Cohort profile: the Siyakhula cohort, rural South Africa

No abstract available

Successful paediatric HIV treatment in rural primary care in Africa

<p>Objective: Clinical outcomes of HIV-infected children on antiretroviral treatment (ART) in a decentralised, nurse/counsellor-led programme.</p> <p>Design: Clinical cohort.</p> <p>Setting: KwaZulu-Natal, South Africa.</p> <p>Patients: HIV-infected children aged <= 15 years on ART, June 2004-2008.</p> <p>Main outcome measures: Survival according to baseline characteristics including age, WHO clinical stage, haemoglobin and CD4%, was assessed in Kaplan-Meier analyses. Hazard ratios for mortality were estimated using Cox proportional hazards regression and changes in laboratory parameters and weight-for-age z scores after 6-12 months' treatment were calculated.</p> <p>Results: 477 HIV-infected children began ART at a median age of 74 months (range 4-180), median CD4 count (CD4%) of 433 cells/mm(3) (17%) and median HIV viral load of log 4.2 copies/ml; 105 (22%) were on treatment for tuberculosis and 317 (76.6%) were WHO stage 3/4. There were significant increases after ART initiation in CD4% (17% vs 22%; p<0.001), haemoglobin (9.9 vs 11.7 g/l; p <= 0.001) and albumin (30 vs 36 g/l; p <= 0.001). 32 (6.7%) children died over 732 child-years of follow-up (43.7 deaths/1000 child-years; 95% CI 32.7 to 58.2), 17 (53.1%) within 90 days of treatment initiation; median age of death was 84 (IQR 10-181) months. Children with baseline haemoglobin <= 8 g/l were more likely to die (adjusted HR 4.5; 95% CI 1.6 to 12.3), as were those aged <18 months compared with >60 months (adjusted HR 3.2; 95% CI 1.2 to 9.1).</p> <p>Conclusions Good clinical outcomes in HIV-infected children on ART are possible in a rural, decentralised service. Few young children are on ART, highlighting the urgent need to identify HIV-exposed infants.</p&gt

Human resources needs for universal access to antiretroviral therapy in South Africa: a time and motion study

<p>Background - Although access to life-saving treatment for patients infected with HIV in South Africa has improved substantially since 2004, treating all eligible patients (universal access) remains elusive. As the prices of antiretroviral drugs have dropped over the past years, availability of human resources may now be the most important barrier to achieving universal access to HIV treatment in Africa. We quantify the number of HIV health workers (HHWs) required to be added to the current HIV workforce to achieve universal access to HIV treatment in South Africa, under different eligibility criteria.</p> <p>Methods - We performed a time and motion study in three HIV clinics in a rural, primary care-based HIV treatment program in KwaZulu-Natal, South Africa, to estimate the average time per patient visit for doctors, nurses, and counselors. We estimated the additional number of HHWs needed to achieve universal access to HIV treatment within one year.</p> <p>Results - For universal access to HIV treatment for all patients with a CD4 cell count of ≤350 cells/μl, an additional 2,200 nurses, 3,800 counselors, and 300 doctors would be required, at additional annual salary cost of 929 million South African rand (ZAR), equivalent to US$141 million. For universal treatment (‘treatment as prevention’), an additional 6,000 nurses, 11,000 counselors, and 800 doctors would be required, at an additional annual salary cost of ZAR 2.6 billion (US$ 400 million).</p> <p>Conclusions - Universal access to HIV treatment for patients with a CD4 cell count of ≤350 cells/μl in South Africa may be affordable, but the number of HHWs available for HIV treatment will need to be substantially increased. Treatment as prevention strategies will require considerable additional financial and human resources commitments.</p&gt

Rapid testing may not improve uptake of HIV testing and same day results in a rural South African community: a cohort study of 12,000 women

