School of Public Health (Journal Articles)

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    Alcohol use and optimal chronic diseases’ treatment outcomes among adults aged 40 years and above in rural South Africa
    (Nature Research, 2025-03) Mupfuti, Rumbidzai; Kabudula, Chodziwadziwa. W.; Francis, Joel Msafiri
    Chronic diseases are significant problems in South Africa. Chronic diseases’ treatment outcomes are critical to the reduction of morbidity and mortality. There is limited data in South Africa on alcohol use and treatment outcomes of chronic diseases in older people. Understanding the association between alcohol use and chronic diseases treatment outcomes would inform potential interventions to address the duo. We analysed data from wave 1 of the Health and Ageing in Africa-a longitudinal Study in an INDEPTH community (HAALSI) study. We performed descriptive analysis to determine the prevalence of optimal chronic diseases’ treatment outcomes (suppressed HIV viral load, normal blood pressure and normal blood sugar- euglycemia) and applied modified Poisson regression to determine the association between alcohol use and chronic diseases’ treatment outcomes. The prevalence of optimal treatment outcomes was 87.4% suppressed viral load for those living with HIV, 42.7% normal blood pressure for hypertensives, 53.6% with euglycemia among diabetics and 52.4% with normal outcome parameters among those with multimorbidity. Alcohol use did not negatively impact the optimal treatment outcomes for HIV (aRR = 1.00, 95%CI 0.93–1.09), hypertension (aRR = 0.88, 95%CI 0.68–1.14), diabetes mellitus (aRR = 0.73, 95%CI 0.44–1.22), and multimorbidity (aRR = 1.00, 95%CI 0.93–1.09). Alcohol use was not significantly associated with treatment outcomes possibly due to underreporting of alcohol use. There is need to incorporate objective alcohol measurements and alcohol interventions in chronic diseases care settings. Furthermore, there is urgent need to strengthen the management of hypertension and diabetes, by adopting the strategies deployed for HIV management.
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    T‑cell responses to ancestral SARS‑CoV‑2 and Omicron variant among unvaccinated pregnant and postpartum women living with and without HIV in South Africa
    (Nature Research, 2024-09) Madhi, Shabir A.; McMahon, William C.; Kwatra, Gaurav; Izu, Alane; Jones, Stephanie A.; Mbele, Nkululeko J.; Jafta, Nwabisa; Lala, Rushil; Shalekof, Sharon; Tiemessen, Caroline T.; Nunes, Marta C.
    SARS-CoV-2 cell-mediated immunity remains understudied during pregnancy in unvaccinated Black African women living with HIV (WLWH) from low- and middle-income countries. We investigated SARS-CoV-2-specifc T-cell responses 1 month following infection in 24 HIV-uninfected women and 15 WLWH at any stage during pregnancy or postpartum. The full-length spike (FLS) glycoprotein and nucleocapsid (N) protein of wild-type (WT) SARS-CoV-2, as well as mutated spike protein regions found in the Omicron variant (B.1.1.529) were targeted by flow cytometry. WT-specific CD4+and CD8+T cells elicited similar FLS- and N-specific responses in HIV-uninfected women and WLWH. SARS-CoV 2-specifc T-lymphocytes were predominantly TNF-α monofunctional in pregnant and postpartum women living with and without HIV, with fever cells producing either IFN-γ or IL-2. Furthermore, T-cell responses were unaffected by Omicron-specific spike mutations as similar responses between Omicron and the ancestral virus were detected for CD4+ and CD8+ T cells. Our results collectively demonstrate comparable T-cell responses between WLWH on antiretroviral therapy and HIV-uninfected pregnant and postpartum women who were naïve to Covid-19 vaccination. Additionally, we show that T cells from women infected with the ancestral virus, Beta variant (B.1.351), or Delta variant (B.1.617.2) can cross-recognize Omicron, suggesting an overall preservation of T-cell immunity.
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    Perceptions of counsellors and youth-serving professionals about sexual and reproductive health services for adolescents in Soweto, South Africa
    (BMC, 2018-02) Mulaudzi, Mamakiri; Dlamini, Busisiwe Nkala; Coetzee, Jenny; Sikkema, Kathleen; Gray, Glenda; Dietrich, Jana Janine
    Background: Adolescents in South Africa remain vulnerable to HIV. Therefore, it is crucial to provide accessible adolescent-friendly HIV prevention interventions that are sensitive to their needs. This study aimed to investigate the perceptions of HIV counsellors and other youth-serving professionals about the barriers to providing adolescent youth-friendly sexual and reproductive health services to adolescents in Soweto, South Africa. The study also explored how sexual and reproductive health services in South Africa could be improved to become more accessible to adolescents. Methods: The research team conducted two focus group discussions with HIV counsellors, and 19 semi-structured interviews with youth-serving professionals from organisations working with adolescents. Audio-recorded data were transcribed verbatim and analysed using thematic analysis. Results: The results of the study reveal that counsellors were expected to give adolescents HIV counselling and testing (HCT) but felt restricted by what they perceived as inflexible standard operating procedures. Counsellors reported inadequate training to address adolescent psychosocial issues during HCT. Healthcare provider attitudes were perceived as a barrier to adolescents using sexual and reproductive health services. Participants strongly recommended augmenting adolescent sexual and reproductive health services to include counsellors and adolescents in developing age- and context-specific HIV prevention services for adolescents. Conclusion: Continuous upskilling of HIV counsellors is a critical step in providing adolescent-friendly services.