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Item A community mobilization intervention to improve engagement in HIV testing, linkage to care, and retention in care in South Africa: a cluster-randomized controlled trial(2022-09) Sheri A. Lippman; Audrey Pettifor; Mi-Suk Kang Dufour; Chodziwadziwa Whiteson Kabudula; Rhian Twine; Dean Peacock; Rhandzekile Mathebula; Aimée Julien; Rebecca West; Torsten B. Neilands; Ryan Wagner; Ann Gottert; F. Xavier Gómez Olivé; Dumisani Rebombo; Nicole Haberland; Julie Pulerwitz; Louis Pappie Majuba; Stephen Tollman; Kathleen KahnBackground: Community Mobilization (CM), engaging communities in a process to collectively enact change, could improve HIV testing and care engagement. We assessed whether CM increased HIV testing, linkage to, and retention in care over time in intervention relative to control communities. Methods: Fifteen communities in Mpumalanga, South Africa were randomized to either a CM intervention engaging residents to address social barriers to HIV testing and treatment or to control. Implementation occurred from August 2015-July 2018. Outcomes included quarterly rates of HIV testing, linkage to care, and retention in care documented from health facility records among 18-49 year-old residents of intervention and control communities over the three years of study. Intention-to-treat analyses employed generalized estimating equations stratified by sex. ClinicalTrials.gov number NCT02197793. Findings: Residents in eight intervention communities (N=20,544) and seven control communities (N=17,848) contributed data. Among men, HIV testing increased quarterly by 12·1% (Relative Change (RC):1·121, 95%CI:1·099-1·143) in intervention communities and 9·5% (RC:1·095, 95%CI:1·075-1·114) in control communities; differences by arm were marginally significant (exponentiated interaction coefficient:1·024, 95%CI:0·997-1·052, p-value=0·078). Among women, HIV testing increased quarterly by 10·6% (RC:1·106, 95%CI:1·097-1·114) in intervention and 9·3% (RC:1·093, 95%CI:1·084-1·102) in control communities; increases were greater in intervention communities (exponentiated interaction coefficient:1·012, 95%CI:1·001-1·023, p-value=0·043). Quarterly linkage increased significantly among intervention community women (RC:1·013, 95%CI:1·002-1·023) only. Quarterly retention fell among women in both arms; however, reductions were tempered among intervention women (exponentiated interaction coefficient:1·003, 95%CI:<1·000-1·006, p-value=0·062). No significant differences were detected in linkage or retention among men. Interpretation: CM was associated with modest improvements in select trial outcomes. The sum of these incremental, quarterly improvements achieved by addressing social barriers to HIV care engagement can impact epidemic control. However, achieving optimal impacts will likely require integrated efforts addressing both social barriers through CM and provision of improved service delivery.Item A long walk to freedom: the epidemiology of penetrating trauma in South Africa- analysis of 4 697 patients over a six year period at Chris Hani Baragwanath Academic HospitalBhana, Malini; Fru, Pascaline; Plani, FrancoBackground: Despite the city of Johannesburg having one of the highest rates of crime in the world, no national databank for trauma exists. This study profiles the victims of penetrating trauma and identifies geographical areas in which it occurs, while describing the outcomes and patterns of injury. Methods: A retrospective study including penetrating trauma patients triaged as Priority 1, presenting at the Chris Hani Baragwanath Academic Hospital's (CHBAH) trauma department over a six-year period (2011-2016). Results: A total of 4 697 patients were included. The majority of victims were Black African males (92.1%) between the ages of 29-40 years, and stabbings were the most common mechanism of injury (71.8%), followed by gunshots. The commonest body area affected was the thorax, with a consequent haemothorax the most likely result. Weekends accounted for over 48% of all presentations - the last weekend of the month being the busiest. Region D was the area in Johannesburg with the highest trauma incidence (51.9%), with the oldest townships in Soweto found to be "hot spots". Conclusion: Penetrating trauma is inherently linked to alcohol abuse and interpersonal violence in South Africa,1 primarily affecting its young economic, working-class citizens. The data provided some insight into the burden, structure and challenges of our trauma system. These should be regarded as opportunities to implement change and improve our surveillance and prevention, beginning with a national trauma databankItem A prospective study of asymptomatic SARS-CoV-2 infection among individuals involved in academic research under limited operations