The status of vaccine availability and associated factors in Tshwane government clinics

Background. Vaccines have greatly contributed to the control of vaccine-preventable diseases and to human development. Efforts by many countries to introduce new vaccines are a significant move towards achieving the sustainable development goal for health. However, effective vaccine supply chains that ensure an uninterrupted supply of vaccines are pivotal to attaining universal access to life-saving vaccines and sustainable development. The introduction of new vaccines puts a strain on supply chains; South Africa (SA) is no exception, as there are indications of vaccine stock-outs in clinics. Objective. To establish the status of vaccine availability and associated factors in government health facilities of Tshwane Health District in Gauteng Province, SA. Methods. A cross-sectional study was conducted in a sample of randomly selected government clinics in the Tshwane health district of Gauteng Province. Data were collected using a structured measurement instrument in participating clinics. Data were analysed using Excel-based software (Microsoft, USA). Results. A total of 31 clinics participated. In the preceding 12 months, clinics had experienced vaccine stock-outs, especially of the three newer vaccines: pneumococcal conjugate vaccine, rotavirus and Pentaxim. These were also out of stock for a long duration; for over 2 weeks in a majority of clinics. The causes of vaccine stock-outs were: poor management of stock, district depot out of stock, unreliable deliveries, lack of pharmacy assistants and limited fridge capacity. Further burdening the situation is the ineffective emergency-ordering system. Conclusion. Significant shortages of vaccines, which are essential drugs, occur in Tshwane government clinics. Vaccine supply chain issues and vaccine shortages should be treated as a priority at all levels of the healthcare system; therefore, a similar study should be conducted at national level. It is recommended that the vaccine supply chain should be restructured and overhauled with the use of advances in technology and could be linked with current initiatives such as MomConnect

The status of vaccine availability and associated factors in Tshwane government clinics

Background. Vaccines have greatly contributed to the control of vaccine-preventable diseases and to human development. Efforts by many countries to introduce new vaccines are a significant move towards achieving the sustainable development goal for health. However, effective vaccine supply chains that ensure an uninterrupted supply of vaccines are pivotal to attaining universal access to life-saving vaccines and sustainable development. The introduction of new vaccines puts a strain on supply chains; South Africa (SA) is no exception, as there are indications of vaccine stock-outs in clinics.Objective. To establish the status of vaccine availability and associated factors in government health facilities of Tshwane Health District in Gauteng Province, SA.Methods. A cross-sectional study was conducted in a sample of randomly selected government clinics in the Tshwane health district of Gauteng Province. Data were collected using a structured measurement instrument in participating clinics. Data were analysed using Excel-based software (Microsoft, USA).Results. A total of 31 clinics participated. In the preceding 12 months, clinics had experienced vaccine stock-outs, especially of the three newer vaccines: pneumococcal conjugate vaccine, rotavirus and Pentaxim. These were also out of stock for a long duration; for over 2 weeks in a majority of clinics. The causes of vaccine stock-outs were: poor management of stock, district depot out of stock, unreliable deliveries, lack of pharmacy assistants and limited fridge capacity. Further burdening the situation is the ineffective emergency-ordering system.Conclusion. Significant shortages of vaccines, which are essential drugs, occur in Tshwane government clinics. Vaccine supply chain issues and vaccine shortages should be treated as a priority at all levels of the healthcare system; therefore, a similar study should be conducted at national level. It is recommended that the vaccine supply chain should be restructured and overhauled with the use of advances in technology and could be linked with current initiatives such as MomConnect

HIV Testing and Counseling Leads to Immediate Consistent Condom Use Among South African Stable HIV-Discordant Couples

Effective behavioral HIV prevention is needed for stable HIV-discordant couples at risk for HIV, especially those without access to biomedical prevention. This analysis addressed whether HIV testing and counseling (HTC) with ongoing counseling and condom distribution lead to reduced unprotected sex in HIV-discordant couples

A retrospective 5-year review of rubella in South Africa prior to the introduction of a rubella-containing vaccine

South Africa has yet to introduce a rubella-containing vaccine (RCV) into its Expanded Programme on Immunisation (EPI). Here we evaluated the incidence of laboratory-confirmed rubella and congenital rubella syndrome (CRS) cases over the years 2015 to 2019, to document the epidemiology of rubella and CRS within South Africa prior to a RCV introduction. This retrospective study evaluated the number of laboratory-confirmed rubella cases reported through the national febrile rash surveillance system. A positive test for rubella immunoglobulin M (IgM) antibodies was considered a confirmed rubella case. For CRS cases, we reported laboratory-confirmed CRS cases collected from 28 sentinel-sites from all nine provinces of South Africa. From 2015–2019, 19 773 serum samples were tested for rubella IgM antibodies, 6 643 (33.6%) were confirmed rubella cases. Rubella was seasonal, with peaks in spring (September to November). Case numbers were similar between males (n = 3 239; 50.1%) and females (n = 3 232; 49.9%). The highest burden of cases occurred in 2017 (n = 2 526; 38%). The median age was 5 years (IQR: 3–7 years). Importantly, of females with rubella, 5.0% (161 of 3 232) of the cases were among women of reproductive age (15–44 years). A total of 62 CRS cases were reported, the mortality rate was 12.9% (n = 8), and the most common birth defect was congenital heart disease. In conclusion, rubella is endemic in South Africa. Children below the age of 10 years were the most affected, however, rubella was also reported among women of reproductive age. The baseline data represented here provides insight into the burden of rubella and CRS in South Africa prior to the introduction of a RCV, and can enable planning of RCV introduction into the South African EPI.The National Institute for Communicable Diseases, a division of the National Health Laboratory Service, South Africa.http://www.plosone.orgdm2022School of Health Systems and Public Health (SHSPH

