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Wand H, Vujovich-Dunn C, Derrick K, Moodley J, Reddy T, Naidoo S. Geospatial variations in socioeconomic conditions and health outcomes in COVID-19 era: insights from South Africa (2020-2022). GEOJOURNAL 2023; 88:1-17. [PMID: 38625344 PMCID: PMC9988606 DOI: 10.1007/s10708-023-10851-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 02/20/2023] [Indexed: 04/17/2024]
Abstract
South Africa also has the highest burden of coronavirus disease 2019 (COVID-19) related comorbidities in Africa. We aimed to quantify the temporal and geospatial changes in unemployment, food insecurity, and their combined impact on depressive symptoms among South Africans who participated into several rounds of national surveys. We estimated the population-attributable risk percent (P A R % ) for the combinations of the risk factors after accounting for their correlation structure in multifactorial setting. Our study provided compelling evidence for immediate and severe effect of the pandemic where 60% of South Africans reported household food insecurity or household hunger, shortly after the pandemic emerged in 2020. Despite the grants provided by the government, these factors were also identified as the most influential risk factors (adjusted odds ratios (aORs) ranged from 2.06 to 3.10, p < 0.001) for depressive symptoms and collectively associated with 62% and 53% of the mental health symptoms in men and women, respectively. Similar pattern was observed among pregnant women and 41% of the depressive symptoms were exclusively associated with those who reported household hunger. However, aORs associated with the concerns around pandemic and vaccine were mostly not significant and ranged from 1.12 to 1.26 which resulted substantially lower impacts on depressive symptoms (PAR%:7%-and-14%). Our findings suggest that South Africa still has unacceptably high rates of hunger which is accelerated during the pandemic. These results may have significant clinical and epidemiological implications and may also bring partial explanation for the low vaccine coverage in the country, as priorities and concerns are skewed towards economic concerns and food insecurity.
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Affiliation(s)
- Handan Wand
- Biostatistics and Databases Program ,Kirby Institute, University of New South Wales, Level 6, Wallace Wurth Building, Kensington, NSW 2052 Australia
| | - Cassandra Vujovich-Dunn
- Biostatistics and Databases Program ,Kirby Institute, University of New South Wales, Level 6, Wallace Wurth Building, Kensington, NSW 2052 Australia
| | - Kate Derrick
- Emergency Department, Royal Prince Alfred Hospital, Sydney, Australia
| | | | - Tarylee Reddy
- Biostatistics Unit, South African Medical Research Council, Durban, Kwazulu-Natal South Africa
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Quantifying the temporal changes in geographical-level contributions of risk factors to hypertension (2008-2017): Results from national surveys. Prev Med 2022; 163:107222. [PMID: 36027992 DOI: 10.1016/j.ypmed.2022.107222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 07/06/2022] [Accepted: 08/18/2022] [Indexed: 11/20/2022]
Abstract
South Africa has one of the world's highest proportions of hypertensive individuals, which has become a major public health problem. Understanding the temporal and spatial patterns in hypertension rates is crucial for evaluating the existing prevention and care models, which have not been fully understood in South Africa. The geoadditive models were used to quantify the geographical clustering of hypertension in the Black South African population enrolled in the most recent cross-sectional national surveys (2008-2017). Population-attributable risks were calculated for modifiable risk factors. 80,270 men (41%) and women (59%) aged 15+ were included. Using the 2017 guidelines, 52% of the men and 51% of the women were classified as hypertensive. As expected, these proportions were slightly lower when we used the previous guidelines (48% and 47% for men and women, respectively). There was significant geospatial heterogeneity in hypertension prevalence with substantial province-specific disparities. Western, Northern, and Eastern Capes were the most significant provinces, with >50% of the hypertensive men and women. The population-level impact of obesity remained high in all provinces, where 33%-to-57% and 47%-to-65% of hypertensives were exclusively associated with obese/overweight men and women respectively. Despite some improvements in certain areas, most of the country is behind the targeted levels set in 2011/2013. Identifying the most relevant risk factors and their sub-geographical-level contributions to hypertension may have significant public health implications for developing and implementing cost-effective prevention programs to raise awareness of healthy diet and lifestyle behaviours.