during the COVID-19 pandemic(2022-04-25) Audrey Pettifor; Bethany L DiPrete; Bonnie E Shook-Sa; Lakshmanane Premkumar; Kriste Kuczynski; Dirk Dittmer; Allison Aiello; Shannon Wallet; Robert Maile; Joyce Tan; Ramesh Jadi; Linda Pluta; Aravinda M de Silva; David J Weber; Min Kim; Arlene C Seña; Corbin D JonesBackground: Early in the pandemic, transmission risk from asymptomatic infection was unclear, making it imperative to monitor infection in workplace settings. Further, data on SARS-CoV-2 seroprevalence within university populations has been limited. Methods: We performed a longitudinal study of University research employees on campus July-December 2020. We conducted questionnaires on COVID-19 risk factors, RT-PCR testing, and SARS-CoV-2 serology using an in-house spike RBD assay, laboratory-based Spike NTD assay, and standard nucleocapsid platform assay. We estimated prevalence and cumulative incidence of seroconversion with 95% confidence intervals using the inverse of the Kaplan-Meier estimator. Results: 910 individuals were included in this analysis. At baseline, 6.2% (95% CI 4.29-8.19) were seropositive using the spike RBD assay; four (0.4%) were seropositive using the nucleocapsid assay, and 44 (4.8%) using the Spike NTD assay. Cumulative incidence was 3.61% (95% CI: 2.04-5.16). Six asymptomatic individuals had positive RT-PCR results. Conclusions: Prevalence and incidence of SARS-CoV-2 infections were low; however, differences in target antigens of serological tests provided different estimates. Future research on appropriate methods of serological testing in unvaccinated and vaccinated populations is needed. Frequent RT-PCR testing of asymptomatic individuals is required to detect acute infections, and repeated serosurveys are beneficial for monitoring subclinical infection.Item Abnormal behavioural patterns in dogs with cleft palates(1973) Dreyer, C. J.; Preston, C. B.Item Abnormal swallowing habits(1961) Dreyer, C. J.; Viljoen, P. T.Item Access to Social Protection by People Living with, at Risk of, or Afected by HIV in Eswatini, Malawi, Tanzania, and Zambia: Results from Population‑Based HIV Impact Assessments(2022-09) David Chipanta; Audrey Pettifor; Jessie Edwards; Danielle Giovenco; Hillary Mariko Topazian; Rachel M. Bray; Monique C. Millington; Janne Estill; Olivia Keiser; Jessica E. JustmanWe aimed to measure social protection coverage among the general population, women and men living with HIV (WLHIV, MLHV), female and male sex workers (FSW, MSW), men who have sex with men (MSM), adolescent girls young women (AGYW), and orphans vulnerable children (OVC) in Eswatini, Malawi, Tanzania, and Zambia. We used Population-Based HIV Impact Assessment data. We operationalised social protection benefits as external economic support from private and public sources to the household in the last three or 12 months. We estimated survey-weighted proportions and 95% confidence intervals (CI) for each population receiving social protection benefits. The sample size ranged from 10,233 adults ages 15-59 years in Eswatini to 29,638 in Tanzania. In the surveyed countries, social protection coverage among the general population was lower than the global average of 45%, ranging from 7.7% (95% CI 6.7%-8.8%) in Zambia to 39.6% (95% CI 36.8%-42.5%) in Eswatini. In Malawi and Zambia, social protection coverage among OVC, AGYW, SW, MSM, and people living with HIV (PLHIV) was similar to the general population. In Eswatini, more AGWY reported receiving social projection benefits than older women and more men not living with HIV reported receiving social protection benefits than MLHIV. In Tanzania, more WLHIV than women not living with HIV, MLHIV than men not living with HIV, and FSW than women who were not sex workers reported receiving social protection benefits. More data on access to social protection benefits by PLHIV or affected by HIV are needed to estimate better their social protection coverage.Item Accurate diagnosis of occlusal carious lesions - a stereo microscope evaluation of clinical diagnosis(2002) Grossman, E. S.; Cleaton-Jones, P. E.; Côrtes, D. F.; et alThis study was undertaken to validate the caries status of 214 teeth by serial sectioning and microscopy after caries diagnosis using four methods. Two hundred and fourteen extracted human teeth with varying degrees of caries were mounted in the jaws of nine training manikins. All tooth surfaces were examined and recorded for caries by four dentists using bitewing radiographs, fibre-optic transillumination (FOTI), mirror alone and a mirror and sharp probe on two separate occasions. Thereafter the teeth were serially sectioned and assessed microscopically for depth of caries lesion on a graded score of 0-7. This report assessed the diagnostic outcome of 2,183 observations for occlusal surfaces. Sound diagnoses