Recognition of Prior Learning as an integral component of competence-based assessment in South Africa

The concept of recognising and accrediting - what people already know and can do - is having a significant impact on many of the education and training programmes currently being developed. This is irrespective of whether that learning has been acquired through unstructured learning, performance development, off-the-job assessment, or skills and knowledge that meet workplace needs but have been gained through various previous learning experiences. The concept Recognition of Prior Learning (RPL) is understood by most in the area of adult education as the method of assessing relevant competences gained by adults through work and life experiences, which can then be counted towards qualifications or for promotion in the workplace by using a systematic set of procedures. A practical elaboration of RPL policy and practice in the current South African education and training sector is urgently needed. Administered carefully, and supported by explicitly anti-discriminatory policies and practices, RPL can indeed contribute to movements for greater casual mobility, thus optimising South Africa's under-used skills and expertise. In doing so, this country can embark upon a realistic and attainable strategy towards becoming a winning nation. (South African Journal of Education: 2002 22(4): 293-296

Health of the street child: the relation between life-style, immunity and HIV / AIDS - a synergy of research

A scrutiny and synergy of the research that was done on the health of street children revealed the relation between their poor living conditions and unhealthy life style and their depleted immune systems which, even in the best situations, wins a victory at a cost. This article probes the relation between the harsh circumstances in which millions of street children in the developed and developing world live and the devastating consequences thereof on their state of health, quality of life and life expectancy. (South African Journal of Education: 2003 22(3): 188-192

Characteristics of sexually experienced HIV testers aged 18 to 32 in rural South Africa: baseline results from a community-based trial, NIMH Project Accept (HPTN 043)

BACKGROUND: Young people in South Africa are at high risk of HIV infection and yet may have more limited access to prevention and treatment services than others in the population. Testing facilitates the sharing of prevention messages but also enables the linkage to care and treatment of those who test positive and therefore has wider public health implications.METHODS: This baseline survey conducted in 2005 for a community randomized trial in rural KwaZulu-Natal explored factors associated with a history of ever, repeat and recent testing amongst sexually debuted men and women aged 18 to 32 years.RESULTS: Over 35% of this rural population ever tested for HIV, with men less likely to ever (unadjusted OR 0.26, 95% CI: 0.21-0.32) and repeatedly test than women (adjusted OR (aOR) 0.68, 95% CI: 0.48-0.97). Men aged 24-28 years (aOR 2.02, 95% CI: 1.10-3.71) and 29-32 years (aOR 2.69, 95% CI: 1.46-4.94) were more likely to ever test than those <20 years. Those who reported having discussed HIV with others had significantly greater odds of reporting ever (men's aOR 2.83, 95% CI: 1.63-4.89; women's aOR 3.36, 95% CI: 2.50-4.53), recent (irrespective of sex, aOR 2.87, 95% CI: 2.02-4.09) and repeat testing (aOR 2.02, 95% CI: 1.28-3.19).CONCLUSION: These findings highlight the need for novel youth- and men-friendly testing services and emphasises the importance of discussions about HIV in the home and community to encourage testing

Mobile HIV Screening in Cape Town, South Africa: Clinical Impact, Cost and Cost-Effectiveness

