Economic evaluation of short treatment for multidrugresistant tuberculosis, Ethiopia and South Africa : the STREAM trial

OBJECTIVE STREAM was a phase-III non-inferiority randomised controlled trial (RCT) to evaluate a shortened regimen for multi-drug resistant tuberculosis (MDR-TB), and included the first-ever within-trial economic evaluation of such regimens, reported here. METHODS We compared the costs of ‘Long’ (20-22 months) and ‘Short’ (9-11 months) regimens in Ethiopia and South Africa. Cost data were collected from trial participants, and health system costs estimated using ‘bottom-up’ and ‘top-down’ costing approaches. A cost-effectiveness analysis was conducted with the trial primary outcome as the measure of effectiveness, including a probabilistic sensitivity analysis (PSA) to illustrate decision uncertainty. FINDINGS The Short-regimen reduced healthcare costs per case by 21% in South Africa (US$8,341 Long vs US$6,619 Short) and 25% in Ethiopia (US$6,097 Long vs US$4,552 Short). The largest component of this saving was medication in South Africa (67%) and social support in Ethiopia (35%). In Ethiopia, participants on the Short-regimen reported reductions in dietary supplementation expenditure (US$225 per case (95$13 (95%CI 11-14), South Africa US$64 (95$19,000 (Ethiopia) or <US$14,500 (South Africa). CONCLUSION The Short-regimen provided substantial health system cost savings and reduced financial burden on participants. Shorter regimens are likely to be cost-effective in most settings, and an effective strategy to support the WHO goal of eliminating catastrophic costs in T

Recommendations for athletes and COVID-19 vaccinations: A South African Sports Medicine Association (SASMA) position statement – Part 3

The COVID-19 pandemic initially led to the shutdown of all sport at a high cost to both the economy and athlete health. As risk-mitigating protocols evolved and were implemented, the playing of sport returned slowly to normal. The introduction of COVID-19 vaccinations enhances the means of protection and risk management for all. This South African Sports Medicine Association position statement provides recommendations for the vaccination of athletes

Recommendations for the return of spectators to sport stadiums: A South African Sports Medicine Association (SASMA) position statement – Part 4

All sports were discontinued in 2020 with the arrival of COVID-19. Since then most have been reinstated, albeit without spectators. However, several countries have put together a number of different risk-mitigating strategies to allow spectators back into stadiums. This position statement gives an outline of the minimum requirements that should be considered upon the return of spectators at live sporting events

Successful students’ negotiation of township schooling in contemporary South Africa

This article draws on data from a larger longitudinal qualitative case study which is tracking the progress of students over the course of their undergraduate degrees at a South African university. For this paper, we used background questionnaires and semi-structured interviews with 62 first-year students from working-class, township schools who were first registered for Extended Degree Programmes in 2009. The article draws on post-structuralist theory on learning and identity to describe and analyse the participants’ perspectives on how they negotiated their high school contexts. We analyse the subject positions in which participants invested, as well as how they negotiated their way through social networks and used resources. Our data illustrate the ways in which students had to carry the burden of negotiating their way through home, school and neighbourhood spaces that were generally not conducive to learning. Nevertheless, participants consciously positioned themselves as agents. They were resilient, motivated and took highly strategic adult decisions about their learning. We argue that a focus on how successful students negotiate their environments challenges the pathologising paradigm of “disadvantage” that characterises research and debates in higher education. It also offers an additional lens for admissions processes and for providing appropriate intervention strategies in the tertiary setting

South African Institute of Drug-Free Sport Position Statement on CBD (Cannabidiol) and THC (Tetrahydrocannabinol)

Cannabidiol (CBD) and Tetrahydrocannabinol (THC) have become easily available to athletes over the years. Using these substances may inadvertently expose an athlete to the possibility of an adverse analytical finding (a ”positive” test) and a sanction. Athletes need to understand the risk of an antidoping rule violation or adverse analytical finding should these products be used, especially if no therapeutic use exemption exists. This position statement attempts to clarify the use of CBD and THC and their associated risks with Anti-Doping Rule Violations (ADRV) in the athletic population. The South African Sports Medicine Association supports this position statement

