Investigation of in vitro prostate-specific membrane antigen expression in MCF-7 and MDA-MB-231 breast tumour cells

National Research Foundationhttps://drive.google.com/file/d/18ZHR2pTZ3kocMdmAHy2_xOoICb-01e3T/view?usp=sharinghttps://drive.google.com/drive/folders/1XKJ5RaIFxQX6cH8epnd5PRiRe412-W4b?usp=sharinghttps://drive.google.com/drive/folders/1pSta6YT69dR4AmQ8CLEP9fPauw9ovUFV?usp=sharin

Leopards and mesopredators as indicators of mammalian species richness across diverse landscapes of South Africa

The rapid extinction of species over the past few decades has created a biodiversity crisis. Factors contributing to recent extirpations are linked to increased human population growth, habitat loss and fragmentation, and over-exploitation of wildlife. Only decisive, effective action to combat biodiversity loss can reverse these trends. The use of indicator species as surrogates for biodiversity provides a way to identify areas with high biodiversity so that conservation efforts can be accelerated and supported in those areas. Predators are considered important indicators of healthy, biodiverse ecosystems due to their high trophic level and their direct and indirect interaction with other species. Using camera trap data from 221 cameras set across five vegetation types and five land use zones in South Africa, we evaluated carnivores as potential surrogates for biodiversity

Understanding Treatment Refusal Among Adults Presenting for HIV-Testing in Soweto, South Africa: A Qualitative Study

HIV treatment initiatives have focused on increasing access to antiretroviral therapy (ART). There is growing evidence, however, that treatment availability alone is insufficient to stop the epidemic. In South Africa, only one third of individuals living with HIV are actually on treatment. Treatment refusal has been identified as a phenomenon among people who are asymptomatic, however, factors driving refusal remain poorly understood. We interviewed 50 purposively sampled participants who presented for voluntary counseling and testing in Soweto to elicit a broad range of detailed perspectives on ART refusal. We then integrated our core findings into an explanatory framework. Participants described feeling “too healthy” to start treatment, despite often having a diagnosis of AIDS. This subjective view of wellness was framed within the context of treatment being reserved for the sick. Taking ART could also lead to unintended disclosure and social isolation. These data provide a novel explanatory model of treatment refusal, recognizing perceived risks and social costs incurred when disclosing one’s status through treatment initiation. Our findings suggest that improving engagement in care for people living with HIV in South Africa will require optimizing social integration and connectivity for those who test positive

Contacts and foot and mouth disease transmission from wild to domestic bovines in Africa

Wildlife is a maintenance host for several significant livestock diseases. Interspecific pathogen transmission may occur in complex socio-ecological systems at wild-domestic interfaces that have so far been seldom studied. We investigated the relationship between the dynamics of foot and mouth disease (FMD) in vaccinated and unvaccinated cattle populations with respect to frequency of contacts with African buffalo at different buffalo-cattle interfaces. A total of 36 GPS collars were deployed on African buffalo (Syncerus caffer) and cattle (Bos taurus, Bos indicus) to assess contact patterns at the periphery of 3 protected areas in Zimbabwe. Simultaneously, a longitudinal survey of 300 cattle with five repeated sampling sessions on known individuals during 16 months was undertaken. Immunological assays (ELISAs), that allowed tracking the production of antibodies following infection or vaccination, were used to assess serological transitions (i.e., incidence and reversion) in the surveyed cattle. Variation in rates of serological transitions across seasons, sites and as a function of the frequency of contact with buffalo was analyzed using generalized linear mixed models. The incidence in the cattle populations of FMD antibodies produced following infection varied among sites and as a function of contact rates with African buffalo. The incidence was higher for sites with higher contact rates between the two species. The serological incidence was also related to seasons, being higher during the dry or rainy seasons depending on sites. The reversion rate pattern was the opposite of this incidence rate pattern. Vaccination seemed partly efficient at the individual level, but it did not prevent the diffusion of FMD viruses from the wild reservoir host to the domestic cattle population. Furthermore, antibodies were detected in areas where cattle had not been vaccinated, suggesting that the virus may have spread without being detected in domestic populations. Access to resources shared by buffalo and livestock, particularly water and grazing areas during the dry season, could partly explain the observed patterns of FMD transmission. We discuss how insights on ecological processes leading to wildlife-livestock contacts may provide some innovative solutions to improve FMD management, including surveillance, prevention or control of buffalo-borne outbreaks, by adopting strategies targeting risky areas and periods. (Résumé d'auteur

