Sentinel seroprevalence of SARS-CoV-2 in Gauteng Province, South Africa, August - October 2020

Background. Estimates of prevalence of anti-SARS-CoV-2 antibody positivity (seroprevalence) for tracking the COVID-19 epidemic are lacking for most African countries.Objectives. To determine the prevalence of antibodies against SARS-CoV-2 in a sentinel cohort of patient samples received for routine testing at tertiary laboratories in Johannesburg, South Africa.Methods. This sentinel study was conducted using remnant serum samples received at three National Health Laboratory Service laboratories in the City of Johannesburg (CoJ) district. Collection was from 1 August to 31 October 2020. We extracted accompanying laboratory results for glycated haemoglobin (HbA1c), creatinine, HIV, viral load and CD4 T-cell count. An anti-SARS-CoV-2 targeting the nucleocapsid (N) protein of the coronavirus with higher affinity for IgM and IgG antibodies was used. We reported crude as well as population-weighted and test-adjusted seroprevalence. Multivariate logistic regression analysis was used to determine whether age, sex, HIV and diabetic status were associated with increased risk for seropositivity.Results. A total of 6 477 samples were analysed, the majority (n=5 290) from the CoJ region. After excluding samples with no age or sex stated, the model population-weighted and test-adjusted seroprevalence for the CoJ (n=4 393) was 27.0% (95% confidence interval (CI) 25.4 - 28.6). Seroprevalence was highest in those aged 45 - 49 years (29.8%; 95% CI 25.5 - 35.0) and in those from the most densely populated areas of the CoJ. Risk for seropositivity was highest in those aged 18 - 49 years (adjusted odds ratio (aOR) 1.52; 95% CI 1.13 - 2.13; p=0.0005) and in samples from diabetics (aOR 1.36; 95% CI 1.13 - 1.63; p=0.001).Conclusions. Our study conducted between the first and second waves of the pandemic shows high levels of current infection among patients attending public health facilities in Gauteng Province

Behavioral and cognitive interventions to improve treatment adherence and access to HIV care among older adults in sub-Saharan Africa: an updated systematic review

BACKGROUND: Approximately 14% of Africans infected with HIV are over the age of 50, yet few intervention studies focus on improving access to care, retention in care, and adherence to antiretroviral therapy (ART) in this population. A review of the published literature until 2012, found no relevant ART management and care interventions for older people living with HIV (OPLHIV) in sub-Saharan Africa. The aim of this systematic review is to update the original systematic review of intervention studies on OPLHIV, with a focus on evidence from sub-Saharan Africa. METHODS: We conducted a systematic review of the available published literature from 2012 to 2017 to explore behavioral and cognitive interventions addressing access to ART, retention in HIV care and adherence to ART in sub-Saharan Africa that include older adults (50+). We searched three databases (MEDLINE, EMBASE, and Education Resources Information Center) using relevant Medical Subject Headings (MeSH) terms as well as a manual search of the reference lists. No language restrictions were placed. We identified eight articles which were analyzed using content analysis with additional information obtained directly from the corresponding authors. RESULTS AND DISCUSSION: There were no studies that exclusively focused on OPLHIV. Three studies referred only to participants being over 18 years and did not specify age categories. Therefore, it is unclear whether these studies actively considered people living with HIV over the age of 50. Although the studies sampled older adults, they lacked sufficient data to draw conclusions about the relevance of the outcomes of this group. CONCLUSIONS: These findings underscore the need to increase the evidence-base of which interventions will work for older Africans on ART

Successfully controlling malaria in South Africa

Following major successes in malaria control over the past 75 years, South Africa is now embarking on a malaria elimination campaign with the goal of zero local transmission by the year 2018. The key control elements have been intensive vector control, primarily through indoor residual spraying, case management based on parasitological diagnosis using evidence-based drug policies with artemisinin-based combination therapy since 2001, active health promotion in partnership with communities living in the malaria transmission areas, and cross-border collaborations. Political commitment and long-term funding for the malaria control programme have been a critical component of the programme’s success. Breaking the cycle of transmission through strengthening of active surveillance using sensitive molecular tests and field treatment of asymptomatic persons, monitoring for antimalarial drug resistance and insecticide resistance, strengthening cross-border initiatives, and ongoing programme advocacy in the face of a significant decrease in disease burden are key priorities for achieving the elimination goal.http://www.samj.org.zaam201

Assessing changes in adolescent girls’ and young women’s sexual and reproductive health service utilisation following a COVID-19 lockdown in eSwatini

