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Item Associations of father and adult male presence with first pregnancy and HIV infection: Longitudinal evidence from adolescent girls and young women in rural South Africa (HPTN 068)(Springer, 2021-01) Albert, Lisa M; Edwards, Jess; Pence, Brian; Hills, Susan; Kahn, Kathleen; Gómez‑Olivé, F. Xavier; Wagner, Ryan G; Twine, Rhian; Pettifor, AudreyThis study, a secondary analysis of the HPTN 068 randomized control trial, aimed to quantify the association of father and male presence with HIV incidence and first pregnancy among 2533 school-going adolescent girls and young women (AGYW) in rural South Africa participating in the trial between March 2011 and April 2017. Participants’ ages ranged from 13–20 years at study enrollment and 17–25 at the post-intervention visit. HIV and pregnancy incidence rates were calculated for each level of the exposure variables using Poisson regression, adjusted for age using restricted quadratic spline variables, and, in the case of pregnancy, also adjusted for whether the household received a social grant. Our study found that AGYW whose fathers were deceased and adult males were absent from the household were most at risk for incidence of first pregnancy and HIV (pregnancy: aIRR = 1.30, Wald 95% CI 1.05, 1.61, Wald chi-square p = 0.016; HIV: aIRR = 1.27, Wald 95% CI 0.84, 1.91, Wald chi-square p = 0.263) as compared to AGYW whose biological fathers resided with them. For AGYW whose fathers were deceased, having other adult males present as household members seemed to attenuate the incidence (pregnancy: aIRR = 0.92, Wald 95% CI 0.74, 1.15, Wald chi-square p = 0.462; HIV: aIRR = 0.90, Wald 95% CI 0.58, 1.39, Wald chi-square p = 0.623) such that it was similar, and therefore not statistically significantly different, to AGYW whose fathers were present in the household.Item CD4+ T-cell count at antiretroviral therapy initiation in the "Treat AII" era in South A: an interrupted time series analysis.(2012-11-05) Yapa HM; Kim H-y; Post FA; Jiamsakul A; de Neve J-W; Tanser F; Iwuji C; Baisley K; Shamanesh M; Pillay D; Siedner MJ; Barnighausen T; Bot JItem Classical Cardiovascular Risk Factors and HIV are Associated With Carotid IntimaMedia Thickness in Adults From SubSaharan Africa Findings From H3Africa AWIGen Study(2019-06-07) Boua P; Ali S; Soo CBackground-—Studies on the determinants of carotid intima-media thickness (CIMT), a marker of sub-clinical atherosclerosis, mostly come from white, Asian, and diasporan black populations. We present CIMT data from sub-Saharan Africa, which is experiencing a rising burden of cardiovascular diseases and infectious diseases. Methods and Results-—The H3 (Human Hereditary and Health) in Africa’s AWI-Gen (African-Wits-INDEPTH partnership for Genomic) study is a cross-sectional study conducted in adults aged 40 to 60 years from Burkina Faso, Kenya, Ghana, and South Africa. Cardiovascular disease risk and ultrasonography of the CIMT of right and left common carotids were measured. Multivariable linear and mixed-effect multilevel regression modeling was applied to determine factors related to CIMT. Data included 8872 adults (50.8% men), mean age of 50 6 years with age- and sex-adjusted mean ( SE) CIMT of 640 123lm. Participants from Ghana and Burkina Faso had higher CIMT compared with other sites. Age (b = 6.77, 95%CI [6.34–7.19]), body mass index (17.6[12.5–22.8]), systolic blood pressure (7.52[6.21–8.83]), low-density lipoprotein cholesterol (5.08[2.10–8.06]) and men (10.3[4.75– 15.9]) were associated with higher CIMT. Smoking was associated with higher CIMT in men. High-density lipoprotein cholesterol (12.2 [17.9– 6.41]), alcohol consumption (–13.5 [19.1–7.91]) and HIV (8.86 [15.7–2.03]) were inversely associated with CIMT. Conclusions-—Given the rising prevalence of cardiovascular diseases risk factors in sub-Saharan Africa, atherosclerotic diseases may become a major pan-African epidemic unless preventive measures are taken particularly for prevention of hypertension, obesity, and smoking. HIV-specific studies are needed to fully understand the association between HIV and CIMT in sub-Saharan AfricaItem Exploring the perception of and attitude towards preconception care service provision and utilisation in a South Western Nigerian community – a qualitative study(School of Public Health, University of the Witwatersrand, Johannesburg, South Africa, 2021-02) Ojifinni, Oludoyinmola O.; Munyewende, Pascalia O.; Ibisomi, LatifatBackground: Hospital-based, quantitative studies in Nigeria show low levels of knowledge and use of preconception care (PCC) services. This study explored the perception of and attitude towards PCC in a southwestern Nigerian community qualitatively. Data Source and Methods: Focus group discussions (FGDs) were held with 57 purposively selected adult women and men and key informant interviews (KIIs) with one female and one male community leader in Ibadan North Local Government Area, Oyo State, Nigeria in 2018. The FGDs and KIIs held within the community were digitally recorded, transcribed verbatim and analysed thematically. Results: Participants placed PCC in the context of marriage, describing its importance for addressing effects of adverse exposures on