Perceptions about the acceptability and prevalence of HIV testing and factors influencing them in different communities in South Africa

HIV counselling and testing (HCT) is considered important because it is an entry point to a comprehensive continuum of care for HIV/AIDS. The South African Department of Health launched an HCT campaign in April 2010, and this reached 13,269,746 people by June 2011, of which 16% tested HIV positive and 400,000 of those were initiated into antiretroviral treatment. The overall objective of this project was to gain insight into the general perceptions about HIV testing in the different South African communities. Factors influencing testing in these communities were also explored. Discussions with twelve focus groups (FG) of 8–12 participants each were  conducted with male and female participants recruited from both urban formal and informal communities in Cape Town and Durban. Participants included four racial groups represented by different age groups as follows: adolescents (12–17 years), youth (18–24 years) and adults (25 years and older). Data were analyzed using thematic coding. Among the key themes that emerged from the findings were the inaccurate perception of risk, fear of testing HIV positive, stigma and discrimination. Participants from both African and Indian FGs reported being less likely to do self-initiated HIV testing and counselling, while those from the FG consisting of young whites were more likely to learn about their HIV status through blood donations and campus HIV testing campaigns. Most FGs said they were likely to test if they understood the testing process better and also if the results are kept confidential. The present findings reiterate the importance of spreading positive messages and ensuring confidentiality for HIV testing in a society where there is still some stigma associated with people living with HIV/AIDS. This can partly be accomplished by the continuation of the national HCT campaign, which has been a considerable success in the fight against HIV/AIDS in South Africa during the past two years.Keywords: HIV Counselling and Testing, perceptions, stigma, discrimination and confidentiality, South AfricaLe conseil et le de´pistage (CDV) du VIH sont conside´re´s importants pour les programmes de soins du VIH/SIDA. Le ministe`re sudafricain de la Sante´ a lance´ une campagne de CDV en avril 2010, et a atteint 13 269 746 personnes en juin 2011, dont 16% ont e´te´ identifie´s se´ropositifs, et dont 400,000 ont commence´ le traitement antire´troviral. L’objectif global de ce projet e´tait de mieux comprendre les perceptions ge´ne´rales sur le de´pistage du VIH dans les diffe´rentes communaute´s sud-africaines. Les facteurs influenc¸ant la participation au de´pistage du VIH ont e´te´ aussi e´tudie´s. Douze groupes de discussion (GDD), consistant de huit a` douze hommes et femmes, ont e´te´ forme´s. Les participants e´taient recrute´s dans les localite´s urbaines formelles et informelles a` Cape-Town et a` Durban. Les groupes e´taient repartie en quatre sur base d’ethnicite´, repre´sentant diffe´rents groupes d’aˆge: les adolescents (12–17 ans), les jeunes (18–24 ans) et les adultes (25 ans et plus). Les donne´es ont e´te´ analyse´es en utilisant un codage the´matique. La  perception errone´e du risque, la peur du de´pistage du VIH, la stigmatisation et la discrimination e´taient parmi les principaux the`mes qui ont e´merge´. Les participants africains et indiens ont de´clare´ d’eˆtre moins dispose´s a` se faire tester pour le VIH a` propre initiative, tandis que les jeunes blancs e´taient dispose´s a` connaıˆtre leur statut VIH graˆce aux dons de sang et aux campagnes universitaires de de´pistage du VIH. La plupart des participants des DDG ont dit qu’ils e´taient dispose´s a` se laisser tester s’ils avaient une meilleure compre´hension du processus de de´pistage, et s’ils e´taient convaincus de sa confidentialite´. Les re´sultats de cette recherche ont re´ite´re´ l’importance de la diffusion de messages positifs et de la confidentialite´ des re´sultats le de´pistage du VIH dans une socie´te´ ou` il y a encore un stigmate associe´ au VIH. Cela peut eˆtre accompli en partie par la poursuite de la campagne nationale de CDV, qui a e´te´ un succe`s conside´rable dans la lutte contre le VIH/SIDA en Afrique du Sud au cours des deux dernie`res anne´es.Mots cle´s: Le conseil et le depistage du VIH, Perceptions, stigmate, discrimination, confidentialite, Afrique du Su

Mapping geographical inequalities in oral rehydration therapy coverage in low-income and middle-income countries, 2000-17

