37 research outputs found
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Experiences of HIV-positive postpartum women and health workers involved with community-based antiretroviral therapy adherence clubs in Cape Town, South Africa
Background
The rollout of universal, lifelong treatment for all HIV-positive pregnant and breastfeeding women (âOption B+â) has rapidly increased the number of women initiating antiretroviral treatment (ART) and requiring ART care postpartum. In a pilot project in South Africa, eligible postpartum women were offered the choice of referral to the standard of care, a local primary health care clinic, or a community-based model of differentiated ART services, the adherence club (AC). ACs have typically enrolled only non-pregnant and non-postpartum adults; postpartum women had not previously been referred directly from antenatal care. There is little evidence regarding postpartum womenâs preferences for and experiences of differentiated models of care, or the capacity of this particular model to cater to their specific needs. This qualitative paper reports on feedback from both postpartum women and health workers who care for them on their respective experiences of the AC.
Methods
One-on-one in-depth qualitative interviews were conducted with 19 (23%) of the 84 postpartum women who selected the AC and were retained at approximately 12Â months postpartum, and 9 health workers who staff the AC. Data were transcribed and thematically analysed using NVivo 11.
Results
Postpartum womenâs inclusion in the AC was acceptable for both participants and health workers. Health workers were welcoming of postpartum women but expressed concerns about prospects for longer term adherence and retention, and raised logistical issues they felt might compromise trust with AC members in general.
Conclusions
Enrolling postpartum women in mixed groups with the general adult population is feasible and acceptable. Preliminary recommendations are offered and may assist in supporting the specific needs of postpartum women transitioning from antenatal ART care.
Trial registration
Number NCT02417675
clinicaltrials.gov/ct2/show/record/NCT02417675
(retrospective reg.
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Re-recruiting postpartum women living with HIV into a follow-up study in Cape Town, South Africa
Objective
Recruitment and retention present major challenges to longitudinal research in maternal and child health, yet there are few insights into optimal strategies that can be employed in low-resource settings. Following prior participation in a longitudinal study following women living with HIV through pregnancy and breastfeeding in Cape Town, women were re-contacted at least 18Â months after the last study contact and were invited to attend an additional follow-up visit. We describe lessons learnt and offer recommendations for a multiphase recruitment approach.
Results
Using telephone calls, home visits, clinic tracing and Facebook/WhatsApp messages, we located 387 of the 463 eligible women and successfully enrolled 353 (91% of those contacted). Phone calls were the most successful strategy, yielding 67% of enrolments. Over half of the women had changed their contact information since participation in the previous study. We recommend that researchers collect multiple contact details and use several recruitment strategies in parallel from the start of a study. Participants in longitudinal studies may require frequent contact to update contact information, particularly in settings where mobility is common
Re-recruiting postpartum women living with HIV into a follow-up study in Cape Town, South Africa
Abstract
Objective
Recruitment and retention present major challenges to longitudinal research in maternal and child health, yet there are few insights into optimal strategies that can be employed in low-resource settings. Following prior participation in a longitudinal study following women living with HIV through pregnancy and breastfeeding in Cape Town, women were re-contacted at least 18Â months after the last study contact and were invited to attend an additional follow-up visit. We describe lessons learnt and offer recommendations for a multiphase recruitment approach.
Results
Using telephone calls, home visits, clinic tracing and Facebook/WhatsApp messages, we located 387 of the 463 eligible women and successfully enrolled 353 (91% of those contacted). Phone calls were the most successful strategy, yielding 67% of enrolments. Over half of the women had changed their contact information since participation in the previous study. We recommend that researchers collect multiple contact details and use several recruitment strategies in parallel from the start of a study. Participants in longitudinal studies may require frequent contact to update contact information, particularly in settings where mobility is common
CareConekta: study protocol for a randomized controlled trial of a mobile health intervention to improve engagement in postpartum HIV care in South Africa
Abstract
Background
South Africa is home to the worldâs largest antiretroviral therapy program but sustaining engagement along the HIV care continuum has proven challenging in the country and throughout the wider region. Population mobility is common in South Africa, but there are important research gaps in describing this mobility and its impact on engagement in HIV care. Postpartum women and their infants in South Africa are known to be at high risk of dropping out of HIV care after delivery and are frequently mobile.