pregnancy and ensuring positive pregnancy outcomes. Conclusion: Barriers to PCC uptake mentioned included lack of awareness and prohibitive service costs. Expressing their willingness to use and promote PCC use, they stated the need to ensure PCC uptake through improved awareness at the community level.Item The global cost of epilepsy: A systematic review and extropolation(Wiley Online LIbrary, 2022-02-22) Begley, Charles; Wagner, Ryan G; Abraham, Annette; Beghi, Ettore; Newton, Charles; Kwon, Churl-Su; Labiner, David; Winkler, Andrea S"Objective Global action for epilepsy requires information on the cost of epilepsy, which is currently unknown for most countries and regions of the world. To address this knowledge gap, the International League Against Epilepsy Commission on Epidemiology formed the Global Cost of Epilepsy Task Force. Methods We completed a systematic search of the epilepsy cost-of-illness literature and identified studies that provided a comprehensive set of direct health care and/or indirect costs, followed standard methods of case identification and cost estimation, and used data on a representative population or subpopulation of people with epilepsy. Country-specific costs per person with epilepsy were extracted and adjusted to generate an average cost per person in 2019 US dollars. For countries with no cost data, estimates were imputed based on average costs per person of similar income countries with data. Per person costs for each country were then applied to data on the prevalence of epilepsy from the Global Burden of Disease collaboration adjusted for the treatment gap. Results One hundred one cost-of-illness studies were included in the direct health care cost database, 74 from North America or Western Europe. Thirteen studies were used in the indirect cost database, eight from North America or Western Europe. The average annual cost per person with epilepsy in 2019 ranged from $204 in low-income countries to $11 432 in high-income countries based on this highly skewed database. The total cost of epilepsy, applying per person costs to the estimated 52.51 million people in the world with epilepsy and adjusting for the treatment gap, was $119.27 billion. Significance Based on a summary and extrapolations of this limited database, the global cost of epilepsy is substantial and highly concentrated in countries with well-developed health care systems, higher wages and income, limited treatment gaps, and a relatively small percentage of the epilepsy population."Item Implementation process and quality of a primary health care system improvement initiative in a decentralized context A retrospective appraisal using the quality implementation framework(2018-09-14) Eboreime E; Eyles J; Nxumalo NSummary Background Effective implementation processes are essential in achieving desired outcomes of health initiatives. Whereas many approaches to implementation may seem straightforward, careful advanced planning, multiple stakeholder involvements, and addressing other contextual constraints needed for quality implementation are complex. Consequently, there have been recent calls for more theory‐informed implementation science in health systems strengthening. This study applies the quality implementation framework (QIF) developed by Meyers, Durlak, and Wandersman to identify and explain observed implementation gaps in a primary health care system improvement intervention in Nigeria. Methods We conducted a retrospective process appraisal by analyzing contents of 39 policy document and 15 key informant interviews. Using the QIF, we assessed challenges in the implementation processes and quality of an improvement model across the tiers of Nigeria's decentralized health system. Results Significant process gaps were identified that may have affected subnational implementation quality. Key challenges observed include inadequate stakeholder engagements and poor fidelity to planned implementation processes. Although needs and fit assessments, organizational capacity building, and development of implementation plans at national level were relatively well carried out, these were not effective in ensuring quality and sustainability at the subnational level. Conclusions Implementing initiatives between levels of governance is more complex than within a tier. Adequate preintervention planning, understanding, and engaging the various interests across the governance spectrum are key to improving quality.Item Integrating community health workers into the formal health system to improve performance A qualitative study on the role of onsite supervision in the South African programme(2019) Tseng m; Grifiths f; De dadt jAbstract Objectives To explore the role of on-site supervision in community health worker (CHW) programmes and CHW integration into the health system. We compared the functioning of CHW teams reporting to a clinic-based nurse with teams supervised by a community-based nurse. We also consider whether a junior nurse can provide adequate supervision, given the shortage of senior nurses. Design A case study approach to study six CHW teams with different configurations of supervision and location. We used a range of qualitative methods: observation of CHW and their supervisors (126 days), focus