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Achoki T, Sartorius B, Watkins D, Glenn SD, Kengne AP, Oni T, Wiysonge CS, Walker A, Adetokunboh OO, Babalola TK, Bolarinwa OA, Claassens MM, Cowden RG, Day CT, Ezekannagha O, Ginindza TG, Iwu CCD, Iwu CJ, Karangwa I, Katoto PD, Kugbey N, Kuupiel D, Mahasha PW, Mashamba-Thompson TP, Mensah GA, Ndwandwe DE, Nnaji CA, Ntsekhe M, Nyirenda TE, Odhiambo JN, Oppong Asante K, Parry CDH, Pillay JD, Schutte AE, Seedat S, Sliwa K, Stein DJ, Tanser FC, Useh U, Zar HJ, Zühlke LJ, Mayosi BM, Hay SI, Murray CJL, Naghavi M. Health trends, inequalities and opportunities in South Africa's provinces, 1990-2019: findings from the Global Burden of Disease 2019 Study. J Epidemiol Community Health 2022; 76:jech-2021-217480. [PMID: 35046100 PMCID: PMC8995905 DOI: 10.1136/jech-2021-217480] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 12/14/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Over the last 30 years, South Africa has experienced four 'colliding epidemics' of HIV and tuberculosis, chronic illness and mental health, injury and violence, and maternal, neonatal, and child mortality, which have had substantial effects on health and well-being. Using data from the 2019 Global Burden of Diseases, Injuries and Risk Factors Study (GBD 2019), we evaluated national and provincial health trends and progress towards important Sustainable Development Goal targets from 1990 to 2019. METHODS We analysed GBD 2019 estimates of mortality, non-fatal health loss, summary health measures and risk factor burden, comparing trends over 1990-2007 and 2007-2019. Additionally, we decomposed changes in life expectancy by cause of death and assessed healthcare system performance. RESULTS Across the nine provinces, inequalities in mortality and life expectancy increased over 1990-2007, largely due to differences in HIV/AIDS, then decreased over 2007-2019. Demographic change and increases in non-communicable diseases nearly doubled the number of years lived with disability between 1990 and 2019. From 1990 to 2019, risk factor burdens generally shifted from communicable and nutritional disease risks to non-communicable disease and injury risks; unsafe sex remained the top risk factor. Despite widespread improvements in healthcare system performance, the greatest gains were generally in economically advantaged provinces. CONCLUSIONS Reductions in HIV/AIDS and related conditions have led to improved health since 2007, though most provinces still lag in key areas. To achieve health targets, provincial governments should enhance health investments and exchange of knowledge, resources and best practices alongside populations that have been left behind, especially following the COVID-19 pandemic.
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Affiliation(s)
- Tom Achoki
- Research, Africa Institute for Health Policy, Nairobi, Kenya
- Center for Pharmaceutical Policy and Regulation, Utrecht University, Utrecht, Netherlands
| | - Benn Sartorius
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, Washington, USA
| | - David Watkins
- Department of Medicine, University of Washington, Seattle, WA, USA
- Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Scott D Glenn
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Andre Pascal Kengne
- Department of Medicine, University of Cape Town, Cape Town, South Africa
- Non-communicable Diseases Research Unit, Medical Research Council South Africa, Cape Town, South Africa
| | - Tolu Oni
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
- School of Public Health and Family Medicine, University of Cape Town, Rondebosch, Western Cape, South Africa
| | - Charles Shey Wiysonge
- School of Public Health and Family Medicine, University of Cape Town, Rondebosch, Western Cape, South Africa
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
| | - Alexandra Walker
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Olatunji O Adetokunboh
- Centre of Excellence for Epidemiological Modelling and Analysis, Stellenbosch University, Stellenbosch, South Africa
- Department of Global Health, Stellenbosch University, Stellenbosch, South Africa
| | - Tesleem Kayode Babalola
- Discipline of Public Health Medicine, University of KwaZulu-Natal, Durban, South Africa
- Department of Community Health and Primary Care, University of Lagos, Lagos, Nigeria
| | | | - Mareli M Claassens
- Department of Biochemistry and Microbiology, University of Namibia, Windhoek, Namibia
- Department of Paediatrics and Child Health, Stellenbosch University, Tygerberg, South Africa
| | - Richard G Cowden
- Department of Psychology, University of the Free State, Park WEst, Free State, South Africa
| | - Candy T Day
- Health Systems Research Unit, Health System Trust, Westville, South Africa
| | - Oluchi Ezekannagha
