Enrollment in HIV Care Two Years after HIV Diagnosis in the Kingdom of Swaziland: An Evaluation of a National Program of New Linkage Procedures

To improve early enrollment in HIV care, the Swaziland Ministry of Health implemented new linkage procedures for persons HIV diagnosed during the Soka Uncobe male circumcision campaign (SOKA, 2011–2012) and the Swaziland HIV Incidence Measurement Survey (SHIMS, 2011). Abstraction of clinical records and telephone interviews of a retrospective cohort of HIV-diagnosed SOKA and SHIMS clients were conducted in 2013–2014 to evaluate compliance with new linkage procedures and enrollment in HIV care at 92 facilities throughout Swaziland. Of 1,105 clients evaluated, within 3, 12, and 24 months of diagnosis, an estimated 14.0%, 24.3%, and 37.0% enrolled in HIV care, respectively, after adjusting for lost to follow-up and non-response. Kaplan-Meier functions indicated lower enrollment probability among clients 14–24 (P = 0.0001) and 25–29 (P = 0.001) years of age compared with clients > 35 years of age. At 69 facilities to which clients were referred for HIV care, compliance with new linkage procedures was low: referral forms were located for less than half (46.8%) of the clients, and few (9.6%) were recorded in the appointment register or called either before (0.3%) or after (4.9%) their appointment. Of over one thousand clients newly HIV diagnosed in Swaziland in 2011 and 2012, few received linkage services in accordance with national procedures and most had not enrolled in HIV care two years after their diagnosis. Our findings are a call to action to improve linkage services and early enrollment in HIV care in Swaziland

Implementation of the Automated Medication Dispensing System–Early Lessons From Eswatini

Objectives: This article describes the implementation of an automated medication dispensing system (AMDS) in Eswatini to increase medication access and presents the early lessons from this implementation.Methods: The AMDS was installed at four health facilities across two regions through collaborative stakeholder engagement. Healthcare workers were trained, and clients who met the inclusion criteria accessed their medications from the system. Each step of the implementation was documented and summarised in this article.Results: Early lessons suggest that implementation of the AMDS is acceptable and feasible to clients and healthcare workers and that phased introduction of medication classes, commencing with antiretroviral therapy (ART) and incorporating other medications in later phases is feasible. Additionally, improved client-centred messaging and communication, consistent power supply and internet network connectivity, and scheduling medication pickup with other services increase AMDS system utilisation.Conclusion: Eswatini has many clients living with HIV and non-communicable diseases (NCDs). Easy, convenient, quick, non-stigmatising and client-centred access to ART and medication for NCDs is critical in addressing retention in care and achieving optimal treatment outcomes

Application of some target formulations of active herbal plant components in reducing animal exposure to mycotoxins and associated health effects

Abstract: The presence of mycotoxigenic fungi and mycotoxins in food and feed commodities causes adverse health effects on both animals and humans. Herbal plant components remain an untapped reservoir for active compounds (phytochemicals) with properties that can potentially reduce the effects associated with animal exposure to mycotoxins. This is mainly through targeting the prevention of fungal crop infestation by screening for antifungal plant components and those that enable the reduction of mycotoxin-induced oxidative stress via antioxidant activity. Thus, the study reported herein evaluated the potential application of Mentha longifolia, Leonotis leonurus and Piptadeniastrium africanum plant extracts for reducing animal exposure to mycotoxins and associated adverse effects. Sequential solvent extraction using hexane, dichloromethane, ethyl acetate and methanol was applied in the extraction of crude extracts from each of the three dried powdered plant materials. The highest % extraction yields were obtained using methanol as extracting solvent, which confirmed the presence of more polar than non-polar components in each plant material. The phytochemistries of the extracts were evaluated using thin layer chromatography (TLC), ultraviolet-visible spectroscopy (UV-Vis), Fourier Transform Infrared spectroscopy (FT-IR), and 2 dimensional time of flight mass spectroscopy gas chromatography (2D GCxGC-TOF/MS). The UV-Vis confirmed the presence of phenolic compounds such as tannins, polyphenols, quinones, phenolic acids and their derivatives. These were seen as FT-IR peaks with functional groups bond/group frequencies of phenolic acids and their derivatives at 3411.66, 3411.5, and 3314.92 cm-1. Amongst the compounds identified by GCxGC-TOF/MS in each plant extract, 6 were selected on the basis of either one or more of the pharmacological properties, i.e., antioxidant, anti-inflammatory, anticancer, antimicrobial and antifungal activity. They are á-pinene, I-menthone, apocynin, naphthalene, 1, 2, 3, 5, 6, 8a, hexahydro-4, 7-dimethyl-1(1-methylethyl), (1Scis), camphene, and à-terpineol from M. longifolia. 1-methyl-pyrrolidine-2-carboxylic acid, 5-hydroxypipecolic acid, cinnamaldehyde, (E)-, 2, 4-dihydroxy-2, 5-dimethyl-3(2H)-furan-3-one, 2-caren-10-al, and 2H-pyran-2, 6(3H)-dione from L. leonurus. The 6 compounds selected from the P. africanum...M.Tech. (Biotechnology

