The S’Khokho ‘bushcan’ initiative: Kick a bush and condoms fall out

Background. People living in rural areas have limited access to condoms owing to distance, cost and time involved in travelling to public health facilities, around which most condom distribution efforts are centralised.Objective. In an effort to increase access to condoms in these areas, we explored the feasibility and efficacy of condom distribution by placing ‘condocans’ on trees along informal footpaths used by residents.Methods. From October 2012, steel condocans, typically seen in clinic settings, were erected on trees along pathways in bushy areas with high levels of foot traffic at several rural locations in the Umgungundlovu district of KwaZulu-Natal Province, South Africa (SA). Because of their location, the condocans were referred to as ‘bushcans’. Condom uptake was closely monitored, and the bushcans were restocked when necessary.Results. Following the introduction of the bushcans, male condom distribution increased by 237% from October 2012 to December 2012. Condom distribution in these areas increased on average by 187% from October 2012 to October 2015, with more than 408 000 condoms distributed over the 3-year period using the bushcans alone. Discussions with residents revealed that they were pleased about the increased access to condoms via the bushcans, and they recommended other areas for potential implementation of this initiative.Conclusions. The bushcan initiative highlighted the fact that condoms are not as easily accessible to all South Africans as is often thought. By providing access to condoms in a discreet and convenient manner, the bushcans have the potential to increase access to condoms in other rural and periurban areas in SA where communities face similar barriers to access.

Efficacy of the informal confidential voting interview in enhancing self-disclosure and reducing social desirability bias : a comparative analysis with the SAQ and FTFI.

Thesis (M.Sc.) - University of KwaZulu-Natal, Pietermaritzburg, [2009]Background and Objectives Self - report data is known to be unrel iable and susceptible to factors such as social desirability bias. Methods used for collecting self - report data has thus far been unsuccessful in ameliorating known obstacles to honest self - disclosure. Considering the current HIV/AIDS pandemic and relate d health crises, it is imperative that self - report data is an accurate depiction of reality, since it informs research requirements and designs as well as intervention designs and the evaluation of the efficacy of the interventions. Aim To evaluate and co mpare the efficacy of the Informal Confidential Voting Interview (ICVI) to the FTFI (Face - to - Face Interview) and the SAQ (Self - Administered Questionnaire) in enhancing self - disclosure and minimizing social desirability bias on sensitive topics of sexual ex perience and sexual activity. Study Design A sample of 110 undergraduate and post - graduate students at various tertiary education institutions in Pietermaritzburg were randomly allocated to the ICVI, the SAQ or the FTFI. The ICVI combined a face - to - face interview with a voting box method devised to enhance response anonymity. The FTFI and the SAQ were administered according to a standardized procedure to maximize confidentiality and self - disclosure. Results The self - disclosure scores were significant ly higher for the ICVI in comparison to the FTFI and the SAQ, with a p = 0.005. Post - hoc tests revealed that the ICVI performed significantly better in self - disclosure scores than the FTFI with p = 0.022 and the SAQ with p = 0.015. There was no significa nt difference in self - disclosure scores between the SAQ and the FTFI. Using the Marlowe - Crowne scale of social desirability bias, a significant difference in social desirability bias scores were achieved with p = 0.043. However, the post - hoc analysis ind icated no affirmative significant mean difference in social desirability score among any of the methods. Males displayed greater self - disclosure than females with p = 0.013, but for both sexes the ICVI group achieved the highest mean self - disclosure score s than the FTFI - and the SAQ group. Conclusion The results of this study concluded that the employment of ICVI fundamentally resulted in better quality data than the SAQ and the FTFI on topics of sensitivity and controversial behaviours. The findings ar e suggestive of the successful implementation of the ICVI method across potentially diverse research contexts that rely on self - report data, as the method is adaptable to the target population and its characteristics. Further research is warranted to buil d on its current design and facilitate the implementation of the ICVI across the wide disciplines of self - report data

Timing of Initiation of Antiretroviral Drugs during Tuberculosis Therapy

The rates of death are high among patients with coinfection with tuberculosis and the human immunodeficiency virus (HIV). The optimal timing for the initiation of antiretroviral therapy in relation to tuberculosis therapy remains controversial

Risk factors for Coronavirus disease 2019 (Covid-19) death in a population cohort study from the Western Cape province, South Africa

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. 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.Among 3 460 932 patients (16% living with HIV), 22 308 were diagnosed with COVID-19, of whom 625 died. COVID19 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)

