Digital Commons Network^™

Magnetic Resonance Imaging Findings In Kenyans And South Africans With Active Convulsive Epilepsy: An Observational Study, Symon M. Kariuki, Ryan Wagner, Roxana Gunny, Felice D'Arco, Martha Kombe, Anthony Kamau, Steven White, Rachel Odhiambo, Helen Cross, Josemir Sander

Population Health, East Africa

Objective: Focal epilepsy is common in low- and middle-income countries. The frequency and nature of possible underlying structural brain abnormalities have, however, not been fully assessed.

Methods: We evaluated the possible structural causes of epilepsy in 331 people with epilepsy (240 from Kenya and 91 from South Africa) identified from community surveys of active convulsive epilepsy. Magnetic resonance imaging (MRI) scans were acquired on 1.5-Tesla scanners to determine the frequency and nature of any underlying lesions. We estimated the prevalence of these abnormalities using Bayesian priors (from an earlier pilot study) and observed data (from this study). We used a …

Introducing Comprehensive Sexuality Education And Hiv Prevention And Treatment Methods Through Pop-Up Clinics To Secondary School Girls In Kwazulu-Natal, South Africa, Eliza I. Tobin, Joaquin Carlos Pinga, Caitlyn Stanya

Capstone Showcase

Human immunodeficiency virus (HIV) is a retrovirus that attacks the immune system leading to people living with HIV (PLHIV) immunodeficient and more susceptible to other infections or diseases (UNAIDS, 2023b). This can lead to acquired immunodeficiency syndrome (AIDS) within 8-10 years of infection (UNAIDS, 2023b). HIV does not always present symptoms, making it hard for people to identify their HIV status without proper screening. The lack of awareness around a person’s status has led HIV to spread worldwide. In addition to the worldwide spread of HIV, there is no cure for the disease, however, antiretroviral therapy (ART) is mainly used …

‘We Were Not Allowed To Gather Even For Christmas.’ Impact Of Covid-19 On South African Young People: Exploring Messaging And Support, Gudani Mukoma, Edna Bosire, Polly Hardy-Johnson, Mary Barker, Shane A. Norris

Brain and Mind Institute

COVID-19 prevention measures including lockdowns, school closures, and restricted movement disrupted young people’s lives. This longitudinal qualitative study conducted in Soweto, South Africa aimed to explore young people’s knowledge and perceptions of COVID-19, vaccination, and the impact of infections. A convenience sample of 30 young black people (n = 15 men; n = 15 women, aged 16–21 years) from Soweto participated in 24 focus group discussions (FGDs), conducted in six phases – each phase had four FGDs stratified by gender and age. Young people’s understanding of COVID-19 deepened throughout the study, however, did not always translate into adherence (following the …

Utilizing Amr Surveillance Data To Analyze Trends In Escherichia Coli Antibiotic Resistance Levels In The South African Provinces Of Gauteng And The Eastern Cape, Celia Maris

Scripps Senior Theses

Antimicrobial resistant bacterial pathogens pose an ongoing threat to universal public health by causing more severe manifestations of infectious diseases, leading to an increase in healthcare expenditures and higher global mortality rates. Therefore, developing strategies to combat bacterial antimicrobial resistance (AMR) is vital for the future of human health. One promising strategy is through the utilization of AMR surveillance programs. This study focused on using AMR surveillance data from South Africa to analyze changes in Escherichia coli resistance levels to numerous antibiotics between January 2012 and December 2022 in Gauteng Province and the Eastern Cape Province. The study aimed to …

A Streptococcus Pneumoniae Lineage Usually Associated With Pneumococcal Conjugate Vaccine (Pcv) Serotypes Is The Most Common Cause Of Serotype 35b Invasive Disease In South Africa, Following Routine Use Of Pcv, Kedibone M. Ndlangisa, Mignon Du Plessis, Stephani Lo, Linda De Gouveia, Chrispin Chaguza, Martin Antonio, Brenda Kwambana-Adams, Jennifer Cornick, Dean B. Everett, Sadia Shakoor

