1. Academic Wits Research Publications (Faculties submissions)
Permanent URI for this communityhttps://hdl.handle.net/10539/37774
Browse
32 results
Search Results
Item Predictors of switch to and early outcomes on third-line antiretroviral therapy at a large public-sector clinic in Johannesburg, South Africa(BMC, 2018) Evans, Denise; Hirasen, Kamban; Berhanu, Rebecca; Malete, Given; Ive, Prudence; Spencer, David; Badal‑Faesen, Sharlaa; Sanne, Ian M.; Fox, Matthew P.Background: While efficacy data exist, there are limited data on the outcomes of patients on third-line antiretroviral therapy (ART) in sub-Saharan Africa in actual practice. Being able to identify predictors of switch to third-line ART will be essential for planning for future need. We identify predictors of switch to third-line ART among patients with significant viraemia on a protease inhibitor (PI)-based second-line ART regimen. Additionally, we describe characteristics of all patients on third-line at a large public sector HIV clinic and present their early outcomes. Methods: Retrospective analysis of adults (≥ 18 years) on a PI-based second-line ART regimen at Themba Lethu Clinic, Johannesburg, South Africa as of 01 August 2012, when third-line treatment became available in South Africa, with significant viraemia on second-line ART (defined as at least one viral load ≥ 1000 copies/mL on second-line ART after 01 August 2012) to identify predictors of switch to third-line (determined by genotype resistance testing). Third line ART was defined as a regimen containing etravirine, raltegravir or ritonavir boosted darunavir, between August 2012 and January 2016. To assess predictors of switch to third-line ART we used Cox proportional hazards regression among those with significant viraemia on second-line ART after 01 August 2012. Then among all patients on third-line ART we describe viral load suppression, defined as a viral load < 400 copies/mL, after starting third-line ART. Results: Among 719 patients in care and on second-line ART as of August 2012 (with at least one viral load ≥ 1000 copies/mL after 01 August 2012), 36 (5.0% over a median time of 54 months) switched to third-line. Time on second-line therapy (≥ 96 vs. < 96 weeks) (adjusted Hazard Ratio (aHR): 2.53 95% CI 1.03–6.22) and never reaching virologic suppression while on second-line ART (aHR: 3.37 95% CI 1.47–7.73) were identified as predictors of switch. In a separate cohort of patients on third-line ART, 78.3% (47/60) and 83.3% (35/42) of those in care and with a viral load suppressed their viral load at 6 and 12 months, respectively. Conclusions: Our results show that the need for third-line is low (5%), but that patients’ who switch to third-line ART have good early treatment outcomes and are able to suppress their viral load. Adherence counselling and resistance testing should be prioritized for patients that are at risk of failure, in particular those who never suppress on second line and those who have been on PI-based regimen for extended periods.Item The relationship between childhood adversity, recent stressors, and depression in college students attending a South African university(BMC, 2018-03) Mall, Sumaya; Mortier, Philippe; Taljaard, Lian; Roos, Janine; Stein, Dan J. Stein; Lochner, ChristineBackground: College students are at risk of depression. This risk may be increased by the experience of childhood adversity and/or recent stressors. This study examined the association between reported experiences of childhood adversity, recent stressors and depression during the last 12 months in a cohort of South African university students. Methods: Six hundred and eighty-six first year students at Stellenbosch University in South Africa completed a health focused e-survey that included items on childhood adversity, recent stressors and mood. Individual and population attributable risk proportions (PARP) between experiences of childhood adversity and 12-month stressful experiences and 12-month depression were estimated using multivariate binomial logistic regression analysis. Results: About one in six students reported depression during the last 12 months. Being a victim of bullying and emotional abuse or emotional neglect during childhood were the strongest predictors of depression in the past year at both individual and population level. With regard to recent stressors, a romantic partner being unfaithful, serious ongoing arguments or break-ups with some other close friend or family member and a sexual or gender identity crisis were the strongest predictors of depression. The predictor effect of recent stressors was significantly reduced in the final model that adjusted for the type and number of childhood traumatic experiences. At a population level, academic stress, serious ongoing arguments or break-ups with a close friend or family member, and serious betrayal by someone close were the variables that yielded the highest PARP. Conclusions: Our findings suggest a significant relationship between early adversity, recent stressors, and depression here and throughout, consistent with the broader literature on predictors of depression. This study contributes to the limited data on college students’ mental health in low and middle income countries including on the African continent. The findings provide information on the population level effect sizes of trauma as a risk factor for depression, as well as on the relationship between specific recent stressors and depression in college students.Item What’s the deal? women’s evidence and gendered negotiations(Springer, 2018-11) Bonthuys, ElsjeSouth African law has traditionally denied property sharing rights to people in nonmarital intimate partnerships, but a series of new cases has created the possibility of enforcing universal partnership contracts to claim a share in partnership property.However, evidential biases within these progressive cases reflect a historical disdain for women’s contributions to relationships and a widespread reluctance to believe women’s testimony about the existence of agreements to share. These biases bear strong