | - Mongezi Mdhluli
- Office of the President, South African Medical Research Council, Tygerberg 7050, South Africa;
| | - Glenda Gray
- Chief Research Operations Office, South African Medical Research Council, Tygerberg 7050, South Africa;
| | - Christo Muller
- Biomedical Research and Innovation Platform (BRIP), South African Medical Research Council (SAMRC), Tygerberg 7505, South Africa; (N.M.); (S.D.); (J.R.S.); (P.R.); (J.L.); (C.M.); (R.J.)
- Department of Biochemistry and Microbiology, University of Zululand, KwaDlangezwa 3886, South Africa
- Centre for Cardio-Metabolic Research in Africa, Division of Medical Physiology, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch 7600, South Africa
| | - Rabia Johnson
- Biomedical Research and Innovation Platform (BRIP), South African Medical Research Council (SAMRC), Tygerberg 7505, South Africa; (N.M.); (S.D.); (J.R.S.); (P.R.); (J.L.); (C.M.); (R.J.)
- Centre for Cardio-Metabolic Research in Africa, Division of Medical Physiology, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch 7600, South Africa
- Discipline of Pharmaceutical Sciences, School of Health Sciences, University of KwaZulu-Natal, Westville Campus, Durban 4001, South Africa
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44
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Wand H, Ramjee G, Reddy T. Quantifying Vulnerabilities of Single Women and Sexually Transmitted Infections in South Africa (2002-2016): Is It Getting Better (or Worse)? Arch Sex Behav 2021; 50:3237-3245. [PMID: 34664154 DOI: 10.1007/s10508-021-01998-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 03/20/2021] [Accepted: 03/29/2021] [Indexed: 06/13/2023]
Abstract
Curable sexually transmitted infections (STIs) affect millions of people across the world. Besides unacceptably high HIV rates, South Africa also has the highest burden of STIs in the world. The aim of the study was to investigate temporal changes in STI incidence rates using the data from ~ 10,000 women who enrolled in several HIV prevention trials, KwaZulu-Natal, South Africa (2002-2016). We particularly focused on the changes in distribution of the most influential factors and their population-level impacts on STI incidence rates over time. Characteristics of the women were compared across the study periods: 2002-2004, 2005-2008, 2009-2011, and 2012-2016. Besides multivariable Cox regression models, population attributable risks were calculated for the significant factors. Despite the significant progress in prevention, testing, and treatment programs, infection rates increased substantially from 13.6 to 20.0 per 100 person-year over the study period. Our findings provided a compelling evidence for single/non-cohabiting South African women to be the most vulnerable population who consistently and substantially contributed to increasing STI rates during the 15 years of study duration (PAR%: 44%-47%). We also highlighted the impact of women's lack of knowledge related to their partner, using injectable contraceptives, less parity, and baseline STI positivity which were increased substantially over time. Our findings suggest that a significant proportion of STIs could be prevented by targeting single/non-cohabiting. These results may provide guidance in developing more effective STI prevention programs by targeting women at highest risk of infections and delivering more realistic messages.
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Affiliation(s)
- Handan Wand
- Kirby Institute, University of New South Wales, Kensington, NSW, 2052, Australia.