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Wand H, Vujovich-Dunn C, Moodley J, Reddy T, Naidoo S. Developing and Validating Risk Algorithm for Hypertension in South Africa: Results from a Nationally Representative Cohort (2008-2017). High Blood Press Cardiovasc Prev 2022; 29:451-461. [PMID: 35917033 PMCID: PMC9537209 DOI: 10.1007/s40292-022-00534-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 07/04/2022] [Indexed: 11/26/2022] Open
Abstract
Introduction There is compelling evidence of significant country-level disparities where African countries, particularly South Africa, have the highest hypertension rates in the world. Aim To develop and validate a simple risk scoring algorithm for hypertension in a large cohort (80,270) of South African men and women. Methods Multivariable logistic regression models were used to build our hypertension risk scoring algorithm and validated externally and internally using the standard statistical techniques. We also compared our risk scores with the results from the Framingham risk prediction model for hypertension. Results Six factors were identified as the significant correlates of hypertension: age, education, obesity, smoking, alcohol intake and exercise. A score of ≥ 25 (out of 57) for men and ≥ 35 (out of 75) for women were selected as the optimum cut-points with 82% (43%) and 83% (49%) sensitivity (specificity) for males and females, respectively in the development datasets. We estimated probabilities of developing hypertension using the Framingham risk prediction model, which were higher among those with higher scores for hypertension. Conclusions Identifying, targeting and prioritising individuals at highest risk of hypertension will have significant impact on preventing severe cardiometabolic diseases by scaling up healthy diet and life-style factors. Our six-item risk scoring algorithm may be included as part of hypertension prevention and treatment programs by targeting older individuals with high body fat measurements who are at highest risk of developing hypertension. Supplementary Information The online version contains supplementary material available at 10.1007/s40292-022-00534-5.
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Affiliation(s)
- Handan Wand
- Biostatistics and Databases Program, Kirby Institute, University of New South Wales (UNSW Sydney), Level 6, Wallace Wurth Building, Kensington, Sydney, NSW 2052 Australia
| | - Cassandra Vujovich-Dunn
- Biostatistics and Databases Program, Kirby Institute, University of New South Wales (UNSW Sydney), Level 6, Wallace Wurth Building, Kensington, Sydney, NSW 2052 Australia
| | | | - Tarylee Reddy
- Biostatistics Unit, South African Medical Research Council, Durban, Kwazulu-Natal South Africa
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Ong JJ, Coulthard K, Quinn C, Tang MJ, Huynh T, Jamil MS, Baggaley R, Johnson C. Risk-Based Screening Tools to Optimise HIV Testing Services: a Systematic Review. Curr HIV/AIDS Rep 2022; 19:154-165. [PMID: 35147855 PMCID: PMC8832417 DOI: 10.1007/s11904-022-00601-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2022] [Indexed: 12/31/2022]
Abstract
PURPOSE OF REVIEW Effective ways to diagnose the remaining people living with HIV who do not know their status are a global priority. We reviewed the use of risk-based tools, a set of criteria to identify individuals who would not otherwise be tested (screen in) or excluded people from testing (screen out). RECENT FINDINGS Recent studies suggest that there may be value in risk-based tools to improve testing efficiency (i.e. identifying those who need to be tested). However, there has not been any systematic reviews to synthesize these studies. We identified 18,238 citations, and 71 were included. The risk-based tools identified were most commonly from high-income (51%) and low HIV (<5%) prevalence countries (73%). The majority were for "screening in" (70%), with the highest performance tools related to identifying MSM with acute HIV. Screening in tools may be helpful in settings where it is not feasible or recommended to offer testing routinely. Caution is needed for screening out tools, where there is a trade-off between reducing costs of testing with missing cases of people living with HIV.
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Affiliation(s)
- J J Ong
- Central Clinical School, Monash University, Melbourne, Australia.
- Melbourne Sexual Health Centre, The Alfred Hospital, Melbourne, Australia.