Department of Pathology and Laboratory Medicine

Pneumococcal serotype 35B is an important non-conjugate vaccine (non-PCV) serotype. Its continued emergence, post-PCV7 in the USA, was associated with expansion of a pre-existing 35B clone (clonal complex [CC] 558) along with post-PCV13 emergence of a non-35B clone previously associated with PCV serotypes (CC156). This study describes lineages circulating among 35B isolates in South Africa before and after PCV introduction. We also compared 35B isolates belonging to a predominant 35B lineage in South Africa (GPSC5), with isolates belonging to the same lineage in other parts of the world. Serotype 35B isolates that caused invasive pneumococcal disease in South Africa in …

“If I Were To Suffer A Stroke Right Now, The First Place That I Should Be Taken To Is The Traditional Healer”: Community Beliefs And Health-Seeking Practices For Noncommunicable Diseases In Rural Kwazulu-Natal, South Africa, Herbert Chikafu, Innocent Tinashe Mutero Dr., Moses John Chimbari Prof.

The Qualitative Report

T

The burden of chronic noncommunicable diseases in rural South Africa is exacerbated by delayed health-seeking. This study explored awareness, beliefs and health-seeking behaviour relating to diabetes, hypertension and cardiovascular diseases in Ingwavuma, a poor rural community in the uMkhanyakude district of KwaZulu-Natal, South Africa. Eight gender and age-stratified Focus Group Discussions (FGD) were conducted in isiZulu using a pre-tested FGD guide with seventy-six participants. Thematic analysis was done to discern views on access to care for noncommunicable diseases. Findings revealed limited awareness of hypertension, diabetes, and cardiovascular-related disease burden. The community practices medical plurality, and consultation with traditional healers …

The Double Burden Of Intra-Household Malnutrition Among Mother–Child Dyads In South Africa, Puveshni Crozier

Walden Dissertations and Doctoral Studies

Household-level double burden of malnutrition (HL-DBM) challenges traditional South African vertical malnutrition programs. Research has associated a household with an overweight/obese mother of reproductive age and her under 5-year-old child with signs of undernutrition (wasting, stunting, or thinness) with socioeconomic levels, maternal characteristics, features of the household, and child’s demographics. Grounded in the social determinants of health conceptual framework, this study aimed to investigate the determinants of HL-DBM in South Africa across the reproductive-child health continuum. Using the representative 2017 Wave 5 South African National Income Dynamics Study survey secondary data, a total sample of 314 homes met this non-experimental …

The Relationships Between Stress, Psychosocial Resources, And Mental Health And Adherence Outcomes Among Perinatally Hiv-Infected Adolescents In South Africa, Thabani Nyoni

Brown School Theses and Dissertations

Adolescents living with perinatally acquired HIV (APHs) in sub-Saharan Africa (SSA) constitute a significant population group that is experiencing poor HIV treatment outcomes (CIPHER Global Cohort Collaboration, 2018). Compared to younger children and older adults within the SSA sub-region, APHs experience poorer health outcomes, including retention in care, virologic treatment failure, and mortality rates (Anderson et al., 2019). Among countries in the SSA sub-region, South Africa has 360,000 adolescents living with HIV (ages 10-19), a disproportionate burden, accounting for 20% of the global adolescents living with HIV (UNAIDS, 2019a). The public health costs of suboptimal antiretroviral treatment (ART) adherence in …

The Power And Process Of Shifting Gender Norms: Insights From A Randomized Controlled Trial In South Africa, Nicole Haberland, Julie Pulerwitz, Ann Gottert, Audrey Pettifor, Sheri A. Lippman, Dean Peacock, Lumbwe Chola, Ryan Wagner, Anna M. Leddy, Rebecca West, Mi-Suk Kang Dufour, Jennifer Hove, Rhian Twine, Rhandzekile Mathebula, Dumisani Rebombo, Angelica Pino, F. Xavier Gómez-Olivé, Chodziwadziwa Whiteson Kabudula, Nkosinathi Masilela, Aimée Julien, Kathryn Spielman, Kathleen Kahn

HIV and AIDS

This Project SOAR report summarizes findings from a randomized controlled trial of Tsima ra rihanyu (“working together for health”), a three-year community mobilization program for treatment as prevention that aimed to address the social barriers to HIV testing and treatment in Mpumalanga Province, South Africa. In this report, the authors explore the types of gender norms that are salient for women and men, how these relate to HIV testing and treatment, and the pathways through which gender norms operate to affect women’s and men’s HIV service use and experience and perpetration of intimate partner violence.