Dyad-related factors in HIV prevention

Includes bibliographical references (leaves 213-234).[Objectives] Currently, HIV prevention strategies focus on promoting the modification of those individual behaviours that lead to an increase in susceptibility to and transmission of HIV infection. The focus on individuals in HIV voluntary counselling and testing frequently overlooks the fact that communication and collaboration between the sexual partners is required to effect any behavioural change within an intimate partnership. Developing HIV prevention strategies targeting couples is therefore noted to be increasingly relevant for improving HIV/STI risk reduction uptake. Couple HIV counselling and testing (CHCT) is a strategy that aims to bridge this gap by providing a safe environment for partners to be tested and counselled together. In this way, the burden of disclosing one's HIV status to one's partner is eliminated, and the difficulties experienced by the tested individual in negotiating risk reduction uptake are significantly reduced. There is a paucity of data regarding couples' experiences in and perceptions of CHCT within the South African setting. This study explores couples' experiences before, during and after CHCT; determines the socio-behavioural risk factors for HIV status in couples; explores the impact of couple HIV status on fertility desires, and lastly examines the reliability of inter-partner reports on sexual and other behaviours. [Methods] This was a cross-sectional study with baseline and follow-up components; in addition to a qualitative study component. Structured interviewer-administered questionnaires were applied to each member of the couple separately at baseline prior to CHCT (n=600 couples), immediately post CHCT, and at least 1 month post the CHCT process (n= 258 couples). In addition, in-depth qualitative interviews were done with each member of 27 couples at least one month post CHCT. [Results] Overall, the HIV prevalence in the study sample was 30% (24% in male and 35% in the female participants). Of the 600 couples tested for HIV, 354 (59%) were HIV concordant negative, 136 (23%) were HIV serodiscordant and 110 (18%) were HIV concordant positive. Of the HIV serodiscordant, 101(74%) were couples in which the female was the HIV positive partner and 35 (26%) had HIV positive males. Contextual factors such as community perceptions and levels of HIV-related stigma significantly influenced the couples' decision to test for HIV. Couples reported improved risk reduction uptake and improved communication as well as general improvements in other aspects of their lives at follow-up post the CHCT process. Factors such as community and family expectations as well as financial stability seemed to play a more influential role as determinants of fertility desire, compared to the couple HIV status. Comparison of couples' responses to some questions regarding sexual and other behaviours revealed that there was low inter-partner agreement particularly with respect to questions regarding communication behaviours. Key findings indicate that CHCT was acceptable to the couples who attended this process, and yet, making the decision to test was difficult for most couples. Partners devised various strategies to initiate the discussion on the need to test for HIV. However, after CHCT attendance, the process was highly rated, regardless of gender or resultant HIV status. [Conclusion] In order to increase the usefulness and effectiveness of CHCT, the process must be able to address pertinent uncertainties and concerns that couples might have with regard to HIV risk-reduction uptake and fertility desires

Recognition of malaria, treatment seeking behaviour and perception of the causes and effects of malaria among women attending antenatal clinic in Mudzi district in Zimbabwe

Includes bibliographical references.Malaria is an important public health problem with a high morbidity and mortality in more than 90 malaria endemic countries in the world. The burden of malaria is quite high especially among pregnant women and children under five years of age. There has been little focus on the factors that influence women's responses to malaria control strategies, It is important to establish whether the control measures, health education and the treatment options are available to and utilised by women. They are the caretakers of young children who are particularly vulnerable to severe malaria, and in need of prompt response to the illness, while women themselves are at great risk of severe anaemia and other complications during pregnancy. The purpose of the study is to better understand the role of women in the control and management of malaria at the household level, particularly with respect to women's awareness of transmission, prophylaxis, symptoms, complications, treatment and control of the disease and to provide recommendations to make malaria control programs more gender sensitive and therefore more effective

HIV Testing and Counseling Leads to Immediate Consistent Condom Use Among South African Stable HIV-Discordant Couples

INTRODUCTION: Effective behavioral HIV prevention is needed for stable HIV-discordant couples at risk for HIV, especially those without access to biomedical prevention. This analysis addressed whether HIV testing and counseling (HTC) with ongoing counseling and condom distribution lead to reduced unprotected sex in HIV-discordant couples. METHODS: Partners in Prevention HSV/HIV Transmission Study was a randomized trial conducted from 2004–2008 assessing whether acyclovir reduced HIV transmission from HSV-2/HIV-1 co-infected persons to HIV-uninfected sex partners. This analysis relied on self-reported behavioral data from 508 HIV-infected South African participants. The exposure was timing of first HTC: 0–7, 8–14, 15–30, or >30 days before baseline. In each exposure group, predicted probabilities of unprotected sex in the last month were calculated at baseline, month one, and month twelve using generalized estimating equations with a logit link and exchangeable correlation matrix. RESULTS: At baseline, participants who knew their HIV status for less time experienced higher predicted probabilities of unprotected sex in the last month: 0–7 days, 0.71; 8–14 days, 0.52; 15–30 days, 0.49; >30 days, 0.26. At month one, once all participants had been aware of being in HIV-discordant relationships for ≥ 1 month, predicted probabilities declined: 0–7 days, 0.08; 8–14 days, 0.08; 15–30 days, 0.15; >30 days, 0.14. Lower predicted probabilities were sustained through month twelve: 0–7 days, 0.08; 8–14 days, 0.11; 15–30 days, 0.05; >30 days, 0.19. CONCLUSIONS: Unprotected sex declined after HIV-positive diagnosis, and declined further after awareness of HIV-discordance. Identifying HIV-discordant couples for behavioral prevention is important for reducing HIV transmission risk