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK.
| | - K Coulthard
- Melbourne Sexual Health Centre, The Alfred Hospital, Melbourne, Australia
| | - C Quinn
- Global HIV, Hepatitis and STIs Programmes, World Health Organization, Geneva, Switzerland
| | - M J Tang
- Central Clinical School, Monash University, Melbourne, Australia
| | - T Huynh
- Central Clinical School, Monash University, Melbourne, Australia
| | - M S Jamil
- Global HIV, Hepatitis and STIs Programmes, World Health Organization, Geneva, Switzerland
| | - R Baggaley
- Global HIV, Hepatitis and STIs Programmes, World Health Organization, Geneva, Switzerland
| | - C Johnson
- Global HIV, Hepatitis and STIs Programmes, World Health Organization, Geneva, Switzerland
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Jubayer Biswas MAA, Kafi MA, Hemel MMM, Ahmed MMM, Khan SI. Women empowerment and sexually transmitted infections: Evidence from Bangladesh demographic and health survey 2014. PLoS One 2022; 17:e0263958. [PMID: 35171939 PMCID: PMC8849524 DOI: 10.1371/journal.pone.0263958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 02/01/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Sexually transmitted infections (STIs) among women have led to substantial public health and economic burdens in several low-middle-income countries. However, there is a paucity of scientific knowledge about the relationship between empowerment and symptoms of STIs among married Bangladeshi women. This article aimed to examine the association between women empowerment and symptoms of STIs among currently married Bangladeshi women of reproductive age. MATERIALS AND METHODS We extracted data from the Bangladesh Demographic and Health Survey (BDHS), conducted from June 28, 2014, to November 9, 2014. We utilised cross-tabulation, the conceptual framework and multivariable multilevel mixed-effect logistics regression to explore the association between women's empowerment indicators and women's self-reported symptoms of genital sore and abnormal genital discharge. All of the analysis was adjusted using cluster weight. RESULTS We found that among 16,858 currently married women, 5.59% and 10.84% experienced genital sores and abnormal genital discharge during the past 12 months, respectively. Women who depended on husbands to make decisions regarding their health care (AOR = 0.75, 95% CI = 0.67-0.84), significant household purchases (AOR = 0.79, 95% CI = 0.71-0.88), and visiting family or relatives (AOR = 0.72, 95% CI = 0.64-0.80) were less likely to report signs of abnormal genital discharge. Women who could make joint healthcare decisions with their husbands were also less likely to report genital sores (AOR = 0.78, 95% CI = 0.67-0.90). CONCLUSION Genital sores and abnormal genital discharge were prevalent across all parameters of women empowerment among currently married women in Bangladesh. Our estimates show that the husband plays a significant role in decision-making about sexual and reproductive health. Efforts need to be invested in establishing culturally relevant gender policies which facilitate the involvement of women in joint decision-making.
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Affiliation(s)
| | - Mohammad Abdullah Kafi
- Program for Emerging Infection, Infectious Diseases Division, icddr,b, Dhaka, Bangladesh
| | | | - Mondar Maruf Moin Ahmed
- Maternal and Child Nutrition, Nutrition and Clinical Services Division, icddr,b, Dhaka, Bangladesh
| | - Sharful Islam Khan
- Program for HIV and AIDS, Infectious Diseases Division, icddr,b, Dhaka, Bangladesh
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Jia KM, Eilerts H, Edun O, Lam K, Howes A, Thomas ML, Eaton JW. Risk scores for predicting HIV incidence among adult heterosexual populations in sub-Saharan Africa: a systematic review and meta-analysis. J Int AIDS Soc 2022; 25:e25861. [PMID: 35001515 PMCID: PMC8743366 DOI: 10.1002/jia2.25861] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 12/06/2021] [Indexed: 11/24/2022] Open
Abstract
Introduction Several HIV risk scores have been developed to identify individuals for prioritized HIV prevention in sub‐Saharan Africa. We systematically reviewed HIV risk scores to: (1) identify factors that consistently predicted incident HIV infection, (2) review inclusion of community‐level HIV risk in predictive models and (3) examine predictive performance. Methods We searched nine databases from inception until 15 February 2021 for studies developing and/or validating HIV risk scores among the heterosexual adult population in sub‐Saharan Africa. Studies not prospectively observing seroconversion or recruiting only key populations were excluded. Record screening, data extraction and critical appraisal were conducted in duplicate. We used random‐effects meta‐analysis to summarize hazard ratios and the area under the receiver‐operating characteristic curve (AUC‐ROC). Results From 1563 initial search records, we identified 14 risk scores in 13 studies. Seven studies were among sexually active women using contraceptives enrolled in randomized‐controlled trials, three among adolescent girls and young women (AGYW) and three among cohorts enrolling both men and women. Consistently identified HIV prognostic factors among women were younger age (pooled adjusted hazard ratio: 1.62 [95% confidence interval: 1.17, 2.23], compared to above 25), single/not cohabiting with primary partners (2.33 [1.73, 3.13]) and having sexually transmitted infections (STIs) at baseline (HSV‐2: 1.67 [1.34, 2.09]; curable STIs: 1.45 [1.17; 1.79]). Among AGYW, only STIs were consistently associated with higher incidence, but studies were limited (n = 3). Community‐level HIV prevalence or unsuppressed viral load strongly predicted incidence but was only considered in 3 of 11 multi‐site studies. The AUC‐ROC ranged from 0.56 to 0.79 on the model development sets. Only the VOICE score was externally validated by multiple studies, with pooled AUC‐ROC 0.626 [0.588, 0.663] (I2: 64.02%). Conclusions Younger age, non‐cohabiting and recent STIs were consistently identified as predicting future HIV infection. Both community HIV burden and individual factors should be considered to quantify HIV risk. However, HIV risk scores had only low‐to‐moderate discriminatory ability and uncertain generalizability, limiting their programmatic utility. Further evidence on the relative value of specific risk factors, studies populations not restricted to “at‐risk” individuals and data outside South Africa will improve the evidence base for risk differentiation in HIV prevention programmes. PROSPERO Number CRD42021236367