predominated over unsound until caries was present in the inner half of dentine. Specificity was between 90% and 95% and sensitivity 26% and 50% depending on which diagnostic method was used and where the sound/unsound threshold was set. Negative and positive predictive values were similarly influenced and varied between 53% and 80% and 73% and 90%, respectively. Probit analysis showed no significant differences (P < 0.05) between examiners and diagnostic methods. Diagnosis of occlusal caries undertaken in an in vitro simulated clinical situation is inaccurate until the caries lesion extends deep into the dentine no matter which of the four methods was used.Item Activation analysis in biological material(1975) Turkstra, J.; Retief, D. H.; Cleaton-Jones, P. E.Item The activities of hospital nursing unit managers and quality of patient care in South African hospitals: a paradox?(2015) Armstrong, S J; Rispel, L C; Penn-Kekana, LBackground: Improving the quality of health care is central to the proposed health care reforms in South Africa. Nursing unit managers play a key role in coordinating patient care activities and in ensuring quality care in hospitals. Objective: This paper examines whether the activities of nursing unit managers facilitate the provision of quality patient care in South African hospitals. Methods: During 2011, a cross-sectional, descriptive study was conducted in nine randomly selected hospitals (six public, three private) in two South African provinces. In each hospital, one of each of the medical, surgical, paediatric, and maternity units was selected (n 36). Following informed consent, each unit manager was observed for a period of 2 hours on the survey day and the activities recorded on a minute-by-minute basis. The activities were entered into Microsoft Excel, coded into categories, and analysed according to the time spent on activities in each category. The observation data were complemented by semi-structured interviews with the unit managers who were asked to recall their activities on the day preceding the interview. The interviews were analysed using thematic content analysis. Results: The study found that nursing unit managers spent 25.8% of their time on direct patient care, 16% on hospital administration, 14% on patient administration, 3.6% on education, 13.4% on support and communication, 3.9% on managing stock and equipment, 11.5% on staff management, and 11.8% on miscellaneous activities. There were also numerous interruptions and distractions. The semi-structured interviews revealed concordance between unit managers’ recall of the time spent on patient care, but a marked inflation of their perceived time spent on hospital administration. Conclusion: The creation of an enabling practice environment, supportive executive management, and continuing professional development are needed to enable nursing managers to lead the provision of consistent and high-quality patient care.Item Addressing alcohol use among blood pressure patients in Thai primary care: Lessons from a survey-based stakeholder consultation(2022) Julia M. Lemp; Supa Pengpid; Doungjai Buntup; Till W. Barnighausen; Pascal Geldsetzerf; Karl Peltzer; Jürgen Rehm; Bundit Sornpaisarn; Charlotte Probstblood pressure. Given that brief intervention can effectively reduce hazardous alcohol consumption, this study aimed to investigate how hypertensive patients with concomitant alcohol use are identified and treated in Thai primary care settings and what this may mean for screening and lifestyle intervention strategies. In a crosssectional, mixed-method design, we surveyed 91 participants from three different groups of Thai stakeholders: policy- and decisionmakers; healthcare practitioners; and patients diagnosed with hypertension. Data was collected between December 2020 and May 2021. Responses were analyzed descriptively and using open coding tools to identify current practices, barriers, facilitators, and implications for interventions. All stakeholder groups regarded alcohol use as an important driver of hypertension. While lifestyle interventions among hypertensive patients were perceived as beneficial, current lifestyle support was limited. Barriers included limited resources in primary healthcare facilities, lack of continuous monitoring or follow-up, missing tools or procedures for risk assessment and lifestyle intervention, and stigmatization of alcohol use. Our results suggest that although screening for lifestyle risk factors (including alcohol use) and lifestyle interventions are not yet sufficiently established, a wide range of stakeholders still recognize the potential of interventions targeted at hazardous alcohol use among hypertensive patients. Future interventions may establish standardized assessment tools, be tailored to high-risk groups, and include