Factors associated with repeat genital symptoms among sexually transmitted infection service attendees in South Africa, 2015 - 2016

Background. South African guidelines recommend a syndromic approach for the management of sexually transmitted infections (STIs), based on the presence of genital symptoms. However, the guidelines do not prescribe specific indications for microbiology testing for patients presenting with or without repeat genital symptoms.Objectives. To describe the prevalence of and factors associated with repeat genital symptoms among STI service attendees at primary care facilities.Methods. This was a cross-sectional study at 7 STI primary care facilities participating in the aetiological surveillance of STIs between January 2015 and December 2016. Demographic and clinical information and appropriate genital specimens were collected from participants presenting with vaginal discharge syndrome (VDS), male urethral syndrome (MUS) and/or genital ulcer syndrome (GUS). Repeat genital symptoms were defined as self-reported history of the same STI-related genital symptoms in the preceding 12 months. Multivariable logistic regression identified factors associated with repeat genital symptoms.Results. Of 1 822 eligible participants, 480 (30%) had repeat genital symptoms (25% and 75% in the preceding 3 months and 12 months, respectively). Of those with repeat genital symptoms, the median age was 28 (interquartile range (IQR) 24 - 32) years, and 54% were females. The most common aetiological agents among participants with VDS, MUS and GUS were bacterial vaginosis (n=132; 55%), Neisseria gonorrhoeae (n=172; 81%) and ulcers (n=67; 63%), respectively. One hundred and seven (20%) participants had no detectable common STI aetiology. In the multivariable analysis, repeat genital symptoms were associated with HIV co-infection (adjusted odds ratio (aOR) 1.43; 95% confidence interval (CI) 1.14 - 1.78), VDS diagnosis (aOR 1.39; 95% CI 1.10 - 1.76), self-reported condom use (aOR 1.56; 95% CI 1.20 - 2.03) and age 25 - 34 years (aOR 1.33; 95% CI 1.03 - 1.71).Conclusions. Our study found a high prevalence of repeat genital symptoms ‒ a significant proportion without STI aetiology. Identified factors of repeat genital symptoms highlight the need for improved integration of HIV and STI prevention and management. Further research is needed to determine the aetiology of repeat genital symptoms and the contribution of non-STI causes

Towards improving learner performance in the national senior certificate examination - script analysis research report

This summary report includes a) a summary of findings across subjects, b) the main findings from each subject area analysis, and c) a background section which describes the purpose, rationale and research approach

The demographic and clinical profiles of women presenting with vaginal discharge syndrome at primary care facilities in South Africa: Associations with age and implications for management

Background. Current South African guidelines for the management of vaginal discharge syndrome (VDS) do not recommend treatment for sexually transmitted infection (STI) pathogens for women aged ≥35 years whose partners do not have male urethritis syndrome. The guideline assumes that older women are unlikely to have an STI and that their partners do not have asymptomatic infections.Objectives. To describe the demographic, behavioural and clinical characteristics of women with VDS, comparing older women (≥35 years) with younger women, and to determine the performance of age alone as a criterion for predicting the presence of STI.Methods. This was a cross-sectional study at seven primary healthcare centres taking part in the aetiological surveillance of STIs between January 2015 and December 2016. Eligible women presenting with VDS were enrolled and completed a nurse-administered questionnaire. Genital swabs and blood specimens were collected for laboratory testing. Data were entered into surveillance-specific databases and exported into Stata 14 for analysis. Descriptive statistics were used to compare demographic and clinical profiles of older with younger women. A receiver operator curve (ROC) was used to determine the age cut-off that would best differentiate between women who had infection with STI pathogens and those without.Results. Of 757 women enrolled, 157 (20.7%) were aged ≥35 years. HIV positivity was 46.6%, and higher in older than younger women (54.9% v. 44.5%; p=0.02). Of those enrolled, 283 (37.4%) had bacterial vaginosis (BV) and/or Candida infection only, 232 (30.7%) had BV or Candida with STI pathogens detected, 98 (13%) were infected with STI pathogens only, and 144 (19.0%) did not have any detectable STI or non-STI causes. Although older women were less likely than younger women to have Neisseria gonorrhoeae, Chlamydia trachomatis or Mycoplasma genitalium infection (23.6% v. 38.2%; p<0.01), the burden in older women was not negligible. The area under the ROC for age was 57.5% (95% confidence interval 53.2 - 61.8%), which implies suboptimal performance.Conclusions. Although older women with VDS were less likely than younger women to have STIs, a significant proportion of them did have an infection with STI pathogens. Age alone was not a good criterion for discriminating between women with and without infection with STI pathogens. Other ways of improving the VDS algorithm performance are needed, as is better integration of HIV and STI prevention and treatment.Â

