The experiences of patients with regard to social and health services factors that contribute to delays in seeking treatment for tuberculosis

Magister Artium - MAThe goal of this research study was to do an explorative study in order to establish the experiences of patients with regard to social and health services factors that contribute to delays in seeking treatment for Tuberculosis.South Afric

HIV management in practice : South Africa has the largest HIV epidemic in the world and it is therefore imperative that all health

This article briefly reviews the new South African HIV treatment guidelines for adults and adolescents, children and pregnant women. It focuses on the timing of the initiation of antiretroviral treatment and argues for earlier initiation. It discusses the construction of a treatment regimen and the monitoring thereof, with emphasis on the importance of HIV viral load testing. Finally, it briefly addresses issues around treatment failure and HIV prevention.http://www.cmej.org.za/index.php/cme

Monitoring early warning indicators for HIV drug resistance in South Africa : challenges and opportunities

No abstract available.http://cid.oxfordjournals.orghb201

Responsible conduct of research: Global trends, local opportunities

Instances of research misconduct reported in the lay and scientific literature as well as international efforts to encourage research integrity and the responsible conduct of research are currently receiving considerable attention. In South Africa, however, the topic has not featured prominently in public debate and clear evidence of a national, coordinated effort to address the problem of research misconduct seems to be lacking. Given increasing globalisation of research efforts, the need exists to promote standardised approaches to interpretation and implementation of the principles and values that underlie responsible conduct of research as well as to create guidelines and structures to promote integrity in research in the country. We explore the notions of research misconduct and research integrity, focusing on initiatives that promote responsible conduct of research, and propose a framework for the South African context

“They come and knock at the gate until the neighbours see”. Perceived barriers and benefits of implementing HIV care at the community level in Tshwane district : a qualitative study

Little is known about the barriers and benefits of home-based HIV services offered by community health workers. These are especially important as the South African government embarks on scaling up community-based health services, which include HIV care. This study set out to understand potential benefits and barriers of these services in Tshwane district and develop recommendations for improvement. From June to August 2019, seven focus group discussions were conducted with 58 participants: four with 36 ward-based outreach team (WBOT) members and three with 22 people living with HIV (PLWHIV). Three aspects of care were explored: 1. Experience of performing, receiving or observing homebased HIV care; 2. Barriers to conducting home visits; and 3. The perceived value of WBOTs and home-based HIV care. While home-based HIV care was seen as a support strategy which could motivate patients to take their medication, the unpredictability of patients’ responses to HIV test results, incorrect addresses (driven by the need for identity documents), fear of stigma through association with WBOTs, especially those in uniform, little or no preparation of patients for home-based care, and lack of confidentiality and trust were raised as potential barriers. To successfully implement effective home-based HIV care in South Africa, perceived barriers should be addressed and recommendations offered by people providing and receiving these services should be seriously considered. Pertinent recommendations include integrating WBOTs into clinics and existing support structures, improving training on confidentiality and HIV testing, and rethinking the recruitment, scope of work and safety of WBOTs. In addition, research should be conducted into the impact of the requirements for identity documents and community health worker uniforms.Supporting information: S1 Table. Interview guide.http://www.plosone.orgpm2020Family MedicineImmunolog

Prevalence of scientific misconduct among a group of researchers in Nigeria

BACKGROUND : There is a dearth of information on the prevalence of scientific misconduct from Nigeria. OBJECTIVES : This study aimed at determining the prevalence of scientific misconduct in a group of researchers in Nigeria. Factors associated with the prevalence were ascertained. METHOD : A descriptive study of researchers who attended a scientific conference in 2010 was conducted using the adapted Scientific Misconduct Questionnaire-Revised (SMQ-R). RESULTS : Ninety-one researchers (68.9%) admitted having committed at least one of the eight listed forms of scientific misconduct. Disagreement about authorship was the most common form of misconduct committed (36.4%) while plagiarism was the least (9.2%). About 42% of researchers had committed falsification of data or plagiarism. Analysis of specific acts of misconduct showed that committing plagiarism was inversely associated with years in research (Fisher exact p-value = 0.02); falsifying data was related to perceived low effectiveness of the institution’s rules and procedures for reducing scientific misconduct (X2 = 6.44, p-value = 0.01); and succumbing to pressure from study sponsor to engage in unethical practice was related to sex of researcher (Fisher exact p-value = 0.02). CONCLUSIONS : The emergent data from this study is a cause for serious concern and calls for prompt intervention. The best response to reducing scientific misconduct will proceed from measures that contain both elements of prevention and enforcement. Training on research ethics has to be integrated into the curriculum of undergraduate and postgraduate students while provision should be made for in-service training of researchers. Penalties against acts of scientific misconduct should be enforced at institutional and national levels.Fogarty International Center, National Institute of Health, Grant number 2R25TW0 1599-10 through the South African Research Ethics Training Initiative SARETI.http://onlinelibrary.wiley.com/journal/10.1111/(ISSN)1471-8847hb2014ay201

Misconduct in research : a descriptive survey of attitudes, perceptions and associated factors in a developing country