The influence of probiotic supplementation on selected athletic performance-related blood markers in men

It has been speculated that probiotics can improve athletic performance. Significant increases in haemoglobin concentration and oxygen consumption have also been shown to follow the ingestion of lactic acid bacteria in athletes. The aim of this study was to determine whether the administration of commercially prepared probiotics could influence haemoglobin concentration and other haematological parameters in moderately active males. Fifty healthy, moderately active male volunteers were divided into two groups (Test Group and Control Group). A randomized, double-blind, placebo-controlled, pre-test/post-test, group comparison study was done. The study showed no significant differences (p≥0.05) between the two groups on any of the dependent measurements. There were statistically significant changes (p≤0.05) between pre- and post-test results within the two groups. These changes were within physiological limits. Sodium increased significantly (p=0,001) from 139.29 mmol/L to 140.96 mmol/L in the Control Group. In the Test Group sodium increased significantly (p=0,035) from 139.60 mmol/L to 140.90 mmol/L, and potassium decreased (p=0.010) from 4.67 mmol/L to 4.44 mmol/L. Study results thus indicated that the ingestion of a lactic acid bacteria preparation for 42 days did not increase the haemoglobin concentration in moderately active males.http://www.ajol.info/journal_index.php?jid=153&ab=ajpher

South African Institute of Drug-Free Sport position statement on CBD (Cannabidiol) and THC (Tetrahydrocannabinol)

Cannabidiol (CBD) and Tetrahydrocannabinol (THC) have become easily available to athletes over the years. Using these substances may inadvertently expose an athlete to the possibility of an adverse analytical finding (a ”positive” test) and a sanction. Athletes need to understand the risk of an antidoping rule violation or adverse analytical finding should these products be used, especially if no therapeutic use exemption exists. This position statement attempts to clarify the use of CBD and THC and their associated risks with Anti-Doping Rule Violations (ADRV) in the athletic population. The South African Sports Medicine Association supports this position statement.https://journals.assaf.org.za/index.php/sajsm/indexhj2023Sports Medicin

The early-stage comprehensive costs of routine PrEP implementation and scale-up in Zambia

Pre-exposure prophylaxis (PrEP) is an effective HIV prevention option, but cost-effectiveness is sensitive to implementation and program costs. Studies indicate that, in addition to direct delivery cost, PrEP provision requires substantial demand creation and client support to encourage PrEP initiation and persistence. We estimated the cost of providing PrEP in Zambia through different PrEP delivery models. Taking a guidelines-based approach for visits, labs and drugs, we estimated the annual cost of providing PrEP per client for five delivery models: one focused on key populations (men-who-have-sex-with-men (MSM) and female sex workers (FSW), one on adolescent girls and young women (AGYW), and three integrated programs (operated within HIV counselling and testing services at primary healthcare centres). Program start-up and support costs were based on program expenditure data and number of PrEP sites and clients in 2018. PrEP clinic visit costs were based on micro-costing at two PrEP delivery sites (2018 USD). Costs are presented in 2018 prices and inflated to 2021 prices. The annual cost/PrEP client varied by service delivery model, from $394 (AGYW) to$655 (integrated model). Cost differences were driven largely by client volume, which impacted the relative costs of program support and technical assistance assigned to each PrEP client. Direct service delivery costs ranged narrowly from $205-212/PrEP-client and were a key component in the cost of PrEP, representing 35–65% of total costs. The results show that, even when integrated into full service delivery models, accessing vulnerable, marginalised populations at substantial risk of HIV infection is likely to cost more than previously estimated due to the programmatic costs involved in community sensitization and client support. Improved data on individual client resource usage and outcomes is required to get a better understanding of the true resource utilization, expected outcomes and annual costs of different PrEP service delivery programs in Zambia

