Application opportunities of geographic information systems analysis to support achievement of the UNAIDS 90-90-90 targets in South Africa

In an effort to achieve control of the HIV epidemic, 90-90-90 targets have been proposed whereby 90% of the HIV-infected population should know their status, 90% of those diagnosed should be receiving antiretroviral therapy, and 90% of those on treatment should be virologically suppressed. In this article we present approaches for using relatively simple geographic information systems (GIS) analyses of routinely available data to support HIV programme management towards achieving the 90-90-90 targets, with a focus on South Africa (SA) and other high-prevalence settings in low- and middle-income countries. We present programme-level GIS applications to map aggregated health data and individual-level applications to track distinct patients. We illustrate these applications using data from City of Johannesburg Region D, demonstrating that GIS has great potential to guide HIV programme operations and assist in achieving the 90-90-90 targets in SA

Strengthening primary eye care in South Africa: An assessment of services and prospective evaluation of a health systems support package

Visual impairment is a significant public health concern, particularly in low- and middle-income countries where eye care is predominantly provided at the primary healthcare (PHC) level, known as primary eye care. This study aimed to perform an evaluation of primary eye care services in three districts of South Africa and to assess whether an ophthalmic health system strengthening (HSS) package could improve these services. Baseline surveys were conducted in Cape Winelands District, Johannesburg Health District and Mopani District at 14, 25 and 36 PHC facilities, respectively. Thereafter, the HSS package, comprising group training, individual mentoring, stakeholder engagement and resource provision, was implemented in 20 intervention sites in Mopani District, with the remaining 16 Mopani facilities serving as control sites. At baseline, less than half the facilities in Johannesburg and Mopani had dedicated eye care personnel or sufficient space to measure visual acuity. Although visual acuity charts were available in most facilities, <50% assessed patients at the correct distance. Median score for availability of nine essential drugs was <70%. Referral criteria knowledge was highest in Cape Winelands and Johannesburg, with poor clinical knowledge across all districts. Several HSS interventions produced successful outcomes: compared to control sites there was a significant increase in the proportion of intervention sites with eye care personnel and resources such as visual acuity charts (p = 0.02 and <0.01, respectively). However, engaging with district pharmacists did not improve availability of essential drugs (p = 0.47). Referral criteria knowledge improved significantly in intervention sites (p<0.01) but there was no improvement in clinical knowledge (p = 0.76). Primary eye care in South Africa faces multiple challenges with regard to organisation of care, resource availability and clinical competence. The HSS package successfully improved some aspects of this care, but further development is warranted together with debate regarding the positioning of eye services at PHC l

Assessing the impacts of mining activities on zooplankton functional diversity

Abstract Aim Mining activities generate countless environmental impacts, including heavy-metal contamination, sorting and increased turbidity. In aquatic ecosystems these impacts can drastically affect the initial links of the food chain, such as zooplankton. Methods To evaluate how the different mining activities can influence the structure and functional diversity of zooplankton, we investigated the geochemical characteristics of the water and sediment in two small impoundments impacted by different mining activities (kaolin and iron extraction). We also explored zooplankton composition, species diversity and functional diversity (feeding guilds taxa). Results As expected, the water and the sediment of both of the reservoirs showed high concentrations of trace elements, particularly Al, Ba, Fe, Mg, Mn, Sr and Zn. Zooplankton biomass and diversity were markedly reduced (< 12 &#956;g.DW.L-1 and H&#8217; < 1.5, respectively), and negatively correlated with turbidity and total suspended solids. Small microphages dominated the trophic composition of zooplankton, and an alternation of trophic guilds was not observed, since the dynamics of raptorial organisms was essentially linked to the temporal fluctuation of a single species of rotifer (Polyarthra cf. dolichoptera). Conclusions In addition to changes in the aquatic habitat and zooplankton composition, the functional niches were also affected by the mining impacts. The use of the functional diversity analysis can emerge as a valuable approach to understand how zooplankton communities respond to drastic environmental changes