Methods
In 2017, we developed a beta version of a smartphone application (app) - CareConekta - that detects a userâs smartphone location to allow for prospective characterization of mobility. Now we will adapt and test CareConekta to conduct essential formative work on mobility and evaluate an intervention - the CareConekta app plus text notifications and phone calls and/or WhatsApp messages - to facilitate engagement in HIV care during times of mobility. During the 3-year project period, our first objective is to evaluate the feasibility, acceptability, and initial efficacy of using CareConekta as an intervention to improve engagement in HIV care. Our second objective is to characterize mobility among South African women during the peripartum period and its impact on engagement in HIV care. We will enroll 200 eligible pregnant women living with HIV and receiving care at the Gugulethu Midwife Obstetric Unit in Cape Town, South Africa.
Discussion
This work will provide critical information about mobility during the peripartum period and the impact on engagement in HIV care. Simultaneously, we will pilot test an intervention to improve engagement with rigorously assessed outcomes. If successful, CareConekta offers tremendous potential as a research and service tool that can be adapted and evaluated in multiple geographic regions, study contexts, and patient populations.
Trial registration
ClinicalTrials.gov: NCT03836625. Registered on 8 February 2019
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Community-based adherence clubs for postpartum women on antiretroviral therapy (ART) in Cape Town, South Africa: a pilot study
Background
With an increasing number of countries implementing Option B+ guidelines of lifelong antiretroviral therapy (ART) for all pregnant and breastfeeding women, there is urgent need to identify effective approaches for retaining this growing and highly vulnerable population in ART care.
Methods
Newly postpartum, breastfeeding women who initiated ART in pregnancy and met eligibility criteria were enrolled, and offered the choice of two options for postpartum ART care: (i) referral to existing network of community-based adherence clubs or (ii) referral to local primary health care clinic (PHC). Women were followed at study measurement visits conducted separately from either service. Primary outcome was a composite endpoint of retention in ART services and viral suppression [VS <â50 copies/mL based on viral load (VL) testing at measurement visits] at 12âmonths postpartum. Outcomes were compared across postpartum services using chi-square, Fisherâs exact tests and Poisson regression models. The primary outcome was compared across services where women were receiving care at 12âmonths postpartum in exploratory analyses.
Results
Between February and September 2015, 129 women (median age: 28.9âyears; median time postpartum: 10âdays) were enrolled with 65% opting to receive postpartum HIV care through an adherence club. Among 110 women retained at study measurement visits, 91 (83%) achieved the composite endpoint, with no difference between those who originally chose clubs versus those who chose PHC services. Movement from an adherence club to PHC services was common: 31% of women who originally chose clubs and were engaged in care at 12âmonths postpartum were attending a PHC service. Further, levels of VS differed significantly by where women were accessing ART care at 12âmonths postpartum, regardless of initial choice: 98% of women receiving care in an adherence club and 76% receiving care at PHC had VS <â50 copies/mL at 12âmonths postpartum (pâ=â0.001).
Conclusion
This study found comparable outcomes related to retention and VS at 12âmonths postpartum between women choosing adherence clubs and those choosing PHC. However, movement between postpartum services among those who originally chose adherence clubs was common, with poorer VS outcomes among women leaving clubs and returning to PHC services.
Trial registration
ClinicalTrials.gov
NCT02417675
, April 16, 2015 (retrospectively registered)
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Carbon and nitrogen isotopic ratios of urine and faeces as novel nutritional biomarkers of meat and fish intake
Purpose
Meat and fish consumption are associated with changes in the risk of chronic diseases. Intake is mainly assessed using self-reporting, as no true quantitative nutritional biomarker is available. The measurement of plasma fatty acids, often used as an alternative, is expensive and time-consuming. As meat and fish differ in their stable isotope ratios, ÎŽ13C and ÎŽ15N have been proposed as biomarkers. However, they have never been investigated in controlled human dietary intervention studies.