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Affiliation(s)
- Katherine M Jia
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, UK
| | - Hallie Eilerts
- Department of Population Health, The London School of Hygiene and Tropical Medicine, London, UK
| | - Olanrewaju Edun
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, UK
| | - Kevin Lam
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, UK
| | - Adam Howes
- Department of Mathematics, Imperial College London, London, UK
| | - Matthew L Thomas
- Joint Centre for Excellence in Environmental Intelligence, University of Exeter & Met Office, Exeter, UK
| | - Jeffrey W Eaton
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, UK
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Wand H, Richmond R, Adily A, Le A, Wilhelm K, Butler T. Identifying significant contributors for smoking cessation among male prisoners in Australia: results from a randomised clinical trial. BMJ Open 2020; 10:e034046. [PMID: 32690730 PMCID: PMC7375500 DOI: 10.1136/bmjopen-2019-034046] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 05/26/2020] [Accepted: 05/29/2020] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION In Australia, an estimated 90% of those entering prison are current tobacco smokers and three-quarters of current prisoners are tobacco smokers. AIMS To identify factors and their relative contributions to smoking cessation among male prisoners. METHODS A total of 425 male tobacco smokers with a median age of 32 years in Australian prisons. The primary outcome was continuous abstinence at 3, 6 and 12 months. We measured various sociodemographic characteristics, drug use, psychological distress and the mental and physical health status of the participants. Multivariate logistic regression models and population attributable risks (PAR%) were used to identify the significant factors and their contributions to smoking cessation rates. RESULTS The median age of participants was 32 years (IQR 25-41 years). High smoking cessation rates were collectively associated with not using drugs, lower psychological distress, good mental health scores and better physical health (PAR%: 93%, 98% and 88% at 3, 6 and 12 months). CONCLUSION Our study suggests that not using drugs and being in good mental/physical health are the important contributors to continuous abstinence among prisoners. Thus, effective smoking cessation programmes require a multicomponent approach that includes addressing drug problems and mental health functioning. TRIAL REGISTRATION NUMBER 12606000229572.
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Affiliation(s)
- Handan Wand
- Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Robyn Richmond
- School of Public Health and Community Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Armita Adily
- Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Andrea Le
- Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Kay Wilhelm
- School of Psychiatry, University of New South Wales, Sydney, Australila
| | - Tony Butler
- Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
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The impact of self-selection based on HIV risk on the cost-effectiveness of preexposure prophylaxis in South Africa. AIDS 2020; 34:883-891. [PMID: 32004205 DOI: 10.1097/qad.0000000000002486] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES We explored the impact and cost-effectiveness of preexposure prophylaxis (PrEP) provision to different populations in South Africa, with and without effective self-selection by individuals at highest risk of contracting HIV (through concurrent partnerships and/or commercial sex). DESIGN AND METHODS We used a previously developed HIV transmission model to analyse the epidemiological impact of PrEP provision to adolescents, young adults, pregnant women, female sex workers (FSWs) and (MSM), and data from South African PrEP programmes to estimate the cost and cost-effectiveness of PrEP (cost in 2019 USD per HIV infection averted over 20 years, 2019, 38). PrEP uptake followed data from early implementation sites, scaled-up linearly over 3 years, with target coverage set to 18% for adolescents, young adults and pregnant women, 30% for FSW and 54% for MSM. RESULTS The annual cost of PrEP provision ranges between $75 and $134 per person. PrEP provision adolescents and young adults, regardless of risk behaviour, will each avert 3.2--4.8% of HIV infections over 20 years; provision to high-risk individuals only has similar impact at lower total cost. The incremental cost per HIV infection averted is lower in high-risk vs. all-risk sub-populations within female adolescents ($507 vs. $4537), male adolescents ($2108 vs. $5637), young women ($1592 vs. $10 323) and young men ($2605 vs. $7715), becoming cost saving within 20 years for high-risk adolescents, young women, MSM and FSWs. CONCLUSION PrEP is an expensive prevention intervention but uptake by those at the highest risk of HIV infection will make it more cost-effective, and cost-saving after 14-18 years.
