Factors associated with not testing for HIV and consistent condom use among men in Soweto, South Africa.

BackgroundBesides access to medical male circumcision, HIV testing, access to condoms and consistent condom use are additional strategies men can use to prevent HIV acquisition. We examine male behavior toward testing and condom use.ObjectiveTo determine factors associated with never testing for HIV and consistent condom use among men who never test in Soweto.MethodsA cross-sectional survey in Soweto was conducted in 1539 men aged 18-32 years in 2007. Data were collected on socio-demographic and behavioral characteristics to determine factors associated with not testing and consistent condom use.ResultsOver two thirds (71%) of men had not had an HIV test and the majority (55%, n = 602) were young (18-23). Of those not testing, condom use was poor (44%, n = 304). Men who were 18-23 years (aOR: 2.261, CI: 1.534-3.331), with primary (aOR: 2.096, CI: 1.058-4.153) or high school (aOR: 1.622, CI: 1.078-2.439) education, had sex in the last 6 months (aOR: 1.703, CI: 1.055-2.751), and had ≥1 sexual partner (aOR: 1.749, CI: 1.196-2.557) were more likely not to test. Of those reporting condom use (n = 1036, 67%), consistent condom use was 43% (n = 451). HIV testing did not correlate with condom use.ConclusionLow rates of both condom use and HIV testing among men in a high HIV prevalence setting are worrisome and indicate an urgent need to develop innovative behavioral strategies to address this shortfall. Condom use is poor in this population whether tested or not tested for HIV, indicating no association between condom use and HIV testing

Exploring macrophytes’ microbial populations dynamics to enhance bioremediation in constructed wetlands for industrial pollutants removal in sustainable wastewater treatment

Toxic contaminants from intense industrial operations are entering wetlands, harming human health and biodiversity. Macrophytes serve as principal producers in aquatic environments including natural wetlands, providing shelter, food, and, most crucially, intricate relationships with the surrounding microbial assemblage for support and microorganisms attachment. Wetlands have been nature's kidneys, for filtering water. Recent research has examined macrophytes' phytoremediation abilities. With recent improvements focused on engineered wetland technology, microbiological characterization, and genetic engineering, phytoremediation strategies have also benefited. However, little research has examined the role surrounding microbial population play on macrophyte efficiency in pollutant degradation, the extent and even mechanisms of these interactions, and their potential utility in wastewater treatment of diverse industrial effluents. Our bid for greener solutions implies that macrophyte-microorganisms’ interspecific interactions for in situ treatment of effluents should be optimised to remove contaminants before discharge in natural waterbodies or for recycle water usage. This review provides for the varied types of plants and microbial interspecific interactions beneficial to effective phytoremediation processes in artificial wetland design as well as considerations and modifications in constructed wetland designs necessary to improve the bioremediation processes. Additionally, the review discusses the latest advancements in genetic engineering techniques that can enhance the effectiveness of phyto-assisted wastewater treatment. We will also explore the potential utilisation of invasive species for their demonstrated ability to remove pollutants in the controlled setting of constructed wetlands.info:eu-repo/semantics/publishedVersio

