Moving beyond access: Towards a quality-orientated substance abuse treatment system in South Africa

There is growing concern about the increased demand for and limited access to substance abuse treatment in South Africa. The government has responded by allocating more money to the delivery of substance abuse treatment, expanding the number of state-funded treatment slots, and training additional health and social workers to deliver these services, particularly in provinces where the prevalence of substance-related problems is high, such as the Western Cape. While these efforts should be commended and continued, steps to improve service availability have occurred without adequate consideration of the quality of services provided. This is not surprising, as there is little or no routine monitoring and evaluation of substance abuse services in the country. It is also disquieting, as access to treatment is necessary but not sufficient for positive treatment outcomes

The impact of alcohol on HIV prevention and treatment for South Africans in primary healthcare

Background: Antiretroviral treatment (ART) has substantially reduced morbidity and mortality for HIV patients. In South Africa, with the largest ART programme globally, attention is needed not only on the further expansion of ART coverage, but also on factors which undermine its effectiveness, such as alcohol use. Objective: Given the decentralised approach of nurse-initiated and -sustained ART in the South African primary health sector, it is important to document key aspects of alcohol use to be conveyed to HIV-positive individuals and those at risk for HIV. Method: This study comprised a narrative review of relevant literature. Results: Alcohol acts through both behavioural and physiological pathways to impact on the acquisition, further transmission and then progression of HIV disease. Besides links to risky sex, alcohol undermines the immune system, raising susceptibility to contracting and then countering HIV and other infections. There are important drug interactions between alcohol and ART, or therapies for opportunistic infections and other co-morbidities. Moreover, alcohol undermines adherence to the medication which is essential for effective ART. Conclusion: Primary healthcare clinic attendees need evidence-based information on the detrimental effects of alcohol consumption on HIV infection, which ensue throughout the clinical course of HIV. This spans the role of alcohol consumption as a risk factor for HIV infection, HIV replication in infected individuals, a person\u27s response to HIV infection and HIV treatment. Primary healthcare workers, especially nurses and HIV counsellors, require training in order to screen for and provide appropriate interventions for HIV-positive patients, those on treatment and treatment-naïve patients, who will benefit from reduced alcohol consumption or the cessation thereof

Special Issue: Alcohol Policy and Public Health-Contributing to the Global Debate on Accelerating Action on Alcohol

First paragraph: In July 2018, under our guidance, IJERPH put out a call for papers to be considered for publication in a Special Issue on “Alcohol and Public Health”. This was motivated by the reports of mixed success regarding the achievements by member states on the objectives of the Global Strategy to Reduce the Harmful Use of Alcohol

A prospective study of methamphetamine use as a predictor of high school non-attendance in Cape Town, South Africa

Publication of this article was funded by the Stellenbosch University Open Access Fund.Background: This prospective study investigated the association between life-long methamphetamine and other drug use and high school non-attendance, in a sample of high school students in Cape Town, South Africa. Methods: A random sample of 1535 high school students completed a baseline questionnaire in 2006, and were asked to complete a follow-up questionnaire 12 months later. The questionnaire included questions on substance use, including tobacco, alcohol, methamphetamine and cannabis use, demographic factors, and questions relating to school attendance and performance. Results: Forty-three percent of the students surveyed at baseline did not complete a follow-up questionnaire after 12 months. Compared with students who were not using selected substances, an adjusted logistic regression model showed that life-time methamphetamine use in addition to other substances was significantly associated with non-attendance (OR = 2.58, 95% CI: 1.24 - 5.36) when other non-substance use factors (repeating a year at school and being older than the norm for current grade) were taken into account. Conclusions: Early identification of students with methamphetamine and other substance use problems, and a supportive rather than punitive school policy, may be valuable in improving high school completion and student retention rates.Peer Reviewe

Legalising medical use of cannabis in South Africa: Is the empirical evidence sufficient to support policy shifts in this direction?