The effects of COVID-19-associated restrictions on youth sexual and reproductive health (SRH) care during the pandemic remain unclear, particularly in sub-Saharan Africa. This study uses interrupted time series analyses to assess changes in SRH care utilisation (including visits for HIV testing and treatment, family planning, and antenatal care) adolescent girls’ and young women’s (AGYW; aged 15–24 years old) in eSwatini following COVID-19 lockdown beginning in March 2020. SRH utilisation data from 32 clinics in the Manzini region that remained open throughout the 2020 COVID-19 period were extracted from eSwatini’s electronic health record system. We tabulated and graphed monthly visits (both overall and by visit type) by AGYW during the two-year period between January 2019 and December 2020. Despite the March to September 2020 lockdown, we did not detect significant changes in monthly visit trends from 2019 to 2020. Our findings suggest little change to AGYW’s SRH utilisation in eSwatini during the 2020 COVID-19 lockdown period

An Evaluation of the Level of Integration and Alignment of the Malabo Commitments

The Sustainable Development Goals (SDGs) have introduced greater integration of development objectives across traditional sectors. This integration is also reflected in Africa’s Agenda 2063 vision for development. Africa’s agricultural and food security initiatives through the 2003 Comprehensive African Agricultural Development Programme (CAADP) seeks to achieve the goals of Agenda 2063 and contribute to the achievement of the SGDs. This commitment is set out in the 2014 Malabo Declaration on Accelerated Agricultural Growth and Transformation for Shared Prosperity and Improved Livelihoods. The African Union recently (2017) established a Biennial Review (BR) mechanism to support the implementation of the Malabo Declaration and hold countries accountable for making progress on the commitments. Currently, many African countries are revising their first five-year CAADP implementation plans and drafting their second five-year National Agriculture and Food Security Investment Plans (or NAIP IIs) in line with the Malabo commitments. This paper set out to assess ten NAIP IIs from the perspective of the indicator sets contained in the NAIPs against the BR, the First 10-year Implementation Plan of the African Union’s Agenda 2063 (2014 to 2023) and the SDG’s. The research was conducted in three steps. i. An assessment of the NAIP monitoring and evaluation frameworks of ten available NAIPs to determine the alignment between: a. Country NAIPs and the BR indicators, b. Country NAIPs and Agenda 2063’s First 10-year Implementation Plan (2014-2023) indicators, c. Country NAIPs and the SDG indicators with a specific focus on food security and nutrition elements, ii. The identification of novel and innovative practices and indicators and establish where there are gaps that could be improved; and iii. Documenting the insights gained from the analysis and drafting of suggestions to improve the design of monitoring and evaluation frameworks in relation to food security and nutrition components of development programmes across the world. We find that the NAIP monitoring and evaluation frameworks were generally compliant with the SDG indicators that were directly related to agriculture and food security. However, they do not exploit the opportunities to align in the areas of the SDGs that address some of the core aspirations of the CAADP agenda – seeking to advance agricultural transformation to reduce poverty, inequality and unemployment. Furthermore, a misalignment exists between the monitoring and evaluation frameworks of the NAIPs, the indicators of the BR and the first ten-year implementation plans for Agenda 2063. At a minimum, alignment of the NAIP indicators with the BR could provide more comprehensive coverage of indicators that generally overlap with both Agenda 2030 and the First 10-year Implementation Plan (2014 – 2023) of Agenda 2063. However, the BR could be strengthened from closer alignment with the SGDs and in some areas, adopting the broader specifications in the SDGs could lend more direction to the BR indicators and the CAADP process in general. For example, the SDGs include monitoring of the incomes of smallholders and the reduction in the rate of unemployment among vulnerable groups (including youth). In addition, a significant number of indicators were included in the NAIPs that were not in the BR and could be considered in improving the BR indicator set. Some countries adopted a more progressive approach to designing their monitoring and evaluation frameworks, resulting in a higher proportion of indicators aligned with the three indicator sets. The lack of appreciation of the full scope of food security (beyond production) led to an imbalanced focus on production by some countries. Malawi and Liberia responded well to interventions by the team and improved their indicator set. As is evident from this analysis, country-level planning does not seem to take into account the international and African transversal sectoral frameworks in the drafting of policies, legislation, strategies and action plans. An insufficient number of indicators focussed on the impact indicators of the CAADP] Results Framework, namely wealth creation; food security and nutrition; economic opportunities, poverty alleviation and shared prosperity; and resilience and sustainability. Although the second highest performance area coverage was in resilience to climate change, the focus in the BR on climate change meant the NAIPs neglected other elements of resilience related to food security, peace and migration. There is room for improvement in the inclusion of more food security and related indicators, shifting the focus to the inclusion of impact indicators. We recommend a review of the drafting process and the composition of the drafting team to ensure that NAIP II monitoring and evaluation frameworks include a comprehensive, integrated indicator set that is aligned with the BR, Agenda 2063’s First 10-year Implementation Plan (2014 – 2023) and the SDGs. Clearer guidance, supported by oversight and the development of enhanced guidance tools and regular updates (such as the NAIP toolkit) are essential to support country teams in their efforts, especially in view of the rapidly changing circumstances and events such as the passing of new agreements that affect the policy context (such as the recently signed African Free Trade Agreement). The findings of the analysis raise the need for considerably more training on the BR, the design of the NAIP monitoring and evaluation and the alignment of these with Agenda 2063 and the SGDs to ensure alignment and compliance, as well as improve the quality of reporting across the transversal development space. Mid-term reviews of the NAIPs and their monitoring and evaluation frameworks could provide opportunities for updating and strengthening the frameworks and aligning these more closely with the First 10-year Implementation Plan (2014 – 2023) of Agenda 2063 and the SDGs. Although we have not analysed the alignment of the NAIP monitoring and evaluation frameworks with the individual countries’ long-term national development plans and medium-term (five years) Growth and Development Strategies (GDSs; sometimes referred to as Medium Term Strategic Frameworks (MTSFs), this is an area for further analysis and assessment

