The impact of an HIV/AIDS workplace wellness programme in a large packaging factory

ABSTRACT Introduction: As the impact of HIV/AIDS on the business sector has become more visible, businesses have increasingly seen the advantages of creating HIV/AIDS management programmes for their workplaces – and some even beyond the workplace, to their surrounding communities. The aim of the study was to determine the effect and benefit of a large company’s HIV/AIDS workplace wellness programme. Study objectives were to a) describe the effect of the wellness programme as measured by differences in CD4 counts and percentages, weight, episodes of diarrhoea and sick leave; and b) to explore the perceptions and views of the occupational health nursing practitioners (OHNPs) regarding what they observe the benefit of the wellness programme to be on the general sense of health and well-being of the HIV-positive employees. Materials and methods: The study was performed at 10 of the Gauteng factories of a large multi-national packaging company. Quantitative data was collected by means of a confidential retrospective review of 36 HIV-positive employees’ occupational health records. Mostly descriptive and some inferential data analysis was performed. Qualitative measurement was done through semi-structured interviews with nine OHNPs to gain information about their perceptions and opinions regarding the benefit of the wellness programme. Thematic analysis of qualitative data was carried out. Results: The benefit of the HIV workplace wellness programme was not seen when considering CD4 counts and CD4 percentages. Episodes of diarrhoea over time and absenteeism data also did not show any benefit. However, changes in weight were observed (participants gained an average of 1.5kg over the study period) although this was not statistically significant. The qualitative data showed that employees benefit from the wellness programme, particularly in terms of their physical and mental well-being. Emerging themes related to fear of loosing one’s job and denial of the reality of HIV/AIDS; stigma and discrimination in the workplace and in the community at large; trust versus mistrust of the Company’s HIV management system; acceptance of the condition; the acceptability of nutritional supplements; and the general benefit of the wellness programme. Other related themes that emerged included issues regarding VCT, peer education, the provision of anti-retroviral therapy (ART), the role of trade unions, barriers in the public health care system and OHNPs’ frustrations with the wellness programme. Discussion: The most beneficial aspect of the wellness programme appeared to be the trust relationship that employees on the wellness programme have with the OHNPs. Because of this, employees experience a sense of support and are more likely to accept their HIV-positive condition. This contributes to a sense of mental well-being. Early intervention and better management of the condition also occur and there is better compliance to treatment and disease management protocols. There was also a general sentiment that there were benefits in the use of nutritional supplements. Employees reported feeling healthier (e.g. having more energy when using nutritional supplements) and this contributed to a sense of physical well-being. A big challenge is to overcome mistrust amongst the general employee population who have not joined the wellness programme and to deal with the ever-present issues relating to the fear of loosing their job if found to be HIV-positive as well as denial of the condition. This fear and denial perpetuates the reality of discrimination and stigmatisation, which inevitably negatively affects the social well-being of HIV-positive employees. Limitations of the study included a small sample size; inconsistent data collection methods by the OHNPs in the various clinics; the complicated nature of nutritional supplementation, which makes it difficult to study superficially; and that HIV-positive employees could not be interviewed directly as they were not willing to be interviewed. Recommendations: Further research should be performed in the area of workplace wellness programmes. More efficient data collection systems should be put in place to measure the impact of HIV/AIDS and the effectiveness of workplace interventions. HIV-positive employees who have disclosed their status could be used as positive role models in HIV/AIDS programmes. Confidentiality protocols should continue to be strictly adhered to as this promotes the trust relationship. An HIV/AIDS nutritional expert should be involved in advising about the use of optimal supplements in the wellness programmes as OHNPs have differing opinions. Other health professionals could be involved in HIV wellness programmes, e.g. occupational therapists, social workers, etc. Companies should investigate how they can get involved in HIV/AIDS-related activities and partnerships in the communities where their employees live as many employees struggle with issues of poverty over-and-above being HIV-positive

An evaluation of the National Certificate (Vocational) Primary Health qualification for community health workers in South Africa

