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Ratshisusu L, Simani OE, Blackard JT, Selabe SG. The Impact of Drugs and Substance Abuse on Viral Pathogenesis-A South African Perspective. Viruses 2024; 16:971. [PMID: 38932263 PMCID: PMC11209167 DOI: 10.3390/v16060971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2024] [Revised: 06/11/2024] [Accepted: 06/12/2024] [Indexed: 06/28/2024] Open
Abstract
Illicit drug and alcohol abuse have significant negative consequences for individuals who inject drugs/use drugs (PWID/UDs), including decreased immune system function and increased viral pathogenesis. PWID/UDs are at high risk of contracting or transmitting viral illnesses such as human immunodeficiency virus (HIV), hepatitis B virus (HBV), and hepatitis C virus (HCV). In South Africa, a dangerous drug-taking method known as "Bluetoothing" has emerged among nyaope users, whereby the users of this drug, after injecting, withdraw blood from their veins and then reinject it into another user. Hence, the transmission of blood-borne viruses (BBVs) is exacerbated by this "Bluetooth" practice among nyaope users. Moreover, several substances of abuse promote HIV, HBV, and HCV replication. With a specific focus on the nyaope drug, viral replication, and transmission, we address the important influence of abused addictive substances and polysubstance use in this review.
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Affiliation(s)
- Lufuno Ratshisusu
- HIV and Hepatitis Research Unit, Department of Virology, Sefako Makgatho Health Sciences University, Pretoria 0208, South Africa; (O.E.S.); (J.T.B.); (S.G.S.)
| | - Omphile E. Simani
- HIV and Hepatitis Research Unit, Department of Virology, Sefako Makgatho Health Sciences University, Pretoria 0208, South Africa; (O.E.S.); (J.T.B.); (S.G.S.)
| | - Jason T. Blackard
- HIV and Hepatitis Research Unit, Department of Virology, Sefako Makgatho Health Sciences University, Pretoria 0208, South Africa; (O.E.S.); (J.T.B.); (S.G.S.)
- Division of Digestive Diseases, Department of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, OH 45267-0595, USA
| | - Selokela G. Selabe
- HIV and Hepatitis Research Unit, Department of Virology, Sefako Makgatho Health Sciences University, Pretoria 0208, South Africa; (O.E.S.); (J.T.B.); (S.G.S.)
- National Health Laboratory Service, Sefako Makgatho Health Sciences University, Pretoria 0208, South Africa
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Moore HP, Palumbo PJ, Notarte KI, Fogel JM, Cummings V, Gamble T, Del Rio C, Batey DS, Mayer KH, Farley JE, Remien RH, Beyrer C, Hudelson SE, Eshleman SH. Performance of the Applied Biosystems HIV-1 Genotyping Kit with Integrase. J Clin Microbiol 2024; 62:e0013624. [PMID: 38727213 PMCID: PMC11237527 DOI: 10.1128/jcm.00136-24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Accepted: 04/15/2024] [Indexed: 06/13/2024] Open
Abstract
HIV genotyping is used to assess HIV susceptibility to antiretroviral drugs. The Applied Biosystems HIV-1 Genotyping Kit with Integrase (AB kit, Thermo Fisher Scientific) detects resistance-associated mutations (RAMs) in HIV protease (PR), reverse transcriptase (RT), and integrase (IN). We compared results from the AB kit with results obtained previously with the ViroSeq HIV-1 Genotyping System. DNA amplicons from the AB kit were also analyzed using next-generation sequencing (NGS). HIV RNA was extracted using the MagNA Pure 24 instrument (Roche Diagnostics; 96 plasma samples, HIV subtype B, viral load range: 530-737,741 copies/mL). FASTA files were generated from AB kit data using Exatype (Hyrax Biosciences). DNA amplicons from the AB kit were also analyzed by NGS using the Nextera XT kit (Illumina). Drug resistance was predicted using the Stanford HIV Drug Resistance Database. The mean genetic distance for sequences from ViroSeq and the AB kit was 0.02% for PR/RT and 0.04% for IN; 103 major RAMs were detected by both methods. Four additional major RAMs were detected by the AB kit only. These four major RAMs were also detected by NGS (detected in 18.1%-38.2% of NGS reads). NGS detected 27 major RAMs that were not detected with either of the Sanger sequencing-based kits. All major RAMs detected with ViroSeq were detected with the AB kit; additional RAMs were detected with the AB kit only. DNA amplicons from the AB kit can be used for NGS for more sensitive detection of RAMs.
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Affiliation(s)
- Hannah P. Moore
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Philip J. Palumbo
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Kin Israel Notarte
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Jessica M. Fogel
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Vanessa Cummings
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | | | - Carlos Del Rio
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - D. Scott Batey
- School of Social Work, Tulane Universtiy, New Orleans, Louisiana, USA
| | - Kenneth H. Mayer
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
- Fenway Institute, Boston, Massachusetts, USA
| | - Jason E. Farley
- The Center for Infectious Disease and Nursing Innovation, Johns Hopkins University School of Nursing, Baltimore, Maryland, USA
| | - Robert H. Remien
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute, New York, New York, USA
- Department of Psychiatry, Columbia University, New York, New York, USA
| | - Chris Beyrer
- Global Health Institute, Duke University, Durham, North Carolina, USA
| | - Sarah E. Hudelson
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Susan H. Eshleman
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - for the HPTN 078 study
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- FHI 360, Durham, North Carolina, USA
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
- School of Social Work, Tulane Universtiy, New Orleans, Louisiana, USA
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
- Fenway Institute, Boston, Massachusetts, USA
- The Center for Infectious Disease and Nursing Innovation, Johns Hopkins University School of Nursing, Baltimore, Maryland, USA
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute, New York, New York, USA
- Department of Psychiatry, Columbia University, New York, New York, USA
- Global Health Institute, Duke University, Durham, North Carolina, USA
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Comins CA, Baral S, Mcingana M, Shipp L, Phetlhu DR, Young K, Guddera V, Hausler H, Schwartz S. ART coverage and viral suppression among female sex workers living with HIV in eThekwini, South Africa: Baseline findings from the Siyaphambili study. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002783. [PMID: 38776334 PMCID: PMC11111033 DOI: 10.1371/journal.pgph.0002783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 03/04/2024] [Indexed: 05/24/2024]
Abstract
In South Africa >60% of female sex workers (FSW) are living with HIV, the majority of whom are not virally suppressed. Identifying multi-level determinants of viral suppression is central to developing implementation strategies to promote retention in HIV care and viral suppression among FSW with unmet treatment needs. Adult cisgender FSW living with HIV for ≥6 months, conducting sex work as their primary source of income, and residing in Durban (South Africa) were enrolled into the Siyaphambili Study, a sequential multiple assignment randomized trial. Baseline viral load and CD4 were assessed, and an interviewer-administered survey was conducted, capturing socio-demographic, reproductive and sexual history and behaviors, vulnerabilities, substance use, mental health, and stigma. We assessed baseline determinants of viral suppression (<50 copies/mL) using bivariate and multivariable robust poisson regression, considering associations across the individual, network, environmental and macrostructural levels. From June 2018 -March 2020, 1,644 women were screened, with 1,391 eligible FSW living with HIV enrolled. The analyses were conducted among the 1,373 participants with baseline data. Overall, 65% (889/1,373) of participants were reported to be on antiretroviral therapy and 38% (520/1,373) were virally suppressed. In the multivariable model, FSW who experienced a lack of housing in the prior six months were less likely to be virally suppressed (aPR: 0.72, 95%CI 0.56-0.91), while older FSW (aPR: 1.46 95%CI: 1.16-1.83 for 30-39 years old vs. 18-29 years old; aPR: 2.15 95%CI: 1.64-2.80 for 40+ years vs. 18-29 years old) and FSW reporting hormonal or long-acting contraception use were more likely to be virally suppressed (aPR: 1.19 95% CI: 1.00-1.43). We found vulnerability to be high among FSW living with HIV in South Africa and identified individual and structural determinants associated with viral suppression. Taken together these results suggest optimizing HIV treatment outcomes necessitates supporting younger sex workers and addressing housing instability. Trial registration: NCT03500172.
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Affiliation(s)
- Carly A. Comins
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Stefan Baral
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | | | - Lily Shipp
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Deliwe Rene Phetlhu
- Department of Nursing, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | | | | | - Harry Hausler
- TB HIV Care, Cape Town, South Africa
- University of Pretoria, Pretoria, South Africa
| | - Sheree Schwartz
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
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Lujintanon S, Hausler H, Comins C, Mcingana M, Shipp L, Phetlhu DR, Makama S, Guddera V, Mishra S, Baral S, Schwartz S. Estimating the mortality risk correcting for high loss to follow-up among female sex workers with HIV in Durban, South Africa, 2018-2021. Ann Epidemiol 2024; 92:8-16. [PMID: 38382770 PMCID: PMC10981924 DOI: 10.1016/j.annepidem.2024.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 02/13/2024] [Accepted: 02/17/2024] [Indexed: 02/23/2024]
Abstract
PURPOSE This study assesses risk factors of loss to follow-up (LTFU) and estimates mortality risk among female sex workers (FSW) with HIV in Durban, South Africa, in 2018-2021. METHODS We used data from the Siyaphambili trial, which evaluated strategies for improved viral suppression. FSW with HIV aged ≥ 18 years with viral load ≥ 50 copies/mL were followed up for 18 months. LTFU was defined as absence from study or intervention visits for 6 months. We traced LTFU participants by calling/in-person visit attempts to ascertain their vital status. We used Cox regression to determine risk factors of LTFU and inverse probability of tracing weights to correct mortality risk. RESULTS Of 777 participants, 10 (1.3%) had died and 578 (74.4%) were initially LTFU. Among those LTFU, 36.3% (210/578) were traced successfully, with 6 additional deaths ascertained. Recent physical and sexual violence, and non-viral suppression were associated with increased LTFU. The unweighted and weighted 18-month mortality risks were 2.4% (95% CI: 0.8%-3.9%) and 3.7% (95% CI: 1.8%-5.9%), respectively. CONCLUSIONS LTFU is common among FSW with HIV in South Africa with additional investigation of vital status demonstrating under-ascertained mortality. These data suggest the need for comprehensively addressing risks for mortality among FSW.
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Affiliation(s)
- Sita Lujintanon
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD, 21205, United States.
| | - Harry Hausler
- TB HIV Care, 7th Floor, 11 Adderley St, Cape Town City Centre, Cape Town 8001, South Africa; Department of Family Medicine, School of Medicine, University of Pretoria, 7th Floor, HW Snyman North building, Prinshof Campus, 31 Bophelo Rd, Gezina, Pretoria 0084, South Africa
| | - Carly Comins
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD, 21205, United States
| | - Mfezi Mcingana
- TB HIV Care, Suit No. 2, Sutton Square, 306/310 Mathews Meyiwa Rd, Morningside, Durban 4001, South Africa
| | - Lillian Shipp
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD, 21205, United States
| | - Deliwe Rene Phetlhu
- Department of Nursing, Sefako Makgatho Health Sciences University, Molotlegi St, Ga-Rankuwa, Pretoria, Gauteng 0208, South Africa
| | - Siyanda Makama
- TB HIV Care, Suit No. 2, Sutton Square, 306/310 Mathews Meyiwa Rd, Morningside, Durban 4001, South Africa
| | - Vijayanand Guddera
- TB HIV Care, Suit No. 2, Sutton Square, 306/310 Mathews Meyiwa Rd, Morningside, Durban 4001, South Africa
| | - Sharmistha Mishra
- St. Michael's Hospital, Li Ka Shing Knowledge Institute, University of Toronto, 30 Bond St, Toronto, Ontario, M5B 1W8, Canada
| | - Stefan Baral
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD, 21205, United States
| | - Sheree Schwartz
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD, 21205, United States
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Rosen JG, Knox JR, Rucinski KB, Mcingana M, Mulumba N, Comins CA, Shipp L, Makama S, Beckham SW, Hausler H, Baral SD, Schwartz SR. Polysubstance Use Profiles and HIV Viremia in a South African Cohort of Female Sex Workers: A Latent Class Analysis. J Acquir Immune Defic Syndr 2024; 95:222-230. [PMID: 38032752 PMCID: PMC10922222 DOI: 10.1097/qai.0000000000003356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 09/14/2023] [Indexed: 12/02/2023]
Abstract
BACKGROUND Given intersecting social and structural factors, female sex workers (FSW) exhibit elevated risk of HIV and substance use. However, there is limited study of how distinct substance use typologies influence HIV treatment outcomes among FSW. SETTING A cross-sectional survey with objective viral load assessments of 1391 FSW enrolled into a treatment optimization-focused trial in Durban, South Africa (2018-2020). METHODS We used latent class analysis to uncover discrete patterns in past-month self-reported use of the following substances: heavy alcohol use, cannabis, cocaine, crack, ecstasy, methamphetamine, heroin, and Whoonga . We used Wald tests to identify multilevel predictors of latent class membership and multivariable mixture modeling to quantify associations of substance use classes with HIV viremia (≥50 RNA copies/mL). RESULTS Substance use (87%) and HIV viremia (62%) were highly prevalent. Latent class analysis uncovered 3 polysubstance use profiles: Heavy Alcohol Use Only (∼54%); Cannabis, Heavy Alcohol, & Crack Use (∼28%); and Whoonga & Crack Use (∼18%). Whoonga & Crack Use was associated with social and structural adversities, including homelessness, outdoor/public sex work, HIV stigma, and violence. Relative to Heavy Alcohol Use Only , HIV viremia was significantly higher in the Whoonga & Crack Use class (adjusted odds ratio 1.97, 95% confidence interval: 1.13 to 3.43), but not in the Cannabis, Heavy Alcohol, & Crack Use class (adjusted odds ratio 1.17, 95% confidence interval: 0.74 to 1.86). CONCLUSION HIV viremia differed significantly across identified polysubstance use profiles among South African FSW. Integrating drug treatment and harm reduction services into HIV treatment programs is key to improving virologic outcomes in marginalized communities.