Evaluation of a nurse practitioner-physician task-sharing model for multidrug-resistant tuberculosis in South Africa.

Treatment success rates for multidrug-resistant tuberculosis (MDR-TB) in South Africa remain close to 50%. Lack of access to timely, decentralized care is a contributing factor. We evaluated MDR-TB treatment outcomes from a clinical cohort with task-sharing between a clinical nurse practitioner (CNP) and a medical officer (MO).We completed a retrospective evaluation of outcomes from a prospective, programmatically-based MDR-TB cohort who were enrolled and received care between 2012 and 2015 at a peri-urban hospital in KwaZulu-Natal, South Africa. Treatment was provided by either by a CNP or MO.The cohort included 197 participants with a median age of 33 years, 51% female, and 74% co-infected with HIV. The CNP initiated 123 participants on treatment. Overall MDR-TB treatment success rate in this cohort was 57.9%, significantly higher than the South African national average of 45% in 2012 (p<0·0001) and similar to the provincal average of 60% (p = NS). There were no significant differences by provider type: treatment success was 61% for patients initiated by the CNP and 52.7% for those initiated by the MO.Clinics that adopted a task sharing approach for MDR-TB demonstrated greater treatment success rates than the national average. Task-sharing between the CNP and MO did not adversely impact treatment outcome with similar success rates noted. Task-sharing is a feasible option for South Africa to support decentralization without compromising patient outcomes. Models that allow sharing of responsibility for MDR-TB may optimize the use of human resources and improve access to care

Evaluation of a nurse practitioner-physician task-sharing model for multidrug-resistant tuberculosis in South Africa.

Treatment success rates for multidrug-resistant tuberculosis (MDR-TB) in South Africa remain close to 50%. Lack of access to timely, decentralized care is a contributing factor. We evaluated MDR-TB treatment outcomes from a clinical cohort with task-sharing between a clinical nurse practitioner (CNP) and a medical officer (MO).We completed a retrospective evaluation of outcomes from a prospective, programmatically-based MDR-TB cohort who were enrolled and received care between 2012 and 2015 at a peri-urban hospital in KwaZulu-Natal, South Africa. Treatment was provided by either by a CNP or MO.The cohort included 197 participants with a median age of 33 years, 51% female, and 74% co-infected with HIV. The CNP initiated 123 participants on treatment. Overall MDR-TB treatment success rate in this cohort was 57.9%, significantly higher than the South African national average of 45% in 2012 (p<0·0001) and similar to the provincal average of 60% (p = NS). There were no significant differences by provider type: treatment success was 61% for patients initiated by the CNP and 52.7% for those initiated by the MO.Clinics that adopted a task sharing approach for MDR-TB demonstrated greater treatment success rates than the national average. Task-sharing between the CNP and MO did not adversely impact treatment outcome with similar success rates noted. Task-sharing is a feasible option for South Africa to support decentralization without compromising patient outcomes. Models that allow sharing of responsibility for MDR-TB may optimize the use of human resources and improve access to care

Patient characteristics by provider type.

<p>Patient characteristics by provider type.</p