Prevention of vertical transmission of HIV in Khayelitsha, South Africa: A contemporary review of services after 20 years

Background. The first vertical transmission of HIV prevention (VTP) programme in South Africa was launched in 1999 in Khayelitsha, Western Cape Province (WC). Since then, VTP guidelines have expanded in complexity and scope. Objectives. To describe contemporary VTP uptake in Khayelitsha and quantify vertical transmission (VT) risk factors based on linked routine electronic health data. Methods. In the WC, all patients at public health facilities have a unique identifier allowing linkage across electronic health platforms through a health information exchange hosted within the WC Department of Health. We conducted a cohort analysis of mother-infant pairs where the mother was living with HIV and attended any obstetric care in Khayelitsha in 2017. Descriptive statistics assessed VTP coverage along the care cascade, including maternal viral load (VL) testing and early infant diagnosis (EID). Logistic regression analysis quantified a priori-defined risk factors associated with VT. Results. Antenatal HIV prevalence in the cohort was 31.3%, and VT was 1.8% by 12 months. Of women living with HIV, 88.3% knew of their positive status at the first antenatal visit and 77.9% were already receiving antiretroviral therapy (ART). Most women diagnosed prior to delivery (94.5%) were initiated on ART; 85.0% received an antenatal VL test, of whom 88.0% were virologically suppressed. Women who were not virally suppressed had a five-fold (adjusted odds ratio (aOR) 5.3; 95% confidence interval (CI) 2.5 - 12.3) increased VT risk compared with those who were suppressed. Women who attended no antenatal care were at higher risk of VT (aOR 1.6; 95% CI 0.7 - 3.6) than those who did attend. EID coverage was suboptimal: a birth HIV polymerase chain reaction (PCR) test was available for 79.2% of infants, and a low proportion with a negative birth test had a repeat test around 10 weeks (57.9%). Data linkage identified an additional 15 infants living with HIV who were not detected by HIV-PCR testing alone. Conclusion. Although most women presented to care already knowing their HIV status, ART initiation was suboptimal prior to the first antenatal visit but improved over the course of pregnancy. The VT rate based on laboratory HIV-PCR testing alone underestimated HIV transmission: linked data from multiple sources suggested higher VT than programme-reported rates based on HIV-PCR testing alone

Risk factors for Coronavirus Disease 2019 (COVID-19) death in a population cohort study from the Western Cape Province, South Africa

BACKGROUND. Risk factors for coronavirus disease 2019 (COVID-19) death in sub-Saharan Africa and the effects of human immunodeficiency virus (HIV) and tuberculosis on COVID-19 outcomes are unknown. METHODS. We conducted a population cohort study using linked data from adults attending public-sector health facilities in the Western Cape, South Africa. We used Cox proportional hazards models, adjusted for age, sex, location, and comorbidities, to examine the associations between HIV, tuberculosis, and COVID-19 death from 1 March to 9 June 2020 among (1) public-sector “active patients” (≥1 visit in the 3 years before March 2020); (2) laboratory-diagnosed COVID-19 cases; and (3) hospitalized COVID-19 cases. We calculated the standardized mortality ratio (SMR) for COVID-19, comparing adults living with and without HIV using modeled population estimates. RESULTS. Among 3 460 932 patients (16% living with HIV), 22 308 were diagnosed with COVID-19, of whom 625 died. COVID- 19 death was associated with male sex, increasing age, diabetes, hypertension, and chronic kidney disease. HIV was associated with COVID-19 mortality (adjusted hazard ratio [aHR], 2.14; 95% confidence interval [CI], 1.70–2.70), with similar risks across strata of viral loads and immunosuppression. Current and previous diagnoses of tuberculosis were associated with COVID-19 death (aHR, 2.70 [95% CI, 1.81–4.04] and 1.51 [95% CI, 1.18–1.93], respectively). The SMR for COVID-19 death associated with HIV was 2.39 (95% CI, 1.96–2.86); population attributable fraction 8.5% (95% CI, 6.1–11.1). CONCLUSIONS. While our findings may overestimate HIV- and tuberculosis-associated COVID-19 mortality risks due to residual confounding, both living with HIV and having current tuberculosis were independently associated with increased COVID-19 mortality. The associations between age, sex, and other comorbidities and COVID-19 mortality were similar to those in other settings.The Western Cape Provincial Health Data Centre from the Western Cape Department of Health, the US National Institutes for Health (grant numbers R01 HD0804, the Bill and Melinda Gates Foundation, the United States Agency for International Development and the Wellcome Trust.https://academic.oup.com/cid/am2023Veterinary Tropical Disease

Revitalised Intersections: The Palimpsest of Durban and its Port

The discourse of the dissertation is focused on the near future development of Durban’s premier port towards the year 2048 (Transnet 2019: 37) whilst reflecting on the developmental interest of the city to extend or overlap within port boundaries to create more dynamic and integrated programmes. The dissertation focuses on a particular characteristic of port design related to the architectural discipline being the immediate harbour mouth interface to existing infrastructure. By doing this the researcher is able to outline opportunities or constraints on-site and develop possible building strategies concurrently with available theory. The aim of the study is then to dissect concepts/precedents of harbour/port-city identity and explore how Durban shapes up to other international port-city expansions that deal with modernisation proposals regarding port efficiency, programme and productivity. The methodology breaks down the main research question and sub question(s) with their particular needs in parallel with the port extension development project envisioned by Transnet and Transnet National Port Authority port expansion documentation (Mpuku 2018, Tnpa 2019: 21-37, Transnet 2019: 19) and from such methods, an architectural possibility arrises by noticing absences in planning and opportunities through the research questions investigated. The intention is to recognise the port as an extension of civic possibility as well as industrial/commercial development that can deal with functionality, architectural innovation and spatial integration issues that spill into the city. The project seeks to explore challenges and potentials of the site as well as combine and/or overlay programmes and typologies to benefit the fluid nature of constant movement and access around the harbour and the vision is to create a dynamic and inviting urban environment that promotes innovation and trade whilst bringing in leisure, craft, events and conference in a singular space. This living ‘waterfront’ can therefore form basis of a catalyst for the resurgence of an identified seaport.Mini Dissertation (MArch Prof)--University of Pretoria, 2021.ArchitectureMArch ProfUnrestricte

Children's experiences and needs in relation to domestic and family violence : Findings from a meta-synthesis

Domestic and family violence is a significant issue experienced by many children that can have severe detrimental impacts to their health, development, and well-being. Despite the significance of this issue, it is only recently that children have been included in research that seeks to understand the impacts that domestic and family violence may have on their lives. This paper reports on the findings of a meta-synthesis, which explored qualitative research about children's experiences of domestic and family violence. Thirty-two studies, including from the United Kingdom, North America, and Australia were included for review. The meta-synthesis found that children describe domestic violence as being a complex, isolating, and enduring experience that often results in disruption, losses, and challenges to their significant relationships. Children's common feelings of fear, worry, powerlessness, and sadness were also uncovered, in addition to the strategies they employed to try and facilitate the safety and emotional well-being of themselves and their family. Children's wants and needs are also highlighted. The findings demonstrate that despite the increasing interest in children's experiences of domestic and family violence, qualitative research remains limited, with many gaps evident. Implications for research, policy, and practice are considered