Background: Mobile HIV screening may facilitate early HIV diagnosis. Our objective was to examine the cost-effectiveness of adding a mobile screening unit to current medical facility-based HIV testing in Cape Town, South Africa. Methods and Findings: We used the Cost Effectiveness of Preventing AIDS Complications International (CEPAC-I) computer simulation model to evaluate two HIV screening strategies in Cape Town: 1) medical facility-based testing (the current standard of care) and 2) addition of a mobile HIV-testing unit intervention in the same community. Baseline input parameters were derived from a Cape Town-based mobile unit that tested 18,870 individuals over 2 years: prevalence of previously undiagnosed HIV (6.6%), mean CD4 count at diagnosis (males 423/µL, females 516/µL), CD4 count-dependent linkage to care rates (males 31%–58%, females 49%–58%), mobile unit intervention cost (includes acquisition, operation and HIV test costs, $29.30 per negative result and$31.30 per positive result). We conducted extensive sensitivity analyses to evaluate input uncertainty. Model outcomes included site of HIV diagnosis, life expectancy, medical costs, and the incremental cost-effectiveness ratio (ICER) of the intervention compared to medical facility-based testing. We considered the intervention to be “very cost-effective” when the ICER was less than South Africa's annual per capita Gross Domestic Product (GDP) ($8,200 in 2012). We projected that, with medical facility-based testing, the discounted (undiscounted) HIV-infected population life expectancy was 132.2 (197.7) months; this increased to 140.7 (211.7) months with the addition of the mobile unit. The ICER for the mobile unit was$2,400/year of life saved (YLS). Results were most sensitive to the previously undiagnosed HIV prevalence, linkage to care rates, and frequency of HIV testing at medical facilities. Conclusion: The addition of mobile HIV screening to current testing programs can improve survival and be very cost-effective in South Africa and other resource-limited settings, and should be a priority

Project Masihambisane: a cluster randomised controlled trial with peer mentors to improve outcomes for pregnant mothers living with HIV

Abstract Background Pregnant women living with HIV (WLH) face daily challenges maintaining their own and their babies' health and mental health. Standard Prevention of Maternal to Child Transmission (PMTCT) programs are not designed to address these challenges. Methods/Design As part of a cluster randomized controlled trial, WLH are invited to attend four antenatal and four postnatal small group sessions led by a peer WLH (a Peer Mentor). The WLH and their babies are assessed during pregnancy and at one week, six months, and twelve months post-birth. Mobile phones are used to collect routine information, complete questionnaires and remain in contact with participants over time. Pregnant WLH (N = 1200) are randomly assigned by clinic (N = 8 clinics) to an intervention program, called Masihambisane (n = 4 clinics, n = 600 WLH) or a standard care PMTCT control condition (n = 4 clinics; n = 600 WLH). Discussion Data collection with cellular phones are innovative and effective in low-resource settings. Standard PMTCT programs are not designed to address the daily challenges faced by WLH; Peer Mentors may be useful in supporting WLH to cope with these challenges. Trial registration ClinicalTrials.gov registration # NCT0097269

The evolving SARS-CoV-2 epidemic in Africa: Insights from rapidly expanding genomic surveillance

INTRODUCTION Investment in Africa over the past year with regard to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) sequencing has led to a massive increase in the number of sequences, which, to date, exceeds 100,000 sequences generated to track the pandemic on the continent. These sequences have profoundly affected how public health officials in Africa have navigated the COVID-19 pandemic. RATIONALE We demonstrate how the first 100,000 SARS-CoV-2 sequences from Africa have helped monitor the epidemic on the continent, how genomic surveillance expanded over the course of the pandemic, and how we adapted our sequencing methods to deal with an evolving virus. Finally, we also examine how viral lineages have spread across the continent in a phylogeographic framework to gain insights into the underlying temporal and spatial transmission dynamics for several variants of concern (VOCs). RESULTS Our results indicate that the number of countries in Africa that can sequence the virus within their own borders is growing and that this is coupled with a shorter turnaround time from the time of sampling to sequence submission. Ongoing evolution necessitated the continual updating of primer sets, and, as a result, eight primer sets were designed in tandem with viral evolution and used to ensure effective sequencing of the virus. The pandemic unfolded through multiple waves of infection that were each driven by distinct genetic lineages, with B.1-like ancestral strains associated with the first pandemic wave of infections in 2020. Successive waves on the continent were fueled by different VOCs, with Alpha and Beta cocirculating in distinct spatial patterns during the second wave and Delta and Omicron affecting the whole continent during the third and fourth waves, respectively. Phylogeographic reconstruction points toward distinct differences in viral importation and exportation patterns associated with the Alpha, Beta, Delta, and Omicron variants and subvariants, when considering both Africa versus the rest of the world and viral dissemination within the continent. Our epidemiological and phylogenetic inferences therefore underscore the heterogeneous nature of the pandemic on the continent and highlight key insights and challenges, for instance, recognizing the limitations of low testing proportions. We also highlight the early warning capacity that genomic surveillance in Africa has had for the rest of the world with the detection of new lineages and variants, the most recent being the characterization of various Omicron subvariants. CONCLUSION Sustained investment for diagnostics and genomic surveillance in Africa is needed as the virus continues to evolve. This is important not only to help combat SARS-CoV-2 on the continent but also because it can be used as a platform to help address the many emerging and reemerging infectious disease threats in Africa. In particular, capacity building for local sequencing within countries or within the continent should be prioritized because this is generally associated with shorter turnaround times, providing the most benefit to local public health authorities tasked with pandemic response and mitigation and allowing for the fastest reaction to localized outbreaks. These investments are crucial for pandemic preparedness and response and will serve the health of the continent well into the 21st century