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Ramjee G, Dassaye R, Reddy T, Wand H. Targeted Pregnancy and Human Immunodeficiency Virus Prevention Risk-Reduction Counseling for Young Women: Lessons Learned from Biomedical Prevention Trials. J Infect Dis 2019; 218:1759-1766. [PMID: 29947802 DOI: 10.1093/infdis/jiy388] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Accepted: 06/23/2018] [Indexed: 01/17/2023] Open
Abstract
Background Women enrolled in human immunodeficiency virus (HIV) prevention efficacy trials receive counseling on prevention of HIV, sexually transmitted infections (STIs), and pregnancy during every visit. Incident pregnancy has an impact on efficacy outcomes. Incidence rates of pregnancy and HIV/STIs among women who became pregnant and associated risk factors were assessed. Methods Data from 9165 women participating in HIV prevention trials in KwaZulu-Natal, South Africa from 2002-2012 were combined. Demographic and behavioral predictors of incidence pregnancy and incidence HIV and STIs were determined using Cox regression models. Results Overall pregnancy incidence was 9.6 per 100 person-year (py) (95% confidence interval [Cl], 9.1-10.3). Human immunodeficiency virus incidence among pregnant women was 5.93 per 100 py (95% Cl, 4.73-7.44). Incidence of STIs among pregnant women for Chlamydia trachomatis, Trichomonas vaginalis, Neisseria gonorrhoeae, and Treponema pallidum (syphilis) were 10.87, 7.42, 3.92, and 1.43 per 100 py, respectively. In the adjusted analyses, we observed overlapping risk factors for HIV acquisition during pregnancy, ie, young age, not married/not cohabitating, and low parity. The risk of pregnancy and HIV acquisition is more than 3 times higher among young women (<20 years of age). Conclusions We identified overlapping risk factors for pregnancy and HIV incidence, suggesting an urgent need for appropriate, targeted, individual-centred counseling for women participating in HIV prevention trials.
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Affiliation(s)
- Gita Ramjee
- HIV Prevention Research Unit, South African Medical Research Council, KwaZulu-Natal, South Africa.,Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, United Kingdom.,Department of Global Health, School of Medicine, University of Washington, Seattle
| | - Reshmi Dassaye
- HIV Prevention Research Unit, South African Medical Research Council, KwaZulu-Natal, South Africa
| | - Tarylee Reddy
- Biostatistics Unit, South African Medical Research Council, Durban, KwaZulu-Natal, South Africa
| | - Handan Wand
- The Kirby Institute, University of New South Wales, Kensington, Australia
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10
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Wand H, Reddy T, Naidoo S, Moonsamy S, Siva S, Morar NS, Ramjee G. A Simple Risk Prediction Algorithm for HIV Transmission: Results from HIV Prevention Trials in KwaZulu Natal, South Africa (2002-2012). AIDS Behav 2018; 22:325-336. [PMID: 28470458 DOI: 10.1007/s10461-017-1785-7] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
We aimed to develop a HIV risk scoring algorithm for targeted screening among women in South Africa. We used data from five biomedical intervention trials (N = 8982 Cox regression models were used to create a risk prediction algorithm and it was internally and externally validated using standard statistical measures; 7-factors were identified as significant predictors of HIV infection: <25 years old, being single/not cohabiting, parity (<3), age at sexual debut (<16), 3+ sexual partners, using injectables and diagnosis with a sexually transmitted infection(s). A score of ≥25 (out of 50) was the optimum cut point with 83% (80%) sensitivity in the development (validation) dataset. Our tool can be used in designing future HIV prevention research and guiding recruitment strategies as well as in health care settings. Identifying, targeting and prioritising women at highest risk will have significant impact on preventing new HIV infections by scaling up testing and pre-exposure prophylaxis in conjunction with other HIV prevention modalities.
