Message from the Executive

No abstract available

The role of re-appropriation in open design : a case study on how openness in higher education for industrial design engineering can trigger global discussions on the theme of urban gardening

This case study explores the opportunities for students of Industrial Design Engineering to engage with direct and indirect stakeholders by making their design process and results into open-ended Designed Solutions. The reported case study involved 47 students during a two-weeks intensive course on the topic of urban gardening. Observations were collected during three distinctive phases: the co-design phase, the creation of an Open Design and the sharing of these design solutions on the online platform Instructables.com. The open sharing of local solutions triggered more global discussions, based on several types of feedbacks: from simple questions to reference to existing works and from suggestions to critiques. Also some examples of re-appropriation of the designed solutions were reported. These feedbacks show the possibilities for students to have a global vision on their local solutions, confronting them with a wider and more diverse audience. The case study shows on the other hand the difficulty in keeping students engaged in this global discussion, considering how after a few weeks the online discussions dropped to an almost complete silence. It is also impossible with such online platforms to follow the re-appropriation cycles, losing the possibility of exploring the new local context were the replication / modification of the designed product occurred. The course’s focus on Open Design is interesting both under the design and educational points of view. It implies a deep change in the teaching approach and learning attitude of students, allowing unknown peers to take part of the design process and fostering a global discussion starting from unique and local solutions

What is the role of CD4 count in a large public health antiretroviral programme?

No abstract available

A call to action: Addressing the reproductive health needs of women with drug-resistant tuberculosis

Although there is substantial risk to maternal and neonatal health in the situation of pregnancy during treatment for rifampicin-resistant tuberculosis (RR-TB), there is little evidence to guide clinicians as to how to manage this complexity. Of the 49 680 patients initiated on RR-TB treatment from 2009 to 2014 in South Africa, 47% were women and 80% of them were in their reproductive years (15 - 44). There is an urgent need for increased evidence of the safety of RR-TB treatment during pregnancy, increased access to contraception during RR-TB treatment, and inclusion of reproductive health in research on the prevention and treatment of TB.

The medical proof doesn't get much better than VMMC

This forum debate article is in response to the editorial by Professor Ncayiyana concerning the national circumcision programme in South Africa (S Afr Med J 2011;101:775-777). Other articles in this debate: Kessinger and Millard. S Afr Med J 2012;102(3):123-124. Ncayiyana. S Afr Med J 2012;102(3):125-126

Frequency of Circulating CD4+Ki67+HLA-DR− T Regulatory Cells Prior to Treatment for Multidrug Resistant Tuberculosis Can Differentiate the Severity of Disease and Predict Time to Culture Conversion

Identifying a blood circulating cellular biomarker that can be used to assess severity of disease and predict the time to culture conversion (TCC) in patients with multidrug resistant tuberculosis (MDR-TB) would facilitate monitoring response to treatment and may be of value in the design of future drug trials. We report on the frequency of blood Ki67+HLA-DR− CD4+ T regulatory (Treg) cells in predicting microbiological outcome before initiating second-line treatment for MDR-TB. Fifty-one patients with MDR-TB were enrolled and followed over 18 months; a subset of patients was sputum culture (SC) negative at baseline (n = 9). SC positive patients were divided into two groups, based on median TCC: rapid responders (≤71 days TCC; n = 21) and slow responders (>71 days TCC; n = 21). Whole blood at baseline, months 2 and 6 was stimulated with M tuberculosis (Mtb) antigens and Treg cells were then identified as CD3+CD4+CD25hiFoxP3+CD127−CD69− and further delineated as Ki67+HLA-DR− Treg. The frequency of these cells was significantly enlarged at baseline in SC positive relative to SC negative and smear positive relative to smear negative patients and in those with lung cavitation. This difference was further supported by unsupervised hierarchical clustering showing a significant grouping at baseline of total and early differentiated memory Treg cells in slow responders. Conversely, there was a clustering of a lower proportion of Treg cells and activated IFNγ-expressing T cells at baseline in the rapid responders. Examining changes over time revealed a more gradual reduction of Treg cells in slow responders relative to rapid responders to treatment. Receiver operating curve analysis showed that baseline Mtb-stimulated Ki67+HLA-DR− Treg cells could predict the TCC of MDR-TB treatment response with 81.2% sensitivity and 85% specificity (AUC of 0.87, p < 0.0001), but this was not the case after 2 months of treatment. In conclusion, our data show that the frequency of a highly defined Mtb-stimulated blood Treg cell population at baseline can discriminate MDR-TB disease severity and predict time to culture clearance

Adult antiretroviral therapy guidelines 2017

These guidelines are intended as an update to those published in the Southern African Journal of HIV Medicine in 2014 and the update on when to initiate antiretroviral therapy in 2015. Since the release of the previous guidelines, the scale-up of antiretroviral therapy (ART) in southern Africa has continued. New antiretroviral drugs have become available with improved efficacy, safety and robustness. The guidelines are intended for countries in the southern African region, which vary between lower and middle income

Third-line antiretroviral therapy program in the South African public sector : cohort description and virological outcomes

BACKGROUND : The World Health Organization recommends that antiretroviral therapy (ART) programs in resource-limited settings develop third-line ART policies. South Africa developed a national third-line ART program for patients who have failed both first-line non-nucleoside reverse transcriptase inhibitor–based ART and second-line protease inhibitor (PI)-based ART. We report on this program. METHODS : Third-line ART in South Africa is accessed through a national committee that assesses eligibility and makes individual regimen recommendations. Criteria for third-line include the following: $1 year on PI-based ART with virologic failure, despite adherence optimization, and genotypic antiretroviral resistance test showing PI resistance. We describe baseline characteristics and resistance patterns of this cohort and present longitudinal data on virological suppression rates. RESULTS : Between August 2013 and July 2014, 144 patients were approved for third-line ART. Median age was 41 years [interquartile range (IQR): 19–47]; 60% were women (N = 85). Median CD4+ count and viral load were 172 (IQR: 128–351) and 14,759 (IQR: 314–90,378), respectively. About 2.8% started PI-based ART before 2004; 11.1% from 2004 to 2007; 31.3% from 2008 to 2011; and 6.3% from 2012 to 2014 (48.6% unknown start date). Of the 144 patients, 97% and 98% had resistance to lopinavir and atazanavir, respectively; 57% had resistance to darunavir. All were initiated on a regimen containing darunavir, with raltegravir in 101, and etravirine in 33. Among those with at least 1 viral load at least 6 months after third-line approval (n = 118), a large proportion (83%, n = 98) suppressed to ,1000 copies per milliliter, and 79% (n = 93) to ,400 copies per milliliter. CONCLUSION : A high proportion of third-line patients with followup viral loads are virologically suppressed.Presented at the meeting of the Conference of Retroviruses and Opportunistic Infections, Seattle, WA, February 2017.Cooperative Agreement AID 674-A-12-00029 from the United States Agency for International Development (USAID), in partnership with PEPFAR.http://journals.lww.com/jaidsInternal Medicin

Southern African HIV Clinicians Society 2023 Guideline for post-exposure prophylaxis: Updated recommendations

No abstract available