- Independent Consultant, Awka, Nigeria
- International Institute of Tropical Agriculture, Ibadan, Nigeria
| | - Themba G Ginindza
- Discipline of Public Health Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Chidozie C D Iwu
- School of Health Systems and Public Health, University of Pretoria, Pretoria, South Africa
| | - Chinwe Juliana Iwu
- Department of Global Health, Stellenbosch University, Stellenbosch, South Africa
- South African Medical Research Council, Cape Town, South Africa
| | - Innocent Karangwa
- Department of Statistics and Population Studies, University of the Western Cape, Cape Town, South Africa
| | - Patrick Dmc Katoto
- Department of Global Health, Stellenbosch University, Stellenbosch, South Africa
- Centre for Tropical Diseases and Global Health, Catholic University of Bukavu, Bukavu, Democratic Republic of Congo
| | - Nuworza Kugbey
- University of Environment and Sustainable Development, Somanya, Ghana
| | - Desmond Kuupiel
- School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
- Department of Nursing, Research for Sustainable Development Consult, Sunyani, Ghana
| | - Phetole Walter Mahasha
- Grants, Innovation and Product Development Unit, South African Medical Research Council, Cape Town, South Africa
| | | | - George A Mensah
- Department of Medicine, University of Cape Town, Cape Town, South Africa
- Center for Translation Research and Implementation Science, National Institutes of Health, Bethesda, Maryland, USA
| | | | - Chukwudi A Nnaji
- School of Public Health and Family Medicine, University of Cape Town, Rondebosch, Western Cape, South Africa
- South African Medical Research Council, Cape Town, South Africa
| | - Mpiko Ntsekhe
- Division of Cardiology, University of Cape Town, Rondebosch, Western Cape, South Africa
- The Cardiac Clinic, Groote Schuur Hospital, Cape Town, South Africa
| | - Thomas Elliot Nyirenda
- Department of Global Health, Stellenbosch University, Stellenbosch, South Africa
- European and Developing Countries Clinical Trials Partnership (EDCTP), European Commission, Cape Town, South Africa
| | - Julius Nyerere Odhiambo
- Discipline of Public Health Medicine, University of KwaZulu-Natal, Durban, South Africa
- Department of Management Science and Technology, Technical University of Kenya, Nairobi, Nairobi, Kenya
| | | | - Charles D H Parry
- Alcohol, Tobacco & Other Drug Research Unit, South African Medical Research Council, Cape Town, South Africa
- Department of Psychiatry, Stellenbosch University, Stellenbosch, South Africa
| | - Julian David Pillay
- Department of Basic Medical Sciences, Durban University of Technology, Durban, South Africa
| | - Aletta Elisabeth Schutte
- School of Public Health and Community Medicine, University of New South Wales, Sydney, New South Wales, Australia
- The George Institute for Global Health, Sydney, New South Wales, Australia
| | - Soraya Seedat
- Department of Psychiatry, Stellenbosch University, Stellenbosch, South Africa
| | - Karen Sliwa
- Hatter Institute Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Dan J Stein
- Unit on Risk and Resilience in Mental Disorders, South African Medical Research Council, Cape Town, South Africa
| | - Frank C Tanser
- University of KwaZulu-Natal, Durban, South Africa
- Africa Health Research Institute, Berea, South Africa
| | - Ushotanefe Useh
- Health Sciences Department, North-West University, Mmbatho, South Africa
| | - Heather J Zar
- Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa
- Unit on Child & Adolescent Health, Medical Research Council South Africa, Cape Town, South Africa
| | - Liesl J Zühlke
- Department of Medicine, University of Cape Town, Cape Town, South Africa
- Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa
| | | | - Simon I Hay
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, Washington, USA
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Christopher J L Murray
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, Washington, USA
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Mohsen Naghavi
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, Washington, USA
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