electronic or remote elements.Item Adhesion in biological systems(1975) Retief, D. H.Item Adhesion in dentistry(1973) Retief, D. H.Item Adolescent sleep health in Africa: a scoping review protocol(2023-08-17) Oluwatosin Eunice Olorunmoteni; F Xavier Gómez-Olivé; Biliamin O Popoola; Adesegun Olayiwola Fatusi; Karine ScheuermaierIntroduction Problematic sleep is a major threat to health and quality of life among adolescents. Hence, to provide directions for research and interventions, there is a need to examine the literature on adolescent sleep health in Africa. However, available studies on adolescent sleep health in Africa have not been properly mapped. Thus, this scoping review aims to investigate the extent and type of available evidence concerning sleep health among adolescents in Africa and to highlight the relationship of adolescent sleep health with adverse mental health outcomes and cardiometabolic risk factors. The review will further highlight areas of agreement and controversies on adolescent sleep health, and identify evidence gaps that require research attention across the continent. Methods and analysis This scoping review will be conducted using Arksey and O’Malley’s six-step procedure. Thus, we have prepared this protocol according to the framework for scoping reviews developed by the Joanna Briggs Institute. To identify eligible studies, we will search MEDLINE, Scopus, PsycINFO, AJOL, JSTOR, HINARI and Google Scholar. The review will include all published articles in English, French, Spanish, Portuguese and Italian languages on adolescent sleep health in Africa from the inception of the databases, while relevant information will be extracted from included studies using an adapted data extraction tool. The results will be presented using tables and charts as appropriate. Ethics and dissemination The scoping review does not require ethical approval because the publications to be used for the review are publicly available and the study does not involve contact with humans or other animals as research participants. Furthermore, clinical records will not be used for the study. Upon completion, findings from the study will be disseminated through presentations at scientific meetings and publication in a relevant peer reviewed journal.Item Advances in osteogenin and related bone morphogenetic proteins in bone induction and repair(1992) Luyten, F. P.; Cunningham, N. S.; Vukicevic, S.; et alBone matrix is a repository of growth and differentiation factors as demonstrated by the induction of local cartilage and bone formation in rats. The bone inductive activity, termed osteogenin, can be dissociatively extracted, and it was isolated by heparin affinity, hydroxyapatite and molecular sieve chromatography. Osteogenin has been purified to homogeneity from bovine bone matrix and the sequences of several tryptic peptides have been determined. The sequences were similar to portions of the amino acid sequence deduced from the cDNA clone of bone morphogenetic protein-3 (BMP-3). The carboxyl-terminal quarter of osteogenin has sequence identity to the corresponding regions of two related proteins BMP-2A and BMP-2B. The bone inductive proteins are members of the TGF-beta superfamily, by virtue of the location of the highly conserved cysteines in their carboxyl-terminal region. Osteogenin and related BMPs initiate cartilage and bone formation in vivo. The study of the mechanism of action of these proteins will add considerable new information on the molecular signals controlling endochondral bone formation. In vitro data indicate that osteogenin stimulates the expression of the osteogenic and chondrogenic phenotypes. Our results demonstrate their profound influence on proteoglycan synthesis and degradation in bovine cartilage explant cultures. High affinity specific binding sites have been identified in both MC3T3 cells and articular chondrocytes. In vivo experiments demonstrate the efficacy of primate osteogenin in restoring large calvarial defects in adult baboons, establishing a primary role for osteogenin in therapeutic initiation and promotion of osteogenesis.Item Age-incidence and prevalence of HIV among intact and circumcised men: an analysis of PHIA surveys in Southern Africa(2022-10-05) Michel GarenneThe study investigates the statistical relationship between male circumcision and HIV prevalence in Africa, in the context of the Voluntary Medical Male Circumcision (VMMC) campaigns in place since 2008. Data from the Population-based HIV Impact Assessment (PHIA) surveys conducted in African countries in 2017-2018 were utilized. Six countries with high HIV prevalence, low traditional circumcision and large VMMC programs were selected: Eswatini, Lesotho, Malawi, Namibia, Zambia, Zimbabwe. The statistical analysis investigated the relative risk (RR) of HIV