Knowledge of final year undergraduate nursing students about HIV and AIDS in Eswatini

Background: Human immunodeficiency virus (HIV) and acquired immune deficiency syndrome (AIDS) are overwhelming health issues globally. They have caused many devastating and draining health issues, which have escalated a critical need for a well-trained and sustainable healthcare workforce in order to meet the needs of people living with HIV and AIDS (PLWHA). Health science students are the future healthcare providers who will implement proper preventive measures, as well as health educational and promotional sessions to promote information and knowledge among the public regarding HIV and AIDS in Eswatini.Methods: A quantitative cross-sectional study was conducted on 140 final-year undergraduate nursing students in three nursing universities in Eswatini. A questionnaire adapted from Othman and Ali in Malaysia with closed-ended questions was modified and used to collect data. The questionnaire consisted of questions on the virus structure, transmission, prevention and management of HIV and AIDS. Statistical Package for the Social Sciences (SPSS) version 20 was utilised to analyse the data.Results: The level of knowledge about HIV and AIDS was high, as evidenced by a mean score and standard deviation of (91.02 ± 5.00). However, there were low scores on questions related to the transmission of the disease.Conclusion: Across all three universities in Eswatini, there were good nursing education programmes on HIV and AIDS, evidenced by the high knowledge level about HIV and AIDS. However, there are still some knowledge gaps on HIV and AIDS transmission and management that need to be attended to.Contribution: This study contributed by providing knowledge of undergraduate nursing students’ HIV and AIDS training and management of PLWHA.

Costs of distributing HIV self-testing kits in Eswatini through community and workplace models

Abstract Background This study evaluates the implementation and running costs of an HIV self-testing (HIVST) distribution program in Eswatini. HIVST kits were delivered through community-based and workplace models using primary and secondary distribution. Primary clients could self-test onsite or offsite. This study presents total running economic costs of kit distribution per model between April 2019 and March 2020, and estimates average cost per HIVST kit distributed, per client self-tested, per client self-tested reactive, per client confirmed positive, and per client initiating antiretroviral therapy (ART). Methods Distribution data and follow-up phone interviews were analysed to estimate implementation outcomes. Results were presented for each step of the care cascade using best-case and worst-case scenarios. A top-down incremental cost-analysis was conducted from the provider perspective using project expenditures. Sensitivity and scenario analyses explored effects of economic and epidemiological parameters on average costs. Results Nineteen thousand one hundred fifty-five HIVST kits were distributed to 13,031 individuals over a 12-month period, averaging 1.5 kits per recipient. 83% and 17% of kits were distributed via the community and workplace models, respectively. Clients reached via the workplace model were less likely to opt for onsite testing than clients in the community model (8% vs 29%). 6% of onsite workplace testers tested reactive compared to 2% of onsite community testers. Best-case scenario estimated 17,458 (91%) clients self-tested, 633 (4%) received reactive-test results, 606 (96%) linked to confirmatory testing, and 505 (83%) initiated ART. Personnel and HIVST kits represented 60% and 32% of total costs, respectively. Average costs were: per kit distributed US$17.23, per client tested US$18.91, per client with a reactive test US$521.54, per client confirmed positive US$550.83, and per client initiating ART US$708.60. Lower rates for testing, reactivity, and linkage to care in the worst-case scenario resulted in higher average costs along the treatment cascade. Conclusion This study fills a significant evidence gap regarding costs of HIVST provision along the client care cascade in Eswatini. Workplace and community-based distribution of HIVST accompanied with effective linkage to care strategies can support countries to reach cascade objectives

Interviewed client self-reported and verified enrollment in HIV care, and reasons for enrolling at an alternate facility or not enrolling in HIV care at all, by study-gender group.

<p>Interviewed client self-reported and verified enrollment in HIV care, and reasons for enrolling at an alternate facility or not enrolling in HIV care at all, by study-gender group.</p

Cumulative verified enrollment in HIV care, by age group (years).

<p>Log-rank test for differences in functions = 18.39; <i>P</i> = 0.0004.</p

Cumulative verified enrollment in HIV care, by region of facility.

<p>Log-rank test for differences in functions = 0.73; <i>P</i> = 0.87.</p

Cumulative verified enrollment in HIV care, by study-gender group.

<p>See text for evaluation of differences in functions.</p