HIV risk, risk perception, and PrEP interest among adolescent girls and young women in Lilongwe, Malawi: operationalizing the PrEP cascade

Introduction: As a user-controlled HIV prevention method, oral pre-exposure prophylaxis (PrEP) holds particular promise for adolescent girls and young women (AGYW). HIV prevention cascades, critical frameworks for the design and evaluation of PrEP programmes, outline the priorities of identifying individuals at greatest HIV risk and motivating them to initiate PrEP through perceived HIV risk. To inform future iterations of these cascades and PrEP delivery for AGYW, the objective of this study was to understand the level of interest in PrEP among AGYW at highest HIV risk, and the potential role of perceived risk in motivating PrEP interest. Methods: Using data from a cohort study of HIV-negative AGYW in Lilongwe, Malawi (February 2016 to August 2017), we assessed the relationship between epidemiologic HIV risk (risk index developed in a previous analysis) and PrEP interest, and the extent to which perceived risk explains the relationship between HIV risk and PrEP interest. We further aimed to operationalize the pre-initiation steps of the HIV prevention cascade in the study population. Results: In total, 825 AGYW were included in analyses, of which 43% met the criterion for high epidemiologic HIV risk. While epidemiologic risk scores were positively associated with PrEP interest, high numbers of AGYW both above and below the high-risk cutoff were very interested in PrEP (68% vs. 63%). Perceived risk partially explained the relationship between HIV risk and PrEP interest; greater epidemiologic HIV risk was associated with high perceived risk, which was in turn associated with PrEP interest. Many more high-risk AGYW were interested in PrEP (68%) than expressed a high level of perceived HIV risk (26%). Conclusions: These results highlight key relationships between epidemiologic HIV risk, risk perception and interest in PrEP. While risk perception did partially explain the relationship between epidemiologic risk and PrEP interest, there may be other important motivational mechanisms that are not captured in many HIV prevention cascades. The high number of participants with risk scores below the high-risk cutoff who both expressed high perceived risk and interest in PrEP suggests that demand for PrEP among AGYW may not be well aligned with epidemiologic risk

Recommendations for the management of subsistence fisheries in South Africa

This paper summarizes recommendations for the management of previously marginalized and neglected subsistence fisheries in South Africa. The recommendations stem from the activities and analyses of a task group appointed by Government and mandated to provide advice about management of the new fishing sector. The following focus areas were identified for attention: planning for implementation; definitions of subsistence fishers and other sectors; assessment and categorization of resources; determination of types of fishing activities; zonation; management systems; training; communication mechanisms; application and allocation procedures; compliance processes; research and monitoring; development of institutional capacity. Subsistence fishers were defined as poor people who personally harvest marine resources as a source of food or to sell them to meet basic needs of food security; they operate on or near to the shore or in estuaries, live in close proximity to the resource, consume or sell the resources locally, use low-technology gear (often as part of a long-standing community-based or cultural practice), and the resources they harvest generate only sufficient returns to meet basic needs of food security. A second group of informal fishers was identified that fishes for profit but cannot be equated to large industrial fisheries, and a new sector was proposed to accommodate these artisanal “small-scale commercial” fishers. Resources were classified for use by these different sectors based on accessibility, fishing methods, cash value and sustainability. In all, 12 different categories of subsistence and small-scale commercial fisheries were identified, and a preliminary list of resource species suitable for different fishing sectors is presented. A multi-tiered institutional management structure is recommended, with the national agency (MCM) controlling issues of national concern, and supporting and coordinating the activities of provincial and local structures. The management agents required for effective implementation were identified and include a dedicated national Subsistence Fisheries Management Unit, provincial management agencies that have the capacity to be delegated authority, Regional Fieldworkers, an independent Advisory Group for Subsistence Fisheries Management, local comanagement structures, and community monitors responsible for observing and recording fishing activities and catches. Co-management, involving both authorities and users in joint management, is advocated in preference to previous top-down approaches, because of its potential to improve communication and compliance.Keywords: coastal zonation, fisheries management, fisheries rights, subsistence fisheriesAfrican Journal of Marine Science 2002, 24: 503–52

The process of developing a management system for subsistence fisheries in South Africa: recognizing and formalizing a marginalized fishing sector in South Africa

