The Role Of The Multidisciplinary Team Meeting in An Antiretroviral Treatment Programme

The importance of adherence in the management of patients on combination antiretroviral therapy has been well documented.1-6 However, for  sustainability of the overall programme adequate patient ‘tracking’ is required in order to understand where the programme may be failing

The Effect of Job Satisfaction on the Organisational Commitment of Administrators

Administrators are an important human resource in Higher Education because they perform various duties that are critical to the daily operations of universities. In light of this, organisational commitment and job satisfaction of administrators are essential for the efficiency and effectiveness of universities. Notwithstanding the critical relevance and necessity of organisational commitment and job satisfaction, there is evidence of paucity of research on these areas among administrative staff in the South African higher education sector. The objective of this study was to examine the relationship between organisational commitment and overall job satisfaction on the organisational commitment of administrators at a university in Gauteng. To achieve the aforementioned objective, a quantitative survey approach was used to examine the relationship between overall job satisfaction and organisational commitment. The selfadministered structured questionnaires were issued to 383 administrative staff members. Descriptive statistics was utilised to assess the levels of both organisational commitment and job satisfaction, results of which revealed that administrators were satisfied with and committed to the university. Spearman’s rho correlation analysis showed that there was a strong correlation between affective commitment and job satisfaction; and moderate correlations between job satisfaction and moral imperative. Similar strong correlation was observed between indebted obligation and job satisfaction. Conversely, a weak correlation occurred between job satisfaction and continuance commitment. Regression coefficients indicated that job satisfaction contributed positively to the prediction of affective commitment, moral imperative, indebted obligation and continuance commitment. Based on these findings, the recommendations and future research opportunities were suggested

Anaerobic ammonium oxidation in the old trickling filters at Daspoort Wastewater Treatment Works

The century-old trickling filters at the Daspoort Wastewater Treatment Works in Pretoria (Gauteng, South Africa) are known for their remarkable removal of nitrogen from municipal wastewater. Our study was conducted to identify the microbiological processes responsible for this phenomenon and to establish whether anammox bacteria may be involved. An aerobic and anaerobic bench top reactor, both inoculated with biofilm-covered stones from one of the filters, were spiked with ammonia-nitrogen  (NH4+-N) and nitrite-nitrogen (NO2.-N). These reactors were subsequently monitored by conducting stoichiometric analyses of chemical oxygen demand (COD), NH4+-N, NO2.-N, and nitrate-nitrogen (NO3.-N). In the aerobic reactor, the COD concentration decreased over the 56 h batch reaction period and nitrification was revealed by a decrease in NH4+-N and NO2.-N concentrations. However, the NO3.-N concentration showed no  notable decrease. In contrast, in the anaerobic reactor the concentrations of COD, NH4+-N, NO2¡¥-N, NO3¡¥-N, as well as total nitrogen decreased during the batch reaction period. The decrease of both the NH4+-N and NO2.-N concentrations, the latter to zero under anaerobic conditions,   suggested that, in addition to heterotrophic denitrification, anaerobic ammonium oxidation (anammox) may also occur in the trickling filter biofilm. This was highlighted by the observation that ammonium removal in the anaerobic reactor stopped as soon as the nitrite concentration  became zero. The ratio of nitrite:ammonium removal was 1.33 on  average, which conforms to anammox behaviour. Gene sequence analysis was used to test for the possible presence of anammox bacteria in the  trickling filter biofilm. Genomic DNA was extracted from trickling filter  humus sludge and the polymerase chain reaction (PCR) was used to  amplify taxonomically informative 16S rRNA gene sequences, using  primers specific for selected anammox species. Subsequent sequence analysis, including using the online Basic Local Alignment Search Tool (BLAST), and constructing a phylogenic tree using a heuristic search  strategy for Maximum Parsimony analysis, confirmed the presence of an anammox bacterium closely related to Candidatus ¡®Brocadia  anammoxidans¡¯ and Candidatus ¡®Brocadia fulgida¡¯ on the biofilm-covered stones of the Daspoort trickling filters.Keywords: Daspoort, trickling filter, anammox, nitrification, denitrification, stoichiometric analyses, polymerase chain reactio