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Affiliation(s)
- Joseph G. Rosen
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States
- Center for Public Health and Human Rights, Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States
| | - Justin R. Knox
- HIV Center for Clinical and Behavioral Studies, Columbia University, New York, New York, United States
- Department of Psychiatry, Irving Medical Center, Columbia University, New York, New York, United States
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, New York, United States
| | - Katherine B. Rucinski
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States
- Center for Public Health and Human Rights, Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States
| | | | - Ntambue Mulumba
- Key Populations Programme, TB HIV Care, Durban, South Africa
| | - Carly A. Comins
- Center for Public Health and Human Rights, Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States
| | - Lillian Shipp
- Center for Public Health and Human Rights, Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States
| | - Siyanda Makama
- Key Populations Programme, TB HIV Care, Durban, South Africa
| | - S. Wilson Beckham
- Department of Health, Behavior, and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States
| | - Harry Hausler
- Department of Psychiatry, Irving Medical Center, Columbia University, New York, New York, United States
- Department of Family Medicine, University of Pretoria, Pretoria, South Africa
| | - Stefan D. Baral
- Center for Public Health and Human Rights, Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States
| | - Sheree R. Schwartz
- Center for Public Health and Human Rights, Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States
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Ngcobo SJ, Makhado L, Sehularo LA. Registered nurses' experiences regarding operational factors influencing the implementation of HIV care services in the mobile health clinics of eThekwini Municipality in KwaZulu-Natal. BMC Nurs 2024; 23:102. [PMID: 38321401 PMCID: PMC10848521 DOI: 10.1186/s12912-024-01764-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 01/25/2024] [Indexed: 02/08/2024] Open
Abstract
BACKGROUND Registered nurses working in the mobile health clinics (MHCs) play an important role in enabling HIV care access to populations in remote areas through Nurse Initiated Antiretroviral Therapy program (NIMART). AIM To explore and describe the nurses' experiences regarding operational factors influencing the implementation of HIV care services in the mobile health clinics (MHCs) of eThekwini Municipality in KwaZulu Natal. METHODS Qualitative Exploratory Descriptive (QED) method was used after permission was granted from North-West University Human Research Ethics Committee provincial and local health authorities. Data saturation informed sample size of thirteen MHCs nurses were purposefully sampled to participate. Audio-recorded, semi-structured, online, one-on-one interviews guided by open-ended questions were done for data collection, and including demographic profile. The interview transcripts were analysed using Atlas-TI and SPSS descriptive statistics was used for demographics. RESULTS Eleven subthemes emerged under patient-related, nurse-related, and organisational-related themes which influence the operational factors in the MHCs, namely: patient defaulting treatment, lack of privacy, unavailability of phones, stressful and demotivating MHCs, nurses feel unsafe, lack of support from management, lack of budget, unavailability of computers, shortage of medical equipment, shortage of nursing staff and absence of data capturers. CONCLUSION Structured contextual coaching and support program for nurses is imperative to ensure effective and strengthened operations in MHCs, further supported by improvement in human resource for health allocation for MHCs in light of expanding health care programs CONTRIBUTIONS: Evaluation of health care programmes, and human resource for health quality improvement needs in the clinical practice of HIV care of MHCs nurses which advocate for specific policy formulations.
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Affiliation(s)
- Silingene Joyce Ngcobo
- Lifestyle Diseases Research Focus Area, Faculty of Health Sciences, North-West University, Mmabatho, South Africa.
- School of Nursing and Public Health, College Health Sciences, University of KwaZulu Natal, Durban, South Africa.
| | - Lufuno Makhado
- Department of Public Health, Faculty of Health Sciences, University of Venda, Thohoyandou, South Africa
| | - Leepile Alfred Sehularo
- Lifestyle Diseases Research Focus Area, Faculty of Health Sciences, North-West University, Mmabatho, South Africa
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Nzaumvila DK, Mash R, Helliwell T. Exploring the perspectives of community members on use of Nyaope in Tshwane, South Africa. S Afr Fam Pract (2004) 2023; 65:e1-e10. [PMID: 37916696 PMCID: PMC10546252 DOI: 10.4102/safp.v65i1.5715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 06/04/2023] [Accepted: 06/24/2023] [Indexed: 11/03/2023] Open
Abstract
BACKGROUND Substance use is a major public health issue in South Africa. Cocktails, containing two or more low-quality substances, have been reported. Nyaope is one of the most popular and is widely available. It has a significant impact on users and communities. The aim of this study was to explore community members' perceptions of the potential contributors to Nyaope use and dependency. METHODS This was an exploratory descriptive qualitative study that conducted three focus group interviews with 29 community members. A maximum variation sample was used. Data were analysed using the framework method, assisted by Atlas-ti. RESULTS Seven main themes were identified, namely unfavourable home environments, distrust between community members and the local police, easy access to Nyaope at school, inadequate social services, lack of religious or spiritual drive, unfavourable community environments and the effects of Nyaope on users. CONCLUSION The factors identified, were used to construct an emerging model of how Nyaope use is driven in Tshwane. It is clear that a multisectoral response is required involving health and social services, basic education, policing and community leadership. Further research will explore the views of family members and users and quantify the importance of the factors identified.Contribution: This study showed that rather than a simple linear chain of events, Nyaope use is enabled by a complex system of interconnected elements. According to the respondents, variables in the community at large, the school, the home and the specific user all have a role in Nyaope usage and dependency.
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Affiliation(s)
- Doudou K Nzaumvila
- Department of Family Medicine and Primary Health Care, Faculty of Medicine, Sefako Makgatho Health Sciences University, Pretoria; Department of Family and Emergency Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town.
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Kennedy CE, Feng X, Ssekubugu R, Rosen JG, Ssekasanvu J, Kigozi G, Serwadda D, Yeh PT, Kagaayi J, Quinn TC, Tobian AAR, Wawer MJ, Reynolds SJ, Chang LW, Grabowski MK, Nalugoda F. Population prevalence of antiretroviral therapy sharing and its association with HIV viremia in rural Uganda: a cross-sectional population-based study. J Int AIDS Soc 2023; 26:e26135. [PMID: 37705364 PMCID: PMC10500261 DOI: 10.1002/jia2.26135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 06/07/2023] [Indexed: 09/15/2023] Open
Abstract
INTRODUCTION Antiretroviral treatment (ART) sharing has been reported among fishermen and sex workers in Uganda and South Africa. However, no population-based studies have documented ART diversion prevalence (including sharing [giving/receiving], buying and selling) or its relationship with viremia among men and women living with HIV in Africa. METHODS In 2018-2020, we surveyed people living with HIV aged 15-49 years in 41 communities in the Rakai Community Cohort Study, a population-based cohort in south-central Uganda. We assessed the prevalence and correlates of self-reported lifetime and past-year ART diversion, stratifying by age and gender and documenting sources of diverted drugs. We used log-binomial regression to quantify the relationship between diversion patterns and viremia (viral load >40 copies/ml), reported as unadjusted and adjusted prevalence ratios (aPR) with 95% confidence intervals (CI). RESULTS Of 2852 people living with HIV and self-reporting current ART use, 266 (9.3%) reported lifetime ART diversion. Giving/receiving drugs were most common; few participants reported buying, and none reported selling. Men (12.9%) were more likely to report lifetime diversion than women (7.4%), with men aged 25-34 reporting high levels of sharing (18.9%). Friends were the most common sources of shared drugs, followed by spouses/sexual partners. Patterns of lifetime and past-year diversion were similar. Among participants with viral load results, 8.6% were viraemic. In adjusted analyses, people who reported only giving ART were nearly twice as likely to be viraemic than those who reported no diversion (aPR: 1.94, 95% CI: 1.10-3.44), and those reporting only receiving ART were less likely to exhibit viremia (aPR: 0.46, 95% CI: 0.12-1.79), although the latter was not statistically significant. Reporting both giving and receiving ART was not associated with viremia (aPR: 0.79, 95% CI: 0.43-1.46). Reporting buying ART, though rare, was also correlated with higher rates of viremia, but this relationship was not statistically significant (aPR: 1.98, 95% CI: 0.72-5.45). CONCLUSIONS ART sharing is common among persons reporting ART use in rural Uganda, particularly among men. Sharing ART was associated with viremia, and receiving ART may facilitate viral suppression. HIV programmes may benefit from considering ART sharing in counselling messages.
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Affiliation(s)
- Caitlin E. Kennedy
- Social and Behavioral Interventions ProgramDepartment of International HealthJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
| | - Xinyi Feng
- Department of PathologyJohns Hopkins School of MedicineBaltimoreMarylandUSA
| | | | - Joseph G. Rosen
- Social and Behavioral Interventions ProgramDepartment of International HealthJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
| | - Joseph Ssekasanvu
- Department of EpidemiologyJohns Hopkins School of MedicineBaltimoreMarylandUSA
| | | | | | - Ping Teresa Yeh
- Social and Behavioral Interventions ProgramDepartment of International HealthJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
| | | | - Thomas C. Quinn
- Division of Intramural ResearchNational Institute of Allergy and Infectious DiseasesNational Institutes of HealthBethesdaMarylandUSA
- Division of Infectious DiseasesDepartment of MedicineJohns Hopkins School of MedicineBaltimoreMarylandUSA
| | - Aaron A. R. Tobian
- Department of PathologyJohns Hopkins School of MedicineBaltimoreMarylandUSA
- Rakai Health Sciences ProgramKalisizoUganda
- Division of Infectious DiseasesDepartment of MedicineJohns Hopkins School of MedicineBaltimoreMarylandUSA
| | - Maria J. Wawer
- Rakai Health Sciences ProgramKalisizoUganda
- Department of EpidemiologyJohns Hopkins School of MedicineBaltimoreMarylandUSA
| | - Steven J. Reynolds
- Division of Intramural ResearchNational Institute of Allergy and Infectious DiseasesNational Institutes of HealthBethesdaMarylandUSA
- Division of Infectious DiseasesDepartment of MedicineJohns Hopkins School of MedicineBaltimoreMarylandUSA
| | - Larry W. Chang
- Social and Behavioral Interventions ProgramDepartment of International HealthJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
- Rakai Health Sciences ProgramKalisizoUganda
- Department of EpidemiologyJohns Hopkins School of MedicineBaltimoreMarylandUSA
- Division of Infectious DiseasesDepartment of MedicineJohns Hopkins School of MedicineBaltimoreMarylandUSA
| | - M. Kate Grabowski
- Department of PathologyJohns Hopkins School of MedicineBaltimoreMarylandUSA
- Rakai Health Sciences ProgramKalisizoUganda
- Department of EpidemiologyJohns Hopkins School of MedicineBaltimoreMarylandUSA
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Zanoni BC, Milford C, Sithole K, Mosery N, Wilson M, Bosman S, Smit J. High risk injection drug use and uptake of HIV prevention and treatment services among people who inject drugs in KwaZulu-Natal, South Africa. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.01.16.23284613. [PMID: 36711846 PMCID: PMC9882559 DOI: 10.1101/2023.01.16.23284613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
The use of injection drugs in South Africa is increasing. HIV prevention, treatment and addiction services for people who inject drugs (PWID) in South Africa are not well documented. We conducted a mixed-methods study to understand current drug use practices and access to HIV prevention and treatment services for PWID in KwaZulu-Natal, South Africa. We used respondent-driven sampling to recruit 45 people who reported injecting opiates within the past 6 months from Durban, KwaZulu-Natal, South Africa. We found high rates of practices that increase HIV/viral hepatitis risk including the use of shared needles (43%) and direct blood injections (bluetoothing) (18%). Despite 35% of participants living with HIV, only 40% accessed antiretroviral therapy within the past year, and one accessed PrEP. None of the participants reported ever testing for Hepatitis C.
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Affiliation(s)
- Brian C. Zanoni
- Emory University, Atlanta, Georgia, United States of America,Children’s Healthcare of Atlanta, Atlanta, Georgia, United States of America,Rollins School of Public Health, Atlanta, Georgia, United States of America
| | - Cecilia Milford
- Wits MRU (MatCH Research Unit), Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of the Witwatersrand, Durban, South Africa
| | - Kedibone Sithole
- Wits MRU (MatCH Research Unit), Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of the Witwatersrand, Durban, South Africa
| | - Nzwakie Mosery
- Wits MRU (MatCH Research Unit), Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of the Witwatersrand, Durban, South Africa
| | - Michael Wilson
- Advance Access & Delivery, Durban, South Africa,Department of Health Behaviour, University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - Shannon Bosman
- Centre for Community Based Research, Human Sciences Research Council, Pietermaritzburg, South Africa
| | - Jennifer Smit
- Wits MRU (MatCH Research Unit), Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of the Witwatersrand, Durban, South Africa
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Varshney K, Browning SD, Debnath SK, Shet P, Shet D. A Systematic Review of Risk Factors and Consequences of Nyaope Usage: The Illicit Street Drug Containing HIV Antiretrovirals. AIDS Behav 2023; 27:558-577. [PMID: 35895149 PMCID: PMC9908705 DOI: 10.1007/s10461-022-03791-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/05/2022] [Indexed: 11/28/2022]
Abstract
South Africa currently has the highest number of cases of HIV in the world. HIV antiretrovirals (ARVs) are publicly available across the country to address this crisis. However, a consequence of widely available ARVs has been the diversion of these drugs for recreational usage in a drug cocktail commonly known as "nyaope" or "whoonga," which poses a significant public health concern. To better understand nyaope, we conducted a systematic review investigating the risks and consequences associated with its usage. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, searches were conducted in eight different databases and screened thereafter. Articles were eligible for inclusion if they included analysis of least one nyaope user and considered either demographics, risk factors, or consequences of usage. Data extracted included study characteristics and limitations, as well as demographic factors, risk factors for usage in the general population, and consequences. Quality assessments were performed using the Joanna Briggs Institute's tools. Searches produced a total of 228 articles and, after screening, a total of 19 articles were eligible for inclusion. There was a pooled total of 807 nyaope users, all in South Africa. Major risk factors for usage were being male, unemployed, not completing secondary education, pressure from peer groups, having HIV, prior use of cannabis, and to a lesser extent, usage of other substances such as alcohol and tobacco. While young adults tend to be at high-risk, evidence indicates that adolescents are also at-risk. Consequences of usage include high rates of infection, cortical atrophy, depression, and addiction. Addiction was shown to lead to individuals stealing from friends and family to pay for the drugs. HIV-positive nyaope users were more likely to partake in risk behaviours and tended to have high viral loads. Nyaope's rise has been linked to many health and social issues. Considering that this may also disrupt HIV control efforts in South Africa, there is an urgent need to address the rise of nyaope.
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Affiliation(s)
- Karan Varshney
- School of Medicine, Deakin University, 75 Pigdons St, Waurn Ponds, Geelong, VIC, 3216, Australia. .,College of Population Health, Thomas Jefferson University, Philadelphia, USA.
| | | | - Sujit K. Debnath
- Department of Biosciences and Bioengineering, Indian Institute of Technology Bombay, Mumbai, India
| | - Pavan Shet
- School of Medicine, Deakin University, 75 Pigdons St, Waurn Ponds, Geelong, VIC 3216 Australia
| | - Darshan Shet
- School of Pharmacy, Monash University, Melbourne, Australia
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11
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Zanoni BC, Milford C, Sithole K, Mosery N, Wilson M, Bosman S, Smit J. High risk injection drug use and uptake of HIV prevention and treatment services among people who inject drugs in KwaZulu-Natal, South Africa. PLoS One 2023; 18:e0281030. [PMID: 37172026 PMCID: PMC10180682 DOI: 10.1371/journal.pone.0281030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 04/12/2023] [Indexed: 05/14/2023] Open
Abstract
We conducted a mixed-methods study to understand current drug use practices and access to healthcare services for people who use injection drugs in KwaZulu-Natal, South Africa. We used respondent-driven sampling to recruit 45 people who used injection drugs within the past 6 months from KwaZulu-Natal, South Africa. We found high rates of practices that increase HIV/viral hepatitis risk including the use of shared needles (43%) and direct blood injections (bluetoothing) (18%). Despite 35% living with HIV, only 40% accessed antiretroviral therapy within the past year, and one accessed PrEP. None of the participants ever tested for Hepatitis C.
