Misinformation and lack of knowledge hinder cervical cancer prevention

Cervical cancer is the second most common cancer, with an age-standardised incidence rate of 30 per 100 000 per year, and is the leading cause of cancer mortality among South African women.1 The National Department of Health (NDOH) national screening policy entitles every woman attending public sector services to 3 free Papanicolaou (Pap) smears in her lifetime at 10-year intervals, starting at the age of 30 years. Properly implemented, this policy could decrease the incidence of cervical cancer by more than 50%. Community awareness is the key to achieving optimal coverage and participation in the screening programme. The causative link between high-risk human papillomavirus (HPV) and cervical cancer has been established.2 HPV vaccine offers great potential for primary prevention of cervical cancer in South Africa. Two prophylactic vaccines, with a good safety profile and sustained efficacy after 5 years,3,4 have been licensed for use in South Africa but are not yet available in the public health sector. Secondary prevention of cervical cancer through Pap smears remains vitally important as all women will not be vaccinated, some cervical cancers are caused by HPV types not included in the current HPV vaccines, and the vaccines are not effective in women who already have HPV infection

Three-dimensional simulations of rotationally-induced line variability from a Classical T Tauri star with a misaligned magnetic dipole

We present three-dimensional (3-D) simulations of rotationally induced line variability arising from complex circumstellar environment of classical T Tauri stars (CTTS) using the results of the 3-D magnetohydrodynamic (MHD) simulations of Romanova et al., who considered accretion onto a CTTS with a misaligned dipole magnetic axis with respect to the rotational axis. The density, velocity and temperature structures of the MHD simulations are mapped on to the radiative transfer grid, and corresponding line source function and the observed profiles of neutral hydrogen lines (H-beta, Pa-beta and Br-gamma) are computed using the Sobolev escape probability method. We study the dependency of line variability on inclination angles (i) and magnetic axis misalignment angles (Theta). By comparing our models with the Pa-beta profiles of 42 CTTS observed by Folha & Emerson, we find that models with a smaller misaligngment angle (Theta<~15 deg.) are more consistent with the observations which show that majority of Pa-beta are rather symmetric around the line centre. For a high inclination system with a small dipole misalignment angle (Theta ~ 15 deg.), only one accretion funnel (on the upper hemisphere) is visible to an observer at any given rotational phase. This can cause an anti-correlation of the line equivalent width in the blue wing (v0) over a half of a rotational period, and a positive correlation over other half. We find a good overall agreement of the line variability behaviour predicted by our model and those from observations. (Abridged)Comment: 15 pages, 13 figures. Accepted for publication in MNRAS. A version with full resolution figures can be downloaded from http://www.physics.unlv.edu/~rk/preprint/inclined_dipole.pd

Voluntary Counselling, HIV Testing and Adjunctive Cotrimoxazole Reduces Mortality in Tuberculosis Patients in Thyolo, Malawi.

OBJECTIVES: To assess the feasibility and effectiveness of voluntary counselling, HIV testing and adjunctive cotrimoxazole in reducing mortality in a cohort of tuberculosis (TB) patients registered under routine programme conditions in a rural district of Malawi. DESIGN: 'Before' and 'after' cohort study using historical controls. METHODS: Between 1 July 1999 and 30 June 2000 all TB patients were started on standardized anti-TB treatment, and offered voluntary counselling and HIV testing (VCT). Those found to be HIV-positive were offered cotrimoxazole at a dose of 480 mg twice daily, provided there were no contraindications. Side-effects were monitored clinically. End-of-treatment outcomes in this cohort (intervention group) were compared with a cohort registered between 1 July 1998 and 30 June 1999 in whom VCT and cotrimoxazole was not offered (control group). FINDINGS: A total of 1986 patients was registered in the study: 1061 in the intervention group and 925 in the control cohort. In the intervention group, 1019 (96%) patients were counselled pre-test, 964 (91%) underwent HIV testing and 938 (88%) were counselled post-test. The overall HIV-seroprevalence rate was 77%. A total of 693 patients were given cotrimoxazole of whom 14 (2%) manifested minor dermatological reactions. The adjusted relative risk of death in the intervention group compared with the control group was 0.81 (P < 0.001). The number needed to treat with VCT and adjunctive cotrimoxazole to prevent one death during anti-TB treatment was 12.5. INTERPRETATION: This study shows that VCT and adjunctive cotrimoxazole is feasible, safe and reduces mortality rates in TB patients under routine programme conditions

Outcomes of tuberculosis patients who start antiretroviral therapy under routine programme conditions in Malawi