The community involvement of nursing and medical practitioners in KwaZulu-Natal

BackgroundThe basis of the health system in South Africa is purported to be primary health care (PHC), as defined by the Alma Ata Declaration of 1978. This approach emphasises community involvement in all health-related activities, but it would appear that a very limited or selective PHC approach is actually being pursued in South Africa, without meaningful community participation or ownership. This study explores the involvement of exemplary medical and nursing clinical practitioners in non-clinical community-wide activities in terms of the primary health care approach, which demands a broader scope of practice than primary medical care.MethodsThe objectives of the study were to identify exemplary medical and nurse practitioners in primary health care, to document their practices and perceptions with regard to their community involvement, to analyse the common themes arising from the findings, and to present recommendations based on the findings. Seventeen primary care clinicians in KwaZulu-Natal, half of whom were professional nurses and the rest medical practitioners, were purposively selected through their district managers. A team of four medical students was trained to collect the data and interviewed the subjects in their places of work using open-ended questions. The interviews were recorded, translated where necessary, and transcribed. Content analysis was carried out as a team, with the identification of major and minor themes.ResultsThe findings of this study were consistent with studies from other countries, with some interesting differences. The major themes that emerged from the data included the wide range of activities that subjects were involved in, the importance of relationships, the context of poverty, the frustrations of this kind of work, and the respondents' motivations. These are illustrated by numerous verbatim quotes from the respondents. Minor themes were the roles that the respondents play in the community, the difficulty of obtaining funding, and experiences in starting up. Significantly, the fact that the role of clinicians in the community emerged as only a minor theme rather than a major theme in this study indicates the absence of expectation and policy in this area of practice in South Africa. In the light of the supposed centrality of the primary healthcare approach in the national health system, this is a serious gap. ConclusionThe lack of a clearly defined role in the community outside of the clinical role that deals with the individual patient who presents for care is discussed in relation to the policy of the primary health care approach. The concept of community-oriented primary care provides a framework for a more systematic approach to community engagement, and this study serves as a basis for further research into the subject.For full text, click here:SA Fam Pract 2006;48(8):16-16

Factors impacting the selection of psychiatric hospitals for community service placement of nurses

Background. As a strategy to promote access to quality health services, including psychiatric nursing, compulsory community service for nurses wasintroduced in January 2008.Objective. To determine the factors impacting the KwaZulu-Natal College of Nursing (KZNCN) student nurses’ selection of psychiatric hospitals as theirplacement areas for community service.Methods. A quantitative, exploratory, descriptive research design was adopted. Convenience sampling was used to select 125 respondents from sixcampuses of KZNCN. An electronic 5-point Likert scale-based self-administered questionnaire was used to collect data. SPSS version 26 (IBM Corp.,USA) was used for data analysis.Results. The study found that the following factors impacted the selection of psychiatric hospitals for community service: insufficient time allocated forthe practice of psychiatry during training; fear of exposure to threat; poor infrastructure and scarce facilities; and insufficient danger allowance.Conclusion. A positive practice environment should be created in psychiatric hospitals to attract student nurses and retain them in the psychiatricenvironment after community service

A cluster‐randomized controlled trial to improve the quality of integrated HIV‐tuberculosis services in primary healthcareclinics in South Africa

Introduction: Tuberculosis (TB) remains the most common cause of death among people living with HIV. Integrating HIV and TB services reduces mortality but is sub-optimally implemented. Quality improvement (QI) methods offer a low-cost and easily implementable approach to strengthening healthcare delivery systems. This trial assessed a QI intervention on key process indicators for delivering integrated HIV-TB care in rural South African primary healthcare (PHC) clinics. Methods: Sixteen nurse supervisors, (each with a cluster of clinics) overseeing 40 PHC clinics, were randomized 1:1 to the intervention or the standard of care (SOC) groups. The QI intervention comprised three key components: clinical and QI skills training, on-site mentorship of nurse supervisors and clinic staff, and data quality improvement activities to enhance accuracy and completeness of routine clinic data. The SOC comprised monthly supervision and data feedback meetings. From 01 December 2016 to 31 December 2018, data were collected monthly by a team of study-appointed data capturers from all study clinics. This study's outcomes were HIV testing services (HTS), TB screening, antiretroviral therapy (ART) initiation, isoniazid preventive therapy (IPT) initiation and viral load (VL) testing. Results: The QI group (eight clusters) comprised 244 clinic staff who attended to 13,347 patients during the trial compared to the SOC group (eight clusters) with 217 clinic staff who attended to 8141 patients. QI mentors completed 85% (510/600) of expected QI mentorship visits to QI clinics. HTS was 19% higher [94.5% vs. 79.6%; relative risk (RR)=1.19; 95% CI: 1.02–1.38; p=0.029] and IPT initiation was 66% higher (61.2 vs. 36.8; RR=1.66; 95% CI: 1.02–2.72; p=0·044), in the QI group compared to SOC group. The percentage of patients screened for TB (83.4% vs. 79.3%; RR=1.05; p=0.448), initiated on ART (91.7 vs. 95.5; RR=0.96; p=0.172) and VL testing (72.2% vs. 72.8%; RR=0.99; p=0.879) was similar in both groups. Conclusions: QI improved HIV testing and IPT initiation compared to SOC. TB screening, ART initiation and VL testing remained similar. Incorporating QI methods into routine supervision and support activities may strengthen integrated HIV-TB service delivery and increase the success of future QI scale-up activities