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Affiliation(s)
- Brian C Zanoni
- Emory University, Atlanta, Georgia, United States of America
- Children's Healthcare of Atlanta, Atlanta, Georgia, United States of America
- Rollins School of Public Health, Atlanta, Georgia, United States of America
| | - Cecilia Milford
- Faculty of Health Sciences, MRU (MatCH Research Unit), School of Obstetrics and Gynecology, University of the Witwatersrand, Durban, South Africa
| | - Kedibone Sithole
- Faculty of Health Sciences, MRU (MatCH Research Unit), School of Obstetrics and Gynecology, University of the Witwatersrand, Durban, South Africa
| | - Nzwakie Mosery
- Faculty of Health Sciences, MRU (MatCH Research Unit), School of Obstetrics and Gynecology, University of the Witwatersrand, Durban, South Africa
| | - Michael Wilson
- Advance Access & Delivery, Durban, South Africa
- Department of Health Behaviour, University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC, United States of America
| | - Shannon Bosman
- Centre for Community Based Research, Human Sciences Research Council, Pietermaritzburg, South Africa
| | - Jennifer Smit
- Faculty of Health Sciences, MRU (MatCH Research Unit), School of Obstetrics and Gynecology, University of the Witwatersrand, Durban, South Africa
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12
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Selwe KP, Thorn JPR, Desrousseaux AOS, Dessent CEH, Sallach JB. Emerging contaminant exposure to aquatic systems in the Southern African Development Community. ENVIRONMENTAL TOXICOLOGY AND CHEMISTRY 2022; 41:382-395. [PMID: 35020964 PMCID: PMC9304188 DOI: 10.1002/etc.5284] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 12/12/2021] [Accepted: 12/28/2021] [Indexed: 05/26/2023]
Abstract
The growing production and use of chemicals and the resultant increase in environmental exposure is of particular concern in developing countries where there is rapid industrialization and population growth but limited information on the occurrence of emerging contaminants. Advances in analytical techniques now allow for the monitoring of emerging contaminants at very low concentrations with the potential to cause harmful ecotoxicological effects. Therefore, we provide the first critical assessment of the current state of knowledge about chemical exposure in waters of the Southern African Developmental Community (SADC). We achieved this through a comprehensive literature review and the creation of a database of chemical monitoring data. Of the 59 articles reviewed, most (n = 36; 61.0%) were from South Africa, and the rest were from Botswana (n = 6; 10.2%), Zimbabwe (n = 6; 10.2%), Malawi (n = 3; 5.1%), Mozambique (n = 3; 5.1%), Zambia (n = 2; 3.4%), Angola (n = 1; 1.7%), Madagascar (n = 1; 1.7%), and Tanzania (n = 1; 1.7%). No publications were found from the remaining seven SADC countries. Emerging contaminants have only been studied in South Africa and Botswana. The antiretroviral drug ritonavir (64.52 µg/L) was detected at the highest average concentration, and ibuprofen (17 times) was detected most frequently. Despite being the primary water source in the region, groundwater was understudied (only 13 studies). High emerging contaminant concentrations in surface waters indicate the presence of secondary sources of pollution such as sewage leakage. We identify research gaps and propose actions to assess and reduce chemical pollution to enable the SADC to address the Sustainable Development Goals, particularly Goal 3.9, to reduce the deaths and illnesses from hazardous chemicals and contamination. Environ Toxicol Chem 2022;41:382-395. © 2022 The Authors. Environmental Toxicology and Chemistry published by Wiley Periodicals LLC on behalf of SETAC.
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Affiliation(s)
- Kgato P. Selwe
- Department of Chemistry, University of YorkHeslingtonYorkUK
| | - Jessica P. R. Thorn
- Department of Environment and Geography, University of YorkHeslingtonYorkUK
- African Climate and Development InitiativeUniversity of Cape TownCape TownSouth Africa
| | | | | | - J. Brett Sallach
- Department of Environment and Geography, University of YorkHeslingtonYorkUK
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Ndirangu JW, Gichane MW, Browne FA, Bonner CP, Zule WA, Cox EN, Smith KM, Carney T, Wechsberg WM. ‘We have goals but [it is difficult]’. Barriers to antiretroviral therapy adherence among women using alcohol and other drugs living with HIV in South Africa. Health Expect 2022; 25:754-763. [PMID: 35060260 PMCID: PMC8957738 DOI: 10.1111/hex.13422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 12/03/2021] [Accepted: 12/19/2021] [Indexed: 12/01/2022] Open
Abstract
Background Methods Results Conclusion Patient or Public Contribution
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Affiliation(s)
- Jacqueline W. Ndirangu
- Substance Use, Gender, and Applied Research Program, RTI International Research Triangle Park North Carolina USA
| | - Margaret W. Gichane
- Substance Use, Gender, and Applied Research Program, RTI International Research Triangle Park North Carolina USA
| | - Felicia A. Browne
- Substance Use, Gender, and Applied Research Program, RTI International Research Triangle Park North Carolina USA
- Gillings School of Global Public Health University of North Carolina at Chapel Hill Chapel Hill North Carolina USA
| | - Courtney P. Bonner
- Substance Use, Gender, and Applied Research Program, RTI International Research Triangle Park North Carolina USA
- Gillings School of Global Public Health University of North Carolina at Chapel Hill Chapel Hill North Carolina USA
| | - William A. Zule
- Substance Use, Gender, and Applied Research Program, RTI International Research Triangle Park North Carolina USA
| | - Erin N. Cox
- Substance Use, Gender, and Applied Research Program, RTI International Research Triangle Park North Carolina USA
| | - Kevin M. Smith
- Gillings School of Global Public Health University of North Carolina at Chapel Hill Chapel Hill North Carolina USA
| | - Tara Carney
- Alcohol, Tobacco and Other Drug Research Unit South African Medical Research Council Tygerberg South Africa
- Department of Psychiatry and Mental Health University of Cape Town Rondebosch Cape Town South Africa
| | - Wendee M. Wechsberg
- Substance Use, Gender, and Applied Research Program, RTI International Research Triangle Park North Carolina USA
- Gillings School of Global Public Health University of North Carolina at Chapel Hill Chapel Hill North Carolina USA
- Department of Psychology North Carolina State University Raleigh North Carolina USA
- Psychiatry and Behavioral Sciences Duke University School of Medicine Durham North Carolina USA
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14
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Rock A, Comins C, Mulumba N, Young K, Mcingana M, Guddera V, Hausler H, Phetlhu R, Baral S, Schwartz S. Antiretroviral Treatment Sharing among Female sex Workers Living with HIV in eThekwini (Durban), South Africa: Drivers and Implications for Treatment Success. J Int Assoc Provid AIDS Care 2022; 21:23259582221110820. [PMID: 35786210 PMCID: PMC9263844 DOI: 10.1177/23259582221110820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
In South Africa, 62% of female sex workers (FSW) are estimated to be living with HIV. Qualitative research indicates that FSW share antiretroviral therapy (ART) with peers to surmount treatment barriers. We quantitatively described ART sharing, its correlates, and its relationship with viral suppression (VS) among FSW living with HIV in eThekwini, South Africa. Among FSW on ART (n = 890), 30% ever shared (gave and/or received) ART. Sharing ART was more likely among those with higher levels of alcohol use, illicit drug use, depression severity, and physical/sexual violence in the adjusted model. There was a positive, dose-response relationship between number of pills given to peers in the last 30 days and VS likelihood (aPR: 1.05, 95% CI: 1.02, 1.08; p < 0.01). Giving pills may strengthen peer relationships, which may facilitate ART adherence. ART distribution through peer networks holds promise as a context-appropriate intervention for improving ART adherence among FSW in this setting.
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Affiliation(s)
- Amelia Rock
- Department of Epidemiology, 25802Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Carly Comins
- Department of Epidemiology, 25802Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Ntambue Mulumba
- Key Populations Programme, TB HIV Care, Durban, South Africa
| | | | | | | | | | - Rene Phetlhu
- TB HIV Care, Cape Town, South Africa.,School of Nursing, 108325University of the Western Cape, Cape Town, South Africa
| | - Stefan Baral
- Department of Epidemiology, 25802Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Sheree Schwartz
- Department of Epidemiology, 25802Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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Le Roux M, Möller M, Harvey BH. Prolonged efavirenz exposure reduces peripheral oxytocin and vasopressin comparable to known drugs of addiction in male Sprague Dawley rats. IBRO Neurosci Rep 2021; 11:56-63. [PMID: 34939063 PMCID: PMC8664698 DOI: 10.1016/j.ibneur.2021.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Revised: 03/03/2021] [Accepted: 06/22/2021] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION Several drugs of abuse (DOA) are capable of modulating neurohypophysial hormones, such as oxytocin (OT) and vasopressin (VP), potentially resulting in the development of psychological abnormalities, such as cognitive dysfunction, psychoses, and affective disorders. Efavirenz (EFV), widely used in Africa and globally to treat HIV, induces diverse neuropsychiatric side effects while its abuse has become a global concern. The actions of EFV may involve neurohypophysial system (NS) disruption like that of known DOA. This study investigated whether sub-chronic EFV exposure, at a previously-determined rewarding dose, alters peripheral OT and VP levels versus that of a control, ∆9-tetrahydrocannabinol (∆9-THC), methamphetamine (MA) and cocaine. MATERIALS AND METHODS To simulate the conditions under which reward-driven behavior had previously been established for EFV, male Sprague Dawley rats (n = 16/exposure) received intraperitoneal vehicle (control) or drug administration across an alternating sixteen-day dosing protocol. Control administration (saline/olive oil; 0.2 ml) occurred on odd-numbered and drug administration (EFV: 5 mg/kg, ∆9-THC: 0.75 mg/kg, MA: 1 mg/kg, or cocaine: 20 mg/kg) on even-numbered days followed by euthanasia, trunk blood collection and plasma extraction for neuropeptide assay. Effect of drug exposure on peripheral OT and VP levels was assessed versus controls and quantified using specific ELISA kits. Statistical significance was determined by Kruskal-Wallis ANOVA, with p < 0.05. Ethics approval: NWU-00291-17-A5. RESULTS Delta-9-THC reduced OT and VP plasma levels (p < 0.0001, p = 0.0141; respectively), cocaine reduced plasma OT (p = 0.0023), while MA reduced plasma VP levels (p = 0.0001), all versus control. EFV reduced OT and VP plasma levels (p < 0.0001; OT and VP) versus control, and similar to ∆9-THC. CONCLUSION EFV markedly affects the NS in significantly reducing both plasma OT and VP equivalent to DOA. Importantly, EFV has distinct effects on peripheral OT and VP levels when assessed within the context of drug dependence. The data highlights a possible new mechanism underlying previously documented EFV-induced effects in rats, and whereby EFV may induce neuropsychiatric adverse effects clinically; also providing a deeper understanding of the suggested abuse-potential of EFV.
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Key Words
- 5-HT, 5-hydroxytryptamine (serotonin)
- ADH, antidiuretic hormone
- AEA, N-arachidonoylethanolamine (anandamide)
- ANOVA, one-way analysis of variance
- ARRIVE, animal research: reporting of in vivo experiments (guidelines)
- ARV, antiretroviral
- Ach, acetylcholine
- CB, cannabinoid
- CNS, central nervous system
- CPP, conditioned place preference
- Cocaine
- DA, dopamine
- DAT, dopamine transporter
- DOA‘s, drug(s) of abuse
- ECS, endocannabinoid system
- EFV, efavirenz
- ELISA, enzyme-linked immunosorbent assay
- Efavirenz
- GABA, gamma-aminobutyric acid
- Glu, glutamate
- HIV, human immunodeficiency virus
- HNS, hypothalamic neurohypophysial system
- HPA, hypothalamic-pituitary-adrenal (axis)
- IP, intraperitoneal
- IV, intravenous
- M, muscarinic
- MA, methamphetamine
- MAO, monoamine oxidase
- Methamphetamine
- NAc, nucleus accumbens
- NE, norepinephrine
- NO, nitric oxide
- NPAE, neuropsychiatric adverse effect
- OT, oxytocin
- OTR, oxytocin receptor
- Oxytocin
- PND, postnatal day
- PVN, paraventricular nucleus
- SC, subcutaneous
- SD, Sprague Dawley (rat)
- SEM, standard error of the mean
- SERT, serotonin transporter
- SON, supraoptic nucleus
- VMAT, vesicular monoamine transporter
- VP, vasopressin
- VPR, vasopressin receptor
- Vasopressin
- cART, combined antiretroviral therapy
- ∆9-THC, delta-9-tetrahydrocannabinol
- ∆9-tetrahydrocannabinol
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Affiliation(s)
- Mandi Le Roux
- Division of Pharmacology, School of Pharmacy, North-West University, Potchefstroom, South Africa
- Centre of Excellence for Pharmaceutical Sciences (PharmaCenTM), School of Pharmacy, North-West University, Potchefstroom, South Africa
| | - Marisa Möller
- Division of Pharmacology, School of Pharmacy, North-West University, Potchefstroom, South Africa
- Centre of Excellence for Pharmaceutical Sciences (PharmaCenTM), School of Pharmacy, North-West University, Potchefstroom, South Africa
| | - Brian H. Harvey
- Division of Pharmacology, School of Pharmacy, North-West University, Potchefstroom, South Africa
- Centre of Excellence for Pharmaceutical Sciences (PharmaCenTM), School of Pharmacy, North-West University, Potchefstroom, South Africa
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Mthembi PM, Mwenesongole EM, Cole MD. A validated method for the analysis and profiling of ‘nyaope’ using gas chromatography – mass spectrometry. S AFR J SCI 2021. [DOI: 10.17159/sajs.2021/8738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Nyaope, a Tswana word for a mixture or ‘mish-mash’, describes a drug cocktail consisting of heroin, cannabis, and on occasion other controlled substances and warfarin. It is highly addictive with extremely unpleasant side effects caused by withdrawal from the drug. It is a problem drug especially in townships in South Africa. However, its prevalence in neighbouring southern African states and further afield is not yet known. There is currently no validated method for the analysis and comparison of nyaope. We describe a validated method for the gas chromatography – mass spectrometry analysis of nyaope so that within-batch and between-batch comparisons of nyaope can successfully be made for the first time. The validated method managed an accuracy within the range 80–120%, the precision was less than 20% for all analytes and managed linearity with R2≥0.99. The detection limits for diamorphine, efavirenz, nevirapine and Δ9-tetrahydrocannabinol were 14.2, 18.6, 18.7 and 9.94 pg on column, respectively, and the limits of quantitation were 43.1, 56.3, 56.6 and 30.1 pg on column, respectively. The simulated and casework samples were successfully discriminated into original batches using the identified nyaope components, the unsupervised chemometric methods principal component analysis and hierarchical clustering, as well as chromatographic profiles.