Inkatha Freedom Party MP Mario Oriani-Ambrosini’s impassioned plea to legalise the medical use of cannabis must be understood in the context of his own condition as well as legislative changes in at least ten countries. This article argues that any decisions to shift policy must be based on a consideration of the evidence on the risks and benefits associated with the medical use of cannabis for the individual and broader society. It concludes that there are important gaps in the evidence base, particularly in human trials supporting the efficacy of cannabis use for treating and preventing medical conditions and alleviating negative symptoms associated with these conditions. South African researchers should be enabled actively to support development of the necessary evidence base actively by conducting preclinical and clinical research in this area. Human trials to establish the efficacy of the use of cannabis/cannabinoids in addressing AIDS wasting syndrome and other negative sequelae of HIV and AIDS are especially needed

Tobacco use and nicotine dependence among people living with HIV who drink heavily in South Africa: a cross-sectional baseline study

Abstract

The socioeconomic profile of alcohol-attributable mortality in South Africa : a modelling study

CITATION: Probst, C. et al. 2018. The socioeconomic profile of alcohol-attributable mortality in South Africa : a modelling study. BMC Medicine, 16:97, doi:10.1186/s12916-018-1080-0.The original publication is available at https://bmcmedicine.biomedcentral.comBackground: Globally, illness and life expectancy follow a social gradient that puts people of lower socioeconomic status (SES) at higher risk of dying prematurely. Alcohol consumption has been shown to be a factor contributing to socioeconomic differences in mortality. However, little evidence is available from low- and middle-income countries. The objective of this study was to quantify mortality attributable to alcohol consumption in the adult (15+ years) general population of South Africa in 2015 by SES, age, and sex. Methods : A comparative risk assessment was performed using individual and aggregate data from South Africa and risk relations reported in the literature. Alcohol-attributable fractions (AAFs) and alcohol-attributable mortality rates were estimated for cause-specific mortality by SES, sex, and age. Monte Carlo simulation techniques were used to calculate 95% uncertainty intervals (UI). Results: Overall, approximately 62,300 (95% UI 27,000–103,000) adults died from alcohol-attributable causes in South Africa in 2015, with 60% of deaths occurring in people in the low and 15% in the high SES groups. Age-standardized, alcohol-attributable mortality rates per 100,000 adults were highest for the low SES group (727 deaths, 95% UI 354–1208 deaths) followed by the middle (377 deaths, 95% UI 165–687 deaths) and high SES groups (163 deaths, 95% UI 71–289 deaths). The socioeconomic differences were highest for mortality from infectious diseases. People of low SES had a lower prevalence of current alcohol use but heavier drinking patterns among current drinkers. Among men, AAFs were elevated at low and middle SES, particularly for the middle and higher age groups (35+). Among women, AAFs differed less across SES groups and, in the youngest age group (15–34), women of high SES had elevated AAFs. Conclusions: Alcohol use contributed to vast socioeconomic differences in mortality. Where observed, elevated AAFs for people of low and middle SES arose from higher levels of consumption among current drinkers and not from the prevalence of current alcohol use per se. The findings can direct preventive measures and interventions on those at highest risk. Future research is needed to investigate socioeconomic differences in the risk functions relating alcohol use to cause-specific mortality.https://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-018-1080-0Publisher's versio

Constraining mass ratio and extinction in the FU Orionis binary system with infrared integral field spectroscopy

We report low resolution near infrared spectroscopic observations of the eruptive star FU Orionis using the Integral Field Spectrograph Project 1640 installed at the Palomar Hale telescope. This work focuses on elucidating the nature of the faint source, located 0.5" south of FU Ori, and identified in 2003 as FU Ori S. We first use our observations in conjunction with published data to demonstrate that the two stars are indeed physically associated and form a true binary pair. We then proceed to extract J and H band spectro-photometry using the damped LOCI algorithm, a reduction method tailored for high contrast science with IFS. This is the first communication reporting the high accuracy of this technique, pioneered by the Project 1640 team, on a faint astronomical source. We use our low resolution near infrared spectrum in conjunction with 10.2 micron interferometric data to constrain the infrared excess of FU Ori S. We then focus on estimating the bulk physical properties of FU Ori S. Our models lead to estimates of an object heavily reddened, A_V =8-12, with an effective temperature of ~ 4000-6500 K . Finally we put these results in the context of the FU Ori N-S system and argue that our analysis provides evidence that FU Ori S might be the more massive component of this binary syste