Nurturing the continuum of HIV testing, treatment and prevention matrix cascade in reducing HIV transmission

Background: Despite the shift in antiretroviral therapy (ARVs) eligibility  cascade from CD4 ≤ 200 to CD4 ≤ 350 to CD4 ≤ 500 mm3, HIV related  morbidity and mortality continue to escalate annually, as do HIV infections. The new paradigm of treatment for all HIV positives individual irrespective of CD4 count may significantly reduce HIV and related illnesses. The author assumes that all HIV infected partners should be eligible for HIV treatment and care, irrespective of CD4 count. A second assumption is that high risk HIV negative partners have free access to continuum of HIV pre-exposure prophylaxis  (PrEP), post exposure prophylaxis (PEP) and other prevention packages. Methods: A literature review search was used to extract evidence-based ARVs-HIV treatment and prevention interventions among HIV positives and high risk partners respectively. Only articles published in English and indexed in journal nuclei were used for the study. The information was used to nurture understanding of HIV treatment and prevention approaches as well as HIV incidence multiplier effect among HIV serodiscordant partners. The imputed HIV incident reference was assumed at 1.2 per 100 person-years (2). This was based on the imputation that retention in care, adherence and other predetermined factors are functions of an effective health care delivery system. Result: The model showed a reduced HIV transmission from 1.2 per 100  person-years to 1.032 per 100 person-years in 6 months. The average threshold period of HIV suppressed partners on ARVs to an undetectable level. The  combined multiplier protective-effect probability of transmitting HIV from HIV positive partners on ARVs-suppressed viremic load to HIV negative partners on PrEP/PEP-prevention was detected at 86% Conclusion: The model showed a significant reduction in HIV incidence. Placing serodiscordant sexual partners in HIV treatment and prevention plays a significant role in reducing and controlling HIV infection. Therefore, the policy of enrolling all HIV positives irrespective of CD4 count on ARVs and high risk partners on prevention if adopted and sustained may underpin reduction and control of HIV genotype and HIV related morbidity, mortality and opportunistic infections. Keywords: HIV, test and treat, linkage to care, prevention, incidenc

The association between dietary intake and risk of overweight among 17-year-old adolescents in Soweto, Johannesburg, South Africa, in 2007/2008

A Research Report submitted to the School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, in fulfillment of the requirements for the Degree of Masters in Epidemiology and Biostatistics. Johannesburg, February 2014Background: Overweight continues to be a major indicator of adulthood non-communicable diseases (NCDs) risk and can be linked to early childhood and adolescent dietary lifestyles. Research has shown that the burden of childhood and adolescent overweight in sub-Saharan Africa (SSA) and especially in South Africa is rising. There is therefore an urgent need to address this burden in the context of overweight risk related to nutrition transition. The current study used Birth to Twenty (BT20) cohort study data to examine the association between dietary intake and overweight status of 17-year old adolescents residing in Soweto, South Africa in 2007/2008. Methods: A secondary data analysis was conducted including 227 seventeen-year old adolescents (43.6% boys) from the BT20 cohort study. A modified quantitative Food Frequency Questionnaire (FFQ) was used to estimate dietary intake. Height and weight were measured by trained research assistants and overweight was categorized using the International Obesity Task Force (IOBTF) cut-offs. A multinomial logistic regression model was used to examine the association between overweight category (BMI) and dietary intake, socio-demographic factors and other covariates. The base reference used for Body Mass Index (BMI) category was normal weight. Results: The overall overweight prevalence was 14.5% (33/227), and prevalence of underweight was 23.3% (53/227) among the 17-year old Soweto adolescents. The prevalence of overweight was significantly higher in girls (19.3%) than boys (8.1%). The prevalence of underweight was 33.3% for boys and 15.6% for girls. The univariate analysis found the following macronutrient intake positively associated with boys’ BMI category: fat 189.4g (IQR=119.9-239.8, P<0.001), proteins 154.6g (IQR = 98.7-198.2, P<0.001) and carbohydrate 673.1g (IQR = 461-794.2, P<0.001). The following macronutrients: fat 176.4g (IQR = 99.5-220.1, P<0.001), proteins 126.1g (IQR = 70.4-145, P<0.001.) and carbohydrates 523.1g (IQR = 326.6-640.9, P<0.001) were positively associated with girls’ BMI category. The socio-demographic factors found associated with girls’ BMI were ethnicity (p=0.042) and maternal education (p=0.05). Also factors such as washing machine ownership (p=0.046), and parents having a car (p=0.048) were positively associated with boys BMI category. The multinomial logistic regression showed no significant differences in dietary intake when overweight boys were compared to normal weight boys: fat intake (RRR=0.99, 95% CI=0.95-1.01), carbohydrate (RRR=0.99, 95% CI=.96-1.01) and energy intake (RRR=1.01, 95% CI=0.99-1.01). Similar non significant results were observed for girls: fat intake (RRR=1.0, 95% CI =0.96-1.01), carbohydrate (RRR=1.0, 95% CI =0.99-1.02) and energy intake (RRR=1.0, 95% CI=0.99-1.01). Girls from the coloured community were more likely to be underweight than black African girls (RRR= 2.8, 95% CI=0.89-8.57). The results also showed that girls from mixed ancestral community (RRR= 0.25, 95% CI=0.05-1.20) were less likely to be overweight than black African girls. Discussion and Conclusion: The survey indicated high prevalence of both underweight and overweight among 17 year old adolescents residing in Soweto. This underscores the urgent need for both underweight and overweight prevention interventions and also highlights the need for an integrated surveillance system for both underweight and overweight among South African adolescents

The spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2): South African resilience and survival strategies

Containment of the COVID-19 pandemic relies on accurate data regarding symptoms, transmission, prevention, nature of the virus, strains, immunological factors, relevant demographic and behavioural factors, and control strategies. In South Africa, epidemiological infection data revealed 622,551 cases and 231 deaths per million population as of 29 August 2020. This study describes the strategies South Africa is applying in containing the COVID-19 outbreak that could be used to inform appropriate monitoring and surveillance in other settings, and to improve global health preparedness

HIV and sexually transmitted co-infections among sex workers in the Southern African economic region

Abstract: The Southern African Development Community (SADC) economic block is the most affected region by HIV epidemic in Sub‑Saharan Africa (SSA). Despite programmatic interventions, HIV infections remain unprecedentedly high among female sex workers (FSW) in the region. This review assesses the HIV burden and the drivers associated with FSW in the SADC region. Methods: We systematically extracted and analyzed HIV burden and other sexually transmitted infections (STIs) research data on FSW indexed in various journal platform and reports from governmental and nongovernmental organizations between 2003 and 2015. Metaanalysis technique was used to estimate the pooled prevalence of the HIV burden among FSW in the region. Results: Of the 192 peer‑reviewed articles and reports addressing HIV burden, only 21 articles met eligibility criteria totaling 14998 FSW. The combined overall pool HIV prevalence was estimated at 42.0% (95% CI 0.41– 0.43). The estimated pooled HIV prevalence ranged from 16% (95% CI 0.13–18) in Democratic Republic of Congo, 59% (95% CI 0.57–0.62) in South Africa and 71% (95% CI 0.65–0.76) in Malawi. The most common STIs reported were syphilis, Chlamydia, and gonorrhea with little emphasis on viruses. Structural factors such as stigma and discrimination, access to healthcare services and various socioeconomic and political barriers impeded treatment and prevention. Conclusion: The HIV prevalence among FSW was 5–30 times higher when compared to the overall female reproductive age population in the SADC region. This signifies and necessitates increase evidence based HIV/STIs research and programs among FSW in the SADC region

Estimating actual COVID-19 case numbers using cumulative death count-A method of measuring effectiveness of lockdown of non-essential activities : a South African case study

INTRODUCTION : estimating the number of SARS-CoV-2 infected individuals at any specific time point is always a challenge due to asymptomatic cases, the incubation period and testing delays. Here we use an empirical analysis of cumulative death count, transmission-to-death time lag, and infection fatality rate (IFR) to evaluate and estimate the actual cases at a specific time point as a strategy of tracking the spread of COVID-19. METHODS : this method mainly uses death count, as COVID-19 related deaths are arguably more reliably reported than infection case numbers. Using an IFR estimate of 0.66%, we back-calculate the number of cases that would result in the cumulative number of deaths at a given time point in South Africa between 27 February and 14 April. We added the mean incubation period (6.4 days) and the onset-to-death time lag (17.8 days) to identify the estimated time lag between transmission and death (25 days, rounded up). We use the statistical programming language R to analyze the data and produce plots. RESULTS : we estimate 28,182 cases as of 14 April, compared with 3,465 reported cases. Weekly growth rate of actual cases dropped immediately after lockdown implementation and has remained steady, measuring at 51.2% as of 14 April. The timing of drop in growth rate suggests that South Africa’s infection prevention strategy may have been effective at reducing viral transmission. CONCLUSION : estimating the actual number of cases at a specific time point can support evidence-based policies to reduce and prevent the spread of COVID-19. Non-reported, asymptomatic, hard to reach and, mild cases are possible sources of outbreaks that could emerge after lockdown. Therefore, close monitoring, optimized screening strategy and prompt response to COVID-19 could help in stopping the spread of the virus.http://www.panafrican-med-journal.comam2021School of Health Systems and Public Health (SHSPH

