Mental health policy: Options for South Africa

This paper emphasizes the need for mental health professionals to become involved in developing mental health policies in South Africa. In particular, it examines three options that are currently the focus of attention with respect to national health options, i.e. a free market system, a national health service (NHS) and a national health insurance system (NHIS). While the paper does not provide support for any one of these options it does attempt to investigate some of the implications of each option for the funding and delivery of mental health care

Building Mutual Understanding for Effective Development

In recent years a number of countries, referred to collectively as the rising powers, have achieved rapid economic growth and increased political influence. In many cases their experience challenges received wisdom on inclusive development. Research funded by traditional development donors has tended to focus on their own aid recipients. Policy analysts in the rising powers have faced several challenges in generating systematic learning from their countries’ rapidly changing development experiences. This has created a knowledge-sharing gap. The IDS Rising Powers in International Development programme invited highly experienced policymakers and analysts to review important development experiences from their countries, as Senior International Associates, creating new opportunities for mutual learning.UK Department for International Developmen

The South African Tuberculosis Care Cascade: Estimated Losses and Methodological Challenges

Background: While tuberculosis incidence and mortality are declining in South Africa, meeting the goals of the End TB Strategy requires an invigorated programmatic response informed by accurate data. Enumerating the losses at each step in the care cascade enables appropriate targeting of interventions and resources. / Methods: We estimated the tuberculosis burden; the number and proportion of individuals with tuberculosis who accessed tests, had tuberculosis diagnosed, initiated treatment, and successfully completed treatment for all tuberculosis cases, for those with drug-susceptible tuberculosis (including human immunodeficiency virus (HIV)–coinfected cases) and rifampicin-resistant tuberculosis. Estimates were derived from national electronic tuberculosis register data, laboratory data, and published studies. / Results: The overall tuberculosis burden was estimated to be 532005 cases (range, 333760–764480 cases), with successful completion of treatment in 53% of cases. Losses occurred at multiple steps: 5% at test access, 13% at diagnosis, 12% at treatment initiation, and 17% at successful treatment completion. Overall losses were similar among all drug-susceptible cases and those with HIV coinfection (54% and 52%, respectively, successfully completed treatment). Losses were substantially higher among rifampicin- resistant cases, with only 22% successfully completing treatment. / Conclusion: Although the vast majority of individuals with tuberculosis engaged the public health system, just over half were successfully treated. Urgent efforts are required to improve implementation of existing policies and protocols to close gaps in tuberculosis diagnosis, treatment initiation, and successful treatment completion

Role of the cluster structure of 7^7Li in the dynamics of fragment capture

Exclusive measurements of prompt $\gamma$-rays from the heavy-residues with various light charged particles in the $^7$Li + $^{198}$Pt system, at an energy near the Coulomb barrier (E/$V_b$ $\sim$ 1.6) are reported. Recent dynamic classical trajectory calculations, constrained by the measured fusion, $\alpha$ and $t$ capture cross-sections have been used to explain the excitation energy dependence of the residue cross-sections. These calculations distinctly illustrate a two step process, breakup followed by fusion in case of the capture of $t$ and $\alpha$ clusters; whereas for $^{6}$He + $p$ and $^{5}$He + $d$ configurations, massive transfer is inferred to be the dominant mechanism. The present work clearly demonstrates the role played by the cluster structures of $^7$Li in understanding the reaction dynamics at energies around the Coulomb barrier.Comment: 6 pages, 4 figures, Accepted for publication in Phys. Letts.

