Strengthening the health system and ensuring equity in the wide-scale implementation of an antiretroviral therapy programme in South Africa

Antiretroviral therapy (ART) makes a dramatic difference to the survival and health of people living with HIV. At present there are over 5 million people infected with HIV in South Africa. Greater access to ART could change the lives of millions of people. In the light of cabinet's announcement to make highly active antiretroviral therapy (HAART) widely available in South Africa and the mandate to develop an implementation plan, some thought should be given to the principles and strategies that should underlie the implementation of such a programme

African perceptions of female attractiveness

Little is known about mate choice preferences outside Western, educated, industrialised, rich and democratic societies, even though these Western populations may be particularly unrepresentative of human populations. To our knowledge, this is the first study to test which facial cues contribute to African perceptions of African female attractiveness and also the first study to test the combined role of facial adiposity, skin colour (lightness, yellowness and redness), skin homogeneity and youthfulness in the facial attractiveness preferences of any population. Results show that youthfulness, skin colour, skin homogeneity and facial adiposity significantly and independently predict attractiveness in female African faces. Younger, thinner women with a lighter, yellower skin colour and a more homogenous skin tone are considered more attractive. These findings provide a more global perspective on human mate choice and point to a universal role for these four facial cues in female facial attractiveness.Publisher PDFPeer reviewe

THE FUTURE OF WILDFLOWER RESEARCH AND DEVELOPMENT IN SOUTH AFRICA - THE LACHENALIA CASE STUDY

This paper reports the socio-economic impact of the lachenalia research program of the ARCRoodeplaat Vegetable and Ornamental Plant Institute (ARC-Roodeplaat) over the period 1965-2010. Data were collected from researchers, the local propagator and the market agent in Holland, using guidelines and questionnaires. A financial and economic analysis were conducted. The results of both were negative, unless increased productivity, early entry into all potential markets and a decreased research gestation period were assumed. Additional impacts were qualitatively assessed. The program contributed to employment creation, the preservation of biodiversity, capacity building and beneficial institutional linkages. The management information generated by the study was used in planning and priority setting at the institute.Crop Production/Industries, Research and Development/Tech Change/Emerging Technologies,

The Effect of Complete Integration of HIV and TB Services on Time to Initiation of Antiretroviral Therapy: A Before-After Study.

Studies have shown that early ART initiation in TB/HIV co-infected patients lowers mortality. One way to implement earlier ART commencement could be through integration of TB and HIV services, a more efficient model of care than separate, vertical programs. We present a model of full TB/HIV integration and estimate its effect on time to initiation of ART

Influence of HIV and other risk factors on tuberculosis

Background. Tuberculosis (TB) notification in South Africa has increased six-fold over the past two decades, mainly because of the HIV epidemic.Objectives. To describe the sociodemographic and outcome characteristics of TB patients, and to identify risk factors associated with TB treatment outcomes stratified by HIV status.Methods. A cross-sectional study was used to analyse data from the Cape Town Metro East geographical service area (GSA) electronic TB register (ETR.Net), including adult patients aged ≥15 years who initiated TB treatment between 1 July 2011 and 30 June 2012.Results. TB case notification in the GSA was 922 per 100 000 population. Of the 12 672 TB patients registered, 50.5% were co-infected with HIV. The death rate in co-infected patients was 5.4% v. 2.8% in HIV-negative patients, the rate of treatment success 66.6% v. 73.5%, and the rate of unfavourable treatment outcome 28.1% v. 23.7%. The Khayelitsha subdistrict had the highest proportion of TB burden (37.0%) and co-infection (47.6%). Fourteen percent of patients had extrapulmonary TB, 65.9% of whom were co-infected with HIV. In the multivariate analysis, HIV infection (relative risk (RR) 1.2), retreatment (RR 1.4) and sputum smear microscopy not done (RR 1.4) were significantly associated with unfavourable treatment outcome. The Eastern (RR 0.9) and Northern (RR 0.7) subdistricts were less likely to have unfavourable outcomes compared with Khayelitsha. In the stratified analysis, retreatment and smear not done were significant risk factors for an unfavourable treatment outcome in both co-infected and HIV-negative patients.Conclusions. The burdens of both TB and co-infection were high in this community, although HIV prevalence varied. Mortality was higher and treatment completion lower in co-infected patients than in those who were HIV-negative. Co-infection, previous TB treatment and smear not done were significant risk factors for an unfavourable outcome in all patients