<p>Background: Rapid testing of pregnant women aims to increase uptake of HIV testing and results and thus optimize care. We report on the acceptability of HIV counselling and testing, and uptake of results, before and after the introduction of rapid testing in this area.</p> <p>Methods and Principal Findings: HIV counsellors offered counselling and testing to women attending 8 antenatal clinics, prior to enrolment into a study examining infant feeding and postnatal HIV transmission. From August 2001 to April 2003, blood was sent for HIV ELISA testing in line with the Prevention of Mother-to-Child Transmission (PMTCT) programme in the district. From May 2003 to September 2004 women were offered a rapid HIV test as part of the PMTCT programme, but also continued to have ELISA testing for study purposes. Of 12,323 women counselled, 5,879 attended clinic prior to May 2003, and 6,444 after May 2003 when rapid testing was introduced; of whom 4,324 (74.6%) and 4,810 (74.6%) agreed to have an HIV test respectively. Of the 4,810 women who had a rapid HIV test, only 166 (3.4%) requested to receive their results on the same day as testing, the remainder opted to return for results at a later appointment. Women with secondary school education were less likely to agree to testing than those with no education (AOR 0.648, p<0.001), as were women aged 21–35 (AOR 0.762, p<0.001) and >35 years (AOR 0.756, p<0.01) compared to those <20 years.</p> <p>Conclusions: Contrary to other reports, few women who had rapid tests accepted their HIV results the same day. Finding strategies to increase the proportion of pregnant women knowing their HIV results is critical so that appropriate care can be given.</p&gt

Shape of the oxygen abundance profiles in CALIFA face-on spiral galaxies

Astronomy & Astrophysics 587 (2016): A70 reproduced with permission from Astronomy & AstrophysicsWe measured the gas abundance profiles in a sample of 122 face-on spiral galaxies observed by the CALIFA survey and included all spaxels whose line emission was consistent with star formation. This type of analysis allowed us to improve the statistics with respect to previous studies, and to properly estimate the oxygen distribution across the entire disc to a distance of up to 3-4 disc effective radii (re). We confirm the results obtained from classical H ii region analysis. In addition to the general negative gradient, an outer flattening can be observed in the oxygen abundance radial profile. An inner drop is also found in some cases. There is a common abundance gradient between 0.5 and 2.0 re of αO/H =-0.075 dex/re with a scatter of σ = 0.016 dex/re when normalising the distances to the disc effective radius. By performing a set of Kolmogorov-Smirnov tests, we determined that this slope is independent of other galaxy properties, such as morphology, absolute magnitude, and the presence or absence of bars. In particular, barred galaxies do not seem to display shallower gradients, as predicted by numerical simulations. Interestingly, we find that most of thegalaxies in the sample with reliable oxygen abundance values beyond ~2 effective radii (57 galaxies) present a flattening of the abundance gradient in these outer regions. This flattening is not associated with any morphological feature, which suggests that it is a common property of disc galaxies. Finally, we detect a drop or truncation of the abundance in the inner regions of 27 galaxies in the sample; this is only visible for the most massive galaxiesWe acknowledge financial support from the Spanish Ministerio de Economía y Competitividad (MINECO) via grant AYA2012-31935, and from the “Junta de Andalucía” local government through the FQM-108 project. We also acknowledge support to the ConaCyt funding program 180125. Y.A. acknowledges fi- nantial support from the Ramón y Cajal programme (RyC-2011-09461). Y.A. and A.I.D. acknowledge support from the project AYA2013-47742-C4-3-P from the Spanish MINECO, as well as the “Study of Emission-Line Galaxies with Integral-Field Spectroscopy” (SELGIFS) programme, funded by the EU (FP7- PEOPLE-2013-IRSES-612701). Support for L.G. is provided by the Ministry of Economy, Development, and Tourism’s Millennium Science Initiative through grant IC120009, awarded to The Millennium Institute of Astrophysics, MAS. LG acknowledges support by CONICYT through FONDECYT grant 3140566. R.M.G.D. acknowledges support from the Spanish grant AYA2014-57490-P, and from the “Junta de Andalucía” P12-FQM2828 project. RAM thanks the Spanish program of International Campus of Excellence Moncloa (CEI). IM and A.d.O. acknowledge support from the Spanish MINECO grant AYA2013-42227P. JMA acknowledges support from the European Research Council Starting Grant (SEDmorph, P.I. V. Wild). Support for MM has been provided by DGICYT grant AYA2013-47742-C4-4-P. PSB acknowledges support from the Ramón y Cajal programme, grant ATA2010-21322-C03-02 from the Spanish MINECO. CJW acknowledges support through the Marie Curie Career Grant Integration 30391