Objective
In a short-term feeding study, we investigated the suitability of ÎŽ13C and ÎŽ15N in blood, urine and faeces as biomarkers of meat and fish intake.
Methods
The dietary intervention study (n = 14) followed a randomised cross-over design with three eight-day dietary periods (meat, fish and half-meatâhalf-fish). In addition, 4 participants completed a vegetarian control period. At the end of each period, 24-h urine, fasting venous blood and faeces were collected and their ÎŽ13C and ÎŽ15N analysed.
Results
There was a significant difference between diets in isotope ratios in faeces and urine samples, but not in blood samples (KruskalâWallis test, p < 0.0001). In pairwise comparisons, ÎŽ13C and ÎŽ15N were significantly higher in urine and faecal samples following a fish diet when compared with all other diets, and significantly lower following a vegetarian diet. There was no significant difference in isotope ratio between meat and half-meatâhalf-fish diets for blood, urine or faecal samples.
Conclusions
The results of this study show that urinary and faecal ÎŽ13C and ÎŽ15N are suitable candidate biomarkers for short-term meat and fish intake
Finishing the euchromatic sequence of the human genome
The sequence of the human genome encodes the genetic instructions for human physiology, as well as rich information about human evolution. In 2001, the International Human Genome Sequencing Consortium reported a draft sequence of the euchromatic portion of the human genome. Since then, the international collaboration has worked to convert this draft into a genome sequence with high accuracy and nearly complete coverage. Here, we report the result of this finishing process. The current genome sequence (Build 35) contains 2.85 billion nucleotides interrupted by only 341 gaps. It covers âŒ99% of the euchromatic genome and is accurate to an error rate of âŒ1 event per 100,000 bases. Many of the remaining euchromatic gaps are associated with segmental duplications and will require focused work with new methods. The near-complete sequence, the first for a vertebrate, greatly improves the precision of biological analyses of the human genome including studies of gene number, birth and death. Notably, the human enome seems to encode only 20,000-25,000 protein-coding genes. The genome sequence reported here should serve as a firm foundation for biomedical research in the decades ahead
Children of a syndemic: coâoccurring and mutually reinforcing adverse child health exposures in a prospective cohort of HIVâaffected motherâinfant dyads in Cape Town, South Africa
Abstract Introduction Several HIVârelated syndemics have been described among adults. We investigated syndemic vulnerability to hazardous drinking (HD), intimate partner violence (IPV) and household food insecurity (HFIS) in breastfed children born without HIV in urban South Africa. We compared those who were perinatally HIV exposed (CHEU) to those who were not (CHU), under conditions of universal maternal antiretroviral therapy (ART) and breastfeeding. Methods A prospective cohort of pregnant women living with HIV (WLHIV), and without HIV, were enrolled and followed with their infants for 12 months postpartum (2013â2017). All WLHIV initiated antenatal efavirenzâbased ART. Measurements of growth (âŒ3 monthly), infectious cause hospitalisation, ambulatory childhood illness (2âweek recall) and neurodevelopment (BSIDâIII, measured at âŒ12 monthsâ age) were compared across bioâsocial strata using generalised linear regression models, with interaction terms; maternal data included interviewâbased measures for HD (AUDITâC), IPV (WHO VAW) and HFIS. Results Among 872 breastfeeding motherâinfant pairs (n = 461 CHEU, n = 411 CHU), WLHIV (vs. HIV negative) reported more unemployment (279/461, 60% vs. 217/411, 53%; p = 0.02), incomplete secondary education (347/461, 75% vs. 227/411, 55%; p  0.0001). There were positive interactions between maternal HIV and other characteristics. Compared to food secure CHU, the mean difference (95% CI) in weightâforâage Zâscore (WAZ) was 0.06 (â0.14; 0.25) for food insecure CHU; â0.26 (â0.42; â0.10) for food secure CHEU; and â0.43 (â0.61; â0.25), for food insecure CHEU. Results were similar for underweight (WAZ < â2), infectiousâcause hospitalisation, cognitive and motor delay. HIVâIPV interactions were evident for ambulatory diarrhoea and motor delay. There were HIVâHD interactions for odds of underweight, stunting, cognitive and motor delay. Compared to HDâunexposed CHU, the odds ratios (95% CI) of underweight were 2.31 (1.11; 4.82) for HDâexposed CHU; 3.57 (0.84; 15.13) for HDâunexposed CHEU and 6.01 (2.22; 16.22) for HDâexposed CHEU. Conclusions These data suggest that maternal HIVârelated syndemics may partly drive excess CHEU health risks, highlighting an urgent need for holistic maternal and family care and support alongside ART to optimise the health of CHEU