Anticipating future challenges to ART provision in South Africa: reflections on the Khayelitsha ART programme

The Khayelitsha ART programme has been in existence for five years. The emerging challenges are indicative of challenges other districts will face in the future. The number of adult patients started on ART annually in Khayelitsha has increased from 80 to 1 500. The gap between need and provision has narrowed, with a concomitant increase in the baseline CD4 count at ART initiation. Over time, adherence preparation has become less intensive, but the patient-centred approach has been retained. Consultations and staffing (especially doctors and counsellors) have increased   substantially over four years, without deterioration in clinical outcomes. To keep up with projected demand, the service needs to quadruple enrolment over the next five years. This will only be possible by utilising the full breadth of the primary care system and by integrating TB/HIV/ART care at each service point

Adopting exergy analysis for use in aerospace

Thermodynamic analysis methods, based on an exergy metric, have been developed to improve system efficiency of traditional heat driven systems such as ground based power plants and aircraft propulsion systems. However, in more recent years interest in the topic has broadened to include applying these second law methods to the field of aerodynamics and complete aerospace vehicles. Work to date is based on highly simplified structures, but such a method could be shown to have benefit to the highly conservative and risk averse commercial aerospace sector. This review justifies how thermodynamic exergy analysis has the potential to facilitate a breakthrough in the optimization of aerospace vehicles based on a system of energy systems, through studying the exergy-based multidisciplinary design of future flight vehicles

Skin Blood Perfusion and Oxygenation Colour Affect Perceived Human Health

Skin blood perfusion and oxygenation depends upon cardiovascular, hormonal and circulatory health in humans and provides socio-sexual signals of underlying physiology, dominance and reproductive status in some primates. We allowed participants to manipulate colour calibrated facial photographs along empirically-measured oxygenated and deoxygenated blood colour axes both separately and simultaneously, to optimise healthy appearance. Participants increased skin blood colour, particularly oxygenated, above basal levels to optimise healthy appearance. We show, therefore, that skin blood perfusion and oxygenation influence perceived health in a way that may be important to mate choice

Seven-year experience of a primary care antiretroviral treatment programme in Khayelitsha, South Africa.

OBJECTIVES: We report on outcomes after 7 years of a community-based antiretroviral therapy (ART) programme in Khayelitsha, South Africa, with death registry linkages to correct for mortality under-ascertainment. DESIGN: This is an observational cohort study. METHODS: Since inception, patient-level clinical data have been prospectively captured on-site into an electronic patient information system. Patients with available civil identification numbers who were lost to follow-up were matched with the national death registry to ascertain their vital status. Corrected mortality estimates weighted these patients to represent all patients lost to follow-up. CD4 cell count outcomes were reported conditioned on continuous virological suppression. RESULTS: Seven thousand, three hundred and twenty-three treatment-naive adults (68% women) started ART between 2001 and 2007, with annual enrolment increasing from 80 in 2001 to 2087 in 2006. Of 9.8% of patients lost to follow-up for at least 6 months, 32.8% had died. Corrected mortality was 20.9% at 5 years (95% confidence interval 17.9-24.3). Mortality fell over time as patients accessed care earlier (median CD4 cell count at enrolment increased from 43 cells/microl in 2001 to 131 cells/microl in 2006). Patients who remained virologically suppressed continued to gain CD4 cells at 5 years (median 22 cells/microl per 6 months). By 5 years, 14.0% of patients had failed virologically and 12.2% had been switched to second-line therapy. CONCLUSION: At a time of considerable debate about future global funding of ART programmes in resource-poor settings, this study has demonstrated substantial and durable clinical benefits for those able to access ART throughout this period, in spite of increasing loss to follow-up