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Affiliation(s)
- Handan Wand
- Kirby Institute, University of New South Wales, Kensington, NSW, 2052, Australia.
| | - Tarylee Reddy
- Biostatistics Unit, South African Medical Research Council, Durban, Kwazulu-Natal, South Africa
| | - Sarita Naidoo
- HIV Prevention Research Unit, South African Medical Research Council, Westville, Durban, 3630, KwaZulu-Natal, South Africa
| | - Suri Moonsamy
- HIV Prevention Research Unit, South African Medical Research Council, Westville, Durban, 3630, KwaZulu-Natal, South Africa
| | - Samantha Siva
- HIV Prevention Research Unit, South African Medical Research Council, Westville, Durban, 3630, KwaZulu-Natal, South Africa
| | - Neetha S Morar
- HIV Prevention Research Unit, South African Medical Research Council, Westville, Durban, 3630, KwaZulu-Natal, South Africa
| | - Gita Ramjee
- HIV Prevention Research Unit, South African Medical Research Council, Westville, Durban, 3630, KwaZulu-Natal, South Africa
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Abrahams N, Seedat S, Lombard C, Kengne AP, Myers B, Sewnath A, Mhlongo S, Ramjee G, Peer N, Garcia-Moreno C, Jewkes R. Study protocol for a longitudinal study evaluating the impact of rape on women's health and their use of health services in South Africa. BMJ Open 2017; 7:e017296. [PMID: 28965098 PMCID: PMC5640088 DOI: 10.1136/bmjopen-2017-017296] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
INTRODUCTION South Africa is a country known for its high levels of HIV infection and sexual violence. Although the interface between gender-based violence, HIV and mental health has been described, there are substantial gaps in knowledge of the medium-term and long-term health impact. The 2010 Global Burden of Disease study excluded many health outcomes associated with rape and other forms of gender-based violence because systematic reviews revealed huge gaps in data and poor evidence of health effects. This study aims to describe the incidence and attributable burden of physical and mental health problems (including HIV acquisition) in adult women over a 2-year postrape period, through comparison with a cohort of women who have not been raped. The study will substantially advance our understanding of the impact of rape and will generate robust data to assist in the development of postrape health services and the delivery of evidence-based care. METHODS AND ANALYSIS This longitudinal study seeks to recruit 1008 rape-exposed and 1008 rape non-exposed women. Women were recruited from health services, and assessments were carried out at baseline, 3, 6, 9, 12, 18 and 24 months. Outcome measures include exposure to risk factors; mental health status; cardio-metabolic risks; and biomarkers for HIV, sexually transmitted infections, pregnancy and stress. The primary analysis will be to compare HIV incidence in the two groups using log-rank tests. Appropriate models to predict health outcomes over time will also be applied. ETHICS AND DISSEMINATION The South African Medical Research Council's Ethics Committee approved the study. As rape is a key element of the study, the safety and protection of participants guides the research process. We will adopt a research uptake strategy to ensure dissemination to policy makers, service providers and advocacy groups. Peer-reviewed journal articles will be published.