Five recommendations to accelerate sustainable solutions in cement and concrete through partnership

Though the technical knowledge to make cement and concrete more sustainable already exists, implementation of solutions lags behind the rate needed to mitigate climate change and meet the targets set by the Sustainable Development Goals. Whilst most of the focus around the built environment is on embodied carbon, we stress an important but neglected dimension: partnership (SDG17). Effective partnerships can be powerful enablers to accelerate sustainable solutions in cement and concrete, and let such solutions transfer from academia to the market. This can be achieved through knowledge generation, solution implementation, and policy development, among other routes. In this article, we share five recommendations for how partnerships can address neglected research questions and practical needs: 1) reform Science, Technology, Engineering and Mathematics (STEM) education to train “circular citizens”; 2) map out routes by which cementitious materials can contribute to a “localization” agenda; 3) generate open‐access maps for the geographical distribution of primary and secondary raw materials; 4) predict the long‐term environmental performance of different solutions for low‐CO2 cements in different geographical areas; 5) overhaul standards to be technically and regionally fit for purpose. These approaches have the potential to make a unique and substantial contribution towards achieving collective sustainability goals

Antimicrobial resistance of Neisseria gonorrhoeae isolates from high-risk men in Johannesburg, South Africa

Neisseria gonorrhoeae antimicrobial drug resistance has emerged worldwide; however, the situation in sub-Saharan Africa is not well documented. We investigated the molecular epidemiology and occurrence of antimicrobial resistance in Neisseria gonorrhoeae infections in two core transmission groups of men in Johannesburg, South Africa. We recruited men who have sex with men (MSM) presenting with urethral discharge and men with recurrent episodes of urethral discharge. Molecular testing and culture for N. gonorrhoeae were performed, followed by antimicrobial susceptibility testing. Whole-genome sequencing (WGS) was used to identify resistance-conferring mutations and to determine the genetic relatedness of the isolates. In all, 51 men were recruited; 42 (82%) had N. gonorrhoeae infections. Most gonococcal isolates were resistant to ciprofloxacin (78%) and tetracycline (74%); 33% were penicillin resistant. All gonococcal isolates were susceptible to cephalosporins and spectinomycin. Azithromycin resistance was observed in 4 (15%) isolates (epidemiological cutoff), all with mutations in the mtrR promoter region. Most of the isolates (19/27) harbored the gonococcal genetic island, which is associated with antimicrobial resistance. WGS revealed a diverse epidemic with mostly novel NG-STAR (70%) and NG-MAST (70%) sequence types. Thus, we demonstrate a high prevalence of antimicrobial resistance in Neisseria gonorrhoeae strains obtained from high-risk men in South Africa. The introduction of diagnostics and scale-up of surveillance are warranted to prevent the emergence of multidrug-resistant infections.The National Health Laboratory Service Research Trust and the University of Pretoria Postgraduate Study Abroad Program.http://aac.asm.org2021-04-20hj2021Medical Microbiolog

Predicted effects of the introduction of long-acting injectable cabotegravir pre-exposure prophylaxis in sub-Saharan Africa: a modelling study