Background Oral rehydration solution (ORS) is a form of oral rehydration therapy (ORT) for diarrhoea that has the potential to drastically reduce child mortality; yet, according to UNICEF estimates, less than half of children younger than 5 years with diarrhoea in low-income and middle-income countries (LMICs) received ORS in 2016. A variety of recommended home fluids (RHF) exist as alternative forms of ORT; however, it is unclear whether RHF prevent child mortality. Previous studies have shown considerable variation between countries in ORS and RHF use, but subnational variation is unknown. This study aims to produce high-resolution geospatial estimates of relative and absolute coverage of ORS, RHF, and ORT (use of either ORS or RHF) in LMICs. Methods We used a Bayesian geostatistical model including 15 spatial covariates and data from 385 household surveys across 94 LMICs to estimate annual proportions of children younger than 5 years of age with diarrhoea who received ORS or RHF (or both) on continuous continent-wide surfaces in 2000-17, and aggregated results to policy-relevant administrative units. Additionally, we analysed geographical inequality in coverage across administrative units and estimated the number of diarrhoeal deaths averted by increased coverage over the study period. Uncertainty in the mean coverage estimates was calculated by taking 250 draws from the posterior joint distribution of the model and creating uncertainty intervals (UIs) with the 2 center dot 5th and 97 center dot 5th percentiles of those 250 draws. Findings While ORS use among children with diarrhoea increased in some countries from 2000 to 2017, coverage remained below 50% in the majority (62 center dot 6%; 12 417 of 19 823) of second administrative-level units and an estimated 6 519 000 children (95% UI 5 254 000-7 733 000) with diarrhoea were not treated with any form of ORT in 2017. Increases in ORS use corresponded with declines in RHF in many locations, resulting in relatively constant overall ORT coverage from 2000 to 2017. Although ORS was uniformly distributed subnationally in some countries, within-country geographical inequalities persisted in others; 11 countries had at least a 50% difference in one of their units compared with the country mean. Increases in ORS use over time were correlated with declines in RHF use and in diarrhoeal mortality in many locations, and an estimated 52 230 diarrhoeal deaths (36 910-68 860) were averted by scaling up of ORS coverage between 2000 and 2017. Finally, we identified key subnational areas in Colombia, Nigeria, and Sudan as examples of where diarrhoeal mortality remains higher than average, while ORS coverage remains lower than average. Interpretation To our knowledge, this study is the first to produce and map subnational estimates of ORS, RHF, and ORT coverage and attributable child diarrhoeal deaths across LMICs from 2000 to 2017, allowing for tracking progress over time. Our novel results, combined with detailed subnational estimates of diarrhoeal morbidity and mortality, can support subnational needs assessments aimed at furthering policy makers' understanding of within-country disparities. Over 50 years after the discovery that led to this simple, cheap, and life-saving therapy, large gains in reducing mortality could still be made by reducing geographical inequalities in ORS coverage. Copyright (c) 2020 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license.Peer reviewe

Visual impairment and blindness: an overview of prevalence and causes in Brazil

Our purpose is to provide a summary overview of blindness and visual impairment on the context of recent Brazilian ocular epidemiologic studies. Synthesis of data from two cross-sectional population-based studies - the São Paulo Eye Study and the Refractive Error in School Children Study is presented. 3678 older adults and 2441 school children were examined between July 2004 and December 2005. Prevalence of blindness in older adults using presenting visual acuity was 1.51% decreasing to 1. 07% with refractive correction. The most common causes of blindness in older adults were retinal disorders, followed by cataract and glaucoma. In school children, the prevalence of uncorrected visual impairment was 4.82% decreasing to 0.41% with refractive correction. The most common cause of visual impairment in school children was uncorrected refractive error. Visual impairment and blindness in Brazil is an important public health problem. It is a significant problem in older Brazilians, reinforcing the need to implement prevention of blindness programs for elderly people with emphasis on those without schooling. In school-children cost-effective strategies are needed to address a readily treatable cause of vision impairment - prescription and provision of glasses.<br>Nosso objetivo é fazer uma revisão de cegueira e deficiência visual no contexto de recentes estudos epidemiológicos oculares brasileiros. É apresentada a síntese dos dados de dois estudos populacionais transversais - o Estudo Ocular de São Paulo e o Estudo de Erros Refrativos em Escolares. Entre julho de 2004 e dezembro de 2005 foram examinados 3678 adultos e 2441 escolares. A prevalência de cegueira em adultos mais velhos considerando a acuidade visual apresentada foi de 1, 51% diminuindo para 1, 07% com a correção refrativa. As causas mais comuns de cegueira em adultos mais velhos foram os distúrbios de retina, seguidos de catarata e glaucoma. Em escolares a prevalência de deficiência visual não corrigida foi de 4,82% diminuindo para 0,41% com a correção refrativa. Em escolares a causa mais comum de deficiência visual foram erros refrativos não corrigidos. A deficiência visual e a cegueira são um importante problema de saúde pública no Brasil. É um problema significante em brasileiros mais velhos reforçando a necessidade de implementação de programas de prevenção de cegueira para pessoas idosas com ênfase nos indivíduos sem escolaridade. Em escolares são necessárias estratégias de custo-eficácia para atingir uma causa de deficiência visual facilmente tratável - a prescrição e a provisão de óculos