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Affiliation(s)
- Naeemah Abrahams
- Gender and Health Research Unit, South African Medical Research Council, Tygerberg, South Africa
| | - Soraya Seedat
- Anxiety and Stress Disorder Unit, University of Stellenbosch, Cape Town, South Africa
| | - Carl Lombard
- Biostatistics Unit, South Africa Medical Research Council, Cape Town, South Africa
| | - Andre P Kengne
- Non-Communicable Disease Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Bronwyn Myers
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Alesha Sewnath
- Gender and Health Research Unit, South African Medical Research Council, Tygerberg, South Africa
| | - Shibe Mhlongo
- Gender and Health Research Unit, South African Medical Research Council, Tygerberg, South Africa
| | - Gita Ramjee
- HIV Prevention Research Unit, South African Medical Research Council, Durban, South Africa
| | - Nasheeta Peer
- Non-Communicable Disease Research Unit, South African Medical Research Council, Durban, South Africa
| | - Claudia Garcia-Moreno
- Department of Reproductive Health and Research, World Health Organisation, Geneva, Switzerland
| | - Rachel Jewkes
- Gender and Health Research Unit, South African Medical Research Council, Tygerberg, South Africa
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Dubbink JH, van der Eem L, McIntyre JA, Mbambazela N, Jobson GA, Ouburg S, Morre SA, Struthers HE, Peters RPH. Sexual behaviour of women in rural South Africa: a descriptive study. BMC Public Health 2016; 16:557. [PMID: 27405338 PMCID: PMC4942904 DOI: 10.1186/s12889-016-3207-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2015] [Accepted: 06/23/2016] [Indexed: 11/24/2022] Open
Abstract
Background Sexual behaviour is a core determinant of the HIV and sexually transmitted infection (STI) epidemics in women living in rural South Africa. Knowledge of sexual behaviour in these areas is limited, but constitutes essential information for a combination prevention approach of behavioural change and biomedical interventions. Methods This descriptive study was conducted in rural Mopani District, South Africa, as part of a larger study on STI. Women of reproductive age (18–49 years) who reported sexual activity were included regardless of the reason for visiting the facility. Questionnaires were administered to 570 women. We report sexual behaviour by age group, ethnic group and self-reported HIV status. Results Young women (<25 years) were more likely to visit bars, practice fellatio, have concurrent sexual partners and report a circumcised partner than older women (>34 years); there was no difference for condom use during last sex act (36 % overall). Sotho women were more likely to report concurrent sexual partners whereas Shangaan women reported more frequent intravaginal cleansing and vaginal scarring practice in our analysis. HIV-infected women were older, had a higher number of lifetime sexual partners, reported more frequent condom use during the last sex act and were more likely to have a known HIV-infected partner than women without HIV infection; hormonal contraceptive use, fellatio, and a circumcised partner were less often reported. Conclusions This study provides insight into women’s sexual behaviour in a rural South African region. There are important differences in sexual behaviour by age group and ethnicity and HIV status; these should be taken into account when designing tailor-made prevention packages.
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Affiliation(s)
- Jan Henk Dubbink
- Anova Health Institute, Johannesburg, Tzaneen, South Africa.,Institute for Public Health Genomics (IPHG), Department of Genetics and Cell Biology, Research School GROW (School for Oncology & Developmental Biology), Faculty of Health, Medicine & Life Sciences, University of Maastricht, Maastricht, The Netherlands.,Department of Medical Microbiology & Infection Control, Laboratory of Immunogenetics, VU University Medical Center, Amsterdam, The Netherlands
| | - Lisette van der Eem
- Anova Health Institute, Johannesburg, Tzaneen, South Africa.,Department of Medical Microbiology & Infection Control, Laboratory of Immunogenetics, VU University Medical Center, Amsterdam, The Netherlands
| | - James A McIntyre
- Anova Health Institute, Johannesburg, Tzaneen, South Africa.,School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | | | | | - Sander Ouburg
- Department of Medical Microbiology & Infection Control, Laboratory of Immunogenetics, VU University Medical Center, Amsterdam, The Netherlands
| | - Servaas A Morre
- Institute for Public Health Genomics (IPHG), Department of Genetics and Cell Biology, Research School GROW (School for Oncology & Developmental Biology), Faculty of Health, Medicine & Life Sciences, University of Maastricht, Maastricht, The Netherlands.,Department of Medical Microbiology & Infection Control, Laboratory of Immunogenetics, VU University Medical Center, Amsterdam, The Netherlands
| | - Helen E Struthers
- Anova Health Institute, Johannesburg, Tzaneen, South Africa.,Division of Infectious Diseases & HIV Medicine, Department of Internal Medicine, University of Cape Town, Cape Town, South Africa
| | - Remco P H Peters
- Anova Health Institute, Johannesburg, Tzaneen, South Africa. .,Department of Medical Microbiology, University of Pretoria, Pretoria, South Africa. .,Department of Medical Microbiology, Maastricht University Medical Center, Maastricht, The Netherlands. .,Anova Health Institute, PostNet Suite 242, Private Bag X30500, 2041, Houghton, Johannesburg, South Africa.