BACKGROUND: Long-acting injectable cabotegravir pre-exposure prophylaxis (PrEP) is recommended by WHO as an additional option for HIV prevention in sub-Saharan Africa, but there is concern that its introduction could lead to an increase in integrase-inhibitor resistance undermining treatment programmes that rely on dolutegravir. We aimed to project the health benefits and risks of cabotegravir-PrEP introduction in settings in sub-Saharan Africa. METHODS: With HIV Synthesis, an individual-based HIV model, we simulated 1000 setting-scenarios reflecting both variability and uncertainty about HIV epidemics in sub-Saharan Africa and compared outcomes for each with and without cabotegravir-PrEP introduction. PrEP use is assumed to be risk-informed and to be used only in 3-month periods (the time step for the model) when having condomless sex. We consider three groups at risk of integrase-inhibitor resistance emergence: people who start cabotegravir-PrEP after (unknowingly) being infected with HIV, those who seroconvert while on PrEP, and those with HIV who have residual cabotegravir drugs concentrations during the early tail period after recently stopping PrEP. We projected the outcomes of policies of cabotegravir-PrEP introduction and of no introduction in 2022 across 50 years. In 50% of setting-scenarios we considered that more sensitive nucleic-acid-based HIV diagnostic testing (NAT), rather than regular antibody-based HIV rapid testing, might be used to reduce resistance risk. For cost-effectiveness analysis we assumed in our base case a cost of cabotegravir-PrEP drug to be similar to oral PrEP, resulting in a total annual cost of USD$144 per year ($114 per year and $264 per year considered in sensitivity analyses), a cost-effectiveness threshold of$500 per disability-adjusted life years averted, and a discount rate of 3% per year. FINDINGS: Reflecting our assumptions on the appeal of cabotegravir-PrEP, its introduction is predicted to lead to a substantial increase in PrEP use with approximately 2·6% of the adult population (and 46% of those with a current indication for PrEP) receiving PrEP compared with 1·5% (28%) without cabotegravir-PrEP introduction across 20 years. As a result, HIV incidence is expected to be lower by 29% (90% range across setting-scenarios 6-52%) across the same period compared with no introduction of cabotegravir-PrEP. In people initiating antiretroviral therapy, the proportion with integrase-inhibitor resistance after 20 years is projected to be 1·7% (0-6·4%) without cabotegravir-PrEP introduction but 13·1% (4·1-30·9%) with. Cabotegravir-PrEP introduction is predicted to lower the proportion of all people on antiretroviral therapy with viral loads less than 1000 copies per mL by 0·9% (-2·5% to 0·3%) at 20 years. For an adult population of 10 million an overall decrease in number of AIDS deaths of about 4540 per year (-13 000 to -300) across 50 years is predicted, with little discernible benefit with NAT when compared with standard antibody-based rapid testing. AIDS deaths are predicted to be averted with cabotegravir-PrEP introduction in 99% of setting-scenarios. Across the 50-year time horizon, overall HIV programme costs are predicted to be similar regardless of whether cabotegravir-PrEP is introduced (total mean discounted annual HIV programme costs per year across 50 years is $151·3 million vs$150·7 million), assuming the use of standard antibody testing. With antibody-based rapid HIV testing, the introduction of cabotegravir-PrEP is predicted to be cost-effective under an assumed threshold of $500 per disability-adjusted life year averted in 82$144 per year, in 52% at $264, and in 87$114. INTERPRETATION: Despite leading to increases in integrase-inhibitor drug resistance, cabotegravir-PrEP introduction is likely to reduce AIDS deaths in addition to HIV incidence. Long-acting cabotegravir-PrEP is predicted to be cost-effective if delivered at similar cost to oral PrEP with antibody-based rapid HIV testing. FUNDING: Bill & Melinda Gates Foundation, National Institute of Allergy and Infectious Diseases of the National Institutes of Health

MDR-TB patients in KwaZulu-Natal, South Africa: cost-effectiveness of 5 models of care.

CAPRISA, 2018.Abstract available in pdf

Comprehensive global genome dynamics of Chlamydia trachomatis show ancient diversification followed by contemporary mixing and recent lineage expansion.

Chlamydia trachomatis is the world's most prevalent bacterial sexually transmitted infection and leading infectious cause of blindness, yet it is one of the least understood human pathogens, in part due to the difficulties of in vitro culturing and the lack of available tools for genetic manipulation. Genome sequencing has reinvigorated this field, shedding light on the contemporary history of this pathogen. Here, we analyze 563 full genomes, 455 of which are novel, to show that the history of the species comprises two phases, and conclude that the currently circulating lineages are the result of evolution in different genomic ecotypes. Temporal analysis indicates these lineages have recently expanded in the space of thousands of years, rather than the millions of years as previously thought, a finding that dramatically changes our understanding of this pathogen's history. Finally, at a time when almost every pathogen is becoming increasingly resistant to antimicrobials, we show that there is no evidence of circulating genomic resistance in C. trachomatis