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Affiliation(s)
- Pabalala M. Mthembi
- Department of Genetics, University of the Free State, Bloemfontein, South Africa
- South African Police Service Forensic Science Laboratory – Chemistry Section, Pretoria, South Africa
| | - Ellen M. Mwenesongole
- Department of Genetics, University of the Free State, Bloemfontein, South Africa
- Department of Chemical and Forensic Sciences, Botswana International University of Science and Technology, Palapye, Botswana
| | - Michael D. Cole
- Faculty of Science and Engineering, Anglia Ruskin University, Cambridge, United Kingdom
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Mavhandu-Ramarumo LG, Tambe LAM, Matume ND, Katerere D, Bessong PO. Undisclosed exposure to antiretrovirals prior to treatment initiation: An exploratory analysis. South Afr J HIV Med 2021; 22:1200. [PMID: 33936791 PMCID: PMC8063556 DOI: 10.4102/sajhivmed.v22i1.1200] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 02/19/2021] [Indexed: 11/01/2022] Open
Abstract
Background The proportion of individuals with a history of exposure ('pre-exposure') to antiretrovirals (ARVs) prior to formal initiation into antiretroviral treatment (ART) is unknown. Objectives This study describes the detection of ARVs in plasma and/or hair, of persons who self-reported no pre-exposure to ART at their first-time initiation onto ART in three clinics in the province of Limpopo, South Africa (SA). Method Concentrations of tenofovir (TDF), emtricitabine (FTC) and efavirenz (EFV) in the plasma and hair of individuals initiating ART were analysed using a validated liquid chromatography tandem mass spectrometry (LC-MS/MS) method. Next generation sequences of HIV polymerase gene were analysed with Geneious software 11.15, and drug resistance (DR) mutations were determined according to the Stanford HIV Drug-Resistance database. Participants' demographic data were collected on a structured questionnaire. Data that describe prior exposure to ARV were also collected by this self-reporting method. Results Paired blood and hair samples were collected from 77 individuals newly initiated onto ART from 2017 to 2019. We detected at least one of the drugs in the plasma or hair of 41/77 (53.2%) patients who responded with a 'no' to the question 'have you received ARVs before initiation onto ART?' Thirty-one participants (n = 31/77, 40.3%) had TDF in either plasma or hair. Emtricitabine and EFV were found in the plasma or hair of 12/77 (15.6%) and 25/77 (32.4%) of participants respectively. Six (n = 6/77, 7.792%) had all three ARVs in plasma or hair. Prevalence of DR mutations at the > 5% significance threshold level in those known to have had ARV-exposure determined by LC-MS/MS prior to ART-initiation was not significant (χ2 = 0.798; p = 0.372), when compared to those who had no prior exposure but still showed DR. Conclusion Antiretroviral levels in the hair of individuals initiating treatment imply prolonged prior-exposure to that ARV. The presence of ARV in plasma and hair of persons living with HIV (PLWH) who deny ARV-use, requires an explanation. A larger study at multiple sites and regular DR surveillance of ART-naïve PLWH will be necessary to confirm the generalisability of these findings to the wider South African population.
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Affiliation(s)
- Lufuno G Mavhandu-Ramarumo
- HIV/AIDS and Global Health Research Programme, Department of Microbiology, School of Mathematical and Natural Sciences, University of Venda, Thohoyandou, South Africa
| | - Lisa A M Tambe
- HIV/AIDS and Global Health Research Programme, Department of Microbiology, School of Mathematical and Natural Sciences, University of Venda, Thohoyandou, South Africa
| | - Nontokozo D Matume
- HIV/AIDS and Global Health Research Programme, Department of Microbiology, School of Mathematical and Natural Sciences, University of Venda, Thohoyandou, South Africa
| | - David Katerere
- Department of Pharmaceutical Sciences, Faculty of Pharmaceutical Science, Tshwane University of Technology, Pretoria, South Africa
| | - Pascal O Bessong
- HIV/AIDS and Global Health Research Programme, Department of Microbiology, School of Mathematical and Natural Sciences, University of Venda, Thohoyandou, South Africa.,Center for Global Health Equity, University of Virginia, Charlottesville, United States of America
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18
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Kuo C, Dietrich J, Slingers N, Beauclair R, Lombard C, Mathews C. An Emerging Substance Use Epidemic: Recreational Use of HIV Pre-Exposure Prophylaxis and Treatment in South Africa. AIDS Patient Care STDS 2021; 35:92-101. [PMID: 33689456 DOI: 10.1089/apc.2020.0218] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
South Africa has the largest HIV burden and treatment program in the world. Diversion of HIV prevention and treatment medication for recreational use-or nonmedical use for psychoactive effects-is a public health concern globally and in South Africa. Few South African studies examine recreational use of HIV antiretrovirals (ARVs). The objective of this article is to evaluate the prevalence of recreational ARV use and to identify risk and protective factors associated with use. Data are drawn from a cross-sectional household survey of N = 4399 adolescent girls and young women (AGYW) aged 15-24 years in six districts across South Africa where an evaluation of a South African combination HIV prevention for girls and young women was implemented. The use of ARVs to "get high" was reported by 8.3% of AGYW across all districts. Logistic regressions showed that those engaging in transactional sex were at two times higher odds of recreational ARV use [adjusted odds ratio (aOR) = 2.01; confidence interval (95% CI): 1.51-2.68]. Recreational ARV use was more likely among those who used pre-exposure prophylaxis (PrEP) (aOR = 2.17; 95% CI: 1.36-3.48); HIV-positive participants who were not on ARVs for treatment (aOR = 0.36; 95% CI: 0.18-0.68); and those who were not virally suppressed (aOR, no vs. yes = 2.84; 95% CI: 1.21-6.66). As ARVs become more widely available for prevention and treatment, it will be important to monitor and address the possible emergence of ARVs as a substance for misuse or abuse.
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Affiliation(s)
- Caroline Kuo
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Janan Dietrich
- Perinatal HIV Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Nevilene Slingers
- Office of AIDS and TB, UnSouth African Medical Research Council, Cape Town, South Africa
| | - Roxanne Beauclair
- Centre of Excellence in Epidemiological Modelling and Analysis, Stellenbosch University, Stellenbosch, South Africa
| | - Carl Lombard
- Biostatistics Unit, UnSouth African Medical Research Council, Cape Town, South Africa
- Division of Epidemiology and Biostatistics, Department of Global Health, Stellenbosch University, Cape Town, South Africa
| | - Catherine Mathews
- Health Systems Research Unit, UnSouth African Medical Research Council, Cape Town, South Africa
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19
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Krogstad EA, Atujuna M, Montgomery ET, Minnis AM, Morroni C, Bekker LG. Perceptions matter: Narratives of contraceptive implant robbery in Cape Town, South Africa. CULTURE, HEALTH & SEXUALITY 2021; 23:383-396. [PMID: 32216584 PMCID: PMC7529647 DOI: 10.1080/13691058.2020.1714739] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Accepted: 01/08/2020] [Indexed: 06/10/2023]
Abstract
Uptake of contraceptive implants has declined in South Africa since their introduction in 2014, with side effects and inadequate health provider training cited as primary contributors underlying a poor community perception of implants. In this paper we explore a theme that emerged unexpectedly during analysis of our research in Cape Town that may be an additional factor in this decline: narratives of women being assaulted by robbers who physically remove the implants for smoking as drugs. Narratives were described consistently across interviews and focus groups with youth (aged 18-24 years) and in interviews with health providers, with six participants (two young people, four health providers) sharing personal experiences of robbery. While there was a range of perspectives on whether narratives are based on real experiences or are myths, there was strong consensus that narratives of implant robbery may be influencing women's decisions around implant use in Cape Town. This is a potent example of how perceptions of new products can affect uptake and offers important lessons for implementers to reflect on in planning for rollout of other health technologies.
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Affiliation(s)
- Emily A. Krogstad
- Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa
- Women’s Global Health Imperative, RTI International, San Francisco, CA, USA
| | - Millicent Atujuna
- Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa
| | | | | | - Chelsea Morroni
- Women’s Health Research Unit, School of Public Health and Family Medicine, University of Cape Town, South Africa
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Linda-Gail Bekker
- Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa
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20
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Recreational Use of HIV Antiretroviral Medication and Implications for HIV Pre-exposure Prophylaxis and Treatment. AIDS Behav 2020; 24:2650-2655. [PMID: 32140876 DOI: 10.1007/s10461-020-02821-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Diversion of antiretroviral therapy (ART) for recreational use is concerning for countries with high HIV prevalence. This paper presents reports of recreational use of ART among adolescents from two HIV prevention studies in South Africa: (1) a cross-sectional survey of N = 200 adolescents and (2) a qualitative study of pre-exposure prophylaxis with N = 57 adolescents and N = 25 clinicians. Among adolescents, 3% used and 14% knew someone who used non-prescribed ART for recreational purposes. Administration included smoking (71%), snorting (15%), injecting (15%), ingesting (15%), and inserting (3%). Participants predicted increased crime as recreational use of ART increased. Future studies should investigate prevalence, composition, and diversion of ART from HIV prevention and treatment.
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21
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Sedumedi TP, Winter DA. I Killed My Children: Construing Pathways to Filicide. JOURNAL OF CONSTRUCTIVIST PSYCHOLOGY 2020. [DOI: 10.1080/10720537.2020.1805067] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
| | - David A. Winter
- Department of Psychology and Sport Sciences, University of Hertfordshire, Hatfield, UK
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22
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Zareifopoulos N, Lagadinou M, Karela A, Kyriakopoulou O, Velissaris D. Neuropsychiatric Effects of Antiviral Drugs. Cureus 2020; 12:e9536. [PMID: 32905132 PMCID: PMC7465925 DOI: 10.7759/cureus.9536] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
The adverse events of antiviral drugs are dose-dependent and often reversible. The nervous system is often affected and to date, many studies have been published regarding the central nervous system toxicity of antiviral agents. They may cause significant neuropsychiatric complications, which range from mild symptoms such as irritability and difficulty sleeping to severe complications such as depression, psychosis, and painful peripheral neuropathy, side effects which may necessitate discontinuation of treatment. The pathogenetic mechanisms may involve molecular targets common to other centrally active drugs, including human monoamine oxidase‐A (MAO‐A), serotonin receptors, gamma-aminobutyric acid (GABA) GABA-A receptors, 5-HT2A and 5-HT2C receptors and others. Notable examples include oseltamivir which may act as MAO inhibitor and efavirenz, which has an affinity for serotonin 5-HT2 and GABA-A receptors, the serotonin transporter, the MAO enzyme, and the vesicular monoamine transporter, with subjective effects which may be similar to those of the psychedelic hallucinogen lysergic acid diethylamide (LSD). Other antiviral drugs with prominent nervous system effects include nucleoside reverse transcriptase inhibitors, which are associated with the development of peripheral neuropathy after prolonged use (an effect strongly associated with older drugs which have since fallen into disfavor such as stavudine) and interferons, which may cause depression. Clinicians should be familiar with such adverse effects in order to recognise them promptly once they occur and manage them appropriately.
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Affiliation(s)
| | - Maria Lagadinou
- Emergency Department, General University Hospital of Patras, Patras, GRC
| | - Anastasia Karela
- Emergency Department, General University Hospital of Patras, Patras, GRC
| | | | - Dimitrios Velissaris
- Department of Internal Medicine, University of Patras, School of Health Sciences, Patras, GRC.,Emergency Department, General University Hospital of Patras, Patras, GRC
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23
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Tyree GA, Mosery N, Closson EF, Mabude Z, du Toit C, Bangsberg DR, Safren SA, Mayer KH, Smit JA, Mimiaga MJ, Grelotti DJ. Trajectories of initiation for the heroin-based drug whoonga - qualitative evidence from South Africa. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2020; 82:102799. [PMID: 32535541 PMCID: PMC7493467 DOI: 10.1016/j.drugpo.2020.102799] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2018] [Revised: 03/04/2020] [Accepted: 05/12/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Whoonga is a smoked heroin-based street drug that first emerged in South Africa a decade ago. While previous scientific reports suggest that use is growing and youth are particularly vulnerable, trajectories of initiation are not well characterized. METHODS In 2015, 30 men undergoing residential addiction treatment for this smoked heroin drug in KwaZulu-Natal, South Africa participated in semi-structured interviews about their experiences using the drug. Interview data were coded using qualitative content analysis. RESULTS Participant trajectories to initiating smoked heroin were "vertical" in the context of marijuana use or "horizontal" in the context of other hard drug use. Participants reporting vertical trajectories began smoking heroin as youth at school or in other settings where people were smoking marijuana. Several participants with horizontal trajectories started smoking heroin to address symptoms of other drug or alcohol addiction. Social influences on initiation emerged as an overarching theme. Members of participants' social networks who were smoking or distributing heroin figured prominently in initiation narratives. Surprisingly, references to injection drug use were absent from initiation narratives. Participants reported people who smoke heroin differ from those who inject heroin by race. CONCLUSION Consistent with theories implicating social and structural influences on substance use initiation, people who started smoking heroin had social contacts who smoked heroin and frequented places where substance use was common. Smoked heroin initiation for several participants with horizontal trajectories may have been averted if they accessed evidence-based treatments for stimulant or alcohol use disorders. With increasing reports of heroin use across Africa, a coordinated approach to address this growing epidemic is needed. However, because smoked heroin and injection heroin use occur in distinct risk environments, interventions tailored to people who use smoked heroin will be needed to prevent smoked heroin use, prevent transition to injection use, and mitigate other social harms.
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Affiliation(s)
- Griffin A Tyree
- University of California, San Diego School of Medicine, 9500 Gilman Drive, La Jolla, CA 92093, United States
| | - Nzwakie Mosery
- MatCH Research Unit (MRU), Department of Obstetrics and Gynaegology, Faculty of Health Sciences, University of the Witwatersrand, 40 Dr AB Xuma Street, Suite 1108-9, Commercial City, Durban, KwaZulu-Natal 4001, South Africa
| | - Elizabeth F Closson
- The Fenway Institute, Fenway Health, 1340 Boylston Street, Boston, MA 02215, United States
| | - Zonke Mabude
- MatCH Research Unit (MRU), Department of Obstetrics and Gynaegology, Faculty of Health Sciences, University of the Witwatersrand, 40 Dr AB Xuma Street, Suite 1108-9, Commercial City, Durban, KwaZulu-Natal 4001, South Africa
| | - Carol du Toit
- SANCA Durban Alcohol & Drug Centres, 185 Vause Road, Durban, KwaZulu-Natal 4001, South Africa
| | - David R Bangsberg
- OHSU-PSU School of Public Health, 506 SW Mill Street, Portland, OR 97201, United States
| | - Steven A Safren
- The Fenway Institute, Fenway Health, 1340 Boylston Street, Boston, MA 02215, United States; University of Miami, 1320 S Dixie Highway, Coral Gables, FL 33146, United States
| | - Kenneth H Mayer
- The Fenway Institute, Fenway Health, 1340 Boylston Street, Boston, MA 02215, United States; Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, United States
| | - Jennifer A Smit
- MatCH Research Unit (MRU), Department of Obstetrics and Gynaegology, Faculty of Health Sciences, University of the Witwatersrand, 40 Dr AB Xuma Street, Suite 1108-9, Commercial City, Durban, KwaZulu-Natal 4001, South Africa
| | - Matthew J Mimiaga
- The Fenway Institute, Fenway Health, 1340 Boylston Street, Boston, MA 02215, United States; Brown University, School of Public Health, 121 S Main Street, Providence, RI 02903, United States; Alpert Medical School, 222 Richmond Street, Providence, RI 02903, United States
| | - David J Grelotti
- University of California, San Diego School of Medicine, 9500 Gilman Drive, La Jolla, CA 92093, United States; HIV Neurobehavioral Research Program, University of California, San Diego, 220 Dickinson Street, San Diego, CA 92103, United States.