The traditional custom of chastity and sexual restraint in the education of the young Swazi girl

This article deals with the traditional custom of chastity and sexual restraint of the Swazi people, living in a ‘tiny kindom’ in Southern Africa under the current leadership of King Mswati III. The custom, referred to as Umcwasho, is a custom that forbids young, unmarried females engaging in any form of sexual activity for a specified period, the length of which is determined by the king. The Swazi people are known to be very strict and conservative, and traditionally permit only a restricted form of sexual activity among the young who have reached puberty. Swazi parents grant their teenagers no free sexual experimentation whatsoever. Parents, at all times, call upon restricted and inhibited sexual behaviour, which means that they will allow, ‘at the utmost’ only external intercourse and sex play. The maintenance of virginity in both boys and girls is above all treasured and extremely highly valued. The above facts and the supposed impact thereof on young people contributed to determine the aim and focus of this research, namely, to determine what the custom of chastity and sexual restraint in Swazi culture entail, and what meaning and value the Swazi people attach to this type of traditional education. The value and importance of the custom of chastity and sexual restraint, that falls under the jurisdiction of the King himself became obvious during the course of this research. From the results of the study it is understood that not only the observation of the custom, but particularly the meaning thereof, are highly valued and respected by the nation

Health of the street child : the relation between life-style, immunity and HIV/AIDS - a synergy of research

A scrutiny and synergy of the research that was done on the health of street children revealed the relation between their poor living conditions and unhealthy life style and their depleted immune systems which, even in the best situations, wins a victory at a cost. This article probes the relation between the harsh circumstances in which millions of street children in the developed and developing world live and the devastating consequences thereof on their state of health, quality of life and life expectancy

Implementation of an HIV & AIDS programme in South African schools : strengths and weaknesses

The primary aim of this study was to explore the lived-experiences of teachers who were responsible for the presentation of the official HIV & AIDS Programme of the Department of Education of South Africa. The study was motivated by the fact that it seemed as if schools do not implement the prescribed programmes as research has indicated that a mere 18% of schools are following a Sexuality Education Programme with HIV & AIDS as a core component. Experts commonly hold the view that HIV infection can be prevented through education and positive changes in sexual behaviour. The spread and the rising incidence of HIV & AIDS in South Africa are damaging our society and our education system. Many schools are already experiencing great difficulties, and school communities no longer depend on healthy learners, stable families, competent teachers or a strong economy. The findings of this study indicated teachers’ perceptions and experiences of the HIV & AIDS programme. Although the implementation of HIV & AIDS programmes in schools was made compulsory, the study indicated that schools were not adhering to this requirement, due to factors such as a lack of sound management practices in schools, insufficient training of teachers and school managers and uninvolved stakeholders