resemblances to the gender stereotypes which have been the subject of feminist critique in rape law. Central to both rape and universal partnerships is the issue of consent or agreement between men and women. This, in turn, depends on social beliefs about male and female entitlements in the realms of sex and intimate relationships. The paper highlights the commonalities and parallels between the legal treatment of women’s evidence about the existence of contracts on the one hand, and the prejudice faced by complainants in rape cases.Item Cash transfer interventions for sexual health: meanings and experiences of adolescent males and females in inner-city Johannesburg(BMC, 2018) Khoza, Nomhle; Stadler, Jonathan; MacPhail, Catherine; Chikandiwa, Admire; Brahmbhatt, Heena; Delany-Moretlwe, SineadBackground: In sub-Saharan Africa, there is growing interest in the use of cash transfer (CT) programs for HIV treatment and prevention. However, there is limited evidence of the consequences related to CT provision to adolescents in low-resourced urban settings. We explored the experiences of adolescents receiving CTs to assess the acceptability and unintended consequences of CT strategies in urban Johannesburg, South Africa. Methods: We collected qualitative data during a pilot randomized controlled trial of three CT strategies (monthly payments unconditional vs. conditional on school attendance vs. a once-off payment conditional on a clinic visit) involving 120 adolescents aged 16–18 years old in the inner city of Johannesburg. Interviews were conducted in isiZulu, Sesotho or English with a sub-sample of 49 participants who adhered to study conditions, 6 months after receiving CT (280 ZAR/ 20 USD) and up to 12 months after the program had ended. Interviews were transcribed and translated by three fieldworkers. Codes were generated using an inductive approach; transcripts were initially coded based on emerging issues and subsequently coded deductively using Atlas.ti 7.4. Results: CTs promoted a sense of independence and an adult social identity amongst recipients. CTs were used to purchase personal and household items; however, there were gender differences in spending and saving behaviours. Male participants’ spending reflected their preoccupation with maintaining a public social status through which they asserted an image of the responsible adult. In contrast, female participants’ expenditure reflected assumption of domestic responsibilities and independence from older men, with the latter highlighting CTs’ potential to reduce transactional sexual partnerships. Cash benefits were short-lived, as adolescents reverted to previous behavior after the program’s cessation. Conclusion: CT programs offer adolescent males and females in low-income urban settings a sense of agency, which is vital for their transition to adulthood. However, gender differences in the expenditure of CTs and the effects of ending CT programs must be noted, as these may present potential unintended risks.Item Social health insurance contributes to universal coverage in South Africa, but generates inequities: survey among members of a government employee insurance scheme(BMC, 2018) Goudge, Jane; Harris, Bronwyn; Nxumalo, Nonhlanhla; Chersich, Matthew F.; Alaba, Olufunke A.; Govender, VeloshneeBackground: Many low- and middle-income countries are reforming their health financing mechanisms as part of broader strategies to achieve universal health coverage (UHC). Voluntary social health insurance, despite evidence of resulting inequities, is attractive to policy makers as it generates additional funds for health, and provides access to a greater range of benefits for the formally employed. The South African government introduced a voluntary health insurance scheme (GEMS) for government employees in 2005 with the aim of improving access to care and extending health coverage. In this paper we ask whether the new scheme has assisted in efforts to move towards UHC. Methods: Using a cross-sectional survey across four of South Africa’s nine provinces, we interviewed 1329 government employees, from the education and health sectors. Data were collected on socio-demographics, insurance coverage, health status and utilisation of health care. Multivariate logistic regression was used to determine if service utilisation was associated with insurance status. Results: A quarter of respondents remained uninsured, even higher among 20–29 year olds (46%) and lower-skilled employees (58%). In multivariate analysis, the odds of an outpatient visit and hospital admission for the uninsured was 0.3 fold that of the insured. Cross-subsidisation within the scheme has provided lower-paid civil servants with improved access to outpatient care at private facilities and chronic medication, where their outpatient (0.54 visits/ month) and inpatient utilisation (10.1%/year) approximates that of the overall population (29.4/month and 12.2% respectively). The scheme, however, generated inequities in utilisation among its members due to its differential benefit packages, with, for example, those with the most benefits having 1.0 outpatient visits/month compared to 0.6/ month with lowest benefits. Conclusions: By introducing the scheme, the government chose to prioritise access to private sector care for government employees, over improving the availability and quality of public sector services available to all. Government has recently regained its focus on achieving UHC through the public system, but is unlikely to discontinue GEMS, which is now firmly established. The inequities generated by the scheme have thus been institutionalised within the country’s financing system, and warrant attention. Raising scheme uptake and reducing differentials between benefit packages will ameliorate inequities within civil servants, but not across the country as a whole.Item Education service delivery: the disastrous case of outcomes-based qualifications frameworks(SAGE Publications, 2007) Allais, Stephanie MatselengInternational trends towards outcomes-based qualifications frameworks as the drivers of educational reform