Subsistence fishers were first recognized as a formal fishing sector in South Africa when new fishing legislation, aimed at redressing past inequalities, was enacted in 1998. Little information was available about these fishers, their activities, and the resources upon which they rely. Recognizing the imperative to gain an understanding of the fishers and to consult broadly, the national agency responsible for the management of marine living resources, Marine and Coastal Management (MCM) of the Department of Environmental Affairs and Tourism, appointed a Subsistence Fisheries Task Group (SFTG) in December 1998 to provide advice on the implementation of appropriate management systems for subsistence fisheries. This paper describes the process followed to formulate recommendations that were presented by the SFTG to MCM in February 2000. The activities of the SFTG fell into two categories: research aimed at identifying subsistence fishers and gaining an understanding of their activities and socio-economic profiles; and consultation aimed at ensuring that the needs and aspirations of fishers and the experience of local managers were incorporated. Research included both field-based studies and synthesis of information about comparative fisheries elsewhere. Consultation took the form of local interviews and focusgroup discussions, meetings with fishers and a national workshop. A pivotal activity was the development of a clear definition and qualifying criteria for subsistence fishers. A significant outcome was the identification of a separate small-scale commercial sector, previously erroneously lumped with subsistence fishers. Needs of fishers and problems identified during the process provided the basis for recommendations in the following areas: definitions, assessment and categorization of resources, management systems, communication mechanisms, application and allocation procedures, capacity building, compliance, research and monitoring, and funding and staff required for the management of this new sector. An evaluation is made of the opportunities presented by the SFTG process, constraints experienced and lessons learnt, giving important insights that are applicable to other similar processes, yet seldom documented in formal literature. Keywords: management of fisheries, subsistence fisheriesAfrican Journal of Marine Science 2002, 24: 405–42

Perceptions of and interest in HIV pre-exposure prophylaxis use among adolescent girls and young women in Lilongwe, Malawi

Background Oral Pre-Exposure Prophylaxis (PrEP) is an effective HIV prevention strategy for adherent users. Adolescent girls and young women (AGYW) in sub-Saharan Africa may particularly benefit from PrEP because of the disproportionate burden of HIV in this group. Understanding potential users’ perceptions of and interest in using PrEP is critical to promote the utilization of PrEP by individuals at risk of HIV. Methods This qualitative investigation of AGYW’s knowledge of and interest in PrEP use was conducted in the context of Girl Power, a quasi-experimental cohort study comparing four models of service delivery at four health centers in Lilongwe, Malawi. We conducted individual in-depth interviews (IDIs) with 40 HIV-negative AGYW ages 15–24 years old six months after enrolment in the parent study. An explanation of PrEP was provided to participants. Interview topics included participants’ prior knowledge of, interest in, concerns about, and delivery preferences for PrEP. Analysis consisted of structural coding of interview transcripts corresponding to interview topics, summary of responses within these topics, and identification and description of emerging themes within each topic. Results None of the AGYW had knowledge of PrEP prior to the IDIs, but once explained, a majority expressed an interest in using it due to inconsistencies in condom use, condom use errors, their own or their partners’ concurrent sexual partnerships, and rape. Most AGYW hoped that PrEP would be available in youth-friendly sections of health centers for easy access and youth-friendly counselling. They suggested that discrete packaging of PrEP would be needed to ensure user privacy. Concerns about relationship destabilization and accusations of promiscuity were raised as potential barriers to use. Conclusion General interest in PrEP among AGYW was high. Discrete packaging and access to youth-friendly PrEP delivery modalities may facilitate the utilization of PrEP as a prevention strategy among sexually active AGYW. Attention to potential negative reactions from partners and community members to PrEP use will be needed when introducing PrEP to this population

The relationship between intimate partner violence and probable depression among adolescent girls and young women in Lilongwe, Malawi

This analysis estimates prevalence of intimate partner violence (IPV) and its association with probable depression among adolescent girls and young women (AGYW) in Lilongwe, Malawi, and whether partner’s controlling behaviour modifies this relationship. Baseline data was utilised from the Girl Power-Malawi study of 1000 15–24-year-old AGYW in Lilongwe. Emotional, physical, and sexual IPV experiences with a current or recent partner were measured using the modified Conflict Tactics Scale. Probable depression was measured by scoring ≥10 on the Centre for Epidemiologic Studies-Short Depression Scale (CES-D-10). Generalised linear models with log-link and binomial distribution estimated prevalence ratios (PR) and 95% confidence intervals (CI) for the association between IPV types and probable depression. Partner’s controlling behaviour was examined as an effect modifier. Participants’ mean age was 19.2 years, with 70% never-married. IPV prevalence varied for emotional (59%), physical (36%), sexual (46%), and all forms (20%). Prevalence of probable depression was 47%. AGYW who experienced each IPV type had a higher prevalence of probable depression: physical (PR:1.54, CI:1.28–1.86), sexual (1.46, CI:1.21–1.75), emotional (1.37, CI:1.14–1.64), all forms (1.72, CI:1.41–2.09). IPV and probable depression were prevalent and strongly associated, especially among AGYW reporting controlling behaviour. Interventions addressing IPV and controlling behaviour may positively impact depression among AGYW