Factors Influencing Hiv Care Outcomes Among Adolescents Living With Hiv In Rural South Africa, Lindsey M. Filiatreau, Audrey Pettifor, Jess Edwards, Nkosinathi Masilela, Rhian Twine, F. Xavier Gómez-Olivé, Nicole Haberland, Chodziwadziwa Whiteson Kabudula, Sheri A. Lippman, Kathleen Kahn

HIV and AIDS

In the Agincourt Health and Socio-Demographic Surveillance System (HDSS) site in rural Mpumalanga Province, South Africa the Project SOAR team hypothesized that HIV status disclosure, individuals’ prior healthcare seeking experiences, history of depression and overall emotional well-being, experiences with domestic and intimate partner violence, and substance use could contribute to poor levels of treatment adherence among adolescents living with HIV. The overall objective of this study was to better understand HIV care outcomes among HIV-positive adolescents in the Agincourt HDSS in the era of universal test and treat so we can better inform HIV care programs targeting this vulnerable population.

Improving The Coverage And Accuracy Of Syphilis Testing: The Development Of A Novel Rapid, Point-Of-Care Test For Confirmatory Testing Of Active Syphilis Infection And Its Early Evaluation In China And South Africa, Minh D. Pham, Amy Wise, Mary L. Garcia, Huy Van, Shuning Zheng, Yasmin Mohamed, Yan Han, Wan-Hui Wei, Yue-Ping Yin, Stanley Luchters

Population Health, East Africa

Background: Current point-of-care tests (POCT) for syphilis, based on the detection of Treponema pallidum (TP) total antibodies, have limited capacity in distinguishing between active and past/treated syphilis. We report the development and early evaluation of a new prototype POCT based on the detection of TP-IgA antibodies, a novel biomarker for active syphilis.

Methods: The TP-IgA POCT (index test) was developed in response to the World Health Organisation (WHO) target product profile (TPP) for a POCT for confirmatory syphilis testing. Two sub-studies were conducted consecutively using 458 pre-characterised stored plasma samples in China (sub-study one, addressing the criteria for the WHO …

Reducing Hiv Risk Among Young Women And Their Partners: Highlights From The Dreams Implementation Science Research Portfolio, Population Council

HIV and AIDS

The Population Council, with funding from the Bill & Melinda Gates Foundation and the U.S. Agency for International Development through Project SOAR, led a set of implementation science studies to capture multiple perspectives that reflect the innovative aspects of DREAMS. These mixed-method studies conducted across seven countries (Eswatini, Kenya, Malawi, South Africa, Tanzania, Uganda, and Zambia) provide critical evidence that fill knowledge gaps on how to reduce HIV risk among AGYW and their male partners. This brief presents key findings grouped around four areas of inquiry: 1) HIV vulnerability and risk; 2) social drivers of HIV risk; 3) effects of …

Impacts Of Rift Valley Fever Virus: A One Health Approach To Assess Burden And Inform Prevention And Control Options, Catherine Machalaba

Dissertations and Theses

Background: Rift Valley Fever (RVF) is a climate-sensitive emerging zoonotic disease associated with large-scale livestock production losses and human disease burden in Sub-Saharan Africa and the Middle East. While recognized as a key One Health issue based on its transmission dynamics involving human, animal and environmental determinants, there has been poor coordination between sectors to reduce the risk and impact of RVF. Efforts to counter the disease remain largely reactive, presenting an ongoing threat to local and global health security. The intent of this dissertation was to improve understanding of the burden of RVF across society and to identify entry …

Qualitative Assessment Of South African Healthcare Worker Perspectives On An Instrument-Free Rapid Cd4 Test, Fiona Scorgie, Yasmin Mohamed, David Anderson, Suzanne M. Crowe, Stanley Luchters, Matthew F. Chersich

Population Health, East Africa

Background: Accurate measurement of CD4 cell counts remains an important tenet of clinical care for people living with HIV. We assessed an instrument-free point-of-care CD4 test (VISITECT® CD4) based on a lateral flow principle, which gives visual results after 40 min. The test involves five steps and categorises CD4 counts as above or below 350 cells/μL. As one component of a performance evaluation of the test, this qualitative study explored the views of healthcare workers in a large women and children’s hospital on the acceptability and feasibility of the test.