Deep learning of HIV field-based rapid tests

Although deep learning algorithms show increasing promise for disease diagnosis, their use with rapid diagnostic tests performed in the field has not been extensively tested. Here we use deep learning to classify images of rapid human immunodeficiency virus (HIV) tests acquired in rural South Africa. Using newly developed image capture protocols with the Samsung SM-P585 tablet, 60 fieldworkers routinely collected images of HIV lateral flow tests. From a library of 11,374 images, deep learning algorithms were trained to classify tests as positive or negative. A pilot field study of the algorithms deployed as a mobile application demonstrated high levels of sensitivity (97.8%) and specificity (100%) compared with traditional visual interpretation by humans-experienced nurses and newly trained community health worker staff-and reduced the number of false positives and false negatives. Our findings lay the foundations for a new paradigm of deep learning-enabled diagnostics in low- and middle-income countries, termed REASSURED diagnostics1, an acronym for real-time connectivity, ease of specimen collection, affordable, sensitive, specific, user-friendly, rapid, equipment-free and deliverable. Such diagnostics have the potential to provide a platform for workforce training, quality assurance, decision support and mobile connectivity to inform disease control strategies, strengthen healthcare system efficiency and improve patient outcomes and outbreak management in emerging infections

Transcription as a Key Phase of Data Analysis in Qualitative Research: Experience from KwaZulu-Natal, South Africa.

Transforming spoken words into written text in qualitative research is a vital step in familiarizing and immersing oneself in the data. We share a three-step approach of how data transcription facilitated an interpretative act of analysis in a study using qualitative data collection methods on the barriers and facilitators of HIV testing and treatment in KwaZulu-Natal, South Africa

Pitfalls of Single Measurement Screening for Diabetes and Hypertension in Community-Based Settings

Background: Cross-sectional screening programs are used to detect and refer individuals with non-communicable diseases to healthcare services. We evaluated the positive predictive value of cross-sectional measurements for Diabetes Mellitus (DM) and hypertension (HTN) as part of a community-based disease screening study, ‘Vukuzazi’ in rural South Africa. Methods: We conducted community-based screening for HTN and DM using the World Health Organization STEPS protocol and glycated haemoglobin A1c (HbA1c) testing, respectively. Nurses conducted follow-up home visits for confirmatory diagnostic testing among individuals with a screening BP above 140/90 mmHg and/or HbA1c above 6.5% at the initial screen, and without a prior diagnosis. We assessed the positive predictive value of the initial screening, compared to the follow up measure. We also sought to identify a screening threshold for HTN and DM with greater than 90% positive predictive value. Results: Of 18,027 participants enrolled, 10.2% (1,831) had a screening BP over 140/90 mmHg. Of those without a prior diagnosis, 871 (47.6%) received follow-up measurements. Only 51.2% (451) of those with completed follow-up measurements had a repeat BP>140/90 mmHg at the home visit and were referred to care. To achieve a 90% correct referral rate, a systolic BP threshold of 192 was needed at first screening. For DM screening, 1,615 (9.0%) individuals had an HbA1c > 6.5%, and of those without a prior diagnosis, 1,151 (71.2%) received a follow-up blood glucose. Of these, only 34.1% (395) met criteria for referral for DM. To ensure a 90% positive predictive value i.e. a screening HbA1c of >16.6% was needed. Conclusions: A second home-based screening visit to confirm a diagnosis of DM and HTN reduced health system referrals by 48% and 66%, respectively. Two-day screening programmes for DM and HTN screening might save individual and healthcare resources and should be evaluated carefully in future cost effectiveness evaluations