Crystalline Structures of Alkylamide Monolayers Adsorbed on the Surface of Graphite
Synchrotron X-ray and neutron diffraction have been used to determine the two-dimensional crystalline structures of alkylamides adsorbed on graphite at submonolayer coverage. The calculated structures show that the plane of the carbon backbone of the amide molecules is parallel to the graphite substrate. The molecules form hydrogen-bonded dimers, and adjacent dimers form additional hydrogen bonds yielding extended chains. By presenting data from a number of members of the homologous series, we have identified that these chains pack in different arrangements depending on the number of carbons in the amide molecule. The amide monolayers are found to be very stable relative to other closely related alkyl species, a feature which is attributed to the extensive hydrogen bonding present in these systems. The characteristics of the hydrogen bonds have been determined and are found to be in close agreement with those present in the bulk materials
The Implementation of a GPS-Based Location-Tracking Smartphone App in South Africa to Improve Engagement in HIV Care: Randomized Controlled Trial
BackgroundMobile health interventions are common in public health settings in Africa, and our preliminary work showed that smartphones are increasing in South Africa. We developed a novel smartphone appâCareConektaâthat used GPS location data to characterize personal mobility to improve engagement in HIV care among pregnant and postpartum women living with HIV in South Africa. The app also used the userâs location to map nearby clinics.
ObjectiveWe aimed to describe the feasibility, acceptability, and initial efficacy of using the app in a real-world setting.
MethodsWe conducted a prospective randomized controlled trial at a public sector clinic near Cape Town, South Africa. We enrolled 200 pregnant (third trimester) women living with HIV who owned a smartphone that met the required specifications. All participants installed the app, designed to collect 2 GPS heartbeats per day to geolocate the participant within a random 1-km fuzzy radius (for privacy). We randomized (1:1) participants to a control arm to receive the app with no additional support or an intervention arm to receive supportive phone calls, WhatsApp (Meta Platforms, Inc) messages, or both from the study team when traveling >50 km from the study area for >7 days. In addition to mobility data collected daily through the phone, participants completed questionnaires at enrollment and follow-up (approximately 6 months post partum).
ResultsA total of 7 participants were withdrawn at enrollment or shortly after because of app installation failure (6/200, 3%) or changing to an unsuitable phone (1/200, 0.50%). During the study period, no participantâs smartphone recorded at least 1 heartbeat per day, which was our primary feasibility measure. Of the 171 participants who completed follow-up, only half (91/171, 53.2%) reported using the same phone as that used at enrollment, with the CareConekta app still installed on the phone and GPS usually enabled. The top reasons reported for the lack of heartbeat data were not having mobile data, uninstalling the app, and no longer having a smartphone. Acceptability measures were positive, but participants at follow-up demonstrated a lack of understanding of the appâs purpose and function. The clinic finder was a popular feature. Owing to the lack of consistent GPS heartbeats throughout the study, we were unable to assess the efficacy of the intervention.
ConclusionsSeveral key challenges impeded our study feasibility. Although the app was designed to reverse bill participants for any data use, the lack of mobile data was a substantial barrier to our study success. Participants reported purchasing WhatsApp data, which could not support the app. Problems with the web-based dashboard meant that we could not consistently monitor mobility. Our study provides important lessons about implementing an ambitious GPS-based study under real-world conditions in a limited-resource setting.
Trial RegistrationClinicalTrials.gov NCT03836625; https://clinicaltrials.gov/ct2/show/NCT03836625
International Registered Report Identifier (IRRID)RR2-10.1186/s13063-020-4190-