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Ramjee G, Daniels B. Women and HIV in Sub-Saharan Africa. AIDS Res Ther 2013; 10:30. [PMID: 24330537 PMCID: PMC3874682 DOI: 10.1186/1742-6405-10-30] [Citation(s) in RCA: 164] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2013] [Accepted: 11/26/2013] [Indexed: 12/24/2022] Open
Abstract
Thirty years since the discovery of HIV, the HIV pandemic in sub-Saharan Africa accounts for more than two thirds of the world's HIV infections. Southern Africa remains the region most severely affected by the epidemic. Women continue to bear the brunt of the epidemic with young women infected almost ten years earlier compared to their male counterparts. Epidemiological evidence suggests unacceptably high HIV prevalence and incidence rates among women. A multitude of factors increase women's vulnerability to HIV acquisition, including, biological, behavioral, socioeconomic, cultural and structural risks. There is no magic bullet and behavior alone is unlikely to change the course of the epidemic. Considerable progress has been made in biomedical, behavioral and structural strategies for HIV prevention with attendant challenges of developing appropriate HIV prevention packages which take into consideration the socioeconomic and cultural context of women in society at large.
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14
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Wand H, Ramjee G. Evaluating HIV prevention efforts using semiparametric regression models: results from a large cohort of women participating in an HIV prevention trial from KwaZulu-Natal, South Africa. J Int AIDS Soc 2013; 16:18589. [PMID: 24280372 PMCID: PMC3841298 DOI: 10.7448/ias.16.1.18589] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2013] [Revised: 09/08/2013] [Accepted: 10/02/2013] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVE To describe and quantify the differences in risk behaviours, HIV prevalence and incidence rates by birth cohorts among a group of women in Durban, South Africa. METHODS Cross-sectional and prospective cohort analyses were conducted for women who consented to be screened and enrolled in an HIV prevention trial. Demographic and sexual behaviours were described by five-year birth cohorts. Semiparametric regression models were used to investigate the bivariate associations between these factors and the birth cohorts. HIV seroconversion rates were also estimated by birth cohorts. RESULTS The prevalence of HIV-1 infection at the screening visit was lowest (20.0%) among the oldest (born before 1960) cohorts, while the highest prevalence was observed among those born between 1975 and 79. Level of education increased across the birth cohorts while the median age at first sexual experience declined among those born after 1975 compared to those born before 1975. Only 33.03% of the oldest group reported ever using a condom while engaging in vaginal sex compared to 73.68% in the youngest group; however, HIV and other sexually transmitted infection (STI) incidence rates were significantly higher among younger women compared to older women. CONCLUSIONS These findings clearly suggest that demographic and sexual risk behaviours are differentially related to the birth cohorts. Significantly high HIV and STI incidence rates were observed among the younger group. Although the level of education increased, early age at sexual debut was more common among the younger group. The continuing increase in HIV and STI incidence rates among the later cohorts suggests that the future trajectory of the epidemic will be dependent on the infection patterns in younger birth cohorts.
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Affiliation(s)
- Handan Wand
- The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Gita Ramjee
- HIV Prevention Research Unit, Medical Research Council, Durban, South Africa
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Community-based conservation reduces sexual risk factors for HIV among men. Global Health 2013; 9:27. [PMID: 23837454 PMCID: PMC3708736 DOI: 10.1186/1744-8603-9-27] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2013] [Accepted: 06/17/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Despite numerous programs to combat the global HIV and AIDS pandemic, infection rates remain high, especially in sub-Saharan Africa, where two-thirds of all people living with HIV reside. Here, we describe how we used rigorous program evaluation methods to assess the effectiveness of a community-based natural resource management program that "mainstreamed" HIV awareness and prevention activities within rural communities in Namibia. FINDINGS We used data from two rounds of the Namibia Demographic and Health Surveys (2000 and 2006/2007) and quasi-experimental statistical methods to evaluate changes in critical health-related outcomes in men and women living in communal conservancies, relative to several non-conservancy comparison groups. Our final dataset included 117 men and 318 women in 2000, and 170 men and 357 women in 2006/2007. We evaluated the statistical significance of the main effects of survey year and conservancy residence, and a conservancy-year interaction term, using generalized linear models. Our analyses show that community-based conservation in Namibia has significantly reduced multiple sexual partnerships, the main behavioural determinant of HIV/AIDS infection in Africa. CONCLUSIONS Our results demonstrate the effectiveness of holistic community-based approaches centered on the preservation of lives and livelihoods, and highlight the potential benefits of integrating conservation and HIV prevention programming in other areas of communal land tenure in Africa.
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