fi t in well with trends in service delivery and public sector reform. Education reform in South Africa provides a particularly interesting case study of this phenomenon, because of the very comprehensive outcomes-based national qualifications framework that was implemented shortly after the transition to democracy. Problems with the framework as a basis for education reform became rapidly apparent, and the system is now deadlocked in a series of unresolved policy reviews. A key to understanding this collapse is the role of knowledge in relation to education. The outcomes based qualification framework approach turns out to have very little to do with education, and in fact to have the potential to increase educational inequalities, particularly in poor countries.Item Why the South African NQF failed: lessons for countries wanting to introduce national qualifications frameworks(Blackwell Publishing Ltd, 2007) Allais, Stephanie MatselengThis article examines the South African National Qualifications Framework as a case study of a particular approach to the design of qualifications frameworks, which revolves around the specification of learning outcomes separate from educational institutions or programmes. It shows how an outcomes-led qualifications framework was seen as a desirable policy intervention by educationalists and reformers across the political spectrum, as outcomes were thought to be a mechanism for improving the quality and quantity of education as well as its relevance to the economy and society, for increasing access to education, and for democratising education. All these claims are based on the idea that outcomes statements are transparent. The article demonstrates that outcomes-based qualifications cannot provide the clear, unambiguous, and explicit statements of competence that would be required for everyone to know what it is that the bearer of a qualification can do. This lack of transparency leads to a further specification of outcomes. This in turn leads to a downward spiral of specification, which never reaches transparency, and an upward spiral of regulations, which is also caught in the logical problem of the downward spiral of specification. This model is not just unnecessary, but could in fact undermine the provision of education. The article suggests that while this type of model appears attractive particularly to poor countries, it is in these countries that it is likely to do the most damage.Item Subjective well-being impact of old age pension in South Africa: A difference in difference analysis across the gender divide(AOSIS (pty) Ltd, 2019-12-06) Kollamparambil, Umakrishnan; Etinzock, Mfongeh, NBackground: South Africa provides old age pension (OAP), a non-contributory means-tested income transfer to persons aged 60 and above. More than two-thirds of the elderly population report receiving the OAP. Women have historically had a lower pension eligibility age of 60, while the eligibility of men decreased from 65 to 60 between 2008 and 2010. Aim: This study analyses the impact of the OAP on the subjective well-being of the elderly in South Africa. The study aims at understanding the differential impact on the subjective wellbeing of male and female recipients. Methods: The study adopts the difference in difference (DiD) impact evaluation framework to establish the impact of OAP using a sub-sample of data for elderly persons aged between 55 and 64, collected from the first four waves of the National Income Dynamics study. Linear and non-linear DiD models are estimated as robustness checks given the ordinal nature of the dependent variable. Results: The OAP variable consistently produced positive and significant estimates for the sample as a whole. Further, anticipatory effect of OAP was not found to exist. A gender specific analysis indicates that female recipients have a positive and significant change in well-being as a result of OAP, while male recipients did not. Conclusion: The difference in the well-being impact of OAP between male and female recipients can be attributed to the gender difference in the use and meaning of pensions. Our findings question the uniform criteria introduced for male and female recipients for OAP in South Africa.Item An exploratory perspective of student performance and access to resources(Mediterranean Center of Social and Educational Research, 2014-11-01) Papageorgiou, E; Callaghan, C.WThis research investigated the relationships between potential constraints to students’ access to technological resources and student academic performance. Longitudinal data from 2010 (n=228), 2011 (n=340) and 2012 (n=347) from South African accounting students was used to test the relationships between technological resources access and student academic performance using correlation analysis, multiple linear regression analysis and factor analysis. Access to the latest software was found to be associated with student academic performance; a ‘digital divide’ between students may influence their academic performance. This research specifically identifies certain constraints potentially associated with a ‘digital divide’ that may influence student performance.Item An exploratory perspective of student performance and access to resources(Mediterranean Center of Social and Educational Research, 2014-11-01) Papageorgiou, E; Callaghan, C.WThis research investigated the relationships between potential constraints to students’ access to technological resources and student academic performance. Longitudinal data from 2010 (n=228), 2011 (n=340) and 2012 (n=347) from South African accounting students was used to test the relationships between technological resources access and student academic performance using correlation analysis, multiple linear regression analysis and factor analysis. Access to the latest software was found to be associated with student academic performance; a ‘digital divide’ between students may influence their academic performance. This research specifically identifies certain constraints potentially associated with a ‘digital divide’ that may influence student performance.