prevalence by circumcision status (circumcised vs intact) among men age 20-59, and the age-incidence of HIV in the two groups among men age 20-49, defined as the linear-logistic slope of the relationship between prevalence and age. Results show that the standardized RR was not different from 1 at older ages (50-59): RR = 0.923, 95% CI = 0.769-1.108, P = 0.390. Furthermore, the age-incidence was at least as high or higher among the circumcised groups than among the intact groups. The standardized RR was lower than 1 at younger ages, and this could be explained by selection biases. HIV prevalence at age 40-59 (27.3%) was also the same in the four groups of circumcision status (intact, traditional, medical, unknown). Results matched earlier observations made in South Africa that circumcised and intact men had similar levels of HIV infection. The study questions the current strategy of large scale VMMC campaigns to control the HIV epidemic. These campaigns also raise a number of ethical issuesItem Age-incidence and prevalence of HIV among intact and circumcised men: an analysis of PHIA surveys in Southern Africa(2022-10-05) Michel GarenneThe study investigates the statistical relationship between male circumcision and HIV prevalence in Africa, in the context of the Voluntary Medical Male Circumcision (VMMC) campaigns in place since 2008. Data from the Population-based HIV Impact Assessment (PHIA) surveys conducted in African countries in 2017-2018 were utilized. Six countries with high HIV prevalence, low traditional circumcision and large VMMC programs were selected: Eswatini, Lesotho, Malawi, Namibia, Zambia, Zimbabwe. The statistical analysis investigated the relative risk (RR) of HIV prevalence by circumcision status (circumcised vs intact) among men age 20-59, and the age-incidence of HIV in the two groups among men age 20-49, defined as the linear-logistic slope of the relationship between prevalence and age. Results show that the standardized RR was not different from 1 at older ages (50-59): RR = 0.923, 95% CI = 0.769-1.108, P = 0.390. Furthermore, the age-incidence was at least as high or higher among the circumcised groups than among the intact groups. The standardized RR was lower than 1 at younger ages, and this could be explained by selection biases. HIV prevalence at age 40-59 (27.3%) was also the same in the four groups of circumcision status (intact, traditional, medical, unknown). Results matched earlier observations made in South Africa that circumcised and intact men had similar levels of HIV infection. The study questions the current strategy of large scale VMMC campaigns to control the HIV epidemic. These campaigns also raise a number of ethical issues.Item Aids and the workplace with a specific focus on employee benefits: Issues and responses(Centre for Health Policy - School of Public Health - University of the Witwatersrand, 2001) Stevens, MarionEXECUTIVE SUMMARYThis report reflects the first activity in a three-year research project, funded by the European Union, which is part of a programme of support to NGOs which are working with communities to combat discrimination against and provide support for people with HIV/AIDS. The aim of the project is to investigate, using a variety of methods, the world of AIDS and the workplace with a specific focus on employee benefits. These benefits include medical schemes and other health benefits, death, disability and pension funds. The research will concentrate on the experience of formally employed, unskilled or semi-skilled workers who are vulnerable because employers consider them dispensable or replaceable should they get ill or die, and whose employee benefits may be eroded in the face of HIV. By creating workplaces which are supportive of individual employees, one sustains households and, in turn, the broader society. This report presents the findings of an initial situational analysis of responses to HIV in the workplace, using a policy analysis methodology, which combined documentation review and key informant interviews with 27 players in the field.
The report starts with a review of the South African literature and documentation on HIV/AIDS and the workplace. Available evidence on the direct and indirect impacts of HIV on workplaces and the current models used to project impacts are presented; the legal and policy frameworks relevant to AIDS in the workplace are summarised; and a chronology of key events and processes that have informed this area are noted.
The main body of the report outlines responses to HIV/AIDS of the three major players: government, the private sector including NGOs, and trade unions. In each sector consideration is given to the areas of: leadership and organisational responses, networking and policy processes, and workplace policies and programmes including health care.
