Population uptake of antiretroviral treatment through primary care in rural South Africa

<p>Abstract</p> <p>Background</p> <p>KwaZulu-Natal is the South African province worst affected by HIV and the focus of early modeling studies investigating strategies of antiretroviral treatment (ART) delivery. The reality of antiretroviral roll-out through primary care has differed from that anticipated and real world data are needed to inform the planning of further scaling up of services. We investigated the factors associated with uptake of antiretroviral treatment through a primary healthcare system in rural South Africa.</p> <p>Methods</p> <p>Detailed demographic, HIV surveillance and geographic information system (GIS) data were used to estimate the proportion of HIV positive adults accessing antiretroviral treatment within northern KwaZulu-Natal, South Africa in the period from initiation of antiretroviral roll-out until the end of 2008. Demographic, spatial and socioeconomic factors influencing the likelihood of individuals accessing antiretroviral treatment were explored using multivariable analysis.</p> <p>Results</p> <p>Mean uptake of ART among HIV positive resident adults was 21.0% (95%CI 20.1-21.9). Uptake among HIV positive men (19.2%) was slightly lower than women (21.8%, P = 0.011). An individual's likelihood of accessing ART was not associated with level of education, household assets or urban/rural locale. ART uptake was strongly negatively associated with distance from the nearest primary healthcare facility (aOR = 0.728 per square-root transformed km, 95%CI 0.658-0.963, <it>P </it>= 0.002).</p> <p>Conclusions</p> <p>Despite concerns about the equitable nature of antiretroviral treatment rollout, we find very few differences in ART uptake across a range of socio-demographic variables in a rural South African population. However, even when socio-demographic factors were taken into account, individuals living further away from primary healthcare clinics were still significantly less likely to be accessing ART</p

Music venues and hearing loss: Opportunities for and barriers to improving environmental conditions

This study explores the opportunities for and barriers to improving environmental conditions in order to reduce the risk for music-induced hearing loss in people who attend music venues. Individual semi-structured interviews were held with 20 representatives of music venues and of governmental organizations, according to a semi-structured interview guide. The interviews were audiotaped, transcribed, and systematically coded using a content-analysis technique. Reported opportunities to reduce music volume included improving the acoustics and installing advanced speaker systems. The most important barrier reported was the lack of clear definitions of what levels of high-volume music are hazardous. Other barriers mentioned included economic considerations, and the beliefs that visitors demand high-volume music in music venues and are personally responsible for their own hearing. Before measures to improve environmental conditions are implemented, the exact dangers of exposure to high-volume music have to be established. Evidence-based guidelines and safety standards for leisure-time noise exposure should therefore be developed