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Laher F, Salami T, Hornschuh S, Makhale LM, Khunwane M, Andrasik MP, Gray GE, Van Tieu H, Dietrich JJ. Willingness to use HIV prevention methods among vaccine efficacy trial participants in Soweto, South Africa: discretion is important. BMC Public Health 2020; 20:1669. [PMID: 33160341 PMCID: PMC7648553 DOI: 10.1186/s12889-020-09785-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 10/28/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Despite multiple available HIV prevention methods, the HIV epidemic continues to affect South Africa the most. We sought to understand willingness to use actual and hypothetical HIV prevention methods among participants enrolled in a preventative HIV vaccine efficacy trial in Soweto, South Africa. METHODS We conducted a qualitative study with 38 self-reporting HIV-uninfected and consenting 18-35 year olds participating in the HVTN 702 vaccine efficacy trial in Soweto. Using a semi-structured interview guide, five focus group discussions (FGDs) were held, stratified by age, gender and sexual orientation. The FGDs were composed of: (i) 10 heterosexual women aged 18-24 years; (ii) 9 heterosexual and bisexual women aged 25-35 years; (iii & iv) heterosexual men aged 25-35 years with 7 in both groups; and (v) 5 men aged 18-35 years who have sex with men. FGDs were audio-recorded, transcribed verbatim, translated into English and analysed using thematic analysis. RESULTS We present five main themes: (i) long-lasting methods are preferable; (ii) condoms are well-known but not preferred for use; (iii) administration route of HIV prevention method is a consideration for the user; (iv) ideal HIV prevention methods should blend into the lifestyle of the user; and the perception that (v) visible prevention methods indicate sexual indiscretion. CONCLUSIONS The participants' candour about barriers to condom and daily oral pre-exposure prophylaxis (PrEP) use, and expressed preferences for long-lasting, discreet, lifestyle-friendly methods reveal a gap in the biomedical prevention market aiming to reduce sexually acquired HIV in South Africa. Product developers should consider long-acting injectable formulations, such as vaccines, passive antibodies and chemoprophylaxis, for HIV prevention technologies. Future innovations in HIV prevention products may need to address the desire for the method to blend easily into lifestyles, such as food-medication formulations.
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Affiliation(s)
- Fatima Laher
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Diepkloof, P.O. Box 114, Johannesburg, Soweto, 1864, South Africa.
| | - Taibat Salami
- School of Medicine, University of Texas, San Antonio, TX, USA
| | - Stefanie Hornschuh
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Diepkloof, P.O. Box 114, Johannesburg, Soweto, 1864, South Africa
| | - Lerato M Makhale
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Diepkloof, P.O. Box 114, Johannesburg, Soweto, 1864, South Africa
| | - Mamakiri Khunwane
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Diepkloof, P.O. Box 114, Johannesburg, Soweto, 1864, South Africa
| | - Michele P Andrasik
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Glenda E Gray
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Diepkloof, P.O. Box 114, Johannesburg, Soweto, 1864, South Africa
- South African Medical Research Council, Cape Town, South Africa
| | - Hong Van Tieu
- Laboratory of Infectious Disease Prevention, New York Blood Center, New York, NY, USA
- Division of Infectious Diseases, Columbia University Medical Center, New York, NY, USA
| | - Janan J Dietrich
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Diepkloof, P.O. Box 114, Johannesburg, Soweto, 1864, South Africa
- South African Medical Research Council, Cape Town, South Africa
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5
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Bruxelle JF, Kirilenko T, Qureshi Q, Lu N, Trattnig N, Kosma P, Pantophlet R. Serum alpha-mannosidase as an additional barrier to eliciting oligomannose-specific HIV-1-neutralizing antibodies. Sci Rep 2020; 10:7582. [PMID: 32371950 PMCID: PMC7200719 DOI: 10.1038/s41598-020-64500-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 04/15/2020] [Indexed: 01/04/2023] Open
Abstract
Oligomannose-type glycans on HIV-1 gp120 form a patch that is targeted by several broadly neutralizing antibodies (bnAbs) and that therefore is of interest to vaccine design. However, attempts to elicit similar oligomannose-specific bnAbs by immunizing with oligomannosidic glycoconjugates have only been modestly successful so far. A common assumption is that eliciting oligomannose-specific bnAbs is hindered by B cell tolerance, resulting from the presented oligomannosides being sensed as self molecules. Here, we present data, along with existing scientific evidence, supporting an additional, or perhaps alternate, explanation: serum mannosidase trimming of the presented oligomannosides in vivo. Mannosidase trimming lessens the likelihood of eliciting antibodies with capacity to bind full-sized oligomannose, which typifies the binding mode of existing bnAbs to the oligomannose patch. The rapidity of the observed trimming suggests the need for immunization strategies and/or synthetic glycosides that readily avoid or resist mannosidase trimming upon immunization and can overcome possible tolerance restrictions.