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24
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DeAtley T, Mathews C, Stein DJ, Grelotti D, Brown LK, Giovenco D, Atujuna M, Beardslee W, Kuo C. Risk and protective factors for whoonga use among adolescents in South Africa. Addict Behav Rep 2020; 11:100277. [PMID: 32373707 PMCID: PMC7195513 DOI: 10.1016/j.abrep.2020.100277] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 04/08/2020] [Accepted: 04/17/2020] [Indexed: 11/17/2022] Open
Abstract
Adolescents are reporting recreational exposure and use of ARVs in South Africa. Individual level risk factors increase risk for whoonga use or known use among adolescents. Food insecurity has a slightly protective effect on whoonga use or known use among adolescents. Surveillance studies are warranted to understand multilevel risk factors of whoonga.
Background Antiretroviral therapy (ART) is publicly available in South Africa in response to the urgent need to address HIV and AIDS. Off-label use of ARV medication alone or in combination with other substances is known as “whoonga” and “nyaope” in South Africa. Diversion of ARVs for whoonga use is not well understood, especially among adolescents. This secondary analysis explores risk and protective factors for adolescent whoonga use in a community-based HIV endemic setting. Methods Data on whoonga use were derived from a baseline survey of N = 200 adolescents recruited for participation in a randomized controlled trail to reduce adolescent HIV risk behaviors and depression. Risk and protective factors for adolescent whoonga use were explored using an ecological systems framework using one-way ANOVAs, chi-squared tests and hierarchical regression. Results Individual level factors increased the odds of whoonga use or known use such as child age OR:1.22 (95% CI, 1.03–1.43), hazardous drug use OR:1.62 (95% CI, 1.02–2.59), and hazardous alcohol OR:1.80 (95% CI, 1.05–3.09). Food insecurity appears to have a slightly protective effect on the odds of whoonga use or reports of use among people adolescents knew OR:0.649 (95% CI, 0.541–0.779). Conclusions Larger epidemiological studies should expand the surveillance of hazardous alcohol use and illicit drug use, specifically for recreational use of prescription medication. Granular data is warranted to characterize the patters of use, especially among highly vulnerable populations. Future surveillance studies that explore these multi-level relationships are warranted to further understand this phenomenon among teens in South Africa.
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Affiliation(s)
- Teresa DeAtley
- Brown University School of Public Health, Department of Behavioral and Social Sciences Brown University School of Public Health, 121 S Main St, Providence, Rhode Island 02903, USA
| | - Catherine Mathews
- University of Cape Town, Department of Psychiatry and Mental Health & South African Medical Research Council, Unit on Risk & Resilience in Mental Disorders, Groote Schuur Hospital, Anzio Road, Observatory, Cape Town 7925, South Africa
| | - Dan J Stein
- University of Cape Town, Department of Psychiatry and Mental Health & South African Medical Research Council, Unit on Risk & Resilience in Mental Disorders, Groote Schuur Hospital, Anzio Road, Observatory, Cape Town 7925, South Africa
| | - David Grelotti
- University of California San Diego, Department of Psychiatry, 220 Dickinson Street, Suite B, San Diego, CA 92103, USA
| | - Larry K Brown
- Alpert Medical School of Brown University, Department of Psychiatry and Human Behavior, 222 Richmond St, Providence, Rhode Island 02903, USA.,Providence/Boston Center for AIDS Research, 164 Summit Avenue CFAR Building, Room 134, Providence, Rhode Island 02906, USA
| | - Danielle Giovenco
- University of North Carolina at Chapel Hill, Department of Epidemiology, 135 Dauer Drive, 2101 McGavran-Greenberg Hall, CB #7435, Chapel Hill, NC 27599-7435, USA
| | - Millicent Atujuna
- Desmond Tutu HIV Foundation, P.O. Box 13801, Mowbray, 7705 Cape Town, South Africa
| | - William Beardslee
- Boston Children's Hospital & Judge Baker Children's Center & Harvard Medical School, Department of Psychiatry, 53 Parker Hill Ave, Roxbury Crossing, MA 02120, USA
| | - Caroline Kuo
- Brown University School of Public Health, Department of Behavioral and Social Sciences Brown University School of Public Health, 121 S Main St, Providence, Rhode Island 02903, USA.,University of Cape Town, Department of Psychiatry and Mental Health & South African Medical Research Council, Unit on Risk & Resilience in Mental Disorders, Groote Schuur Hospital, Anzio Road, Observatory, Cape Town 7925, South Africa.,Providence/Boston Center for AIDS Research, 164 Summit Avenue CFAR Building, Room 134, Providence, Rhode Island 02906, USA
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25
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Ghura S, Gross R, Jordan-Sciutto K, Dubroff J, Schnoll R, Collman RG, Ashare RL. Bidirectional Associations among Nicotine and Tobacco Smoke, NeuroHIV, and Antiretroviral Therapy. J Neuroimmune Pharmacol 2019; 15:694-714. [PMID: 31834620 DOI: 10.1007/s11481-019-09897-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 12/01/2019] [Indexed: 12/12/2022]
Abstract
People living with HIV (PLWH) in the antiretroviral therapy (ART) era may lose more life-years to tobacco use than to HIV. Yet, smoking rates are more than twice as high among PLWH than the general population, contributing not just to mortality but to other adverse health outcomes, including neurocognitive deficits (neuroHIV). There is growing evidence that synergy with chronic inflammation and immune dysregulation that persists despite ART may be one mechanism by which tobacco smoking contributes to neuroHIV. This review will summarize the differential effects of nicotine vs tobacco smoking on inflammation in addition to the effects of tobacco smoke components on HIV disease progression. We will also discuss biomarkers of inflammation via neuroimaging as well as biomarkers of nicotine dependence (e.g., nicotine metabolite ratio). Tobacco smoking and nicotine may impact ART drug metabolism and conversely, certain ARTs may impact nicotine metabolism. Thus, we will review these bidirectional relationships and how they may contribute to neuroHIV and other adverse outcomes. We will also discuss the effects of tobacco use on the interaction between peripheral organs (lungs, heart, kidney) and subsequent CNS function in the context of HIV. Lastly, given the dramatic rise in the use of electronic nicotine delivery systems, we will discuss the implications of vaping on these processes. Despite the growing recognition of the importance of addressing tobacco use among PLWH, more research is necessary at both the preclinical and clinical level to disentangle the potentially synergistic effects of tobacco use, nicotine, HIV, cognition and immune dysregulation, as well as identify optimal approaches to reduce tobacco use. Graphical Abstract Proposed model of the relationships among HIV, ART, smoking, inflammation, and neurocognition. Solid lines represent relationships supported by evidence. Dashed lines represent relationships for which there is not enough evidence to make a conclusion. (a) HIV infection produces elevated levels of inflammation even among virally suppressed individuals. (b) HIV is associated with deficits in cognition function. (c) Smoking rates are higher among PLWH, compared to the general population. (d) The nicotine metabolite ratio (NMR) is associated with smoking behavior. (e) HIV and tobacco use are both associated with higher rates of psychiatric comorbidities, such as depression, and elevated levels of chronic stress. These factors may represent other mechanisms linking HIV and tobacco use. (f) The relationship between nicotine, tobacco smoking, and inflammation is complex, but it is well-established that smoking induces inflammation; the evidence for nicotine as anti-inflammatory is supported in some studies, but not others. (g) The relationship between tobacco use and neurocognition may differ for the effects of nicotine (acute nicotine use may have beneficial effects) vs. tobacco smoking (chronic use may impair cognition). (h) Elevated levels of inflammation may be associated with deficits in cognition. (i) PLWH may metabolize nicotine faster than those without HIV; the mechanism is not yet known and the finding needs validation in larger samples. We also hypothesize that if HIV-infection increases nicotine metabolism, then we should observe an attenuation effect once ART is initiated. (j) It is possible that the increase in NMR is due to ART effects on CYP2A6. (k) We hypothesize that faster nicotine metabolism may result in higher levels of inflammation since nicotine has anti-inflammatory properties.
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Affiliation(s)
- Shivesh Ghura
- Department of Pathology, School of Dental Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Robert Gross
- Division of Infectious Diseases, University of Pennsylvania, Philadelphia, PA, USA.,Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA, USA
| | - Kelly Jordan-Sciutto
- Department of Pathology, School of Dental Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Jacob Dubroff
- Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA
| | - Robert Schnoll
- Department of Psychiatry, University of Pennsylvania, 3535 Market Street, Suite, Philadelphia, PA, 4100, USA
| | - Ronald G Collman
- Pulmonary, Allergy and Critical Care Division, University of Pennsylvania, Philadelphia, PA, USA
| | - Rebecca L Ashare
- Department of Psychiatry, University of Pennsylvania, 3535 Market Street, Suite, Philadelphia, PA, 4100, USA.
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26
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Rosen JG, Nakyanjo N, Isabirye D, Wawer MJ, Nalugoda F, Reynolds SJ, Nakigozi G, Grabowski MK, Kennedy CE. Antiretroviral treatment sharing among highly mobile Ugandan fisherfolk living with HIV: a qualitative study. AIDS Care 2019; 32:912-915. [PMID: 31533449 DOI: 10.1080/09540121.2019.1668528] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Antiretroviral treatment (ART) diversion from prescribed to non-prescribed users (i.e., sharing or selling) is an understudied dimension of HIV treatment adherence. We sought to explore ART diversion patterns in high-prevalence fishing communities on Lake Victoria, Uganda. We implemented a qualitative study in two fishing communities on Lake Victoria in south-central Uganda to identify facilitators of and pathways to ART diversion. We conducted 25 semi-structured interviews with HIV-positive fishermen (n = 25) and female sex workers (n = 10) covering personal and community experiences with ART selling/sharing, reasons for medication diversion, and potential solutions to reduce diversion. Data were analyzed using an adapted framework analysis approach. Participants reported frequent ART sharing within occupational networks, but no selling. Mobility was the principal driver of ART sharing and was associated with other barriers to treatment access including stigma, fear of negative health provider interactions, and transportation. ART sharing appears to emerge in response to short-term treatment interruptions in this setting. Future studies should explore characteristics and drivers of ART diversion in other high-burden settings and identify how these practices are correlated with key health outcomes like virologic failure and drug resistance.
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Affiliation(s)
- Joseph G Rosen
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Neema Nakyanjo
- Department of Social and Behavioral Sciences, Rakai Health Sciences Program, Kalisizo, Uganda
| | - Dauda Isabirye
- Department of Social and Behavioral Sciences, Rakai Health Sciences Program, Kalisizo, Uganda
| | - Maria J Wawer
- Department of Social and Behavioral Sciences, Rakai Health Sciences Program, Kalisizo, Uganda.,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Fred Nalugoda
- Department of Social and Behavioral Sciences, Rakai Health Sciences Program, Kalisizo, Uganda
| | - Steven J Reynolds
- Department of Social and Behavioral Sciences, Rakai Health Sciences Program, Kalisizo, Uganda.,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Gertrude Nakigozi
- Department of Social and Behavioral Sciences, Rakai Health Sciences Program, Kalisizo, Uganda
| | - M Kathryn Grabowski
- Department of Social and Behavioral Sciences, Rakai Health Sciences Program, Kalisizo, Uganda.,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Department of Pathology, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Caitlin E Kennedy
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Department of Social and Behavioral Sciences, Rakai Health Sciences Program, Kalisizo, Uganda
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27
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Vanyoro KP. 'When they come, we don't send them back': counter-narratives of 'medical xenophobia' in South Africa's public health care system. PALGRAVE COMMUNICATIONS 2019; 5:101. [PMID: 31867116 PMCID: PMC6924992 DOI: 10.1057/s41599-019-0309-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2019] [Accepted: 07/10/2019] [Indexed: 06/10/2023]
Abstract
Relying on the experiences of migrant patients, research on migration and health in South Africa has documented a particular concern with public health care providers as indiscriminately practicing 'medical xenophobia'. This article argues that there is more complexity, ambivalence, and a range of possible experiences of non-nationals in South Africa's public health care system than the current extant literature on 'medical xenophobia' has suggested. Based upon in-depth interviews with frontline health care providers and participant observation at a public health care clinic in Musina sub-District, this article demonstrates how discretion may play a crucial role in inclusive health care delivery to migrants in a country marred by high xenophobic sentiment. It finds that in spite of several institutional and policy-related challenges, frontline health care providers in Musina provided public health care services and HIV treatment to black African migrants who are often at the receiving end of xenophobic sentiment and violence. The article concludes that citizenship, nationality or legal status alone do not appear to tell us much as 'bureaucratic incorporation' and 'therapeutic citizenship' are some of the modalities through which migrants are constantly being (re)defined by some of South Africa's health care providers.
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Affiliation(s)
- Kudakwashe P Vanyoro
- African Centre for Migration & Society, University of the Witwatersrand, Johannesburg 2000, South Africa
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28
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Khidir H, Psaros C, Greener L, O’Neil K, Mathenjwa M, Mosery FN, Moore L, Harrison A, Bangsberg DR, Smit JA, Safren SA, Matthews LT. Developing a Safer Conception Intervention for Men Living with HIV in South Africa. AIDS Behav 2019; 22:1725-1735. [PMID: 28194587 PMCID: PMC5554741 DOI: 10.1007/s10461-017-1719-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Within sexual partnerships, men make many decisions about sexual behavior, reproductive goals, and HIV prevention. There are increasing calls to involve men in reproductive health and HIV prevention. This paper describes the process of creating and evaluating the acceptability of a safer conception intervention for men living with HIV who want to have children with partners at risk for acquiring HIV in KwaZulu-Natal, South Africa. Based on formative work conducted with men and women living with HIV, their partners, and providers, we developed an intervention based on principles of cognitive-behavioral therapy to support men in the adoption of HIV risk-reduction behaviors such as HIV-serostatus disclosure and uptake of and adherence to antiretroviral therapy. Structured group discussions were used to explore intervention acceptability and feasibility. Our work demonstrates that men are eager for reproductive health services, but face unique barriers to accessing them.