The correlation between the health-related fitness of healthy participants measured at home as opposed to fitness measured by sport scientists in a laboratory

BACKGROUND : Fitness is defined in the health context as a state of good health or physical condition, primarily as a result of exercise and proper nutrition. Conventional methods of measuring fitness are expensive, time consuming and require specialised methods. There is a need for noninvasive, fast methods of assessing health-related fitness and activity in athlete and non-athlete populations. The aim of this study was to establish any correlation between participants’ self-assessed health-related fitness (HRF) index and the HRF index determined by sports scientists, as well as the laboratory-assessed HRF index and maximum oxygen uptake (VO2max) determined by sports scientists via direct methods in a laboratory, and finally, to determine any potential correlation between an activity-recall questionnaire (Kasari) and VO2max. METHOD : The participants consisted of 169 male and female volunteers between the ages of 18 and 55 years, taking neither supplements nor medication. The University of Pretoria’s HRF index protocol was first carried out by participants on their own at home, and then in the laboratory under the supervision of sport scientists. The complete datasets of 150 participants were statistically analysed to establish correlations. RESULTS : The results indicated highly significant and substantial correlations (ρ = 0.696, p < 0.001) between the participants’ self-assessed HRF index and measurements by the sports scientists. There were moderate correlations between the laboratoryassessed HRF index and the direct VO2max (ρ = 0 512, p < 0.005), as well as the indirect VO2max (ρ = 0.588; p < 0.001). A significant correlation was found between the self-assessed HRF index and the indirect VO2max (ρ = 0.454; p < 0.001). The Kasari questionnaire correlated only weakly with the indirect VO2max (ρ = 0.278, p < 0.002) and not at all with the direct VO2max (ρ = 0.072, p = 0.731). CONCLUSION : Indications are that this test protocol may be conducted at home by individuals, without supervision, to determine exercise ability or fitness, or to monitor changes in physical fitness, thereby limiting expenses and costs.Momentum Interactivehttp://www.safpj.co.za/index.php/safpjhb201

Evaluation of Typhoid Conjugate Vaccine Effectiveness in Ghana (TyVEGHA) Using a Cluster-Randomized Controlled Phase IV Trial: Trial Design and Population Baseline Characteristics.

Typhoid fever remains a significant health problem in sub-Saharan Africa, with incidence rates of >100 cases per 100,000 person-years of observation. Despite the prequalification of safe and effective typhoid conjugate vaccines (TCV), some uncertainties remain around future demand. Real-life effectiveness data, which inform public health programs on the impact of TCVs in reducing typhoid-related mortality and morbidity, from an African setting may help encourage the introduction of TCVs in high-burden settings. Here, we describe a cluster-randomized trial to investigate population-level protection of TYPBAR-TCV®, a Vi-polysaccharide conjugated to a tetanus-toxoid protein carrier (Vi-TT) against blood-culture-confirmed typhoid fever, and the synthesis of health economic evidence to inform policy decisions. A total of 80 geographically distinct clusters are delineated within the Agogo district of the Asante Akim region in Ghana. Clusters are randomized to the intervention arm receiving Vi-TT or a control arm receiving the meningococcal A conjugate vaccine. The primary study endpoint is the total protection of Vi-TT against blood-culture-confirmed typhoid fever. Total, direct, and indirect protection are measured as secondary outcomes. Blood-culture-based enhanced surveillance enables the estimation of incidence rates in the intervention and control clusters. Evaluation of the real-world impact of TCVs and evidence synthesis improve the uptake of prequalified/licensed safe and effective typhoid vaccines in public health programs of high burden settings. This trial is registered at the Pan African Clinical Trial Registry, accessible at Pan African Clinical Trials Registry (ID: PACTR202011804563392)