| | - Gita Ramjee
- HIV Prevention Research Unit, South African Medical Research Council, Westville, KwaZulu-Natal, 3630, South Africa
| | - Tarylee Reddy
- Biostatistics Unit, South African Medical Research Council, Durban, KwaZulu-Natal, 3630, South Africa
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45
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Jooste S, Mabaso M, Taylor M, North A, Shean Y, Simbayi LC, Reddy T, Mwandingi L, Schmidt T, Nevhungoni P, Manda S, Zuma K. Geographical variation in HIV testing in South Africa: Evidence from the 2017 national household HIV survey. South Afr J HIV Med 2021; 22:1273. [PMID: 34522430 PMCID: PMC8424727 DOI: 10.4102/sajhivmed.v22i1.1273] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 07/21/2021] [Indexed: 11/01/2022] Open
Abstract
Background Identification of the geographical areas with low uptake of HIV testing could assist in spatial targeting of interventions to improve the uptake of HIV testing. Objectives The objective of this research study was to map the uptake of HIV testing at the district level in South Africa. Method The secondary analysis used data from the Human Sciences Research Council's 2017 National HIV Prevalence, Incidence, Behaviour and Communication Survey, where data were collected using a multistage stratified random cluster sampling approach. Descriptive spatial methods were used to assess disparities in the proportion of those ever tested for HIV at the district level in South Africa. Results The districts with the highest overall coverage of people ever having tested for HIV (> 85%) include West Rand in Gauteng, Lejweleputswa and Thabo Mofutsanyane in Free State, and Ngaka Modiri Molema in North-West. These provinces also had the least variation in HIV testing coverage between their districts. Districts in KwaZulu-Natal had the widest variation in coverage of HIV testing. The districts with the lowest uptake of HIV testing were uMkhanyakude (54.7%) and Ugu (61.4%) in KwaZulu-Natal and Vhembe (61.0%) in Limpopo. Most districts had a higher uptake of HIV testing amongst female than male participants. Conclusion The uptake of HIV testing across various districts in South Africa seems to be unequal. Intervention programmes must improve the overall uptake of HIV testing, especially in uMkhanyakude and Ugu in KwaZulu-Natal and Vhembe in Limpopo. Interventions must also focus on enhancing uptake of HIV testing amongst male participants in most districts. Strategies that would improve the uptake of HIV testing include HIV self-testing and community HIV testing, specifically home-based testing.
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Affiliation(s)
- Sean Jooste
- Human Sciences Research Council, Cape Town, South Africa.,School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | | | - Myra Taylor
- School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - Alicia North
- Human Sciences Research Council, Cape Town, South Africa
| | - Yolande Shean
- Human Sciences Research Council, Cape Town, South Africa
| | - Leickness C Simbayi
- Human Sciences Research Council, Cape Town, South Africa.,Department of Psychiatry & Mental Health, University of Cape Town, Cape Town, South Africa
| | - Tarylee Reddy
- South African Medical Research Council, Durban, South Africa
| | - Leonard Mwandingi
- Human Sciences Research Council, Cape Town, South Africa.,Division of Epidemiology and Biostatistics, Stellenbosch University, Cape Town, South Africa.,Ministry of Health and Social Sciences, Windhoek, Namibia
| | | | | | - Samuel Manda
- South African Medical Research Council, Pretoria, South Africa.,Department of Statistics, University of Pretoria, Pretoria, South Africa
| | - Khangelani Zuma
- Human Sciences Research Council, Pretoria, South Africa.,School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
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46
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Wand H, Moodley J, Reddy T, Naidoo S. Impact of recurrent sexually transmitted infections on HIV seroconversion: Results from multi-state frailty models. Int J STD AIDS 2021; 32:1308-1317. [PMID: 34392715 DOI: 10.1177/09564624211036587] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
After several decades of research, South Africa is still considered to be the epicentre of HIV epidemic. The country also has the highest burden of sexually transmitted infections (STIs) which have been frequently linked to increasing rates of HIV transmission due to biological and behavioural associations between these two pathogeneses. We investigated the cumulative impact of recurrent STIs on subsequent HIV seroconversion among a cohort of South African women. We used the 'frailty' models which can account for the heterogeneity due to the recurrent STIs in a longitudinal setting. The lowest HIV incidence rate was 5.0/100 person-year among women who had no baseline STI and remained negative during the follow-up. This estimate was three times higher among those who had recurrent STIs in the follow-up period regardless of their STI status at baseline (15.8 and 14.0/100 person-year for women with and without STI diagnosis at baseline, respectively). Besides younger age and certain partnership characteristics, our data provided compelling evidence for the impact of recurrent STI. diagnoses on increasing rates of HIV. At the population-level, 65% of HIV infections collectively associated with recurrent STIs. These results have significant clinical and epidemiological implications and may play critical role in the trajectory of the infections in the region.