Engineered nanoparticle bio-conjugates toxicity screening: The xCELLigence cells viability impact

Introduction: The vast diverse products and applications of engineered nanoparticle bio-conjugates (ENPBCs) are increasing, and thus flooding the-markets. However, the data to support risk estimates of ENPBC are limited. While it is important to assess the potential benefits, acceptability and uptake, it is equally important to understand where ENPBCs safety is and how to expand and affirm consumer security concerns. Methods: Online articles were extracted from 2013 to 2016 that pragmatically used xCELLigence real-time cell analysis (RTCA) technology to describe the in-vitro toxicity of ENPBCs. The xCELLigence is a +noninvasive in vitro toxicity monitoring process that mimics exact continuous cellular bio-responses in real-time settings. On the other hand, articles were also extracted from 2008 to 2016 describing the in vivo animal models toxicity of ENPBCs with regards to safety outcomes. Results: Out of 32 of the 121 (26.4%) articles identified from the literature, 23 (71.9%) met the in-vitro xCELLigence and 9(28.1%) complied with the in vivo animal model toxicity inclusion criteria. Of the 23 articles, 4 of them (17.4%) had no size estimation of ENPBCs. The xCELLigence technology provided information on cell interactions, viability, and proliferation process. Eighty-three (19/23) of the in vitro xCELLigence technology studies described ENPBCs as nontoxic or partially nontoxic materials. The in vivo animal model provided further toxicity information where 1(1/9) of the in vivo animal model studies indicated potential animal toxicity while the remaining results recommended ENPPCs as potential candidates for drug therapy though with limited information on toxicity. Conclusion: The results showed that the bioimpacts of ENPBCs either at the in vitro or at in vivo animal model levels are still limited due to insufficient information and data. To keep pace with ENPBCs biomedical products and applications, in vitro, in vivo assays, clinical trials and long-term impacts are needed to validate their usability and uptake. Besides, more real-time ENPBCs-cell impact analyses using xCELLigence are needed to provide significant data and information for further in vivo testing

Multi-antibiotics-resistance Plasmid Profile Of Enteric Pathogens In Pediatric Patients From Nigeria

A total of 938 faecal samples of diarrheal stool of pediatric patients attending Madonna University Teaching Hospital (MUTH) from June 2003 to June 2004 were examined. 218 of eight different bacterial strains namely Escherichia coli 90(41.3%), Shigella dysenteriae 38(17.4%), Pseudomonas aeruginosa 20(9.2%), Salmonella typhi 18(8.3%), Staphylococcus aureus 7(3.2%), Proteus mirabilis 5(2.3%), Enterococcus faecalis 25(11.5%) and Klebsiella pneumoniae 15(6.9%) were isolated. The susceptibility pattern of the isolates to the various antibiotics varied with Proteus mirabilis and Klebsiella pneumoniae 100% sensitive to peflacine and Enterococcus faecalis 100% sensitive to ciprofloxacin and augmentin.Most of the isolates were least sensitive tocotrimoxazole, ampicillin, erythromycin gentamicin, streptomycin and chloramphenicol. The resistance plasmids to the various isolates were very diverse and distributive among the isolates. They were also highly transferable with a high frequency range of 2x10-2 to 6x10-4. Some of the isolates had plasmids bands that ranged from 640.55kbp to 651.14kbp. This indicates that plasmids allow the movement of genetic materials, including antimicrobial resistance genes between bacterial species and strains

Incidence of Sindbis virus in hospitalized patients with acute fevers of unknown cause in South Africa, 2019–2020