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29
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Fogel JM, Zhang Y, Palumbo PJ, Guo X, Clarke W, Breaud A, Richardson P, Piwowar-Manning E, Hamilton EL, Ha TV, Dumchev K, Djoerban Z, Hoffman I, Hanscom B, Miller WC, Eshleman SH. Use of Antiretroviral Drug Testing to Assess the Accuracy of Self-reported Data from HIV-Infected People Who Inject Drugs. AIDS Behav 2019; 23:2101-2108. [PMID: 30600453 DOI: 10.1007/s10461-018-2379-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
We used antiretroviral (ARV) drug testing to evaluate the accuracy of self-reported data for HIV status and antiretroviral treatment (ART) among people who inject drugs enrolled in an HIV prevention trial. ARV drugs were detected in enrollment samples from 72/482 = 14.9% HIV-infected participants (39/52 = 75.0% who reported being on ART; 33/430 = 7.7% who reported not being on ART). Overall, 213/482 = 44.2% participants indicated that they were not aware of their HIV-positive status prior to study entry; of those, 30 had ARV drugs detected at enrollment, including 15 who also had ARV drugs detected at the screening visit. These participants were likely aware of their HIV-positive status at study entry but did not report this to study staff. This study shows that self-reported data on HIV testing history and ART may not be accurate and that ARV drug testing can help identify persons who are aware of their HIV-positive status and are on ART.
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30
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Mthembi PM, Mwenesongole EM, Cole MD. Chemical profiling of the street cocktail drug 'nyaope' in South Africa using GC-MS II: Stability studies of the cannabinoid, opiate and antiretroviral components during sample storage. Forensic Sci Int 2019; 300:187-192. [PMID: 31128330 DOI: 10.1016/j.forsciint.2019.04.040] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 04/30/2019] [Accepted: 04/30/2019] [Indexed: 01/30/2023]
Abstract
Nyaope is a mixture of low grade heroin, cannabis products, antiretroviral drugs and other materials added as bulking agents. It is a highly physically additive mixture which is smoked by users. As part of the development of a method for the analysis and profiling of nyaope this study evaluates the stability of the cannabinoid, opiate and antiretroviral components of nyaope during storage following seizure. Conditions used were those typically used for storage of drug seizures: in a desiccator in a refrigerator, in a desiccator in the dark at room temperature, in a desiccator in daylight at room temperature and ambient room temperature in the dark in a cabinet used for storage of drug seizures. Street samples of cannabis (Δ9-tetrahydrocannabinol) and heroin were mixed with efavirenz and nevirapine tablets to mimic a nyaope sample. The samples were homogenized and transferred into glass bottles and extracted with tertiary butyl alcohol (tBuOH) and analysed by gas chromatography - mass spectrometry (GC-MS) after the powdered drugs had been stored for intervals of 0 and 24 h under each storage condition. The data obtained indicates that the target drug components in nyaope samples decompose and that for comparison purposes the drug extracts should be prepared in tBuOH immediately after seizure because of the decomposition of the drug components during storage prior to extraction and analysis. The implications of this work are that law enforcement agencies dealing with nyaope and wanting to compare drug samples may need to change their practice around how the drug is handled after seizure but prior to analysis.
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Affiliation(s)
- P M Mthembi
- Department of Genetics, University of the Free State, P.O. Box 339, Bloemfontein, 9300, South Africa; South African Police Services Forensic Science Laboratory, Chemistry Section, Private Bag X620, Pretoria, 0001, South Africa.
| | - E M Mwenesongole
- Department of Genetics, University of the Free State, P.O. Box 339, Bloemfontein, 9300, South Africa; Department of Chemical and Forensic Sciences, Botswana International University of Science and Technology, Palapye, Botswana
| | - M D Cole
- Faculty of Science & Technology, Anglia Ruskin University, Cambridge, United Kingdom
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Magidson JF, Iyer HS, Regenauer KS, Grelotti DJ, Dietrich JJ, Courtney I, Tshabalala G, Orrell C, Gray GE, Bangsberg DR, Katz IT. Recreational ART use among individuals living with HIV/AIDS in South Africa: Examining longitudinal ART initiation and viral suppression. Drug Alcohol Depend 2019; 198:192-198. [PMID: 30953938 PMCID: PMC6644059 DOI: 10.1016/j.drugalcdep.2019.02.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 01/30/2019] [Accepted: 02/03/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND South Africa has the highest number of people living with HIV (PLWH) and one of the largest antiretroviral therapy (ART) programs globally. High rates of substance use comorbidity exist, including speculation of recreational ART use (i.e., mixing ART with other illicit drugs). Recreational ART use may affect viral load among PLWH due to ART nonadherence and/or viral resistance; however, prior quantitative research has not examined rates of recreational ART use, nor associations with HIV treatment outcomes longitudinally. METHODS Data were drawn from a prospective, observational cohort study (n = 500) of ART-eligible adults recruited from two HIV voluntary counseling and testing centers in Cape Town, and Johannesburg, South Africa. Multiple logistic regression models assessed recreational ART use as a predictor of ART initiation over six months and viral load suppression over nine months, above and beyond other substance use (binge drinking and illicit drug use). RESULTS Approximately 5% (n = 24) reported recreational ART use, which was less frequent in Cape Town compared to Johannesburg (AOR = 0.025; 95%CI: 0.003-0.19; p < 0.001). Recreational ART use was not significantly associated with ART initiation or viral suppression. Other substance use, but not recreational ART use, was significantly associated with lower odds of ART initiation (AOR = 0.54; 95%CI: 0.33-0.87; p = .01) and viral suppression (AOR = 0.47; 95%CI: 0.25-0.89; p = .02). CONCLUSIONS Recreational ART use was infrequent and not uniquely associated with ART initiation or viral suppression. Findings suggest that comorbid use of other substances is ultimately what may make recreational ART use problematic for ongoing engagement in care and viral suppression.
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Affiliation(s)
- Jessica F Magidson
- Department of Psychology, University of Maryland, College Park, 4095 Campus Drive, College Park, MD, USA.
| | - Hari S Iyer
- Harvard T. H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA, USA.
| | - Kristen S Regenauer
- Department of Psychiatry, Massachusetts General Hospital, One Bowdoin Square, Boston, MA, USA.
| | - David J Grelotti
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA.
| | - Janan J Dietrich
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa.
| | - Ingrid Courtney
- Department of Medicine and the Institute of Infectious Disease and Molecular Medicine, Desmond Tutu HIV Foundation, University of Cape Town, Cape Town, ZA, South Africa.
| | - Gugu Tshabalala
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa.
| | - Catherine Orrell
- Department of Medicine and the Institute of Infectious Disease and Molecular Medicine, Desmond Tutu HIV Foundation, University of Cape Town, Cape Town, ZA, South Africa.
| | - Glenda E Gray
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa; Office of the President, South African Medical Research Council, Western Cape, ZA, South Africa.
| | - David R Bangsberg
- Oregon Health & Science University-Portland State University School of Public Health, Portland, OR, USA.
| | - Ingrid T Katz
- Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA; Massachusetts General Hospital Center for Global Health, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
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Mvune N, Bhana D, Mayeza E. Umhlalaphansi and inkwari: teenage men's accounts on becoming fathers. CULTURE, HEALTH & SEXUALITY 2019; 21:147-159. [PMID: 29688135 DOI: 10.1080/13691058.2018.1459843] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Accepted: 03/27/2018] [Indexed: 06/08/2023]
Abstract
This paper explores how some South African teenage fathers in rural KwaZulu-Natal engage in heterosexual relationships. Drawing on findings from a qualitative based study with twenty teenage fathers aged between seventeen and nineteen years old, we examine how they talk about two highly sexualised gatherings - umhlalaphansi (an overnight Zulu dance ceremony) and inkwari (a weekend-long rave-like party). We find that these social and cultural gatherings provide opportunities to express gender and sexuality whilst simultaneously increasing the risk for early childbearing. Umhlalaphansi is produced at the cultural nexus which supports respect and cultural norms that prohibit sexual secrecy and unregulated sexuality. Paradoxically, umhlalaphansi is a key site in which teenage men and women engaged in courtships, sexual relationships and risky sexual conduct. Inkwari lacks cultural scripts and is based on partying, alcohol, drug use and engagement in spontaneous sexual encounters. We show how these two sites provide opportunities for young men to pursue sexuality in ways that are risky as they increase vulnerability for unplanned teenage fatherhood. Our conclusion provides some implications for school-based interventions to tackle sexual risk within rural contexts in South Africa.
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Affiliation(s)
- Nozipho Mvune
- a School of Education , University of KwaZulu-Natal , Durban , South Africa
| | - Deevia Bhana
- a School of Education , University of KwaZulu-Natal , Durban , South Africa
| | - Emmanuel Mayeza
- a School of Education , University of KwaZulu-Natal , Durban , South Africa
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Fogel JM, Sandfort T, Zhang Y, Guo X, Clarke W, Breaud A, Cummings V, Hamilton EL, Ogendo A, Kayange N, Panchia R, Dominguez K, Chen YQ, Eshleman SH. Accuracy of Self-Reported HIV Status Among African Men and Transgender Women Who Have Sex with Men Who were Screened for Participation in a Research Study: HPTN 075. AIDS Behav 2019; 23:289-294. [PMID: 30051192 DOI: 10.1007/s10461-018-2231-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Some HIV-infected individuals in research studies may choose not to disclose knowledge of their HIV status to study staff. We evaluated the accuracy of self-reported HIV status among African men and transgender women who have sex with men and who were screened for a research study. Sixty-seven of 183 HIV-infected participants reported a prior HIV diagnosis. Samples from the remaining 116 participants were tested for antiretroviral (ARV) drugs. Thirty-six of the 116 participants had ARV drugs detected, indicating that they were on antiretroviral treatment; these participants were classified as previously diagnosed based on ARV drug testing. Among participants classified as previously diagnosed, disclosure of a prior HIV diagnosis varied among study sites (p = 0.006) and was more common among those who reported having sex with men only (p = 0.002). ARV drug testing in addition to self-report improves the accuracy for identifying individuals with a prior HIV diagnosis.
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Affiliation(s)
- Jessica M Fogel
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Theodorus Sandfort
- HIV Center for Clinical and Behavioral Studies, Columbia University, New York, NY, USA
| | - Yinfeng Zhang
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Xu Guo
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - William Clarke
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Autumn Breaud
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Vanessa Cummings
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Arthur Ogendo
- Kenya Medical Research Institute (KEMRI) CDC, Kisumu, Kenya
| | - Noel Kayange
- College of Medicine - Johns Hopkins Project, Blantyre, Malawi
| | - Ravindre Panchia
- Perinatal HIV Research Unit, University of the Witwatersrand, Soweto HPTN CRS, Soweto, South Africa
| | - Karen Dominguez
- Desmond Tutu HIV Centre, UCT Medical School, Cape Town, South Africa
| | - Ying Q Chen
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Susan H Eshleman
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
- Department of Pathology, The Johns Hopkins Medical Institutions, Ross Building, Room 646, 720 Rutland Avenue, Baltimore, MD, 21205, USA.
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Mthembi P, Mwenesongole E, Cole M. Chemical profiling of the street cocktail drug ‘nyaope’ in South Africa using GC–MS I: Stability studies of components of ‘nyaope’ in organic solvents. Forensic Sci Int 2018; 292:115-124. [DOI: 10.1016/j.forsciint.2018.08.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Revised: 07/30/2018] [Accepted: 08/01/2018] [Indexed: 10/28/2022]
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Russo D, Siciliano A, Guida M, Andreozzi R, Reis NM, Li Puma G, Marotta R. Removal of antiretroviral drugs stavudine and zidovudine in water under UV 254 and UV 254/H 2O 2 processes: Quantum yields, kinetics and ecotoxicology assessment. JOURNAL OF HAZARDOUS MATERIALS 2018; 349:195-204. [PMID: 29427970 DOI: 10.1016/j.jhazmat.2018.01.052] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Revised: 12/06/2017] [Accepted: 01/25/2018] [Indexed: 05/07/2023]
Abstract
The concentration of antiretroviral drugs in wastewater treatment plants (WWTP) effluents and surface waters of many countries has increased significantly due to their widespread use for HIV treatment. In this study, the removal of stavudine and zidovudine under UV254 photolysis or UV254/H2O2 was investigated in a microcapillary film (MCF) photoreactor, using minimal water samples quantities. The UV254 quantum yield of zidovudine, (2.357 ± 0.0589)·10-2 mol ein-1 (pH 4.0-8.0), was 28-fold higher that the yield of stavudine (8.34 ± 0.334)·10-4 mol ein-1 (pH 6.0-8.0). The second-order rate constant kOH,iof reaction of hydroxyl radical with the antiretrovirals (UV254/H2O2 process) were determined by kinetics modeling: (9.98 ± 0.68)·108 M-1 s-1 (pH 4.0-8.0) for zidovudine and (2.03 ± 0.18)·109 M-1 s-1 (pH 6.0-8.0) for stavudine. A battery of ecotoxicological tests (i.e. inhibition growth, bioluminescence, mutagenic and genotoxic activity) using bacteria (Aliivibrio fischeri, Salmonella typhimurium), crustacean (Daphnia magna) and algae (Raphidocelis subcapitata) revealed a marked influence of the UV dose on the ecotoxicological activity. The UV254/H2O2 treatment process reduced the ecotoxicological risk associated to direct photolysis of the antiretrovirals aqueous solutions, but required significantly higher UV254 doses (≥2000 mJ cm-2) in comparison to common water UV disinfection processes.
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Affiliation(s)
- Danilo Russo
- Dipartimento di Ingegneria Chimica, dei Materiali e della Produzione Industriale, Università di Napoli Federico II, p.le V. Tecchio 80, Napoli, Italy
| | - Antonietta Siciliano
- Dipartimento di Biologia, Università di Napoli Federico II, Complesso Universitario Monte Sant'Angelo, via Cinthia 4, Napoli, Italy
| | - Marco Guida
- Dipartimento di Biologia, Università di Napoli Federico II, Complesso Universitario Monte Sant'Angelo, via Cinthia 4, Napoli, Italy
| | - Roberto Andreozzi
- Dipartimento di Ingegneria Chimica, dei Materiali e della Produzione Industriale, Università di Napoli Federico II, p.le V. Tecchio 80, Napoli, Italy
| | - Nuno M Reis
- Department of Chemical Engineering, University of Bath, Claverton Down, Bath BA2 7AY, UK
| | - Gianluca Li Puma
- Environmental Nanocatalysis & Photoreaction Engineering Department of Chemical Engineering, Loughborough University, Loughborough LE11 3TU, UK.
| | - Raffaele Marotta
- Dipartimento di Ingegneria Chimica, dei Materiali e della Produzione Industriale, Università di Napoli Federico II, p.le V. Tecchio 80, Napoli, Italy.