group discussions (12) and interviews (117). Setting South Africa where a national CHW programme is being implemented with on-site supervision. Participants CHWs, their supervisors, clinic managers and staff, district managers, key informants from the community and CHW clients. Results Effective supervisors supported CHWs through household visits, on-the-job training, debriefing, reviewing CHWs’ daily logs and assistance with compiling reports. CHWs led by senior nurses were motivated and performed a greater range of tasks; junior nurses in these teams could better fulfil their role. Clinic-based teams with senior supervisors were better integrated and more able to ensure continuity of care. In contrast, teams with only junior supervisors, or based in the community, had less engagement with clinic staff, and were less able to ensure necessary care for patients, resulting in lower levels of trust from clients. Conclusion Senior supervisors raised CHW skills, and successfully negotiated a place for CHWs in the health system. Collaboration with clinic staff reduced CHWs’ marginalisation and increased motivation. Despite being clinic-based, teams without senior supervisors had lower skill levels and were less integrated into the health system. This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.Item Interventions addressing the adolescent HIV continuum of care in South Africa: a systematic review and modified Delphi analysis(2022-04-29) Brian Zanoni; Moherndran Archary; Thobekile Sibaya; Tatiana Ramos; Geri Donenberg; Maryam Shahmanesh; Connie Celum; Audrey Pettifor; Linda Gail Bekker; Jessica HabererIntroduction: Compared with adults, adolescents in South Africa have larger gaps at each step of the HIV continuum of care resulting in low levels of viral suppression. Methods: We conducted a systematic review and modified Delphi analysis of interventions addressing the HIV continuum of care for adolescents in South Africa. We searched PubMed, Science Direct, and Google Scholar and online conference proceedings from the International AIDS Society, the International AIDS Conference, and the Conference on Retrovirology and Opportunistic Infections from 1 January 2010 to 30 September 2020. We then conducted a modified Delphi analysis with 29 researchers involved in the National Institutes of Health's Fogarty International-supported Adolescent HIV Implementation Science Alliance-South Africa to evaluate interventions for efficacy, feasibility and potential for scale-up. Results: We identified nine initial published articles containing interventions addressing the adolescent HIV continuum of care in South Africa, including five interventions focused on HIV diagnosis, two on antiretroviral therapy adherence and two on retention in care. No studies addressed linkage to care or transition from paediatric to adult care. Two studies discussed intervention costs. In-home and HIV self-testing, community-based adherence support, and provision of adolescent-friendly services were the most impactful and scalable interventions addressing the adolescent HIV continuum of care. Conclusion: Future interventions should work comprehensively across the adolescent HIV continuum of care and be tailored to the specific needs of adolescents.Item Sociodemographic contributors to health and safety of mine workers in South Africa(2019-02-17) Jodi Pelders; Gill NelsonItem The double-edged role of accessed status on health and well-being among middle- and older-age adults in rural South Africa: The HAALSI study(2022-09) Shao-Tzu Yu; Brian Houle; Lenore Manderson; Elyse A Jennings; Stephen M Tollman; Lisa F Berkman; Guy HarlingBackground: Social capital theory conceptualizes accessed status (the socioeconomic status of social contacts) as interpersonal resources that generate positive health returns, while social cost theory suggests that accessed status can harm health due to the sociopsychological costs of generating and maintaining these relationships. Evidence for both hypotheses has been observed in higher-income countries, but not in more resource-constrained settings. We therefore investigated whether the dual functions of accessed status on health may be patterned by its interaction with network structure and functions among an older population in rural South Africa. Method: We used baseline survey data from the HAALSI study ("Health and Aging in Africa: a Longitudinal Study of an INDEPTH Community in South Africa") among 4,379 adults aged 40 and older. We examined the direct effect of accessed status (measured as network members' literacy), as well as its interaction with network size and instrumental support, on life satisfaction and self-rated health. Results: In models without interactions, accessed status was positively associated with life satisfaction but not self-rated health. Higher accessed status was positively associated with both outcomes for those with fewer personal contacts. Interaction effects were further patterned by gender, being most health-protective for women with a smaller network and most health-damaging for men with a larger network. Conclusions: Supporting social capital theory, we find that having higher accessed status is associated with better health and well-being for older adults in