Background: In South Africa, the re-engineering of primary health care (PHC) includes establishing PHC teams, also called ward-based outreach teams (WBOTs), which consist of community health workers (CHWs) who perform health promotion, disease prevention and disease management in households in defined areas. The need to train CHWs properly has been recognised and various training programmes currently exist. A qualification developed by the Department of Higher Education and Training (DHET) to educate potential CHWs is the National Certificate (Vocational) Primary Health programme. Registered on NQF Levels 2, 3 and 4, subjects include Community Oriented Primary Care, Public Health, Human Body and Mind, South African Health Systems, English, Mathematics, and Life Orientation. It has been offered since 2013 on a full-time basis over three years at various Technical and Vocational Education and Training (TVET) Colleges across South Africa. In 2014 the Department of Family Medicine at the University of Pretoria entered into a partnership with the City of Tshwane and Gert Sibande TVET College to present the NC(V) Primary Health curriculum to a cohort of existing CHWs on a part-time basis over four years. Aim and objectives: This research aimed to evaluate the NC(V) Primary Health qualification to determine whether it is adequate, appropriate, effective, and relevant training for CHWs in PHC teams in South Africa. The objectives of the research were 1) to evaluate the NC(V) Primary Health programme; 2) to determine how the NC(V) Primary Health programme contributed regarding PHC provided to individuals and families in defined geographical areas, curriculated qualifications and human resource development, and individual learning, employment and personal aspirations; 3) to document lessons learnt from the implementation of the NC(V) Primary Health qualification nationwide; and 4) to make recommendations regarding CHW training for South African ward-based outreach teams. Methodology: The pragmatic evaluation used qualitative methods to gain information from participants in three provinces, from both the full-time and part-time offerings. There were 65 participants in the research, including TVET college managers, NC(V) Primary Health lecturers, curriculum experts, a government consultant, a PHC team leader, NC(V) Primary Health students, and existing CHWs doing the programme part-time. Thirteen in-depth interviews, seven focus groups, five written lecturer reflections, nine written student reflections, and various fieldwork notes were used as sources of data. Thematic analysis of data was performed, and relevant theoretical frameworks were used to make sense of the data. Various policy and curriculum documents were also analysed. Results: The NC(V) Primary Health programme was well-structured to produce workers with the required competencies in primary health. Students’ understanding and application of theory and practice contributed to growth in critical thinking and development of agency. Participants expressed deep commitment to and belief in the programme. Although the full-time programme did not have sufficient fieldwork learning opportunities, a unique strength was the interprofessional nature of teaching and students benefitted from exposure to various health professionals. Improving English, mathematics and computer skills were also advantageous. Hope at the possibility of second chances and a better future was evident, and some students were able to access further educational opportunities. The programme was regarded by participants as transformative, empowering and, thus, of value to communities. However, frustration and disappointment were apparent from those who had experienced criticism of their participation in the programme or when their learning and contribution was not valued in PHC teams. Disappointment and despondency were palpable among participants regarding the unfolding uncertainty about the future of the programme, and also their own futures. Conclusion: This study contributes to the ongoing discourse around the education and training of CHWs in South Africa. Careful, respectful and thoughtful regard must be given to the training as people’s lives – individuals, families, and communities – are deeply and directly affected by the training and associated vocational prospects (or lack thereof). CHW education and training programmes should be based on the community oriented primary care (COPC) approach and consider the capabilities of CHWs in context. Novel partnerships and interprofessional contributions will optimise education and training and produce well-rounded and competent CHWs. Structuring of programmes should be in line with the NQF to facilitate career progression and pathways. These findings are in line with policy recommendations from the recently published WHO ‘Guideline on health policy and system support to optimize community health worker programmes’. CHWs should not be underestimated and their voices need to be heard, especially in terms of their contributions and valuable work, their learning needs, and as advocates for the communities they serve. Keywords: NC(V) Primary Health, Community Health Worker, Education and Training, Primary health care re-engineering, Ward-based primary health care outreach teamsThesis (PhD)--University of Pretoria, 2019.NRF UP PhD BursaryFamily MedicinePhDUnrestricte

A qualitative study of occupational therapists’ understanding of spirituality in South Africa

Occupational therapy is a holistic profession that assists clients to restore meaning to their lives—a vital spiritual task. Spirituality is a multifaceted and multidimensional construct that occupational therapists need to integrate into everyday practice. In this study, Occupational Therapy educators’ and clinicians’ understanding of spirituality in their practice was qualitatively explored by purposively selecting 24 participants who attended a workshop based on an appreciative approach, in Gauteng, South Africa. Data were collected through self-report interview schedules and focus group inquiries and were analysed using the creative hermeneutic method. Participants expressed spirituality in occupational therapy as connectedness, meaning of life and client-centred practice.https://link.springer.com/journal/10943hj2023Family MedicineNursing ScienceOccupational Therap

Retention of service users on opioid substitution therapy in the City of Tshwane, South Africa