While a legal framework and a set of legal precedents for a rights-based orientation to HIV in the workplace have been established, prohibiting, for example, pre-employment HIV testing, a consistent and sound response to HIV in the workplace has yet to emerge. The report concludes that there is a need for strong, bold and coherent leadership in all sectors of society.
Responsibility for workplace HIV/AIDS programmes has generally been delegated to human resource departments, rather than being seen as a core management issue. The overall view noted by stakeholders was of strategic failures in managing HIV/AIDS in the workplace due to the lack centralised responsibility and commitment within organisations. The business sector and the trade union movement need to ensure that HIV/AIDS is fore-grounded as an issue and that it is the concern of the most senior leaders in their sectors. Many interviewees also felt that there was a need for better alliances and networking on workplace issues, and that government needed to play a leadership role in this regard.
Respondents across sectors called for planning to be informed by better data. These data need to be independent, open to scrutiny and separate from private interests.
Workplace benefits have undergone considerable restructuring in response to HIV. In the early-nineties schemes changed from defined benefit to defined contributions, motivated by the perceived impact of HIV on risk benefits. During the late-nineties some schemes evolved from group schemes to individualised packages, anti-retroviral drugs became more available in medical schemes, the outsourcing of unskilled functions appeared as a particular response to HIV and new HIV insurance packages became available for workplaces. During v AIDS and THE WORKPLACE WITH A SPECIFIC FOCUS ON EMPLOYEE BENEFITS: ISSUES AND RESPONSES 2001. Centre for Health Policy. 2001, several companies announced their intentions to provide anti-retroviral treatment for semi-skilled and unskilled employees. These changes have been in response to assessments of direct and indirect HIV-related costs and the requirement to adapt to the reforming legal framework. Developments in the field have prompted the emergence of a range of new players dealing with disease management and impact assessments.
The effect of this restructuring has been several fold. Individuals often have to negotiate for benefits directly with insurance companies, as opposed to their companies taking responsibility for this. This has left employees more vulnerable. While routine pre-employment testing is no longer legal, it is apparent that many individuals are losing cover through pre-benefit testing. As a contrary trend, there is a growing realisation, in the face of declining drug prices, that HIV/AIDS treatment is affordable and cost effective in managing the health of employees. However, there is the danger that anti-retroviral therapy, for example, will be offered to some employees and not others. This is clearly of concern in terms of equity and discrimination.
Finally, there is a need to counter the notion that businesses will be able to cope with the HIV/AIDS pandemic because of ‘the ease of substitution’ . This rationale is neither positive nor constructive. Businesses need to balance their fiduciary duties by remaining profitable and viable yet being fair and socially responsible.
Item Airway status in civilian maxillofacial gunshot injuries in Johannesburg, South Africa(2002) Tsakiris, P.; Cleaton-Jones, P. E.; Lownie, M. A.BACKGROUND: Airway management of the maxillofacial gunshot injury constitutes a critical decision and an area that requires review in the context of civilian injuries. Most of our knowledge is extrapolated from military experience, which constitutes a different trauma patient group. This paper reports a retrospective survey of airway status in relation to maxillofacial gunshot injuries. The objective is to correlate clinical findings with treatment decisions. METHODS: A survey was done of 11,622 archived maxillofacial surgery records (1987-1992) in the three academic hospitals in Johannesburg. RESULTS: There were 211 maxillofacial gunshot injuries, for which 92 patient records had sufficient detail for inclusion in the analysis. The typical patient was a black male aged 20-29 years, shot with a low-velocity bullet of 0.38 calibre, admitted to hospital the day of the injury, operated on within 4 days, and discharged 4 days later. The airway was threatened in 20/92 cases at admission; 12/20 cases were treated with oro-or nasotracheal intubation, and 9/12 later had elective tracheostomies; 8/20 needed immediate surgical airways, 5 tracheostomies and 3 cricothyroldotomies (all later converted to tracheostomies). Three of thirty-seven patients with normal airways on admission later required emergency tracheostomy. CONCLUSIONS: An abnormal airway was significantly more likely after a high-velocity injury, and when the tongue, floor of mouth, midline or bilateral facial skeletal bones were involved.Item Alkali resistant haemoglobins from normal and sickle cell bloods(1955) Anderson, C. G.