Development and validation of a foot-and-mouth disease virus SAT serotype-specific 3ABC assay to differentiate infected from vaccinated animals

The effective control of foot-and-mouth disease (FMD) requires sensitive, specific and rapid diagnostic tools. However, the control and eradication of FMD in Africa is complicated by, among other factors, the existence of five of the seven FMD virus (FMDV) serotypes, including the SAT-serotypes 1, 2 and 3 that are genetically and antigenically the most variable FMDV serotypes. A key diagnostic assay to enable a country to re-gain its FMD-free status and for FMD surveillance, is the 3ABC or the non-structural protein (NSP) enzyme-linked immunosorbent assay (ELISA). Although many kits are available to detect 3ABC antibodies, none has been developed specifically for the variable SAT serotypes. This study designed a SAT-specific NSP ELISA and determined whether this assay could better detect NSP-specific antibodies from FMDV SAT-infected livestock. The assay’s performance was compared to validated NSP assays (PrioCheck®-NSP and IZSLER-NSP), using panels of field and experimental sera, vaccinated and/or infected with FMDV SAT1, SAT2 or SAT3. The sensitivity () of the SAT-NSP was estimated as 76% (70%, 81%) whereas the specificity was 96% (95%, 98%) at a 95% confidence interval. The sensitivity and specificity were comparable to the commercial NSP assays, PrioCheck®-NSP (82% and 99%, respectively) and IZSLER-NSP (78% and 98%, respectively). Good correlations were observed for all three assays.Dr FF Maree received funding from the FAO (MTF/INT/003/EEC) and the IAEA (agreement #16085). The work at CODA-CERVA-VAR was funded by the European Community’s Seventh Framework Programme (FP7/2007-2013) under grant agreement no 226556 (FMD-DISCONVAC) and the Veterinary and Agrochemical Research Centre (CODA-CERVA), Ukkel, Belgium.http://www.elsevier.com/locate/jviromet2019-05-01hj2018Microbiology and Plant Patholog

Impact of ‘Ideal Clinic’ implementation on patient waiting time in primary healthcare clinics in KwaZulu-Natal Province, South Africa: A before-and-after evaluation

Background. Long waiting times are a major source of dissatisfaction for patients attending public healthcare facilities in South Africa (SA). The National Department of Health has identified this as one of six priority areas for improvement. Health system-strengthening (HSS) interventions to improve patient waiting time are being implemented in public health facilities across SA as part of the ‘Ideal Clinic’ model. The effect of these interventions on patient waiting time needs to be assessed and evidence generated for system improvement.Objectives. To determine the effect of Ideal Clinic HSS intervention on patient waiting time in public health facilities in Amajuba District, KwaZulu-Natal Province, SA.Methods. We implemented 12 months of HSS activity, including facility reorganisation and patient appointment scheduling. The major outcome of interest was the total time spent by patients in a facility during a visit. This was calculated as the median time spent, obtained through a ‘before-and-after’ intervention survey. Univariate and multivariate factors associated with waiting time were determined.Results. A total of 1 763 patients from nine clinics were surveyed before and after the intervention (n=860 at baseline and n=903 at follow-up). The median overall waiting time after the intervention was 122 minutes (interquartile range (IQR) 81 - 204), compared with 116 minutes (IQR 66 - 168) before (p<0.05). Individual facility results after the intervention were mixed. Two facilities recorded statistically significant reductions in patient waiting time, while three recorded significant increases (p<0.05). Patient load per nurse, type of service received and time of arrival in facilities were all independently associated with waiting time. Patients’ arrival patterns, which were determined by appointment scheduling, played a significant role in the results obtained.Conclusions. Implementation of the Ideal Clinic model in the selected facilities led to changes in patient waiting time. Observed changes were positive when a clinic appointment system was successfully implemented and negative when this was unsuccessful. We recommend strengthening of the appointment system component of the Ideal Clinic model to improve patient waiting time. Assessing facility waiting time performance in terms of average time spent by patients during a clinic visit was shown to be inadequate, and we suggest the inclusion of ‘proportion of clients who spent above the national waiting time threshold during their visit’ as a sensitive measure of performance.