Die toepassing van die K3-model op die televisieteks Colour TV

There are very few instruments of use for the editing of multimedia television scripts. Commissioning editors are responsible for both quality assurance and quality control. Where quality control is a retrospective process, quality assurance is intended to anticipate problems that might occur in order to mitigate them during the production process. This article examines the applicability of Renkema’s CCC model as adapted by Carstens and Van de Poel to a particular television script, namely the first episode of the television show Colour TV. In spite of the generous budget allocated to the show, the length of time spent on content development, the large production team as well as the favourable time-slot in which it was broadcast, the show did not do well. Instead of being the flagship series it was meant to be, research indicates that it confused and offended its intended audience, namely the Afrikaans speaking coloured people of South Africa. By analysing the first episode of the series using the adapted CCC model, it is shown that the show failed in as far as the text type, aspects of the content, the structure, and to a certain extent, the formulation were concerned. The CCC model proved to be a handy, but clumsy, instrument for use by commissioning editors. Consequently, it is suggested that the model be simplified for editing television scripts.Keywords: CCC model, television scripts, quality assuranc

Involvement, self-reported knowledge and ways in which clinicians learn about assessment in the clinical years of a medical curriculum

BACKGROUND. Medical students in their clinical years are assessed by clinician educators (CEs) with different levels of involvement and responsibilities in the assessment process. OBJECTIVE. To obtain a better understanding from CEs of their involvement in assessment activities in the clinical years of a medical degree programme, their self-reported knowledge of assessment and methods of learning about assessment. This study also explored the potential association between involvement in assessment activities, self-reported knowledge of assessment and employment profile. METHODS. An online cross-sectional survey was conducted among CEs involved in assessment of an undergraduate medical programme (years 4 - 6) at a South African university. RESULTS. Fifty-four CEs were contacted and 30 responses (56%) were received. Assessment responsibilities included design of assessment instruments, participation in assessment activities and quality assurance of assessments. The top five assessment activities that CEs were involved in were conducting objective structured practical examinations (OSPEs)/objective structured clinical examinations (OSCEs), designing multiple-choice questions, being a clinical examiner, conducting portfolio-based oral examinations and marking written assessments. CEs (≥80%) reported having some knowledge of formative and summative assessment, and of validity and reliability. Fewer CEs reported knowledge of constructive alignment, standard setting, item analysis and blueprinting. CEs acquired knowledge of assessment predominantly through informal methods such as practical experience and informal discussion rather than through formal education processes such as attending courses. CONCLUSIONS. CEs participated extensively in assessment, but their knowledge with regard to assessment concepts varied.http://www.ajhpe.org.zaam2020School of Health Systems and Public Health (SHSPH

Findings from a novel and scalable community-based HIV testing approach to reduce the time required to complete point-of-care HIV testing in South Africa

Abstract Background Mobile HIV testing approaches are a key to reaching the global targets of halting the HIV epidemic by 2030. Importantly, the number of clients reached through mobile HIV testing approaches, need to remain high to maintain the cost-effectiveness of these approaches. Advances in rapid in-vitro tests such as INSTI® HIV-1/HIV-2 (INSTI) which uses flow-through technologies, offer opportunities to reduce the HIV testing time to about one minute. Using data from a routine mobile HTS programme which piloted the use of the INSTI point-of-care (POC) test, we sought to estimate the effect of using a faster test on client testing volumes and the number of people identified to be living with HIV, in comparison with standard of care HIV rapid tests. Methods In November 2019, one out of four mobile HTS teams operating in Ekurhuleni District (South Africa) was randomly selected to pilot the field use of INSTI-POC test as an HIV screening test (i.e., the intervention team). We compared the median number of clients tested for HIV and the number of HIV-positive clients by the intervention team with another mobile HTS team (matched on performance and area of operation) which used the standard of care (SOC) HIV screening test (i.e., SOC team). Results From 19 to 20 December 2019, the intervention team tested 7,403 clients, and the SOC team tested 2,426 clients. The intervention team tested a median of 442 (IQR: 288–522) clients/day; SOC team tested a median of 97 (IQR: 40–187) clients/day (p<0.0001). The intervention team tested about 180 more males/day compared to the SOC team, and the median number of adolescents and young adults tested/day by the intervention team were almost four times the number tested by the SOC team. The intervention team identified a higher number of HIV-positive clients compared to the SOC team (142 vs. 88), although the proportion of HIV-positive clients was lower in the intervention team due to the higher number of clients tested. Conclusions This pilot programme provides evidence of high performance and high reach, for men and young people through the use of faster HIV rapid tests, by trained lay counsellors in mobile HTS units

Cost savings in male circumcision post-operative care using two-way text-based follow-up in rural and urban South Africa.

