Planning for change: Transformation labs for an alternative food system in Cape Town, South Africa

There has been a call for more participatory processes to feed into urban planning for more resilient food systems. This paper describes a process of knowledge co-production for transforming towards an alternative food system in Cape Town, South Africa. A ‘transformative space’ was created though a T-Lab process involving change-agents advocating for an alternative food system, and was designed to discuss challenges in the local food system from a range of perspectives, in order to co-develop potentially transformative innovations that could feed into government planning. In this paper, we describe and reflect on the T-lab in order to consider whether its design was able to meet its objective: to initiate an experimental phase of coalition-building by diverse actors that could feed into the provincial government’s strategic focus on food and nutrition security. Our findings indicate that T-labs have the potential to be important mechanisms for initiating and sustaining transformative change. They can be complementary to urban planning processes seeking to transform complex social-ecological systems onto more sustainable development pathways. However, as with all experimental co-production processes, there is significant learning and refinement that is necessary to ensure the process can reach its full potential. A key challenge we encountered was how to foster diversity and difference in opinions in the context of significant historical legacies of inequality, whilst simultaneously acting for ‘the common good’ and seeking ways to scale impact across different contexts. The paper concludes with deliberations on the nature of planning and navigating towards systemic transformative change

Detection of Tuberculosis in HIV-Infected and -Uninfected African Adults Using Whole Blood RNA Expression Signatures: A Case-Control Study

BACKGROUND: A major impediment to tuberculosis control in Africa is the difficulty in diagnosing active tuberculosis (TB), particularly in the context of HIV infection. We hypothesized that a unique host blood RNA transcriptional signature would distinguish TB from other diseases (OD) in HIV-infected and -uninfected patients, and that this could be the basis of a simple diagnostic test. METHODS AND FINDINGS: Adult case-control cohorts were established in South Africa and Malawi of HIV-infected or -uninfected individuals consisting of 584 patients with either TB (confirmed by culture of Mycobacterium tuberculosis [M.TB] from sputum or tissue sample in a patient under investigation for TB), OD (i.e., TB was considered in the differential diagnosis but then excluded), or healthy individuals with latent TB infection (LTBI). Individuals were randomized into training (80%) and test (20%) cohorts. Blood transcriptional profiles were assessed and minimal sets of significantly differentially expressed transcripts distinguishing TB from LTBI and OD were identified in the training cohort. A 27 transcript signature distinguished TB from LTBI and a 44 transcript signature distinguished TB from OD. To evaluate our signatures, we used a novel computational method to calculate a disease risk score (DRS) for each patient. The classification based on this score was first evaluated in the test cohort, and then validated in an independent publically available dataset (GSE19491). In our test cohort, the DRS classified TB from LTBI (sensitivity 95%, 95% CI [87-100]; specificity 90%, 95% CI [80-97]) and TB from OD (sensitivity 93%, 95% CI [83-100]; specificity 88%, 95% CI [74-97]). In the independent validation cohort, TB patients were distinguished both from LTBI individuals (sensitivity 95%, 95% CI [85-100]; specificity 94%, 95% CI [84-100]) and OD patients (sensitivity 100%, 95% CI [100-100]; specificity 96%, 95% CI [93-100]). Limitations of our study include the use of only culture confirmed TB patients, and the potential that TB may have been misdiagnosed in a small proportion of OD patients despite the extensive clinical investigation used to assign each patient to their diagnostic group. CONCLUSIONS: In our study, blood transcriptional signatures distinguished TB from other conditions prevalent in HIV-infected and -uninfected African adults. Our DRS, based on these signatures, could be developed as a test for TB suitable for use in HIV endemic countries. Further evaluation of the performance of the signatures and DRS in prospective populations of patients with symptoms consistent with TB will be needed to define their clinical value under operational conditions. Please see later in the article for the Editors' Summary