Introducing an Ethics Framework for health priority-setting in South Africa on the path to universal health coverage

Background. South Africa (SA) has embarked on a process to implement universal health coverage (UHC) funded by National Health Insurance (NHI). The 2019 NHI Bill proposes creation of a health technology assessment (HTA) body to inform decisions about which interventions NHI funds will cover under UHC. In practice, HTA often relies mainly on economic evaluations of cost-effectiveness and budget impact, with less attention to the systematic, specific consideration of important social, organisational and ethical impacts of the health technology in question. In this context, the South African Values and Ethics for Universal Health Coverage (SAVE-UHC) research project recognised an opportunity to help shape the health priority-setting process by providing a way to take account of multiple, ethically relevant considerations that reflect SA values. The SAVE-UHC Research Team developed and tested an SA-specific Ethics Framework for HTA assessment and analysis.Objectives. To develop and test an Ethics Framework for use in the SA context for health priority-setting.Methods. The Framework was developed iteratively by the authors and a multidisciplinary panel (18 participants) over a period of 18 months, using the principles outlined in the 2015 NHI White Paper as a starting point. The provisional Ethics Framework was then tested with multi-stakeholder simulated appraisal committees (SACs) in three provinces. The membership of each SAC roughly reflected the composition of a potential SA HTA committee. The deliberations and dedicated focus group discussions after each SAC meeting were recorded, analysed and used to refine the Framework, which was presented to the Working Group for review, comment and final approval.Results. This article describes the 12 domains of the Framework. The first four (Burden of the Health Condition, Expected Health Benefits and Harms, Cost-Effectiveness Analysis, and Budget Impact) are commonly used in HTA assessments, and a further eight cover the other ethical domains. These are Equity, Respect and Dignity, Impacts on Personal Financial Situation, Forming and Maintaining Important Personal Relationships, Ease of Suffering, Impact on Safety and Security, Solidarity and Social Cohesion, and Systems Factors and Constraints. In each domain are questions and prompts to enable use of the Framework by both analysts and assessors. Issues that arose, such as weighting of the domains and the availability of SA evidence, were discussed by the SACs.Conclusions. The Ethics Framework is intended for use in priority-setting within an HTA process. The Framework was well accepted by a diverse group of stakeholders. The final version will be a useful tool not only for HTA and other priority-setting processes in SA, but also for future efforts to create HTA methods in SA and elsewhere

High-levels of acquired drug resistance in adult patients failing first-line antiretroviral therapy in a rural HIV treatment programme in KwaZulu-Natal, South Africa.

OBJECTIVE: To determine the frequency and patterns of acquired antiretroviral drug resistance in a rural primary health care programme in South Africa. DESIGN: Cross-sectional study nested within HIV treatment programme. METHODS: Adult (≥ 18 years) HIV-infected individuals initially treated with a first-line stavudine- or zidovudine-based antiretroviral therapy (ART) regimen and with evidence of virological failure (one viral load >1000 copies/ml) were enrolled from 17 rural primary health care clinics. Genotypic resistance testing was performed using the in-house SATuRN/Life Technologies system. Sequences were analysed and genotypic susceptibility scores (GSS) for standard second-line regimens were calculated using the Stanford HIVDB 6.0.5 algorithms. RESULTS: A total of 222 adults were successfully genotyped for HIV drug resistance between December 2010 and March 2012. The most common regimens at time of genotype were stavudine, lamivudine and efavirenz (51%); and stavudine, lamivudine and nevirapine (24%). Median duration of ART was 42 months (interquartile range (IQR) 32-53) and median duration of antiretroviral failure was 27 months (IQR 17-40). One hundred and ninety one (86%) had at least one drug resistance mutation. For 34 individuals (15%), the GSS for the standard second-line regimen was <2, suggesting a significantly compromised regimen. In univariate analysis, individuals with a prior nucleoside reverse-transcriptase inhibitor (NRTI) substitution were more likely to have a GSS <2 than those on the same NRTIs throughout (odds ratio (OR) 5.70, 95% confidence interval (CI) 2.60-12.49). CONCLUSIONS: There are high levels of drug resistance in adults with failure of first-line antiretroviral therapy in this rural primary health care programme. Standard second-line regimens could potentially have had reduced efficacy in about one in seven adults involved