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Peltzer K, Phaswana-Mafuya N. Drug use among youth and adults in a population-based survey in South Africa. S Afr J Psychiatr 2018; 24:1139. [PMID: 30263218 PMCID: PMC6138152 DOI: 10.4102/sajpsychiatry.v24i0.1139] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Accepted: 09/12/2017] [Indexed: 12/30/2022] Open
Abstract
Objective Illicit drug use is a growing public health problem. The aim of the study was to assess the prevalence of drug use and the sociodemographic and health characteristics that influence it among young and adult South Africans. Methods Data based on the South African national population-based survey in 2012 for 26 453 individuals (52.0% women and 48.0% men) aged 15 years and older were analysed. Past 3-month drug use was assessed with the ‘Alcohol, Smoking and Substance use Involvement Screening Test (ASSIST)’. Bivariate and multivariable logistic regression was conducted to assess the association between sociodemographic factors, health variables and any past 3-month drug use. Results Overall, any past 3-month drug use was 4.4%, 7.9% among men and 1.3% among women. The proportion of past 3-month cannabis use was 4.0%, followed by sedatives or sleeping pills 0.4%, amphetamine-type stimulants 0.3%, cocaine 0.3%, opiates 0.3%, inhalants 0.2% and hallucinogens 0.1%. Among the nine South African provinces, any past 3-month drug use was the highest in the Western Cape (7.1%), followed by the Free State (6.3%) and Northern Cape (5.2%). In adjusted, multivariable, logistic regression analysis among both men and women, younger age, being mixed race and hazardous or harmful alcohol use were associated with any past 3-month drug use. In addition, having been a victim of violent crime and sexual risk behaviour among men and having psychological distress among women were associated with any past 3-month drug use. Conclusion An increase of any past 3-month drug use from 3.7% in 2008 to 4.4% in 2012 was observed in South Africa. Prevention and intervention activities targeting drug use, in particular in identified risk groups, need to be strengthened in South Africa.
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Affiliation(s)
- Karl Peltzer
- HIV/AIDS/STIs and TB Research Programme, Human Sciences Research Council, South Africa.,Department of Research Innovation and Development, University of Limpopo, South Africa
| | - Nancy Phaswana-Mafuya
- HIV/AIDS/STIs and TB Research Programme, Human Sciences Research Council, South Africa.,Deputy Vice Chancellor Research and Innovation Office, North West University, South Africa
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White MS, Govender P, Lister HE. Community health workers lensed through a South African backdrop of two peri-urban communities in KwaZulu-Natal. Afr J Disabil 2017; 6:294. [PMID: 38362540 PMCID: PMC10867674 DOI: 10.4102/ajod.v6i0.294] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Accepted: 05/18/2017] [Indexed: 02/17/2024] Open
Abstract
Background As the South African government re-engineers primary healthcare (PHC), the need for additional information on stakeholders involved in the process has emerged. Of these are community health workers (CHWs), who have been identified as central to PHC success. Objectives To profile the current CHWs within KwaDabeka and Clermont in KwaZulu-Natal, to describe their roles and to explore the barriers and enablers influencing their service delivery. Method A convergent mixed methods design was employed with a sample of CHWs with the use of a survey (n = 53) and two focus groups (n = 10) and semi-structured interviews with four ward councillors (n = 4). Data were analysed statistically and thematically. Results The profile of CHWs reflected only women with a mixed age range and a majority of 59% who had not completed formal schooling. General work experience as a CHW varied. There were diverse opinions expressed towards the CHW role which related to their job title and identity, supervision, remuneration, growth pathways and psychological and emotional issues. Whilst the National Community Health Worker Profile Framework was established for the CHW programme, there are several factors lacking in the current CHW programme such as a formal growth pathway or formal training to align the CHWs with the National Qualifications Framework. Conclusion The study findings are essential for the monitoring and evaluation as well as development and refinement of policies that will assist in ensuring adequate rollout of PHC with CHWs.
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Affiliation(s)
- Meghan S. White
- Department of Health, University of KwaZulu-Natal, South Africa
| | | | - Helga E. Lister
- School of Health Sciences, University of KwaZulu-Natal, South Africa
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Antiretroviral Drug Use in a Cross-Sectional Population Survey in Africa: NIMH Project Accept (HPTN 043). J Acquir Immune Defic Syndr 2017; 74:158-165. [PMID: 27828875 DOI: 10.1097/qai.0000000000001229] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Antiretroviral (ARV) drug treatment benefits the treated individual and can prevent HIV transmission. We assessed ARV drug use in a community-randomized trial that evaluated the impact of behavioral interventions on HIV incidence. METHODS Samples were collected in a cross-sectional survey after a 3-year intervention period. ARV drug testing was performed using samples from HIV-infected adults at 4 study sites (Zimbabwe; Tanzania; KwaZulu-Natal and Soweto, South Africa; survey period 2009-2011) using an assay that detects 20 ARV drugs (6 nucleoside/nucleotide reverse transcriptase inhibitors, 3 nonnucleoside reverse transcriptase inhibitors, and 9 protease inhibitors; maraviroc; raltegravir). RESULTS ARV drugs were detected in 2011 (27.4%) of 7347 samples; 88.1% had 1 nonnucleoside reverse transcriptase inhibitors ± 1-2 nucleoside/nucleotide reverse transcriptase inhibitors. ARV drug detection was associated with sex (women>men), pregnancy, older age (>24 years), and study site (P < 0.0001 for all 4 variables). ARV drugs were also more frequently detected in adults who were widowed (P = 0.006) or unemployed (P = 0.02). ARV drug use was more frequent in intervention versus control communities early in the survey (P = 0.01), with a significant increase in control (P = 0.004) but not in intervention communities during the survey period. In KwaZulu-Natal, a 1% increase in ARV drug use was associated with a 0.14% absolute decrease in HIV incidence (P = 0.018). CONCLUSIONS This study used an objective, biomedical approach to assess ARV drug use on a population level. This analysis identified factors associated with ARV drug use and provided information on ARV drug use over time. ARV drug use was associated with lower HIV incidence at 1 study site.
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Huang R, Chen Z, Dolan S, Schetz JA, Dillon GH. The dual modulatory effects of efavirenz on GABA A receptors are mediated via two distinct sites. Neuropharmacology 2017; 121:167-178. [PMID: 28456686 DOI: 10.1016/j.neuropharm.2017.04.038] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Revised: 03/27/2017] [Accepted: 04/24/2017] [Indexed: 11/20/2022]
Abstract
Efavirenz is a widely prescribed medicine used to treat type 1 human immunodeficiency virus (HIV-1), the most prevalent pathogenic strain of the virus responsible for the acquired immune deficiency syndrome (AIDS) pandemic. Under prescribed dosing conditions, either alone or in combination therapy, efavirenz-induced CNS disturbances are frequently reported. Efavirenz was recently reported to interact in a similar concentration range with a number of receptors, transporters and ion channels including recombinant rat α1β2γ2 GABAA receptors whose actions were potentiated (Gatch et al., 2013; Dalwadi et al., 2016). Now we report on the molecular mechanism of efavirenz on GABAA receptors as a function of concentration and subunit composition via whole-cell recordings of GABA-activated currents from HEK293 cells expressing varying subunit configurations of GABAA receptors. Efavirenz elicited dual effects on the GABA response; it allosterically potentiated currents at low concentrations, whereas it inhibited currents at higher concentrations. The allosteric potentiating action on GABAA receptors was pronounced in the α1β2γ2, α2β2γ2 and α4β2γ2 configurations, greatly diminished in the α6β2γ2 configuration, and completely absent in the α3β2γ2 or α5β2γ2 configuration. In stark contrast, the inhibitory modulation of efavirenz at higher concentrations was evident in all subunit configurations examined. Moreover, efavirenz-induced modulatory effects were dependent on GABA concentration ([GABA]), with a pronounced impact on currents activated by low [GABA] but little effect at saturating [GABA]. Mutation of a highly-conserved threonine to phenylalanine in transmembrane domain 2 of the α1 subunit abolished the inhibitory effect of efavirenz in α1β2 receptors. Finally, mutations of any of the three conserved extracellular residues in α1/2/4 subunits to the conserved residues at the corresponding positions in α3/5 subunits (i.e., R84P, M89L or I120L) completely eliminated the potentiating effect of efavirenz in α1β2γ2 configuration. These findings demonstrate that efavirenz's positive allosteric modulation of the GABAA receptor is mediated via a novel allosteric site associated with the extracellular domain of the receptor.
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Affiliation(s)
- Renqi Huang
- Center for Neuroscience Discovery, Institute for Healthy Aging, University of North Texas Health Science Center at Fort Worth, Fort Worth, TX 76107, United States.
| | - Zhenglan Chen
- Center for Neuroscience Discovery, Institute for Healthy Aging, University of North Texas Health Science Center at Fort Worth, Fort Worth, TX 76107, United States
| | - Sean Dolan
- Center for Neuroscience Discovery, Institute for Healthy Aging, University of North Texas Health Science Center at Fort Worth, Fort Worth, TX 76107, United States
| | - John A Schetz
- Center for Neuroscience Discovery, Institute for Healthy Aging, University of North Texas Health Science Center at Fort Worth, Fort Worth, TX 76107, United States
| | - Glenn H Dillon
- Center for Neuroscience Discovery, Institute for Healthy Aging, University of North Texas Health Science Center at Fort Worth, Fort Worth, TX 76107, United States
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van Heerden A, Harris DM, van Rooyen H, Barnabas RV, Ramanathan N, Ngcobo N, Mpiyakhe Z, Comulada WS. Perceived mHealth barriers and benefits for home-based HIV testing and counseling and other care: Qualitative findings from health officials, community health workers, and persons living with HIV in South Africa. Soc Sci Med 2017; 183:97-105. [PMID: 28475904 DOI: 10.1016/j.socscimed.2017.04.046] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Revised: 02/13/2017] [Accepted: 04/25/2017] [Indexed: 10/19/2022]
Abstract
mHealth has been proposed to address inefficiencies in the current South African healthcare system, including home-based HIV testing and counseling (HTC) programs. Yet wide-scale adoption of mHealth has not occurred. Even as infrastructure barriers decrease, a need to better understand perceived adoption barriers by stakeholders remains. We conducted focus group discussions (FGD) in South Africa in 2016 with 10 home-based HTC field staff, 12 community health workers (CHWs) and 10 persons living with HIV (PLH). Key informant (KI) interviews were conducted with five health officials. Perceptions about current home-based HTC practices, future mHealth systems and the use of biometrics for patient identification were discussed, recorded and transcribed for qualitative analysis. Themes were based on a conceptual model for perceived mHealth service quality. Stakeholders brought up a lack of communication in sharing patient health information between clinics, between clinics and CHWs, and between clinics and patients as major barriers to care that mHealth can address. CHWs need better patient information from clinics in terms of physical location and health status to plan visitation routes and address patient needs. CHWs perceive that communication barriers create distrust towards them by clinic staff. PLH want automated appointment and medication reminders. KI see mHealth as a way to improve health information transfer to government officials to better allocate healthcare resources. Stakeholders are also optimistic about the ability for biometrics to improve patient identification but disagreed as to which biometrics would be acceptable, especially in older patients. All stakeholders provided useful information towards the development of mHealth systems. Hospitals are adopting patient-centered approaches that solicit feedback from patients and incorporate them into decision-making processes. A similar approach is needed in the development of mHealth systems. Further, such systems are critical to the successful extension of the health system from health facilities into people's homes.
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Affiliation(s)
- Alastair van Heerden
- Human and Social Development Research Programme, Human Sciences Research Council, South Africa; Developmental Pathways to Health Research Unit, School of Community Medicine, University of the Witwatersrand, South Africa.
| | - Danielle M Harris
- Department of Psychiatry & Biobehavioral Sciences, Global Center for Children and Families, University of California, Los Angeles, 10920 Wilshire Blvd, Suite 350, Los Angeles, CA 90024, United States.
| | - Heidi van Rooyen
- Human and Social Development Research Programme, Human Sciences Research Council, South Africa.
| | - Ruanne V Barnabas
- Global Health and Medicine, University of Washington, Seattle, WA, United States.
| | | | - Nkosinathi Ngcobo
- Human and Social Development Research Programme, Human Sciences Research Council, South Africa.
| | - Zukiswa Mpiyakhe
- Human and Social Development Research Programme, Human Sciences Research Council, South Africa.
| | - W Scott Comulada
- Department of Psychiatry & Biobehavioral Sciences, Global Center for Children and Families, University of California, Los Angeles, 10920 Wilshire Blvd, Suite 350, Los Angeles, CA 90024, United States.
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Tshuma N, Mosikare O, Yun JA, Alaba OA, Maheedhariah MS, Muloongo K, Nyasulu PS. Acceptability of community-based adherence clubs among health facility staff in South Africa: a qualitative study. Patient Prefer Adherence 2017; 11:1523-1531. [PMID: 28979100 PMCID: PMC5602677 DOI: 10.2147/ppa.s116826] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Patient retention in care for HIV/AIDS is a critical challenge for antiretroviral treatment programs. Community-based adherence programs (CBAPs) as compared to health care facility-based adherence programs have been considered as one of the options to provide treatment maintenance support for groups of patients on antiretroviral therapy. Such an approach provides a way of enhancing self-management of the patient's condition. In addition, CBAPs have been implemented to support antiretroviral treatment expansion in resource-limited settings. CBAPs involve 30 patients that are allocated to a group and meet at either a facility or a community venue for less than an hour every 2 or 3 months depending on the supply of medication. Our study aimed to establish perceived challenges in moving adherence clubs from health facilities to communities. METHODS A qualitative study was conducted in 39 clinics in Mpumalanga and Gauteng Provinces in South Africa between December 2015 and January 2016. Purposive sampling method was used to identify nurses, club managers, data capturers, pharmacists and pharmacy assistants who had been involved in facility-based treatment adherence clubs. Key-informant interviews were conducted. Also, semi-structured interviews were used and thematic content analysis was done. RESULTS A total of 53 health care workers, 12 (22.6%) males and 41 (77.4%) females, participated in the study. Most of them 49 (92.5%) indicated that participating in community adherence clubs were a good idea. Reduction in waiting time at the health facilities, in defaulter rate, improvement in adherence to treatment as well as reduction in stigma were some of the perceived benefits. However, security of medication, storage conditions and transportation of the prepacked medication to the distribution sites were the areas of concern. CONCLUSION Health care workers were agreeable to idea of the moving adherence clubs from health facilities to communities. Although some challenges were identified, these could be addressed by the key stakeholders. However, government and nongovernmental organizations need to exercise caution when transitioning to community-based adherence clubs.