DATA AVAILABILITY : The data that support the findings of this study are available from the corresponding author, upon reasonable request.BACKGROUND : Opioid substitution therapy (OST) is evidence-based treatment for opioid use disorders and, when taken as maintenance therapy, has proven health and social benefits. The benefits of OST are achieved through the retention of service users in the treatment programme. AIM : To identify factors that affected retention of service users who had OST interrupted in less than 6 months of being in an OST programme. SETTING : This qualitative study was conducted with19 service users from eight Community-Oriented Substance Use Programme (COSUP) sites in the City of Tshwane, Gauteng, South Africa. METHODS : Participants were COSUP service users who had interrupted OST in less than 6 months since initiation and were purposefully selected from all COSUP sites. Demographic information was obtained and four focus group discussions covered challenges of OST retention. Discussions were recorded, transcribed and qualitatively analysed using Attride-Stirling’s thematic networks framework. RESULTS : The 19 participants were all male, mostly black African, with a mean age of 26 years. Facilitators of retention in OST were individual readiness to change OST accessibility, positive family and peer support, treatment monitoring, understanding and managing expectations of service users, contribution in society and meaningful opportunities for engagement. Barriers were the cost of OST, bureaucracy within the programme, inability to communicate challenges timeously and effectively to treatment providers, boredom, cravings and poverty. CONCLUSION : Opioid substitution therapy programmes can ensure a holistic approach to prevent and treat harms related to illicit opioid use if they remain person-centred and are well-funded. CONTRIBUTION : Understanding the barriers to, and facilitators of retention on OST can contribute to improved community-based service delivery.The Community-Oriented Substance Use Programme is funded by the City of Tshwane.http://www.phcfm.orgFamily Medicin

A bacterial quorum-sensing precursor induces mortality in the marine coccolithophore, Emiliania huxleyi

© The Author(s), 2016. This article is distributed under the terms of the Creative Commons Attribution License. The definitive version was published in Frontiers in Microbiology 7 (2016): 59, doi:10.3389/fmicb.2016.00059.Interactions between phytoplankton and bacteria play a central role in mediating biogeochemical cycling and food web structure in the ocean. However, deciphering the chemical drivers of these interspecies interactions remains challenging. Here, we report the isolation of 2-heptyl-4-quinolone (HHQ), released by Pseudoalteromonas piscicida, a marine gamma-proteobacteria previously reported to induce phytoplankton mortality through a hitherto unknown algicidal mechanism. HHQ functions as both an antibiotic and a bacterial signaling molecule in cell–cell communication in clinical infection models. Co-culture of the bloom-forming coccolithophore, Emiliania huxleyi with both live P. piscicida and cell-free filtrates caused a significant decrease in algal growth. Investigations of the P. piscicida exometabolome revealed HHQ, at nanomolar concentrations, induced mortality in three strains of E. huxleyi. Mortality of E. huxleyi in response to HHQ occurred slowly, implying static growth rather than a singular loss event (e.g., rapid cell lysis). In contrast, the marine chlorophyte, Dunaliella tertiolecta and diatom, Phaeodactylum tricornutum were unaffected by HHQ exposures. These results suggest that HHQ mediates the type of inter-domain interactions that cause shifts in phytoplankton population dynamics. These chemically mediated interactions, and other like it, ultimately influence large-scale oceanographic processes.This research was support through funding from the Gordon and Betty Moore Foundation through Grant GBMF3301 to MJ and TM; NIH grant from the National Institute of Allergy and Infectious Disease (NIAID – 1R21Al119311-01) to TM and KW; the National Science Foundation (OCE – 1313747) and US National Institute of Environmental Health Science (P01-ES021921) through the Oceans and Human Health Program to BM. Additional financial support was provided to TM from the Flatley Discovery Lab

Biosynthesis of coral settlement cue tetrabromopyrrole in marine bacteria by a uniquely adapted brominase-thioesterase enzyme pair