IntroductionVoluntary medical male circumcision (VMMC) clients are required to attend multiple post-operative follow-up visits in South Africa. However, with demonstrated VMMC safety, stretched clinic staff in SA may conduct more than 400,000 unnecessary reviews for males without complications, annually. Embedded into a randomized controlled trial (RCT) to test safety of two-way, text-based (2wT) follow-up as compared to routine in-person visits among adult clients, the objective of this study was to compare 2wT and routine post-VMMC care costs in rural and urban South African settings.MethodsActivity-based costing (ABC) estimated the costs of post-VMMC care, including counselling, follow-ups, and tracing in $US dollars. Transportation for VMMC and follow-up was provided for rural clients in outreach settings but not for urban clients in static sites. Data were collected from National Department of Health VMMC forms, RCT databases, and time-and-motion surveys. Sensitivity analysis presents different follow-up scenarios. We hypothesized that 2wT would save per-client costs overall, with higher savings in rural settings.ResultsVMMC program costs were estimated from 1,084 RCT clients: 537 in routine care and 547 in 2wT. On average, 2wT saved$3.56 per client as compared to routine care. By location, 2wT saved $7.73 per rural client and increased urban costs by$0.59 per client. 2wT would save $2.16 and$7.02 in follow-up program costs if men attended one or two post-VMMC visits, respectively.ConclusionQuality 2wT follow-up care reduces overall post-VMMC care costs by supporting most men to heal at home while triaging clients with potential complications to timely, in-person care. 2wT saves more in rural areas where 2wT offsets transportation costs. Minimal additional 2wT costs in urban areas reflect high care quality and client engagement, a worthy investment for improved VMMC service delivery. 2wT scale-up in South Africa could significantly reduce overall VMMC costs while maintaining service quality

Expanding the Evidence on the Safety and Efficiency of 2-Way Text Messaging–Based Telehealth for Voluntary Medical Male Circumcision Follow-up Compared With In-Person Reviews: Randomized Controlled Trial in Rural and Urban South Africa

BackgroundThere is a dearth of high-quality evidence from digital health interventions in routine program settings in low- and middle-income countries. We previously conducted a randomized controlled trial (RCT) in Zimbabwe, demonstrating that 2-way texting (2wT) was safe and effective for follow-up after adult voluntary medical male circumcision (VMMC). ObjectiveTo demonstrate the replicability of 2wT, we conducted a larger RCT in both urban and rural VMMC settings in South Africa to determine whether 2wT improves adverse event (AE) ascertainment and, therefore, the quality of follow-up after VMMC while reducing health care workers’ workload. MethodsA prospective, unblinded, noninferiority RCT was conducted among adult participants who underwent VMMC with cell phones randomized in a 1:1 ratio between 2wT and control (routine care) in North West and Gauteng provinces. The 2wT participants responded to a daily SMS text message with in-person follow-up only if desired or an AE was suspected. The control group was requested to make in-person visits on postoperative days 2 and 7 as per national VMMC guidelines. All participants were asked to return on postoperative day 14 for study-specific review. Safety (cumulative AEs ≤day 14 visit) and workload (number of in-person follow-up visits) were compared. Differences in cumulative AEs were calculated between groups. Noninferiority was prespecified with a margin of −0.25%. The Manning score method was used to calculate 95% CIs. ResultsThe study was conducted between June 7, 2021, and February 21, 2022. In total, 1084 men were enrolled (2wT: n=547, 50.5%, control: n=537, 49.5%), with near-equal proportions of rural and urban participants. Cumulative AEs were identified in 2.3% (95% CI 1.3-4.1) of 2wT participants and 1.0% (95% CI 0.4-2.3) of control participants, demonstrating noninferiority (1-sided 95% CI −0.09 to ∞). Among the 2wT participants, 11 AEs (9 moderate and 2 severe) were identified, compared with 5 AEs (all moderate) among the control participants—a nonsignificant difference in AE rates (P=.13). The 2wT participants attended 0.22 visits, and the control participants attended 1.34 visits—a significant reduction in follow-up visit workload (P<.001). The 2wT approach reduced unnecessary postoperative visits by 84.8%. Daily response rates ranged from 86% on day 3 to 74% on day 13. Among the 2wT participants, 94% (514/547) responded to ≥1 daily SMS text messages over 13 days. ConclusionsAcross rural and urban contexts in South Africa, 2wT was noninferior to routine in-person visits for AE ascertainment, demonstrating 2wT safety. The 2wT approach also significantly reduced the follow-up visit workload, improving efficiency. These results strongly suggest that 2wT provides quality VMMC follow-up and should be adopted at scale. Adaptation of the 2wT telehealth approach to other acute follow-up care contexts could extend these gains beyond VMMC. Trial RegistrationClinicalTrials.gov NCT04327271; https://www.clinicaltrials.gov/ct2/show/NCT0432727