Methods: Perspectives on the VISITECT® CD4 test were elicited through …

Implementing And Scaling-Up Stepping Stones In Kwazulu-Natal, South Africa: Lessons From Working In Informal Settlements, Cecilia Milford, M. Mtshali, Mags Beksinska, Julie Pulerwitz

HIV and AIDS

KwaZulu-Natal (KZN), a major epicenter of the South African HIV epidemic, has large informal settlements where thousands of people live. The settlements are often underserved by municipal services and lack accessible health care. Given high rates of HIV, there is a critical need to assess the successes and challenges of implementing HIV prevention and treatment in this context. Stepping Stones is a widely used life-skills training intervention focused on curbing gender-based violence and reducing HIV risk. The program addresses issues such as communication about HIV, relationship skills, and assertiveness. The manual-based curriculum encourages participants to engage in critical reflection through …

Safety, Tolerability, And Pharmacokinetics Of Long-Acting Injectable Cabotegravir In Low-Risk Hiv-Uninfected Individuals: Hptn 077, A Phase 2a Randomized Controlled Trial., Raphael J Landovitz, Sue Li, Beatriz Grinsztejn, Halima Dawood, Albert Y Liu, Manya Magnus, Mina C Hosseinipour, Ravindre Panchia, Leslie Cottle, Gordon Chau, Paul Richardson, Mark A Marzinke, Craig W Hendrix, Susan H Eshleman, Yinfeng Zhang, Elizabeth Tolley, Jeremy Sugarman, Ryan Kofron, Adeola Adeyeye, David Burns, Alex R Rinehart, David Margolis, William R Spreen, Myron S Cohen, Marybeth Mccauley, Joseph J Eron

Epidemiology Faculty Publications

BACKGROUND: Cabotegravir (CAB) is a novel strand-transfer integrase inhibitor being developed for HIV treatment and prevention. CAB is formulated both as an immediate-release oral tablet for daily administration and as a long-acting injectable suspension (long-acting CAB [CAB LA]) for intramuscular (IM) administration, which delivers prolonged plasma exposure to the drug after IM injection. HIV Prevention Trials Network study 077 (HPTN 077) evaluated the safety, tolerability, and pharmacokinetics of CAB LA in HIV-uninfected males and females at 8 sites in Brazil, Malawi, South Africa, and the United States.

METHODS AND FINDINGS: HPTN 077 was a double-blind, placebo-controlled phase 2a trial. Healthy …

Mobile Hiv Units In South Africa: A Systematic Review, Meaghan Doherty

Senior Honors Projects, 2010-2019

Abstract

Objective: To examine existing literature on mobile HIV testing units to determine if they have the potential to increase access to testing, treatment, and HIV education to decrease rates of HIV in South Africa.

Participants: Ten research articles evaluating the HIV intervention method of mobile HIV units in South Africa, including outcome measures.

Analysis: Systematic search of 87 articles from 2000 to 2018 and review of the 10 articles that met inclusion criteria.

Results: Several studies (n=5) showed that mobile testing units are effective at attracting hard to reach populations, such as men and young adults. Studies (n=3) also …

South Africa: Hiv/Aids, Ninna Therese P. Mendoza

Global Public Health

South Africa is found in the southernmost part of the African continent. Over half of its 54.8 million people live in urban areas such as Johannesburg and Cape Town, which are the largest urban centers in the country. Some major challenges this country currently faces include the growing drug trade, border disputes, and racial tensions attributed to their history with the apartheid. When it comes to public health, one of their biggest challenges is the HIV/AIDS epidemic, which is currently the largest in the world. Although no cure exists yet, antiretroviral treatments (ARTs) have been highly successful for reducing transmission. …