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Affiliation(s)
- Handan Wand
- Kirby Institute, University of New South Wales, Kensington, NSW, Australia
| | - Jayajothi Moodley
- HIV Prevention Research Unit, 59097South African Medical Research Council, KwaZulu-Natal, South Africa.,The Aurum Institute, Johannesburg, South Africa
| | - Tarylee Reddy
- Biostatistics Unit, 59097South African Medical Research Council, Durban, South Africa
| | - Sarita Naidoo
- HIV Prevention Research Unit, 59097South African Medical Research Council, KwaZulu-Natal, South Africa.,The Aurum Institute, Johannesburg, South Africa
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47
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Wand H, Morris N, Reddy T. Understanding the public health implications of self-reported condom use in HIV clinical trials: lessons learned in KwaZulu Natal, South Africa (2002–2016). J Public Health (Oxf) 2021. [DOI: 10.1007/s10389-021-01639-2] [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: 11/28/2022] Open
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48
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Wand H, Morris N, Reddy T. Characteristics of women who use hormonal contraceptives and their population-level impacts on HIV infection in a cohort of South African women (2002-2016). EUR J CONTRACEP REPR 2021; 25:449-455. [PMID: 33140988 DOI: 10.1080/13625187.2020.1831469] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
PURPOSE Women's choice of contraceptive can have broader implications and may play a significant role in shaping their sexual practices. We aim to identify the characteristics of women who use hormonal injectables and those at high-risk of HIV infection. We also quantify the population-level impact of their shared characteristics on HIV incidence rates. MATERIALS AND METHODS Data from 9948 women who enrolled in six-HIV prevention trials conducted in South Africa (2002-2016) were included. We used logistic and Cox regression models and estimated the population-level impact of the use of injectables on HIV incidence in the multifactorial-model setting. RESULTS Using hormonal injectables were associated with increased risk of HIV infection (adjusted Hazard ratio (aHR):1.51, 95% CI:1.22, 1.86). At the population level less than 20% of the infections were associated with injectable contraceptives among younger women (i.e., less than 35 years of age). Factors including being single/not-cohabiting, using condoms at last sex, partner-related factors, and STI diagnosis were all identified as shared characteristics of women who preferred using hormonal injectables and those at high-risk of HIV infection. At the population level, these factors were associated with more than 50% of the infections among women younger than 35 years of age. CONCLUSIONS Our analysis presented evidence for the overlapping characteristics of the women who used hormonal injectables and those at high-risk of HIV infection. These findings reinforce the importance of comprehensive contraceptive counselling to women about the importance of dual protection, such as male condoms and hormonal contraceptives use.
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Affiliation(s)
- Handan Wand
- Kirby Institute, University of New South Wales, Kensington, Australia
| | - Natashia Morris
- Biostatistics Unit: GIS, South African Medical Research Council, Durban, South Africa
| | - Tarylee Reddy
- Biostatistics Unit, South African Medical Research Council, Durban, South Africa
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49
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Wand H, Ramjee G, Reddy T. Quantifying geographical diversity in sexually transmitted infections using population attributable risk: results from HIV prevention trials in South Africa. Int J STD AIDS 2021; 32:600-608. [PMID: 33769896 DOI: 10.1177/0956462420968998] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
In this study, we investigated spatial diversities of sexually transmitted infections (STIs) and quantified their impacts on the STIs using population attributable risk (PAR%). The study population was 7,557 women who participated in several HIV prevention trials from KwaZulu-Natal, South Africa. Our results provide compelling evidence for substantial geographical diversities on STI incidence rates in the region. Their population-level impacts on the STIs exceeded the combined impacts of the individual risk factors considered in this study (PAR%: 41% (<25 years), 52% (25-34 years) and 34% (35+ years). When all these factors are considered together, PAR% was the highest among younger women (PAR%: 67%, 82% and 50% for <25, 25-34 and 35+ years old respectively). Results from our study will bring greater insight into the previous research by increasing our understanding of the impacts of the sub-geographical level variations of STI prevalence and incidence rates in the region.