BACKGROUND : Misconduct in research tarnishes the reputation, credibility and integrity of research institutions. Studies on research or scientific misconduct are still novel in developing countries. In this study, we report on the attitudes, perceptions and factors related to the work environment thought to be associated with research misconduct in a group of researchers in Nigeria - a developing country. METHOD : A survey of researchers attending a scientific conference was done using an adapted Scientific Misconduct Questionnaire-Revised (SMQ-R). Initial descriptive analysis of individual items using frequencies and proportions for all quantitative data was performed. Thereafter, Likert scale responses were transformed into dichotomous responses. Fisher exact test was performed for associations as appropriate. A two-tailed p-value of less than 0.05 was accepted as significant. RESULT : Half of the respondents (50.4%) were aware of a colleague who had committed misconduct, defined as “non-adherence to rules, regulations, guidelines, and commonly accepted professional codes or norms”. Over 88% of the researchers were concerned about the perceived amount of misconduct prevalent in their institution and 96.2% believed that one or more forms of scientific misconduct had occurred in their workplace. More than half (52.7%) rated the severity of penalties for scientific misconduct in their work environment as low. Furthermore¸ the majority (56.1%) were of the view that the chance of getting caught for scientific misconduct in their work environment was low. CONCLUSION : Researchers in Nigeria perceive that scientific misconduct is commonplace in their institutions, but are however worried about the negative effects of scientific misconduct on the credibility of scientific research. We recommend that researchers be empowered with the knowledge and virtues necessary for self-regulation that advance research integrity. Research institutions should however also step into their role of fostering a responsible research ethic and discouraging misconduct.A grant from the Fogarty International Center, National Institute of Health, Grant number 2R25TW0 1599–10 through the South African Research Ethics Training Initiative SARETI.http://www.biomedcentral.com/bmcmedethicsam201

Inequality and ethics in paediatric HIV remission research : from Mississippi to South Africa and back

In 2013, physician-researchers announced that a baby in Mississippi had been ‘functionally cured’ of HIV [Persaud, D., Gay, H., Ziemniak, C. F., Chen, Y. H., Piatak, M., Chun, T.-W., … Luzuriaga, K. (2013b, March). Functional HIV cure after very early ART of an infected infant. Paper presented at the 20th conference on retroviruses and opportunistic infections, Atlanta, GA]. Though the child later developed a detectable viral load, the case remains unprecedented, and trials to build on the findings are planned [National Institute of Allergy and Infectious Diseases. (2014). ‘Mississippi baby’ now has detectable HIV, researchers find. Retrieved from http://www.niaid.nih.gov/news/newsreleases/2014/pages/mississippibabyhiv.aspx]. Whether addressing HIV ‘cure’ or ‘remission’, scrutiny of this case has focused largely on scientific questions, with only introductory attention to ethics. The social inequalities and gaps in care that made the discovery possible – and their ethical implications for paediatric HIV remission – have gone largely unexamined. This paper describes structural inequalities surrounding the ‘Mississippi baby’ case and a parallel case in South Africa, where proof-of-concept studies are in the early stages. We argue that an ethical programme of research into infant HIV remission ought to be ‘structurally competent’, and recommend that paediatric remission studies consider including a research component focused on social protection and barriers to care.http://www.tandfonline.com/loi/rgph202017-07-25hb2016Immunolog

Consent for critical care research after death from COVID-19 : arguments for a waiver

Pandemics challenge clinicians and scientists in many ways, especially when the virus is novel and disease expression becomes variable or unpredictable. Under such circumstances, research becomes critical to inform clinical care and protect future patients. Given that severely ill patients admitted to intensive care units are at high risk of mortality, establishing the cause of death at a histopathological level could prove invaluable in contributing to the understanding of COVID-19. Postmortem examination including autopsies would be optimal. However, in the context of high contagion and limited personal protective equipment, full autopsies are not being conducted in South Africa (SA). A compromise would require tissue biopsies and samples to be taken immediately after death to obtain diagnostic information, which could potentially guide care of future patients, or generate hypotheses for finding needed solutions. In the absence of an advance written directive (including a will or medical record) providing consent for postmortem research, proxy consent is the next best option. However, obtaining consent from distraught family members, under circumstances of legally mandated lockdown when strict infection control measures limit visitors in hospitals, is challenging. Their extreme vulnerability and emotional distress make full understanding of the rationale and consent process difficult either before or upon death of a family member. While it is morally distressing to convey a message of death telephonically, it is inhumane to request consent for urgent research in the same conversation. Careful balancing of the principles of autonomy, non-maleficence and justice becomes an ethical imperative. Under such circumstances, a waiver of consent, preferably followed by deferred proxy consent, granted by a research ethics committee in keeping with national ethics guidance and legislation, would fulfil the basic premise of care and research: first do no harm. This article examines the SA research ethics framework, guidance and legislation to justify support for a waiver of consent followed by deferred proxy consent, when possible, in urgent research after death to inform current and future care to contain the pandemic in the public interest.http://www.samj.org.zaam2021Immunolog

Assessment of Roche Cobas®6800/8800 system For HIV PCR indeterminate results on early infant diagnosis

https://drive.google.com/file/d/11iAmxd5ZFWW1qUrCVDcSmM1CanWUNnZX/view?usp=sharinghttps://drive.google.com/drive/folders/17e-AliUJyL540EtC2jOjGArUM-urTfls?usp=sharinghttps://drive.google.com/drive/folders/1yX1wLM_VOeuvkBqVClJy2Lwar8HjasKy?usp=sharin