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Affiliation(s)
- Ndumiso Tshuma
- Community AIDS Response, Johannesburg, South Africa
- School of Health Sciences, Monash University South Africa, Johannesburg, South Africa
| | - Ofentse Mosikare
- Community AIDS Response, Johannesburg, South Africa
- School of Health Sciences, Monash University South Africa, Johannesburg, South Africa
| | | | - Olufunke A Alaba
- School of Public Health and Family Medicine, University of Cape Town, South Africa
| | - Meera S Maheedhariah
- Department of Human Behaviour, College of South Nevada and University of California, Los Angeles, CA, USA
| | - Keith Muloongo
- Community AIDS Response, Johannesburg, South Africa
- School of Health Sciences, Monash University South Africa, Johannesburg, South Africa
| | - Peter S Nyasulu
- School of Health Sciences, Monash University South Africa, Johannesburg, South Africa
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of Global Health, Division of Epidemiology and Biostatistics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
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Davis GP, Tomita A, Baumgartner JN, Mtshemla S, Nene S, King H, Susser E, Burns JK. Substance use and duration of untreated psychosis in KwaZulu-Natal, South Africa. S Afr J Psychiatr 2016; 22. [PMID: 27307782 PMCID: PMC4904841 DOI: 10.4102/sajpsychiatry.v22i1.852] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Substance use and psychiatric disorders cause significant burden of disease in low- and middle-income countries. Co-morbid psychopathology and longer duration of untreated psychosis (DUP) can negatively affect treatment outcomes. OBJECTIVES The study assessed substance use amongst adults with severe mental illness receiving services at a regional psychiatric hospital in KwaZulu-Natal (South Africa). We describe the prevalence and correlates of lifetime substance use and examine the association between substance use and DUP. METHODS A cross-sectional survey recruited adults diagnosed with severe mental illness and assessed lifetime and past 3-month substance use using the World Health Organization Alcohol, Smoking and Substance Involvement Screening Test. Regression analyses were conducted to determine associations between lifetime substance use (other than alcohol and tobacco) and DUP as measured by the World Health Organization Encounter Form. RESULTS Amongst 87 participants, alcohol (81.6%), tobacco (75.6%) and cannabis (49.4%) were the most common substances reported for lifetime use. Risk of health-related problems (health, social, financial, legal and relationship) of cannabis use was associated with younger age, single marital status and lower education. Adjusted regression analyses indicated that use of amphetamines and methaqualone is associated with longer DUP. CONCLUSIONS Substance use is prevalent amongst psychiatric patients in KwaZulu-Natal and may contribute to longer DUP. Mental health services in this region should address co-morbid substance use and psychiatric disorders.
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Affiliation(s)
- Glen P Davis
- Columbia University Medical Center, Department of Psychiatry, New York, NY, United States of America
| | - Andrew Tomita
- University of KwaZulu-Natal, Nelson R. Mandela School of Medicine, Durban, South Africa
| | - Joy Noel Baumgartner
- Duke Global Health Institute, Duke University, Durham, NC, United States of America
| | - Sisanda Mtshemla
- University of KwaZulu-Natal, Nelson R. Mandela School of Medicine, Durban, South Africa; KwaZulu-Natal Department of Health, Durban, South Africa
| | - Siphumelele Nene
- Health Economics and HIV/AIDS Research Division (HEARD), University of KwaZulu-Natal, Durban, South Africa
| | - Howard King
- University of KwaZulu-Natal, Nelson R. Mandela School of Medicine, Durban, South Africa; KwaZulu-Natal Department of Health, Durban, South Africa
| | - Ezra Susser
- Columbia University Mailman School of Public Health, Department of Epidemiology, New York, NY, United States of America; New York State Psychiatric Institute, United States of America
| | - Jonathan K Burns
- University of KwaZulu-Natal, Nelson R. Mandela School of Medicine, Durban, South Africa; KwaZulu-Natal Department of Health, Durban, South Africa
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Cluck D, Lewis P, Durham SH, Hester EK. The Rise and Fall of Efavirenz. J Int Assoc Provid AIDS Care 2016; 15:181-3. [DOI: 10.1177/2325957416629561] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Affiliation(s)
- David Cluck
- Department of Pharmacy Practice, Gatton College of Pharmacy, East Tennessee State University, Johnson City, TN, USA
| | - Paul Lewis
- Infectious Diseases, Department of Pharmacy, Johnson City Medical Center, Johnson City, TN, USA
| | - Spencer H. Durham
- Department of Pharmacy Practice, Harrison School of Pharmacy, Auburn University, Auburn, AL, USA
| | - E. Kelly Hester
- Department of Pharmacy Practice, Harrison School of Pharmacy, Auburn University, Auburn, AL, USA
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Van de Wijer L, Schellekens AFA, Burger DM, Homberg JR, de Mast Q, van der Ven AJAM. Rethinking the risk-benefit ratio of efavirenz in HIV-infected children. THE LANCET. INFECTIOUS DISEASES 2016; 16:e76-e81. [PMID: 27599655 DOI: 10.1016/s1473-3099(16)00117-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Revised: 02/02/2016] [Accepted: 02/11/2016] [Indexed: 01/25/2023]
Abstract
The non-nucleoside reverse transcriptase inhibitor efavirenz is part of the WHO guidelines for preferred first-line treatment of HIV-1-infected adults, pregnant and lactating women, and children. Efavirenz is well known to cause CNS toxicity. Although good data for CNS toxicity are available for adults, the opposite is true for children. Paediatric studies on this topic frequently suffer from small sample sizes or absence of thorough neuropsychiatric assessments. In this Personal View, we focus on two knowledge gaps of CNS toxicity of efavirenz in children. First, plasma concentrations of efavirenz are difficult to predict in children because of immaturity of and genetic variation in metabolic enzymes. Second, efavirenz exerts a lysergide (LSD)-like effect on brain serotonergic pathways and affects CNS metabolic pathways, including mitochondrial function. Whether these effects interfere with normal brain development is unknown. These uncertainties underline the imminent need for better monitoring of mental health and neurocognitive development in children given and exposed to efavirenz.
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Affiliation(s)
- Lisa Van de Wijer
- Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud university medical center, Nijmegen, Netherlands.
| | - Arnt F A Schellekens
- Department of Psychiatry, Radboud university medical center, Nijmegen, Netherlands
| | - David M Burger
- Department of Pharmacy, Radboud university medical center, Nijmegen, Netherlands
| | - Judith R Homberg
- Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behaviour, Radboud university medical center, Nijmegen, Netherlands
| | - Quirijn de Mast
- Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud university medical center, Nijmegen, Netherlands
| | - Andre J A M van der Ven
- Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud university medical center, Nijmegen, Netherlands
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Loeliger KB, Niccolai LM, Mtungwa LN, Moll A, Shenoi SV. Antiretroviral therapy initiation and adherence in rural South Africa: community health workers' perspectives on barriers and facilitators. AIDS Care 2016; 28:982-93. [PMID: 27043077 DOI: 10.1080/09540121.2016.1164292] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
South Africa has the largest global HIV/AIDS epidemic, but barriers along the HIV care continuum prevent patients from initiating and adhering to antiretroviral therapy (ART). To qualitatively explore reasons for poor ART initiation and adherence rates from the unique perspective of community health workers (CHWs), we conducted focus groups during May-August 2014 with 21 CHWs in rural Msinga, KwaZulu-Natal. Interviews were audio-recorded, transcribed, and translated from Zulu into English. Hybrid deductive and inductive analytical methods were applied to identify emergent themes. Multiple psychosocial, socioeconomic, and socio-medical barriers acted at the level of the individual, social network, broader community, and healthcare environment to simultaneously hinder initiation of and adherence to ART. Key themes included insufficient patient education and social support, patient dissatisfaction with healthcare services, socioeconomic factors, and tension between ART and alternative medicine. Fear of lifelong therapy thwarted initiation whereas substance abuse principally impeded adherence. In conclusion, HIV/AIDS management requires patient counselling and support extending beyond initial diagnosis. Treating HIV/AIDS as a chronic rather than acute infectious disease is key to improving ART initiation and long-term adherence. Public health strategies include expanding CHWs' roles to strengthen healthcare services, provide longitudinal patient support, and foster collaboration with alternative medicine providers.
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Affiliation(s)
- Kelsey B Loeliger
- a Section of Infectious Diseases , Yale University School of Medicine , New Haven , CT , USA.,b Department of Epidemiology of Microbial Diseases , Yale University School of Public Health , New Haven , CT , USA
| | - Linda M Niccolai
- b Department of Epidemiology of Microbial Diseases , Yale University School of Public Health , New Haven , CT , USA
| | - Lillian N Mtungwa
- c Church of Scotland Hospital , Tugela Ferry , KwaZulu-Natal , South Africa
| | - Anthony Moll
- c Church of Scotland Hospital , Tugela Ferry , KwaZulu-Natal , South Africa
| | - Sheela V Shenoi
- a Section of Infectious Diseases , Yale University School of Medicine , New Haven , CT , USA
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Burman CJ, Aphane M, Delobelle P. Weak signal detection: A discrete window of opportunity for achieving 'Vision 90:90:90'? SAHARA J 2016; 13:17-34. [PMID: 26821952 PMCID: PMC5642432 DOI: 10.1080/17290376.2015.1123642] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
INTRODUCTION UNAIDS' Vision 90:90:90 is a call to 'end AIDS'. Developing predictive foresight of the unpredictable changes that this journey will entail could contribute to the ambition of 'ending AIDS'. There are few opportunities for managing unpredictable changes. We introduce 'weak signal detection' as a potential opportunity to fill this void. METHOD Combining futures and complexity theory, we reflect on two pilot case studies that involved the Archetype Extraction technique and the SenseMaker(®) Collector(™) tool. RESULTS Both the piloted techniques have the potentials to surface weak signals--but there is room for improvement. DISCUSSION A management response to a complex weak signal requires pattern management, rather than an exclusive focus on behaviour management. CONCLUSION Weak signal detection is a window of opportunity to improve resilience to unpredictable changes in the HIV/AIDS landscape that can both reduce the risk that emerges from the changes and increase the visibility of opportunities to exploit the unpredictable changes that could contribute to 'ending AIDS'.
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Affiliation(s)
- Christopher J. Burman
- PhD, is affiliated to Rural Development and Innovation Hub, University of Limpopo, Turfloop Campus, Polokwane, South Africa
| | - Marota Aphane
- Masters in Development, is affiliated to Rural Development and Innovation Hub, University of Limpopo, Turfloop Campus, Polokwane, South Africa
| | - Peter Delobelle
- MD, PhD is affiliated to School of Public Health, University of the Western Cape, Robert Sobukwe Road, Belville, Cape Town 7535, South Africa
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Mensch BS, Gorbach PM, Kelly C, Kiepiela P, Gomez K, Ramjee G, Ganesh S, Morar N, Soto-Torres L, Parikh UM. Characteristics Associated with HIV Drug Resistance Among Women Screening for an HIV Prevention Trial in KwaZulu-Natal, South Africa. AIDS Behav 2015; 19:2076-86. [PMID: 25931240 DOI: 10.1007/s10461-015-1056-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
While the expansion of antiretroviral therapy (ART) in sub-Saharan Africa has reduced morbidity and mortality from HIV/AIDS, it has increased concern about drug resistance. The Microbicide Trials Network 009 study assessed the prevalence of drug-resistance mutations among women at clinical sites in Durban, South Africa who tested seropositive for HIV-1 at screening for the VOICE trial. The objective of this paper was to identify characteristics and behaviors associated with drug resistance. Factors found to be significantly associated with increased resistance were high perceived risk of getting HIV and prior participation in a microbicide trial, a likely proxy for familiarity with the health care system. Two factors were found to be significantly associated with reduced resistance: having a primary sex partner and testing negative for HIV in the past year. Other variables hypothesized to be important in identifying women with resistant virus, including partner or friend on ART who shared with the participant and being given antiretrovirals during pregnancy or labor, or the proxy variable-number of times given birth in a health facility-were not significantly associated. The small number of participants with resistant virus and the probable underreporting of sensitive behaviors likely affected our ability to construct a comprehensive profile of the type of HIV-positive women at greatest risk of developing resistance mutations.
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Tsuyuki K, Surratt HL, Levi-Minzi MA, O'Grady CL, Kurtz SP. The Demand for Antiretroviral Drugs in the Illicit Marketplace: Implications for HIV Disease Management Among Vulnerable Populations. AIDS Behav 2015; 19:857-68. [PMID: 25092512 PMCID: PMC4318775 DOI: 10.1007/s10461-014-0856-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The diversion of antiretroviral medications (ARVs) has implications for the integrity and success of HIV care, however little is known about the ARV illicit market. This paper aimed to identify the motivations for buying illicit ARVs and to describe market dynamics. Semi-structured interviews (n = 44) were conducted with substance-involved individuals living with HIV who have a history of purchasing ARVs on the street. Grounded theory was used to code and analyze interviews. Motivations for buying ARVs on the illicit market were: to repurchase ARVs after having diverted them for money or drugs; having limited access or low quality health care; to replace lost or ruined ARVs; and to buy a back-up stock of ARVs. This study identified various structural barriers to HIV treatment and ARV adherence that incentivized ARV diversion. Findings highlight the need to improve patient-provider relationships, ensure continuity of care, and integrate services to engage and retain high-needs populations.
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Affiliation(s)
- Kiyomi Tsuyuki
- Center for Applied Research on Substance Use and Health Disparities, Nova Southeastern University, 2 NE 40th Street, Suite 404, Miami, FL, 33137, USA,
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Mimiaga MJ, Closson EF, Safren SA, Mabude Z, Mosery N, Taylor SW, Perez-Brumer A, Matthews LT, Psaros C, Harrison A, Grelotti DJ, Bangsberg DR, Smit JA. Inkwari: an emerging high-risk place potentiating hiv spread among young adults in a hyper-endemic South African setting. ARCHIVES OF SEXUAL BEHAVIOR 2015; 44:307-15. [PMID: 25091214 PMCID: PMC4441263 DOI: 10.1007/s10508-014-0330-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/01/2013] [Revised: 02/11/2014] [Accepted: 03/03/2014] [Indexed: 05/28/2023]
Abstract
Young adults in South Africa are at the epicenter of the HIV epidemic. The prevalence of HIV among young people in the province of KwaZulu-Natal (KZN) is particularly high. This study characterizes inkwari (Zulu word for raves or weekend-long parties) in eThekwini District, KZN and explored how these place-based dynamics shape the risk environment for the young adult attendees. In 2011, 13 qualitative interviews were conducted with men and women between 18 and 30 years-old who reported unprotected sex with at least one casual partner in the prior 3 months and attended an inkwari in the same time period. Interviews were analyzed using qualitative content analysis. Nine key informant interviews helped to triangulate these data. Five women and eight men were interviewed and the mean age was 25 years (SD 3.24). Ten reported meeting a sexual partner at an inkwari. Inkwari were characterized as sexualized settings with limited adult supervision. Participants attended inkwari to socialize with peers, use drugs and alcohol, and meet sexual partners. Sexual and physical violence also occurred at inkwari. Given the convergence of social, sexual, and substance-using networks at inkwari, further inquiry is needed to determine how this place may potentiate HIV transmission risk in an endemic setting.
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Affiliation(s)
- Matthew J Mimiaga
- Department of Psychiatry, Harvard Medical School, Massachusetts General Hospital, 1 Bowdoin Square, 7th Floor, Boston, MA, 02114, USA,
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