Nuclear matrix elements calculation for 0νββ0\nu\beta\beta decay of 124^{124}Sn using nonclosure approach in nuclear shell model

In this study, we calculate the nuclear matrix elements (NMEs) for the light neutrino-exchange mechanism of neutrinoless double beta $0\nu\beta\beta$) decay of $^{124}$Sn within the framework of the interacting nuclear shell model using the effective shell model Hamiltonian GCN5082. A novel method based on a nonclosure approach is employed, wherein for the intermediate nucleus $^{124}$Sb, effects of energy of 100 states for each $J_{k}^{\pi}$=$0^{+}$ to $11^{+}$ and $2^{-}$ to $9^{-}$ ($\Delta J_{k}$=1) are explicitly included in the NMEs calculation. Other common effects such as the finite size of nucleons, higher-order effects of nucleon currents, and short-range correlations (SRC) of nucleons are also taken into account. The extracted optimal closure energy is 2.9 MeV for a total NME of $^{124}$Sn $0\nu\beta\beta$ decay, which is independent of different forms of SRC parametrizations. A comparison of NMEs and half-lives with some of the recent calculations is presented. Further, to gain a comprehensive understanding of the role of nuclear structure on the $0\nu\beta\beta$ decay, the dependence of NMEs on spin-parity of the intermediate states, coupled spin-parity of neutrons and protons, and the number of intermediate states, is explored. It is observed that the inclusion of the effects of excitation energies of the intermediate nucleus yields more reliable NMEs. The present findings provide valuable insights for experimental investigations of $0\nu\beta\beta$ decay of $^{124}$Sn in India and elsewhere.Comment: 12 pages, 6 figures, submitted in the journal Physical Review C. arXiv admin note: text overlap with arXiv:2308.0821

The impact of health programmes to prevent vertical transmission of HIV. Advances, emerging health challenges and research priorities for children exposed to or living with HIV: Perspectives from South Africa

Over the past three decades, tremendous global progress in preventing and treating paediatric HIV infection has been achieved. This paper highlights the emerging health challenges of HIV-exposed uninfected (HEU) children and the ageing population of children living with HIV (CLHIV), summarises programmatic opportunities for care, and highlights currently conducted research and remaining research priorities in high HIV-prevalence settings such as South Africa. Emerging health challenges amongst HEU children and CLHIV include preterm delivery, suboptimal growth, neurodevelopmental delay, mental health challenges, infectious disease morbidity and mortality, and acute and chronic respiratory illnesses including tuberculosis, pneumonia, bronchiectasis and lymphocytic interstitial pneumonitis. CLHIV and HEU children require three different categories of care: (i) optimal routine child health services applicable to all children; (ii) routine care currently provided to all HEU children and CLHIV, such as HIV testing or viral load monitoring, respectively, and (iii) additional care for CLHIV and HEU children who may have growth, neurodevelopmental, behavioural, cognitive or other deficits such as chronic lung disease, and require varying degrees of specialised care. However, the translation thereof into practice has been hampered by various systemic challenges, including shortages of trained healthcare staff, suboptimal use of the patient-held child’s Road to Health book for screening and referral purposes, inadequate numbers and distribution of therapeutic staff, and shortages of assistive/diagnostic devices, where required. Additionally, in low-middle-income high HIV-prevalence settings, there is a lack of evidence-based solutions/models of care to optimise health amongst HEU and CLHIV. Current research priorities include understanding the mechanisms of preterm birth in women living with HIV to optimise preventive interventions; establishing pregnancy pharmacovigilance systems to understand the short-, medium- and long-term impact of in utero ART and HIV exposure; understanding the role of preconception maternal ART on HEU child infectious morbidity and long-term growth and neurodevelopmental trajectories in HEU children and CLHIV, understanding mental health outcomes and support required in HEU children and CLHIV through childhood and adolescence; monitoring HEU child morbidity and mortality compared with HIV-unexposed children; monitoring outcomes of CLHIV who initiated ART very early in life, sometimes with suboptimal ART regimens owing to medication formulation and registration issues; and testing sustainable models of care for HEU children and CLHIV including later reproductive care and support

Changes to the World Health Organization guideline on hormonal contraceptive eligibility for women at high risk of HIV: South African perspective and response