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Affiliation(s)
- Jean-François Bruxelle
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, V5A1S6, Canada
| | - Tess Kirilenko
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, V5A1S6, Canada
- AbCellera Biologics Inc., Vancouver, British Columbia, Canada
| | - Quratulain Qureshi
- Department of Molecular Biology & Biochemistry, Simon Fraser University, Burnaby, British Columbia, V5A1S6, Canada
| | - Naiomi Lu
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, V5A1S6, Canada
| | - Nino Trattnig
- Department of Chemistry, University of Natural Resources and Life Sciences, Vienna, A-1190, Austria
- Department of Chemical Biology and Drug Discovery, Utrecht University, Utrecht, The Netherlands
| | - Paul Kosma
- Department of Chemistry, University of Natural Resources and Life Sciences, Vienna, A-1190, Austria
| | - Ralph Pantophlet
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, V5A1S6, Canada.
- Department of Molecular Biology & Biochemistry, Simon Fraser University, Burnaby, British Columbia, V5A1S6, Canada.
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6
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O’Rourke SM, Byrne G, Tatsuno G, Wright M, Yu B, Mesa KA, Doran RC, Alexander D, Berman PW. Robotic selection for the rapid development of stable CHO cell lines for HIV vaccine production. PLoS One 2018; 13:e0197656. [PMID: 30071025 PMCID: PMC6071959 DOI: 10.1371/journal.pone.0197656] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Accepted: 07/12/2018] [Indexed: 01/13/2023] Open
Abstract
The production of envelope glycoproteins (Envs) for use as HIV vaccines is challenging. The yield of Envs expressed in stable Chinese Hamster Ovary (CHO) cell lines is typically 10-100 fold lower than other glycoproteins of pharmaceutical interest. Moreover, Envs produced in CHO cells are typically enriched for sialic acid containing glycans compared to virus associated Envs that possess mainly high-mannose carbohydrates. This difference alters the net charge and biophysical properties of Envs and impacts their antigenic structure. Here we employ a novel robotic cell line selection strategy to address the problems of low expression. Additionally, we employed a novel gene-edited CHO cell line (MGAT1- CHO) to address the problems of high sialic acid content, and poor antigenic structure. We demonstrate that stable cell lines expressing high levels of gp120, potentially suitable for biopharmaceutical production can be created using the MGAT1- CHO cell line. Finally, we describe a MGAT1- CHO cell line expressing A244-rgp120 that exhibits improved binding of three major families of bN-mAbs compared to Envs produced in normal CHO cells. The new strategy described has the potential to eliminate the bottleneck in HIV vaccine development that has limited the field for more than 25 years.
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Affiliation(s)
- Sara M. O’Rourke
- Department of Biomolecular Engineering, The University of California at Santa Cruz, Santa Cruz, California, United States of America
| | - Gabriel Byrne
- Department of Biomolecular Engineering, The University of California at Santa Cruz, Santa Cruz, California, United States of America
| | - Gwen Tatsuno
- Department of Biomolecular Engineering, The University of California at Santa Cruz, Santa Cruz, California, United States of America
| | - Meredith Wright
- Department of Biomolecular Engineering, The University of California at Santa Cruz, Santa Cruz, California, United States of America
| | - Bin Yu
- Department of Biomolecular Engineering, The University of California at Santa Cruz, Santa Cruz, California, United States of America
| | - Kathryn A. Mesa
- Department of Biomolecular Engineering, The University of California at Santa Cruz, Santa Cruz, California, United States of America
| | - Rachel C. Doran
- Department of Biomolecular Engineering, The University of California at Santa Cruz, Santa Cruz, California, United States of America
| | - David Alexander
- Department of Biomolecular Engineering, The University of California at Santa Cruz, Santa Cruz, California, United States of America
| | - Phillip W. Berman
- Department of Biomolecular Engineering, The University of California at Santa Cruz, Santa Cruz, California, United States of America
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