a setting with limited formal support resources. However, the explanatory power of both theories appears to depending on other key factors, such as gender and network size, highlighting the importance of contextualizing theories in practice.Item The socioeconomic gradient of alcohol use: an analysis of nationally representative survey data from 55 low-income and middle-income countries(2022-10-22) Yuanwei Xu; Pascal Geldsetzer; Jen Manne-Goehler; Michaela Theilmann; Maja-E Marcus; Zhaxybay Zhumadilov; Sarah Quesnel-Crooks; Omar Mwalim; Sahar Saeedi Moghaddam; Sogol Koolaji; Khem B Karki; Farshad Farzadfar; Narges Ebrahimi; Albertino Damasceno; Krishna K Aryal; Kokou Agoudavi; Rifat Atun; Till Bärnighausen; Justine Davies; Lindsay M Jaacks; Sebastian Vollmer; Charlotte ProbstBackground: Alcohol is a leading risk factor for over 200 conditions and an important contributor to socioeconomic health inequalities. However, little is known about the associations between individuals' socioeconomic circumstances and alcohol consumption, especially heavy episodic drinking (HED; ≥5 drinks on one occasion) in low-income or middle-income countries. We investigated the association between individual and household level socioeconomic status, and alcohol drinking habits in these settings. Methods: In this pooled analysis of individual-level data, we used available nationally representative surveys-mainly WHO Stepwise Approach to Surveillance surveys-conducted in 55 low-income and middle-income countries between 2005 and 2017 reporting on alcohol use. Surveys from participants aged 15 years or older were included. Logistic regression models controlling for age, country, and survey year stratified by sex and country income groups were used to investigate associations between two indicators of socioeconomic status (individual educational attainment and household wealth) and alcohol use (current drinking and HED amongst current drinkers). Findings: Surveys from 336 287 participants were included in the analysis. Among males, the highest prevalence of both current drinking and HED was found in lower-middle-income countries (L-MICs; current drinking 49·9% [95% CI 48·7-51·2] and HED 63·3% [61·0-65·7]). Among females, the prevalence of current drinking was highest in upper-middle-income countries (U-MIC; 29·5% [26·1-33·2]), and the prevalence of HED was highest in low-income countries (LICs; 36·8% [33·6-40·2]). Clear gradients in the prevalence of current drinking were observed across all country income groups, with a higher prevalence among participants with high socioeconomic status. However, in U-MICs, current drinkers with low socioeconomic status were more likely to engage in HED than participants with high socioeconomic status; the opposite was observed in LICs, and no association between socioeconomic status and HED was found in L-MICs. Interpretation: The findings call for urgent alcohol control policies and interventions in LICs and L-MICs to reduce harmful HED. Moreover, alcohol control policies need to be targeted at socially disadvantaged groups in U-MICs. Funding: Deutsche Forschungsgemeinschaft and the National Center for Advancing Translational Sciences of the US National Institutes of Health.Item There are no equal opportunity infectors: Epidemiological modelers must rethink our approach to inequality in infection risk(2022-02-09) Jon Zelner; Nina B Masters; Ramya Naraharisetti; Sanyu A Mojola; Merlin Chowkwanyun; Ryan MaloshMathematical models have come to play a key role in global pandemic preparedness and outbreak response: helping to plan for disease burden, hospital capacity, and inform nonpharmaceutical interventions. Such models have played a pivotal role in the COVID-19 pandemic, with transmission models-and, by consequence, modelers-guiding global, national, and local responses to SARS-CoV-2. However, these models have largely not accounted for the social and structural factors, which lead to socioeconomic, racial, and geographic health disparities. In this piece, we raise and attempt to clarify several questions relating to this important gap in the research and practice of infectious disease modeling: Why do epidemiologic models of emerging infections typically ignore known structural drivers of disparate health outcomes? What have been the consequences of a framework focused primarily on aggregate outcomes on infection equity? What should be done to develop a more holistic approach to modeling-based decision-making during pandemics? In this review, we evaluate potential historical and political explanations for the exclusion of drivers of disparity in infectious disease models for emerging infections, which have often been characterized as "equal opportunity infectors" despite ample evidence to the contrary. We look to examples from other disease systems (HIV, STIs) and successes in including social inequity in models of acute infection transmission as a blueprint for how social connections, environmental, and structural factors can be integrated into a coherent, rigorous, and interpretable modeling framework. We conclude by outlining principles to guide modeling of emerging infections in ways that represent the causes of inequity in infection as central rather than peripheral mechanisms.