The World Health Organization (WHO) published guidelines for hormonal contraceptive eligibility for women at high risk of HIV in March 2017. This guidance followed from a technical consultative meeting convened by the WHO in December 2016, where all the available evidence on hormonal contraceptives and risk of HIV acquisition was reviewed. This was an expert meeting with representation from global experts in family planning and HIV management, including clinicians, epidemiologists, researchers and civil society. The guideline development group, through a consensus, made recommendations to change the medical eligibility criteria for contraceptive use from category 1 to category 2 for progestogen-only injectable contraceptives among women at high risk of HIV. There was no change in the recommendation for all other methods of hormonal contraception. The data that informed this decision are from observational studies, which have limitations; therefore, causality or association of hormonal contraception and risk of HIV acquisition have not been proven. This guidance will have an impact on countries that have a high HIV disease burden and where progestogen-only injectable contraceptives are the highest used, as in South Africa (SA). The information has to be communicated in line with the WHO’s sexual and reproductive health rights principles of ensuring that all women should receive evidence-based recommendations. This will empower them to make informed choices about their reproductive needs. This article seeks to clarify the decision-making process of the WHO and how the new recommendations were formulated. It also gives SA’s response to the guidance and a perspective of what informed the National Department of Health’s position, taking into account the effect this will have on SA’s contraceptive guidelines

Changes to the World Health Organization guideline on hormonal contraceptive eligibility for women at high risk of HIV: South African perspective and response

The World Health Organization (WHO) published guidelines for hormonal contraceptive eligibility for women at high risk of HIV in March 2017. This guidance followed from a technical consultative meeting convened by the WHO in December 2016, where all the available evidence on hormonal contraceptives and risk of HIV acquisition was reviewed. This was an expert meeting with representation from global experts in family planning and HIV management, including clinicians, epidemiologists, researchers and civil society. The guideline development group, through a consensus, made recommendations to change the medical eligibility criteria for contraceptive use from category 1 to category 2 for progestogen-only injectable contraceptives among women at high risk of HIV. There was no change in the recommendation for all other methods of hormonal contraception. The data that informed this decision are from observational studies, which have limitations; therefore, causality or association of hormonal contraception and risk of HIV acquisition have not been proven. This guidance will have an impact on countries that have a high HIV disease burden and where progestogen-only injectable contraceptives are the highest used, as in South Africa (SA). The information has to be communicated in line with the WHO’s sexual and reproductive health rights principles of ensuring that all women should receive evidence-based recommendations. This will empower them to make informed choices about their reproductive needs. This article seeks to clarify the decision-making process of the WHO and how the new recommendations were formulated. It also gives SA’s response to the guidance and a perspective of what informed the National Department of Health’s position, taking into account the effect this will have on SA’s contraceptive guidelines

Elimination of mother-to-child transmission of HIV in South Africa: Rapid scale-up using quality improvement

Background. South Africa (SA) is committed to achieving the goal of eliminating mother-to-child transmission (MTCT) of HIV by 2015. To achieve this, universal coverage of quality antenatal, labour, delivery and postnatal services for all women has to be attained. Over the past decade, the prevention of mother-to-child transmission (PMTCT) programme has been scaled up to reach all healthcare facilities in the country. However, challenges persist in achieving 100% coverage and access to the programme. Objectives. We describe the process undertaken by the National Department of Health (NDoH), in collaboration with partners, to develop, implement and monitor a data-driven intervention to improve facility, district, provincial and national PMTCT-related performance. Methods. Between 2011 and 2013, the NDoH developed and implemented an intervention using data-driven participatory processes to understand facility-level bottlenecks to optimise PMTCT implementation and to scale up priority PMTCT actions nationally. Results. There was remarkable improvement across all key indicators in the PMTCT cascade over the 3 years 2011 - 2013. Simple monitoring tools such as a visual dashboard and data for action reports were successfully used to improve the performance of the PMTCT programme across SA. MTCT has shown a significant downward trend.Conclusions. It is feasible to implement district-level, data-driven quality improvement processes at a national scale to improve the performance of the PMTCT programme at the local level.