Outer-disk reddening and gas-phase metallicities: The CALIFA connection

Astronomy and Astrophysics 585 (2016): A47 reproduced with permission from Astronomy & AstrophysicsWe study, for the first time in a statistically significant and well-defined sample, the relation between the outer-disk ionized-gas metallicity gradients and the presence of breaks in the surface brightness profiles of disk galaxies. Sloan Digital Sky Survey (SDSS) g′- and r′-band surface brightness, (g′ - r′) color, and ionized-gas oxygen abundance profiles for 324 galaxies within the Calar Alto Legacy Integral Field Area (CALIFA) survey are used for this purpose. We perform a detailed light-profile classification, finding that 84% of our disks show down- or up-bending profiles (Type II and Type III, respectively), while the remaining 16% are well fitted by one single exponential (Type I). The analysis of the color gradients at both sides of this break shows a U-shaped profile for most Type II galaxies with an average minimum (g′ - r′) color of ∼ 0.5mag and an ionized-gas metallicity flattening associated with it only in the case of low-mass galaxies. Comparatively, more massive systems show a rather uniform negative metallicity gradient. The correlation between metallicity flattening and stellar mass for these systems results in p-values as low as 0.01. Independent of the mechanism having shaped the outer light profiles of these galaxies, stellar migration or a previous episode of star formation in a shrinking star-forming disk, it is clear that the imprint in their ionized-gas metallicity was different for low- and high-mass Type II galaxies. In the case of Type III disks, a positive correlation between the change in color and abundance gradient is found (the null hypothesis is ruled out with a p-value of 0.02), with the outer disks of Type III galaxies with masses ≤1010 M′ showing a weak color reddening or even a bluing. This is interpreted as primarily due to a mass downsizing effect on the population of Type III galaxies that recently experienced an enhanced inside-out growthWe acknowledge support from the Plan Nacional de Investigación y Desarrollo funding programs, AyA2010-15081, AyA2012-30717 and AyA2013-46724P, of Spanish Ministerio de Economía y Competitividad (MINECO). A.G.d.P. acknowledges the support from the FP7 Marie Curie Actions of the European Commission, via the Initial Training Network DAGAL under REA grant agreement PITNGA- 2011-289313. C.C.-T. thanks the support of the Spanish Ministerio de Educación, Cultura y Deporte by means of the FPU fellowship program. C.J.W. acknowledges support through the Marie Curie Career Integration Grant 303912. Support for L.G. is provided by the Ministry of Economy, Development, and Tourism’s Millennium Science Initiative through grant IC 120009, awarded to The Millennium Institute of Astrophysics, MAS. L.G. acknowledges support by CONIC YT through FONDECYT grant 3140566. S.F.S. thanks the CONACYT-125180 and DGAPA-IA100815 projects for providing him support in this study. J.M.A. acknowledges support from the European Research Council Starting Grant (SEDmorph; P.I. V. Wild). P.P. is supported by FCT through the Investigador FCT Contract No. IF/01220/2013 and POPH/FSE (EC) by FEDER funding through the program COMPETE. He also acknowledges support by FCT under project FCOMP-01-0124-FEDER-029170 (Reference FCT PTDC/FISAST/ 3214/2012), funded by FCT-MEC (PIDDAC) and FEDER (COMPETE