Challenges with using estimates when calculating ART need among adults in South Africa

Background. The Foundation for Professional Development (FPD) collects information annually on HIV/AIDS service provision and estimates service needs in the City of Tshwane Metropolitan Municipality (CTMM). Methods. Antiretroviral therapy (ART) data from the Department of Health and Statistics South Africa (SSA) mid-year population estimates were used to approximate the ART need among adults in the CTMM. Results. According to SSA data, ART need decreased dramatically from 2010 to 2011 and was lower than the number of adults receiving ART. Although the noted difference was probably due to changes in the calculations by SSA, no detailed or confirmed explanation could be offered. Conclusions. We provide a constructive contribution to the discussion regarding the use of model-derived estimates of ART need

Provision and need of HIV/AIDS services in the City of Tshwane Metropolitan Municipality, 2010

Objectives. To determine the need for HIV/AIDS service provision in the City of Tshwane Metropolitan Municipality (CTMM), especially in municipal areas. Methods. The Foundation for Professional Development initiated the Compass Project. Using a questionnaire, data were collected during May - June 2010 from organisations providing HIV/AIDS services in the CTMM (organisational information and types of HIV/AIDS services). The need for HIV counselling and testing (HCT), antiretroviral treatment (ART), prevention of mother-tochild transmission (PMTCT), and care for orphans and vulnerable children (OVC) was estimated using data from various sources. Results. A total of 447 service providers was included in the study: 72.3% non-governmental organisations (NGOs); 18.1% in the public sector; 5.1% in the private sector; and 4.5% faithbased organisations. The majority of the prevention- (70.2%) and support-related services (77.4%) were provided by NGOs, while the majority of treatment-related services originated from the public sector (57.3%). Service need estimates included: HCT – 1 435 438 adults aged 15 - 49 years (11 127/service provider); total ART – 75 211 adults aged 15+ years (1 213/service provider); ART initiation – 30 713 adults aged 15+ years (495/service provider); PMTCTHCT – 30 092 pregnant women (510/service provider); PMTCTART – 7 734 HIV+ pregnant women (221/service provider); and OVC care – 54 590 children (258/service provider). Conclusions. Service gaps remain in the provision of HCT, PMTCT-ART and OVC care. ART provision must be increased, in light of new treatment guidelines from the Department of Health.S Afr Med J 2012;102:44-4

First-time- and repeat testers for HIV : a demographic and HIV prevalence comparison amongst clients at mobile HIV Counselling and Testing sites in Tshwane, South Africa

There has been significant debate, specifically within the African context, regarding the validity of using HCT data as part of routine surveillance data for the HIV epidemic. The use of HCT data in tracking the prevalence of HIV, as well as in estimating incidence rates for HIV, has been applied in some African countries, and may offer opportunities to strengthen surveillance in the Gauteng Province, South Africa. Literature suggests HCT data are biased as a result of the high proportion of repeat testers, where repeat testing may be related to high risk sexual behaviour. (1–8) It has been suggested that HCT data be separated into first-time- and repeat tester data in prevalence or incidence estimations. (9) The aim of this research was to determine if there are demographic and HIV prevalence differences between first-time- and repeat testers, as suggested in the literature. (9) Existing mobile HCT unit data was used from the Foundation for Professional Development (FPD). The data was collected in the Tshwane Metropolitan Municipality, Gauteng Province, South Africa. An observational, cross-sectional study design was applied. A systematic random sample of 400 first-time testers and 400 repeat-testers was drawn and analyzed. The findings of this study indicated an overall 10.0% (n=80) HIV prevalence rate. When compared to the Gauteng adult prevalence (15+) of 14.4%, the study prevalence is lower. (10) When looking at the characteristics of the first-time tester and repeat tester groups, there was an HIV prevalence rate of 12.5% (n=51/407, p=0.0152) in the first-time tester group, and 7.4% (n=29/393, p=0.0152) HIV prevalence rate in the repeat tester group. Although literature suggests that repeat testers are the more at risk population, the finding in this study clearly demonstrates that there is a difference in HIV prevalence between first-time- and repeat testers. When first-time/repeat tester was used as the dependent variable, it was found that females are 0.6 less times likely to be a first-time tester compared to males (OR=0.6, p=0.001). The finding of a difference in HIV prevalence between first-time- and repeat tester groups was consistent with three other studies in Ethiopia, Uganda and Kenya. In these studies, HIV prevalence in first-time testers was slightly higher than in that of repeat-testers. (3,11,12) It was found that there is a difference in the HIV and demographic profile between those who test for HIV for the first time and those who are repeat testers. The perceived risk and vulnerability to HIV plays a heavy role in motivating individuals to test once, or repeatedly. In regards to disease surveillance, this study did not prove that the population that utilises mobile HCT are representative of the Tshwane population. This study highlighted the need to better understand the sub-groups and characteristics of those who test for the first-time and those who test repeatedly for HIV. In conclusion, this study has provided evidence that there is a difference between the HIV prevalence of first-time- and repeat testers. However, there is good reason to doubt that the prevalence rate of first-time testers is genuine. CopyrightDissertation (MSc)--University of Pretoria, 2013.School of Health Systems and Public Health (SHSPH)Unrestricte

Challenges with using estimates when calculating ART need among adults in South Africa

Background. The Foundation for Professional Development (FPD) collects information annually on HIV/AIDS service provision and estimates service needs in the City of Tshwane Metropolitan Municipality (CTMM). Methods. Antiretroviral therapy (ART) data from the Department of Health and Statistics South Africa (SSA) mid-year population estimates were used to approximate the ART need among adults in the CTMM. Results. According to SSA data, ART need decreased dramatically from 2010 to 2011 and was lower than the number of adults receiving ART. Although the noted difference was probably due to changes in the calculations by SSA, no detailed or confirmed explanation could be offered. Conclusions. We provide a constructive contribution to the discussion regarding the use of model-derived estimates of ART need