Male Partners Of Adolescent Girls And Young Women: Relationship Characteristics And Hiv Risk—Findings From Dreams Implementation Science Research, Population Council

HIV and AIDS

Adolescent girls and young women (AGYW) in South Africa, as in many countries, are particularly vulnerable to HIV for a variety of reasons, including economic disadvantage and unequal power dynamics in sexual relationships with their male partners—many of whom are older and engage in high-risk behaviors. In an effort to learn more about men’s relationships with AGYW and how HIV services can better engage them, the Population Council is conducting implementation science research in KwaZulu-Natal Province. This brief reports findings from a 2017 baseline survey with nearly 1,000 men. An endline survey is planned for mid-late 2018, and will focus …

Understanding The Dynamics Of Hiv Testing Services In South African Primary Care Facilities, Tonderai Mabuto, Bhakti Hansoti, Salome Charalambous, Christopher Hoffmann

HIV and AIDS

Facility-based HIV testing services remains underutilized in many settings, including South Africa—even in the context of opt-out testing. Additionally, linkages to care are often not made in a timely manner after an HIV diagnosis, limiting access to ART and the possibility of viral suppression. This brief summarizes findings from formative research conducted by Project SOAR and The Aurum Institute to understand the dynamics of HIV testing services and the key constraints to its optimal delivery.

Strengthening Capacity In Hiv Operations Research: Reflections On A Project Soar Workshop In Johannesburg, South Africa, Project Soar

HIV and AIDS

Capacity strengthening (CS) to support rigorous scientific research is a globally recognized need and central to Project SOAR. Over a four-day period, SOAR conducted a CS workshop to strengthen individual and institutional capacity in HIV operations research, with a particular emphasis on the research utilization process. This brief summarizes the CS activities conducted, insights from the workshop’s organization, and participants’ views of the workshop.

Evaluation Of The Pepfar/Usaid Asibonisane Community Responses Program In Kwazulu-Natal, South Africa, Project Soar

HIV and AIDS

Few programs intended to improve HIV outcomes or modulate gender norms have been rigorously evaluated in South Africa’s informal settlements where nearly 400,000 people live in KwaZulu Natal province alone. There is limited evidence on how to implement large-scale HIV-prevention programming in these contexts. Project SOAR and partners are addressing these knowledge gaps by conducting an evaluation of the PEPFAR/USAID-funded Asibonisane Community Responses Program in South Africa. Specifically, the study will assess the effectiveness of this community-based HIV-prevention program in informal settlements throughout KwaZulu-Natal—one of four provinces where the program is being carried out. This study aims to influence the …

The Role Of Breastfeeding In Mother-To-Child Transmission Of Hiv/Aids: A Comparative Case Study Of Three Countries, Anjali Cherukuri

Honors Undergraduate Theses

The HIV pandemic has affected millions of people around the world both medically and socially, since there is a stigma associated with this disease. Common methods of transmission include sexual intercourse and sharing needles, but there are other lesser known methods through which people can contract this disease. One such way is mother-to-child transmission (MTCT), in which a mother could transmit the virus to her child either during pregnancy, childbirth, or through breastfeeding. This paper focuses on the role of breastfeeding in the transmission of HIV from mother to child. Many studies have investigated how breastfeeding results in the transmission …

A Systems Approach To Improving Delivery And Update Of Facility-Based Hiv Testing And Linkage To Care In South Africa, Project Soar

HIV and AIDS

Project SOAR is examining the current delivery of HIV testing (HTS) and linkages to care (LTC) services—including barriers, facilitators, and infrastructure—in Ekurhuleni District, South Africa which has the second-highest district-level HIV prevalence in the country. Based on these formative findings, the project will develop and test tailored approaches to increase patients’ uptake of HTS and subsequent LTC, if positive. The project expects to find evidence of HTS coverage outside of antenatal care; document key systems-level barriers to HTS and LTC; assess potentially generalizable clinic-level strategies to increase HTS delivery and assess LTC needs; and identify the added value for implementation …

Are We Meeting The Hiv Service Needs Of People Living In Informal Settlements In Kwazulu-Natal, South Africa?, Project Soar