Author Posting. © The Author(s), 2016. This is the author's version of the work. It is posted here by permission of National Academy of Sciences for personal use, not for redistribution. The definitive version was published in Proceedings of the National Academy of Sciences of United States of America 113 (2016): 3797-3802, doi: 10.1073/pnas.1519695113.Halogenated pyrroles (halopyrroles) are common chemical moieties found in bioactive bacterial natural products. The halopyrrole moieties of mono- and di- halopyrrole-containing compounds arise from a conserved mechanism in which a proline-derived pyrrolyl group bound to a carrier protein is first halogenated then elaborated by peptidic or polyketide extensions. This paradigm is broken during the marine pseudoalteromonad bacterial biosynthesis of the coral larval settlement cue tetrabromopyrrole (1), which arises from the substitution of the proline-derived carboxylate by a bromine atom. To understand the molecular basis for decarboxylative bromination in the biosynthesis of 1, we sequenced two Pseudoalteromonas genomes and identified a conserved four-gene locus encoding the enzymes involved its complete biosynthesis. Through total in vitro reconstitution of the biosynthesis of 1 using purified enzymes and biochemical interrogation of individual biochemical steps, we show that all four bromine atoms in 1 are installed by the action of a single flavin-dependent halogenase- Bmp2. Tetrabromination of the pyrrole induces a thioesterase-mediated offloading reaction from the carrier protein and activates the biosynthetic intermediate for decarboxylation. Insights into the tetrabrominating activity of Bmp2 were obtained from the high-resolution crystal structure of the halogenase contrasted against structurally homologous halogenase Mpy16 that forms only a dihalogenated pyrrole in marinopyrrole biosynthesis. Structure-guided mutagenesis of the proposed substrate-binding pocket of Bmp2 led to a reduction in the degree of halogenation catalyzed. Our study provides a biogenetic basis for the biosynthesis of 1, and sets a firm foundation for querying the biosynthetic potential for the production of 1 in marine (meta)genomes.This work was jointly supported by the US National Science Foundation (OCE-1313747) and the US National Institute of Environmental Health Sciences (P01-ES021921) through the Ocean and Human Health Program to B.S.M., and the US National Institute of Allergy and Infectious Disease R01-AI47818 to B.S.M. and R21- AI119311 to K.E.W. and T.J.M., the Mote Protect Our Reef Grant Program (POR-2012-3), the Dart Foundation, the Smithsonian Competitive Grants Program for Science to V.J.P., the Howard Hughes Medical Institute to J.P.N., the US National Institutes of Health (NIH) Marine Biotechnology Training Grant predoctoral fellowship to A.E. (T32-GM067550), the Helen Hay Whitney Foundation postdoctoral fellowship to V.A., and a Swiss National Science Foundation (SNF) postdoctoral Fellowship to S.D.2016-09-2

Bioactive Endophytes Warrant Intensified Exploration and Conservation

A key argument in favor of conserving biodiversity is that as yet undiscovered biodiversity will yield products of great use to humans. However, the link between undiscovered biodiversity and useful products is largely conjectural. Here we provide direct evidence from bioassays of endophytes isolated from tropical plants and bioinformatic analyses that novel biology will indeed yield novel chemistry of potential value.We isolated and cultured 135 endophytic fungi and bacteria from plants collected in Peru. nrDNAs were compared to samples deposited in GenBank to ascertain the genetic novelty of cultured specimens. Ten endophytes were found to be as much as 15–30% different than any sequence in GenBank. Phylogenetic trees, using the most similar sequences in GenBank, were constructed for each endophyte to measure phylogenetic distance. Assays were also conducted on each cultured endophyte to record bioactivity, of which 65 were found to be bioactive.The novelty of our contribution is that we have combined bioinformatic analyses that document the diversity found in environmental samples with culturing and bioassays. These results highlight the hidden hyperdiversity of endophytic fungi and the urgent need to explore and conserve hidden microbial diversity. This study also showcases how undergraduate students can obtain data of great scientific significance

A community resource for paired genomic and metabolomic data mining

Genomics and metabolomics are widely used to explore specialized metabolite diversity. The Paired Omics Data Platform is a community initiative to systematically document links between metabolome and (meta)genome data, aiding identification of natural product biosynthetic origins and metabolite structures.Peer reviewe

MIBiG 3.0 : a community-driven effort to annotate experimentally validated biosynthetic gene clusters

With an ever-increasing amount of (meta)genomic data being deposited in sequence databases, (meta)genome mining for natural product biosynthetic pathways occupies a critical role in the discovery of novel pharmaceutical drugs, crop protection agents and biomaterials. The genes that encode these pathways are often organised into biosynthetic gene clusters (BGCs). In 2015, we defined the Minimum Information about a Biosynthetic Gene cluster (MIBiG): a standardised data format that describes the minimally required information to uniquely characterise a BGC. We simultaneously constructed an accompanying online database of BGCs, which has since been widely used by the community as a reference dataset for BGCs and was expanded to 2021 entries in 2019 (MIBiG 2.0). Here, we describe MIBiG 3.0, a database update comprising large-scale validation and re-annotation of existing entries and 661 new entries. Particular attention was paid to the annotation of compound structures and biological activities, as well as protein domain selectivities. Together, these new features keep the database up-to-date, and will provide new opportunities for the scientific community to use its freely available data, e.g. for the training of new machine learning models to predict sequence-structure-function relationships for diverse natural products. MIBiG 3.0 is accessible online at https://mibig.secondarymetabolites.org/