Provision and need of HIV/AIDS services in the City of Tshwane Metropolitan Municipality, 2010

Objectives. To determine the need for HIV/AIDS service provision in the City of Tshwane Metropolitan Municipality (CTMM), especially in municipal areas. Methods. The Foundation for Professional Development initiated the Compass Project. Using a questionnaire, data were collected during May - June 2010 from organisations providing HIV/AIDS services in the CTMM (organisational information and types of HIV/AIDS services). The need for HIV counselling and testing (HCT), antiretroviral treatment (ART), prevention of mother-to-child transmission (PMTCT), and care for orphans and vulnerable children (OVC) was estimated using data from various sources. Results. A total of 447 service providers was included in the study: 72.3% non-governmental organisations (NGOs); 18.1% in the public sector; 5.1% in the private sector; and 4.5% faith-based organisations. The majority of the prevention- (70.2%) and support-related services (77.4%) were provided by NGOs, while the majority of treatment-related services originated from the public sector (57.3%). Service need estimates included: HCT – 1 435 438 adults aged 15 - 49 years (11 127/service provider); total ART – 75 211 adults aged 15+ years (1 213/service provider); ART initiation – 30 713 adults aged 15+ years (495/service provider); PMTCT-HCT – 30 092 pregnant women (510/service provider); PMTCT-ART – 7 734 HIV+ pregnant women (221/service provider); and OVC care – 54 590 children (258/service provider). Conclusions. Service gaps remain in the provision of HCT, PMTCT-ART and OVC care. ART provision must be increased, in light of new treatment guidelines from the Department of Health

Building capacity for evidence-informed decision making: an example from South Africa

Abstract: To maximise the potential impact and acceptability of EIDM capacity building, there is a need for programmes to coordinate their remits within existing systems, playing both ‘insider’ and ‘outsider’ roles. Through a review of the South African evidence-policy landscape and analysis of a stakeholder event that brought together EIDM role players, this paper illustrates how one capacity-building programme navigated its position within the national evidence-policy interface. It identifies strategies for improving the acceptability and potential effectiveness of donor-funded EIDM capacity-building activities: understanding the evidence-policy interface, incorporating programmes into the decision-making infrastructure (being an ‘insider’), whilst retaining an element of neutrality (being an ‘outsider’)

Low dose Naltrexone for induction of remission in inflammatory bowel disease patients

Background: Around 30% of patients with inflammatory bowel disease (IBD) are refractory to current IBD drugs or relapse over time. Novel treatments are called for, and low dose Naltrexone (LDN) may provide a safe, easily accessible alternative treatment option for these patients. We investigated the potential of LDN to induce clinical response in therapy refractory IBD patients, and investigated its direct effects on epithelial barrier function. Methods: Patients not in remission and not responding to conventional therapy were offered to initiate LDN as a concomitant treatment. In total 47 IBD patients prescribed LDN were followed prospectively for 12 weeks. Where available, endoscopic remission data, serum and biopsies were collected. Further the effect of Naltrexone on wound healing (scratch assay), cytokine production and endoplasmic reticulum (ER) stress (GRP78 and CHOP western blot analysis, immunohistochemistry) were investigated in HCT116 and CACO2 intestinal epithelial cells, human IBD intestinal organoids and patient samples. Results: Low dose Naltrexone induce

Is there scope for community health nurses to address lifestyle risk factors? : the community nursing SNAP trial

Background: This paper examines the opportunity and need for lifestyle interventions for patients attending generalist community nursing services in Australia. This will help determine the scope for risk factor management within community health care by generalist community nurses (GCNs).Methods: This was a quasi-experimental study conducted in four generalist community nursing services in NSW, Australia. Prior to service contacts, clients were offered a computer-assisted telephone interview to collect baseline data on socio-demographics, health conditions, smoking status, physical activity levels, alcohol consumption, height and weight, fruit and vegetable intake and 'readiness-to-change' for lifestyle risk factors.Results: 804 clients participated (a response rate of 34.1%). Participants had higher rates of obesity (40.5% vs 32.1%) and higher prevalence of multiple risk factors (40.4% vs 29.5%) than in the general population. Few with a SNAPW (Smoking-Nutrition-Alcohol-Physical-Activity-Weight) risk factor had received advice or referral in the previous 3 months. The proportion of clients identified as at risk and who were open to change (i.e. contemplative, in preparation or in action phase) were 65.0% for obese/overweight; 73.8% for smokers; 48.2% for individuals with high alcohol intake; 83.5% for the physically inactive and 59.0% for those with poor nutrition.Conclusions: There was high prevalence of lifestyle risk factors. Although most were ready to change, few clients recalled having received any recent lifestyle advice. This suggests that there is considerable scope for intervention by GCNs. The results of this trial will shed light on how best to implement the lifestyle risk factor management in routine practice

UNBOUND

This adjective - ex-traor-di-nary, describes the creative talents of our graduating Fashion Design class of 2009. Their accomplishments are a true celebration of the three years of passion, hard work, and dedication of our student designers. It is our hope that family, friends and the fashion industry will enjoy the creative endeavours of the next generation of Canadian fashion talent from the Fashion design program at Fanshawe College in London, Ontario.https://first.fanshawec.ca/famd_design_fashiondesign_unbound/1006/thumbnail.jp