BACKGROUND : Sindbis virus (SINV) is a mosquito-borne alphavirus that is widely distributed worldwide. Little is known about the febrile and neurological disease burden due to SINV in South Africa. PATIENTS AND METHODS : Clinical samples of patients with acute febrile disease of unknown cause (AFDUC) were collected through the African Network for Improved Diagnostics, Epidemiology and Management of Common Infectious Agents at three sentinel hospital surveillance sites in South Africa. In total, 639 patients were screened using a PCR-based macroarray that can simultaneously detect nucleic acids of 30 pathogens, including SINV, from January 2019 to December 2020. Serum samples were randomly selected from the arbovirus season (January–June) and also screened with a commercial indirect immunofluorescence assay for anti-SINV IgM. In addition, 31 paired cerebrospinal fluid (CSF) specimens from the same patients were screened for IgM. Micro-neutralization assays were performed on all IgM-positive samples. RESULTS : None of the specimens tested positive for SINV by molecular screening; however, 38/197 (19.0%) samples were positive for SINV-specific IgM. A total of 25/38 (65.8%) IgM-positive samples tested positive for SINV-neutralizing antibodies, giving an overall incidence of 12.7%. Furthermore, 2/31 (6.5%) CSF specimens tested positive for IgM but were negative for neutralizing antibodies. There was a higher incidence of SINV-positive cases in Mpumalanga (26.0%) than Gauteng province (15.0%). The most significant months for IgM-positive cases were April 2019 (OR = 2.9, p < 0.05), and May 2020 (OR = 7.7, p < 0.05). CONCLUSION : SINV or a closely related virus contributed to 12.7% of AFDUC cases in hospitalized patients during the late summer and autumn months in South Africa and was significantly associated with arthralgia, meningitis, and headaches.The BMBF (German Federal Ministry of Education and Research) as part of the ANDEMIA collaboration network with the Robert Koch Institute, a NRF scholarship and a UP merit bursary.https://www.frontiersin.org/journals/microbiologydm2022Medical Virolog

The prevalence of pregnancy among adolescent girls and young women across the Southern African development community economic hub : a systematic review and meta-analysis

BACKGROUND: Despite the high rate of HIV infections, there is still high rate of early unprotected sex, unintended pregnancy, and unsafe abortions especially among unmarried adolescent girls and young women (AGYW) 10-24 years of age in sub Saharan Africa. AGYW face challenges in accessing health care, contraception needs, and power to negotiate safer sex. This study aimed to estimate the rate of pregnancy among AGYW aged 10-24, 10-19 and 15-19 years in the Southern African Development Community (SADC) economic region. METHODS: A systematic review and meta-analysis was used to describe the prevalence of pregnancy among AGYW in 15 SADC member countries between January 2007 and December 2017. The articles were extracted from PubMed/MEDLINE, African Index Medicus, and other reports. They were screened and reviewed according to PRISMA methodology to fulfil study eligibility criteria. RESULTS: The overall regional weighted pregnancy prevalence among AGYW 10-24 years of age was 25% (95% CI: 21% to 29%). Furthermore, sub-population 10-19 years was 22% (95% CI: 19% to 26%) while 15-19 years was 24% (18% to 30%). There was a significant heterogeneity detected between the studies (I2 =99.78%, P<0.001), even within individual countries. CONCLUSION: The findings revealed a high pregnancy rate among AGYW in the SADC region. This prompts the need to explore innovative research and programs expanding and improving sexual and reproductive health communication to reduce risk and exposure of adolescents to early planned, unplanned and unwanted pregnancies, SRHR challenges, access to care, HIV/ STIs, as well as other risk strategies.http://journals.tbzmed.ac.ir/HPPpm2021School of Health Systems and Public Health (SHSPH

A scoping review of mycotoxin contamination of maize and other grains in South Africa

BACKGROUND : Despite global legislative and regulatory efforts to ensure sustainable food safety and security, mycotoxins remain a serious challenge in the supply of staple food commodities like maize and other grains in South Africa. OBJECTIVES : We reviewed mycotoxin contamination of maize, maize-associated food products, together with other cereals to emphasis the need for continuous monitoring and management in South Africa. METHODS : A scoping review was conducted on mycotoxin contamination of maize, maize-related products, and other cereals, as well as associated health implications in South Africa. The review intended to identify relevant articles and reports from 1980 to 2020 based on Arksey and O’Malley guidelines. RESULTS : Of the 103 articles/reports identified for the research questions “that define to what extend the South African population is exposed to mycotoxins, and why”, 31 (30 %) were eligible for this study. The most recurrent mycotoxins were fumonisins (FBs) and aflatoxins (AFs). The levels of FBs and AFs were as high as 140480 and 762 g/kg, respectively. CONCLUSION : The FBs and AFs were the main mycotoxins in maize, other cereals, and related products. Therefore, adopting effective, sustainable, and scalable measures in limiting mycotoxin contamination is critical for the mitigation of food insecurity and the resulted health burden. Training farmers and other stakeholders on good hygiene and farming practices along the food chain is important.This research is largely funded by the National Research Foundation via the Thuthuka Funding Scheme of South Africa.https://brief.land/semj/pages/journal_info.htmlam2022School of Health Systems and Public Health (SHSPH