HIV and AIDS

This brief summarizes the characteristics and circumstances of approximately 1,500 men and women living in 18 informal settlements in KwaZulu-Natal, South Africa. The data come from a baseline survey conducted in mid-2017 as part of an evaluation of the PEPFAR/USAID-funded Asibonisane Community Responses program. Project SOAR/Population Council conducted the evaluation in partnership with the MatCH Research Unit at the University of Witwatersrand. The findings presented here highlight the need for HIV treatment services to be more responsive to residents living with HIV in informal settlements. Furthermore, continued efforts are needed to reduce HIV risk and intimate partner violence among young …

A Qualitative Exploration Of The Meaning And Understanding Of Male Partner Involvement In Pregnancy-Related Care Among Men In Rural South Africa, Motlagabo G. Matseke, Robert A. C. Ruiter, Violeta J. Rodriguez, Nicole A. Barylski, Stephen M. Weiss, Deborah L. Jones, Karl Peltzer, Geoffrey Setswe, Sibusiso Sifunda

Journal of Social, Behavioral, and Health Sciences

Male partner involvement (MPI) during antenatal care has been promoted as an effective intervention to improve maternal and newborn health outcomes. Although MPI is commonly defined as men attending antenatal clinic visits with their female partner, few men attend antenatal clinic visits in rural communities in the province of Mpumalanga, South Africa. The study aimed to qualitatively explore the meaning and understanding of MPI as perceived by men visiting primary health care clinics in rural communities in Mpumalanga. Six focus groups discussions (n = 53) were conducted, digitally recorded, simultaneously transcribed, and translated verbatim into English. Data were analyzed …

Effective Engagement Of Male Partners Of Adolescent Girls And Young Women In South Africa, Population Council

HIV and AIDS

The Population Council is conducting implementation research in South Africa, in collaboration with local partner organizations, to learn more about men’s relationships with adolescent girls and young women (AGYW) and how HIV services can better engage them—two neglected areas of research. Similar studies are being conducted in Uganda, Swaziland, and Malawi. Learnings from these studies will be valuable for informing ongoing programming in South Africa and the region, as well as HIV prevention, care, and treatment efforts for AGYW and their male partners globally, particularly in this era of test and start.

Optimizing Community Services For An Improved Continuum Of Hiv Care, Project Soar

HIV and AIDS

Project SOAR, together with Aurum Institute, is conducting research in Ekurhuleni District and Bojanala District in South Africa to improve the availability of effective care continuum services to meet the communities’ HIV treatment needs. The two districts have a combined population of 3.6 million inhabitants and approximately 350 public clinics and hospitals. Through improved information on community HIV care services and their relationship to care continuum outcomes, the study will provide valuable new knowledge about service gaps and approaches to planning and delivering services that best achieve HIV treatment goals.

Private Sector Costing Of Voluntary Medical Male Circumcision In South Africa, Michel Tchuenche, Steven Forsythe

HIV and AIDS

In 2010, after voluntary medical male circumcision (VMMC) had been shown to be one of the most cost-effective strategies for preventing HIV infections, South Africa initiated a VMMC program with an ambitious target of performing 4.3 million circumcisions by 2016. However, because of a gap in knowledge concerning the overall cost of scaling up services, the South African National Department of Health requested that Project SOAR—Supporting Operational AIDS Research—conduct a private-sector costing of providing VMMC services in South Africa. The findings presented in this report provide a detailed investigation, through a comprehensive bottom-up approach, of the costs to private providers …

Preventing Pediatric Tuberculosis: A Randomized Trial Of Symptom-Based Screening Of South African Children Exposed To Tuberculosis, Population Council

HIV and AIDS

In South Africa, a country with one of the highest levels of HIV prevalence, HIV-positive adults are the source case for a large proportion of pediatric tuberculosis (TB) cases. Unfortunately, TB index cases are not consistently asked about their child contacts, not all child contacts present to the clinic for TB screening, and it remains unknown what proportion of child contacts receive isoniazid preventive therapy (IPT)—a highly effective treatment for preventing TB in these children, long recommended by the World Health Organization. Project SOAR is assessing whether a symptom-based screening approach by TB nurses in community health clinics is more …