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Affiliation(s)
- Handan Wand
- Kirby Institute, University of New South Wales, Kensington, Australia
| | - Gita Ramjee
- HIV Prevention Research Unit, South African Medical Research Council, Westville, South Africa
| | - Tarylee Reddy
- Biostatistics Unit, South African Medical Research Council, Durban, South Africa
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50
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Loveday M, Hughes J, Sunkari B, Master I, Hlangu S, Reddy T, Chotoo S, Green N, Seddon JA. Maternal and Infant Outcomes Among Pregnant Women Treated for Multidrug/Rifampicin-Resistant Tuberculosis in South Africa. Clin Infect Dis 2021; 72:1158-1168. [PMID: 32141495 PMCID: PMC8028100 DOI: 10.1093/cid/ciaa189] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 02/27/2020] [Indexed: 11/16/2022] Open
Abstract
Background Data on safety and efficacy of second-line tuberculosis drugs in pregnant women and their infants are severely limited due to exclusion from clinical trials and expanded access programs. Methods Pregnant women starting treatment for multidrug/rifampicin-resistant (MDR/RR)-tuberculosis at King Dinuzulu Hospital in KwaZulu-Natal, South Africa, from 1 January 2013 to 31 December 2017, were included. We conducted a record review to describe maternal treatment and pregnancy outcomes, and a clinical assessment to describe infant outcomes. Results Of 108 pregnant women treated for MDR/RR-tuberculosis, 88 (81%) were living with human immunodeficiency virus.. Favorable MDR/RR-tuberculosis treatment outcomes were reported in 72 (67%) women. Ninety-nine (91%) of the 109 babies were born alive, but overall, 52 (48%) women had unfavorable pregnancy outcomes. Fifty-eight (54%) women received bedaquiline, and 49 (45%) babies were exposed to bedaquiline in utero. Low birth weight was reported in more babies exposed to bedaquiline compared to babies not exposed (45% vs 26%; P = .034). In multivariate analyses, bedaquiline and levofloxacin, drugs often used in combination, were both independently associated with increased risk of low birth weight. Of the 86 children evaluated at 12 months, 72 (84%) had favorable outcomes; 88% of babies exposed to bedaquiline were thriving and developing normally compared to 82% of the babies not exposed. Conclusions MDR/RR-tuberculosis treatment outcomes among pregnant women were comparable to nonpregnant women. Although more babies exposed to bedaquiline were of low birth weight, over 80% had gained weight and were developing normally at 1 year.
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Affiliation(s)
- Marian Loveday
- Health Systems Research Unit, South African Medical Research Council, KwaZulu-Natal, South Africa.,South African Medical Research Council HIV-TB Pathogenesis and Treatment Research Unit, CAPRISA, Doris Duke Medical Research Institute, University of KwaZulu-Natal, Durban, South Africa
| | - Jennifer Hughes
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Stellenbosch University, South Africa
| | - Babu Sunkari
- MDR-TB unit, King Dinuzulu Hospital, Durban, South Africa
| | - Iqbal Master
- MDR-TB unit, King Dinuzulu Hospital, Durban, South Africa
| | - Sindisiwe Hlangu
- Health Systems Research Unit, South African Medical Research Council, KwaZulu-Natal, South Africa
| | - Tarylee Reddy
- Department of Biostatistics, South African Medical Research Council, KwaZulu-Natal, South Africa
| | - Sunitha Chotoo
- MDR-TB unit, King Dinuzulu Hospital, Durban, South Africa
| | - Nathan Green
- MDR-TB unit, King Dinuzulu Hospital, Durban, South Africa.,Department of Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - James A Seddon
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Stellenbosch University, South Africa.,Department of Infectious Diseases, Imperial College London, United Kingdom
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