SETTING: Public sector facilities in Malawi providing antiretroviral therapy (ART) to human immunodeficiency virus (HIV) positive patients, including those with tuberculosis (TB). OBJECTIVES: To compare 6-month and 12-month cohort treatment outcomes of HIV-positive TB patients and HIV-positive non-TB patients treated with ART. DESIGN: Retrospective data collection using ART patient master cards and ART patient registers. RESULTS: Between July and September 2005, 7905 patients started ART, 6967 with a non-TB diagnosis and 938 with a diagnosis of active TB. 6-month cohort outcomes of non-TB and TB patients censored on 31 March 2006 showed significantly more TB patients alive and on ART (77%) compared with non-TB patients (71%) (P < 0.001). Between January and March 2005, 4580 patients started ART, 4179 with a non-TB diagnosis and 401 with a diagnosis of active TB. 12-month cohort outcomes of non-TB and TB patients censored on 31 March 2006 showed significantly more TB patients alive and on ART (74%) compared with non-TB patients (66%) (P < 0.001). Other outcomes of default and transfer out were also significantly less frequent in TB compared with non-TB patients. CONCLUSION: HIV-positive TB patients on ART in Malawi have generally good treatment outcomes, and more patients need to access this HIV treatment

Outcomes and safety of concomitant nevirapine and rifampicin treatment under programme conditions in Malawi.

SETTING: Thyolo District Hospital, rural Malawi. OBJECTIVES: To report on 1) clinical, immunological and virological outcomes and 2) safety among human immunodeficiency virus (HIV) infected patients with tuberculosis (TB) who received concurrent nevirapine (NVP) and rifampicin (RMP) based treatment. DESIGN: Retrospective cohort study. METHODS: Analysis of programme data, June-December 2007. RESULTS: Of a total of 156 HIV-infected TB patients who started NVP-based antiretroviral treatment, 136 (87%) completed TB treatment successfully, 16 (10%) died and 5 (4%) were transferred out. Mean body weight and CD4 gain (adults) were respectively 4.4 kg (95%CI 3.3-5.4) and 140 cells/mm(3) (95%CI 117-162). Seventy-four per cent of patients who completed TB treatment and had a viral load performed (n = 74) had undetectable levels (<50 copies/ml), while 17 (22%) had a viral load of 50-1000 copies/ml. Hepatotoxicity was present in 2 (1.3%) patients at baseline. Two patients developed Grade 2 and one developed Grade 3 alanine transaminase enzyme elevations during TB treatment (incidence rate per 10 years of follow-up 4.2, 95%CI 1.4-13.1). There were no reported deaths linked to hepatotoxicity. CONCLUSIONS: In a rural district in Malawi, concomitant NVP and RMP treatment is associated with good TB treatment outcomes and appears safe. Further follow-up of patients would be useful to ascertain the longer-term effects of this concurrent treatment

A qualitative exploration of HIV-positive pregnant women’s decision-making regarding abortion in Cape Town, South Africa

HIV-positive women’s abortion decisions were explored by: (i) investigating influencing factors; (ii) determining knowledge of abortion policy and public health services; and (iii) exploring abortion experiences. In-depth interviews were held with 24 HIVpositive women (15 had an abortion; 9 did not), recruited at public health facilities in Cape Town, South Africa. Negative perceptions towards HIV-positive pregnant women were reported. Women wanted abortions due to socio-economic hardship in conjunctionwith HIV-positive status. Respondents were generally aware that women in South Africa had a right to free abortions in public health facilities. Both positive and negative abortion experiences were described. Respondents reported no discrimination by providers due to their HIV-positive status. Most respondents reported not using contraceptives, while describing their pregnancies as ‘unexpected’. The majority of women who had abortions wanted to avoid another one, and would encourage other HIV-positive women to try to avoid abortion. However, most felt abortions were acceptable for HIV-positive women in some circumstances. Data suggestedthat stigma and discrimination affect connections between abortion, pregnancy and HIV/AIDS, and that abortion may be more stigmatised than HIV/AIDS. Study results provide important insights, and   any revision of reproductive health policy, services, counselling for abortion and HIV/AIDS care should address these issues

The ancient heritage of water ice in the solar system

Identifying the source of Earth's water is central to understanding the origins of life-fostering environments and to assessing the prevalence of such environments in space. Water throughout the solar system exhibits deuterium-to-hydrogen enrichments, a fossil relic of low-temperature, ion-derived chemistry within either (i) the parent molecular cloud or (ii) the solar nebula protoplanetary disk. Utilizing a comprehensive treatment of disk ionization, we find that ion-driven deuterium pathways are inefficient, curtailing the disk's deuterated water formation and its viability as the sole source for the solar system's water. This finding implies that if the solar system's formation was typical, abundant interstellar ices are available to all nascent planetary systems.Comment: 33 pages, 7 figures including main text and supplementary materials. Published in Scienc