An Exploration of Diabetes Care in Durban, Kwa-Zulu Natal, Suburbs as Seen Through the Work of Diabetes South Africa

This study portrays the lived experiences of diabetics and diabetes caregivers in Durban suburbs through the lens of Diabetes South Africa (DSA), a Non-Governmental Organization (NGO) operating out of Durban. Furthermore, this study also analyzes the progression of the treatment and services offered to diabetics. The specific aim of this study was to understand the situation of diabetic care in the suburbs and the obstacles to improvement. Because diabetes is registered by the World Health Organization (WHO) as a worldwide epidemic and because the rate of diagnosis will be increasing (World Health Organization: Diabetes updated March 2013), it is necessary to comprehend the current state of care in order to cope with the worsening situation as the population of diabetics is increasing. This study provides a unique perspective on diabetes care facilitated by DSA and others through narrative, triangulating my personal experience and others’ personal experiences about being diabetic or offering services to diabetics. Interview was the most significant vehicle for obtaining information, and the interviews are retold in narrative form. Members of DSA, an endocrinologist, two nutritionists, a podiatrist, and a community member have all offered their experiences as aids to understand the situations that face diabetics in Durban. The primary site for the project is DSA and my relative personal experiences while volunteering with DSA as a Type 1 diabetic have also been recounted in this comprehensive report. Each individual that was interviewed about their experience with diabetes had different experiences in that they each interpreted their involvement and relationship with the disease differently. In this study, I found that my opinion about diabetes care and management in Durban shifted from critical and skeptical to an opinion that is now appreciative with increasing trust in the medical system of South Africa. The services that are currently offered via hospital (public and private) or clinic are not offered effectively to diabetics, but the system is ever-improving. The support system that DSA offers is utilized widely in the Durban suburbs and DSA supplements necessary knowledge to diabetic patients, even from suburbs where public hospitals or clinics are not able to perform on par. I personally have become inspired by the amount of work that DSA accomplishes with limited staffing and monetary (donation) resources

Influence of viral genes on the cell-to-cell spread of RNA silencing

The turnip crinkle virus-based vector TCV–GFPΔCP had been devised previously to study cell-to-cell and long-distance spread of virus-induced RNA silencing. TCV–GFPΔCP, which had been constructed by replacing the coat protein (CP) gene with a green fluorescent protein (GFP) coding sequence, was able to induce RNA silencing in single epidermal cells, from which RNA silencing spread from cell-to-cell. Using this unique local silencing assay together with mutagenesis analysis, two TCV genes, p8 and p9, which were involved in the intercellular spread of virus-induced RNA silencing, were identified. TCV–GFPΔCP and its p8- or p9-mutated derivatives, TCVmp8–GFPΔCP and TCVmp9–GFPΔCP, replicated efficiently but were restricted to single Nicotiana benthamiana epidermal cells. TCV–GFPΔCP, TCVmp8–GFPΔCP, or TCVmp9–GFPΔCP was able to initiate RNA silencing that targeted and degraded recombinant viral RNAs in inoculated leaves of the GFP-expressing N. benthamiana line 16c. However, cell-to-cell spread of silencing to form silencing foci was triggered only by TCV–GFPΔCP. Non-replicating TCVmp88–GFPΔCP and TCVmp28mp88–GFPΔCP with dysfunctional replicase genes, and single-stranded gfp RNA did not induce RNA silencing. Transient expression of the TCV p9 protein could effectively complement TCVmp9–GFPΔCP to facilitate intercellular spread of silencing. These data suggest that the plant cellular trafficking machinery could hijack functional viral proteins to permit cell-to-cell movement of RNA silencing

HIV status alters disease severity and immune cell responses in beta variant SARS-CoV-2 infection wave

There are conflicting reports on the effects of HIV on COVID-19. Here we analyzed disease severity and immune cell changes during and after SARS-CoV-2 infection in 236 participants from South Africa, of which 39% were people living with HIV (PLWH), during the first and second (beta dominated) infection waves. The second wave had more PLWH requiring supplemental oxygen relative to HIV negative participants. Higher disease severity was associated with low CD4 T cell counts and higher neutrophil to lymphocyte ratios (NLR). Yet, CD4 counts recovered and NLR stabilized after SARS-CoV-2 clearance in wave 2 infected PLWH, arguing for an interaction between SARS-CoV-2 and HIV infection leading to low CD4 and high NLR. The first infection wave, where severity in HIV negative and PLWH was similar, still showed some HIV modulation of SARS-CoV-2 immune responses. Therefore, HIV infection can synergize with the SARS-CoV-2 variant to change COVID-19 outcomes

Immunogenicity of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Infection and Ad26.CoV2.S Vaccination in People Living With Human Immunodeficiency Virus (HIV)

BACKGROUND: People living with HIV (PLWH) have been reported to have a higher risk of more severe Covid-19 disease and death. We assessed the ability of the Ad26.CoV2.S vaccine to elicit neutralizing activity against the Delta variant in PLWH relative to HIV-negative individuals. We also examined effects of HIV status and suppression on Delta neutralization response in SARS-CoV-2 infected unvaccinated participants. METHODS: We enrolled participants who vaccinated through the SISONKE South African clinical trial of the Ad26.CoV2.S vaccine in health care workers (HCW). PLWH in this group had well controlled HIV infection. We also enrolled unvaccinated participants previously infected with SARS-CoV-2. Neutralization capacity was assessed by a live virus neutralization assay of the Delta variant. RESULTS: Majority of Ad26.CoV2.S vaccinated HCW were previously infected with SARS-CoV-2. In this group, Delta variant neutralization was 9-fold higher compared to the infected only group and 26-fold higher relative to the vaccinated only group. No decrease in Delta variant neutralization was observed in PLWH relative to HIV-negative participants. In contrast, SARS-CoV-2 infected, unvaccinated PLWH showed 7-fold lower neutralization and a higher frequency of non-responders, with the highest frequency of non-responders in people with HIV viremia. Vaccinated only participants showed low neutralization capacity. CONCLUSIONS: The neutralization response of the Delta variant following Ad26.CoV2.S vaccination in PLWH with well controlled HIV was not inferior to HIV-negative participants, irrespective of past SARS-CoV-2 infection. In SARS-CoV-2 infected and non-vaccinated participants, HIV infection reduced the neutralization response to SARS-CoV-2, with the strongest reduction in HIV viremic individuals