Plasma Micronutrient Concentrations Are Altered by Antiretroviral Therapy and Lipid-Based Nutrient Supplements in Lactating HIV-Infected Malawian Women

Background: Little is known about the influence of antiretroviral therapy with or without micronutrient supplementation on the micronutrient concentrations of HIV-infected lactating women in resource-constrained settings

Adherence to extended postpartum antiretrovirals is associated with decreased breast milk HIV-1 transmission

Estimate association between postpartum antiretroviral adherence and breastmilk HIV-1 transmissio

Knowledge and Perception of Sexual Harassment in an Institution of Higher Education in Sub-Saharan Africa

Objective: To find out if Sexual Harassment existed at a higher institute of learning and explore perception of sexual harassment in the university community and to make recommendations based on the findings.Methodology: This was a cross sectional study that collected both primary and secondary data. The participants included 913 students, 90 academic staff and97 non-academic staff who were selected from within the university community. Questionnaires were administered in class for the students and individually with staff members after obtaining informed consent. Secondary data records from 1996 to 2006 on issues to do with sexual harassment from Registrar's department, Deans of students, counselling center, at the university clinic and records from staff and students were collected.Results: The study found that the majority of the participant (54.1%) knew what  sexual harassment was. It was Further found that Fifty seven (57%) of the respondents acknowledged that Sexual Harassment does occur at the university with more females indicating the occurrence of Sexual harassment acts. There washowever a discrepancy in the understanding of what constitutes sexual harassment with the students being the least to identify sexual harassment acts. The study alsorevealed that that more female; students and nonacademic staff identified more  forms of sexual harassment acts and behaviour than the male participants.Conclusion: It could be concluded that Sexual harassment may be a problem at the university. However, despite the varying responses on perceptions of the occurrence of sexual harassment, a university sexual harassment policy should be formulated and implemented at the university in order to deter the would be harassers and protect the potential victi

Competency-based training “Helping Mothers Survive: Bleeding after Birth” for providers from central and remote facilities in three countries

AbstractObjectiveTo validate a new training module for skilled and semiskilled birth attendants authorized to provide care at birth—Helping Mothers Survive: Bleeding After Birth (HMS:BAB)—aimed at reducing postpartum hemorrhage, the leading cause of maternal mortality worldwide. BAB training involves single-day, facility-based training that emphasizes simulation of scenarios related to prevention, detection, and management of postpartum hemorrhage.MethodsA total of 155 skilled and semiskilled birth attendants participated in training in India, Malawi, and Zanzibar, Tanzania. Knowledge and confidence were assessed before and after training. Skills and acceptability were assessed after training.ResultsKnowledge and confidence scores improved significantly from pre- to post-training among all cadres in all three countries. The proportion of providers with passing knowledge scores increased significantly from pre- to post-training among all cadres except for those already high at baseline. On three post-training skills tests the overall proportion of individuals with a passing score ranged from 83% to 89%.ConclusionBAB training in prevention and management of postpartum hemorrhage increased knowledge and confidence among skilled and semiskilled birth attendants. Further studies are needed to determine the impact of this training on skills retention and clinical outcomes following postpartum hemorrhage, after broader implementation of the training program

Criminalising HIV Transmission

Objective: This paper attempts to summarise the global state with regard to the criminalisation of Human Immunodeficiency Virus (HIV) transmission.Method: A comprehensive analysis of both global and Zambian publications, legislation and case laws was conducted.Results: Proponents of criminalisation of HIV transmission argue that criminalization would serve as a deterrent to the culprit and others to engage in prohibited conduct in future while the opponents argue that that there are no well-founded evidences that criminalization of HIV transmission will lead to a reduction in new infections.Conclusion: The onus is on the government and other institutions to critically look at the positive and negative aspects of criminalization of HIV in so far as the legal approach to the fight against the pandemic is concerned. A combination of effective evidence-based approaches should be adopted to expand targeted efforts in preventing new HIV infections in Zambia